Rad Onc Twitter

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Zahramar said:
You brave man you
View attachment 321455
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F

Simul you're always welcome here.

I just hope that when they finally throw me out of academics and all their affiliates for my online identity that there will be a job left for me to go to.
 
Grubbe-a-dub-dub said:
I was pressured to take my comments off Twitter by my medical director. Let's just say a not so happy chair contacted him so I folded.

I'm too fresh out of training to risk being blackballed by the community.

I can only assume the same happened to him.
Click to expand...

"We don't understand why people post under anonymous accounts", say academic faculty who pressure people to remove dissenting viewpoints from social media.

More news at 11!

Here's John with the weather.
 
I really, really hope that this is just a self-imposed hiatus rather than a permanent exodus for so many reasons

Simul is the one of the most valuable advocates for trainees in this field

His voice of dissent (if you want to call it that) on Twitter is much more valuable than the anonymous accounts' precisely because he represents himself openly & owns what he says - although that definitely comes at a potential personal price that I fear he is now facing the consequences of
 
DebtRising said:
Astro - where are all the non anonymous people who have concerns about the job market?

Non anonymous people - right here

Astro - ban them
Click to expand...

In case anyone thinks you're being hyperbolic, this is exactly what happened to Simul on ROHub.
 
bergonieandtribondeau said:
I really, really hope that this is just a self-imposed hiatus rather than a permanent exodus for so many reasons

Simul is the one of the most valuable advocates for trainees in this field

His voice of dissent (if you want to call it that) on Twitter is much more valuable than the anonymous accounts' precisely because he represents himself openly & owns what he says - although that definitely comes at a potential personal price that I fear he is now facing the consequences of
Click to expand...

I fear that he would have announced said hiatus rather than just going dark.

Wish I could say I were surprised. What I'm surprised about is how long it took for MDACC to apply the squeeze.
 
Neuronix said:
In case anyone thinks you're being hyperbolic, this is exactly what happened to Simul on ROHub.
Click to expand...

"WE can't have an official opinion on this, because the government will charge us with antitrust and collusion, and YOU can't have an official opinion on this...because we'll ban you."
 
RickyScott said:
Obviously someone at mdacc said something to banner
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Grubbe-a-dub-dub said:
I was pressured to take my comments off Twitter by my medical director. Let's just say a not so happy chair contacted him so I folded.
Click to expand...
RickyScott said:
Astro not happy about flurry of tweets yesterday.
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OTN said:
Wish I could say I were surprised. What I'm surprised about is how long it took for MDACC to apply the squeeze.
Click to expand...
We're buildin' rat ships here! Executing souls.
 
medgator said:
Word on the street is Marty said " Not my circus, not my clowns" before dropping the mic and riding out into that beautiful Arizona sunset
Click to expand...
Given my Polish blood I cannot let this pass. The appropriate idiom is ‘’Nie mój cyrk, nie moje małpy which translates to "Not my circus, not my monkeys"
 
Rad Onc twitter is the gift that keeps on giving. I swear. Check that upper right hand corner.
1603764960788.png


Jokes aside folks, mental illness is a serious thing and being an academic rad onc these days under the aegis of boomer chairs who know nothing about anything can easily upset mental wellbeing.

L'Chaim!!!
1603765148469.png
 
Zahramar said:
Rad Onc twitter is the gift that keeps on giving. I swear. Check that upper right hand corner.
View attachment 321490

Jokes aside folks, mental illness is a serious thing and being an academic rad onc these days under the aegis of boomer chairs who know nothing about anything can easily upset mental wellbeing.

L'Chaim!!!
View attachment 321491
Click to expand...

1603839537795.png


1603839623735.png


MAN that blackboard background certainly is...something
 
brushbeamscanning said:
I'm going to be honest, survey results are better than I expected aside from the full time private practice individual making <200k with a partnership outlook of <200k (I wonder if it's like an overseas job)
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Eh, I'm not that surprised (in part because ARRO Tweeted teaser results several weeks ago). We're making a "climate change" argument here, but people misconstrue the "SDN argument" as "those fools claim the sky is falling and there are no jobs, look at all these jobs".

I think it's important to make a distinction that right now, in 2020 (COVID problems and bombastic breadline jokes aside), there shouldn't be residents lining up at the unemployment office.

This survey reflects exactly what I would expect - perceptions of the job market by ~70% of the graduating class were negative-to-neutral. Those aren't your average SDN or Twitter posters. That's 130-140 who did not experience a positive employment experience. Does that happen in any other physician specialty outside of things like Nuclear Medicine or Pathology? Not to my knowledge.

This is the beginning. Without COVID I would have expected a continued deterioration over the next several years, with actual measurable unemployment metrics showing up before the decade was out. I think COVID kicked this into high gear. I think COVID threw the class of 2021 into disarray which will have downstream effects on future classes.

Every specialty, every economic sector of America is negatively affected by COVID. But Radiation Oncology has no elasticity to absorb this. ARRO knows this and already predicted this in one of their Tweets today. The survey is going to be horrible next year, because of COVID. But while other specialties will bounce back, we will really struggle. People want metrics? This survey kicks those metrics off.

Get ready.
 
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Whether market is saturated now or 3- 5 years from now, it will be saturated in the near future. I am not trying to convince arro or Astro of anything. Medstudents are the audience, and they are hyper alert to issue like geography, etc can’t see too many falling in love with the field when they rotate in a year and exposed to seniors looking for jobs then.
 
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elementaryschooleconomics said:
Eh, I'm not that surprised (in part because ARRO Tweeted teaser results several weeks ago). We're making a "climate change" argument here, but people misconstrue the "SDN argument" as "those fools claim the sky is falling and there are no jobs, look at all these jobs".

I think it's important to make a distinction that right now, in 2020 (COVID problems and bombastic breadline jokes aside), there shouldn't be residents lining up at the unemployment office.

This survey reflects exactly what I would expect - perceptions of the job market by ~70% of the graduating class were negative-to-neutral. Those aren't your average SDN or Twitter posters. That's 130-140 who did not experience a positive employment experience. Does that happen in any other physician specialty outside of things like Nuclear Medicine or Pathology? Not to my knowledge.

This is the beginning. Without COVID I would have expected a continued deterioration over the next several years, with actual measurable unemployment metrics showing up before the decade was out. I think COVID kicked this into high gear. I think COVID threw the class of 2021 into disarray which will have downstream effects on future classes.

Every specialty, every economic sector of America is negatively affected by COVID. But Radiation Oncology has no elasticity to absorb this. ARRO knows this and already predicted this in one of their Tweets today. The survey is going to be horrible next year, because of COVID. But while other specialties will bounce back, we will really struggle. People want metrics? This survey kicks those metrics off.

Get ready.
Click to expand...

I'm on the top row of salary with about twice the median vacay in a place I love. I didn't think I filled out that survey, but maybe I got tricked into it somehow. I'd have put satisfied. Still am. But now that I'm here, I also don't see how this is sustainable. I'm now exposed to the bottom line of it all in ways that academic docs are shielded from. I have the capacity to handle ~2x my current census. They're not gonna hire 1 more doc should the numbers go up that much on a regular basis. Iow, demand could go up 100% and I wouldn't look to increase the supply.
 
- I am glad for PGY-5 (2020 class) that has full (or close to FT) employment.
For the most part, they are new and cheaper, which is exactly what many hospitals and chairs want: cheap labor.

- However, to do a proper study, one needs to look at the BIG picture.

* How about a 40 yo radonc with 7 yrs of experience, quit job A bc it is so bad but have not found job B yet, so that radonc is unemployed.

* How about a 52 yo radon with 20 yrs of experience and for whatever reasons, work on PT 60% (3 days a week) bc he/she cannot find FT job.

This is a very complex picture and it will take massive amount of survey to get the complete national picture...I guess we can wait after Nov. 3 and see if we can get the Trump or Biden campaign army (this army should be free after Nov. 3 lol) to do a phone survey on every single radonc in the country.
 
While it's great that folks are looking at these issues, there's a number of methodological limitations with the abstracts and surveys related to residency expansion, the job market, and the decline of US student applications to the field.

1) They do not define the boundaries for a healthy radiation oncology job market.
2) They do not look at radiation oncology from the buyer (aka student) perspective.

It's very, very easy for graduating residents to be pleased they're getting any job, because they're getting a pay bump compared to PGY-5 year (except for fellows and instructors...sorry guys). It's also very, very easy for chairs and academic leaders to be pleased with job surveys, since beyond getting A job, getting A GOOD job is not their priority. They've said this on many occasions, and to be fair, it's not their responsibility to be looking after the income potential and happiness of residents.

Now, if I was a medical student looking into radiation oncology, I'd be looking at a number of factors. The job itself, in terms of intellectual engagement, patient relationships, and novel technology hasn't changed much in the last 10-15 years, and if anything, it's just gotten better. So, as a medical student, I'd be looking out for myself (I wouldn't be naive enough to trust my future chair to do that!). I'd be comparing rad onc against other fields (ROAD, surgical specialties, cancer-related specialties like heme onc).

A. Compensation

What is a "good" median compensation?

Looking at time-in-training as a crude metric, we'd expect rad onc to be better paid than anesthesiology, PM&R, ophthalmology, dermatology; similarly paid as radiology, orthopedics, urology, ENT; and lesser paid than neurosurgery. Because rad onc is a specialty, it's more valid to compare it against other specialties than to pediatrics or internal medicine.

Further, I'd argue that MGMA data is invalid because it considers the entire radiation oncology workforce. We all know there are older rad onc's that are doing very well financially in ownership arrangements that are rarely accessible to new graduates. Also, early signs of problems with the rad onc job market would likely affect newcomers, i.e. graduating residents. Looking at ARRO's survey data, the median year 1 salary for graduating residents is $325-350k/year (with bonus).

Instead of MGMA, which Trevor Royce uses to claim rad onc is #2 amongst 20 specialties in his ARRO survey breakdown, we'll use Merritt Hawkins. Merritt Hawkins’ Review tracks the starting salaries being offered to recruit physicians. Average starting salaries represent the base only and are not inclusive of bonuses or other incentives. Merritt Hawkins’ salary ranges are therefore indicators of the financial incentives needed to attract physicians already established in a practice or those coming out of residency to a practice opportunity [arguably the vast majority of job seekers].
  • Anesthesiology mean: $399k
  • Dermatology mean: $419k
  • Radiology mean: $423k
  • Urology mean: $477k
  • Orthopedics mean: $626k
It's difficult to compare across specialties, and I don't have Merritt Hawkins' data for radiation oncology (but I'd welcome it), but my point is this. You can't just say $325-350k is a lot of money. You have to establish what a "good" median/mean compensation is prior to data collection, and compare against other choices that medical students have when looking at specialties.

B. Geographic Freedom

Others have discussed this, but the main issue with abstracts or papers on the geography of rad onc employment is that they're out of touch with the decision-making process of students or graduating residents.

1. Instead of 4-5 mega-regions (e.g. "The West"), geographic regions ought to be more granular, reflecting cultural, recreational, sociopolitical, economic, and culinary strengths of each region. For example, I'd divide geographic regions into:
  • Pacific Northwest (WA, OR): whale-watching, ferryboats
  • California (CA): sunshine, beaches, high taxes
  • Desert Southwest (NV, AZ, NM): sunshine, rattlesnakes
  • Mountain West (CO, WY, MT): skiing, national parks, grizzly bears
  • Texas (TX): oil, bbq
  • Great Plains (OK, KS, NE...): open spaces, wind turbines
  • Deep South (LA, AL, MS...): crawfish, college football
  • Florida (FL): sunshine, Disney, alligators
  • Midwest (MO, IN, IA...): corn fields, college sports
  • Great Lakes (MN, WI, MI...): summers on the lake, cold winters
  • Appalachia (Upstate NY, PA, WV...): forests, open spaces
  • Mid-Atlantic (NYC, NJ, DC): city life, tourist attractions
  • New England (MA, NH, CT, RI...): college kids, clam chowder
Jokes aside, if I wanted to end up in a specific region, this would represent my thinking on what's reasonably close to family and friends rather than the mega-regions.

2. There's also methodological issues in terms of how rural vs. urban locations are defined, but I won't get into that.

C. Academic Career Development

I won't touch on this in depth, but if I was a capable MD student or a star MD/PhD, and I was interested in academics, I'd look at opportunities for career development. I'd be interesting in startup funding, protected time, formal mentorship from senior faculty, pathways to R01 funding, and pathways up the academic ladder. I'm out of touch with the academic radiation oncology world, but especially for academics, which now comprises 55% of new jobs apparently, there's much more to recruiting medical students besides dollars and living somewhere desirable like SoHo or the Mission.

Lastly, I'll just touch on one other aspect of residency expansion. Residency expansion isn't just about the job market, it's about the quality of residency training. As Chelain Goodman described across a variety of metrics, there's significant heterogeneity across residency programs. My concern is that, with the RRC's lack of power, residency programs can open or expand with little quality control. What's to stop a community hospital or private practice from opening a residency program, because it's cheaper than hiring 4-8 midlevels and it brings "prestige"?
 
Just curious... how many hours per week of social media posting & browsing is needed at the assistant radonc professor level to successfully grow one's career? What about the mental and emotional energy spent carefully rethinking & rephrasing tweet drafts to achieve the necessary politically correct luster before hitting the post button?
 
FreakFlag said:
Just curious... how many hours per week of social media posting & browsing is needed at the assistant radonc professor level to successfully grow one's career?
Click to expand...

Almost as much time as some of us (like myself) spend on SDN. It's unfortunate, if the two halves of rad onc (PP/academics, Twitter/SDN) could work together, we could go far.
 
bluebubbles said:
While it's great that folks are looking at these issues, there's a number of methodological limitations with the abstracts and surveys related to residency expansion, the job market, and the decline of US student applications to the field.

1) They do not define the boundaries for a healthy radiation oncology job market.
2) They do not look at radiation oncology from the buyer (aka student) perspective.

It's very, very easy for graduating residents to be pleased they're getting any job, because they're getting a pay bump compared to PGY-5 year (except for fellows and instructors...sorry guys). It's also very, very easy for chairs and academic leaders to be pleased with job surveys, since beyond getting A job, getting A GOOD job is not their priority. They've said this on many occasions, and to be fair, it's not their responsibility to be looking after the income potential and happiness of residents.

Now, if I was a medical student looking into radiation oncology, I'd be looking at a number of factors. The job itself, in terms of intellectual engagement, patient relationships, and novel technology hasn't changed much in the last 10-15 years, and if anything, it's just gotten better. So, as a medical student, I'd be looking out for myself (I wouldn't be naive enough to trust my future chair to do that!). I'd be comparing rad onc against other fields (ROAD, surgical specialties, cancer-related specialties like heme onc).

A. Compensation

What is a "good" median compensation?

Looking at time-in-training as a crude metric, we'd expect rad onc to be better paid than anesthesiology, PM&R, ophthalmology, dermatology; similarly paid as radiology, orthopedics, urology, ENT; and lesser paid than neurosurgery. Because rad onc is a specialty, it's more valid to compare it against other specialties than to pediatrics or internal medicine.

Further, I'd argue that MGMA data is invalid because it considers the entire radiation oncology workforce. We all know there are older rad onc's that are doing very well financially in ownership arrangements that are rarely accessible to new graduates. Also, early signs of problems with the rad onc job market would likely affect newcomers, i.e. graduating residents. Looking at ARRO's survey data, the median year 1 salary for graduating residents is $325-350k/year (with bonus).

Instead of MGMA, which Trevor Royce uses to claim rad onc is #2 amongst 20 specialties in his ARRO survey breakdown, we'll use Merritt Hawkins. Merritt Hawkins’ Review tracks the starting salaries being offered to recruit physicians. Average starting salaries represent the base only and are not inclusive of bonuses or other incentives. Merritt Hawkins’ salary ranges are therefore indicators of the financial incentives needed to attract physicians already established in a practice or those coming out of residency to a practice opportunity [arguably the vast majority of job seekers].
  • Anesthesiology mean: $399k
  • Dermatology mean: $419k
  • Radiology mean: $423k
  • Urology mean: $477k
  • Orthopedics mean: $626k
It's difficult to compare across specialties, and I don't have Merritt Hawkins' data for radiation oncology (but I'd welcome it), but my point is this. You can't just say $325-350k is a lot of money. You have to establish what a "good" median/mean compensation is prior to data collection, and compare against other choices that medical students have when looking at specialties.

B. Geographic Freedom

Others have discussed this, but the main issue with abstracts or papers on the geography of rad onc employment is that they're out of touch with the decision-making process of students or graduating residents.

1. Instead of 4-5 mega-regions (e.g. "The West"), geographic regions ought to be more granular, reflecting cultural, recreational, sociopolitical, economic, and culinary strengths of each region. For example, I'd divide geographic regions into:
  • Pacific Northwest (WA, OR): whale-watching, ferryboats
  • California (CA): sunshine, beaches, high taxes
  • Desert Southwest (NV, AZ, NM): sunshine, rattlesnakes
  • Mountain West (CO, WY, MT): skiing, national parks, grizzly bears
  • Texas (TX): oil, bbq
  • Great Plains (OK, KS, NE...): open spaces, wind turbines
  • Deep South (LA, AL, MS...): crawfish, college football
  • Florida (FL): sunshine, Disney, alligators
  • Midwest (MO, IN, IA...): corn fields, college sports
  • Great Lakes (MN, WI, MI...): summers on the lake, cold winters
  • Appalachia (Upstate NY, PA, WV...): forests, open spaces
  • Mid-Atlantic (NYC, NJ, DC): city life, tourist attractions
  • New England (MA, NH, CT, RI...): college kids, clam chowder
Jokes aside, if I wanted to end up in a specific region, this would represent my thinking on what's reasonably close to family and friends rather than the mega-regions.

2. There's also methodological issues in terms of how rural vs. urban locations are defined, but I won't get into that.

C. Academic Career Development

I won't touch on this in depth, but if I was a capable MD student or a star MD/PhD, and I was interested in academics, I'd look at opportunities for career development. I'd be interesting in startup funding, protected time, formal mentorship from senior faculty, pathways to R01 funding, and pathways up the academic ladder. I'm out of touch with the academic radiation oncology world, but especially for academics, which now comprises 55% of new jobs apparently, there's much more to recruiting medical students besides dollars and living somewhere desirable like SoHo or the Mission.

Lastly, I'll just touch on one other aspect of residency expansion. Residency expansion isn't just about the job market, it's about the quality of residency training. As Chelain Goodman described across a variety of metrics, there's significant heterogeneity across residency programs. My concern is that, with the RRC's lack of power, residency programs can open or expand with little quality control. What's to stop a community hospital or private practice from opening a residency program, because it's cheaper than hiring 4-8 midlevels and it brings "prestige"?
Click to expand...

Overall a great post, except the median compensation part. I know you said "the vast majority of job seekers" are new grads. There are tons of people who change jobs across specialties at different career points (often going from a ****ty academic instructor job to the brighter pastures of private practice), and you don't have the number for rad onc at all so it's a total guess there.
 
bluebubbles said:
While it's great that folks are looking at these issues, there's a number of methodological limitations with the abstracts and surveys related to residency expansion, the job market, and the decline of US student applications to the field.

1) They do not define the boundaries for a healthy radiation oncology job market.
2) They do not look at radiation oncology from the buyer (aka student) perspective.

It's very, very easy for graduating residents to be pleased they're getting any job, because they're getting a pay bump compared to PGY-5 year (except for fellows and instructors...sorry guys). It's also very, very easy for chairs and academic leaders to be pleased with job surveys, since beyond getting A job, getting A GOOD job is not their priority. They've said this on many occasions, and to be fair, it's not their responsibility to be looking after the income potential and happiness of residents.

Now, if I was a medical student looking into radiation oncology, I'd be looking at a number of factors. The job itself, in terms of intellectual engagement, patient relationships, and novel technology hasn't changed much in the last 10-15 years, and if anything, it's just gotten better. So, as a medical student, I'd be looking out for myself (I wouldn't be naive enough to trust my future chair to do that!). I'd be comparing rad onc against other fields (ROAD, surgical specialties, cancer-related specialties like heme onc).

A. Compensation

What is a "good" median compensation?

Looking at time-in-training as a crude metric, we'd expect rad onc to be better paid than anesthesiology, PM&R, ophthalmology, dermatology; similarly paid as radiology, orthopedics, urology, ENT; and lesser paid than neurosurgery. Because rad onc is a specialty, it's more valid to compare it against other specialties than to pediatrics or internal medicine.

Further, I'd argue that MGMA data is invalid because it considers the entire radiation oncology workforce. We all know there are older rad onc's that are doing very well financially in ownership arrangements that are rarely accessible to new graduates. Also, early signs of problems with the rad onc job market would likely affect newcomers, i.e. graduating residents. Looking at ARRO's survey data, the median year 1 salary for graduating residents is $325-350k/year (with bonus).

Instead of MGMA, which Trevor Royce uses to claim rad onc is #2 amongst 20 specialties in his ARRO survey breakdown, we'll use Merritt Hawkins. Merritt Hawkins’ Review tracks the starting salaries being offered to recruit physicians. Average starting salaries represent the base only and are not inclusive of bonuses or other incentives. Merritt Hawkins’ salary ranges are therefore indicators of the financial incentives needed to attract physicians already established in a practice or those coming out of residency to a practice opportunity [arguably the vast majority of job seekers].
  • Anesthesiology mean: $399k
  • Dermatology mean: $419k
  • Radiology mean: $423k
  • Urology mean: $477k
  • Orthopedics mean: $626k
It's difficult to compare across specialties, and I don't have Merritt Hawkins' data for radiation oncology (but I'd welcome it), but my point is this. You can't just say $325-350k is a lot of money. You have to establish what a "good" median/mean compensation is prior to data collection, and compare against other choices that medical students have when looking at specialties.

B. Geographic Freedom

Others have discussed this, but the main issue with abstracts or papers on the geography of rad onc employment is that they're out of touch with the decision-making process of students or graduating residents.

1. Instead of 4-5 mega-regions (e.g. "The West"), geographic regions ought to be more granular, reflecting cultural, recreational, sociopolitical, economic, and culinary strengths of each region. For example, I'd divide geographic regions into:
  • Pacific Northwest (WA, OR): whale-watching, ferryboats
  • California (CA): sunshine, beaches, high taxes
  • Desert Southwest (NV, AZ, NM): sunshine, rattlesnakes
  • Mountain West (CO, WY, MT): skiing, national parks, grizzly bears
  • Texas (TX): oil, bbq
  • Great Plains (OK, KS, NE...): open spaces, wind turbines
  • Deep South (LA, AL, MS...): crawfish, college football
  • Florida (FL): sunshine, Disney, alligators
  • Midwest (MO, IN, IA...): corn fields, college sports
  • Great Lakes (MN, WI, MI...): summers on the lake, cold winters
  • Appalachia (Upstate NY, PA, WV...): forests, open spaces
  • Mid-Atlantic (NYC, NJ, DC): city life, tourist attractions
  • New England (MA, NH, CT, RI...): college kids, clam chowder
Jokes aside, if I wanted to end up in a specific region, this would represent my thinking on what's reasonably close to family and friends rather than the mega-regions.

2. There's also methodological issues in terms of how rural vs. urban locations are defined, but I won't get into that.

C. Academic Career Development

I won't touch on this in depth, but if I was a capable MD student or a star MD/PhD, and I was interested in academics, I'd look at opportunities for career development. I'd be interesting in startup funding, protected time, formal mentorship from senior faculty, pathways to R01 funding, and pathways up the academic ladder. I'm out of touch with the academic radiation oncology world, but especially for academics, which now comprises 55% of new jobs apparently, there's much more to recruiting medical students besides dollars and living somewhere desirable like SoHo or the Mission.

Lastly, I'll just touch on one other aspect of residency expansion. Residency expansion isn't just about the job market, it's about the quality of residency training. As Chelain Goodman described across a variety of metrics, there's significant heterogeneity across residency programs. My concern is that, with the RRC's lack of power, residency programs can open or expand with little quality control. What's to stop a community hospital or private practice from opening a residency program, because it's cheaper than hiring 4-8 midlevels and it brings "prestige"?
Click to expand...

This post (and logical argument) speaks to my soul.

bluebubbles said:
Almost as much time as some of us (like myself) spend on SDN. It's unfortunate, if the two halves of rad onc (PP/academics, Twitter/SDN) could work together, we could go far.
Click to expand...

I ironically use SDN as my "stress release valve". I can't explore these topics in real life safely - my faculty would crucify me, and my family doesn't understand what in the world I'm talking about (I did literally laugh at loud when I was catching up with my Mom a few weeks ago and she goes "I don't get why you're so stressed out about finding a job, aren't you a doctor?").

It's why I rarely comment on the clinical posts too. That at least, I'm "allowed" to explore to my heart's content in real life. It's much safer for me to disagree with faculty opinion on a new manuscript than it is for me to disagree on the number of residents we're matching.
 
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1603883424423.png


1) Oh my God, I agree with Ralph.

2) As someone who has a PhD, Brian NAILS IT for me here. I fit into most of those boxes (burned out, slow project, want to focus on clinical learning). That being said...I can still play the game, and have managed to author or co-author over a dozen manuscripts in residency. Are any of them good? Eh...
 
elementaryschooleconomics said:
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1) Oh my God, I agree with Ralph.

2) As someone who has a PhD, Brian NAILS IT for me here. I fit into most of those boxes (burned out, slow project, want to focus on clinical learning). That being said...I can still play the game, and have managed to author or co-author over a dozen manuscripts in residency. Are any of them good? Eh...
Click to expand...
Excessive Publication is out of hand and probably a bigger driver of residency expansion than cheap labor. It wasn’t that long ago that resident at top programs would be expected to produce 2-3 articles over 4 years. No one had 12.
 
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Although it's only one year, one of the biggest take-aways from the presentation was the percent of 2019 graduates entering each type of practice:

Academic: 54% (n=96)
Private practice: 30% (53)
Hospital employed community practice: 13% (n=23)
Fellowship: n=2
Military: n=3

Of those 95 graduates starting academic jobs, 62 reported that they will only be staffing the main site, with 18 staffing main + satellite, and 14 staffing only satellite locations.

I could be wrong, but I recall this number being significantly lower in the past. I do not think prior hiring years had >50% of graduating residents going into academia (but please correct me if I'm wrong).

From a labor pool perspective, this may explain why we are not (yet) seeing significant unemployment. Academic ROs typically have other duties (research, teaching, @Ing each other on Twitter) and may see fewer patients than a RO employed by a hospital or part of a private practice. Even with hypofractionation, salaries may be (temporarily) buttressed by a higher percentage of graduates in academia. These systems typically attract patients with higher reimbursing insurance and their systems have negotiated higher rates.

In other words, academic practices can absorb new graduates, have them treat fewer patients than 1 FTE at a non-academic, maintain salaries (for the time being), and there can be relatively full employment. Other smarter people have commented that there is "slack" in the hiring system, and I think that's what we are seeing here.
 
elementaryschooleconomics said:
As someone who has a PhD, Brian NAILS IT for me here. I fit into most of those boxes (burned out, slow project, want to focus on clinical learning). That being said...I can still play the game, and have managed to author or co-author over a dozen manuscripts in residency. Are any of them good? Eh...
Click to expand...

Great work! You've done right by yourself.

Brian nails it and this resonates with my experience ~10 years ago. I had a PhD. I also had kids before I started residency (more likely with PhD holders) and did not have research continuity between my PhD work and whatever I was going to try to accomplish in Oncology. Perhaps due to laziness (likely) and the fact that I had a good number of publications, I had no interest in doing chart reviews or getting easy publications. I chose an interesting fairly basic science project out of the mainstream and was able to get one good basic/early translational type publication out of it and several abstracts. I discovered lots of limitations to the project and impressed no one but myself. I am now a community doc but would have been happy in academics, I don't think the academics wanted me. (No one should take my approach to residency.)

That 4-8 year age difference is a big deal going into residency and all things change when life has already happened to you and you have a family. My program was pretty notable and have placed people well, but all the folks doing science at the next level either had 1. continuity with their PhD or other research that preceded residency or 2. were willing to do research fellowships and commit enormous time to career development during and after residency (not PhDs).

In addition, there has been an enormous investment in radiation/immunotherapy research, to the point that nearly every person that I knew from residency that was successful getting a position doing some basic/translational work is doing this. This is obviously important work, but not a wise allocation of resources or talent from a distant perspective.

Chairs likes PhDs and clearly this provides a competitive edge when matching, but unless you have research continuity going in or are really good at playing the game, it can be an albatross on your career.
 
communitydoc13 said:
Chairs likes PhDs and clearly this provides a competitive edge when matching, but unless you have research continuity going in or are really good at playing the game, it can be an albatross on your career.
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This has been exactly my experience with the job market. I was recruited because of the PhD at the residency level, but it definitely feels like an albatross at the jobs level. Especially if you didn't just do retrospective chart reviews and also tried to do a more longitudinal/substantial project during your elective time, many places assume you're interested in not just academics, but physician-scientist academics.

Small problem, those jobs aren't plentiful even in the best of times. For something which often gave me an edge before, I find it weighing me down as time goes on. Fortunately I did keep my hand in a wide range of projects, which I highly recommend residents do, unless you have a defined career plan and are willing to accept nothing else.
 
GapCalc said:
Although it's only one year, one of the biggest take-aways from the presentation was the percent of 2019 graduates entering each type of practice:

Academic: 54% (n=96)
Private practice: 30% (53)
Hospital employed community practice: 13% (n=23)
Fellowship: n=2
Military: n=3

Of those 95 graduates starting academic jobs, 62 reported that they will only be staffing the main site, with 18 staffing main + satellite, and 14 staffing only satellite locations.

I could be wrong, but I recall this number being significantly lower in the past. I do not think prior hiring years had >50% of graduating residents going into academia (but please correct me if I'm wrong).

From a labor pool perspective, this may explain why we are not (yet) seeing significant unemployment. Academic ROs typically have other duties (research, teaching, @Ing each other on Twitter) and may see fewer patients than a RO employed by a hospital or part of a private practice. Even with hypofractionation, salaries may be (temporarily) buttressed by a higher percentage of graduates in academia. These systems typically attract patients with higher reimbursing insurance and their systems have negotiated higher rates.

In other words, academic practices can absorb new graduates, have them treat fewer patients than 1 FTE at a non-academic, maintain salaries (for the time being), and there can be relatively full employment. Other smarter people have commented that there is "slack" in the hiring system, and I think that's what we are seeing here.
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I have made the point that academics is the only reason there’s not employment-related wailing and gnashing of teeth many many times. Can they keep hiring and absorbing the brunt of the oversupply forever? Maybe? As long as they keep slowly strangling their competitors, and APM or something other never forces new financial realities. Academics: it’s where the jobs at. Yay.
 
scarbrtj said:
I have made the point that academics is the only reason there’s not employment-related wailing and gnashing of teeth many many times. Can they keep hiring and absorbing the brunt of the oversupply forever? Maybe? As long as they keep slowly strangling their competitors, and APM or something other never forces new financial realities. Academics: it’s where the jobs at. Yay.
Click to expand...

Practices have to stop selling out to academic centres. This is the result of the Hallahan crony plan to keep wages down and make everyone an “academic” at a sleepy satellite with zero chance for career advancement. the fact that most jobs are in “academics” is definitely alarming. New graduates have very rarely opportunities with even split of fees and technical which is something people had access to in the past. the future is take it or leave it and i dont care because i have 80 people on my desk who want the job. No chance to lateral and you’re stuck.

if you have a chance at one of those rare excellent academic jobs with protected time at main site with tons of support and career advancement with a great department, i am very happy for you. The majority of people will not get this job.
 
As a field medicine tends to put md phds on a pedestal and rad onc is very guilty of this.

Are people thinking residents should be running trials? Putting out nature papers that take 3 years of work full time at a minimum?

What exactly are they supposed to do?

honestly another dumb take all around. Yes much of the research is **** but let’s also not have a dumb impossible standard for residents, and lets not pretend like the “talent” would be pumping out nejm papers if they matched in radiology. Retrospective research is what is realistically achievable and what is done in other fields by most trainees.

Better take: drop the overemphasis on research across medicine and in our field especially, for residents, so they don’t feel pressure to do crap and get done with training sooner. Obviously a double edged sword when we have a huge oversupply though.
 
MegaVoltagePhoton said:
As a field medicine tends to put md phds on a pedestal and rad onc is very guilty of this.

Are people thinking residents should be running trials? Putting out nature papers that take 3 years of work full time at a minimum?

What exactly are they supposed to do?

honestly another dumb take all around. Yes much of the research is **** but let’s also not have a dumb impossible standard for residents, and lets not pretend like the “talent” would be pumping out nejm papers if they matched in radiology. Retrospective research is what is realistically achievable and what is done in other fields by most trainees.

Better take: drop the overemphasis on research across medicine and in our field especially, for residents, so they don’t feel pressure to do crap and get done with training sooner. Obviously a double edged sword when we have a huge oversupply though.
Click to expand...

This is right on the money.
 
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