Quantifying Job Market Difficulties and predicting ahead

[Ray D. Ayshun]

Yup.... And some people speak out about while others remain silent (some of them even like/benefit from it!)

My impression of jd's point is that a fellowship exploiting foreign grads isn't necessarily germane to the job market discussion, unless of course, they're staying after. The ethics of doing this is a separate topic.

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[jondunn]

My impression of jd's point is that a fellowship exploiting foreign grads isn't necessarily germane to the job market discussion, unless of course, they're staying after. The ethics of doing this is a separate topic.

yeah

 

[elementaryschooleconomics]

of course can be criticized, but when FMGs are the predominant takers of all of these fellowships, discussion of the ethics of fellowships that are non-accredited should be divorced from the job market discussion to a certain extent. not a popular opinion, but seems to be clear to me.

My impression of jd's point is that a fellowship exploiting foreign grads isn't necessarily germane to the job market discussion, unless of course, they're staying after. The ethics of doing this is a separate topic.

I agree, FMGs (and the exploitation thereof) are more the "target" of these unaccredited fellowships, which is distinct from the US MD/DO job market.

However, I personally view this as a "slippery slope" area. There appear to be two concurrent processes, at least as best available data suggests:

1) A proliferation of unaccredited Radiation Oncology fellowship positions (usually filled by FMG/IMG docs)
2) A yearly surplus production of American-trained Radiation Oncologists (roughly 200 new attendings produced per year, roughly 100 attendings retiring or leaving clinical practice per year)

As the (ultra robust) ARRO survey demonstrates, there is currently enough elasticity in the job market to keep new grad unemployment under 5% (as far as we know, and I'll refrain from commenting on the quality of the jobs taken by new grads).

Given current practice, reimbursement, and retirement trends - is it reasonable to assume consistent expansion is sustainable, indefinitely? I don't think it is, but I don't know when the tipping point will happen.

If/when this juggernaut of supply finally goes too far, what is the obvious escape valve for the pressure? Fellowships. All these institutions are effectively preparing for an even bigger army of cheap labor by building out a web of unaccredited fellowships.

So yeah, right now, fellowships and the job market can be separated into two conversations, but the two are far and away NOT divorced.

 

[Mandelin Rain]

Certain populations are exploited while the others have rights…yes I’m quite certain that I’ve read about this somewhere in my HS history class. This is the story of America.

LIAR! Columbus sailed the ocean blue! Washington crossed the Potomac! Civil War ended racism! "Ask not what your country can do for you..."! Mission Accomplished!

That's all the American history that should be taught. The rest is all too distasteful to discuss.

 

[jondunn]

agree with slippery slope and that in the future these fellowships MAY be taken by grads who can't find jobs. It's just that often when this topic comes up over the last 5 years on SDN, it is framed as 'fellowships are being offered because people can't get jobs' and this doesnt seem to be the cause and effect genesis of these fellowships.

 

[Mandelin Rain]

agree with slippery slope and that in the future these fellowships MAY be taken by grads who can't find jobs. It's just that often when this topic comes up over the last 5 years on SDN, it is framed as 'fellowships are being offered because people can't get jobs' and this doesnt seem to be the cause and effect genesis of these fellowships.

I think the point is they are offering a fellowship to someone they have no intention of hiring long term rather than just hiring a new 20:80 faculty member.

 

[jondunn]

I think the point is they are offering a fellowship to someone they have no intention of hiring long term rather than just hiring a new 20:80 faculty member.

there were multiple fellows (1/year) during my residency - I graduated 6 years ago or so. each was an FMG. none served in positions that would have precluded a faculty hire, they just served as an extra resident on a service that would have been otherwise uncovered. Of the 4, only 1 decided to try to stay in the US, the other 3 went back to their home country. One of them in fact did a second year (at another institution) to gain more US experience before going back.

Obviously the program, from a totally cynical view, got 'cheap labor' in the form of a fellow (true of other fields too of course) for a year, and the trainees got experience that they felt was valuable enough in their home country (from multiple continents). they also made a decent salary in US dollars for a year, so it was more than worth it for them.

 

[RickyScott]

agree with slippery slope and that in the future these fellowships MAY be taken by grads who can't find jobs. It's just that often when this topic comes up over the last 5 years on SDN, it is framed as 'fellowships are being offered because people can't get jobs' and this doesnt seem to be the cause and effect genesis of these fellowships.

Slippery slope is real when it comes to Moffitt as Lou Harrison asked multiple graduating residents to stay on as fellows although dont know of any who accepted his generous offer. He never mentioned this in his ASTRO "masterclass" on leadership.

 

[Ray D. Ayshun]

Equally pertinent, of course, is, are some of these fellowships existing in place of a new residency spot? If that's the case, one could argue they're good for the market.

 

[Mandelin Rain]

there were multiple fellows (1/year) during my residency - I graduated 6 years ago or so. each was an FMG. none served in positions that would have precluded a faculty hire, they just served as an extra resident on a service that would have been otherwise uncovered. Of the 4, only 1 decided to try to stay in the US, the other 3 went back to their home country. One of them in fact did a second year (at another institution) to gain more US experience before going back.

Obviously the program, from a totally cynical view, got 'cheap labor' in the form of a fellow (true of other fields too of course) for a year, and the trainees got experience that they felt was valuable enough in their home country (from multiple continents). they also made a decent salary in US dollars for a year, so it was more than worth it for them.

So every single year of your residency, the program needed an extra doc to help "cover" a service, but you don't think rotating these fellows precluded a faculty (or even NP) hire?

 

[jondunn]

So every single year of your residency, the program needed an extra doc to help "cover" a service, but you don't think rotating these fellows precluded a faculty (or even NP) hire?

faculty is wildly different than an NP. I think you mean NP. but there were always uncovered services

 

[Mandelin Rain]

Did the fellows take call?

 

[deleted1111261]

So every single year of your residency, the program needed an extra doc to help "cover" a service, but you don't think rotating these fellows precluded a faculty (or even NP) hire?

I think the point is fair and the didn’t doesn’t show that US MDs are being “forced” to do fellowships. The ones I talk to are doing by choice / interest. Does it matter for job market? Maybe soon it well, but I think this is a minor issue at the moment.

 

[jondunn]

Did the fellows take call?

no. but they did participate in the resident lecture rotation, gave conferences, did research. they were glorified residents with a PGY6 salary and no call.