New ACGME recommendations and implications for the RO residency programs

[Barcelona PSG]

The new ACGME rules for radiation oncology recommend a resident-to-faculty ratio of 1:1.5, meaning for 8 residents, one needs 12 full-time faculty. I know at least one program that is sizing its resident complement from 9 to 7. Are anyone aware of what other programs are doing?

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[fiji128]

The new ACGME rules for radiation oncology recommend a resident-to-faculty ratio of 1:1.5, meaning for 8 residents, one needs 12 full-time faculty. I know at least one program that is sizing its resident complement from 9 to 7. Are anyone aware of what other programs are doing?

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Hard to know. Any decrease should be reflected in the 2024 acgme program report. Only program that has officially decreased its residency complement over that past several years is MDACC by one per year. I think some places might also struggle in regards to the new off site rotation limitations (thinking of Emory here).

 

[Gfunk6]

This problem may fix itself with RO over-supply. Graduating residents need jobs and residency programs need more "faculty" to continue to pump out more residents. This is a good opportunity to generate "assistant clinical" faculty at $80k per year to meet the ACGME requirements on paper. Of course, only the old guard get resident coverage.

 

[NotMattSpraker]

The new ACGME rules for radiation oncology recommend a resident-to-faculty ratio of 1:1.5, meaning for 8 residents, one needs 12 full-time faculty. I know at least one program that is sizing its resident complement from 9 to 7. Are anyone aware of what other programs are doing?

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I think this rule change is great for education, but would not expect it to address oversupply.

I asked a question on twitter, what happens to "non compliant" programs? Here is what Neha said.

 

[evilbooyaa]

Some are hiring more attendings, others are decreasing resident complement by 1-2 total so that they get under that 1.5:1 rule.

Definitely gonna be more academic attendings that don't have 100% resident coverage out there.... make sure, as a resident, you go to a place that is as equitable as possible with that! Don't go to a place where the boomer has to be hand-held through basic 2023 Rad Onc because they're otherwise dangerous clinically.

 

[sirspamalot]

Now F right off! Oh right, can't say that. Instead right.. here we go..

"Its an escalating process, we can't really say. We're sorry. We're very sorry."

(Goes back to eating lunch at their academic job, while a bunch of 80k/yr instructors scurry about)

FASTRO? HELL NAW

F ASTRO!

 

[sirspamalot]

The po po know that only pain brings change. Not paid enough? WALK. TOGETHER. TO. THE. LIGHT.

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The Goodhue City Council discussed options for police coverage after the entire department's resignation.

www.nbcnews.com

 

[thecarbonionangle]

This is one of those things where the execution is what is important. Some hellpits are hiring more people but will now be adding more faculty to cover. So you essentially end up with “compliance” and potentially an even more exploitaitive situation becuse you now triple cover more “faculty”. The requirements were well intentioned but likely will not have much effect. There was an opportunity with these changes to improve residency experience in more meaningful ways but it falls quite short imo

 

[A_DeMichele]

ACGME is not shutting programs down. They are too timid to face political blowback. Behind each struggling RadOnc residency, we usually have strong institutional backing (“University”). 1st hand knowledge of the matter

 

[Lamount]

The ACGME funds a fixed number of residency spots… are they allowed to reallocate residency spots from specialties that have too many physicians to those that have a shortage?

 

[Fpg1245]

The ACGME funds a fixed number of residency spots… are they allowed to reallocate residency spots from specialties that have too many physicians to those that have a shortage?

Umm ACGME just gives accreditation. It does not provide funding. They accredit all programs that fit their criteria. Funding can come from a number of sources but not ACGME.

 

[DoctwoB]

Some are hiring more attendings, others are decreasing resident complement by 1-2 total so that they get under that 1.5:1 rule.

Definitely gonna be more academic attendings that don't have 100% resident coverage out there.... make sure, as a resident, you go to a place that is as equitable as possible with that! Don't go to a place where the boomer has to be hand-held through basic 2023 Rad Onc because they're otherwise dangerous clinically.

Hey it takes all kinds for a good education.

I learned a lot operating with skilled Uro-oncologists.

I also learned a lot fixing C-section bladder perfs at 2AM while the on call attending who only treats stones cowers in the corner.

 

[radoncftw]

Hey it takes all kinds for a good education.

I learned a lot operating with skilled Uro-oncologists.

I also learned a lot fixing C-section bladder perfs at 2AM while the on call attending who only treats stones cowers in the corner.

the problem is for us, you don't know what you don't know and it often takes a while for you to see a bad outcome related to your treatment. A local failure or G4/5 toxicity probably won't happen on your 2-3 month rotation for a patient you planned.

i found that i got really good at writing notes in residency. anything that required an attending to take time out of their day to teach was low priority for many of the old guard (anatomy, contouring, plan review, offline imaging).

 

[evilbooyaa]

Hey it takes all kinds for a good education.

I learned a lot operating with skilled Uro-oncologists.

I also learned a lot fixing C-section bladder perfs at 2AM while the on call attending who only treats stones cowers in the corner.

Sure, agree that residency needs blocks of hand holding combined with blocks of 'You're the attending now with a medicolegal cover because the original attending is either incompetent or lazy'. Historically most programs always had someone who had full coverage. Doesnt' necessarily mean that that person is incompetent. But, for prospective applicants now, having an attending who can go uncovered and do their own work is valuable because it means that they are self-sufficient, if the resident say has a vacation, or a meeting, or interviews, without having to find a resident to 'cover the service'.

It's different than surgery where you want to do all the OR cases you can. 'Covering the service' usually means doing a bunch of scut without educational benefit...

 

[sam1234567]

Check the 2022 version it’s literally the same requirements and it’s effective since July 2022 yet this year we got more residency spots.

 

[DebtRising]

ACGME is trying to do its job to make education standard uniform. It is timid and can’t make large changes. ACGME rad onc leadership gets it. CMS funds residency. The way to impact CMS is through a whistleblower suit against rad onc programs that request funding to train physicians who are not needed.

Larger departments have adjusted by manipulating young faculty into “academic” positions. Why? Because there are no other jobs in many markets. Buy a private practice, assign a young MD there 4 days per week, main center for a day. Call them academic. Two birds one stone, drove down salaries for clinical work and more names on the paper to file with ACGME. Should call it the SCAROP / ASTRO special.

Unfortunately this won’t have any impact on our rampant overtraining and abuse of human capital until leadership views young trainees as people and not budget line items (where is the line between rad onc academic society leadership and a private equity group, both seem to have very similar principles) or leadership has taken enough money they finally step aside.

It also wouldn’t solve how drastically and quickly radiation utilization and fractions are shrinking.