Rad-Onc programs DO friendly?

[PossibleEMapplicant]

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Just a lost soul of a 3rd year medical student here. Are their any Rad-Onc programs that are DO friendly? And to all you working and lurking the forums, do any of you wish you went into heme/onc?

 

[hockyfan]

off-hand, I know wayne state, FCCC, Jefferson, Cincinnati, Cleveland Clinic - I'm sure others.. although I'd say Midwest overall is more DO-friendly than the coasts

 

[medgator]

The entire specialty is probably more DO friendly at this point... Having nearly 30 unfilled spots in the last match and a tightening job market will do that to you.

DO > IMG is my guess and both groups will make up a bigger chunk of applications until the specialty addresses its existential issues and rampant residency slot expansion the last decade

 

[deleted941485]

Just a lost soul of a 3rd year medical student here. Are their any Rad-Onc programs that are DO friendly? And to all you working and lurking the forums, do any of you wish you went into heme/onc?

Dude it’s a free for all for interested Med students MD or DO. RO isn’t competitive anymore. DOs have a legit shot at good programs. PDs used to turn their noses up at people with DOs and sub 240 step 1 scores are now basically looking for warm bodies to do their work.

They don’t care if you didn’t learn anything or if you ever pass your boards. Just that you decided to spend four years of doing consults and drawing circles so they can press plan approved and suck up more CMS money.

 

[GapCalc]

For whatever it's worth, my program is getting >30% DO rotator applications this year, and we've never matched a DO. We're near a coast. Things are opening up!

Do I wish I did med onc? Hmm. I like the day-to-day of rad onc more than med onc, but I don't like not having an option to live in my preferred state. We'll see how things go in the next 1-2 years.

 

[deleted941485]

Just a lost soul of a 3rd year medical student here. Are their any Rad-Onc programs that are DO friendly? And to all you working and lurking the forums, do any of you wish you went into heme/onc?

Wish I did heme onc. More interesting scientific developments and far superior job opportunities. Crack open an NEJM article sometime look whose really moving it forward.

 

[scarbrtj]

And to all you working and lurking the forums, do any of you wish you went into heme/onc?

Just make sure you know what you're getting into. As an example...

In 2015, a randomized trial of about 500 patients appeared testing consolidation RT in extensive stage small cell. The trial was positive:
2y OS 13% vs 3%, p=0.004. Progression free survival @6mos 24% vs 7%, p=0.001.
Conclusion: "Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy."

Last year, a randomized trial (IMpower133) of about 400 patients appeared testing atezolizumab (Tecentriq) in extensive stage small cell. The trial was positive:
Median OS 12 mos vs 10 mos, p=0.007. Median progression free survival 5 mos vs 4 mos, p=0.02.
Conclusion: "The addition of atezolizumab to chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer resulted in significantly longer overall survival and progression-free survival than chemotherapy alone."

Just look at the conclusions and their wording to understand the first hint of the problem. Today, thoracic RT in ES-SCLC is not that commonly practiced; mostly because the med oncs don't refer them! Even if I were to urge for it on this forum, amongst radiation oncologists, I would receive lackluster support. "That is not really the standard." "Be careful, there are drawbacks." It is not a category 1 NCCN recommendation. It is simply to be "considered."

But almost immediately upon publication of IMPower 133, Tecentriq became standard of care in ES-SCLC. (And this single drug will make more for its company in one year than is spent upon the entirety of radiation oncology for all treatments in one year.) It's a category 1 now about 4 months after publication and was just FDA approved last month!

Like I said. Just be aware. "Woke." And then stick with your choice.

 

[Haybrant]

Long time lurker. This is my situation and obviously not the norm, so take this as you will. I am 1 month away from graduation with no job so I will be doing locums. Failed the biology boards so I have been studying frantically over the last 6 months for something that I will never use in my life. Spouse filed for divorce 3 weeks ago (likely unrelated to my career choice...but not entirely). Do I wish I did Heme/Onc? Selling hotdogs in LA looks pretty awesome right now, so I can't really give you an unbiased answer.

This sucks man, when the chairs and PDs that come here to laugh at SDN They should keep an open mind about what they have sown. They’ll follow Wallner to the depths apparently especially kachnic, these stories are the casualties of that.

 

[Palex80]

Just make sure you know what you're getting into. As an example...

In 2015, a randomized trial of about 500 patients appeared testing consolidation RT in extensive stage small cell. The trial was positive:
2y OS 13% vs 3%, p=0.004. Progression free survival @6mos 24% vs 7%, p=0.001.
Conclusion: "Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy."

Last year, a randomized trial (IMpower133) of about 400 patients appeared testing atezolizumab (Tecentriq) in extensive stage small cell. The trial was positive:
Median OS 12 mos vs 10 mos, p=0.007. Median progression free survival 5 mos vs 4 mos, p=0.02.
Conclusion: "The addition of atezolizumab to chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer resulted in significantly longer overall survival and progression-free survival than chemotherapy alone."

Just look at the conclusions and their wording to understand the first hint of the problem. Today, thoracic RT in ES-SCLC is not that commonly practiced; mostly because the med oncs don't refer them! Even if I were to urge for it on this forum, amongst radiation oncologists, I would receive lackluster support. "That is not really the standard." "Be careful, there are drawbacks." It is not a category 1 NCCN recommendation. It is simply to be "considered."

But almost immediately upon publication of IMPower 133, Tecentriq became standard of care in ES-SCLC. (And this single drug will make more for its company in one year than is spent upon the entirety of radiation oncology for all treatments in one year.) It's a category 1 now about 4 months after publication and was just FDA approved last month!

Like I said. Just be aware. "Woke." And then stick with your choice.

Well... That's not entirely accurate scarbrtj...

CREST was actually NEGATIVE for its primary endpoint, which was 1-year-OS.
At 1 year OS was 33% for CT+RT vs. 25% vor CT alone and that was not a statistical significant difference

The 2-year endpoint is nice, but it was not the endpoint of the trial.
And the observation at 2 years was based on 19 (!) evaluable patients left. 14 with CT+RT and 5 with CT only.

🙂

Do I practice consolidation thoracic RT for ED-SCLC-patients? I do. Mostly on
a) "favorable" prognosis patients (by common sense) which to me means no extensive liver disease at baseline and
b) patients with substantial residual disease in the thorax after CT. It seems that they may profit a bit more according to the (underpowered) subgroup analysis of the CREST trial.

 

[medgator]

Do I practice consolidation thoracic RT for ED-SCLC-patients? I do. .

You can only practice appropriate medicine on the patients who were appropriately referred to you. Sometimes, I'll get LS referrals directly from pulm, but less so in ES since it's chemo upfront. So essentially you're hoping MO understands the benefit in ES pts as well as you do 😉

MOs that are more recently trained will send me those pts for evaluation, but old school ones won't in my experience

 

[scarbrtj]

Well... That's not entirely accurate scarbrtj...

CREST was actually NEGATIVE for its primary endpoint, which was 1-year-OS.
At 1 year OS was 33% for CT+RT vs. 25% vor CT alone and that was not a statistical significant difference

The 2-year endpoint is nice, but it was not the endpoint of the trial.
And the observation at 2 years was based on 19 (!) evaluable patients left. 14 with CT+RT and 5 with CT only.

🙂

Do I practice consolidation thoracic RT for ED-SCLC-patients? I do. Mostly on
a) "favorable" prognosis patients (by common sense) which to me means no extensive liver disease at baseline and
b) patients with substantial residual disease in the thorax after CT. It seems that they may profit a bit more according to the (underpowered) subgroup analysis of the CREST trial.

"Even if I were to urge for it on this forum, amongst radiation oncologists, I would receive lackluster support." I don't need to make any points if y'all make 'em for me.

"The 2-year endpoint [for thoracic RT] is nice, but it was not the endpoint of the trial. And the observation at 2 years was based on 19 (!) evaluable patients left. 14 with CT+RT and 5 with CT only." And in IMpower133 we don't even have data at 2 years. Heck at 18 months, there are about 8 (!!!) patients followed out that long thus far.

"What if they had a priori set a 2y OS endpoint in the thoracic RT ES-SCLC trial?"
"But they didn't."
"But what if they had done that before the trial started?"
"Well then they would have met their endpoint I guess. But they didn't set it that way, and didn't meet what they set. Thus, the results take on an entirely different flavor because of this even though the arbitrary pre-trial endpoint setting, which totally vary from trial to trial, wouldn't have changed the raw results one iota."

Number of rad oncs poo-pooing (or damning by faint praise) thoracic RT for ES-SCLC, >0. Number of med oncs poo-pooing Tecentriq, = 0.

EDIT:
(Theoretically those two lines, the cyan and the light grey, are the same patient population subsets. Theoretically. So even getting considered for immunotherapy but not receiving it improves survival dramatically! This immunotx is powerful stuff.)

 

[RadOncDoc21]

You can only practice appropriate medicine on the patients who were appropriately referred to you. Sometimes, I'll get LS referrals directly from pulm, but less so in ES since it's chemo upfront. So essentially you're hoping MO understands the benefit in ES pts as well as you do 😉

MOs that are more recently trained will send me those pts for evaluation, but old school ones won't in my experience

My experience as well. The new surgeons, med oncs are more willing to discuss treatment options vs. practicing without any input. The old school ones just give the chemo, do surgery and only refer to me when there are no other available options left. Hopefully in time, there will be a change in referral patterns so there may be a silver lining once these docs retire.

 

[scarbrtj]

This sucks man, when the chairs and PDs that come here to laugh at SDN They should keep an open mind about what they have sown. They’ll follow Wallner to the depths apparently especially kachnic, these stories are the casualties of that.

Wallner, DO

 

[scarbrtj]

My experience as well. The new surgeons, med oncs are more willing to discuss treatment options vs. practicing without any input. The old school ones just give the chemo, do surgery and only refer to me when there are no other available options left. Hopefully in time, there will be a change in referral patterns so there may be a silver lining once these docs retire.

Neglected to mention above, but the Tecentriq data and trial, and what with Tecentriq being now the "true standard" (above thoracic XRT), radiation oncologists should be out of the front line ES-SCLC business anyways. So it's all water under bridge. (And the Tecentriq trialists should be castigated mightily for not making the control arm chemo/XRT; don't hold breath for rad oncs to do this.)

 

[thecarbonionangle]

Long time lurker. This is my situation and obviously not the norm, so take this as you will. I am 1 month away from graduation with no job so I will be doing locums. Failed the biology boards so I have been studying frantically over the last 6 months for something that I will never use in my life. Spouse filed for divorce 3 weeks ago (likely unrelated to my career choice...but not entirely). Do I wish I did Heme/Onc? Selling hotdogs in LA looks pretty awesome right now, so I can't really give you an unbiased answer.

Seeious or trolling? I cannot imagine what that is like. I’m so sorry man. Hope you see light soon.

If you don’t mind sharing a few more details: are you unemployed because you are very geographically restricted or did you apply for jobs pretty broadly? (Rural wisconsin broad). There have been multiple job postings in ASTRO board recently. Check it out!

Sorry about the wife. Hopefully you can compartmentalize and focus on rad bio. Gotta know that Taqman to be “minimally competent” you know.

 

[thecarbonionangle]

"Even if I were to urge for it on this forum, amongst radiation oncologists, I would receive lackluster support." I don't need to make any points if y'all make 'em for me.

"The 2-year endpoint [for thoracic RT] is nice, but it was not the endpoint of the trial. And the observation at 2 years was based on 19 (!) evaluable patients left. 14 with CT+RT and 5 with CT only." And in IMpower133 we don't even have data at 2 years. Heck at 18 months, there are about 8 (!!!) patients followed out that long thus far.

"What if they had a priori set a 2y OS endpoint in the thoracic RT ES-SCLC trial?"
"But they didn't."
"But what if they had done that before the trial started?"
"Well then they would have met their endpoint I guess. But they didn't set it that way, and didn't meet what they set. Thus, the results take on an entirely different flavor because of this even though the arbitrary pre-trial endpoint setting, which totally vary from trial to trial, wouldn't have changed the raw results one iota."

Number of rad oncs poo-pooing (or damning by faint praise) thoracic RT for ES-SCLC, >0. Number of med oncs poo-pooing Tecentriq, = 0.

EDIT:
(Theoretically those two lines, the cyan and the light grey, are the same patient population subsets. Theoretically. So even getting considered for immunotherapy but not receiving it improves survival dramatically! This immunotx is powerful stuff.)
View attachment 260875

Hilarious. Only in rad onc!

 

[evilbooyaa]

"Even if I were to urge for it on this forum, amongst radiation oncologists, I would receive lackluster support." I don't need to make any points if y'all make 'em for me.

"The 2-year endpoint [for thoracic RT] is nice, but it was not the endpoint of the trial. And the observation at 2 years was based on 19 (!) evaluable patients left. 14 with CT+RT and 5 with CT only." And in IMpower133 we don't even have data at 2 years. Heck at 18 months, there are about 8 (!!!) patients followed out that long thus far.

"What if they had a priori set a 2y OS endpoint in the thoracic RT ES-SCLC trial?"
"But they didn't."
"But what if they had done that before the trial started?"
"Well then they would have met their endpoint I guess. But they didn't set it that way, and didn't meet what they set. Thus, the results take on an entirely different flavor because of this even though the arbitrary pre-trial endpoint setting, which totally vary from trial to trial, wouldn't have changed the raw results one iota."

Number of rad oncs poo-pooing (or damning by faint praise) thoracic RT for ES-SCLC, >0. Number of med oncs poo-pooing Tecentriq, = 0.

EDIT:
(Theoretically those two lines, the cyan and the light grey, are the same patient population subsets. Theoretically. So even getting considered for immunotherapy but not receiving it improves survival dramatically! This immunotx is powerful stuff.)
View attachment 260875

I know we've argued about statistics in other threads, but just want you to know that I whole heartedly agree with you on this. Don't give 2 craps on the primary endpoint not being positive if it gives us a clinically relevant endpoint that is improved with RT.

However, because the trial is officialy a 'negative' trial I'm not surprised it wasn't included in the control arm. I feel like we see a decent amount of Thoracic consolidation for ES-SCLC but obviously I don't know the denominator. Would prefer it for the 'more favorable' ES-SCLC prognosis patients, personally.

 

[Palex80]

I stand by what I said.
CREST was designed to detect a 10% survival benefit at 1 year. The investigators assumed a 27% OS at 1 year with standard of care and 37% with the addition to RT (10% benefit). Were they to achieve that, the trial would have been positive. They didn't. Survival was 28% without and 33% with RT. They predicted 1 year survival with standard of care pretty accurate (congratulations for that), but the benefit with RT was smaller than assumed.

The difference at 2-years survival is based on data coming from 19 patients.
CREST could not have been designed with a 2-years-endpoint, because noone knows what survival will look at 2 years, it's too hard to predict since so few patients live that long (and crest proved that too: these 19 patients represent 4% of the entire study population; the other 96% were either dead or censored by then).

The Tecentriq trial had another primary endpoint and reached it with a positive result. That's it.

And of course big pharma has the money to fund big trials. But we cannot measure the results our trials with other levels of scientific evidence, simply because we don't have the money. That's life.

 

[scarbrtj]

I know we've argued about statistics in other threads, but just want you to know that I whole heartedly agree with you on this. Don't give 2 craps on the primary endpoint not being positive if it gives us a clinically relevant endpoint that is improved with RT.

However, because the trial is officialy a 'negative' trial I'm not surprised it wasn't included in the control arm. I feel like we see a decent amount of Thoracic consolidation for ES-SCLC but obviously I don't know the denominator. Would prefer it for the 'more favorable' ES-SCLC prognosis patients, personally.

I stand by what I said.
CREST was designed to detect a 10% survival benefit at 1 year. The investigators assumed a 27% OS at 1 year with standard of care and 37% with the addition to RT (10% benefit). Were they to achieve that, the trial would have been positive. They didn't. Survival was 28% without and 33% with RT. They predicted 1 year survival with standard of care pretty accurate (congratulations for that), but the benefit with RT was smaller than assumed.

The difference at 2-years survival is based on data coming from 19 patients.
CREST could not have been designed with a 2-years-endpoint, because noone knows what survival will look at 2 years, it's too hard to predict since so few patients live that long (and crest proved that too: these 19 patients represent 4% of the entire study population; the other 96% were either dead or censored by then).

The Tecentriq trial had another primary endpoint and reached it with a positive result. That's it.

And of course big pharma has the money to fund big trials. But we cannot measure the results our trials with other levels of scientific evidence, simply because we don't have the money. That's life.

And as Paul Harvey would say...
In one trial, thoracic RT improved survival (p=0.04).
In another trial, it also improved survival (p=0.06).

And in another trial, thoracic RT harmed survival (p=0.21).

Thank Minerva for Tecentriq.

 

[RadOncG]

If you want to work with colleagues that debate about thoracic radiation in small cell lung cancer when the question is about DO friendly residency programs go for it.

 

[medgator]

If you want to work with colleagues that debate about thoracic radiation in small cell lung cancer when the question is about DO friendly residency programs go for it.

Fair point, but it provided a great example of the mentality present that is to the detriment of our field

 

[RadOncDoc21]

Don’t all arguments in life eventually lead back to discussing the role for consolidative thoracic radiation for extensive stage small cell lung cancer?

 

[Palex80]

And as Paul Harvey would say...
In one trial, thoracic RT improved survival (p=0.04).
In another trial, it also improved survival (p=0.06).

And in another trial, thoracic RT harmed survival (p=0.21).

Thank Minerva for Tecentriq.

You are comparing apples with oranges here.

Jeremic was not simple "thoracic RT" in an unselected patient collective. It was concurrent chemo-RT with currative doses in highly selected patients with complete remission at metastatic sites and good response in the primary site. Highly aggresive treatment in (perhaps) the best patients with ED-SCLC.

Slotman was thoracic RT with a palliative dose in unselected patients with ED-SCLC ("any response").

And the RTOG-trial was a) underpowered since stopped early b) treated all disease.

These 3 trials share only one common thing: they investigated radiation therapy in ED-SCLC. That's all.

 

[scarbrtj]

Fair point, but it provided a great example of the mentality present that is to the detriment of our field

For the benefit of the OP, our specialty's speciality: reductio ad absurdum.

 

[evilbooyaa]

If you want to work with colleagues that debate about thoracic radiation in small cell lung cancer when the question is about DO friendly residency programs go for it.

Fair point, and I'm guilty of it as well.

Let's try to get back on topic folks. People espousing value of thoracic RT are welcome to start a new thread on the matter or take it to PMs.

off-hand, I know wayne state, FCCC, Jefferson, Cincinnati, Cleveland Clinic - I'm sure others.. although I'd say Midwest overall is more DO-friendly than the coasts

On top of this,
Pitt, Allegheny General, Georgetown, NY Presbyterian,

 

[radoncradonc]

It is clear where the future of oncology is heading

 

[scarbrtj]

There will always be a role for radiation in oncology.
There will always be a role for IV ethanol in preterm labor.
There will always be a role for hirudotherapy in tissue grafting.

 

[medgator]

View attachment 261414

It is clear where the future of oncology is heading

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

 

[Neuronix]

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.

 

[scarbrtj]

But, are there 200 quality new full-time positions per year in rad onc? My answer: probably not now, and certainly not for long.

200 *new* jobs a year in rad onc??? What were people thinking.

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.

It's not unlike the mafia's business model. What does that make the modern rad onc? Davey Scatino?

Parting random thoughts...
"The best tolerated form of radiotherapy is no radiotherapy."
"I prefer the machine-drawn contour."
"In China they are working on 'washing machine' radiation, 4 buttons will do the treatment with a remote doctor... one doctor, 70 clinics, 70 million people."
EDIT: "Single ten-minute shot of radiation can save prostate cancer patients misery of weeks of gruelling treatment, study finds."

 

[Haybrant]

The latest is leadership feels the unfilled spots are a one time blip. They’re about to really wake up next year, 27 unfilled is nothing. There simply are not 200 jobs a year to fill in the country, not even 150. This year 27 unfilled, next year 50. So feel free to apply DO’s, this is among the easiest fields in medicine to get into now

 

[radoncul prime]

Dude it’s a free for all for interested Med students MD or DO. RO isn’t competitive anymore. DOs have a legit shot at good programs. PDs used to turn their noses up at people with DOs and sub 240 step 1 scores are now basically looking for warm bodies to do their work.

They don’t care if you didn’t learn anything or if you ever pass your boards. Just that you decided to spend four years of doing consults and drawing circles so they can press plan approved and suck up more CMS money.

This is 100% my PD and the tenured folks at my program.

 

[Lamount]

If DOs now "stand a shot" in radiation oncology, maybe that isn't such a bad thing after all. MCATs and college grades don't always translate into clinical and emotional competence... in fact, it wouldn't surprise me if the opposite is true in some cases. The hardest working residents are those who are grateful for the opportunity, not those who feel entitled to have it easy because they cracked 250 on step I. I worked with some amazing DOs and FMGs during my internship and would feel no apprehension about referring my patients to them over a top ten grad, AOA+/step 1 270 etc... Elitism is its own punishment. Maybe now we will be rewarded by getting work with some talented, invested, compassionate residents with different perspectives and experiences who fought tooth and nail for a spot they never dreamed they could get.

 

[evilbooyaa]

If DOs now "stand a shot" in radiation oncology, maybe that isn't such a bad thing after all. MCATs and college grades don't always translate into clinical and emotional competence... in fact, it wouldn't surprise me if the opposite is true in some cases. The hardest working residents are those who are grateful for the opportunity, not those who feel entitled to have it easy because they cracked 250 on step I. I worked with some amazing DOs and FMGs during my internship and would feel no apprehension about referring my patients to them over a top ten grad, AOA+/step 1 270 etc... Elitism is its own punishment. Maybe now we will be rewarded by getting work with some talented, invested, compassionate residents with different perspectives and experiences who fought tooth and nail for a spot they never dreamed they could get.

I do whole heartedly agree that I would much rather have somebody who was interested in Rad Onc during medical school and is a DO and/or doesn't have the strongest stats (ideally no failures on the board exams though) rather than somebody who tried to match derm/ortho/ophtho/other competitive specialty and fell into rad onc as a back-up.

But the reality is that the 'competitiveness' of rad onc likely just took a nose dive. I imagine there will be minimal unfilled spots next year as it becomes known to DOs and IMGs that this field is no longer competitive and programs will be forced to interview and rank them to ensure that they match any warm body to their program.

 

[thecarbonionangle]

Many people in “leadership” now got into rad onc when it was much easier. We have a DO running our boards lecturing people on declining resident quality and being dumb. the pendulum swinging back doesn’t necessarily mean we get better people. Sure some entitled derm person is not my choice for a rad onc but neither is someone with a language barrier in a field where communication means so much. We need to attract better people, whoever they are, to join the field to be compassionate, do the right thing for our specialty, and not ride us off the abyss. Currently we have a leadership crisis in the field which can be summarized by some outright denial, blaming/fingerpointing, calling people “mianthropes”, “insane” and “echochamber”. The recent joke article in red journal paints a bad picture.

 

[thecarbonionangle]

This is 100% my PD and the tenured folks at my program.

Sums up a significant portion of academia. It all comes down to the warmth of the body.

 

[deleted941485]

I do whole heartedly agree that I would much rather have somebody who was interested in Rad Onc during medical school and is a DO and/or doesn't have the strongest stats (ideally no failures on the board exams though) rather than somebody who tried to match derm/ortho/ophtho/other competitive specialty and fell into rad onc as a back-up.

But the reality is that the 'competitiveness' of rad onc likely just took a nose dive. I imagine there will be minimal unfilled spots next year as it becomes known to DOs and IMGs that this field is no longer competitive and programs will be forced to interview and rank them to ensure that they match any warm body to their program.

I have it on good authority that candidates with <220 board scores were not only given serious consideration but also matched. This was unthinkable even 1 year ago.

The fascinating thing is that we still have Med student lemmings rotating in our Dept. That are happy is not competitive.

 

[deleted950463]

Paul wallner, DO

 

[eggeggeggegg]

The latest is leadership feels the unfilled spots are a one time blip. They’re about to really wake up next year, 27 unfilled is nothing. There simply are not 200 jobs a year to fill in the country, not even 150. This year 27 unfilled, next year 50. So feel free to apply DO’s, this is among the easiest fields in medicine to get into now

If this is true, won't students initially turned away form the competitiveness (eg. DOs, lower step scores etc) enter the field and take up those unfilled spots? Regardless of job opportunities, if that happens, it'll actually look like a one time blip.

 

[Haybrant]

If this is true, won't students initially turned away form the competitiveness (eg. DOs, lower step scores etc) enter the field and take up those unfilled spots? Regardless of job opportunities, if that happens, it'll actually look like a one time blip.

Their intent isn’t to just fill spots as many here will have you believe. They do want the best candidates and they have easily gotten that in the past. But not anymore. Med students aren’t dumb

 

[evilbooyaa]

If this is true, won't students initially turned away form the competitiveness (eg. DOs, lower step scores etc) enter the field and take up those unfilled spots? Regardless of job opportunities, if that happens, it'll actually look like a one time blip.

You're right but it's a balancing act. I think at least 5 or 6 spots didn't fill after SOAP, indicating that the chairs would rather a spot go unfilled than fill it with somebody they deem below the level of 'competitive' for whatever reason (DO, lower step score, etc.).

Some of the initial numbers will be buoyed with the news getting out that Rad Onc is no longer competitive if you're OK with a spot anywhere in the country. I don't think the number will be 27 unfilled or whatever again this match cycle, I think it'll be lower as programs lower the barrier for entry.

 

[xrthopeful]

I’m really interested to see what happens this year. Is there a google doc this year btw? Anyone know?

ENT actually had more spots than applicants in 2017, see this thread:

Attention Medical Students...

Now seems to be a good time for you to apply to ENT... Not surprisingly, forcing applicants to our specialty to waste hours of their time writing 50+ "unique" essays on why they want to apply to each program has led to a large drop in the number of applicants since 2014 and more than 10...

forums.studentdoctor.net

 

[evilbooyaa]

Not aware of a new google doc, and based on the factually incorrect IJROBP article calling it the 'SDN spreadsheet' when it had bad, bad things in it that SDN does not agree with but was outside the scope of our moderation for the past 2 years, we will not be stickying the thread that links to it or 'promoting' it in anyway on SDN.

Maybe whoever creates it can post it on ROHub and academicians can call it 'the ROHub spreadsheet' in future publications.

 

[Krukenberg]

Not aware of a new google doc, and based on the factually incorrect IJROBP article calling it the 'SDN spreadsheet' when it had bad, bad things in it that SDN does not agree with but was outside the scope of our moderation for the past 2 years, we will not be stickying the thread that links to it or 'promoting' it in anyway on SDN.

Maybe whoever creates it can post it on ROHub and academicians can call it 'the ROHub spreadsheet' in future publications.

Can we encourage applicants to go back to the system we had of interview impressions being a forum thread? The “reviews” of programs on the spreadsheet are so easily manipulated that I think it’s unfair to applicants and programs. When we had threads, the reviews were more systematic and comprehensive. Now it’s maybe a sentence or two summarizing an entire program. Also, 95% of the “data” on the spreadsheet is completely meaningless

 

[evilbooyaa]

Can we encourage applicants to go back to the system we had of interview impressions being a forum thread? The “reviews” of programs on the spreadsheet are so easily manipulated that I think it’s unfair to applicants and programs. When we had threads, the reviews were more systematic and comprehensive. Now it’s maybe a sentence or two summarizing an entire program. Also, 95% of the “data” on the spreadsheet is completely meaningless

I am happy, as always, to revive the interview impressions thread. If people have feedback they wish to be anonymous about any program, at any stage of training, I am happy to post that review, unedited (within reason), for SDN viewership. I have offered this ever since I became mod and have had unfortunately no takers.

The google doc seemed to have been started primarily to have an anonymous (to SDN even) chat about things before it evolved.