I have followed this whole thing very closely over the past 5 years or so. There are no avenues available for the specialty to improve the employment prospects of its current/recent grads and those looking for better positions over the next 10 years. Just not going to happen. RRC has publicly declared they are not interested in raising training standards in such a way that would force poor quality programs to close or even from expanding (at least no new ones have been opening lately). So the only forward is for a places to voluntarily reduce their compliment. This may reduce the total number of rad oncs that are trained by about 10 to 20 a year in the most optimistic scenarios. Meanwhile the Emory's and Pittsburg's of the world will continue to soap and chase after bottom tier candidates so they can fill while Columbia increases their resident numbers simply to satisfy the chair's ego.
Employment prospects will continue to dim as the supply of available rad oncs increases while indications and foot print of the specialty trend ever downward. At that's all there is to understand about it. All you can do is see it coming and plan for your exit strategy.
After watching the oversupply naysayers over the last few years cling to the "low unemployment" argument, my concern for the "most likely scenario" is thus:
1) While the height of expansion fever is probably done, I don't see much contraction happening. I think we will likely continue to produce 175-200 new graduates per year
2) As has been demonstrated by data at the ASTRO 2020 meeting, about 100 RadOncs seem to retire/leave the specialty every year. I imagine this number will remain relatively stable
3) Therefore, there will always be SOME level of full-time jobs available to new grads. Because of this, oversupply detractors will continue to point at anecdotes of new grads getting jobs as "proof" that everything is fine
4) Salary will continue to stagnate or decrease (especially when adjusted for inflation)
5) As has been demonstrated by data, we will continue to see a rise in fellowship positions and the number of new grads entering fellowships
6) There will likely be an increase in instructor positions at academic centers (paying $100-$150k per year) as well as non-partner track associate positions at private practices (either full or part time, also at fixed salary with little to no bonus structure). Everyone is aware that this is a seller's market, and institutions/practices are under no obligation to offer the same opportunities to new grads that they once received, especially with continued hypofrac, lower reimbursement, and APM. This will compliment the ongoing academic satellite process where people are hired/paid for "academic" positions but work as community physicians.
7) With the increase in fellowship, instructor, and part-time employed associate positions, unemployment will be unlikely to rise above 5-10%, which the naysayers will point to as an acceptable number
I'm throwing this prediction onto the internet for me to return to in 10 years to see how close I was to reality.
