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Yes, given state of field, and huge knowledge assymetry, incessant zealous Outreach can be construed as an attempt to get medstudents to act against their own interests. Instead, you should make the field desirable and rewarding for those whose representation you seek to increase, not try to sell them a ticket on the titanic.
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One thing I am surprised has not been done is for someone to manually go through the last 4 years of graduating residents and account for their job status. Looking up ~800 people on google is definitely a grind, but every person should have been accounted for in the ARRO directory and I'm sure you could get some med student sitting home on quarantine to do it. In modern times, its probably pretty feasible to tell if a person has a job or not by an internet search.
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deleted774703
I’m sure it’s 100%
That doesn’t indicate good job market though
Taking a nonappealing job is always going to be better than homelessness
Problem is there are fewer appealing jobs remaining...
This is what radonc twitter doesn’t understand smh
The thing against FMGs and people who didn't have enough publications/letters from famous people isn't just isolated to radonc. In other fields when there aren't enough US MD applicants, they simply fill with FMGs / IMGs and USMDs with fewer objective achievements to go by, and don't even say much about it (no discussion on twitter). Like radiology back in 2014-2016. There are good radiology programs out there where almost the entire pgy5 class is from Caribbean schools. Now the incoming /junior class are entirely US MD. Or back in 2014-2016ish anesthesia had plenty of good spots for an unmatched ortho ent derm uro to soap into, no problem. Now there's only soap spots at crash and burn anesthesia programs, and those are limited in picking. Mediocre OB programs used to fill with IMG/FMGs 5 years ago. Now thanks to the rampant expansion of US med schools/class sizes, those ob programs now fill entirely with US MD's, sometimes from very pedigreed schools. Similar deal for psych. Its just natural for when a field has an issue (job market concerns-radiology anesthesia, or for OB horrendous hours and malignant personalities), US MD's will not choose it as their first choice, and FMGs/IMGs who've been trying for it for many years + the ortho ent derm uro rejects who are said to have extremely strong resumes, just not in the field they are soaping into now have their chance.
The long discussion about diversity may even detract from the true point about how radonc needs to contract, and contract hard now. A waste of taxpayer funded GME funding when there are plenty of other true shortage fields like uro ent psych IR that could use those funds and plenty of US MDs going unmatched. those acgme case log requirements for radonc are dismally low compared to gen surg /surgical subs (discussed here before) and even diagnostic radiology.
The long discussion about diversity may even detract from the true point about how radonc needs to contract, and contract hard now. A waste of taxpayer funded GME funding when there are plenty of other true shortage fields like uro ent psych IR that could use those funds and plenty of US MDs going unmatched. those acgme case log requirements for radonc are dismally low compared to gen surg /surgical subs (discussed here before) and even diagnostic radiology.
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deleted774703
What additional knowledge will we gain from this analysis?
1st of all we have no benchmark study to compare against
2nd we know ppl will just say oh they got a job it’s all good
3rd they will also say we should be filling rural spots anyways (these ppl always happen to live in NYC or LA btw)
I think it would be useful. You could tell what percent are going into academics, the geographic distribution of jobs, size of practices they are going into, etc. It wouldn't solve any of the problems but some data is better than no data.
It may be a zero percent unemployment rate the last 4 years. It may not. If it's 5% or so IMHO that's unacceptable. But right now we're all conjecturing for the most part. I have seen data where it suggests we've produced more rad oncs per year than graduates (impossible right?)... and also seen data that we are producing more graduates than practicing rad oncs per year. It's a moving target if you try and drill down.
We're talking about a national group of about 200 people a year. Even single digit/individual human experiences can have ripples across the entire country given the tininess of such a group. The last thorough employment data for a class of which I'm aware was 2014:
167 graduates, 101 (60.5%) responded to the survey.
97 sought employment, 4 sought fellowship
90/97 were successful; 5 of the 7 unsuccessful entered fellowship, 2 unemployed
The 97 employment seekers received average of 2 job offers, 30% received 1 or fewer
3 of 66 non-respondents confirmed unemployed
Sixty-five (out of 101) (67.0%) felt the job market was more challenging than expected
Thirty (30.9%) found no job openings to apply to in their geographic area of preference
23 (23.7%) found no job openings to apply to in cities of their preferred population.
TOTAL UNEMPLOYMENT RATE in 2014: ~5/167 (3%)
TOTAL UNDEREMPLOYMENT* RATE: 5/167 to 9/167 (3% to 5%)
TOTAL UN/UNDEREMPLOYMENT RATE 2014: ~8%
I define underemployment as intentional or unintentional seeking of fellowship after residency. Many fellows wind up not doing what they fellowshipped in, and fellowship increases have correlated with poor job markets in past. Fellowship numbers are increasing in rad onc but the last data I have on that was about 2017.
So I ask: if poor employment rate was around 8% in 2014, what do we think it is today? Unemployment was at least 3% in 2014. Mortality rate from COVID is lower than 3% and we've seen how people have responded to that risk rate; what we are seeing is medical students rightfully socially distance from rad onc.
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Thank you for bringing attention to this study. This is precisely the point. This study should be repeated today to see where we stand 6-7 years later.
Thank you Scarbrtj.
Probably need some PPE around it also given recent developments pre covid
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deleted774703
We already know there are more going into academics mainly b/c academics are expanding into communities
The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study - PubMed
Since 2012, race and gender gaps narrowed, but geographic disparities persisted, with ROs gravitating toward resource-rich suburban and urban locations over rural practices. The workforce has shifted from predominantly private practice to more equal balance with academic/university systems...
www.ncbi.nlm.nih.gov
The Employment Experience of Recent Graduates From US Radiation Oncology Training Programs: The Practice Entry Survey Results From 2012 to 2017 - PubMed
These data can help gauge the competitiveness of an offer as well as what to expect during the job hunt and interview process.
www.ncbi.nlm.nih.gov
This is all literally hand wringing. RO love data more than action, smh
Yup... I mean you literally have these two tweets nearly the same day....
KO thinks residency expansion is just an "assumption"
This guy wants data on breadlines published before he'll believe anything
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Not sure how else to interpret that
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deleted774703
That sounds like fake news
Rumors though that new MDACC hires this year have had their contracts revoked
I've heard of at least 2 contracts were delayed/deferred, essentially they will have find employment for a year (?), Of course i doubt mdacc actually gave them a date of 7/1/2021 but as they say... We shall see about that
If verified, would that count as objective data, or just an anecdote?
Depends on who's looking at situation
both, by definition of the words.
we are soon going to be within “cigarettes have never conclusively been proven to cause cancer” territory.
The objective data is the price to buy into Rad Onc.
if supply expands as demand diminishes, the price goes down. Duh. Currently, the price to enter rad onc is “a pulse”.
When Russia and Saudi Arabia flooded the market with crude during a global pandemic that severely diminished oil demand, did we request studies on the market or do we see the price is 99 cents per gallon and instantly realize something is amiss?
pull your thumb out your ass and stop playing dumb. It’s not cute or funny.
if supply expands as demand diminishes, the price goes down. Duh. Currently, the price to enter rad onc is “a pulse”.
When Russia and Saudi Arabia flooded the market with crude during a global pandemic that severely diminished oil demand, did we request studies on the market or do we see the price is 99 cents per gallon and instantly realize something is amiss?
pull your thumb out your ass and stop playing dumb. It’s not cute or funny.
Canaries in a Coal Mine
I recently attended the Annual UCSF Rad Onc course. One of the featured speakers was Anthony Zietman. Dr. Zietman has always been a highly engaging speaker and his topic was particularly timely - "the future of RO as a specialty." Many, many interesting points came out of this talk: 1. He...
forums.studentdoctor.net
Canaries in a Coal Mine
I recently attended the Annual UCSF Rad Onc course. One of the featured speakers was Anthony Zietman. Dr. Zietman has always been a highly engaging speaker and his topic was particularly timely - "the future of RO as a specialty." Many, many interesting points came out of this talk: 1. He...
Futures went negative at the end of last month. Might happen again next week.
Some med students would have to get really incentivized to go into rad onc
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For objective data, why don't we just graph yearly radiotherapy-related RVU's, minus dermatology XOFT, etc. or radiotherapy patients by number of practicing radiation oncologists? It'd show that RVU/radonc is declining year-over-year, and that at some point ---- my guess is 2015 ---- it crosses below a threshold at which some number of radonc's are underemployed or underutilized.
For the sake of argument, assume RVU/radonc to be fully employed or financially viable for a practice is 10,000. From 2010 to 2020, plot RVU/radonc and show that it declines from 12,000 to 8,000 in 2019, until it drops off a cliff at 2020 due to coronavirus. In any case, 8,000 is still lower than 10,000, indicating that 20% of the aggregate radonc manpower is underemployed aka wasted human capital.
For the sake of argument, assume RVU/radonc to be fully employed or financially viable for a practice is 10,000. From 2010 to 2020, plot RVU/radonc and show that it declines from 12,000 to 8,000 in 2019, until it drops off a cliff at 2020 due to coronavirus. In any case, 8,000 is still lower than 10,000, indicating that 20% of the aggregate radonc manpower is underemployed aka wasted human capital.
The known knowns are that rad onc has oversupply issues right now. The known unknowns are how much to reduce the oversupply and how to realistically do so within the confines of a monolithic system. The posters who think its as simple as convincing the greedy academic chairs to see to error in their ways are being disingenuous - there are no easy ways to do shrink residency spots across all institutions. The unknown unknowns, are well... unknown. Does a drastic oversupply cause dramatic shift in salaries and ensuing downfall of the specialty? Does a drastic oversupply force large number of research fellowships and we get broader uses of radiation? What are the consequences of perpetually staying a small field in an increasingly bureaucratic landscape where reimbursement decisions are decided by money and power? How do we innovate as a field with less intellectual capital?
It's called forced fellowships with possible job offering down the road
Innovation so far during the golden era of rad onc has been how to give radiation more quickly or less altogether
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The supply of radiation oncologists, and ostensibly therefore its "intellectual capital," has been on a significant upswing for 10+ years. What hath that wrought? The only innovation (not protons... they're 30+ years old now) we've truly seen is in the shrinkage of treatments. Thus causing a shrinkage in reimbursements. Thus causing a shrinkage in daily case loads. Thus causing the "small field" of radiation oncology to downsize its overall "global self"—even as the number of rad onc humans grew—in the eyes of patients and referring physicians. Don't misunderstand: not downsizing in a bad way per se. But downsizing in an impactful/importance/"high stakes" fashion: six weeks of breast radiotherapy seems scary and a slog. But 6 weeks it was, 6 weeks it would always be, and that was the only option. Any other option was anathema. Then came "innovation." Ponder it from afar... to laypersons (patients and non-rad onc MDs) 6+ weeks sounds more complex and requires more hand-holding and more of a polymathic captain than a much simpler-sounding 5 treatments only. Radiation oncology seemed to be accomplishing more and to possess more cachet when it was an even smaller field. Exclusivity and a "black box" can be its own protection. To quote Zietman: "We have hitched our wagon to a modality rather than an anatomic site; this puts us at considerable risk for future irrelevance." Have we not increasingly but perhaps unwittingly downsized the modality the last decade?
Discuss.
I think "black box" protection has been one of our biggest attributes.
"You need to know a lot about physics."
Agree we have had limited innovation in the last 30 years. So whats the solution to that? Innovate more with less people? Is that real long term solution, or a problem for the next generation to deal with after the current mid career rad oncs retire? And are we really not considering SBRT an innovation? I would not lump it into the broad category of hypofractionation. The paradigm is clearly different - ignore the differential effect of radiation and ablate everything in your target. Obviously its not always practiced this way, but to reduce the innovation to just shrinkage of treatments is just not being entirely accurate.
One of the worst things that happened to our specialty was to tie our reimbursement to the number of fractions we deliver. There is no real reason why this should have ever been done and was done operationally at the time. I would say hitching our wagon to keeping our specialty a "black box" would be just as perilous a route. No doubt hypofractionation has cost us economically - but would we rather be like the cardiologists who continue to do PCIs without any demonstrable benefit? Is our "fraction shaming" an internal way we have been policing ourselves where other specialties would not? We are probably the only exception to the rule in which every other specialty have contributed to the skyrocketing costs of medicine (ignoring protons). If you are med onc, are the exponential costs of systemic therapy (most of which do not improve OS/QOL or have marginal gains) sustainable? Everyone will agree here that radiation is underused, would we rather be the modality that is overused?
Totally disagree about contribution to health care costs. That comes mostly from prices not utilization and fractionation. Btw References to prices are constantly cover of nytimes:
.” At Mayo Clinic centers in Florida and Wisconsin, according to RAND estimates, insurers pay three to four times the Medicare prices for outpatient care. Similar data for inpatient prices is not publicly available.”
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deleted774703
Only 3 innovations in rad onc, 2 of which have yet to be fully adopted or still overall low numbers
1) SBRT lung + other sites (overall big pro, but has led to decreased fxn and pay. Also many sites still not adopted like HCC)
2) SBRT arrhythmias (niche, fledgling at the moment(
3) Oligometastases (limited no. of pts present with oligomets, still don't have exact definition for each disease site, still don't have many P3 RCT, so still fledgling, but very promosing)
These 3 combined do not overcome the decrease in fractions and patients we are seeing overall, as well as the rising number of residents over the years
Agree that reimbursements tied to fractions and increasing trend with hypofractionation is definitely hurting us.
Possible magical thinking, but perhaps with APM coming out, it will just stabilize the reimbursements and give it more of a floor. Once you get paid for a diagnosis, there will be a huge shift towards hypofractionation and potentially more utilization. I don't think the possible increase in utilization that might come with APM will solve our issue of trainee oversupply, but it will at least help a little bit with our current trend of hypofractionating everything.
NOTHING could have overcome such a dramatic increase in residents over the last decade. This is a disaster of our own making.
Having said that, I'm very bullish on SBRT for oligomets. It's a big part of my practice now. However, our practice also isn't planning on hiring another radonc locally for another ten years. Both can be true.
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deleted774703
As long as there are ppl with these views, nothing will change...smh
I definitely don't want to practice in Vermont. Went for the foliage, left for lack of biryani
I definitely don't want to practice in Vermont. Went for the foliage, left for lack of biryani
It’s like I’m watching the current administration’s reaction during the first phase of the pandemic.
I interpret that to mean that the match rate should be enough to act, but because he thinks it won't be, call for data to further the argument
Sent from my Pixel 2 XL using Tapatalk
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Evicore told me oligiomets are fake news. They basically won't pay for SBRT under any circumstance except for symptomatic retreatment in my experience.
I agree with you, I think we could keep blasting away at prostate oligiomets and keep patients asymptomtic with low PSA for many years, but at a pretty high cost! Evicore says no, let them progress to widespread disease.
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deleted774703
"perceived poor job market"
"match rate alone isn't sufficient to call for appropriate contraction"
All those onboarding microaggression seminars finally coming to use 😉
Brower, Nat, and other cheerleaders will only admit they were wrong when ppl are homeless...bet they also won't hire anyone at that point to keep their salary intact as well
Sure hope phase 3 COMET is positive....
I get these approved by Evicore all the time including today in peer to peer. They do sometimes deny in this setting and then I appeal directly to payer, as one does. Payer typically approves.
Who/what do we need to bleach to solve this problem??
