Perspective of PGY2 at "top 10" program

[metview]

PGY2 at a "top 10" program here, and if I had to do it all over again, I wouldn't apply to rad onc or even consider it. It's ridiculous how little our leadership cares about the state of the field. This change in CMS supervision will not affect expansion. In fact, I still expect programs to open because at the end of the day no one cares about what happens in 5-10 years. It's all about how much they can abuse the system now and leave unscathed. Last year, we had fewer apps, more people unmatched, but the # of total positions filled was greater than the year before (2019: 196, 2018: 192). Let that sink in.

The jobs that our recent graduates have been taking are garbage academic satellite jobs (ie.msk, mgh, mda) that pay pretty much pay $325-$425 for the rest of their sad career with zero ability to advance in "academics."

I read this last night (changes in CMS supervision of centers), and wished this happened during my intern year because I would have switched to Rads or Optho; it would have been plenty of time to find an unfilled/open PGY2 spot at that point. If you are/were one of those competitive rad onc applicants (Not too many out there anymore. The only criteria to is to have done a rotation and say you have passion, per Sushil Beriwal), I would consider looking out for open IM/Rads/Optho/Derm spots. I'm even thinking about switching right now, but unfortunately it means I would have to relocate and waste another year of my late 20s/early 30s.

Just think about it..... if you are a med student, PGY1, PGY2, or PGY3. There are 180-190 graduating residents EACH YEAR looking for jobs. If you are a PGY1, that's 700-750 RO jobs taken before you even have a chance to apply! Good luck to us.

I just wanted to share a resident's perspective on this because it seems like people on twitter always bash sdn for being biased/not representative, and I am not posting this on twitter for obvious reasons.

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[Mandelin Rain]

Sorry man. This really does suck.

 

[beawareindn]

Sorry you feel this way. Hope you have family and friends close by that can support you.

If you are really thinking about switching PGY2 year is a perfect year. As per your match contract you are supposed to atleast spend I think 2-3 months at the place you matched before you switch. So, you wouldn't have been able to switch your intern year if you wanted to. There are always open spots in other fields. However, like you said they might not be around where you are living. I don't think you will be wasting any time as most programs will count your rad onc time as elective time. If you really think you will regret and be miserable in rad onc, this is the best time to switch.

PS my information might be outdated. So, please double check and correct me if I am wrong. Good luck in your career! I am sure things will work out.

 

[elementaryschooleconomics]

PGY2 at a "top 10" program here, and if I had to do it all over again, I wouldn't apply to rad onc or even consider it. It's ridiculous how little our leadership cares about the state of the field. This change in CMS supervision will not affect expansion. In fact, I still expect programs to open because at the end of the day no one cares about what happens in 5-10 years. It's all about how much they can abuse the system now and leave unscathed. Last year, we had fewer apps, more people unmatched, but the # of total positions filled was greater than the year before (2019: 196, 2018: 192). Let that sink in.

The jobs that our recent graduates have been taking are garbage academic satellite jobs (ie.msk, mgh, mda) that pay pretty much pay $325-$425 for the rest of their sad career with zero ability to advance in "academics."

I read this last night (changes in CMS supervision of centers), and wished this happened during my intern year because I would have switched to Rads or Optho; it would have been plenty of time to find an unfilled/open PGY2 spot at that point. If you are/were one of those competitive rad onc applicants (Not too many out there anymore. The only criteria to is to have done a rotation and say you have passion, per Sushil Beriwal), I would consider looking out for open IM/Rads/Optho/Derm spots. I'm even thinking about switching right now, but unfortunately it means I would have to relocate and waste another year of my late 20s/early 30s.

Just think about it..... if you are a med student, PGY1, PGY2, or PGY3. There are 180-190 graduating residents EACH YEAR looking for jobs. If you are a PGY1, that's 700-750 RO jobs taken before you even have a chance to apply! Good luck to us.

I just wanted to share a resident's perspective on this because it seems like people on twitter always bash sdn for being biased/not representative, and I am not posting this on twitter for obvious reasons.

PGY-4 also at a top tier program here. This whole situation is absolutely ridiculous for the senior resident cohort. When I was considering this field in 2014-2015, I knew about the geographic limitations, but the current mess had yet to really go full swing. I've had the unfortunate privilege of watching this entire field deteriorate essentially year-by-year of my residency. Up until recently (with the match fiasco) our institutional (and national) leadership has been tone deaf to the situation. They’re starting to pay attention now, but the true challenge won’t even hit until the combo of APM and “general supervision” start.

The sad thing is that I actually love Radiation Oncology, but I would probably not pick this field if I could do it over again. Many, many fields outside of medicine face these issues, but the opportunity cost is SO HIGH for us (in medicine) that there should be some sort of guaranteed career at the end – as it used to be. Though I love Radiation Oncology there are definitely other fields I could see myself doing with much stronger job prospects. I have developed “backup plans” over the past year or two, but unfortunately these generally require extra year(s) of my life before finally getting a “real job”.

I can’t believe I’m actually jumping on this train but…med students, look elsewhere.

 

[medgator]

Honestly the best thing for all parties in RO at this point, except those in academics, would be for NONE of the spots to fill through the match and all of them to go to the SOAP.

There will be enough rad oncs to take care of patients in 5 years if 0 people match next year. Guaranteed. It isn't trolling, it's the truth

 

[elementaryschooleconomics]

Seriously guys - listen to these two. This is how the majority of residents at my program feel. Demotivated, despondent, utterly and completely betrayed by the “leaders” they are supposed to look up to. If someone is trying to convince you this is just internet trolls, remember, this was the top issue raised in a NATIONAL survey.

Exactly. My situation, from my perspective: I did everything I was supposed to. >260 board scores, AOA, PhD in an Oncology discipline, two dozen publications, grants, fellowships, etc etc. For over a decade and a half, I have worked hard, sought advice, always tried to improve myself and my CV to give me the professional edge I needed to secure a stable job for the rest of my life. However, as I near the end of my training period, this whole thing feels like it blew up in my face. "Demotivated" is an understatement. Why should I even care anymore? My attendings love to placate me with "oh I'm sure it will work out" but can't elaborate on how it will work out. It's insulting and ridiculous. The problem, as I see it, is that APM and "general supervision" will take a few years to shake out. So even if I get a job, what guarantee do I have that my contract will be renewed? Who will a practice cut first once they figure out they don't need as many docs? The senior people with pull or the new grads?

And I desperately wish I were an internet troll. This is just the situation, as it appears to me. These are my personal feelings. I'm so tired of hearing the "ra-ra RadOnc" **** on Twitter or this year at ASTRO with the follow-up refrain, "SDN is just for trolls". No. It's not. This is the only place where we can discuss these issues anonymously, which is SO NECESSARY in a field as small as ours. I just couldn't stay quiet any longer and had to get this off my chest - perhaps if enough of us do, "they" can stop saying "oh it's just one or two crazy people on SDN who think this..."

 

[UndecidedM3]

PGY2 at a "top 10" program here, and if I had to do it all over again, I wouldn't apply to rad onc or even consider it. It's ridiculous how little our leadership cares about the state of the field. This change in CMS supervision will not affect expansion. In fact, I still expect programs to open because at the end of the day no one cares about what happens in 5-10 years. It's all about how much they can abuse the system now and leave unscathed. Last year, we had fewer apps, more people unmatched, but the # of total positions filled was greater than the year before (2019: 196, 2018: 192). Let that sink in.

The jobs that our recent graduates have been taking are garbage academic satellite jobs (ie.msk, mgh, mda) that pay pretty much pay $325-$425 for the rest of their sad career with zero ability to advance in "academics."

I read this last night (changes in CMS supervision of centers), and wished this happened during my intern year because I would have switched to Rads or Optho; it would have been plenty of time to find an unfilled/open PGY2 spot at that point. If you are/were one of those competitive rad onc applicants (Not too many out there anymore. The only criteria to is to have done a rotation and say you have passion, per Sushil Beriwal), I would consider looking out for open IM/Rads/Optho/Derm spots. I'm even thinking about switching right now, but unfortunately it means I would have to relocate and waste another year of my late 20s/early 30s.

Just think about it..... if you are a med student, PGY1, PGY2, or PGY3. There are 180-190 graduating residents EACH YEAR looking for jobs. If you are a PGY1, that's 700-750 RO jobs taken before you even have a chance to apply! Good luck to us.

I just wanted to share a resident's perspective on this because it seems like people on twitter always bash sdn for being biased/not representative, and I am not posting this on twitter for obvious reasons.

Suggestions for a current TY that matched at a well respected top program? how do you look for open spots in other specialties?

 

[metview]

Exactly. My situation, from my perspective: I did everything I was supposed to. >260 board scores, AOA, PhD in an Oncology discipline, two dozen publications, grants, fellowships, etc etc. For over a decade and a half, I have worked hard, sought advice, always tried to improve myself and my CV to give me the professional edge I needed to secure a stable job for the rest of my life. However, as I near the end of my training period, this whole thing feels like it blew up in my face. "Demotivated" is an understatement. Why should I even care anymore? My attendings love to placate me with "oh I'm sure it will work out" but can't elaborate on how it will work out. It's insulting and ridiculous. The problem, as I see it, is that APM and "general supervision" will take a few years to shake out. So even if I get a job, what guarantee do I have that my contract will be renewed? Who will a practice cut first once they figure out they don't need as many docs? The senior people with pull or the new grads?

And I desperately wish I were an internet troll. This is just the situation, as it appears to me. These are my personal feelings. I'm so tired of hearing the "ra-ra RadOnc" **** on Twitter or this year at ASTRO with the follow-up refrain, "SDN is just for trolls". No. It's not. This is the only place where we can discuss these issues anonymously, which is SO NECESSARY in a field as small as ours. I just couldn't stay quiet any longer and had to get this off my chest - perhaps if enough of us do, "they" can stop saying "oh it's just one or two crazy people on SDN who think this..."

This x100. We all worked so hard/sacrificed a lot in medical school......studying countless hours for step 1, going in on weekends to do research, spending 3 months in different cities doing away rotations, kissing butt to get good LORs, and what do have to show for it? Nothing! This doesn't apply to me, but what about medical students who had families during medical school and had to pretty much ignore them for 4 years? It's quite sad.

 

[radOresident]

What are current PGY5's supposed to do?

I am considering signing with a relatively rural clinic that is part of a larger hospital system. I want to sign because I really don't mind small towns and historically it seemed like these rural jobs were fairly stable. As soon as my first contract expires am I going to be on the chopping block? Will they outsource my clinic to one of the other hospitals that has more than a single doc to come 1-2 days a week?

I can't do another residency, I am so sick of being in training and just want to graduate and do the job I enjoy doing but it seems like there is a good chance that 1-2 years down the line when all this shakes out you're going to see mass layoffs of rad oncs even in the rural clinics that used to be somewhat "safe" jobs. I wish I had just done internal medicine. Hospitalists are making good salaries and demand seems to only be going up.

I worry that this rule is the death of our field.

 

[GapCalc]

What are current PGY5's supposed to do?

Being employed directly by a hospital has always been a somewhat risky position. However, it's not all downsides. There is loan forgiveness if you have federal medical school loans and the hospital is a 501c3. If it's truly rural and you are a reliable doc who the referring physicians trust, and you generate revenue for the hospital, they won't be in a tremendous hurry to get rid of you.
I would say like most things in life, focus on what you can control, and try to forget the rest. A relatively rural clinic will (probably) have fewer new grads clamoring to join (compared to more desirable city locales) and if the admin and referring docs are happy, you should be pretty safe.

Or just stagger your new starts and SBRT/SRS every day so that you are 'required' to be on site daily...

 

[Haybrant]

PGY2 at a "top 10" program here, and if I had to do it all over again, I wouldn't apply to rad onc or even consider it. It's ridiculous how little our leadership cares about the state of the field. This change in CMS supervision will not affect expansion. In fact, I still expect programs to open because at the end of the day no one cares about what happens in 5-10 years. It's all about how much they can abuse the system now and leave unscathed. Last year, we had fewer apps, more people unmatched, but the # of total positions filled was greater than the year before (2019: 196, 2018: 192). Let that sink in.

The jobs that our recent graduates have been taking are garbage academic satellite jobs (ie.msk, mgh, mda) that pay pretty much pay $325-$425 for the rest of their sad career with zero ability to advance in "academics."

I read this last night (changes in CMS supervision of centers), and wished this happened during my intern year because I would have switched to Rads or Optho; it would have been plenty of time to find an unfilled/open PGY2 spot at that point. If you are/were one of those competitive rad onc applicants (Not too many out there anymore. The only criteria to is to have done a rotation and say you have passion, per Sushil Beriwal), I would consider looking out for open IM/Rads/Optho/Derm spots. I'm even thinking about switching right now, but unfortunately it means I would have to relocate and waste another year of my late 20s/early 30s.

Just think about it..... if you are a med student, PGY1, PGY2, or PGY3. There are 180-190 graduating residents EACH YEAR looking for jobs. If you are a PGY1, that's 700-750 RO jobs taken before you even have a chance to apply! Good luck to us.

I just wanted to share a resident's perspective on this because it seems like people on twitter always bash sdn for being biased/not representative, and I am not posting this on twitter for obvious reasons.

“pay $325-$425 for the rest of their sad career” - this is a bit harsh. Taking care of patients is great and 325-425 while not worrying about overhead or admin is not so bad. But yes if you thought you’d have opportunities for 6-700k+ that’s not happening anymore. Careful about what you say to other people as well, talking Like this will sink your ship pretty fast and if you decided to stay you’ll be in trouble. Stay even and calm and make a discrete decision about what you want to do. Don’t take the sulking w you to work

 

[radoncgrad2019]

“pay $325-$425 for the rest of their sad career” - this is a bit harsh. Taking care of patients is great and 325-425 while not worrying about overhead or admin is not so bad. But yes if you thought you’d have opportunities for 6-700k+ that’s not happening anymore. Careful about what you say to other people as well, talking Like this will sink your ship pretty fast and if you decided to stay you’ll be in trouble. Stay even and calm and make a discrete decision about what you want to do. Don’t take the sulking w you to work

So true.

 

[radoncgrad2019]

To add to Haybrant's point, just read this post about potential Psych salaries (which is 'on the rise' and 'super hot right now') for some context.

if you move to rural areas you can make 300k+ and if you work really hard maybe 400k!

loan repayment, psychiatry, step 1- 250

Hey there, Current MS3 feeling very undecided about what specialty to pursue and making my 4th year schedule. I had no intentions on going into psychiatry, but enjoyed my rotation thoroughly and am highly considering applying for residency, but others/my family have me very worried about being...

forums.studentdoctor.net

 

[deleted774703]

Good luck finding an open derm spot lol including myself

IM not a bad field. Great flexibility and lots of subspecialty options. Rounds though...

 

[OTN]

To add to Haybrant's point, just read this post about potential Psych salaries (which is 'on the rise' and 'super hot right now') for some context.

if you move to rural areas you can make 300k+ and if you work really hard maybe 400k!

loan repayment, psychiatry, step 1- 250

Hey there, Current MS3 feeling very undecided about what specialty to pursue and making my 4th year schedule. I had no intentions on going into psychiatry, but enjoyed my rotation thoroughly and am highly considering applying for residency, but others/my family have me very worried about being...

forums.studentdoctor.net

And you have unlimited job mobility for salaries that as you state are similar to those in academic satellites are receiving. So psych is definitely a better job, right?

 

[Burt Radnolds]

I wouldn’t feel comfortable going into something like peds, rad onc or pathology with 400k on ~7% interest right now, but the rest of the fields seem good for paying off loans

Lol we are getting dunked on in the psych forum now! Welcome to the bottom.

 

[medgator]

Lol we are getting dunked on in the psych forum now! Welcome to the bottom.

I'm guessing rad onc might be worth a look in 2025+ after the dust settles and half the spots are gone/programs close

 

[RickyScott]

I'm guessing rad onc might be worth a look in 2025+ after the dust settles and half the spots are gone/programs close

I would like to think that but logically I can’t see that happening, Take a marginal recent program like LIJ. Chair just wrote that scadrop editorial. No way they are giving up their residency and like many new programs, consolidation of hospital systems provides them with multiple hospitals for clinical volume to justify their questionable residency.

 

[metview]

Lol we are getting dunked on in the psych forum now! Welcome to the bottom.

Started from the top, now we're here.

 

[scarbrtj]

Or just stagger your new starts and SBRT/SRS every day so that you are 'required' to be on site daily...

Actually here is one situation where a court has given unambiguous guidance. A rad onc is not *required* to be present for SRS/SBRT.

 

[medgator]

Actually here is one situation where a court has given unambiguous guidance. A rad onc is not *required* to be present for SRS/SBRT.

Vs less than an hour away.... Still can't figure out the logic....

Justice Department: Florida Hospital to pay $5.4 million over inadequate cancer care

Florida Hospital’s parent company has agreed to pay $5.4 million to resolve allegations that it didn’t provide adequate staffing of

www.news-journalonline.com

 

[Neuronix]

Many of us are sort of semi-anonymous. Let's not make it any easier than it already is to guess our identities.

 

[RickyScott]

Vs less than an hour away.... Still can't figure out the logic....

Justice Department: Florida Hospital to pay $5.4 million over inadequate cancer care

Florida Hospital’s parent company has agreed to pay $5.4 million to resolve allegations that it didn’t provide adequate staffing of

www.news-journalonline.com

One is a court ruling. The other by Florida hospital is just settlement, a leave me alone payment, to avoid further legal hassles. Court rulings provide legal precedence. Had that ruling preceded Florida hospital case, very much doubt they would have settled.

 

[medgator]

One is a court ruling. The other by Florida hospital is just settlement, a leave me alone payment, to avoid further legal hassles. Court rulings provide legal precedence. Had that ruling preceded Florida hospital case, very much doubt they would have settled.

$5 million can feed a lot of lawyers and court motions...

 

[evilbooyaa]

Thanks for the post. It's good to hear from other residents and the disenfranchised feeling that is affecting current residents (myself included). Once I finally nail down what I'm doing I'll be putting a post together on the ****tiness that is the RO Job search in a few months.

 

[RadOncMegatron]

PGY2 at a "top 10" program here, and if I had to do it all over again, I wouldn't apply to rad onc or even consider it. It's ridiculous how little our leadership cares about the state of the field. This change in CMS supervision will not affect expansion. In fact, I still expect programs to open because at the end of the day no one cares about what happens in 5-10 years. It's all about how much they can abuse the system now and leave unscathed. Last year, we had fewer apps, more people unmatched, but the # of total positions filled was greater than the year before (2019: 196, 2018: 192). Let that sink in.

The jobs that our recent graduates have been taking are garbage academic satellite jobs (ie.msk, mgh, mda) that pay pretty much pay $325-$425 for the rest of their sad career with zero ability to advance in "academics."

I read this last night (changes in CMS supervision of centers), and wished this happened during my intern year because I would have switched to Rads or Optho; it would have been plenty of time to find an unfilled/open PGY2 spot at that point. If you are/were one of those competitive rad onc applicants (Not too many out there anymore. The only criteria to is to have done a rotation and say you have passion, per Sushil Beriwal), I would consider looking out for open IM/Rads/Optho/Derm spots. I'm even thinking about switching right now, but unfortunately it means I would have to relocate and waste another year of my late 20s/early 30s.

Just think about it..... if you are a med student, PGY1, PGY2, or PGY3. There are 180-190 graduating residents EACH YEAR looking for jobs. If you are a PGY1, that's 700-750 RO jobs taken before you even have a chance to apply! Good luck to us.

I just wanted to share a resident's perspective on this because it seems like people on twitter always bash sdn for being biased/not representative, and I am not posting this on twitter for obvious reasons.

PGY-4 also at a top tier program here. This whole situation is absolutely ridiculous for the senior resident cohort. When I was considering this field in 2014-2015, I knew about the geographic limitations, but the current mess had yet to really go full swing. I've had the unfortunate privilege of watching this entire field deteriorate essentially year-by-year of my residency. Up until recently (with the match fiasco) our institutional (and national) leadership has been tone deaf to the situation. They’re starting to pay attention now, but the true challenge won’t even hit until the combo of APM and “general supervision” start.

The sad thing is that I actually love Radiation Oncology, but I would probably not pick this field if I could do it over again. Many, many fields outside of medicine face these issues, but the opportunity cost is SO HIGH for us (in medicine) that there should be some sort of guaranteed career at the end – as it used to be. Though I love Radiation Oncology there are definitely other fields I could see myself doing with much stronger job prospects. I have developed “backup plans” over the past year or two, but unfortunately these generally require extra year(s) of my life before finally getting a “real job”.

I can’t believe I’m actually jumping on this train but…med students, look elsewhere.

People are adverse to risks, how much so, well I like using this example from Nassim Taleb's Antifragile. He noted that when you look at a random stochastic processes the "absorbing barrier will have an observed mean higher than the barrier." Let's use the data from the resident survey:

https://www.redjournal.org/article/S0360-3016(19)33454-6/fulltext

"72% of trainees were offered a position consistent with the applicant's preferred region, job type, or city population size, and 56% received a position consistent with all of their preferences. "

This means we would expect > 28% (100-72) [or 44% (100-56%)?!?!] to be the "barrier" for undesirable jobs ie I'd hypothesize we'd expect more than 28% affect on residency selection by med students b/c the risk of poor job placement is 28%.

For highly talented med students, who could've done literally anything, such risk may not be worth taking. I think the recent unfilled match data bears that out. Also, these highly talented individuals here are real life examples / warnings to all. I am not saying to not be rad onc. What I am advocating rather is that the risk is there, it is real, it is about 30% and will likely increase given the continued expansion of residencies + nonchalance of academics. If you are willing to take that risk then I have no problem and you will then be responsible, as it is now however, the risks are being down played by the academicians who, as Nassim Taleb notes, have no "skin in the game."

Edit: Poor math skills - 28% not 18%! I think that matches even closer to the unfilled resident spot data

 

[RickyScott]

People are adverse to risks, how much so, well I like using this example from Nassim Taleb's Antifragile. He noted that when you look at a random stochastic processes the "absorbing barrier will have an observed mean higher than the barrier." Let's use the data from the resident survey:

https://www.redjournal.org/article/S0360-3016(19)33454-6/fulltext

"72% of trainees were offered a position consistent with the applicant's preferred region, job type, or city population size, and 56% received a position consistent with all of their preferences. "

This means we would expect > 18% (100-72) [or 44% (100-56%)?!?!] to be the "barrier" for undesirable jobs ie I'd hypothesize we'd expect more than 18% affect on residency selection by med students b/c the risk of poor job placement is 18%.

For highly talented med students, who could've done literally anything, such risk may not be worth taking. I think the recent unfilled match data bears that out. Also, these highly talented individuals here are real life examples / warnings to all. I am not saying to not be rad onc. What I am advocating rather is that the risk is there, it is real, it is about 20% and will likely increase given the continued expansion of residencies + nonchalance of academics. If you are willing to take that risk then I have no problem and you will then be responsible, as it is now however, the risks are being down played by the academicians who, as Nassim Taleb notes, have no "skin in the game."

Absolutely. loss aversion is much bigger driver of decision making than potential upside. personally, would never take a 20% risk that I may not have a job or live in the middle of nowhere, when it comes to selecting a specialty, (those numbers certainly arent going to decrease with time) Enough great specialties out there where you dont have to incur this type of downside risk. Everyone surveyed here is presumably AOA, high board scores.

 

[thecarbonionangle]

when we are lumped with path in the psych forums as laughing stock, you know we are hitting rock bottom. Pay attention folks, the storm is coming.

anybody who is soon joining bad mediocre programs should at least consider switching out of the field.

the job search has been an absolute crapshoot. Post to come eventually!!!

 

[medgator]

Programs do not close based on the job market. They fill their spots to get the GME $$.
Pathology has had a crap job market for years and programs have not closed. Only 33% of slots are filled by US grads.
See table 8 (they just fill the spots with IMGs):
View attachment 287152

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/04/NRMP-Results-and-Data-2019_04112019_final.pdf

Nephrology job market is crap too and the programs are not closing.
View attachment 287151
The red line shows that programs are not closing

AY 2019 Nephrology Match—Preliminary Results

Rad onc programs closed in the 90s and spots dropped significantly so there is precedent for it, leading to the Renaissance of RO as one of the most competitive specialties to match into after the turn of the century.

Prior to that, some really weak candidates used to get in, I've met several who trained in the 70s and 90s who wouldn't get in today and I wouldn't let my dog get treated by

 

[PhotonBomb]

Programs do not close based on the job market. They fill their spots to get the GME $$.

Again, this is misguided.

You are correct that programs are often motivated to fill. because they have infrastructures built on residents to do work. They need bodies. It's not about the individual programs wanting money (which again goes to pay salary and benefits of the resident anyways).

We will see what happens in rad onc, if FMGs will start to flood it to get spots in the US or not, but I think it will be diffeent in rad onc for multiple reasons.

 

[PhotonBomb]

Rad onc programs closed in the 90s and spots dropped significantly so there is precedent for it

Yep.

Even this year itself, before the match even happened, some programs have been promising not to SOAP and some programs have even apparently cut back how many they will take. I doubt you would see this in other fields.

This is where the ‘we are special’-ness of radiation oncologists is actually a good thing. Some places won’t just take anyone.


Last year multiple programs chose NOT to fill in the SOAP. That doesn’t happen in Path, Psych, etc, other fields that have a long history of being seen as less desirable

 

[Haybrant]

Rad onc programs closed in the 90s and spots dropped significantly so there is precedent for it, leading to the Renaissance of RO as one of the most competitive specialties to match into after the turn of the century.

Prior to that, some really weak candidates used to get in, I've met several who trained in the 70s and 90s who wouldn't get in today and I wouldn't let my dog get treated by

My gosh the number of people that shouldn’t even be allowed to treat at a vet clinic that continue to blast away is so mind boggling - can’t even communicate w a patient compassionately, obvious detritus that matched bc nobody else wanted to touch this disaster and act like they’re somehow special bc our generation is actually the strong cohort

 

[medgator]

My gosh the number of people that shouldn’t even be allowed to treat at a vet clinic that continue to blast away is so mind boggling and can’t even communicate w a patient compassionately, obvious detritus that matched bc nobody else wanted to touch this disaster and act like they’re somehow special

And that's exactly where we are cycling back to under the current trajectory while the #radoncrocks Twitter crowd is dancing on the Titanic

 

[2021Doctor]

Yep.

Even this year itself, before the match even happened, some programs have been promising not to SOAP and some programs have even apparently cut back how many they will take. I doubt you would see this in other fields.

Last year multiple programs chose NOT to fill in the SOAP. That doesn’t happen in Path, Psych, etc, other fields that have a long history of being seen as less desirable

I believe this is mythology. The data does not show programs not filling. Those that allegedly did not fill in the SOAP must have filled before or after the SOAP. The total number of active residents is at an alltime record of 774.

ACGME Data Resource Book

www.acgme.org

 

[PhotonBomb]

people that matched last Spring (or did not match) aren't even in those tables yet.

 

[2021Doctor]

people that matched last Spring (or did not match) aren't even in those tables yet.

Oh. So the job market was great in 2018 and the PDs filled all their spots.
The job market then went bad in 2019 so the PDs did not fill all their spots.
LOL.

 

[PhotonBomb]

not sure what you are saying.

All I am saying is some programs did not SOAP in 2019 when they could have. It's ultimately small numbers, but its a signal that perhpas every program won't fill every last spot, which is a good thing at least.

we will see what happens in 2020.

 

[2021Doctor]

not sure what you are saying.

All I am saying is some programs did not SOAP in 2019 when they could have. It's ultimately small numbers, but its a signal that perhpas every program won't fill every last spot, which is a good thing at least.

we will see what happens in 2020.

I think what you are saying is that you somehow believe that the same people who have selfishly allowed for unchecked expansion for years have suddenly become unselfish. LOL.

 

[PhotonBomb]

I think what you are saying is that you somehow believe that the same people who have selfishly allowed for unchecked expansion for years have suddenly become unselfish. LOL.

There was a clear Rad Onc Bubble and lots of people got caught up in it.

the bubble has burst.

 

[PhotonBomb]

No one is arguing with you that numbers have risen.

 

[Neuronix]

So 19/27 positions (PGY-1 and PGY-2) filled in the SOAP. I would bet big $$ that most or all of the other 8 positions filled after the SOAP. Gotta keep that GME $$ and cheap resident labor pipeline flowing.

I can't account for all 8 spots, but based on personal communication some of the spots filled post-SOAP and a few didn't.

So IMO both sides are sort of right here.

On the one hand, yes, a few spots did not fill last year. On the other hand, the spots that didn't fill represent less than 5% of total rad onc positions.

We need a significant correction to the oversupply. If we have another 5-10 spots that go empty this year out of the 210-220 spots in the match, it will do little to nothing to correct the overall problem. If 30+ spots go unfilled after the match and SOAP, in my opinion that's a good start to correcting the oversupply problem. I do think that's unlikely to happen, but time will tell.

 

[PhotonBomb]

I can't account for all 8 spots, but based on personal communication some of the spots filled post-SOAP and a few didn't.

So IMO both sides are sort of right here.

On the one hand, yes, a few spots did not fill last year. On the other hand, the spots that didn't fill represent less than 5% of total rad onc positions.

We need a significant correction to the oversupply. If we have another 5-10 spot that go empty this year out of the 210-220 spots in the match, it will do little to nothing to correct the overall problem. If 30+ spots go unfilled after the match and SOAP, in my opinion that's a good start to correcting the oversupply problem. I do think that's unlikely to happen, but time will tell.

yes.

 

[bluebubbles]

The only way to fix oversupply is for leadership to close programs. By leadership, I’m referring to the senior faculty at the top programs that overwhelmingly comprise ASTRO, ADROP, RRC, SCAROP leadership. I’m sympathetic to these folk because their programs, by and large, are healthy and successful. It’s hard for them to see a problem with oversupply because they don’t interact with the bottom ~50% of residency programs. This is where the excess fat can and must be trimmed, because these are the programs that are poor in education, poor in research, and poor in mentored clinical training. The residents at these programs are those that are suffering, since their attendings are employed and happy to have coverage. If the bottom 50% were closed, the current crop of residents absorbed into other programs (with a //temporary// increase in cohort size), and the attendings at the bottom 50% acting as proper doctors without resident “coverage” but with all the RN’s/NP’s/PA’s that their tightwad hospital middle-managers deign to hire, we could fix oversupply within a few years.

 

[PhotonBomb]

The only way to fix oversupply is for leadership to close programs. By leadership, I’m referring to the senior faculty at the top programs that overwhelmingly comprise ASTRO, ADROP, RRC, SCAROP leadership. I’m sympathetic to these folk because their programs, by and large, are healthy and successful. It’s hard for them to see a problem with oversupply because they don’t interact with the bottom ~50% of residency programs. This is where the excess fat can and must be trimmed, because these are the programs that are poor in education, poor in research, and poor in mentored clinical training. The residents at these programs are those that are suffering, since the attendings are employed and happy to have coverage. If the bottom 50% were closed, the current crop of residents absorbed into other programs (with a //temporary// increase in cohort size), and the attendings at the bottom 50% acting as proper doctors without resident “coverage” but with all the RN’s/NP’s/PA’s that their tightwad hospital middle-managers deign to hire, we could fix oversupply within a few years.

This should be stickied.

 

[RickyScott]

This should be stickied.

I really doubt cutting 50% of residency spots could fix oversupply in a few years. With 1000 residents already committed 5 years, we are talking about a correction that would only slowly start to take effect 6 years from now and then would take 10 years to really take effect.

Were about 100 residents in my graduating class 2006 and that’s probably correct number given that job search was not that easy (even DM admitted such) and now we have hypofra/apm. Cutting down to the correct number without overcorrecting would still take generation to have impact on the job market.

I am going to define a healthy job market as one in which you can find employment in almost any city, but may have to take salary on par with pimary care in very desirable locations.

 

[PhotonBomb]

I really doubt cutting 50% of residency spots could fix oversupply in a few years. With 1000 residents already committed 5 years, we are talking about a correction that would only slowly start to take effect 6 years from now and then would take 10 years to really take effect.

Were about 100 residents in my graduating class 2006 and that’s probably correct number given that job search was not that easy and now we have hypofra/apm. Cutting down to the correct number without overcorrecting would still take generation to have impact on the job market.

I disagree.

There are not half of graduating classes not finding jobs. nowhere close. If that was the case, then I would agree with you that cutting by half immediately wouldn't have a big enough impact.

 

[medgator]

I disagree.

There are not half of graduating classes not finding jobs. nowhere close. If that was the case, then I would agree with you that cutting by half immediately wouldn't have a big enough impact.

Yeah they are just being exploited more and more.

Lower salaries, more productivity required despite that, lower research time in academics, more difficult geography (academic jobs are focused on outlying satellites, not main center).

Even boonie jobs like khe took apparently are dropping in salary for new grads per anecdotal evidence posted here previously.

Theoretically, everyone could take exploitative jobs at $200k a year and some would think we are fine because very few are "unemployed"

 

[PhotonBomb]

That’s ‘SAD!’ for KHE!

 

[GapCalc]

Not to be antagonistic, but it’s magical thinking to consider that these programs will voluntarily contract or close down in any self-directed fashion. I have a couple friends from the interview trail that I would see at ASTRO every year and they said as recently as this year that expansions are still being considered at their programs.

I’m generally an optimist (I think you have to be in oncology), but I am nothing but pessimistic about current leadership making any real changes to address the current situation.

 

[medgator]

Not to be antagonistic, but it’s magical thinking to consider that these programs will voluntarily contract or close down in any self-directed fashion. I have a couple friends from the interview trail that I would see at ASTRO and they said as recently as this year that expansions are still being considered at their programs.

I’m generally an optimist (I think you have to be in oncology), but I am nothing but pessimistic about current leadership making any real changes to address the current situation.

Only chance in hell of anything happening is sending lots of spots into the SOAP, year in, year out. Eventually some programs will tire of filling with non interested/weak candidates