I guess I can look forward to nothing being done about it
I guess I can look forward to nothing being done about it
No there are the good jobs for boys and girls who networked hard enough!! And you didn’t so now you will be banished to the netherworld to Hypofrac your job into obsolescence while contemplating your own suicide
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deleted1116990
Correct. At any given time, there are also 20 or so malignant solo rural hospital employed radiologist (radiology oncology) jobs put up on Indeed by an in-house recruiter that doesn't know what ASTRO is. Enjoy your phone call with the CEO asking for your case logs of IGRT patients because they treat a lot of IGRT there.
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The evidence will need to be that MORE jobs are not on the ASTRO career boards than they were in the past. At this point given need for academic places to post a job on the internet (even if they have an internal candidate for it) I'd be surprised if it doesn't suggest a higher percentage of jobs are available through the career center.
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deleted1111261
Yes exactly
A lot of these academic centers jobs…the fix is already in especially if it’s in a desirable city…where alot of these criminal excuse me health systems are located.
They need to make the process appear fair but honestly they already know who they want. I won’t name anybody but if someone has an axe to grind and some time on their hands this place’s definitely are not EEOs
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Some big name institutions have to advertise a position to promote someone, i.e. an associate professor position is posted to promote someone from assistant to associate. This is so that the institution can claim that nobody more qualified than their current faculty member could be identified for the position. In this situation, no new job was actually created.
A few other thoughts on using ASTRO jobs data to reflect the job market.
1. Over the years I have applied to maybe two dozen jobs posted on a job site that wasn't ASTRO. I've never heard a thing from any of those. Were they even real? I think it's fine to exclude them from analysis.
2. There are some jobs out there that don't deserve to be filled. There are some vultures circling who will pick the corpses of desperate new grads. It's hard to know which positions these are when they are advertised. I know of a few in my state that I used to moonlight for that have been hiring for years, but the positions mostly stay empty due to low pay, no/fake partnership track, and boomer rad onc work. Anyone who joins lasts for 1-2 years tops before moving on. Just because a job is available does not mean that it deserves to be filled.
3. Supply and demand is real. People will treat you as well as you are difficult to replace. For the health of the job market, there needs to be some slack in the job market that you can't be replaced instantly when you have a complaint. More rad oncs than jobs is completely unhealthy for the physician, the job market, and even for society as all these rad oncs fight with each other to provide quality care (often at odds with admin), see enough patients to make a living, and have no stability within their communities when they are replaced or quit they have to move across country.
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“If medical students know more about the job market than radiation oncologists than shame on us”. 2 million dollar Lou during seminar with simul and kavanaugh
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Knowing a lot of SCAROP members and having worked at a few institutions, I always interpreted this statement to mean
"Rad oncs need to shut up and recruit med students. The med students shouldn't know the truth."
And then SDN showed up...
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deleted1116990
Worse than that. I was in a position that had been vacant for probably 5 years before I showed up. I made the naive mistake of thinking I would be treated well. I was treated like dogsh/t and left. Zero effort or desire by admin to retain. Now, years later, still vacant. Locums easier to control and cost neutral if not cost beneficial ($3k/day locums agency cost * 254 days/year = $762k/year vs. $650k employed salary + 50k benefits/payroll expense + 90k for 30 days PTO locums coverage = 790k/year). It's basic math.
So, you have to look at the locums market as well in determining the health of the field. Most locums markets are not oversupplied like rad onc, which is probably the most bloated and desparate in all of medicine. Med onc locums is paying $5k/day (to the physician, not agency). I'm STILL getting texts advertising rad onc locums for only $1800 (vs. $1600 pre-pandemic/inflation). Total joke.
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Yes these things are all interrelated. Locums market is a disaster since you can always find some boomer post-retirement who is willing to pick up a little extra money. They bid the locums market down to the floor. I have always been open that I have never been offered more than $1500/day for locums, and it's usually $800-$1200/day with $1000/day being most common. I stopped doing locums years ago as a result. Regarding annual salary, in my competitive VHCOL urban market even $650 - $750k/year is big money, and about as high as I can imagine most rad oncs making here outside of chairs or some well established private guys.
In my case, there's a reason why I'm no longer 25th percentile assistant professor 4 lyfe. The job market opened up post-COVID. I got a good job offer in my area and outside non-compete after years of looking and used that plus an NIH grant to negotiate an improvement in my situation here. I wasn't the only one looking... Our department isn't that big, and we lost 7 people in the past 2 years, the vast majority due to dissatisfaction and taking new jobs elsewhere. I would have been #8. Replacing them has not been easy. So guess what? My pay is better now. They also are a lot nicer to me. I actually stopped looking for a new job for the first time in about five years.
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In my circumstance, this has reached outrageous levels regarding the disparity between radonc and medonc. I'm in a nice, coastal location several hours from a major metro area. Nice area but not terribly diverse. Schools are fine but not top achieving.
All the radoncs in the region are very well trained, affable and intelligent. All are pretty good at soft skills with patients. None of them have moved jobs in the last 10 years except for new hires into the area. Nobody is moving out.
Multiple medonc clinics have been running with locums only for a while now. It is prohibitive to get rid of a bad medonc and there are a few. They have freedom to move between jobs/locations within the region without difficulty. They are now being offered much more than radiation oncologists regarding employed salaries. J1 folks easily move to regional cities when their commitment is up. Solid IMG applicants that I interview are getting offers at good centers in major metro areas.
Admin literally hoping that market forces will close down some of the marginal community onc centers and change supply/demand regarding medonc. Guess who will be collateral damage regarding that dynamic?
I know you've not been happy for awhile, so I'm very glad to hear things are turning around!
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Thanks OTN and Simul.
I wouldn't say that I was unhappy. I would have said that I was unhappy with my job and my choice in radiation oncology as a specialty. I've always been happy with my family. I do my best to dissociate my work issues from my patient care and family life. I am from a disadvantaged background and spent time homeless, so my life as an attending has always been magnitudes better than how it was when I was younger.
My current job has turned out well for me now 5+ years into being an attending, but this is mainly because I am very driven, and I work two jobs as an academic clinician and researcher. Additionally, now that the job market has improved a bit, it has given me an opportunity to re-negotiate my position. I have excelled as both a physician and scientist and have a strong reputation in both. This has taken a ton of work and many years to accomplish. I'm not shy that what I have achieved cannot and should not be expected of everyone, and I'm lucky that things worked out for me. I work a lot of hours, and when I walk in the door I rarely have downtime, so you don't see me posting as much on SDN these days.
Things are never ideal. I still have no choice on location. Where I did residency and landed as faculty are not in the cities I would have chosen to live if I could choose freely. My wife had a difficult time here for a few reasons and wanted out badly our first few years here which could have ended our lives together. But, she stuck it out with me and things finally turned around for her after six years here.
So such is rad onc. I tell everyone interested in the specialty that there are jobs, you just need to be ready to live anywhere and do anything within the specialty. You may not get much choice. If I had been a radiologist or a med onc, life would have been easier, I would have had my choice of location, and I almost certainly would have made more money by now. But then again, I love rad onc as a field, and I think I'm uniquely suited for it. You always have to take the good with the bad.
I wouldn't say that I was unhappy. I would have said that I was unhappy with my job and my choice in radiation oncology as a specialty. I've always been happy with my family. I do my best to dissociate my work issues from my patient care and family life. I am from a disadvantaged background and spent time homeless, so my life as an attending has always been magnitudes better than how it was when I was younger.
My current job has turned out well for me now 5+ years into being an attending, but this is mainly because I am very driven, and I work two jobs as an academic clinician and researcher. Additionally, now that the job market has improved a bit, it has given me an opportunity to re-negotiate my position. I have excelled as both a physician and scientist and have a strong reputation in both. This has taken a ton of work and many years to accomplish. I'm not shy that what I have achieved cannot and should not be expected of everyone, and I'm lucky that things worked out for me. I work a lot of hours, and when I walk in the door I rarely have downtime, so you don't see me posting as much on SDN these days.
Things are never ideal. I still have no choice on location. Where I did residency and landed as faculty are not in the cities I would have chosen to live if I could choose freely. My wife had a difficult time here for a few reasons and wanted out badly our first few years here which could have ended our lives together. But, she stuck it out with me and things finally turned around for her after six years here.
So such is rad onc. I tell everyone interested in the specialty that there are jobs, you just need to be ready to live anywhere and do anything within the specialty. You may not get much choice. If I had been a radiologist or a med onc, life would have been easier, I would have had my choice of location, and I almost certainly would have made more money by now. But then again, I love rad onc as a field, and I think I'm uniquely suited for it. You always have to take the good with the bad.
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Will scarop retract their letter to the deans of American medical schools and acknowledge they were lying?
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deleted1116990
Your story is an inspiration to those of us who have been in a pit of suck for the first 5 years of our career. I am glad to know there is a chance things will work out and you can land in a tolerable permanent situation eventually if you keep on trying because I have been starting to wonder...
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Great post. I think there are still applicants out there for whom this is true. Where their intrinsic scientific/clinical interests dovetail with particular radonc academic initiatives and who are willing to move anywhere to pursue those interests.
It will always (well at least for a while) be good for these applicants to apply to and go into radonc. I'm sure there are several of you on this board.
However, for someone with a general interest in oncology/science and a primary commitment to the region they grew up in, I would no longer recommend the field.
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deleted1111261
It takes a while, some times and that’s not just our specialty. The hard part is we can’t easily pick up and move.
I’ve found what makes me most happy in clinical practice, but I didn’t know I even wanted what I have now. Solo practice in a rural area 50 miles from where I grew up sounds like a nightmare for 2009 Simul but is a dream job for me now.
So kudos to Neuronix for taking matters into his own hands. We have to be captains of our own ship - sometimes it means leaping without looking
I’ve found what makes me most happy in clinical practice, but I didn’t know I even wanted what I have now. Solo practice in a rural area 50 miles from where I grew up sounds like a nightmare for 2009 Simul but is a dream job for me now.
So kudos to Neuronix for taking matters into his own hands. We have to be captains of our own ship - sometimes it means leaping without looking
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This is a great story, I hope the range of people see it from med students all the way to potentially unhappy junior faculty in a struggling department, lots of good info for all.
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Resilience is a rare attribute; even rarer when combined with your curiosity and gratitude. Your family, your patients and our discipline is fortunate to have people like you. This post has made my month.
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Congrats Neuronix, you deserve it!
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Math is even worse against permanent docs. In our region, 2 young independent guys undercut CompHealth by charging 2K per day or so
Glad to hear.... I might even consider the lower rate just to put those leeches out of business.
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On one hand, the SDN purgatory
On one hand, the Twitter hellscape
This is tougher than deciding when or when not to irradiate IMNs
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How do you discuss non-equipoise/ty in a 1 arm trial?
Edit:. Maybe there's a historical control arm. I found myself not caring enough to look. And would noninferior mean not >10% worse?
They should present the same survey to men. I haven't married or had kids specifically because of my career. But then again I'm very privileged because I can always do that later.
Unfortunately; I'm finding that as an older male.... I really don't want a woman around anymore. Can we consider that infertility?
Unfortunately; I'm finding that as an older male.... I really don't want a woman around anymore. Can we consider that infertility?
This is depressing and yet totally relatable on some level.
Yes, the separation in degrees being granted by sex is happening, but it is not a good thing.
I would argue we need academic physician leaders to take the lead in helping young men in this country succeed, rather than suggesting their voice has no value.
I would argue we need academic physician leaders to take the lead in helping young men in this country succeed, rather than suggesting their voice has no value.
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“I don't pay them for...... I pay them to leave.”
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deleted1116990
It sounds like the concern is that men and the childless rad oncs end up farther along in their careers because they didn't spend time and effort being a mother. So it's desired to make the outcomes "equitable" for women who want to both have children and be a physician acknowledging the inconvenient truth that doing so requires 10-15 years of training during one's prime childbearing years. That this isn't fair and you should be able to have both without any detriment to either in comparison to their childless rad onc and stay-at-home-mom peers. Or at least try to make it as close as possible. How do you do this? What "systemic changes" can be made? I can think of lots of ways:
- Part time residency. Ability to take a gap year or two. As long as you pass your exams, take as long as you need.
- Higher salary at your first job to account for lost wages/opportunity cost of spending 7 years in residency instead of 5.
- Multiple years PTO given by employers for those that have babies after residency. Coverage provided to fill in the gap.
- More protected research time for academics.
- Ability to do half days until kids are in high school.
- Preference given in hiring/promotion/publication decisions to adjust for family status
- Paid surrogates and nannies for those who want to have children after child-bearing years
I'm not sure who pays for all of the above. But if you wanted to make it truly equitable, where taking time to start a family has no impact on your career trajectory compared to non-mother peers, I guess you'd have to do something like that. I think we have to be clear about what the goal is and what the proposal is to shift resources around in the fixed payment pie to accomplish it (giving these benefits is naturally going to come at the expense of those who did not have children, so the nuance of how that is equitable/fair to both parties is going to have to be explained). Otherwise these publications just seem to exist to do nothing but highlight the fact that it's harder to do the same job while being a mother than it is while not being a mother, which it obviously is and should surprise no one. So why publish it?
The counterargument will be that what I have just written is hyperbole. But surely they are not just talking about support for being pregnant and new mothers at work. Policies protecting them from being fired or otherwise discriminated against? We already have those things. If there is a place out there now that denies women time to pump during the day or objectively discriminates in retaliation for being pregnant, please name it. I simply do not believe that is happening these days, especially in woke and post-MeToo university environments. They are talking about actual equity, not just accommodations like a pumping room or something, and that requires going to the lengths of the above. If you want to equitably account for time being taken away to have children, that time has to be given back somehow.
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Seems like if you care about accommodating women in the specialty, you would care deeply about the residency over expansion and the fact that employers have all the leverage. One of our medoncs has young kids and is allowed to come in to work at 10:00. My hospital would never do that for a radonc.
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RadOnc is likely easier to have shift type schedules and remote access. Of course there needs to be some type of Linac babysitting but shouldn’t be hard to coordinate. We def can do more as a field in general but admin would never have it!
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deleted1116990
Altering the supply and demand favor away from the employer would benefit all rad oncs, not just female rad oncs with children. An equitable solution would require actions that preferentially benefit working mothers to close the systemic biases that are claimed. Unless you are saying that women would benefit to a greater degree from a less competitive labor market, and I could maybe see that, especially if it is true that they are more geographically restricted than say single males. It certainly wouldn't be a bad thing, either way.
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Good luck to those women with young kids who want to live near family for extra help.
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deleted1116990
That was my thought, exactly. I would like to live near my family, but I don't have to. Even if there were a job there (which there is not), if it were exploitative, I would not take it unless there were literally no other option anywhere. That is the upside of not having children, I suppose. Like some other posters above, I have also lost more than one relationship specifically because of my career and job locations. It's a double edged sword.
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On the contrary. We need more warm bodies. If all of these women need accommodations to have and rear children while on PTO, we will need people to generate the revenue that affords them that opportunity.
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Men have children too they just dont have them in their bellies and lets be honest that responsability falls on women often. So yes men have skin in the game and having a more pro family environment benefits ALL.
It is a difficult subject without an easy solution. Is it “fair” for a female resident to be off all the time because she has kids or is pregnant while her coresidents “subsidize” this? Of course not but this is a classic hellpit system where the work falls on the residents instead of institution hiring more people to make up for it. Can a practice/institution make it so people can take more time off and be more
Flexible? I think so but it takes everyone buying into it. Difficult problems require difficult solutions and if all you think is me and how it affects me, then you will not solve the issue.
It is a difficult subject without an easy solution. Is it “fair” for a female resident to be off all the time because she has kids or is pregnant while her coresidents “subsidize” this? Of course not but this is a classic hellpit system where the work falls on the residents instead of institution hiring more people to make up for it. Can a practice/institution make it so people can take more time off and be more
Flexible? I think so but it takes everyone buying into it. Difficult problems require difficult solutions and if all you think is me and how it affects me, then you will not solve the issue.
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deleted1116990
If locums rates are $1800/day, we have the warm bodies.
I will gladly volunteer to travel and cover as much parental PTO as needed for med onc rates of $4000-5000/day.
Seriously, at this point I would make a career out of that. Have a nice home in the place I want to live in and travel every other week to fill in where I'm needed. Win-win.
So yeah, these big institutions can dig into their large TC pool and offer those benefits. They could do it right now if they wanted to pay for it. They could afford it, right? PP extra nasty and anti-female because they can't afford to do the same.
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I advocate for more generous parental leave across the board, for residents and the general employed.
At least 6 months per parent with an expectation that dad takes 6 months as well (maybe (probably) not at the same time). No differentiation in time between maternal and paternal leave. Mom's can have additional medical leave for pregnancy related complications.
No truncation of residency for parental leave. You make that up on the back end.
Would make things much better. Docs should be having kids.
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Amen to that.
We are inching closer and closer to Idiocracy every day. I look forward to voting for President Dwayne Elizondo Mountain Dew Herbert Camacho as a leader of ASTRO in the near future.
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The article, as written, is excessively simplistic, kind of dumb, and honestly makes me wonder if any of the authors, or the person shilling it on Twitter, have kids. (Apparently at least one does, although a very young one). This is spoken as a female primary care physician, with two small children, who is married to a radiation oncologist.
Some of what you have proposed is, frankly, silly, and not the real obstacles to career advancement. Everyone acts like maternity leave is THE REASON that a woman's career stalls as a physician. That's kind of dumb - those 6-12 weeks that you took are not going to derail your career forever. It's everything that comes afterwards that derails your career.
How does someone advance their career in academic medicine? You participate in committees, go to national conferences and meetings, and publish, right?
Except those committee meetings always start at 5:30 or 6. Daycare closes at 6 (and, by the way, keeping your kid at the daycare for the extra half hour between 5:30 and 6 costs an extra $30 a day), and it is an extra $2 for each minute that you are late. So no, I'm not signing up for those committee meetings. I'm not going to tumor board to get the surgeons to know who I am. I'm in the carpool lane trying to get my kids before the daycare bankrupts me (that's as an attending; if you're on a resident salary, then the daycare has already bankrupted you because you have to pay extra to drop the kids off at 7 and to pick them up after 5:30).
I could probably figure out childcare for one big meeting a year, like ASTRO. But if you expect me to go to ASTRO AND a bunch of specialty/disease site specific meetings, then....no. Again, especially not on a resident salary.
Protected research time is hard to come by in any specialty - it's all about RVUs and seeing patients, etc. So when do you write your papers and grants, especially as a young investigator? On the weekends. But who's going to watch your kids on the weekend? If you're lucky, you have a spouse who is capable and willing to do that, but generally speaking, you're going to have to pay a baby sitter to get a few hours of productive work done. And again, if you're an attending, that's ok, but as a resident? Very difficult.
So what are the solutions?
Stop pressuring residents and junior attendings to participate in these kind of extracurriculars. You shouldn't have to participate in a committee to show that you're committed to the institution and therefore worthy of promotion. Or, crazy thought, hold those committee meetings during daytime hours.
Move more committee meetings and maybe national meetings to virtual meetings. I get the social aspect of the meetings, but maybe one big meeting a year is enough?
Hospital-based daycare centers that are affordable AND have extended hours. As a resident, a daycare next to the hospital that opens at 6AM and closes at 8PM would be a godsend, particularly in a surgical specialty. The hospital could subsidize that. Alternatively, subsidies for nannies or au pairs would be something else that might work.
More protected research time, but that's important for other reasons as well. You shouldn't have to sacrifice your weekends to write papers and grants.
I don't think that the solutions have to be crazy to make things more equitable.
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deleted1111261
There is no way someone can be open, honest and nuanced like this on twitter.
The paper will only be congratulated, but there is zero chance of serious anf thoughtful criticism because you’ll be called an -ist or accused of trashing the paper.
Anyway, thank you for that. Same problem for male physicians that like to be parents. My last job had 7a and 5p meetings almost everyday for physician leaders, while of course doing absolutely zero meaningful things to improve WLB
The paper will only be congratulated, but there is zero chance of serious anf thoughtful criticism because you’ll be called an -ist or accused of trashing the paper.
Anyway, thank you for that. Same problem for male physicians that like to be parents. My last job had 7a and 5p meetings almost everyday for physician leaders, while of course doing absolutely zero meaningful things to improve WLB
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Yep, 100% agree - this kind of nonsense needs to end. And I guarantee that about 75% of those meetings (at least) could have been replaced by a well written email.
The old guard of male physicians seem mystified by the idea that dads(!!!) might <gasp> actually want to spend quality time with their kids. It will take both genders to push back before changes get made.
