Rad Onc Twitter

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
All students: that ↑↑ this guy ↑↑ is having ANY job-finding pain is a huge indictment of rad onc, a big blinking red light saying STAY AWAYYYYY.
Exactly this. It is very depressing to be midway through residency, and to essentially be hearing from everyone ahead of you that you should have very little hope for your future career.

Like most current/recently graduated residents, I had >250 step 1/2, publications, and graduated at the top of my class. I worked my ass off to get here, and put in more time than most of my colleagues in other specialties. I felt like I matched into my dream specialty, but now I have to wonder if I’ll even have A job after all of this, much less a desirable one. Now, I feel like...how did I get here? I thought I was doing well in the grand scheme of things. Now, I can’t even feel proud about my accomplishments or hopeful about my future in this “dumpster fire” of a career field. Meanwhile, I’m seeing classmates starting their fellowships and attendingships, mostly exactly where they want to be geographically and career-wise.

I probably would have been a great candidate for rads or a top-tier IM program, and tbh I regret not choosing the IM>heme/onc path. Obviously, I read about the job market concerns before I applied, but I was also told by “mentors” that the situation wasn’t so desperate and it would turn around eventually as we’ve seen with other fields. I was told told to expect some geographic limitations, along the lines of “you might not end up in NYC or LA, but you‘ll be able to find something the state/region of preference”. I was told that this is still a great field with a great future, by the heads of programs and departments in this field, and why wouldn’t I have trusted them as a medical student? I’m sure many of you have had similar experiences. And this was still one of the most competitive fields to match, and why would “the best of the best” applicants still be applying if the doom and gloom were true?

Thankfully, seems like med students have absolutely wised up, and maybe it’s that the voice of the younger generation of rad oncs who have been yelling at the top of their lungs about these issues and are finally being acknowledged (seemingly by everyone EXCEPT leadership). I still think it is wholly unethical for our so called “mentors” and leaders still try to stoke any interest in this field for current med students, especially highly accomplished/desirable residency candidates.

I still love most aspects of working in radiation oncology, and in a perfect world, I don’t think any other field would have been a better fit for me. But the world is far from perfect rn, and enjoying the day-to-day work just isn’t worth the constant anxiety that myself and my coresidents have of a hopeless future in a seemingly irreparably broken field, before our careers as doctors have even really started.

Med students, PLEASE consider that this is what you would have to be dealing with 3 or 4 years down the line. It is NOT worth it.

Members don't see this ad.
 
  • Sad
  • Care
  • Like
Reactions: 9 users
Exactly this. It is very depressing to be midway through residency, and to essentially be hearing from everyone ahead of you that you should have very little hope for your future career.

Like most current/recently graduated residents, I had >250 step 1/2, publications, and graduated at the top of my class. I worked my ass off to get here, and put in more time than most of my colleagues in other specialties. I felt like I matched into my dream specialty, but now I have to wonder if I’ll even have A job after all of this, much less a desirable one. Now, I feel like...how did I get here? I thought I was doing well in the grand scheme of things. Now, I can’t even feel proud about my accomplishments or hopeful about my future in this “dumpster fire” of a career field. Meanwhile, I’m seeing classmates starting their fellowships and attendingships, mostly exactly where they want to be geographically and career-wise.

I probably would have been a great candidate for rads or a top-tier IM program, and tbh I regret not choosing the IM>heme/onc path. Obviously, I read about the job market concerns before I applied, but I was also told by “mentors” that the situation wasn’t so desperate and it would turn around eventually as we’ve seen with other fields. I was told told to expect some geographic limitations, along the lines of “you might not end up in NYC or LA, but you‘ll be able to find something the state/region of preference”. I was told that this is still a great field with a great future, by the heads of programs and departments in this field, and why wouldn’t I have trusted them as a medical student? I’m sure many of you have had similar experiences. And this was still one of the most competitive fields to match, and why would “the best of the best” applicants still be applying if the doom and gloom were true?

Thankfully, seems like med students have absolutely wised up, and maybe it’s that the voice of the younger generation of rad oncs who have been yelling at the top of their lungs about these issues and are finally being acknowledged (seemingly by everyone EXCEPT leadership). I still think it is wholly unethical for our so called “mentors” and leaders still try to stoke any interest in this field for current med students, especially highly accomplished/desirable residency candidates.

I still love most aspects of working in radiation oncology, and in a perfect world, I don’t think any other field would have been a better fit for me. But the world is far from perfect rn, and enjoying the day-to-day work just isn’t worth the constant anxiety that myself and my coresidents have of a hopeless future in a seemingly irreparably broken field, before our careers as doctors have even really started.

Med students, PLEASE consider that this is what you would have to be dealing with 3 or 4 years down the line. It is NOT worth it.

In conversations with Chairs/senior attendings, I think they honestly don't know.

Many of them have been in their positions for 20+ years, and their own job search was much different than ours.

I believe someone hit the nail on the head here recently, that people aren't inclined to talk about their defeats, especially high-performing doctors accustomed to success and definitely to the portrayal of success. Dan Golden's recent post being a great example - 7 years ago he had to reach out to 40-ish institutions to ultimately receive 2 job offers. Sure, he seems to love his job now and I'm happy for him - but in terms of our specialty, is that a success? Talking with my peers in other specialties, they're not doing this - they're debating between multiple offers in desirable geographic locations. I had dinner with a friend in a different field a few months ago, and he casually asked if I had signed a contract yet (as a PGY4). He wasn't joking - that was the norm for him.

Now that I know what to ask, talking with recent grads is eye opening. One person I know who secured a good job said he had to cold-email every department on an entire coast as well as in almost every major city in America. Is he a success? Things worked out for him, sure, but that's a razors-edge away from it not "working out".

I feel like more people are inclined to speak up and say "yeah, I struggled", which is what we need. I certainly plan on giving a general account of my experience + all of my buddies in my social circle (in an anonymous fashion). I can tell you right now - other than the jobs posted online or on Twitter, we have found MAYBE 2 jobs in "major" cities that might hire a 2021 grad. The jobs posted online are getting 35-45 applications each.

May the odds be ever in our favor.
 
Last edited:
  • Like
  • Sad
  • Wow
Reactions: 3 users
Like most current/recently graduated residents, I had >250 step 1/2, publications, and graduated at the top of my class. I worked my ass off to get here, and put in more time than most of my colleagues in other specialties. I felt like I matched into my dream specialty, but now I have to wonder if I’ll even have A job after all of this, much less a desirable one. Now, I feel like...how did I get here? I thought I was doing well in the grand scheme of things. Now, I can’t even feel proud about my accomplishments or hopeful about my future in this “dumpster fire” of a career field. Meanwhile, I’m seeing classmates starting their fellowships and attendingships, mostly exactly where they want to be geographically and career-wise.

No one should have to feel this way after working so hard. I'm sorry our leadership has failed you, and I hope you find a job you enjoy on the other side of training.
 
  • Like
Reactions: 1 users
Members don't see this ad :)
The thing is too, with a finite supply of jobs, fellowship may bring skills in brachy or Peds, but it definitely pushes the job hunt one year further out. I don’t think it would be possible, but having a commitment or plan for post fellowship work may be necessary to a avoid unemployment even post fellowship. Second fellowships were common for a while in Canada for many grads, and are only now we seeing to subside I think.
 
  • Like
Reactions: 1 user
The thing is too, with a finite supply of jobs, fellowship may bring skills in brachy or Peds, but it definitely pushes the job hunt one year further out. I don’t think it would be possible, but having a commitment or plan for post fellowship work may be necessary to a avoid unemployment even post fellowship. Second fellowships were common for a while in Canada for many grads, and are only now we seeing to subside I think.

It's pretty much inevitable. It's what happened in Radiology, it will happen here too.

I imagine in a few years the applicant pool will be folks who perhaps aren't the most competitive on paper who know a Fellowship will be required who are applying to RadOnc.
 
  • Like
Reactions: 1 user
A fellowship for a position that doesn’t exist though. How many peds or brachy or proton (or gamma knife or palliative radiation or ...) fellowship people do we really need?

Other group of people are doing research fellowships- similarly because can’t find assistant professor jobs out of training.

If we could join an IR fellowship that would be different.
 
Last edited:
  • Like
Reactions: 1 users
It's pretty much inevitable. It's what happened in Radiology, it will happen here too.

I imagine in a few years the applicant pool will be folks who perhaps aren't the most competitive on paper who know a Fellowship will be required who are applying to RadOnc.
Except fellowships in RO are unaccredited trash and everyone knows it (save maybe peds or brachy).
 
  • Like
Reactions: 1 users
As a recent grad I would like to echo what ROResident said. I was never warned about the job market when applying to residency, I was told you could have location, salary or job, and could maybe swing 2/3, but was never warned about how tight the job market would be.

I also want to echo what elementaryschooleconomics said, that I don't really think the older generation knows! I was talking to my PD when I was a resident several years ago with another couple co-residents and my PD was both clueless and blown away by the amount of student debt we had and the cost of applying to residency (that being said the PD was an older PD).

It's challenging when we try over and over and over to get those above us to understand that things are very different for us, but all we get is a pat on the head and a "you're overreacting".

I do have a job I like (thankfully), but I also don't feel like I have any mobility should my situation or job change in the next couple of years, which could happen given CMS, etc. I also think there are other fields in medicine in which I would have thrived as well with less of this kind of stress.
 
  • Like
Reactions: 8 users
hankfully, seems like med students have absolutely wised up, and maybe it’s that the voice of the younger generation of rad oncs who have been yelling at the top of their lungs about these issues and are finally being acknowledged (seemingly by everyone EXCEPT leadership). I still think it is wholly unethical for our so called “mentors” and leaders still try to stoke any interest in this field for current med students, especially highly accomplished/desirable residency candidates.

It's import to control the language so things are stated as clearly as possible. It is absolutely UNETHICAL to advise anyone to go into this field at this point given how uncertain the future is and that there are no viable exit strategies once you start/finish training. No one who is in a position to advised med students should advocate for anyone going down such a path.
 
  • Like
Reactions: 5 users
Another current PGY-5 lurker here. I will also echo ROResident has said here -- I am looking for a job in the midwest (think Kansas, Iowa, Missouri, etc) and this is actually proving to be VERY difficult. Entire states are not hiring, or are hiring for a single rural position and have received so many applications that they cannot process them all. Every single practice in my relatively undesirable hometown is not hiring this year.

I was told the same as ROResident prior to matching, and maybe it was true at that time: that getting a job in the midwest should be relatively easy -- it is unfortunately anything but. I am legitimately worried that I might end up unemployed or in the middle of nowhere. Multiple PGY-5s I personally know are looking at applying for fellowships as a backup including palliative care. Myself and others have discussed this with multiple leaders in the field with 0 result -- these same people are actively trying to expand their residency slots, I wish I was joking.

I am from a perennial top 10 program. I have 10+ publications, great references, and believe that I was trained rather well -- I have few issues with my training program overall and have been treated fairly here. My chair and other faculty make calls for us but they cannot make a phone call that conjures a job into existence.

I also had 250+ step1/2 scores and matched at the height of rad onc competitiveness like many of us here. I really enjoy what I do and love treating cancer patients. Bluntly speaking, it is not worth this level of stress, uncertainty, and ultimately unhappiness. No one in medicine should be wondering if they are going to be left unemployed at the end of a 9+ year post-graduate process. I am posting this so that others can see what awaits them -- if this convinces even one person to match into something else, then it was worth it. I hope others will continue to share their stories so that I feel less alone and also so that prospective residents/students can get a glimpse into their potential reality.
 
  • Like
  • Sad
  • Care
Reactions: 16 users
Another current PGY-5 lurker here. I will also echo ROResident has said here -- I am looking for a job in the midwest (think Kansas, Iowa, Missouri, etc) and this is actually proving to be VERY difficult. Entire states are not hiring, or are hiring for a single rural position and have received so many applications that they cannot process them all. Every single practice in my relatively undesirable hometown is not hiring this year.

I was told the same as ROResident prior to matching, and maybe it was true at that time: that getting a job in the midwest should be relatively easy -- it is unfortunately anything but. I am legitimately worried that I might end up unemployed or in the middle of nowhere. Multiple PGY-5s I personally know are looking at applying for fellowships as a backup including palliative care. Myself and others have discussed this with multiple leaders in the field with 0 result -- these same people are actively trying to expand their residency slots, I wish I was joking.

I am from a perennial top 10 program. I have 10+ publications, great references, and believe that I was trained rather well -- I have few issues with my training program overall and have been treated fairly here. My chair and other faculty make calls for us but they cannot make a phone call that conjures a job into existence.

I also had 250+ step1/2 scores and matched at the height of rad onc competitiveness like many of us here. I really enjoy what I do and love treating cancer patients. Bluntly speaking, it is not worth this level of stress, uncertainty, and ultimately unhappiness. No one in medicine should be wondering if they are going to be left unemployed at the end of a 9+ year post-graduate process. I am posting this so that others can see what awaits them -- if this convinces even one person to match into something else, then it was worth it. I hope others will continue to share their stories so that I feel less alone and also so that prospective residents/students can get a glimpse into their potential reality.

This is clearly painful to read. It sounds like you are a great candidate and would make an excellent addition to any practice/hospital. I will refrain from reassurance/false hope as nothing really feels like it is getting better yet: hiring freezes, salary cuts, practices close etc... but there will come a time when things start to improve, and it still is early in the application season. When it feels like the nadir is passing, be ready for a full court press, leaning on the current faculty and alumni in your program. As soon as hiring resumes, those of us who have just gone through this are ready to advocate for you guys with our chairs and bosses
 
  • Like
Reactions: 3 users
Another current PGY-5 lurker here. I will also echo ROResident has said here -- I am looking for a job in the midwest (think Kansas, Iowa, Missouri, etc) and this is actually proving to be VERY difficult. Entire states are not hiring, or are hiring for a single rural position and have received so many applications that they cannot process them all. Every single practice in my relatively undesirable hometown is not hiring this year.

I was told the same as ROResident prior to matching, and maybe it was true at that time: that getting a job in the midwest should be relatively easy -- it is unfortunately anything but. I am legitimately worried that I might end up unemployed or in the middle of nowhere. Multiple PGY-5s I personally know are looking at applying for fellowships as a backup including palliative care. Myself and others have discussed this with multiple leaders in the field with 0 result -- these same people are actively trying to expand their residency slots, I wish I was joking.

I am from a perennial top 10 program. I have 10+ publications, great references, and believe that I was trained rather well -- I have few issues with my training program overall and have been treated fairly here. My chair and other faculty make calls for us but they cannot make a phone call that conjures a job into existence.

I also had 250+ step1/2 scores and matched at the height of rad onc competitiveness like many of us here. I really enjoy what I do and love treating cancer patients. Bluntly speaking, it is not worth this level of stress, uncertainty, and ultimately unhappiness. No one in medicine should be wondering if they are going to be left unemployed at the end of a 9+ year post-graduate process. I am posting this so that others can see what awaits them -- if this convinces even one person to match into something else, then it was worth it. I hope others will continue to share their stories so that I feel less alone and also so that prospective residents/students can get a glimpse into their potential reality.

I want to thank the PGY5s from coming here and sharing their stories. No one likes to share stories of defeat or unhappiness, so it truly does take bravery to come here and do it.

However, it's very, very valuable. Those of us out of training have been thinking we've been seeing the writing on the wall for at least 6-7 years now, but without firsthand knowledge with those involved in the job search, it's not easy to know if that writing was truly there.
 
  • Like
Reactions: 6 users
In conversations with Chairs/senior attendings, I think they honestly don't know.

Many of them have been in their positions for 20+ years, and their own job search was much different than ours.

I believe someone hit the nail on the head here recently, that people aren't inclined to talk about their defeats, especially high-performing doctors accustomed to success and definitely to the portrayal of success. Dan Golden's recent post being a great example - 7 years ago he had to reach out to 40-ish institutions to ultimately receive 2 job offers. Sure, he seems to love his job now and I'm happy for him - but in terms of our specialty, is that a success? Talking with my peers in other specialties, they're not doing this - they're debating between multiple offers in desirable geographic locations. I had dinner with a friend in a different field a few months ago, and he casually asked if I had signed a contract yet (as a PGY4). He wasn't joking - that was the norm for him.

Now that I know what to ask, talking with recent grads is eye opening. One person I know who secured a good job said he had to cold-email every department on an entire coast as well as in almost every major city in America. Is he a success? Things worked out for him, sure, but that's a razors-edge away from it not "working out".

I feel like more people are inclined to speak up and say "yeah, I struggled", which is what we need. I certainly plan on giving a general account of my experience + all of my buddies in my social circle (in an anonymous fashion). I can tell you right now - other than the jobs posted online or on Twitter, we have found MAYBE 2 jobs in "major" cities that might hire a 2021 grad. The jobs posted online are getting 35-45 applications each.

May the odds be ever in our favor.

I’m in a position that I deal with alot chairs. You’re spot on about them not having any clue, most of them are quite self centered and self absorbed and only think from their point of reference it’s all about them and nobody else. They see themselves as experts in everything, you name it anything - they’re covid experts, experts at job search, real estate experts, investment experts etc. No question it exists elsewhere but there is something about Rad onc where it seems to be very amp’d up. It’s that same level of hubris that has made them totally miss out on this issue whereas we were full fledged discussing here what to do 5 years ago.
 
Last edited:
  • Like
  • Hmm
Reactions: 5 users
Members don't see this ad :)
I’m in a position of leadership and deal with some of these chairs. You’re spot on about them not having any clue, most of them are so self centered and self absorbed they only think from their point of reference it’s all about them and nobody else. They see themselves as experts in everything where they literally have no clue, you name it anything - they’re covid experts, experts at job search, real estate experts, investment experts etc. No question it exists elsewhere but there is something about Rad onc where it seems to be very amp’d up. It’s that same level of hubris that has made them totally miss out on this issue whereas we were full fledged discussing here what to do 5 years ago. Anonymity has the effect of striping your hubris.
I can see a chair or elder pd being out of touch. What I find inflammatory are the younger faculty like Dan(I had to apply to 50 jobs 7 years ago) Golden, Percy lee, Erin Gillespie and subatomic doc guy and his group who know the issues at hand but deceive medical students to promote their own image.
 
  • Like
Reactions: 2 users
For those on the other side who don't find anything. And there will be many. Given the sorry state of the field and the COVID financial collapse, what is their recourse ?

Re-train ?

Leave medicine altogether? And if so then where to go? Maybe get a job at Siemens in their newly acquired Varian department?
 
For those on the other side who don't find anything. And there will be many. Given the sorry state of the field and the COVID financial collapse, what is their recourse ?

Re-train ?

Leave medicine altogether? And if so then where to go? Maybe get a job at Siemens in their newly acquired Varian department?

I heard ASTRO's yearly conference has numerous openings for janitor positions. Good opportunity to network while getting paid!
 
  • Haha
  • Like
Reactions: 6 users
Another current PGY-5 lurker here. I will also echo ROResident has said here -- I am looking for a job in the midwest (think Kansas, Iowa, Missouri, etc) and this is actually proving to be VERY difficult. Entire states are not hiring, or are hiring for a single rural position and have received so many applications that they cannot process them all. Every single practice in my relatively undesirable hometown is not hiring this year.

I was told the same as ROResident prior to matching, and maybe it was true at that time: that getting a job in the midwest should be relatively easy -- it is unfortunately anything but. I am legitimately worried that I might end up unemployed or in the middle of nowhere. Multiple PGY-5s I personally know are looking at applying for fellowships as a backup including palliative care. Myself and others have discussed this with multiple leaders in the field with 0 result -- these same people are actively trying to expand their residency slots, I wish I was joking.

I am from a perennial top 10 program. I have 10+ publications, great references, and believe that I was trained rather well -- I have few issues with my training program overall and have been treated fairly here. My chair and other faculty make calls for us but they cannot make a phone call that conjures a job into existence.

I also had 250+ step1/2 scores and matched at the height of rad onc competitiveness like many of us here. I really enjoy what I do and love treating cancer patients. Bluntly speaking, it is not worth this level of stress, uncertainty, and ultimately unhappiness. No one in medicine should be wondering if they are going to be left unemployed at the end of a 9+ year post-graduate process. I am posting this so that others can see what awaits them -- if this convinces even one person to match into something else, then it was worth it. I hope others will continue to share their stories so that I feel less alone and also so that prospective residents/students can get a glimpse into their potential reality.

I pm'ed you.
 
For those on the other side who don't find anything. And there will be many. Given the sorry state of the field and the COVID financial collapse, what is their recourse ?

Re-train ?

Leave medicine altogether? And if so then where to go? Maybe get a job at Siemens in their newly acquired Varian department?

Do you remember the story of Barry Badrinath from Beerfest? The difference is that he returned to glory.
 
  • Haha
  • Love
Reactions: 1 users
I heard ASTRO's yearly conference has numerous openings for janitor positions. Good opportunity to network while getting paid!

as the ASTRO “leaders” walk by you’re just hoping for anybody to acknowledge you. You have a mop in your hands. People you look up to tell you “just network bro it will all work out”. The floor is looking pretty clean but the “leaders” are approching and ruin the floor. One of them is eating a twinkie mouth opening as they chew, disgusting character, “well known chair”, gets crumbs all over your floor, gets fatter everytime you see him from eating young souls, the young and baby cow, does not acknowledge you. It all finally sets on you, no amount of “networking” is going to fix this. You best get good with that mop
 
Last edited:
  • Haha
  • Like
Reactions: 5 users
For those on the other side who don't find anything. And there will be many. Given the sorry state of the field and the COVID financial collapse, what is their recourse ?

Re-train ?

Leave medicine altogether? And if so then where to go? Maybe get a job at Siemens in their newly acquired Varian department?
This is what I’d like to know. I’ve asked my own PD and department chair exactly this - in worst (and now looking like most likely) situation where we cannot find ANY job, much less an ideal one, wtf are we supposed to do?? And, how can I prepare for that now?

I haven’t gotten a direct answer yet, just a lot of “well it might be tough but we’ll make phone calls for you”. As many of you have emphasized, they just do not get it.

The situation wouldn’t feel so desperately hopeless if there were some option on the other side. I’d happily do a a proton or peds fellowship, if it could promise a position afterward. I’d even be happy doing a med onc fellowship or IR, if I couldn’t find a position in rad onc and that were an option.

Bu, I’m already in my 30s, with almost 400K of student debt. I’ve put off having a family, a home, hell even a reliable vehicle - a normal life - and I’m starting to accept that I probably won’t ever have some of those things before well into my 50s, and I might not ever be out of debt.

The thought of going back to redo residency altogether AFTER this 5 years of training, to maybe shoot for a hospitalist position in a semi-desirable location...it’s just too much to think about, if I want to keep functioning and not drive myself into a legitimate deep depression right now. I’ve looked into transferring residency specialties now, and it’s far more complicated than people like to make it seem, if a position even becomes available.

I genuinely hope that our field leadership can recognize that this is the situation that so many current trainees are in. If they can’t accept responsibility for creating the problem, I implore them to at least step up and act as leaders, and try to find some answers or solution for us.
 
  • Like
  • Sad
  • Care
Reactions: 15 users
If the Chairs can smell blood in the water and desperation from their graduating residents, they may create a fellowship for you, pay you far less than an attending, and expect you to be thankful for the privilege.

If you are lucky, they may assign you to staff a satellite facility and give you something close in compensation to what an attending makes. Alternatively, they may make you an instructor in the mothership seeing the crap that the real faculty don't want (bone mets, indigent patients with very locally advanced cancers and no social support, or general palliative).
 
  • Like
  • Haha
Reactions: 5 users
If the Chairs can smell blood in the water and desperation from their graduating residents, they may create a fellowship for you, pay you far less than an attending, and expect you to be thankful for the privilege.

If you are lucky, they may assign you to staff a satellite facility and give you something close in compensation to what an attending makes. Alternatively, they may make you an instructor in the mothership seeing the crap that the real faculty don't want (bone mets, indigent patients with very locally advanced cancers and no social support, or general palliative).
that could work for a year or 2 of grads, but with 200 coming out / year for next 5-6 years, will saturate soon.
 
  • Like
Reactions: 2 users
If the Chairs can smell blood in the water and desperation from their graduating residents, they may create a fellowship for you, pay you far less than an attending, and expect you to be thankful for the privilege.

If you are lucky, they may assign you to staff a satellite facility and give you something close in compensation to what an attending makes. Alternatively, they may make you an instructor in the mothership seeing the crap that the real faculty don't want (bone mets, indigent patients with very locally advanced cancers and no social support, or general palliative).

absolutely, like in Sharks movie, once the great white (old man) smells blood you are DONE. Chairs will love your desperation and offer you a “solution” to your sorrows basically being a pgy6-7 in a “fellowship” with zero room for a real job. Some may be facing this reality soon for those who are not wisening up!
 
that could work for a year or 2 of grads, but with 200 coming out / year for next 5-6 years, will saturate soon.

I concur. What I wrote wasn't meant to be offered as a solution, but rather a reality many new grads will soon face.
 
  • Like
Reactions: 4 users
Do we have any idea how many residents who graduated this last June did not land jobs? I haven't seen any of them post on here. It seems there's usually posts from nervous PGY-5s July-December but then they peter out by Feb-Mar when the second wave of people all secure jobs.
 
  • Like
Reactions: 1 user
absolutely, like in Sharks movie, once the great white (old man) smells blood you are DONE. Chairs will love your desperation and offer you a “solution” to your sorrows basically being a pgy6-7 in a “fellowship” with zero room for a real job. Some may be facing this reality soon for those who are not wisening up!

Coming to an institution near you:

A 2-year Community Radiation Oncology Fellowship. Paid at the level of a PGY-5, you will rotate through community satellites, performing at the level of an attending!

Because, as Dr Olivier reminds us, anything else is good for the doctor, not for the patient.

If you're against the 2-year Fellowships, you're against patients!
 
  • Like
  • Haha
  • Wow
Reactions: 7 users
that could work for a year or 2 of grads, but with 200 coming out / year for next 5-6 years, will saturate soon.
Not to say to much to preserve anonymity, but my department has already taken on more than one recent grad who had no other job offers. They still acting as if we have a 100% employment rate after graduation. They can’t create jobs for all of us, unless they start to force older faculty (who are also the highest paid, least useful from an educational and patient care standpoint) into retirement. I don’t see that ever happening while they’re in charge.
 
  • Like
Reactions: 4 users
Not to say to much to preserve anonymity, but my department has already taken on more than one recent grad who had no other job offers. They still acting as if we have a 100% employment rate after graduation. They can’t create jobs for all of us, unless they start to force older faculty (who are also the highest paid, least useful from an educational and patient care standpoint) into retirement. I don’t see that ever happening while they’re in charge.
Y'all can browse academic depts' updated faculty listings and cross-correlate w/ where they did their residency. Seems a fair spate of folks stayed at the same institution they trained this year as faculty. How hard would it be to see % of PGY-5s that "stayed home" in 2020. My guess is ~50%. If so, that's a reasonably alarming stat. That natl avg has historically been ~25% or less.
 
  • Like
Reactions: 1 users
Y'all can browse academic depts' updated faculty listings and cross-correlate w/ where they did their residency. Seems a fair spate of folks stayed at the same institution they trained this year as faculty. How hard would it be to see % of PGY-5s that "stayed home" in 2020. My guess is ~50%. If so, that's a reasonably alarming stat. That natl avg has historically been ~25% or less.
This is the issue with ever expanding academic departments and the expectation that faculty have 100% resident coverage. Without a robust PP and community hospital job market, you literally have to replace your entire academic staff every 4 years to keep the new resident grads employed. What happens to the departing docs after their 4 year grace period is anyone's guess.
 
  • Like
  • Angry
Reactions: 2 users
I don't know any academic departments that still hire faculty (at least junior faculty) with 100% resident coverage. Maybe these departments and/or positions still exist, but I have never interviewed for such a position. They still want more residents, because 60% coverage is better than 40% coverage, or 100% covering another big name is better than not, that sort of thing.
 
  • Like
Reactions: 1 users
This is what I’d like to know. I’ve asked my own PD and department chair exactly this - in worst (and now looking like most likely) situation where we cannot find ANY job, much less an ideal one, wtf are we supposed to do?? And, how can I prepare for that now?

I haven’t gotten a direct answer yet, just a lot of “well it might be tough but we’ll make phone calls for you”. As many of you have emphasized, they just do not get it.

The situation wouldn’t feel so desperately hopeless if there were some option on the other side. I’d happily do a a proton or peds fellowship, if it could promise a position afterward. I’d even be happy doing a med onc fellowship or IR, if I couldn’t find a position in rad onc and that were an option.

Bu, I’m already in my 30s, with almost 400K of student debt. I’ve put off having a family, a home, hell even a reliable vehicle - a normal life - and I’m starting to accept that I probably won’t ever have some of those things before well into my 50s, and I might not ever be out of debt.

The thought of going back to redo residency altogether AFTER this 5 years of training, to maybe shoot for a hospitalist position in a semi-desirable location...it’s just too much to think about, if I want to keep functioning and not drive myself into a legitimate deep depression right now. I’ve looked into transferring residency specialties now, and it’s far more complicated than people like to make it seem, if a position even becomes available.

I genuinely hope that our field leadership can recognize that this is the situation that so many current trainees are in. If they can’t accept responsibility for creating the problem, I implore them to at least step up and act as leaders, and try to find some answers or solution for us.

try not to give up hope the situation isn’t great but doesn’t mean there are 0 jobs, people are getting some. That 400k debt is pretty rough though you need to come up with some very valid plan to get that down. you might be able to save 100k a year if your job is ok and live in lower cost area maybe 150 if you do some side hustling but ya you need to be aggressive paying that down and don’t think about living above means. How did you end up 400 in the hole?
 
Y'all can browse academic depts' updated faculty listings and cross-correlate w/ where they did their residency. Seems a fair spate of folks stayed at the same institution they trained this year as faculty. How hard would it be to see % of PGY-5s that "stayed home" in 2020. My guess is ~50%. If so, that's a reasonably alarming stat. That natl avg has historically been ~25% or less.
Biggest problem with that type of statistic is it's impossible to know on the face of it who wanted the position at the home institution and who had no other choice.

From my personal experience in the last few years, I know of 4 residents who stayed on at a program for 1 yr fellowship or attending. The fellowship one stayed due to family reasons, spouse finishing their own training, and had great job lined up for afterwards. The first resident I know who stayed on was because the job was available and spouse already had a job working locally. More recently, two more home program hires. One had been gunning for the home institution and wanted it to the exclusion of all else. The other had another offer but when spot at home institution opened up stuck around because of job quality alone.

It's hard to quantify these changes and resident desires because a lot of residency programs are in big hospital systems that have been expanding, so the spots are made organically as the hospital footprint expands and of course if the program is good (at least good enough), why wouldn't a resident want to stick around in the place they've been for 4+ years?
 
  • Like
Reactions: 1 user
Biggest problem with that type of statistic is it's impossible to know on the face of it who wanted the position at the home institution and who had no other choice.

From my personal experience in the last few years, I know of 4 residents who stayed on at a program for 1 yr fellowship or attending. The fellowship one stayed due to family reasons, spouse finishing their own training, and had great job lined up for afterwards. The first resident I know who stayed on was because the job was available and spouse already had a job working locally. More recently, two more home program hires. One had been gunning for the home institution and wanted it to the exclusion of all else. The other had another offer but when spot at home institution opened up stuck around because of job quality alone.

It's hard to quantify these changes and resident desires because a lot of residency programs are in big hospital systems that have been expanding, so the spots are made organically as the hospital footprint expands and of course if the program is good (at least good enough), why wouldn't a resident want to stick around in the place they've been for 4+ years?

I can answer that last question - when I came out of training 11 years ago, the philosophy of some was "leave your home institution, as they will always see you as a resident"
 
  • Like
Reactions: 10 users
Radonc needs to merge with radiology or Medonc. Let the current residents do 2-3 years of rads and they can practice as radiology or radonc (whichever they can get a job). Or create a clinical oncologist like in U.K.
 
  • Like
Reactions: 2 users
I can answer that last question - when I came out of training 11 years ago, the philosophy of some was "leave your home institution, as they will always see you as a resident"
Or... " Don't be incestual and practice where you train" as one gets hardened into practicing a certain way rather than getting different viewpoints
 
  • Like
Reactions: 2 users
Radonc needs to merge with radiology or Medonc. Let the current residents do 2-3 years of rads and they can practice as radiology or radonc (whichever they can get a job). Or create a clinical oncologist like in U.K.

Given our legacy association with the radiology, I think it would make sense to turn rad onc into a fellowship after general radiology residency. This would look like 1 year of internship, 4 years of general radiology and maybe 2 years of rad onc fellowship. Most current radiologist do various fellowship anyways so it would not be that unusual from that speciality's perspective. As the specialty continues to move towards treating patient's with 0, 1 or 5 fractions we will no longer need years in the clinic as we will become more and more like technical proceduralist. This paradigm would also drastically cut down on the number of physicians willing to pursue radiation oncology and this well eventually work to bring things in the specialty back into balance as unethical programs could no longer soap in med students and fmgs. And of course one could always fall back on their general radiology training if need be for employment.
 
Last edited:
  • Like
  • Love
Reactions: 1 users
I can answer that last question - when I came out of training 11 years ago, the philosophy of some was "leave your home institution, as they will always see you as a resident"

While that's definitely a thought process, there are many residents who matched at their favored geographical location when they were MS4s and want to prioritize staying there for their attending position. With the decrease in PP due to academic center supernova-like expansions, I'm not surprised to see that percentage going up aggressively. I would have stayed on as an attending at my residency program if they had a position for me available at the mothership as full time faculty. Was not interested in staying in that region for a satellite position. However, I would be an outlier for that latter statement.
 
Given our legacy association with the radiology, I think it would make sense to turn rad onc into a fellowship after general radiology residency. This would look like 1 year of internship, 4 years of general radiology and maybe 2 years of rad onc fellowship. Most current radiologist do various fellowship anyways so it would not be that unusual from that speciality's perspective. As the specialty continues to move towards treating patient's with 0, 1 or 5 fractions we will no longer need years in the clinic as we will become more and more like technical proceduralist. This paradigm would also drastically cut down on the number of physicians willing to pursue radiation oncology and this well eventually work to bring things in the specialty back into balance as unethical programs could no longer soap in med students and fmgs. And of course one could always fall back on their general radiology training if need be for employment.

This is ABSOLUTELY the way forward given what is happening to our specialty and American Medicine in general.

While some people grow furious when I say this, we've very much transitioned into Cookbook Radiation. Between the NCCN Guidelines and eviCore, a medical student could crack open a book and come up with an appropriate treatment plan in 10 minutes for most common pathologies. The 2 years of RadOnc fellowship would be dedicated to nuance/out-of-the-box issues, and the 4 years of Radiology training covers contouring.

It makes a lot of sense...therefore it will never happen.
 
  • Haha
  • Like
Reactions: 2 users
While some people grow furious when I say this, we've very much transitioned into Cookbook Radiation. Between the NCCN Guidelines and eviCore, a medical student could crack open a book and come up with an appropriate treatment plan in 10 minutes for most common pathologies.
Now let's REALLY take a look at this everyone. Is this guy right? Is he just hyperbolic? Sensationalist drivel?

If he's just being an alarmist, move on. Nothing to see. He's stupid and you're smart and all's right with the world.

But what if he's right? Is anyone really willing to admit the hard truth if he is? The actual, real ramifications? Can anyone believe we're not having the needed, painful discussions about this at all levels of radiation oncology? Some days, I can not believe it. People "grow furious" when he says such things. Because he's stupid? Maybe they're angry they let such a stupid person become a rad onc. No. It's human nature at work. (Or he's lying; maybe people get happy when he says this and he's just lying. It's possible.)

That people get furious means he's right. My retrospectoscope will point back to the oversupplying of rad onc and it losing its "black boxness." A guideline should have never been published on how to treat any site. Choosing Wisely was a huge nail in the coffin. That we could shoehorn any radiation patient's necessary treatment plan into a worksheet was really something that would have seemed malpractice-y 20 years ago. Take a look at eviCore med onc vs rad onc worksheets:

WQQ1r5T.png
 
  • Like
Reactions: 6 users
Now let's REALLY take a look at this everyone. Is this guy right? Is he just hyperbolic? Sensationalist drivel?

If he's just being an alarmist, move on. Nothing to see. He's stupid and you're smart and all's right with the world.

But what if he's right? Is anyone really willing to admit the hard truth if he is? The actual, real ramifications? Can anyone believe we're not having the needed, painful discussions about this at all levels of radiation oncology? Some days, I can not believe it. People "grow furious" when he says such things. Because he's stupid? Maybe they're angry they let such a stupid person become a rad onc. No. It's human nature at work. (Or he's lying; maybe people get happy when he says this and he's just lying. It's possible.)

That people get furious means he's right. My retrospectoscope will point back to the oversupplying of rad onc and it losing its "black boxness." A guideline should have never been published on how to treat any site. Choosing Wisely was a huge nail in the coffin. That we could shoehorn any radiation patient's necessary treatment plan into a worksheet was really something that would have seemed malpractice-y 20 years ago. Take a look at eviCore med onc vs rad onc worksheets:

WQQ1r5T.png
Can you argue that surg onc is cookbook? Treatment plan:. Cut out the tumor, sew patient closed. I like cookbook. Get energy to the thing that shouldn't be there while avoiding the things that should. I don't wanna hear my doc say, "lemme try something."
 
  • Like
Reactions: 2 users
Now let's REALLY take a look at this everyone. Is this guy right? Is he just hyperbolic? Sensationalist drivel?

If he's just being an alarmist, move on. Nothing to see. He's stupid and you're smart and all's right with the world.

But what if he's right? Is anyone really willing to admit the hard truth if he is? The actual, real ramifications? Can anyone believe we're not having the needed, painful discussions about this at all levels of radiation oncology? Some days, I can not believe it. People "grow furious" when he says such things. Because he's stupid? Maybe they're angry they let such a stupid person become a rad onc. No. It's human nature at work. (Or he's lying; maybe people get happy when he says this and he's just lying. It's possible.)

That people get furious means he's right. My retrospectoscope will point back to the oversupplying of rad onc and it losing its "black boxness." A guideline should have never been published on how to treat any site. Choosing Wisely was a huge nail in the coffin. That we could shoehorn any radiation patient's necessary treatment plan into a worksheet was really something that would have seemed malpractice-y 20 years ago. Take a look at eviCore med onc vs rad onc worksheets:

WQQ1r5T.png
This trend is in no way unique to radiation oncology. Guidelines have proliferated across medicine over the last two decades.
 
  • Like
Reactions: 2 users
Can you argue that surg onc is cookbook? Treatment plan:. Cut out the tumor, sew patient closed. I like cookbook. Get energy to the thing that shouldn't be there while avoiding the things that should. I don't wanna hear my doc say, "lemme try something."

SurgOnc is already doing the model we're talking about - general surgery residency + 2 year SurgOnc fellowship. The art is in the surgery part, not the oncology part.

The "hard" part of RadOnc is the target delineation, which anyone who completes a Radiology residency should be able to learn...pretty fast.

Let's go Back to the Future and merge with Radiology again!

[100 Chairs of RadOnc departments pulling down $600-$900k/year cry out in horror]
 
  • Like
Reactions: 3 users
We certainly have provided the rope to hang ourselves but the graphic below was the beginning of the end.
1596660351844.png


Published in the NEJM it became evident that a very small specialty (read little political power) was an outlier. Willie SUtton robbed banks because that's where the money was. Now I know that we are a small bank relative to others as far as aggregate spending but our small size and being wedded to a single technology made for an easy target.
 
  • Like
  • Haha
  • Love
Reactions: 3 users
We certainly have provided the rope to hang ourselves but the graphic below was the beginning of the end. View attachment 315048

Published in the NEJM it became evident that a very small specialty (read little political power) was an outlier. Willie SUtton robbed banks because that's where the money was. Now I know that we are a small bank relative to others as far as aggregate spending but our small size and being wedded to a single technology made for an easy target.

I think about this a lot, I agree 100%. This was absolutely the turning point.
 
  • Like
Reactions: 1 user
The job market is terrible and we need to contract residency badly.

But you’re not less of a technician because you do 39 treatments instead of 5 (for example). If you had a cookie cutter approach before that’s on you. Many rad oncs are well respected due to wholistic management of the patient, advice on staging, survivorship, etc etc. and I don’t mean respected as in national leaders I mean respected by referring physicians and patients. Do not act like we are technicians just because the number of treatments per regimen shrank.

let’s keep the arguments focused and not devolve into nonsense.
 
  • Like
Reactions: 4 users
A few MedOncs at my hospital just plug stuff into pathways that tell them which regimen to use. Doubtful they are the only ones that do that. If that's not cookbook I don't know what is.
 
  • Like
Reactions: 1 users
This is ABSOLUTELY the way forward given what is happening to our specialty and American Medicine in general.

While some people grow furious when I say this, we've very much transitioned into Cookbook Radiation. Between the NCCN Guidelines and eviCore, a medical student could crack open a book and come up with an appropriate treatment plan in 10 minutes for most common pathologies. The 2 years of RadOnc fellowship would be dedicated to nuance/out-of-the-box issues, and the 4 years of Radiology training covers contouring.

It makes a lot of sense...therefore it will never happen.

It’s funny that you say this because I was just lamenting to a colleague how I would kill for a textbook case. It might just be my patient population, but these days it seems like every patient has at very locally advanced disease, is on anti-rejection meds that can’t be held and/or some other catch 22... or maybe it just feels that way because I am just starting out.
 
We certainly have provided the rope to hang ourselves but the graphic below was the beginning of the end. View attachment 315048

Published in the NEJM it became evident that a very small specialty (read little political power) was an outlier. Willie SUtton robbed banks because that's where the money was. Now I know that we are a small bank relative to others as far as aggregate spending but our small size and being wedded to a single technology made for an easy target.
I have posted that here a few times... a good graph and a bad one...

Uqo2WMu.png
 
  • Like
Reactions: 1 user
Astro spent all its effort trying to kill urorads. Then acandemic centers squeezed out and bought out private practices.

For its nobility, CMS rewarded rad onc with draconian cuts/bundles (and more to come!), academic centers could care two you know what’s about advocating for the speciality so lobbying dried up, and departments and chairs never looked up long enough to notice the “best and brightest” were basically being exploited for note labor and coverage.
 
  • Like
Reactions: 4 users
Top