Rad Onc Twitter

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GapCalc said:


This is just so sad. MSK PD has to pitch his "top ranked" program? It's almost like... our field is not attracting top talent.

We had a good run, rad onc, but it's time to pack it in.
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Who could have guessed people would have finally done the math on an unwarranted 127% increase in residents?

But hey, ASTRO has graciously agreed to cap the annual meeting registration at $400 for trainees so, we got that going for us, which is nice.
 
When I was applying to residency I had a conversation with the old program director at MSKCC and he said applicants were beating down the door to get in for rotations and you basically have to be a Fulbright Scholar with perfect everything to be in the running for a match spot. Now they're running the equivalent of a blue light special trying to find applicants. Mismanagement and lack of "leadership" are a hell of a thing for a small specialty.

Although, seems about right for a specialty now publishing papers finding that parking in big cities tends to be expensive and are rad onc residency programs active enough on twitter. smh
 
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fiji128 said:
When I was applying to residency I had a conversation with the old program director at MSKCC and he said you basically have to be a Fulbright Scholar with perfect everything to be in the running for a match spot. Now they're basically running the equivalent of a blue light special trying to find applicants. Mismanagement and lack of "leadership" are a hell of a thing for a small specialty.

Although, seems about right for a specialty now publishing papers finding that parking in big cities tends to be expensive and are rad onc residency programs active enough on twitter. smh
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Think of it this way. Over the last 15 years they acquired so many overachievers scholars PhDs and that’s all they have to show for it. What a terrible waste.
 
I think my favorite RadOnc Twitter Thirst Move comes from Duke:

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They're basically taking Mary Kay's playbook:

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Sounds like Duke is using a page out of the University of Phoenix playbook.

Link: University Of Phoenix Reaches $191 Million Settlement With FTC, Including Debt Relief.

Choice quote:

It's the largest settlement the FTC has obtained against a for-profit school, said Andrew Smith, director of the FTC's Bureau of Consumer Protection. In a statement announcing the deal, Smith added, "Students making important decisions about their education need the facts, not fantasy job opportunities that do not exist."
 
Have you ever been to a market in the third world? People accost you basically harassing you, you can bring them down to nothing, total buying market. Rad onc programs are essentially desperate farmers. You’re lucky if all you get is the runs from drinking the home made koolaid from the street vendor. Listen to your instinct. There will be another day to try the fried tripe. Save yourselves folks!
 
Gfunk6 said:
Sounds like Duke is using a page out of the University of Phoenix playbook.

Link: University Of Phoenix Reaches $191 Million Settlement With FTC, Including Debt Relief.

Choice quote:

It's the largest settlement the FTC has obtained against a for-profit school, said Andrew Smith, director of the FTC's Bureau of Consumer Protection. In a statement announcing the deal, Smith added, "Students making important decisions about their education need the facts, not fantasy job opportunities that do not exist."
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I mean, technically, if an attending shows a resident the ASTRO Career Center, they have been "led to multiple job opportunities".

Opportunities =/= Offers
 
I just met with my med student, I was very honest to her and told her that this is a great field, but sadly
it has been mismanaged by our "Dear Leaders" during the last 15-20 yrs. I told her if she wants to go for
it, do her research first. I really do not want her to graduate in 2025 with no jobs. She is smart, she knows.
And I will let her make her own decision. Of course, I will not interfere with her decision.
 
GapCalc said:


This is just so sad. MSK PD has to pitch his "top ranked" program? It's almost like... our field is not attracting top talent.

We had a good run, rad onc, but it's time to pack it in.
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I have to admit, seeing this stings a little bit. I would have literally given up years of my life to match at MSKCC when I applied to this field years ago and Rad Onc was still considered competitive. I knew this sort of thing was inevitable given the recent Match trends (and the restrictions of COVID), but the idea that MSKCC is motivated to put forth any effort to attract applicants - even if only to maximize their ranking options - is very painful to that former self that is still a part of me.

Here's the other thing: I have literally no doubt in my mind that major programs like MSKCC and MDACC will have no problem filling up with great applicants in this Match. To my mind, the social media posts exist simply get as many applicants as possible so as to maximize their selection options. It's the smaller, less conspicuous programs that I think will suffer most, and to some of their collective credit, perhaps unfairly. We need to drastically contract this field, but it's crappy that the non-brand name (but potentially solid) 4 to 6 resident complement programs will have to bear the brunt of that responsibility by either not matching or SOAPING.
 
bergonieandtribondeau said:
I have to admit, seeing this stings a little bit. I would have literally given up years of my life to match at MSKCC when I applied to this field years ago and Rad Onc was still considered competitive. I knew this sort of thing was inevitable given the recent Match trends (and the restrictions of COVID), but the idea that MSKCC is motivated to put forth any effort to attract applicants - even if only to maximize their ranking options - is very painful to that former self that is still a part of me.

Here's the other thing: I have literally no doubt in my mind that major programs like MSKCC and MDACC will have no problem filling up with great applicants in this Match. To my mind, the social media posts exist simply get as many applicants as possible so as to maximize their selection options. It's the smaller, less conspicuous programs that I think will suffer most, and to some of their collective credit, perhaps unfairly. We need to drastically contract this field, but it's crappy that the non-brand name (but potentially solid) 4 to 6 resident complement programs will have to bear the brunt of that responsibility by either not matching or SOAPING.
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mskcc with 4 graduating residents/year. Maybe one stays at main campus every other year, and one gets a satellite job; the other 2 will be employed, but probably something that most of us would consider undesirable (satellite job in Midwest). Residents will be comepting with each other the whole 4 years. The math sucks.
 
GapCalc said:


This is just so sad. MSK PD has to pitch his "top ranked" program? It's almost like... our field is not attracting top talent.

We had a good run, rad onc, but it's time to pack it in.
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I burst out laughing. This is awesome! I’m getting closer to being so far gone lost on hope that now our specialty has become a comedy where I eat popcorn and wait for the good parts. I’m so thankful for SDN- and we definitely have an impact because how else could students find out so quickly about the tragicomedy?
 
Haybrant said:
Feels like we’re being a bit harsh about the reaching out to have a q&a session w med students. Every specialty has done that forever just that it has to be done on zoom now instead of in person so we’re seeing the advertisements for it.
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Definitely never heard of these until this year, and definitely didn't see advertising graphics of residents with quotes about good job prospects etc
 
Haybrant said:
Feels like we’re being a bit harsh about the reaching out to have a q&a session w med students. Every specialty has done that forever just that it has to be done on zoom now instead of in person so we’re seeing the advertisements for it.
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That's a reasonable point.

As a thought experiment, if COVID happened in 2015-2016, in the hyper-competitive Golden Era - do you think Sloan et al would be employing the same tactics? I'm not so sure.

It's obviously an unknowable answer, but if the collapse of the Golden Era hadn't happened, I think things would be playing out differently.
 
elementaryschooleconomics said:
That's a reasonable point.

As a thought experiment, if COVID happened in 2015-2016, in the hyper-competitive Golden Era - do you think Sloan et al would be employing the same tactics? I'm not so sure.

It's obviously an unknowable answer, but if the collapse of the Golden Era hadn't happened, I think things would be playing out differently.
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I guess we can wait to see if there are quotes from current residents on 8/30.
 
Ray D. Ayshun said:


I guess we can wait to see if there are quotes from current residents on 8/30.
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I do really hope these virtual events become the norm even after the pandemic subsides. I've been able to watch more lectures/Grand Rounds/you name it in the past 6 months than I have in several years combined, all from the comfort of my office (or my pajamas).
 
elementaryschooleconomics said:
That's a reasonable point.

As a thought experiment, if COVID happened in 2015-2016, in the hyper-competitive Golden Era - do you think Sloan et al would be employing the same tactics? I'm not so sure.

It's obviously an unknowable answer, but if the collapse of the Golden Era hadn't happened, I think things would be playing out differently.
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The tenor of the whole conversation has changed. Previously even mid and lower tier programs would be like "who are you and why do I care?" You had to fight to get away rotations at good places and you had to apply to 80% of programs to maximize the likelihood of matching at just one.

Now even elite/top tier programs are in the position of having to sell themselves to potential US MD applicants. The tables have turned.

If I was currently making the mistake of applying to this field, given this new dynamic, I would out right ask programs if they at least acknowledge the over supply problem in the face of decreased utilization and if they are planning on doing anything to address that (ie decrease resident compliment). You could probably learn a lot about a place by their answer.
 
hbosch said:
And it will never be that way because an endless supply of FMGs will use Rad Onc as a stepping stool- even if to end up as a palliative care doctor.
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I 100% believe this as well.

Departments will not want to cut back spots - that's an army of cheap labor they're losing.

FMG's can use RadOnc as a gateway specialty - if they can get a job practicing RadOnc, great, if not, either Palliative Care or pursue some of the ad hoc work a licensed physician can perform. Either way, if someone wants to open the door to living and working in America, this is now the specialty to do it.

Other than ego, where is the incentive for academicians to change their behavior in this system?
 
elementaryschooleconomics said:
I 100% believe this as well.

Departments will not want to cut back spots - that's an army of cheap labor they're losing.

FMG's can use RadOnc as a gateway specialty - if they can get a job practicing RadOnc, great, if not, either Palliative Care or pursue some of the ad hoc work a licensed physician can perform. Either way, if someone wants to open the door to living and working in America, this is now the specialty to do it.

Other than ego, where is the incentive for academicians to change their behavior in this system?
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Such irony - one of the most cush specialties with no nights and weekends, save for the rare emergent treatment, has such an addiction to residents to make their life even easier.
 
Ray D. Ayshun said:


I guess we can wait to see if there are quotes from current residents on 8/30.
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I'll bet no quotes. If NSG residents are as busy now as they were when I was in med school/residency, they ain't got time for SOME. I have always said the hardest working person in the entirety of medicine is the PGY-2 NSG resident. Chiefs work hard too. I did a rotation at NYU w/ Patrick Kelly because I was torn between NSG and rad onc. The day I got to the hospital, I was told to wait in a lounge. It was 730 am and the chief resident was supposed to be there at 8am to meet me. I waited and waited... nothing. I figured "Well he'll get here eventually" and thought hey he's busy. I waited til 11am. Finally, in drags one of the tiredest, most harried looking fellas I'd ever seen. He pulls up a chair and slumps his body into it. One of the first questions I asked was "How long has it been since you've been home?" I think NYU had some subsidized resident housing nearby. He said "37 days." I was like "What?" He goes "Yeah, I can practically walk across the street to go home but it's been 37 days. My wife and kid have to come here when/if I see them." So long story short: rad onc residents have WAY more time for SOME than NSG people do. The avg rad onc resident only tends to about 2-3 new patients/week after all. Lots 'o time for pep talking, internet browsing, a** kissing.
 
scarbrtj said:
I'll bet no quotes. If NSG residents are as busy now as they were when I was in med school/residency, they ain't got time for SOME. I have always said the hardest working person in the entirety of medicine is the PGY-2 NSG resident. Chiefs work hard too. I did a rotation at NYU w/ Patrick Kelly because I was torn between NSG and rad onc. The day I got to the hospital, I was told to wait in a lounge. It was 730 am and the chief resident was supposed to be there at 8am to meet me. I waited and waited... nothing. I figured "Well he'll get here eventually" and thought hey he's busy. I waited til 11am. Finally, in drags one of the tiredest, most harried looking fellas I'd ever seen. He pulls up a chair and slumps his body into it. One of the first questions I asked was "How long has it been since you've been home?" I think NYU had some subsidized resident housing nearby. He said "37 days." I was like "What?" He goes "Yeah, I can practically walk across the street to go home but it's been 37 days. My wife and kid have to come here when/if I see them." So long story short: rad onc residents have WAY more time for SOME than NSG people do. The avg rad onc resident only tends to about 2-3 new patients/week after all. Lots 'o time for pep talking, internet browsing, a** kissing.
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2-3? WOW!

I had no idea this was the average. In residency , I would see 8-10 new patients per week.
 
Zahramar said:
2-3? WOW!

I had no idea this was the average. In residency , I would see 8-10 new patients per week.
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Closer to 2 than 3! A real black eye for rad onc residency training in general. The residents don't have enough cases to be facile with rad onc and its total complexity if they're just seeing 480 EBRT cases over 4 years, which is just 120 new EBRT cases/year. However 2-3 new patients/week is the evolving norm for all rad oncs nationwide this decade. Not a prediction* ("I predict that if you add two to two, you'll get four") per se; that's just what the numbers are.

* Unless there's significant rad onc unemployment
 
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scarbrtj said:
Closer to 2 than 3! A real black eye for rad onc residency training in general. The residents don't have enough cases to be facile with rad onc and its total complexity if they're just seeing 480 EBRT cases over 4 years, which is just 120 new EBRT cases/year. However 2-3 new patients/week is the evolving norm for all rad oncs nationwide this decade. Not a prediction* ("I predict that if you add two to two, you'll get four") per se; that's just what the numbers are.

* Unless there's significant rad onc unemployment
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When you talk about the expected drop in new patients for radoncs moving forward, you're not taking into account the insurmountable barriers for a newly-minted radonc. Just because they keep making radoncs doesn't mean my patient census is going to go down. Those new radoncs simply will not have a job. That asterisk at the end is what's going to happen. Why would I bring a new partner on board if I don't need to?
 
OTN said:
When you talk about the expected drop in new patients for radoncs moving forward, you're not taking into account the insurmountable barriers for a newly-minted radonc. Just because they keep making radoncs doesn't mean my patient census is going to go down. Those new radoncs simply will not have a job. That asterisk at the end is what's going to happen. Why would I bring a new partner on board if I don't need to?
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NB: my "calculation" for new pts/rad onc is JUST an average. The average can be met if many people stay the same, but new people are unemployed 🙂 Or maybe some old people get unemployed!
 
Mandelin Rain said:
Click the link. 480 EBRT is the average. 130 of which were mets. Scary stuff if you're a patient.
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Dr O was showing some behind the scenes data on twitter recently where the average resident graduates seeing something like 6 or 7 adult lymphoma cases nowadays. Lymphoma is about the 7th most common cancer. And new rad oncs graduate sticking their chests out saying "I am the best qualified MD when it comes to cancer"? (I don't fault the kids... I fault the parents!) Why? Because cancer bio???
 
scarbrtj said:
Dr O was showing some behind the scenes data on twitter recently where the average resident graduates seeing something like 6 or 7 adult lymphoma cases nowadays. Lymphoma is about the 7th most common cancer. And new rad oncs graduate sticking their chests out saying "I am the best qualified MD when it comes to cancer"? Why? Because cancer bio???
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I'm not sure anyone was ever saying that about hematologic malignancies. But the point remains. We're slowly seeing less of everything except mets. Bad spot to be in.
 
Mandelin Rain said:
I'm not sure anyone was ever saying that about hematologic malignancies. But the point remains. We're slowly seeing less of everything except mets. Bad spot to be in.
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I'm saying cancer is a biiig umbrella. We're little fish. The pond is getting deeper with more rain, but we're thirsty. Rad oncs need H2O for XRT to work. Anyways, this is a pretty failed water analogy.
 
Mandelin Rain said:
I'm not sure anyone was ever saying that about hematologic malignancies. But the point remains. We're slowly seeing less of everything except mets. Bad spot to be in.
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I'd add HPV+ oropharyngeal cancer- outside of academic institutions who operate on everyone even though they shouldn't (cough, cough, Mayo Clinic, cough, cough), I think the message is getting out that chemoRT is the best option for most of these patients.
 
scarbrtj said:
Closer to 2 than 3! A real black eye for rad onc residency training in general. The residents don't have enough cases to be facile with rad onc and its total complexity if they're just seeing 480 EBRT cases over 4 years, which is just 120 new EBRT cases/year. However 2-3 new patients/week is the evolving norm for all rad oncs nationwide this decade. Not a prediction* ("I predict that if you add two to two, you'll get four") per se; that's just what the numbers are.

* Unless there's significant rad onc unemployment
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I mean most programs do 6 if not 12 months of research, so would say 160/year. That pulls you more to 3/week. And they're counting sims not consults - fair number of consults on a per/week basis that don't turn into sims. We probably averaged only a 66-75% conversion rate of consults into sims. Either patients picked an alternate modality, or went to a satellite, or were doctor shopping (like had gone to MDACC and MSKCC for opinions on their intermediate risk prostate cancer) and heard something they didn't want to hear with us.

So might approach somewhere in the 3-5 consults/week with some back of the envelope math.

And the case logs bring about concerns of whether folks are underlogging or just 'stopping' once they hit the minimum 450 number. So those are limitations of the cited study.

This is just for residency, not for the calcs about new patients per rad onc tied to the job market.
 
OTN said:
I'd add HPV+ oropharyngeal cancer- outside of academic institutions who operate on everyone even though they shouldn't (cough, cough, Mayo Clinic, cough, cough), I think the message is getting out that chemoRT is the best option for most of these patients.
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On one hand, great. On another, depressing the message just "getting out," because for 15-plus years places like MSKCC have been advertising great success rates with (chemo)RT for this disease.
 
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evilbooyaa said:
I mean most programs do 6 if not 12 months of research, so would say 160/year. That pulls you more to 3/week. And they're counting sims not consults - fair number of consults on a per/week basis that don't turn into sims. We probably averaged only a 66-75% conversion rate of consults into sims. Either patients picked an alternate modality, or went to a satellite, or were doctor shopping (like had gone to MDACC and MSKCC for opinions on their intermediate risk prostate cancer) and heard something they didn't want to hear with us.

So might approach somewhere in the 3-5 consults/week with some back of the envelope math.

And the case logs bring about concerns of whether folks are underlogging or just 'stopping' once they hit the minimum 450 number. So those are limitations of the cited study.

This is just for residency, not for the calcs about new patients per rad onc tied to the job market.
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All that said, why the significant decline over time... to me that's the lede, not the ~480 current average.
 
scarbrtj said:
All that said, why the significant decline over time... to me that's the lede, not the ~480 current average.
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Equal number of cases across a department but more attendings and more residents = dilution.

Maybe, in part, as residents have gone from frequently covering 2 attendings to covering one attending, some dip in case volume as well.

Potentially more SBRT/SRS (which is not counted in 'standard' EBRT numbers) resulting in decreases (see same paper for explosion of SRS and SBRT for residents).
 
OTN said:
I'd add HPV+ oropharyngeal cancer- outside of academic institutions who operate on everyone even though they shouldn't (cough, cough, Mayo Clinic, cough, cough), I think the message is getting out that chemoRT is the best option for most of these patients.
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Had a few f-ups from the aggressive tertiary center group in our neck of the woods also which did not go unnoticed by the local ENTs... I always tell pts and referrings trimodality therapy should never be a goal in h&n scc.

Suffice to say less pts are leaving the area to get ridiculous TORS procedures on locally-advanced disease
 
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medgator said:
Definitely never heard of these until this year, and definitely didn't see advertising graphics of residents with quotes about good job prospects etc
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Literally had them in med school, residency, and seen them as an attending. If you really think this is something new Bc of the application crash that’s totally incorrect. I wasn’t aware of quotes From residents that the job market is amazing and if that’s true then yes they should def be called out
 
Haybrant said:
Literally had them in med school, residency, and seen them as an attending. If you really think this is something new Bc of the application crash that’s totally incorrect. I wasn’t aware of quotes From residents that the job market is amazing and if that’s true then yes they should def be called out
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When i went to med school 2 decades ago, rad onc was like a secret handshake/fight club. Didn't talk about it, word had gotten out and it was ultra competitive
 
medgator said:
Had a few f-ups from the aggressive tertiary center group in our neck of the woods also which did not go unnoticed by the local ENTs... I always tell pts and referrings trimodality therapy should never be a goal in h&n scc.

Suffice to say less pts are leaving the area to get ridiculous TORS procedures on locally-advanced disease
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I’ve had ENT surgeons outright threaten to stop sending patients to RO if we don’t get on board with their TORs first approach to every OPX cancer
 
hbosch said:
Dan,

I’m repeating what many have already stated eloquently and nicely. You graduated 7 years ago and got a job in Chicago that you enjoy. You limited your search to 3 cities. For anyone looking for a job now is laughable to possibly mentally ill (as in not acknowledging reality). I am not calling you mentally ill to be clear.

Also, I have seen that a bad job market leads to people such as your senior Ralph to getting away with harassment, underpaying, poor leadership, toxic work culture and accepting (this is the worst part) dangerously bad physics with the possibility of hurting your patients and putting yourself at medicolegal risk. (I’m not saying this happening at your institution but it is happening at many community facilities). And you can’t ask your toxic leadership for help because they might just not care and if you complain they will make your life miserable. The people in these jobs (and it’s far more prevalent than you think) can’t just get up and find another job - even if they do it requires relocating far away from the life they have made for themselves with their families enduring yet another move. We’re not where you were 7 years ago. I wish I had started looking for a job that long ago. And yes, if you don’t know what the right residency number is than stop expanding.

And I will post this from an advice column- don’t know the specialty of the doctor but many of the criticizers seem to think young rad Oncs live in a vacuum without a life outside their job.

I absolutely fully regret going into radiation oncology because I can’t find a job near a large city and in small cities the support staff can be dangerous because talented and reliable people don’t want to live there. Otherwise I adore our field and what we do every day. I love being in a room with a patient. I love contouring. One of my favorite parts of a job to this day is opening up a follow up image. None of it makes up for feeling unsafe in your job. And it can’t make up for giving your family a stifling life or negatively affecting the career of your spouse. We are full formed humans not one dimensional contouring machines. And even if we were contour machines we are machines that rely on having adequate support staff.
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so essentially all good people live in big cities... *EDITED BY MODS*
 
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Carotenoid said:
so essentially all good people live in big cities... who is this dickwad?
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No plenty of ****ty people live in big cities too. Plenty of toxic big city programs. It’s not false to say recruiting to a small town is very hard, harder than for a big city, not just for physicians but for staff too. At this point, it’s harder for staff because the staff have more options than physicians do. I’m primarily talking about physics. I’m not saying every physicist in a small town is stupid or unreliable, I’m saying it’s harder in general to recruit a good physicist to a small town and keep them there unless the hospital is willing to pay a lot of money which most won’t.. you really can’t know how good a physicist is until you get there. And yes big city departments can also have crappy physicists but it will be easier for them to rectify and keep good ones. My name is Dr. Dickwad. If you are in a small town and you have a great physicist that is awesome for you.
 
Carotenoid said:
so essentially all good people live in big cities... who is this dickwad?
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It's a fairly common attitude, especially in those who have mindlessly chugged along through the leftist academia machine without asking questions or notice the overt indoctrination and gaslighting. (take a look at the big rad onc woke twitterati names if you want to see the nauseating brainwashed end product of this pipeline)

America's cities are quickly becoming unlivable hellscapes. Yet somehow, the problem is with the blue collar workers in red states without 4 year degrees who have irritatingly somehow achieved a middle class life anyway with jumping through their hoops and are frustratingly difficult to get fired/cancelled if they disagree with you on social media.

Why anyone would actually WANT to live there as a rad onc is beyond me. So what's the alternative?

Anyway, let me give you a perspective from the exact opposite in nowhere-ville...

Hospital systems, especially rural hospital systems, only care about the short term. As in, how can we pay out as little as possible tomorrow, not how can we invest to make higher profits later and deliver higher quality care. As such, they will promise the world to naive young recruits. It's all smoke and mirrors. Large signing bonuses are tied back to 5-10 year repayment plans. wRVU bonuses are unattainable because wRVU numbers are fudged and you can't see the books, 4 day workweeks are promised but you show up and are told to work fridays anyway or else the patients can't get treatment, you are told you will have control over your clinic but your staff questions everything you do because they are used to locums doctors who don't care and do whatever they want and approve crappy plans, you discover 401(k) matches don't vest until being there for 5 years, there is an inappropriate reliance on midlevels to the point that they are considered equals and the term midlevel is banned, the staff are not replaceable because the hospital refuses to pay fair market wages to hire good outside talent and instead prefer to underpay whatever the local community college churns out, the EMR and IT are ancient bottom-dollar relics that hinder your producitivity, perks promised during recruitment (cellphone, housing/relocation assistance, recruitment bonuses for referring new doctors) are never delivered upon, and if you question any of this to the admin you will be patronized, gaslighted, and called a liar for calling them a liar. The fight to try and keep them honest is exhausting. They are penny-wise and pound-foolish and will gladly shoot themselves in the foot and go back to the locums model rather than give you even a fraction of the 8 figures of global you are generating for them.

There is basically nowhere to go in this field. There may be a few opportunities to start your own center, but those are rapidly evaporating as the large university systems try and establish monopolies in the states. Once that final plan has been realized, we will all be contour monkeys following their care pathways and having most of our professional fees skimmed off to support the inefficiencies of the system. Technical revenues? GTFO.

I can't imagine going into debt as a 22 year old now to pursue a career in medicine. In what field can you really hang out your own shingle and make your own way these days without the parasites leeching as much as they can off you without killing you? Psych maybe? I can't believe I gave up the prime decade of my life to end up more miserable than when I started. I went to medical school essentially to have a valuable hard-to-replace skill and not have to worry about getting laid off in corporate america. It turns out hospital systems are happy to save a buck on a "provider" who delivers lower quality care just the way corporate America will gladly outsource your job to China to save a fraction of a percent.
 
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KHE88 said:
It's a fairly common attitude, especially in those who have mindlessly chugged along through the leftist academia machine without asking questions or notice the overt indoctrination and gaslighting. (take a look at the big rad onc woke twitterati names if you want to see the nauseating brainwashed end product of this pipeline)

America's cities are quickly becoming unlivable hellscapes. Yet somehow, the problem is with the blue collar workers in red states without 4 year degrees who have irritatingly somehow achieved a middle class life anyway with jumping through their hoops and are frustratingly difficult to get fired/cancelled if they disagree with you on social media.

Why anyone would actually WANT to live there as a rad onc is beyond me. So what's the alternative?

Anyway, let me give you a perspective from the exact opposite in nowhere-ville...

Hospital systems, especially rural hospital systems, only care about the short term. As in, how can we pay out as little as possible tomorrow, not how can we invest to make higher profits later and deliver higher quality care. As such, they will promise the world to naive young recruits. It's all smoke and mirrors. Large signing bonuses are tied back to 5-10 year repayment plans. wRVU bonuses are unattainable because wRVU numbers are fudged and you can't see the books, 4 day workweeks are promised but you show up and are told to work fridays anyway or else the patients can't get treatment, you are told you will have control over your clinic but your staff questions everything you do because they are used to locums doctors who don't care and do whatever they want and approve crappy plans, you discover 401(k) matches don't vest until being there for 5 years, there is an inappropriate reliance on midlevels to the point that they are considered equals and the term midlevel is banned, the staff are not replaceable because the hospital refuses to pay fair market wages to hire good outside talent and instead prefer to underpay whatever the local community college churns out, the EMR and IT are ancient bottom-dollar relics that hinder your producitivity, perks promised during recruitment (cellphone, housing/relocation assistance, recruitment bonuses for referring new doctors) are never delivered upon, and if you question any of this to the admin you will be patronized, gaslighted, and called a liar for calling them a liar. The fight to try and keep them honest is exhausting. They are penny-wise and pound-foolish and will gladly shoot themselves in the foot and go back to the locums model rather than give you even a fraction of the 8 figures of global you are generating for them.

There is basically nowhere to go in this field. There may be a few opportunities to start your own center, but those are rapidly evaporating as the large university systems try and establish monopolies in the states. Once that final plan has been realized, we will all be contour monkeys following their care pathways and having most of our professional fees skimmed off to support the inefficiencies of the system. Technical revenues? GTFO.

I can't imagine going into debt as a 22 year old now to pursue a career in medicine. In what field can you really hang out your own shingle and make your own way these days without the parasites leeching as much as they can off you without killing you? Psych maybe? I can't believe I gave up the prime decade of my life to end up more miserable than when I started. I went to medical school essentially to have a valuable hard-to-replace skill and not have to worry about getting laid off in corporate america. It turns out hospital systems are happy to save a buck on a "provider" who delivers lower quality care just the way corporate America will gladly outsource your job to China to save a fraction of a percent.
Click to expand...

so you thought you had it made and were gonna make bank and it all turned out to be a total lie? Sad story but cannot say I am surprised. The field is so ripe with conmen, the weight of the fruits is breaking the branches. The smell of rotting fruit fills the air. Be very careful out there folks! Sometimes the swamp you know is the best swamp.
 
thecarbonionangle said:
so you thought you had it made and were gonna make bank and it all turned out to be a total lie? Sad story but cannot say I am surprised. The field is so ripe with conmen, the weight of the fruits are breaking the branches. The smell of rotting fruit fills the air. Be very careful out there folks!
Click to expand...

I realized there were trade-offs and I went out there a bit rosy-eyed thinking I was providing some kind of service to patients who previously had not been getting good consistent cancer care. Nope. Turns out hospital has no interest in spending a dime as soon as you sign on that line. My salary is ok (but I was promised a significant production incentive that turned out to be the proverbial carrot so there's that) and it's the only thing that haven't not lived up to yet, but I'm not dumb enough to think that's going to last. I can see what they've done to older docs. Once they know you've built a house and have kids in school, they will start chipping away at you to see what they can get away with without you leaving When they finally push you too far and you submit your resignation they will come back and offer you some but not all of what they took away and act like they are doing you a favor and really bending them over. I've seen it happen already to two other specialists in less than a year. Hell, I have nothing tying me down. My s.o. bailed on me, I live in a sheithole duplex with walmart furniture, nothing is keeping me here and they are still basically doing everything they can to nudge me over the edge to the point I just don't show up. The patients are the only reason I still do at this point. I feel genuinely terrible that so many of the woke academics act like these deplorables and the poor care the receive aren't even worth discussing. Real issues are the ghost in the machine that holds back women and minorities from positions in the big city university centers. I'll take a paycut to go somewhere that isn't run by pathologic liars, which by the way, I am assured is "standard industry practice." From what I've seen in talking to other hospital systems, that may be the only truth they've told. That lying and screwing over doctors with unethical contracts and empty promises is in fact "standard industry practice."
 
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