Medical Students: Beware these malignant programs!!!

[RollTideRadOnc]

It's quite sad what's happening in our field. Lack of leadership has led to a drastic oversupply of physicians and the job market is simultaneously crashing due to hypofractionation (however good for patients), decreased supervision requirements, and fewer indications for radiotherapy. The people who will suffer the most in this situation are the current crop of residents who will have a very difficult time getting good jobs, in good locations, with good pay. It used to be pick two of the the three. Now it is just be happy you're employed. That is why I would advise any medical student to avoid this field. If you truly are passionate about oncology, go into Medical Oncology or one of the surgical subspecialties. You will have more job options, career flexibility, better pay, more legitimate research opportunities, and more autonomy.

However, if med students are dead set on going into Radiation Oncology, I think it would be a kind service of the SDN community to clearly point out what these malignant programs are. There is a widespread knowledge among attendings which the malignant programs are. This is not always clearly shared with med students. We should be up front about which programs have such reputations and the reasons that they developed those reputations in the first place. This a buyer's market for medical students right now. There is no reason for anyone, especially a competitive applicant, to go to a malignant program (even if that program is top tier).

I also find it unsettling that academics on Twitter seem to be deriding SDN without engaging in the substance of the (very often correct) arguments that SDN brings up. The posters on SDN correctly predicted that the glut of residency expansion and its impact on the job market. Folks on Twitter have essentially made the argument that just because SDN is anonymous that the content contained here is bogus. Well, medical students aren't dumb. The fact that this is anynomous in no way invalidates the information here. This is anonymous for a very good reason... this is a small field with poor employment prospects. A single negative phone call from an academic physicians to a potential employer can sink your chances of working there. The fact that folks on SDN are (legitimately) worried about this should be warning enough to med students to stay away from this field. It's also pretty ironic that folks from residencies with a strong reputation for being malignant (such as MSK and Michigan) are engaged in the Twitter echochamber that has spewed a lot of the negativity about SDN.

So to kick things off, I'd like to offer some warnings to medical students about certain known, malignant residency programs. I strongly encourage other SDN members to share. Med students should confirm any of this with other sources or their own investigation. Don't take my word for it... these are just the informed opinions of an anonymous poster.

1) MSK
- Residents are well known to work outrageous hours, more than 12 hours per day for the majority of residency
- Residents apparently have to deal with attendings who feel entitled to yell and scream at them if they mess up. Not okay in this modern era.
- High level of scut
- Word is that they frequently exceed yearly case limits

2) Michigan
- Apparently all residents cover triple and double services. Newsflash: Double services, and especially triple services, are a sign you should avoid a program like the plague.
- Many attendings apparently not willing to see on treatment checks without a resident, let alone simple follow-ups
- Word is that they frequently exceed yearly case limits
- High level of scut / residents used to perform scheduling etc
- Chair who is well known not to support his residents going into private practice. Doesn't quite sound like a supportive environment. Chairs should support their residents, no matter their career goals.

There are other malignant programs. Other SDN members, please share if you are able.

Current med students: Avoid this field, or at least avoid malignant programs!

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[medgator]

U Chicago: Read Ralph's Twitter account, nuff said.

Emory: Wally supposedly oversaw a malignant TJU program back in the day, plus look at Drew's Twitter account. To be fair though, this is my speculation as I've heard it's actually pretty good training, and Wally isn't as involved in the Dept, while Drew is only part of the residency experience during VA rotations.

 

[dieABRdie]

You might be doxxing yourself with that name... or cleverly throwing people off. (my first time using that term!)

Though I do hate malignant programs... MSK is a gauntlet but the residents are highly sought after even in PP because they know they can handle some sh**
The doctors I know from Michigan are incredibly well versed. Yes these programs will take every moment of the 4 years of residency but you will be highly capable.

 

[PhotonBomb]

I’ve never heard of mayo Jax being malignant tho

Agree that med students should avoid low tier programs. No need to match at a bad program in this era. Match at a good program or don’t match at all. Like seriously, no one should rank programs like NY Methodist or Arkansas

 

[medgator]

You might be doxxing yourself with that name... or cleverly throwing people off. (my first time using that term!)

Though I do hate malignant programs... MSK is a gauntlet but the residents are highly sought after even in PP because they know they can handle some sh**
The doctors I know from Michigan are incredibly well versed. Yes these programs will take every moment of the 4 years of residency but you will be highly capable.

We should be calling out malignant, non-educational programs like.... maybe Mayo Jax?

Yeah. Or LIJ, WVU, Mississippi etc.

Honestly could make two lists of programs to avoid for different reasons.

 

[dieABRdie]

I’ve never heard of mayo Jax being malignant tho

Agree that med students should avoid low tier programs. No need to match at a bad program in this era. Match at a good program or don’t match at all. Like seriously, no one should rank programs like NY Methodist or Arkansas

I edited my post because it was simply based on my interactions with one resident which is not fair.

Maybe we should define what "malignant" means?

 

[RickyScott]

Historically, malignant programs 10 years ago were tju, Maryland and mskcc. UPenn was tough but heard it got much better. Did a rotation at mskcc and there is no way I would have survived that place. In fairness to Wally, TJU residents came out really well trained, but supposedly he hammered minutiae of rtog trials into them on daily basis. Again this was in the era prior to widespread internet and Astro lectures and forums etc. today almost everything you need to know is online.
also never understood the need for so much scut at places like mskcc which has all the money in the world, so why are residents taking on nursing responsibilities?

 

[KHE88]

Yeah. Or LIJ, WVU, Mississippi etc.

Honestly could make two lists of programs to avoid for different reasons.

Oh for Pete's sake... why are you always bringing up these specific programs? What did they ever do to you?

There are actual programs that really do suck. The Emory reveal should surprise nobody. Even 7-8 years ago they had a reputation for hitting work hour restrictions, which is virtually unheard of in rad onc.

*EDITED BY MODS*

 

[KHE88]

It's quite sad what's happening in our field. Lack of leadership has led to a drastic oversupply of physicians and the job market is simultaneously crashing due to hypofractionation (however good for patients), decreased supervision requirements, and fewer indications for radiotherapy. The people who will suffer the most in this situation are the current crop of residents who will have a very difficult time getting good jobs, in good locations, with good pay. It used to be pick two of the the three. Now it is just be happy you're employed. That is why I would advise any medical student to avoid this field. If you truly are passionate about oncology, go into Medical Oncology or one of the surgical subspecialties. You will have more job options, career flexibility, better pay, more legitimate research opportunities, and more autonomy.

However, if med students are dead set on going into Radiation Oncology, I think it would be a kind service of the SDN community to clearly point out what these malignant programs are. There is a widespread knowledge among attendings which the malignant programs are. This is not always clearly shared with med students. We should be up front about which programs have such reputations and the reasons that they developed those reputations in the first place. This a buyer's market for medical students right now. There is no reason for anyone, especially a competitive applicant, to go to a malignant program (even if that program is top tier).

I also find it unsettling that academics on Twitter seem to be deriding SDN without engaging in the substance of the (very often correct) arguments that SDN brings up. The posters on SDN correctly predicted that the glut of residency expansion and its impact on the job market. Folks on Twitter have essentially made the argument that just because SDN is anonymous that the content contained here is bogus. Well, medical students aren't dumb. The fact that this is anynomous in no way invalidates the information here. This is anonymous for a very good reason... this is a small field with poor employment prospects. A single negative phone call from an academic physicians to a potential employer can sink your chances of working there. The fact that folks on SDN are (legitimately) worried about this should be warning enough to med students to stay away from this field. It's also pretty ironic that folks from residencies with a strong reputation for being malignant (such as MSK and Michigan) are engaged in the Twitter echochamber that has spewed a lot of the negativity about SDN.

So to kick things off, I'd like to offer some warnings to medical students about certain known, malignant residency programs. I strongly encourage other SDN members to share. Med students should confirm any of this with other sources or their own investigation. Don't take my word for it... these are just the informed opinions of an anonymous poster.

1) MSK
- Residents are well known to work outrageous hours, more than 12 hours per day for the majority of residency
- Residents apparently have to deal with attendings who feel entitled to yell and scream at them if they mess up. Not okay in this modern era.
- High level of scut
- Word is that they frequently exceed yearly case limits

2) Michigan
- Apparently all residents cover triple and double services. Newsflash: Double services, and especially triple services, are a sign you should avoid a program like the plague.
- Many attendings apparently not willing to see on treatment checks without a resident, let alone simple follow-ups
- Word is that they frequently exceed yearly case limits
- High level of scut / residents used to perform scheduling etc
- Chair who is well known not to support his residents going into private practice. Doesn't quite sound like a supportive environment. Chairs should support their residents, no matter their career goals.

There are other malignant programs. Other SDN members, please share if you are able.

Current med students: Avoid this field, or at least avoid malignant programs!

Med students are not going to listen to you. This is pointless. If you don't believe me, go read their applicant google spreadsheet. The cognitive dissonance is overwhelming. They are convinced they know everything and we have no idea what we are talking about.

Good thing there is a concerted misinformation campaign on Twitter to feed them lies #radoncrocks.

 

[RickyScott]

Oh for Pete's sake... why are you always bringing up these specific programs? What did they ever do to you?

There are actual programs that really do suck. The Emory reveal should surprise nobody. Even 7-8 years ago they had a reputation for hitting work hour restrictions, which is virtually unheard of in rad onc.

Serious question, since 90% of your posts are either bringing up WVU and Tennessee or Donald Trump's presidency out of the blue, which is worse? If I were a genie and could make either (1) Donald Trump go away and be replaced by Hillary Clinton (barf) or Mitt Romney (double barf) or anybody else for that matter OR (2) I could make WVU, Tennessee, Arkansas, and whichever other new middle of nowhere program you hate so much that started in the past 10 years go away, which would you choose? Hypothetical gun to your head, pick one. Genuinely curious.

My vote would be for LIJ, as nyc was not lacking in programs. WVU close second given they are an hour away from Pitt/alleggeny

 

[medgator]

My vote would be for LIJ, as nyc was not lacking in programs. WVU close second given they are an hour away from Pitt/alleggeny

Careful, you'll be accused of hating rural folk by khe

 

[KHE88]

So easy to trigger. Yawn. It's so awesome to watch you go MAGA and totally gloss over when I mention LIJ, mayo whatever or Cedars, since that doesn't fit your agenda or narrative

*EDITED BY MODS*

I interviewed at LIJ btw. I have an opinion about that program and agree with you.

Even tie?

 

[RickyScott]

Would like to point that you can become an excellent resident from program that does not run you through the gauntlet. Places like Harvard, mdacc are very benign. Some really great faculty (as people) at UPenn as well.
edit: Wash u at one time was also very malignant but may have improved. They had actually suspended one faculty member when I was interviewing for being an aXx.
Historically, places like UF had really high expectations of residents ( which actually led me to avoid them as I was a bit of lazy f### myself at the time, but were not malignant.

 

[scarbrtj]

Would like to point that you can become an excellent resident from program that does not run you through the gauntlet. Places like Harvard, mdacc are very benign. Some really great faculty (as people) at UPenn as well.
edit: Wash u at one time was also very malignant but may have improved. They had actually suspended one faculty member when I was interviewing for being an aXx.
Historically, places like UF had really high expectations of residents ( which actually led me to avoid them as I was a bit of lazy f### myself at the time, but were not malignant.

I always bought into the mythology that if you wanted to be worlds best PP rad onc, go to UF.

 

[RollTideRadOnc]

Maybe we should define what "malignant" means?

I think this is a worthwhile conversation. Like other hard to define entities, "you know it when you see it." Certain things are hard to figure out on an interview day (because current residents have a vested interest in recruiting new warm bodies), other thing are more objective. I'll focus on the objective stuff.

But I would propose:

- Has a resident ever left the program? Why?
- Do attendings see follow-ups or on treatment visits on their own?
- Do the current crop of residents feel comfortable talking about private practice? Or is everyone supposedly going into academics?
- The presence of double or triple services: This is almost always accompanied by an attitude that residents are indentured servants and most do everything and anything for there attendings. From an educational standpoint, no reason whatsoever for this.
- Do attendings always go covered? Again, this is typically a mark of helpless attendings.
- Have residents ever been expected to schedule appointments or get outside records for patients? Not many current residents will admit to this, but it is very telling if they do.

I also agree that there are some very good programs with strong reputations, which have also are known for NOT being malignant. For instance:
- MDA
- Harvard
- Yale
- Cleveland Clinic

 

[bluebubbles]

Med students typically hear of “malignant” programs as those of the top tier that aren’t quite as gentle in terms of hours or scut. I’ll give my $0.02.

1) I’m not going to pretend I have knowledge of a majority or even a large minority of residency programs, since as junior attendings or residents, we only have direct experience with roughly 5 programs. The rest is hearsay.

2) With the job market as it is, I’d lean towards programs with a strong placement record for recent graduates. It does not matter if you go to a “cush” program working 40 hours a week if you can’t get a real job at the end of residency; you bet your millennial noggin you’ll wish you would’ve gone to a tougher program working 65 hours per week, IF that program yielded better job prospects. For example, MSKCC residents have a reputation for working long hours, but their graduates will be at the end of the metaphorical Titanic that stays above water until the very end.

3) Certain big programs take a lot of flak on SDN because of simple statistics. There are more faculty at big programs, often with a bigger sphere of influence, either at conferences or in social media or on SDN & the spreadsheet. Some of these faculty will be unpleasant. It is wholly possible that small programs have unpleasant faculty too, but because there are fewer of them, with a smaller sphere of influence, these programs don’t have a reputation (good or bad) among med students. It is something to be aware of.

4) Job placement is the only thing that matters, imho. That, and your likelihood of being happy in a given residency program & city for 4 years. Everything else, such as didactic quality, research opportunities, technology, case mix/load, etc. are secondary.

P.S. Please leave the USA political commentary out, or let the moderator delete those posts.

 

[thecarbonionangle]

LOL. You can just say you don't like my question and don't want to answer it. Sorry about your TDS. Only thing more impossible to cure than toenail fungus.

I don’t know why but my last uber driver was like “doc, i got that toenail fungus” and told me all about her treatments. It really is one tough bug.

i think our field is covered by mycosis fungoides, fungus like but a CANCER eating Us from within and without. You know what they say... total electron therapy To the sickness of our field.

I believe most programs are pretty bad. The majority of programs in the south are pretty pittiful with some exceptions. A few northeast and midwest places are good as well as west coast .

most places should be shut down. If you have a question about a program just post and we can state what we know...

 

[PhotonBomb]

Texas has some really ****ty programs other than MDACC and UTSW (and I don’t even know how good their training program is for UTSW even if their department is strong).

I don’t know how the state has WHIFFED so hard. BCM and UTMB and UTSA are like literal dumpster fires. I know first hand.

For a state so big, it’s embarrassing they have so little to offer graduating students who want to train in Texas

 

[medgator]

Always thought/heard UTHSC/SA was a decent training program. Didn't get an interview there

 

[PhotonBomb]

Always thought/heard UTHSC/SA was a decent training program. Didn't get an interview there

Idk about ten years ago but at least over 5-7 years, It is a poor educational program with zero interest in the resident experience. The classic 'residents are here to work' fake residency program.

 

[thecarbonionangle]

Texas has some really ****ty programs other than MDACC and UTSW (and I don’t even know how good their training program is for UTSW even if their department is strong).

I don’t know how the state has WHIFFED so hard. BCM and UTMB and UTSA are like literal dumpster fires. I know first hand.

For a state so big, it’s embarrassing they have so little to offer graduating students who want to train in Texas

Programs mentioned have zero education

 

[RickyScott]

Nope. Just said wvu, Arkansas, Mississippi, your favorite trigger words. C'mon, ready set go!

Must be tough to realize that many, besides myself, feel these newer, smaller, less developed red state programs (and some blue ones like LIJ, Dartmouth, COH, cedars etc) need to be the first to go.

Dartmouth needs to stay because we can’t find anyone to work in Boston and New Hampshire, where the entire state is covered by a single group.
SoCal- needs more programs? They were bascially a job free zone 10 years ago prior to UCSD starting program.
LIJ. chairman already publishing editorials denying the problem! (Shows you vested interests at work)

 

[Mandelin Rain]

Word of caution to med students on the interview trail:

Residents, even at terrible and/or malignant programs will usually still say everything is great for a couple reasons:

1. They've been coached to and fear repercussions if they don't. It is sad, but true. I experienced it, and I'm sure many can corroborate.

2. Pure self-preservation. Less residents means more call, more didactic presentations, more double/triple coverage services, more pressure to pick up random research project for each active resident at a place. Not filling only makes life tougher for residents in crappy situations.

3. Fear that not filling will make the program (and by extension their own CV) look bad/impact future career options.


All of these are real concerns that I lived and acquiesced to in residency. I put on my happiest face for 4 years around interview time.

 

[theradiator]

DEFINE_ME

 

[evilbooyaa]

@KHE88 and @medgator not this **** again.

Next one of you two go down this politics road again you're getting a month break. Yes medgator is a broken record but he didn't mention politics.

To both of you:

13 posts deleted.

Otherwise carry on discussion.

 

[RadOncDoc21]

@KHE88 and @medgator not this **** again.

Next one of you two go down this politics road again you're getting a month break. Yes medgator is a broken record but he didn't mention politics.

To both of you:

13 posts deleted.

Otherwise carry on discussion.

Damn, he had to get the GOAT involved!

 

[deleted774703]

IMO, any program opening in the last 7 years is malignant.

They knew that residency expansion was too much right now but still opened...

Also avoid MCG at all costs if it opens up again.

 

[berag]

Texas has some really ****ty programs other than MDACC and UTSW (and I don’t even know how good their training program is for UTSW even if their department is strong).

I don’t know how the state has WHIFFED so hard. BCM and UTMB and UTSA are like literal dumpster fires. I know first hand.

For a state so big, it’s embarrassing they have so little to offer graduating students who want to train in Texas

It would be interesting to hear what you know "first hand" about these dumpster fire programs.

 

[RickyScott]

It would be interesting to hear what you know "first hand" about these dumpster fire programs.

Why does it matter? Who cares if they are diamonds. Still need to shut down.

 

[berag]

Why does it matter? Who cares if they are diamonds. Still need to shut down.

Why not shrink the big programs?

 

[PhotonBomb]

Why not shrink the big programs?

Why not do both? The ****ty programs closing is more important tho.

 

[medgator]

To get to 100-120, we need to close many programs trim others. Better to overshoot than undershoot esp when many entrenched interests are against this and there is likely a lot of slack in the system

 

[RadDoc11]

I’m not convinced of the training at TJU under Wally having experienced one of the least competent rad oncs I have ever met who trained under Wally at that program. It could be a one off, but being as that is my N of 1 experience with that program in the Wally era, I’m not convinced it was ever great and he was ever a great leader to residents.

I also would like to bring up the issue of MD/PhDs who spend copious amounts of time doing research during training, perhaps at the cost of clinical experience and then go on to take clinical pp jobs. I know there are a minimum number of cases residents must see in training but I have personally also witnessed a grad from a certain well-renowned four letter program in the Bay Area who was practically incompetent in making clinical decisions. Apparently this person spent a lot of time doing “research” in training as an MD/PhD which is great if you’re going to take a research job, but less ideal if you take a clinical pp job and can’t handle patient volumes greater than 10 on beam and are incapable of basic decision making. A stage I breast consult should not take 3 hours to see and 3 more hours to plan, especially when you’re a few years out of training. If you plan to take a clinical job after residency, please make sure you your program will provide you with the skills to actually treat patients and not just the skills to avoid clinical work and publish impactless red journal papers. Just another factor to consider..

Historically, malignant programs 10 years ago were tju, Maryland and mskcc. UPenn was tough but heard it got much better. Did a rotation at mskcc and there is no way I would have survived that place. In fairness to Wally, TJU residents came out really well trained, but supposedly he hammered minutiae of rtog trials into them on daily basis. Again this was in the era prior to widespread internet and Astro lectures and forums etc. today almost everything you need to know is online.
also never understood the need for so much scut at places like mskcc which has all the money in the world, so why are residents taking on nursing responsibilities?