Soooooo... A trial on stage IV/metastatic RCC between systemic therapy combinations where radiation has never played a major role... means radiation has no future in oncology. Got it
The RCC ad is just one of many exemplifying that medical oncology options for treating cancer are expanding. Med onc fellowship growth may well be justified by the data and job market, and also their fellows can fall back on general internal medicine skills if necessary.
In any case, rad onc physician demand has been flat for on the order of a decade now while residency programs continue to expand dramatically. Still, it is overkill to state that rad onc has no future in oncology. For example, our brain metastasis volume continues to increase since most of these systemic agents don't touch the brain. Nevertheless, such limited indication growth is counterbalanced by hypofractionation for our most common indications and declining utilization in many areas (early stage prostate and breast, lymphoma, seminoma, stage III melanoma, etc). The Ben Smith update paper shows this flat demand very clearly, which I will link again on request.
For more analysis of what this means financially, see this post:
Perspective$ in Oncology.
Residency applications are finally starting to catch up to this reality. We are seeing a dramatic decrease in competitiveness due to the declining job market. To answer the op
@PossibleEMapplicant, it's impossible to know which programs are DO friendly at this point. Some programs that probably wouldn't have considered a DO or only exceptional DO candidates five years ago are now willing to take anyone in order to fill their positions. This is rapidly evolving, and it's hard to know how competitive radiation oncology will be over the next few years. Will the decrease this past year be offset by many thinking they were not competitive for rad onc in the past suddenly applying? In five years will positions not even be fillable in the SOAP? It's impossible to know at this point. Every indication is that the job market will continue to decline until residency positions stop filling. As it stands, residencies seem happy to take less competitive residents that they wouldn't have even considered ten years ago. Many are still trying to expand despite failures to fill in the first round of the match in the past two years.
For those of you thinking about rad onc, I would write the following. There are jobs out there, for sure. But, are there 200 quality new full-time positions per year in rad onc? My answer: probably not now, and certainly not for long. The Twitterverse would like to blame us on SDN for "trolling" or "echo chamber", but our graduating residents and junior faculty have been feeling a tight job market for years with severe location restrictions and salary offers far below the big published MGMA salaries and with no clear pathway to achieve desirable salaries, practice opportunities (whatever that means to you: lifestyle, academics, high productivity, etc), and/or locations that were so prevalent a decade ago. Any medical student who rotates through the radiation oncology department where I work will find these things out. If you're looking to practice in the rural midwest and are rotating through midwestern or small city rad onc departments away from coasts, you may not have this experience as a medical student or resident. But if you're in the coastal cities, you will find out quickly about the harsh reality of the radiation oncology job market. Still, I'm watching the coastal city grads chase the jobs into rural areas. So sometime soon all those rural, less desirable, rad onc jobs are going to be gobbled up by the oversupply of residents. Even now, rad oncs have to settle for lower salaries, lower salary potentials, and less desirable lifestyles than many of these less competitive positions used to command. The bargaining power of being a specialist physician has been severely eroded. But it's not as if radiation oncology reimbursements are being slashed--admins and practice owners are just more than happy to take that extra money off your hands for your work, pay you less, and negotiate downwards to the next desperate new grad if you complain. What happens when even the rural jobs are full? In my opinion, this needs to be a huge worry of the leadership of our field before a crisis hits and a large chunk of our graduating residents can't find jobs at all. But, it simply is not being addressed in any way that I would consider meaningful. For someone going into the specialty now, there's just a lot of uncertainty.
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