Programs that could be candidates for contracting/closing

[thecarbonionangle]

I'm a semi-recent grad and just as pissed about the job market as most posters here. I fortunately found a PP job I'm happy with but not in the location I want. I definitely could've had both as a med onc ... which was the other field I was considering. I too feel cheated and felt trapped towards the end of my residency.

When you're essentially creating a hit list for entire programs based on nothing but rumors, you're not really helping foster a legitimate solution. Singling out individual programs (wether deserved or not) is not a complete solution to the problem. It doesn't addresses the programs that have expanded over the years or the terrible training at most.

Much better than singling out individual programs (and making their current residents feel even more trapped). Why not create criteria to decrease the overall resident volume?

i.e.

1. Increase require cases to 900
2. Make weekly attending lectures mandatory (not the BS resident led 'teaching' that's so common)
3. >2 attending to resident ratio at the primary site
4. min 8 attendings at the primary site

all fair suggestions except where i disagree is not focusing on some places while you’re at it. The tumors need to be chopped off. Bad places need to be closed down along with sending those residents to better places to finish off. We can no longer make excuses for bad places. Some have been bad for quite some time (over a decade) with no improvement. That tells you something about culture. Not everything can be salvaged.

so yes, i unapologetically advocate for the kill list. This will no longer be in the dark. Stay far far away from these bottomless hell pits.

---

Members don't see this ad.

 

[Radonc90]

Actually, the tumor needs a single dose of SBRT, very very large dose of SBRT...

 

[StIGMA]

Fundamentally, residency is about education/experience to train future physicians. The best education should be distributed to the 'correct' number of residents. This number is debatable, but it is much fewer training spots than are currently allocated. There are contrary arguments (future physician distribution, academic department prestige) that are far less compelling than providing the best education to produce the best physicians for the country. Programs must shut down, and this starts at the bottom.

I am much more strongly in favor of shutting down poor programs than contracting excellent programs.

 

[medgator]

Fundamentally, residency is about education/experience to train future physicians. The best education should be distributed to the 'correct' number of residents. This number is debatable, but it is much fewer training spots than are currently allocated. There are contrary arguments (future physician distribution, academic department prestige) that are far less compelling than providing the best education to produce the best physicians for the country. Programs must shut down, and this starts at the bottom.

I am much more strongly in favor of shutting down poor programs than contracting excellent programs.

Has any amazing program opened since the turn of the century? Most, if not all, of the newer ones probably need to go

 

[elementaryschooleconomics]

Has any amazing program opened since the turn of the century? Most, if not all, of the newer ones probably need to go

I vote we go back to 2002.

55 programs offering ~97 spots.

Done and done.

 

[Neuronix]

I personally believe that programs will never agree who should contract. Chairs and program directors will only ever hold what they have or expand. Most will never agree to contract in any meaningful way. It's in each individual program's best interest to hang on to what they have or continue to expand. Tragedy of the commons and all that. We have tried to tighten training requirements, and every time the proposals get watered down to make no significant difference.

I would propose that the entire specialty cut 25% of training spots starting immediately, no matter program size. If that makes your program too small to exist, then the smallest programs will either need to justify their existence in some rigorous way or be disbanded. This is a pipe dream, however, and nobody will ever agree to that either. It would have to come from a higher authority like CMS basically saying, why are we wasting training slots and funding to oversupply a tiny little specialty?

If APM goes through as planned, who knows what things will look like in 5-10 years. It looks like doomsday out there to me, including for a lot of practicing rad oncs. There will be zero demand for new grads. Then even a 25% cut in training spots looks trivial. We will fill only with desperate FMGs, and there are plenty out there, which will drive our salaries to basically nothing.

Scary times.

 

[elementaryschooleconomics]

I personally believe that programs will never agree who should contract. Chairs and program directors will only ever hold what they have or expand. Most will never agree to contract in any meaningful way. It's in each individual program's best interest to hang on to what they have or continue to expand. Tragedy of the commons and all that. We have tried to tighten training requirements, and every time the proposals get watered down to make no significant difference.

I would propose that the entire specialty cut 25% of training spots starting immediately, no matter program size. If that makes your program too small to exist, then the smallest programs will either need to justify their existence in some rigorous way or be disbanded. This is a pipe dream, however, and nobody will ever agree to that either. It would have to come from a higher authority like CMS basically saying, why are we wasting training slots and funding to oversupply a tiny little oversupplied specialty?

If APM goes through as planned, who knows what things will look like in 5-10 years. It looks like doomsday out there to me, including for a lot of practicing rad oncs. There will be zero demand for new grads. Then even a 25% cut in training spots looks trivial. We will fill only with desperate FMGs, and there are plenty out there, which will drive our salaries to basically nothing.

Scary times.

I strongly agree. A few weeks ago I was still holding out hope that CMS would listen to all the feedback on the APM and make some meaningful changes. Instead, they basically chuckled at us and steamrolled ahead.

It looks like doomsday to me too.

 

[thecarbonionangle]

Actually, the tumor needs a single dose of SBRT, very very large dose of SBRT...

at least functional SRS dosing like 100-200gy, but im thinking its sort of like a palliative mastectomy or amputation. Sometimes you gotta chop it off

 

[Neuronix]

Actually, the tumor needs a single dose of SBRT, very very large dose of SBRT...

This analogy has gone too far.

Please nobody use nuclear weapons on training programs

 

[Radonc90]

OK fair enough,

No SBRT then, just active surveillance from now on...

 

[KHE88]

If you go back to posts 10 years ago, even 5 years ago, a lot of the activity here was medical students interested in going into the field and residents. Now it seems ~95% of the posts or so are coming from practicing rad oncs lamenting the job market. I can't remember the last time I saw a medical student post. I tended to avoid job market discussions when I came on this forum to complain about the ABR because my outlook wasn't as pessimistic since I had a number of decent job offers out of residency. Additionally, the majority of these posts came off like a broken record from a handful of annoying individuals well-established in private practices, so their constant complaints were bizzare to me and difficult to take seriously. Testing the waters I'm seeing what everyone else is. Things have gotten remarkably worse in just the past 18 months.

Question.

There are still at least ~100 or so medical students across the country applying to rad onc. Where are they? Why are they applying in this frankly catastrophic environment? Would love to see some posts from med students explaining their rationale and thought process for going ahead anyway. Perhaps some in academics who work with medical students can shine some light on this?

 

[RickyScott]

If you go back to posts 10 years ago, even 5 years ago, a lot of the activity here was medical students interested in going into the field and residents. Now it seems ~95% of the posts or so are coming from practicing rad oncs lamenting the job market. I can't remember the last time I saw a medical student post. I tended to avoid job market discussions when I came on this forum to complain about the ABR because my outlook wasn't as pessimistic since I had a number of decent job offers out of residency. Additionally, the majority of these posts came off like a broken record from a handful of annoying individuals well-established in private practices, so their constant complaints were bizzare to me and difficult to take seriously. Testing the waters I'm seeing what everyone else is. Things have gotten remarkably worse in just the past 18 months.

Question.

There are still at least ~100 or so medical students across the country applying to rad onc. Where are they? Why are they applying in this frankly catastrophic environment? Would love to see some posts from med students explaining their rationale and thought process for going ahead anyway. Perhaps some in academics who work with medical students can shine some light on this?

With determination, follow your dreams, you can accomplish anything: defy gravity and supply and demand because you have a special destiny?

 

[elementaryschooleconomics]

Question.

There are still at least ~100 or so medical students across the country applying to rad onc. Where are they? Why are they applying in this frankly catastrophic environment? Would love to see some posts from med students explaining their rationale and thought process for going ahead anyway. Perhaps some in academics who work with medical students can shine some light on this?

I will continue to update as I work with more medical students over the next ~2 months, but thus far for major themes:

1) I have discovered that there are still "sunk cost" medical students. The class of 2021 started in either 2017 or 2016 (if they took a research year). This was before the bottom absolutely fell out of the specialty, which in my personal opinion began with the ABR Board Exam Debacle of 2018. These students were either attracted to RadOnc before medical school or in M1 and were told of how ultra-competitive the field was at the time. They then started down the path of painting an application that was required to Match in 2015...not 2021.

2) As we all know, there are still RadOnc faculty who don't understand the elementary school economics of supply and demand and confuse how awesome RadOnc is as a specialty with how bad it is that there was 127% increase in residents in the blink of an eye. These faculty are still catching medical students and counseling them to not listen to the "internet malcontents", that everything is fine, and concerns about oversupply/APM/general supervision are overblown.

Oh, speaking of general supervision, I keep meaning to make a post about this. I have discovered that you can still get APEx accreditation and employ general supervision, which is something people think can't happen. I was talking to a practice which spans multiple hospitals, and does not have a RadOnc physically present every day of the week at at least one of their sites. They got APEx accreditation without issue. So, for any faculty left hanging onto the argument that APEx will force direct supervision...let go of your delusions.

 

[seper]

RadOnc is basiy a cult, but our founders sold out to the feds

 

[theradiator]

RadOnc is basiy a cult, but our founders sold out to the feds

or a Ponzi scheme

 

[fiji128]

Has any amazing program opened since the turn of the century? Most, if not all, of the newer ones probably need to go

University of San Diego was like 2012. Very solid.

 

[medgator]

University of San Diego was like 2012. Very solid.

Moffitt and COH probably aren't terrible either from what I'm hearing. But these are really exceptions to the rule

 

[fiji128]

Posted this a while back but here you go, pretty much a dumpster fire after 2010.


List of programs by year founded with number of ACGME approved residency spots:

Dartmouth (2018) 4
University of Arkansas (2017) 4
West Virginia University (2016) 4
Stony Brook (2016) 4
University of Tennessee (2015) 4
Drexel (2014) 4
Medical College of Georgia (2013) 4
Cedars Sinai (2013) 4
Mayo Clinic Arizona (2013) 4
Hofstra (2012) 8
Texas A and M (2011) 8
University of California San Diego (2010) 12
University of Nebraska (2010) 4
University of Mississippi (2010) 4
City of Hope (2008) 6
University of Oklahoma (2007) 6
University of South Florida (2007) 10
University of Texas Southwestern (2005) 14
Rutgers (2005) 9
Mayo Clinic Jacksonville (2005) 4
University of California Davis (2004) 7
University of Colorado (2003) 8
Harvard Combined Program (2002) 30
Vanderbilt (2001) 10
University of Pittsburgh (2001) 8
Case Western Reserve (2000) 6
Cornell (1995) 6
University of Kentucky (1994) 6
Allegheny Health Network (1994) 4
University of Buffalo (1993) 6
Emory (1993) 16
Fox Chase (1992) 9
Mount Sinai (1991) 10
Kaiser Permanente Los Angeles (1985) 8
University of Chicago (1985) 12
National Capital Consortium (1981) 6
Baylor College of Medicine (1981) 8
Georgetown (1981) 6
University of Kansas (1977) 6
University of Texas San Antonio (1976) 6
Indiana University (1976) 9
Medical University of South Carolina (1976) 7
University of Louisville (1974) 8
Medical College of Wisconsin (1974) 8
Loyola (1974) 8
Cleveland Clinic (1974) 12
John Hopkins (1974) 16
Brooklyn Methodist (1974) 5
Beaumont (1974) 12
Wayne State (1973) 8
Thomas Jefferson (1973) 9
University of Pennsylvania (1973) 18
University of Wisconsin (1973) 8
Loma Linda (1973) 5
University of Miami (1973) 12
University of Alabama (1973) 12
University of Arizona (1973) 7
California Pacific Medical Center (1973) 4 Closed in 2019
Columbia (1973) 6
University of North Carolina (1973) 8
University of Utah (1972) 10
University of Virginia (1972) 6
University of Texas Medical Branch (1972) 5
Northwestern University (1972) 8
Mayo Clinic Rochester (1972) 12
Henry Ford (1972) 6
University of Cincinnati (1972) 8
University of California San Francisco (1971) 13
Tufts (1971) 9
SUNY Upstate (1971) 6
University of Rochester (1971) 8
Wake Forrest (1971) 7
University of Michigan (1971) 11
Washington University (1971) 16
Memorial Sloan Kettering (1971) 24
New York University (1971) 10
Ohio State University (1971) 10
University of Southern California (1970) 7
University of Washington (1970) 10
Stanford (1970) 17
Oregon Health and Science University (1970) 6
Albert Einstein (1970) 7
MD Anderson (1970) 28
University of Minnesota (1970) 6
University of California Los Angeles (1970) 12
Yale (1969) 14
Duke University (1969) 13
University of Florida (1969) 9
Virginia Commonwealth University (1969) 8
SUNY Downstate (1969) 8
Rush (1969) 6

 

[medgator]

2010 probably an accurate cutpoint looking at that list. Would be good to get rid of everything after that

 

[fiji128]

I will continue to update as I work with more medical students over the next ~2 months, but thus far for major themes:

Nearly the entire body of research for rad onc durning the past 10 years revolves around fewer fractions and finding ways to treat fewer patients. If a med student can't understand why that's bad for their future career prospects that on them. Its been widely publicized at this point. Completely different from circa 2010.

 

[radOresident]

Other than Harvard, Vanderbilt, maybe UTSW is there a program more recent than 2000 worth keeping?

 

[Radonc90]

Thanks for the chronological list...
Some of the dates "may" be off bc I am going by my memory.
- U Colorado: are you sure it was 2003?
- Vanderbilt: are you sure it was 2001?
- Harvard renamed their system thus 2002, but it certainly started way back then during dinosaurs ages...maybe in the 1960s?

 

[medgator]

Other than Harvard, Vanderbilt, maybe UTSW is there a program more recent than 2000 worth keeping?

I've heard Moffitt, coh, mayo az, ucsd decent. Other than that, none

 

[thecarbonionangle]

Posted this a while back but here you go, pretty much a dumpster fire after 2010.


List of programs by year founded with number of ACGME approved residency spots:

Dartmouth (2018) 4
University of Arkansas (2017) 4
West Virginia University (2016) 4
Stony Brook (2016) 4
University of Tennessee (2015) 4
Drexel (2014) 4
Medical College of Georgia (2013) 4
Cedars Sinai (2013) 4
Mayo Clinic Arizona (2013) 4
Hofstra (2012) 8
Texas A and M (2011) 8
University of California San Diego (2010) 12
University of Nebraska (2010) 4
University of Mississippi (2010) 4
City of Hope (2008) 6
University of Oklahoma (2007) 6
University of South Florida (2007) 10
University of Texas Southwestern (2005) 14
Rutgers (2005) 9
Mayo Clinic Jacksonville (2005) 4
University of California Davis (2004) 7
University of Colorado (2003) 8
Harvard Combined Program (2002) 30
Vanderbilt (2001) 10
University of Pittsburgh (2001) 8
Case Western Reserve (2000) 6
Cornell (1995) 6
University of Kentucky (1994) 6
Allegheny Health Network (1994) 4
University of Buffalo (1993) 6
Emory (1993) 16
Fox Chase (1992) 9
Mount Sinai (1991) 10
Kaiser Permanente Los Angeles (1985) 8
University of Chicago (1985) 12
National Capital Consortium (1981) 6
Baylor College of Medicine (1981) 8
Georgetown (1981) 6
University of Kansas (1977) 6
University of Texas San Antonio (1976) 6
Indiana University (1976) 9
Medical University of South Carolina (1976) 7
University of Louisville (1974) 8
Medical College of Wisconsin (1974) 8
Loyola (1974) 8
Cleveland Clinic (1974) 12
John Hopkins (1974) 16
Brooklyn Methodist (1974) 5
Beaumont (1974) 12
Wayne State (1973) 8
Thomas Jefferson (1973) 9
University of Pennsylvania (1973) 18
University of Wisconsin (1973) 8
Loma Linda (1973) 5
University of Miami (1973) 12
University of Alabama (1973) 12
University of Arizona (1973) 7
California Pacific Medical Center (1973) 4 Closed in 2019
Columbia (1973) 6
University of North Carolina (1973) 8
University of Utah (1972) 10
University of Virginia (1972) 6
University of Texas Medical Branch (1972) 5
Northwestern University (1972) 8
Mayo Clinic Rochester (1972) 12
Henry Ford (1972) 6
University of Cincinnati (1972) 8
University of California San Francisco (1971) 13
Tufts (1971) 9
SUNY Upstate (1971) 6
University of Rochester (1971) 8
Wake Forrest (1971) 7
University of Michigan (1971) 11
Washington University (1971) 16
Memorial Sloan Kettering (1971) 24
New York University (1971) 10
Ohio State University (1971) 10
University of Southern California (1970) 7
University of Washington (1970) 10
Stanford (1970) 17
Oregon Health and Science University (1970) 6
Albert Einstein (1970) 7
MD Anderson (1970) 28
University of Minnesota (1970) 6
University of California Los Angeles (1970) 12
Yale (1969) 14
Duke University (1969) 13
University of Florida (1969) 9
Virginia Commonwealth University (1969) 8
SUNY Downstate (1969) 8
Rush (1969) 6

some of of these places are old and f&&&&$? Terrible still. Puts it into perspective for you if you are dumb enough to think “things are going to get better” in some of these places. Bottomless hellpits with putrid swamp stagnancy. Even the “good” places are sorta like those layers in dante’s inferno which don’t seem THAT bad but you MUST remember one thing, in the entrance of the inferno, sucker if you do not heed the warning: “ABANDON all hope all ye who enter here”

 

[Music Man Stan]

I've heard Moffitt, coh, mayo az, ucsd decent. Other than that, none

COH had issues. Going to keep it vague because I’m not sure about its training quality right now.

 

[elementaryschooleconomics]

some of of these places are old and f&&&&$? Terrible still. Puts it into perspective for you if you are dumb enough to think “things are going to get better” in some of these places. Bottomless hellpits with putrid swamp stagnancy. Even the “good” places are sorta like those layers in dante’s inferno which don’t seem THAT bad but you MUST remember one thing, in the entrance of the inferno, sucker if you do not heed the warning: “ABANDON all hope all ye who enter here”

People forget that "old, prestigious" etc are adjectives that cut both ways. While it may help your career to come from those places, those places are definitely aware that their reputation makes them "special" thus there is ABSOLUTELY NO INCENTIVE to change or improve.

If you're already making money, if you're getting great applicants for both residency and faculty positions, what do you care if the environment is objectively terrible? You don't. You just do whatever you want. It's human nature.

 

[fiji128]

Thanks for the chronological list...
Some of the dates "may" be off bc I am going by my memory.
- U Colorado: are you sure it was 2003?
- Vanderbilt: are you sure it was 2001?
- Harvard renamed their system thus 2002, but it certainly started way back then during dinosaurs ages...maybe in the 1960s?

Accreditation years are from the ACGME. I put the list together by hand about a year and half ago so I'd say the years are accurate. The two or three various Harvard programs were accrideted very early but they technically ceased to exist when they merged and became a combined program in 2002.

 

[RickyScott]

Thanks for the chronological list...
Some of the dates "may" be off bc I am going by my memory.
- U Colorado: are you sure it was 2003?
- Vanderbilt: are you sure it was 2001?
- Harvard renamed their system thus 2002, but it certainly started way back then during dinosaurs ages...maybe in the 1960s?

colorado and Vanderbilt were def not around when I was applying.
Shocked Texas a and m has program. That must be a real stinker.

 

[evilbooyaa]

I'm a semi-recent grad and just as pissed about the job market as most posters here. I fortunately found a PP job I'm happy with but not in the location I want. I definitely could've had both as a med onc ... which was the other field I was considering. I too feel cheated and felt trapped towards the end of my residency.

When you're essentially creating a hit list for entire programs based on nothing but rumors, you're not really helping foster a legitimate solution. Singling out individual programs (wether deserved or not) is not a complete solution to the problem. It doesn't addresses the programs that have expanded over the years or the terrible training at most.

Much better than singling out individual programs (and making their current residents feel even more trapped). Why not create criteria to decrease the overall resident volume?

i.e.

1. Increase require cases to 900
2. Make weekly attending lectures mandatory (not the BS resident led 'teaching' that's so common)
3. >2 attending to resident ratio at the primary site
4. min 8 attendings at the primary site

Increase in educational requirements has been another thing I have (long) advocated for, including #1, 3, and 4, although our preferred numbers are slightly different. #2 is a good idea I had not thought of and agree with.

#3 is literally one of the criteria in the impetus for this post (although is far too high to gain any serious traction). #1 is far too high to get any serious traction. #4 is also far too high to gain serious traction.

 

[KHE88]

mcg/Augusta closed

The MCG/Augusta/Regents/whatever-their-name-is-now was one of the most ergregious examples of peak-stupid rad onc residency expansion. As far as I know this was a freestanding facility with some sort of vague academic affiliation, the chair they recruited bailed immediately, they took a radiology resident out of the match (maybe regretting that switch now?), and as far as I know never had another resident. That should be some sort of casebook study as to what went wrong and how that program ever got approved in the first place.

 

[elementaryschooleconomics]

I will continue to update as I work with more medical students over the next ~2 months, but thus far for major themes:

1) I have discovered that there are still "sunk cost" medical students. The class of 2021 started in either 2017 or 2016 (if they took a research year). This was before the bottom absolutely fell out of the specialty, which in my personal opinion began with the ABR Board Exam Debacle of 2018. These students were either attracted to RadOnc before medical school or in M1 and were told of how ultra-competitive the field was at the time. They then started down the path of painting an application that was required to Match in 2015...not 2021.

2) As we all know, there are still RadOnc faculty who don't understand the elementary school economics of supply and demand and confuse how awesome RadOnc is as a specialty with how bad it is that there was 127% increase in residents in the blink of an eye. These faculty are still catching medical students and counseling them to not listen to the "internet malcontents", that everything is fine, and concerns about oversupply/APM/general supervision are overblown.

Oh, speaking of general supervision, I keep meaning to make a post about this. I have discovered that you can still get APEx accreditation and employ general supervision, which is something people think can't happen. I was talking to a practice which spans multiple hospitals, and does not have a RadOnc physically present every day of the week at at least one of their sites. They got APEx accreditation without issue. So, for any faculty left hanging onto the argument that APEx will force direct supervision...let go of your delusions.

As promised, more reasons:

3) Family legacy! How could I forget? The classic reason to go into RadOnc.

"My Daddy done zapped cancer, now I'm gunna zap cancer like his Daddy 'fore him"

 

[RickyScott]

If you go back to posts 10 years ago, even 5 years ago, a lot of the activity here was medical students interested in going into the field and residents. Now it seems ~95% of the posts or so are coming from practicing rad oncs lamenting the job market. I can't remember the last time I saw a medical student post. I tended to avoid job market discussions when I came on this forum to complain about the ABR because my outlook wasn't as pessimistic since I had a number of decent job offers out of residency. Additionally, the majority of these posts came off like a broken record from a handful of annoying individuals well-established in private practices, so their constant complaints were bizzare to me and difficult to take seriously. Testing the waters I'm seeing what everyone else is. Things have gotten remarkably worse in just the past 18 months.

Question.

There are still at least ~100 or so medical students across the country applying to rad onc. Where are they? Why are they applying in this frankly catastrophic environment? Would love to see some posts from med students explaining their rationale and thought process for going ahead anyway. Perhaps some in academics who work with medical students can shine some light on this?

I kind of get the vibe that some of the interested medstudents on twitter have a “cutesy” immaturity about them: “I can tell we are going to be #radonc besties and have a slumber party at Erin Gillespie’s place? “ or “Can I signal my Humanity by bringing my dog or stuffed animal to the zoom interview? When you are predisposed to such tripe, you will eat anything that a PD says.

 

[scarbrtj]

Additionally, the majority of these posts came off like a broken record from a handful of annoying individuals well-established in private practices, so their constant complaints were bizzare to me and difficult to take seriously.

For the same reason Shelley wrote:

And on the pedestal, these words appear:
My name is Ozymandias, King of Kings;
Look on my Works, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of that colossal Wreck, boundless and bare
The lone and level sands stretch far away.

"My Daddy done zapped cancer, now I'm gunna zap cancer like his Daddy 'fore him"

I kind of get the vibe that some of the interested medstudents on twitter have a “cutesy” immaturity about them: “

There is quite a cadre of #TumorZappers on the twitter and the IG.

 

[elementaryschooleconomics]

I kind of get the vibe that some of the interested medstudents on twitter have a “cutesy” immaturity about them: “I can tell we are going to be #radonc besties and have a slumber party at Erin Gillespie’s place? “ or “Can I signal my Humanity by bringing my dog or stuffed animal to the zoom interview? When you are predisposed to such tripe, you will eat anything that a PD says.

There is quite a cadre of #TumorZappers on the twitter and the IG.

Yes! I've noticed this as well, and I can't figure out if it's a generational thing (these personalities weren't prevalent when I started as a med student in the 2000s) or a RadOnc thing (is this who's willing to look past the obvious warning signs) or a combination of both.

Some of the things medical students have said to me in the past few weeks have blown my mind. Like, there's a level of "the game" that I thought we all knew how to play, but either that level is above RadOnc now or the game in 2020 has changed.

Man, I'm not even that old, what am I even writing right now?

 

[bergonieandtribondeau]

Yes! I've noticed this as well, and I can't figure out if it's a generational thing (these personalities weren't prevalent when I started as a med student in the 2000s) or a RadOnc thing (is this who's willing to look past the obvious warning signs) or a combination of both.

Some of the things medical students have said to me in the past few weeks have blown my mind. Like, there's a level of "the game" that I thought we all knew how to play, but either that level is above RadOnc now or the game in 2020 has changed.

Man, I'm not even that old, what am I even writing right now?

I think it's a combination thereof.

1. Rad Onc programs are courting med students (as opposed to the other way around), and they know they hold the cards. Prior lines of professionalism have soften a bit in light of this. I mean, from what I understand, most RO residencies are literally making videos trying to show off how great their programs are to attract applicants. Holding virtual meet and greets, etc. This would have been unthinkable in, say, 2008. Very different dynamic now.

2. RO social media is much more prominent than it used to be, and any hierarchical distinctions that might otherwise be apparent in "real life" become a little more blurred online. This doesn't just apply to med students by the way; I have seen much more forthright interactions between residents and attendings than I was ever accustomed to before, including discussion of non-RO related personal topics. Even three years ago, when field was not in the same dire straits it is now applicant wise.

I am convinced that the trajectory of the "stereotypical RO" is one of the most protean and fascinating in all of medicine. The RO of 1988 was entirely different from the RO of 2000 in nearly every respect. We are on the cusp of an entirely different personality type in similar fashion.

 

[thecarbonionangle]

“Cutesy” rad oncs. This is very interesting. Like very adorable koreans making a peace sign and anime stuff. Totally adorable stuff. Wouldn’t that be something! Rad onc is filled with cuteness. We should do a baby shark dance to recruit cuties. I suggested this to chairman but was shut down

 

[GreySwan]

If you go back to posts 10 years ago, even 5 years ago, a lot of the activity here was medical students interested in going into the field and residents. Now it seems ~95% of the posts or so are coming from practicing rad oncs lamenting the job market. I can't remember the last time I saw a medical student post. I tended to avoid job market discussions when I came on this forum to complain about the ABR because my outlook wasn't as pessimistic since I had a number of decent job offers out of residency. Additionally, the majority of these posts came off like a broken record from a handful of annoying individuals well-established in private practices, so their constant complaints were bizzare to me and difficult to take seriously. Testing the waters I'm seeing what everyone else is. Things have gotten remarkably worse in just the past 18 months.

Question.

There are still at least ~100 or so medical students across the country applying to rad onc. Where are they? Why are they applying in this frankly catastrophic environment? Would love to see some posts from med students explaining their rationale and thought process for going ahead anyway. Perhaps some in academics who work with medical students can shine some light on this?

I'll go ahead and share my story. Med student here and long time lurker, on this thread and twitter. First thanks to SDN I have had the most difficult discussions with attendings, residents, and other med students. The issues y'all have been pointing out are on point and tbh have led a lot of people to speak out loud.

Now, why am I interested in applying? Tbh I really wanted to hate the field, it would have made my decision easier because it would align perfectly with the current outlook of the field and probably would have saved me the headache. Unfortunately, I did not. I loved every thing about it, the day to day, interventional aspect, peer environment, and patient population to say the least. I tried as much as possible to think why RO vs Med Onc since they both share the patient population and all that + future indications and potential. My list went on, but maybe I am biased. My experiences with attendings from both sides was contrasting. The RO attendings I had were the smartest people I have worked with in medicine, from critical appraisal of the literature behind the interventions, to their demeanor and approach with goals of treatment. My Med Oncs, felt more burnt out, just following the latest NCCN guideline mostly without much of a thought, had too little time to talk to patients. I know this is not the case across the country, and I might be unlucky that my experience was this contradicting. But it made things clearer and pushed me towards RO more.

I like to tell myself that I do understand basic economic principles of supply and demand, and the outlook is grim, but for me RO might still be worth it if I am able to match in a top 20 program. I know upfront that I might be naive, but thanks to you I won't even bother with a program that won't support my goals and education. I am trying to combine my interests ML and RO maybe just maybe I can future proof myself. Plus I am cognizant of the geo limitations down the line, and luckily do not have strong ties or preferences. I am also lucky that my SO isn't tied too and her job allows her to work remotely. Accounting for all this and considering we have little debt, we decided that I should take the risk but on my own terms. I will not lie to you and tell you this is an easy decision. Will I dual apply? Maybe, I am surely leaning towards a Prelim position since it would give me more freedom. But yeah this is my story, again I appreciate all your insight and twitter does seem to be more shiny and rosy but I feel people are starting to talk about it more openly.

 

[RickyScott]

“Cutesy” rad oncs. This is very interesting. Like very adorable koreans making a peace sign and anime stuff. Totally adorable stuff. Wouldn’t that be something! Rad onc is filled with cuteness. We should do a baby shark dance to recruit cuties. I suggested this to chairman but was shut down

A baby shark dance with dosimetry or techs on social media is a great way to signal how much fun there is to be had at your program, and that you really know how to let loose.

 

[DireMoose]

If Neha wants to fly across the country with a flame thrower and burn down programs I’ll fly her first class anywhere in the US.

Flame thrower. First class flight. Problem solved.

 

[Ray D. Ayshun]

I was thinking that we should no longer be talking about dissociating from the ABR as we become an imaging-based specialty that like rads has virtually no patient contact.

 

[scarbrtj]

I'll go ahead and share my story. Med student here and long time lurker, on this thread and twitter. First thanks to SDN I have had the most difficult discussions with attendings, residents, and other med students. The issues y'all have been pointing out are on point and tbh have led a lot of people to speak out loud.

Now, why am I interested in applying? Tbh I really wanted to hate the field, it would have made my decision easier because it would align perfectly with the current outlook of the field and probably would have saved me the headache. Unfortunately, I did not. I loved every thing about it, the day to day, interventional aspect, peer environment, and patient population to say the least. I tried as much as possible to think why RO vs Med Onc since they both share the patient population and all that + future indications and potential. My list went on, but maybe I am biased. My experiences with attendings from both sides was contrasting. The RO attendings I had were the smartest people I have worked with in medicine, from critical appraisal of the literature behind the interventions, to their demeanor and approach with goals of treatment. My Med Oncs, felt more burnt out, just following the latest NCCN guideline mostly without much of a thought, had too little time to talk to patients. I know this is not the case across the country, and I might be unlucky that my experience was this contradicting. But it made things clearer and pushed me towards RO more.

I like to tell myself that I do understand basic economic principles of supply and demand, and the outlook is grim, but for me RO might still be worth it if I am able to match in a top 20 program. I know upfront that I might be naive, but thanks to you I won't even bother with a program that won't support my goals and education. I am trying to combine my interests ML and RO maybe just maybe I can future proof myself. Plus I am cognizant of the geo limitations down the line, and luckily do not have strong ties or preferences. I am also lucky that my SO isn't tied too and her job allows her to work remotely. Accounting for all this and considering we have little debt, we decided that I should take the risk but on my own terms. I will not lie to you and tell you this is an easy decision. Will I dual apply? Maybe, I am surely leaning towards a Prelim position since it would give me more freedom. But yeah this is my story, again I appreciate all your insight and twitter does seem to be more shiny and rosy but I feel people are starting to talk about it more openly.

I for one would welcome pragmatists such as yourself into the field. You might be able to help fix this ship's list one day.

 

[GapCalc]

It's depressing to think that even if every program that started in the last decade (post-UCSD) was closed, the net reduction in yearly spots is only 13...

Good thing #RadOncRocks !!!!

 

[thecarbonionangle]

It's depressing to think that even if every program that started in the last decade (post-UCSD) was closed, the net reduction in yearly spots is only 13...

Good thing #RadOncRocks !!!!

don’t worry ASTRO and “leaders” are working on helping you

 

[Doctorer]

It's depressing to think that even if every program that started in the last decade (post-UCSD) was closed, the net reduction in yearly spots is only 13...

Good thing #RadOncRocks !!!!

Just curious: why does UCSD get a pass? I guess I didn't realize there was a desperate need for radiation oncologists in Southern California.

 

[RollTideRadOnc]

I'll go ahead and share my story. Med student here and long time lurker, on this thread and twitter. First thanks to SDN I have had the most difficult discussions with attendings, residents, and other med students. The issues y'all have been pointing out are on point and tbh have led a lot of people to speak out loud.

Now, why am I interested in applying? Tbh I really wanted to hate the field, it would have made my decision easier because it would align perfectly with the current outlook of the field and probably would have saved me the headache. Unfortunately, I did not. I loved every thing about it, the day to day, interventional aspect, peer environment, and patient population to say the least. I tried as much as possible to think why RO vs Med Onc since they both share the patient population and all that + future indications and potential. My list went on, but maybe I am biased. My experiences with attendings from both sides was contrasting. The RO attendings I had were the smartest people I have worked with in medicine, from critical appraisal of the literature behind the interventions, to their demeanor and approach with goals of treatment. My Med Oncs, felt more burnt out, just following the latest NCCN guideline mostly without much of a thought, had too little time to talk to patients. I know this is not the case across the country, and I might be unlucky that my experience was this contradicting. But it made things clearer and pushed me towards RO more.

I like to tell myself that I do understand basic economic principles of supply and demand, and the outlook is grim, but for me RO might still be worth it if I am able to match in a top 20 program. I know upfront that I might be naive, but thanks to you I won't even bother with a program that won't support my goals and education. I am trying to combine my interests ML and RO maybe just maybe I can future proof myself. Plus I am cognizant of the geo limitations down the line, and luckily do not have strong ties or preferences. I am also lucky that my SO isn't tied too and her job allows her to work remotely. Accounting for all this and considering we have little debt, we decided that I should take the risk but on my own terms. I will not lie to you and tell you this is an easy decision. Will I dual apply? Maybe, I am surely leaning towards a Prelim position since it would give me more freedom. But yeah this is my story, again I appreciate all your insight and twitter does seem to be more shiny and rosy but I feel people are starting to talk about it more openly.

Good luck to you! You are being quite brave but going in with eyes open.

I would aim for a top 10 program (preferably top 3) and not top 20. Job hunt can be very hard even for folks from ostensibly good programs. I would prioritize going to the place with the best reputation possible or going somewhere in your preferred geography, and preferably BOTH simultaneously (eg you want to live in Houston or Texas longterm so you go to MDA).

At some mild risk of outing yourself, feel free to ask for feedback on programs here (or via private message).

 

[RickyScott]

Good luck to you! You are being quite brave but going in with eyes open.

I would aim for a top 10 program (preferably top 3) and not top 20. Job hunt can be very hard even for folks from ostensibly good programs. I would prioritize going to the place with the best reputation possible or going somewhere in your preferred geography, and preferably BOTH simultaneously (eg you want to live in Houston or Texas longterm so you go to MDA).

At some mild risk of outing yourself, feel free to ask for feedback on programs here (or via private message).

Applicants dont understand what a top program really means. There are 3 "top programs" followed by a bunch of "good" programs that probably exceed 25. It will have no bearing on your future employment if you went to Duke vs Univ of Wisconsin vs Emory vs Maryland etc. There are at least 100 residents in such programs and not all will be employed when they leave.

 

[RollTideRadOnc]

Applicants dont understand what a top program really means. There are 3 "top programs" followed by a bunch of "good" programs that probably exceed 25. It will have no bearing on your future employment if you went to Duke vs Univ of Wisconsin vs Emory vs Maryland etc. There are at least 100 residents in such programs and not all will be employed when they leave.

I disagree. I think there is a clear top tier, and it’s easier to get a job from these programs. I would list the top tier roughly as follows (though everyone has their own list):

1a (in order):
Harvard
MSK (known issues with malignancy)
MDA
Stanford
UCSF
——
1b:
Hopkins (name recognition outside our speciality will matter more as the field sinks)
Penn (name recognition)

grads from these will almost certainly have an easier time than those from Wisconsin, Emory, Maryland, UAB etc.

Also, another unsolicited piece of advice: if I were a new resident, I would consider also focusing on a marketable (albeit perhaps niche) skill such as brachy (whether it be gyn or prostate etc). There are a handful of good jobs every year that require real brachy skills and it can be a significant or differentiator that a resident is actually able to acquire imo.

 

[scarbrtj]

Also, another unsolicited piece of advice: if I were a new resident, I would consider also focusing on a marketable (albeit perhaps niche) skill such as brachy (whether it be gyn or prostate etc). There are a handful of good jobs every year that require real brachy skills and it can be a significant or differentiator that a resident is actually able to acquire imo.

Everything you speak is of truth but for this (IMHO). Payors are now pricing all skills at the same level. Preparing a Babbette's Feast vs boiling an egg: same reimbursement. If not now, certainly in the future.

 

[RollTideRadOnc]

Everything you speak is of truth but for this. Payors are now pricing all skills at the same level. Preparing a Babbette's Feast vs boiling an egg: same reimbursement. If not now, certainly in the future.

your point is well taken. Brachy is never going to be a winner in terms of reimbursement. It’s not a winner now, and will be less of a winner in the future (especially for prostate, where sabr will cannibalize it).

However, there will be still be coastal jobs (or in other competitive regions) that are always specifically looking for a brachy person, as many large practices have such a person. And this is one of the very few areas that a new grad can potentially be competitive with established clinicians.

For example, in the last year, I think there have been at least 3 brachy specific jobs that have been advertised on the west coast (2 to 3 at Kaiser NorCal and at least 1 in Seattle). My educated guess is that the pool of people qualified for such jobs is low. And hence new grads can potentially find fruitful inroads along this path.

but you rightly point out that the reimbursement outlook for brachy remains bleak, so who knows...

 

[seper]

I’ve looked for brachy-heavy jobs several times over the past decade, and, to my subjective assessment, brachytherapy market is over-saturated.
For example, university hospitals now usually have multiple attendings competing for cases in both prostate and GYN.
Even inner city-uninsured cervical cases are sought after.