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Looks like the word is out. Many programs won’t fill this cycle
Rad onc with biggest decrease in applications of any specialty
- Thread starter Krukenberg
- Start date
Looks like the word is out. Many programs won’t fill this cycle
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deleted947887
More spots than applicants. Ironically, the article by Kachnic and Wallner criticizing the "quality" of residents is likely responsible for the decline in the "quality" of residents. The system is working. "How do we do more to attract medical students?" How about you stop abusing your residents? How about you don't fail 50% of them? The moral of the story is respect your workers, otherwise you'll lose them.
What an embarassment. The field is lead by a few sad, old, washed-out has-beens.
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All the program slots will still fill, just not with US grads, and the job market will still suffer. This is not about the exam, but job prospects. It is about doubling residencies over past 10 years while number of fractions declines and the field bets on sketchy technologies:
https://www.clinicaloncologyonline.net/article/S0936-6555(17)30479-X/abstract
" Policy makers have now turned their attention, and their anger, to proton beam therapy for prostate cancer, declaring it to be the ultimate practice of ‘no value’ medicine."
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US grads may be getting the messege which is good but IMG/FMG will likely take whatever they can. Need to start closing programs but it’s likely too little too late for those graduating in the next few years. The damage is already done.
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Man, you guys are crazy with this doom and gloom. Rad onc is one of the smallest fields and so subject to more fluctuation. Look at neurosurg or med/peds.. lots of variability there also. I agree we shouldn’t expand residency slots any further, but don’t read so much into 1 time/data point.
Also why would anyone from other fields in medicine login and post or troll a Rad Onc forum? Clearly people who had some prior interest in Rad Onc and didn’t get in or unhappy with current field and want to switch, or just trolling to get a rise.. think about that..
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deleted947887
Yeah, ok. Its a conspiracy. There is no such thing as "someone who couldn't get into rad onc" anymore. This is now officially a Visa-field.
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By your own admission, that "doom and gloom" may be warranted. As others have stated previously, rad onc has always been tough and random in terms of geographic availability.
My gut feeling knowing my geographic region, talking to others and perusing the astro career center the last several years supports a trend of decreasing job availability in more "desirable" locales. This was not as prevalent 5-10 years ago when we were graduating far fewer.
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I think some of the jobs we are seeing presently are a result of a "dead cat bounce." ie. some uptick in hiring because you can get a doc for under 200k (like stanford), or the proton center in new jersey who needs night coverage, or my former residency that seems to have gone on a hiring spree where they now have 12-15 docs for 80-100 pts
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Way to go **EDITED BY MOD**! Your negativity infected class of '19.
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deleted947887
Hey! No cursing. No one is infected. You're in denial. That's ok. It's part of the 7 steps to recovery. You'll be ok. You just may have to write your own notes or spend more time with a non-english speaking grad.
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The anti-hero plays a vital role in life, comic books, history, the American Presidency...
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OR we prevented good medical students from making a terrible decision. That's the way I see it.
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That sentiment is irresponsible. you seem confident that everything will be fine in 5 years?
If a medstudent is interested in tying his professional future to the delivery of radiation for cancer for the next 40 years, they should rotate in the field and speak with the residents about the job search, trends in the field etc. Medstudents, who often have naive reverence for academics, just have to look to pathology to see that a greedy academic society is certainly capable of destroying their future. Had you been in pathology 10 years ago, would you have be telling them to disregard the aholes, that the programs know best?"
Are we on that course? Path residents at my hospital are serving multiple fellowships (and they are all writing 3-4 papers/year). That kind of BS was inconceivable to me as a medstudent 15 years ago and still somehow doesnt seem like it should be possible in America.
Nobody in this field should be marginalized to treating skin cancer in nursing homes with hdr, locumsing, or pimping protons to prostate pts because of irresponsible residency expansion.
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Outside of the cursing (not allowed), yes it did. The sky may be falling on all of us mere peasants not in ASTRO leadership.
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Get ready for multiple programs not to fill this year. Get ready for an FMG in your department. It will begin with smaller programs but eventually trickle to “big names”. Our spots will fill with desperate DOs and FMGs.
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A 20% drop is significant over 5 years, no?
This is the first year there will be more spots than US applicants. This means everybody who wants to get into rad onc will get in.
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The greed of “leaders” like LK, PW, etc have ruined the field-fact that med students know its good thing. I recall Stanford “leaders” shamelessly expanding and being called out on this thread, having the thread locked down. They reap what they sow.
Buckle up!
Buckle up!
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deleted950463
This is good for me as I am a DO med student. I am glad that there will be more than 4 DOs matching radonc this year hopefully.
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Is it good though? If given the information available now and I was in 4th year, I sure as hell would not be applying for rad onc, even though I do enjoy the day-to-day. That’s going to be changing IF one gets a job, it will not be like the jobs that are even available today. Tread with caution.
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Again if you're looking for a decent lifestyle and good pay with an interesting job in the middle of nowhere USA, this may the perfect storm for you.
Eventually those jobs may be gone too though if the leadership of this field continues on this current course
Eventually those jobs may be gone too though if the leadership of this field continues on this current course
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Damn, I'm coming up on my contract renewal, maybe I shouldn't be pressing so hard on my demands these days... 
Yeah I mean it’s sort of like an off the rack sale at Marshall’s You’re getting it on the cheap but it’s still garbage and the colors will run the second you wash it. At the end of the day, you’re the one that’s gotta make it work for the next 30 years. And lest you think you can just retrain if times get tough just remember that at certain age nobody is really interested in retraining or even hiring you unless your willing to work cheaper.
I sincerely hope that glass half full type of attitude sustains you for the long run because you’re in for some real Greek tragedy. Just when you think your expectations are low...reduce that by 75%.
By the way I apologize to anyone who likes Marshall’s, lumping this field in with bargain basement deals is clearly insulting to all those who manage Marshall’s stores across this great nation and work tirelessly to provide us with affordable clothing.
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Speaking to the PGY-5s this year, there seem to be plenty of jobs available in NYC, LA, the Bay Area, Dallas, etc. Its true that many of the available jobs in the desirable locations are satellite jobs, but even those are offering 350k+.
In "less desirable locations" - I have friends who have landed sweet PP gigs with technical and professional revenues/partner tracks in 2-4 years.
From all accounts, the job market IS better than it was 2-3 years ago.
In "less desirable locations" - I have friends who have landed sweet PP gigs with technical and professional revenues/partner tracks in 2-4 years.
From all accounts, the job market IS better than it was 2-3 years ago.
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deleted947887
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Maybe if you spent less time on lawsuits, then you could find a job like that.
Good PP jobs are all about connections and networking. These jobs don't end up on ASTRO jobs.
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deleted947887
Ok. Connections and networking. That makes more sense. Totally changes everything. Now I believe you.
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deleted950463
Connection and networking aka they are MDA or sloan grads. If you are at a smaller program your mileage may vary.
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And just keep in mind, we aren't the only anal orifices 'round here. Nearly 1/3 of US Rad Onc seniors regret their residency choice and have "stresses" about securing a job. Even radiation therapists have some career dyspepsia.
Not. All. Accounts.
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That is a complete lie. I know the NYC and LA job markets very well. And, plenty of jobs in the Bay area- I hope you are just a troll. Again, medstudents are going to rotate in the field a learn from the experiences of senior residents (and now the fellows)
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MSKCC is hiring a few (I think I was quoted 5-10 at ASTRO) in their network (as I mentioned, these were satellite jobs, so perhaps not the ideal job). I had friends interview for jobs in LA area (2 jobs that I know of) as well as the Bay Area (Kaiser expanding, etc). The "not so ideal location" jobs with technical/professional components were in the Southwest, Southeast, and South. btw, most of the folks I spoke to were not from MDA/MSKCC but yes they networked early and often.
A co-resident (mid tier residency program) who is applying to academics told me there are 30+ academic jobs and he doesn't have Nature/NEJM pubs. He is getting plenty of interviews but yes the 80/20 type jobs are limited/next to non-existent unless you're a top 5-10 candidate probably.
Also @scarbrtj - you're over-interpreting the data. I'm sure there are many (maybe even 15-20%?) of rad onc PGY-5 who regret their specialty choice because of some geographic etc restrictions associated with the field. Certainly derm has a better job market and better compensation/work ratio. But that survey asked if they would choose "the same training program." ...which suggests many programs have areas where they can improve on, but it doesn't mean they would pick a different specialty.
Also search JAMA "Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians" for data on "career choice regret" in other specialties (can't post link)
The results from the 2017 workforce study are clear - we have too many trainees (compared to 2012). I agree. That being said, the sky is not falling, and residents this year (anecdotal, I don't have any data) say the market is better than it was 2-3 years ago. Also the number of residents accepted has stayed fairly stable since 2015 (see nrmp match data)
So while some bad actors (read: a certain California program) are expanding residency positions and offering predatory "instructor" positions, I think many leaders/ASTRO are trying to do the right thing.
A co-resident (mid tier residency program) who is applying to academics told me there are 30+ academic jobs and he doesn't have Nature/NEJM pubs. He is getting plenty of interviews but yes the 80/20 type jobs are limited/next to non-existent unless you're a top 5-10 candidate probably.
Also @scarbrtj - you're over-interpreting the data. I'm sure there are many (maybe even 15-20%?) of rad onc PGY-5 who regret their specialty choice because of some geographic etc restrictions associated with the field. Certainly derm has a better job market and better compensation/work ratio. But that survey asked if they would choose "the same training program." ...which suggests many programs have areas where they can improve on, but it doesn't mean they would pick a different specialty.
Also search JAMA "Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians" for data on "career choice regret" in other specialties (can't post link)
The results from the 2017 workforce study are clear - we have too many trainees (compared to 2012). I agree. That being said, the sky is not falling, and residents this year (anecdotal, I don't have any data) say the market is better than it was 2-3 years ago. Also the number of residents accepted has stayed fairly stable since 2015 (see nrmp match data)
So while some bad actors (read: a certain California program) are expanding residency positions and offering predatory "instructor" positions, I think many leaders/ASTRO are trying to do the right thing.
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In the case of New York and LA, there are always several jobs, and both have 15-20 mill metropolitan areas. Probably around 10-20% of residents from those locations can stay if they choose in a given year, assuming no competition from the rest of the country, but the word "plenty" is simply not accurate. I graduated abt 10 years ago with around 90 residents in my class, and could not find a job in NYC at the time. Most major centers have human resource policies that require public posting of jobs even if they have a candidate in mind, so I really doubt there is a hidden stash of jobs in these locations for the well connected. (and large centers with satellites now dominate most desirable urban markets) Lastly, there will be variability in the job market from year to year, just like the weather, but doesnt make me doubt global warming.
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Connections and networking. I think the poster got lost on the way to the pathology forum. Nobody here’s buying that line except perhaps the FMGs.
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A decent amount of jobs, I would say at least >50% if not much more, are posted online somewhere in some form. ASTRO job board probably captures 50-75% of those posted online. I had a lot of interviews (and before you get excited about "a lot of interviews" they were all in what the coastal elites would consider undesirable to flat out unacceptable locations) and only went on a single one that wasn't posted that I got as a result of cold calling.
I remember when I started my job search I had this idea that only the crap jobs that nobody wanted were posted online and that the only people who applied to them were suckers who couldn't figure out how to find the secret good jobs. I discovered this to not be the truth. In fact, many institutions (public institutions) are required by law to advertise all of their openings before they hire somebody (even if they have a candidate lined up for it).
We are doing med students a disservice if we keep perpetuating the lie that there is a vast underground secret job market that your attendings will give you an invite to if you play nice in residency. What's posted is most of what's out there. Sure, sometimes your program will throw you a bone and hook you up with a babysitter job at a satellite. Sweet insider job, yo! Or maybe your dad owns a private practice (which is unfortunately fairly common in this field).
190 applicants? We haven't seen anything yet. This is just a stiff wind and some big waves before the class 5 hurricane hits. Wait 2-3 years from now when the delay from the ABR scandal catches up and the job market and other factors start to exhibit real downward pressure on starting salaries in metro areas and competition for jobs in small cities becomes fierce.
MSK has been expanding far beyond Manhattan for a while now. Usually they just siphon patients away from other hospitals with departments in the area. So really it’s just a redistribution issue. I have spoken with the Rad Onc director of a large health system in the northern NJ who said it’s basically a zero sum game. They barely had enough patients for the attendings staffing the place anyway. Fixed number of patients but new cancer centers popping up. Retirees cant afford the taxes in those areas anyway so they’re gonna migrate to warmer climates and take their Medicare with them. All I know is just a bunch of rad oncs that are gonna have a hell of a time justifying what they are paid while their hospital systems patient volume drops off. It’s really looks like just an MSK expansion at the expense of everybody else. And lest you think these hapless attendings can just up and work for MSK. I got two words for that...restrictive covenant.
Not familiar with the JAMA burnout piece. If they didn’t already then they should have asked residents point blank if they regret their specialty decision and probed that a bit further. Would have been a bit more enlightening than simply “I don’t get enough support, teaching, fullfillment at my current program so I wouldn’t pick it again”.
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"Active surveillance is becoming a mainstream form of management for many men with early prostate cancer, creating the irony that this high investment therapy was being paid for by the treatment of men who needed no treatment at all!"
When I was interviewing some years ago, I remember the residents saying their chair wasn't very involved because they were working on important research. When I finally interviewed with the chair, they said their "research" involved proving that protons were better for prostate cancer, and I remember thinking "you're greedy, senile, or just a straight-up bad person."
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And It all comes together: Patients are shifted from the lower cost community centers to (what is likely) the world's most expensive radiation service. I believe MSKCC can even charge inpatient rates at their satellites as part of their pps exemption. (Our local pps exempt nci center charges inpt rates at satellite 30 miles away.) This is a classic example of "its the prices stupid" and how health care costs are driven up. Given the expanding footprint, of course, MSKCC will need even more residents!
And this virtuous cycle replete with a coming Manhattan proton center (joining the other 2 in northern NJ) will continue. Flush with cash, MSKCC will buy more sattelites (and maybe even Fox Chase) and gain even more monopoly pricing power.
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In the health care of the future, you’ll be able to go to medical school, residency, multiple fellowships, and attending status at the same institution because that’s all there is. Just another cog in the company wheel. Another faceless booksmart idiot working for the local monopoly. All while your admin laugh at you and reap the profits from price gauging all while lecturing you about not being greedy and continually upping RVU thresholds. Hell you may even drop dead at your desk there when all is said and done.
Look at a city like Pittsburgh. You wanna work there? You got 2 choices Highmark-AGH or UPMC. And if you pick one...good luck trying to work for the other if it goes wrong.
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A lot of these “top” cancer centres benefit hugely from the taxpayer, some are even affiliated with state owned institutions, constituting a monopoly, partly taxpayer funded. They spread their wings with satellites and crush competition while charging crazy amounts for the same treatment one could get for far less, also refuse to see indigents and send these patients to nearby other academic institutions. This is Scandalous and happening throughout country. It has to end at some point.
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and tell us to choose wisely
Why the U.S. Spends So Much More Than Other Nations on Health Care
" Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute, studies how health systems from various countries compare in terms of prices and health care use. “What was true in 2003 remains so today,” he said. “The U.S. just isn’t that different from other developed countries in how much health care we use. It is very different in how much we pay for it.”
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Got to pay all those hospital execs!
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Its not a complete lie, you dont know what your talking about. I heard as well from people at MSKCC they are hiring alot of positions. I also spoke with leadership of MD Anderson and they are hiring multiple positions. NYC and Houston TX, are those junk middle of nowhere cities??
Alot of overblown end of the world talk on this thread. Rad Onc is a small competitive field, the med students that applied this year are lucky that they will all match.
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About 5 of us were here to sound the alarm bell 2 years ago. It wasn’t coordinated, just fairly obvious I suspect to a handful of us and we wanted to consent the younger generation lest they end up unhappy with the state of affairs as well. Nobody else was there for them, the academic leaders sure as hell weren’t just listen to them when you have time, they have their head up their rears. The ABR Wallner/kachnic situation is just a result of unchecked power and this is a clear byproduct of what we warned of - as was the pathetic response. Many similar situations are likely to occur in the future and that’s what we were warning med students about - this leadership is not on your side and that’s can have significant consequence.
For those that keep posting that this is overblown bc there are jobs in desireable locations, wouldn’t you like to keep it that way? See, at times I spread some FUD (fear,uncertainty,doubt) but I suspect others also felt compelled to regulate what we see as a future that looks like radiology - it’s simple math. That outlook doesn’t change bc there happen to be some jobs in desireable locations this year. We did save a lot of people from possible disaster of a life choice. I’ve had at least 6-7 people tell me as much over the last 2 years. Not surprised to see this dip, expect it to be much bigger dip next year now we know how Wallner/kachnic’s regards residents with concerns. I have no idea how 190 people were still willing to apply
For those that keep posting that this is overblown bc there are jobs in desireable locations, wouldn’t you like to keep it that way? See, at times I spread some FUD (fear,uncertainty,doubt) but I suspect others also felt compelled to regulate what we see as a future that looks like radiology - it’s simple math. That outlook doesn’t change bc there happen to be some jobs in desireable locations this year. We did save a lot of people from possible disaster of a life choice. I’ve had at least 6-7 people tell me as much over the last 2 years. Not surprised to see this dip, expect it to be much bigger dip next year now we know how Wallner/kachnic’s regards residents with concerns. I have no idea how 190 people were still willing to apply
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From a global standpoint, if MSKCC decides to hire a bunch of docs because they plan to outcompete the local community hospitals in the suburbs, does this really reflect real job growth or will they just displace the community radoncs who then move somewhere else.
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I applied last year and matched to my top choice, but I did it eyes wide open, and I appreciated everyone's input on the specialty. I went in after shadowing nearly every single specialty in medicine, and I did it with the thought that I would rather do rad onc locums than IM/FM etc, I disliked it that much.
I tell people only do rad onc if you can't see yourself doing anything else. There are some rad onc applicants on the interview trail who dismissed SDN, but I suspect these people are going to moan and groan in 4-5 years when the truth comes to bear.
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Technically, they generally dont preach cost control, but resource utilization(hypofractionation), which isnt really the issue as costs are.
Posted in other thread. I think 2x is likely an underestimate when it comes to private insurance pricing, nevertheless.
The Importance of Relative Prices in Health Care Spending
" For example, the Medicare Payment Advisory Commission noted in its June 2013 report that Medicare paid 141% more for a level 2 echocardiogram in a hospital outpatient department relative to an echocardiogram performed in a physician’s office.6 Moreover, this arrangement encourages hospitals to buy physician practices, thereby reducing competition and further contributing to the high level of commercial market prices."
:Nevertheless, changing fee schedules is difficult because politically powerful stakeholders, such as hospitals, that succeed under the current system (many of whom built business models based on the existing prices) vigorously oppose it.9 These groups often maintain they need the revenue resulting from overpriced services to accomplish a valued mission."
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GreyingRadOnc
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ASTRO doesn't have anything to do with that...that's ACGME and the Radiation Oncology Review Committee. They approve positions and have expanded programs. The rationale of that comes from ACGME and new programs have quoted Stark Laws when questions have been asked about whether it's wise to expand "if we fulfill the criteria for a residency, and have funding, it's unethical and illegal to refuse".
Furthermore ASTRO leadership is a mix of private practice and academics. The immediate past chair is a private practice doc (David Beyer). If you find yourself a peasant, than it's your personal choice to be a peasant. They are always looking for volunteers, which is how the private practice docs have worked their way thru the system to those positions. Don't bitch...pitch in.
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My main point of that post is that the attending job market (for either new grads or old grads) is not a good one now. Lateral or upward movement for established attendings is more difficult.
Additionally, the bolded line is an often quoted falsehood that is perpetuated by only those in Rad Onc. There is no evidence (that I am aware of) that that statement is at all true. Stark laws do not play a role in this. Maybe anti-trust, but not Stark. This exact thing is done in Derm, Plastics, Urology, and other in-demand specialties that have good job markets. Residency expansion seems to have slowed down recently, which is good.
ASTRO leadership are generally chairmen/women. Chairmen/women make more money for their department getting residents (even if they have to pay them out of their own pockets) rather than PAs/NPs. Chairs are generally the ones who make the decision on whether to expand or not. It's all the same people.
