Radiation Oncology Resident Numbers Drop

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drop from 774 to 771 !
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FrostyHammer said:
Congratulations SDN, good to know that the cries to curb residency expansion has done very little. Except scare off the AMGs and dilute the field with FMGs and DOs and such.
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So pretty much brought rad onc back to where it was in the 70s and 80s.
 
FrostyHammer said:
Congratulations SDN, good to know that the cries to curb residency expansion has done very little. Except scare off the AMGs and dilute the field with FMGs and DOs and such.
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its nice to know how little you think of us. hopefully you are nicer to the DOs and FMG primary care folks that refer to your service
 
socialcriticism said:
its nice to know how little you think of us. hopefully you are nicer to the DOs and FMG primary care folks that refer to your service
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It's generally seen as a mark of competitiveness and desirability of a specialty. It is what it is, unfortunately
 
FrostyHammer said:
Congratulations SDN, good to know that the cries to curb residency expansion has done very little. Except scare off the AMGs and dilute the field with FMGs and DOs and such.
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It's great that those applicants with options are making informed decisions and choosing not to enter a field with diming employment prospects over the next 30 to 40 years. People here are just providing information. Not really the purpose of this forum to rush up and gaslight candidates like its a sorority or something.

In no universe do we need to be churning out 770 rad oncs every 4 years especially with people routinely practicing well into their late 60's and 70's.
 
fiji128 said:
It's great that those applicants with options are making informed decisions and choosing not to enter a field with diming employment prospects over the next 30 to 40 years. People here are just providing information. Not really the purpose of this forum to rush up and gaslight candidates like its a sorority or something.

In no universe do we need to be churning out 770 rad oncs every 4 years especially with people routinely practicing well into their late 60's and 70's.
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I.e. not a good sign when locums recruiters switch from offering locums opportunities to offering locums candidates for providing coverage
 
FrostyHammer said:
Congratulations SDN, good to know that the cries to curb residency expansion has done very little. Except scare off the AMGs and dilute the field with FMGs and DOs and such.
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can’t change it, can’t change the greed of the previous generation. We broadcast the info and data the chairs and Astro want to minimize, we whine and are over dramatic at times a la all internet discourse. I wish the field would actually care about us as younger physicians, but can’t change that. Let the next generation be well informed.
 
socialcriticism said:
its nice to know how little you think of us. hopefully you are nicer to the DOs and FMG primary care folks that refer to your service
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I think SDNers think much less of themselves. I once showed this forum to a friend and based on the incessant crying, moping, and whining on here 24/7 he thought everyone on here wanted to commit suicide as quickly as possible. It wouldn't kill us to share some positives here and there... unfortunately the threads designed for that quickly and inevitably get turned into the same ol' stuff about the job market. Some people are just "glass half empty" kinds of people. I'm not a fan of the whole "misery loves company" deal. I believe in bucking up and dealing with it - I am definitely not a weak and sensitive person.
 
FrostyHammer said:
I think SDNers think much less of themselves. I once showed this forum to a friend and based on the incessant crying, moping, and whining on here 24/7 he thought everyone on here wanted to commit suicide as quickly as possible. It wouldn't kill us to share some positives here and there... unfortunately the threads designed for that quickly and inevitably get turned into the same ol' stuff about the job market. Some people are just "glass half empty" kinds of people. I'm not a fan of the whole "misery loves company" deal. I believe in bucking up and dealing with it - I am definitely not a weak and sensitive person.
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Then I hope your write articles, publish opinion pieces, or speak frankly with “leaders” in this field as a sign of your strength.

I come on here and whine sometimes to vent. I do the same thing in real life in more polite and professional terms, and still see people 10 year my senior working a quarter as hard for double the pay! Ignoring the same dept rules forced on any younger physician who comes through, without penalty somehow! But I do it. I also have had many non whiny “shove the data we have in your face” posts on this.

Change takes time. Here I can be unfettered in peak emo form. Doesn’t mean I lack professional advocacy skills in real life.

But your original point wasn’t that the lack of optimism offended you. Your point was that all of our whining hasn’t effectively translated into change. So I’m not sure how this pivot occurred.

Really not that pumped to have a cumbayah type moment when our ASTRO president is soaping residents at a brand new program 2 years after the workforce survey showed half the field was concerned about oversupply, and any basic math on indications, fractions, billing, and supervision requires significant mental gymnastics to justify the massive increase in residency spots of the previous decade. I deal with by whining here, working hard and trying to effectively advocate in real life, and living like my income won’t last past 10 years from now. Bring your marshmallows, campfire’s warm.
 
FrostyHammer said:
I think SDNers think much less of themselves. I once showed this forum to a friend and based on the incessant crying, moping, and whining on here 24/7 he thought everyone on here wanted to commit suicide as quickly as possible. It wouldn't kill us to share some positives here and there... unfortunately the threads designed for that quickly and inevitably get turned into the same ol' stuff about the job market. Some people are just "glass half empty" kinds of people. I'm not a fan of the whole "misery loves company" deal. I believe in bucking up and dealing with it - I am definitely not a weak and sensitive person.
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I agree (though in less hyperbolic terms). The job market is no good for people who are in the market for work… but there is a distinction between “the job market” and “the field”. The former is only a small subset of the latter.

Many here appropriately were the first to throw stones at those PDs who were expanding residencies… but many of the same are the first to throw stones when someone tries to add value -dare I say “protons”… you know, the sort of thing that could increase demand to compensate for increased supply. Perhaps some just feel better when they have a rock in their hand.
 
Lamount said:
I agree (though in less hyperbolic terms). The job market is no good for people who are in the market for work… but there is a distinction between “the job market” and “the field”. The former is only a small subset of the latter.

Many here appropriately were the first to throw stones at those PDs who were expanding residencies… but many of the same are the first to throw stones when someone tries to add value -dare I say “protons”… you know, the sort of thing that could increase demand to compensate for increased supply. Perhaps some just feel better when they have a rock in their hand.
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Did you just put "value" and protons in the same sentence?
 
Ask yourselves a question…

Why is it ONLY NOW that med onc is being asked to limit the use of IO?

Because when academic centers were conducting research looking for any indication to use it, the community med oncs were their allies.

Maybe it is not protons, FLASH, or cardiac SBRT that will “save” rad onc, but those are POSSIBILITIES.

Short of making half of the residents vanish, repeating the same (justified) criticisms of the same people is unlikely to help anything anytime soon. Sure, vent… but then what? What’s the next IMRT?
 
Lamount said:
I agree (though in less hyperbolic terms). The job market is no good for people who are in the market for work… but there is a distinction between “the job market” and “the field”. The former is only a small subset of the latter.

Many here appropriately were the first to throw stones at those PDs who were expanding residencies… but many of the same are the first to throw stones when someone tries to add value -dare I say “protons”… you know, the sort of thing that could increase demand to compensate for increased supply. Perhaps some just feel better when they have a rock in their hand.
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That's nonsensical. The proton data on its face is pretty uninspiring by and large for those of us out in the real world practicing adult oncology.

What about stopping all these trials trying to eliminate or reduce fractions in our 2 biggest indications (breast/prostate)? And maybe trying to show RT might be the better option over Endocrine Therapy?

P.S. how do you expect all of us to adopt protons when they are still in the neighborhood for $20 mil+ for those of us who don't have a center? Between that and the data out so far, seems like a lot of cart before the horse action coming from your post
 
Chartreuse Wombat said:
Did you just put "value" and protons in the same sentence?
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How confident are you that are zero undiscovered clinical indications for protons? I’m not talking about cost. Are you certain that we know all we need to know?… that we should stop looking?
 
DebtRising said:
But your original point wasn’t that the lack of optimism offended you. Your point was that all of our whining hasn’t effectively translated into change. So I’m not sure how this pivot occurred.
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My point is this: the lack of optimism on SDN isn't a bad thing. But if it's all that's written here all the time, it's just not a good look for SDN and this forum. We portray ourselves as whiners to the Twitterati and whoever else reads this. People take us less seriously which is why SDN's words clearly didn't change much. Moderation and balance go for a lot...it's amazing how much people listen to you if you "selectively whine" or are positive for the most part.
 
medgator said:
That's nonsensical. The proton data on its face is pretty uninspiring by and large for those of us out in the real world practicing adult oncology.

What about stopping all these trials trying to eliminate or reduce fractions in our 2 biggest indications (breast/prostate)? And maybe trying to show RT might be the better option over Endocrine Therapy?

P.S. how do you expect all of us to adopt protons when they are still in the neighborhood for $20 mil+ for those of us who don't have a center? Between that and the data out so far, seems like a lot of cart before the horse action coming from your post
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Sure. That sounds like a great idea for a trial. It’s simple and could expand indications.

…and the best part of it is, that is an easy study to accrue patients to in the community as well.

Test everything.
 
Lamount said:
Sure. That sounds like a great idea for a trial. It’s simple and could expand indications.

…and the best part of it is, that is an easy study to accrue patients to in the community as well.

Test everything.
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You really think all of us have protons? And how exactly will protons "expand" indications? Seems like it will simply replace a photon case.

The onus for proving protons is on those who chose to get in first and pay $100-150 million+ to do so. Do you really not understand the economics of this?
 
medgator said:
You really think all of us have protons? And how exactly will protons "expand" indications? Seems like it will simply replace a photon case.

The onus for proving protons is on those who chose to get in first and pay $100-150 million+ to do so. Do you really not understand the economics of this?
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No… not everyone has protons, and I don’t have a new indication that’s ready for prime time.
…and I agree that the onus is on people like me to prove it is a valuable treatment.
…but there’s no reason you shouldn’t be on my side while I ask the question. Why are we our own worst critics? You who doesn’t do that? Med onc.

Just think… if protons are as useful as some of us theorize they could be, it’s not going to cost $100 million and everyone will get one… and if not, maybe the next guy figures out it’s something else that changes everything. We all benefit from innovation.
 
Lamount said:
No… not everyone has protons, and I don’t have a new indication that’s ready for prime time.
…and I agree that the onus is on people like me to prove it is a valuable treatment.
…but there’s no reason you shouldn’t be on my side while I ask the question. Why are we our own worst critics? You who doesn’t do that? Med onc.

Just think… if protons are as useful as some of us theorize they could be, it’s not going to cost $100 million and everyone will get one… and if not, maybe the next guy figures out it’s something else that changes everything. We all benefit from innovation.
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Except you haven't actually grown the pie like you claim to be doing, you've simply replaced a photon case with a proton case
 
Protons are one of the worst value propositions in rad onc and certainly not the path forward. Protons will always cost more than photons and require sacrifice in at least one aspect of treatment because they are always on the tail end of delivery technology. There is still no true stereotactic proton treatment because of lack of intrafraction motion management and range uncertainty (which will always be inherent to protons). There are still proton places using passive scatter without cbct. Planning protons is like planning with one hand tied behind your back - one of the cornerstones of radiation is leveraging multiple beam angles but can't be done w/ protons because the more beams you use, the more you've eliminated the only advantage they have in low/med dose bath.

The worst myth in radiation oncology is that protons are better for targets close to a sensitive OAR, when in fact once you account for lack of conformality with limited beam angles, requirement to range through the OAR, and range uncertainty, you end up with higher (and uncertain) doses to OARs vs. equivalent stereotactic plans.

SBRT was a useful innovation in rad onc because it opened new indications for treatment using existing hardware (early stage lung, prostate, oligomets) and was accessible to all without needing private equity money. We need more of that
 
Chartreuse Wombat said:
Did you just put "value" and protons in the same sentence?
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Lamount said:
Yup.
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Protons: not just about value... it's about SAVING LIVES. Thirstiness.

ILNB4L2.png


Lamount said:
What’s the next IMRT?
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Well it sure ain't protons. Travel with me back in time to 2000. You have a linac. You are a community practice place. Your linac has MLCs. You hear about this thing called "IMRT." Varian tells you it simply requires an upgrade to the planning system and a small upgrade to the machine. That's part of why IMRT could become IMRT. This is a hill impossible for protons, or any very expensive/logistically challenging tech for that matter, to climb.
 
FrostyHammer said:
My point is this: the lack of optimism on SDN isn't a bad thing. But if it's all that's written here all the time, it's just not a good look for SDN and this forum. We portray ourselves as whiners to the Twitterati and whoever else reads this. People take us less seriously which is why SDN's words clearly didn't change much. Moderation and balance go for a lot...it's amazing how much people listen to you if you "selectively whine" or are positive for the most part.
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Didn't change much? The match this year was atrocious. The intent from those that control the production of labor supply seemed to be ongoing expansion while studying the situation. The only real change this forum had any chance of making was reducing the quality of the cannon fodder, which I would argue it did. We'll see what are the downstream consequences of this, but this seemed like the only way.
 
Chartreuse Wombat said:
when our ASTRO president is soaping residents at a brand new program 2 years after the workforce survey showed half the field was concerned about oversupply,

that about sums it up....
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credit for audacity though. It would be one thing for Astro to give the survey and just ignore it. But to give it and then really say “not only should we ignore this, let’s expand and soap” is impressive. He and they really care.
 
Am I the only one who believes that lower applicant quality is a good thing? AMG applicants are opting for other specialties with better job opportunities. As for IMG applicants, radiation oncology is open to them now, and may still be attractive to someone from a lower-middle income country, or LMIC.

Without a normalization (i.e. reduction) in residency positions, lower applicant quality and lower applicant numbers is a good thing. From my vantage point as an average joe radiation oncologist, high applicant quality is only a good thing in the context of a drastic normalization in residency positions.

Cardiac SBRT is great and I will support the leaders of clinical trials as an average joe radiation oncologist, but please normalize residency positions to reflect employment opportunities and market demand. The glut of trainees is unsustainable. Many thanks.
 
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thesauce said:
We really need to have influence on selecting Astro leadership somehow. No one except for the 1% of guys at the very top benefit from this job market bloodbath.
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This is definitely the first time I've looked into this, so apologies if it's been discussed. It appears that the Nominating Committee is elected by the membership for 3 year terms. More interestingly, if you get 30 of your closest [internet] friends, you can nominate someone for an ASTRO leadership position.

ASTRO Bylaws

"Section 4 Nominations from the Membership​

Additional nominations may be made from the membership by at least thirty (30) supporting signatures of members of the Society entitled to vote. Nominations shall be received by the Secretary/Treasurer within 30 days of the Notice of Nominations to the membership (Section 3)"


I've said it before, but we may be able to #wallstreetbets this thing.

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Neuronix said:
Can we get 30 supporting signatures to nominate Simul Parikh ?
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Would Simul need to be an ASTRO member to be eligible for a leadership position? Got the sense he may not be from the VVPN speech...
 
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yesmaster said:
Am I the only one who believes that lower applicant quality is a good thing? AMG applicants are opting for other specialties with better job opportunities. As for IMG applicants, radiation oncology is open to them now, and may still be attractive to someone from a lower-middle income country, or LMIC.

Without a normalization (i.e. reduction) in residency positions, lower applicant quality and lower applicant numbers is a good thing. From my vantage point as an average joe radiation oncologist, high applicant quality is only a good thing in the context of a drastic normalization in residency positions.

Cardiac SBRT is great and I will support the leaders of clinical trials as an average joe radiation oncologist, but please normalize residency positions to reflect employment opportunities and market demand. The glut of trainees is unsustainable. Many thanks.
Click to expand...

"Lower quality applicants" unfortunately means lower professionalism. I trained long enough to remember stories about residents literally washing their socks in the staff bathroom instead of attending port conference
 
seper said:
"Lower quality applicants" unfortunately means lower professionalism. I trained long enough to remember stories about residents literally washing their socks in the staff bathroom instead of attending port conference
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That might actually be a better use of their time.

Just kidding. Sort of.
 
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