On a national basis, cutting 10% of spots might be easy, but it is more challenging for an individual department. IMHO, there are a few types of attendings:
A) Those that can function without a resident and maintain patient volume
B) Those that can function without a resident but with decreased patient volume
C) Those that can't function without a resident due to seniority/tenure, legitimate non-clinical responsibilities, or apathy/laziness
D) Those that can't function without a resident due to competency issues
My guess is: A = 15%, B = 55%, C = 15%, D = 15%. I'm actually very sympathetic towards A & B; in particular, for B, there may be pressure from higher powers to maximize or maintain patient volume. C is tough, because no matter what happens on that attending's service, they are untouchable for one reason or another, and any mistakes fall on the resident's shoulders. D is the worst. Their incompetence might've been ignored because of nepotism (daddy's a bigwig in rad onc), because their former PD/chair was afraid to discipline them, because their former residency program was a poor training environment, etc. I am hesitant to join the voices of those calling for "easier" board exams because if anything, clinical written & oral boards should be more difficult. (radbio & physics are, like, whatever). IMO, fellowships should be reserved for those that are subpar clinically, instead of those that failed to network aggressively. In any case, as much as I hate working with C or D, I would never want C or D to be uncovered, and that's what would happen if residencies started cutting spots.
There may be a component of old white men swigging expensive alcohol while conspiring to expand residencies, but the cause for workforce oversupply was and is likely more systemic/decentralized.
With the Affordable Care Act (2008-2016), there was a push towards ACO's or consolidated care delivery systems, so academic hospitals started buying up private practices. By my estimate, with 15 rad onc's per department x 100 departments, there are 1500 academic attendings nationally (including satellite/VA), and 2500 private practice attendings. Whatever the specific numbers are, the % of academics is way too high, and these academics push up the demand & reliance on residency labor because of A-D above. The culture of academics is not one of self-sufficiency; to be fair, there's a legitimate role for resident/NP/PA coverage for true clinician-educators, clinician-scientists, clinical leadership, etc. However, my guess is that compared to private practice, a 100% clinical "academic" isn't expected to run his or her clinic without a resident/NP/PA for at least part of the year. How many academic hospitals are rich and/or disciplined enough to get NP/PA's instead of residents?
One potential fix for workforce oversupply is to undo the consolidation of private practices into academic systems (which, let's be honest, are less & less academic and more & more revenue machines). It's popular for residents to clamor for attendings to be uncovered but this is a subpar solution. Robbing Peter to pay Paul. It'd be better if the pseudo-academic, 100% clinical jobs were just replaced by legit, independent private practice jobs.
In any case, it's hard for me to be upset or point fingers; workforce oversupply is just an unfortunate situation. If it sounds like it's out of my hands, that's because it is. I'm just a resident.
Speculative monologue-of-the-day over.
