Radonc Chairs are the reason residents don't have jobs

[deleted941485]

how long was he traveling for? thats awesome.

edit: I would also add that i read some advice on SDN about how to approach my research year. and i made the absolute best of it. was it categorically a colossal waste of a year? did i publish a few papers in open access journals? yes to both. but i did enjoy it for what it was. learned some new hobbies, worked out, traveled. it was like a sabbatical.

That’s great but honestly you could have been learning badly needed additional skills that could you know…actually help people in clinic. Instead of the sham that is the current training program in rad onc where you basically have a year where the vast majority won’t do anything all that productive except maybe travel and get paid while writing articles that will be forgotten in a few months

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[seper]

That’s great but honestly you could have been learning badly needed additional skills that could you know…actually help people in clinic. Instead of the sham that is the current training program in rad onc where you basically have a year where the vast majority won’t do anything all that productive except maybe travel and get paid while writing articles that will be forgotten in a few months

In this competitive employment situation, one should definitely put in extra work to learn more than clinical minimum (learn prostate brachy, get GK certification, maybe help with some GYN implants, do extra peds observership, do some hanging out around protons planning, etc).
Research year is good for that.
Pumping out retrospective studies will get you exactly nothing

 

[radoncftw]

That’s great but honestly you could have been learning badly needed additional skills that could you know…actually help people in clinic. Instead of the sham that is the current training program in rad onc where you basically have a year where the vast majority won’t do anything all that productive except maybe travel and get paid while writing articles that will be forgotten in a few months

i agree with you.
the scarier thing is the holman resident who spend an extra 6 months in lab then going into community practice.
i am sure i could have done more clinically - but we have to play the game. the goal of our training program per our chair is for us to get an academic position and publishing non-sense is the way to help us get there i guess. if attendings taught more instead of treating us like scut monkeys to write notes perhaps i would have tried to push to get more clinic experience during my research time. rad onc residency training really needs to be overhauled.

 

[deleted941485]

i agree with you.
the scarier thing is the holman resident who spend an extra 6 months in lab then going into community practice.
i am sure i could have done more clinically - but we have to play the game. the goal of our training program per our chair is for us to get an academic position and publishing non-sense is the way to help us get there i guess. if attendings taught more instead of treating us like scut monkeys to write notes perhaps i would have tried to push to get more clinic experience during my research time. rad onc residency training really needs to be overhauled.

The Holman pathway is basically what the clinical RO pathway should be for everyone.

 

[radoncftw]

The Holman pathway is basically what the clinical RO pathway should be for everyone.

Condense to 2.5-3yr? Probably reasonable. If people want to do research, extend 1 yr (or 2 yrs). Many surgical residencies setup this way.

 

[deleted1116990]

The Holman pathway is basically what the clinical RO pathway should be for everyone.

If they could make a 2 year fellowship for boarded ROs to train and become boarded in DR, I would probably do it. You probably need a minimum of 3 years of solid DR training though. Would help both fields with the overtraining in rad onc and undertraining in DR. Would be awesome from a jobs and skills perspective to be double boarded in RO and DR and have the doors opened to subspecialty radiology fellowships including IR. Or a combined 6 year DR-RO residency. RO residency is a lot of wasted time to dump us into an overcrowded job market where we are not needed.

 

[deleted941485]

If they could make a 2 year fellowship for boarded ROs to train and become boarded in DR, I would probably do it. You probably need a minimum of 3 years of solid DR training though. Would help both fields with the overtraining in rad onc and undertraining in DR. Would be awesome from a jobs and skills perspective to be double boarded in RO and DR and have the doors opened to subspecialty radiology fellowships including IR. Or a combined 6 year DR-RO residency. RO residency is a lot of wasted time to dump us into an overcrowded job market where we are not needed.

They’re are probably some interesting educational combos That could be done but not holding my breath. I’ll be in my 50s and maybe in another specialty or industry by the time that **** ever happens. Nothing good happens to you after 50 anyway.

 

[Chartreuse Wombat]

They’re are probably some interesting educational combos That could be done but not holding my breath. I’ll be in my 50s and maybe in another specialty or industry by the time that **** ever happens. Nothing good happens to you after 50 anyway.

As someone over 50 (i know OK boomer) I can tell you that much good happens after 50.

 

[medgator]

That’s great but honestly you could have been learning badly needed additional skills that could you know…actually help people in clinic. Instead of the sham that is the current training program in rad onc where you basically have a year where the vast majority won’t do anything all that productive except maybe travel and get paid while writing articles that will be forgotten in a few months

The Holman pathway is basically what the clinical RO pathway should be for everyone.

Condense to 2.5-3yr? Probably reasonable. If people want to do research, extend 1 yr (or 2 yrs). Many surgical residencies setup this way.

Many forget that rad onc training was only 3 years until the mid 90s. Definitely a reason for that.

 

[deleted1111261]

Many forget that rad onc training was only 3 years until the mid 90s. Definitely a reason for that.

Hmm.. maybe it’s part of the reason that the older docs not appearing as competent - because they had less training, while the specialty has become even more complicated ?

 

[medgator]

Hmm.. maybe it’s part of the reason that the older docs not appearing as competent - because they had less training, while the specialty has become even more complicated ?

I'm sure the standards of who they took back then vs since had nothing to do with it.... The extra year was added in the mid 90s to help address a bad job market, not to improve the actual training afaik, maybe @Chartreuse Wombat or @TheWallnerus may have some further insights on this

As many have said before, the cream of the crop getting in until recently were just better self learners, esp when it came time to learn at these mid to bottom tier hellpits.

Rad Onc had a real problem attracting strong candidates in previous bad job cycles, similar to the current one

 

[deleted1111261]

I'm sure the standards of who they took back then vs since had nothing to do with it.... The extra year was added in the mid 90s to help address a bad job market, not to improve the actual training afaik, maybe @Chartreuse Wombat or @TheWallnerus may have some further insights on this

As many have said before, the cream of the crop getting in until recently were just better self learners, esp when it came time to learn at this mid to bottom tier hellpits. Rad Onc had a real problem attracting strong candidates in previous bad job cycles, similar to the current one

Good you’re sure of something! We can all be feeling more secure when you are sure!

My problem is uncertainty; I’m rarely sure of anything with regards to training. If you suddenly chopped off a full year today, a substantial portion of trainees would struggle in practice. There are PGY4s that would be fine, but many other would struggle and then never really catch up.

 

[medgator]

. If you suddenly chopped off a full year today, a substantial portion of trainees would struggle in practice. There are PGY4s that would be fine, but many other would struggle and then never really catch up.

Yet our field was happy to let that exact thing happen to Holman pathway grads

 

[deleted1111261]

Yet our field was happy to let that exact thing happen to Holman pathway grads

And what was the outcome, oh certain one?

 

[deleted941485]

I'm sure the standards of who they took back then vs since had nothing to do with it.... The extra year was added in the mid 90s to help address a bad job market, not to improve the actual training afaik, maybe @Chartreuse Wombat or @TheWallnerus may have some further insights on this

As many have said before, the cream of the crop getting in until recently were just better self learners, esp when it came time to learn at this mid to bottom tier hellpits. Rad Onc had a real problem attracting strong candidates in previous bad job cycles, similar to the current one

The problem is that even for weak people that are coming into these programs that don't even know how to contour a prostate. You think these programs are gonna refuse to promote them? No? Fire them? No. Like the NYC public schools have social promotion so does Rad Onc.

 

[radoncftw]

The problem is that even for weak people that are coming into these programs that don't even know how to contour a prostate. You think these programs are gonna refuse to promote them? No? Fire them? No. Like the NYC public schools have social promotion so does Rad Onc.

This is a fair point, not specific to rad onc. I have seen it in other specialities too.

The one specialty where they are not afraid to hold people back is surgery and I have been told that is not actually based on clinical skills but on scores for their in service exam or other objective measures.

 

[deleted941485]

This is a fair point, not specific to rad onc. I have seen it in other specialities too.

The one specialty where they are not afraid to hold people back is surgery and I have been told that is not actually based on clinical skills but on scores for their in service exam or other objective measures.

Interesting. They rely on scores rather than actual clinical performance day to day.

 

[jondunn]

anesthesia will threaten to fire you for bad inservice scores too

many fields are harsh and not afraid to fire

 

[metallica81788]

It is unbelievable how much stuff takes to dump a bad RadOnc resident

 

[maxxor]

If they could make a 2 year fellowship for boarded ROs to train and become boarded in DR, I would probably do it. You probably need a minimum of 3 years of solid DR training though. Would help both fields with the overtraining in rad onc and undertraining in DR. Would be awesome from a jobs and skills perspective to be double boarded in RO and DR and have the doors opened to subspecialty radiology fellowships including IR. Or a combined 6 year DR-RO residency. RO residency is a lot of wasted time to dump us into an overcrowded job market where we are not needed.

You guys should do what Zietman has been saying for years and merge with IR.

Or find a dual boarded medonc radonc, appoint him chair, and create a dual residency. 2 years IM, 2 years onc, 2 years radonc.

Maybe the best place to do option 2 is ironically a hellpit with weak IM leadership.

 

[jondunn]

2 years IM, 2 years onc, 2 years radonc.


this would be quite logical. i don't want to do this myself, but it makes a lot of sense as a way to change cancer care in this country

 

[Lamount]

You guys should do what Zietman has been saying for years and merge with IR.

Or find a dual boarded medonc radonc, appoint him chair, and create a dual residency. 2 years IM, 2 years onc, 2 years radonc.

Maybe the best place to do option 2 is ironically a hellpit with weak IM leadership.

We also can go back to rad onc being a DR fellowship… that way future trainees have more job options.

 

[deleted1111261]

We also can go back to rad onc being a DR fellowship… that way future trainees have more job options.

Probably best idea

 

[medgator]

We also can go back to rad onc being a DR fellowship… that way future trainees have more job options.

Probably best idea

Would probably need to be min. 2 years rather than the 1 year for most other DR fellowships

 

[TheWallnerus]

2 years IM, 2 years onc, 2 years radonc.


this would be quite logical. i don't want to do this myself, but it makes a lot of sense as a way to change cancer care in this country

We also can go back to rad onc being a DR fellowship… that way future trainees have more job options.

Would be interesting to see who would win in a fight (a tumor board fight, a street fight, a cat fight, a food fight, etc): the rad onc who came up through rads, or the rad onc who came up through IM/onc. Imagine what different perspectives we would have on our lives and patients and the literature were these the routes we had taken.

Wally Curran was pointing out recently that a neurosurgeon brought IMRT to fruition essentially. If you think of that and Lars Leksell, maybe we should do NSG then RO! NSG seems to really teach you how to come up with the most impactful ways to move radiation oncology forward.

 

[maxxor]

Would probably need to be min. 2 years rather than the 1 year for most other DR fellowships

IR is essentially 2. Not a problem.

I’ve said it before, but radiology is essentially a 3 year residency due to ABR board changes.

1 intern + 3 DR + 2 RO.

It's what IR/DR is now.

 

[medgator]

IR is essentially 2. Not a problem.

I’ve said it before, but radiology is essentially a 3 year residency due to ABR board changes.

1 intern + 3 DR + 2 RO.

It's what IR/DR is now.

Also has it's own residency now right? Things come full circle

 

[elementaryschooleconomics]

It is unbelievable how much stuff takes to dump a bad RadOnc resident

I have been sitting here searching my memory.

I know stories of people who have quit RadOnc residency, people who have transferred between RadOnc residencies, and people who have transferred to a different specialty residency.

I actually don't know a story of a RadOnc resident being fired in the last 10-20 years.

It must have happened though, right?

 

[maxxor]

Also has it's own residency now right? Things come full circle

In theory. The IR training pathway is sort of like plastic surgery.

You can get into IR from

Integrated IR/DR residency
Independent IR residency (which requires base DR training)
You can cut a year off independent IR residency if your program has early specialization in IR (ESIR)

In the end, all of these people are IR/DR.

An IR only training pathway (a la Radonc) does not exist.

 

[medgator]

Would be interesting to see who would win in a fight (a tumor board fight, a street fight, a cat fight, a food fight, etc): the rad onc who came up through rads, or the rad onc who came up through IM/onc. Imagine what different perspectives we would have on our lives and patients and the literature were these the routes we had taken.

Wally Curran was pointing out recently that a neurosurgeon brought IMRT to fruition essentially. If you think of that and Lars Leksell, maybe we should do NSG then RO! NSG seems to really teach you how to come up with the most impactful ways to move radiation oncology forward.

All that extra time on the floors, dealing with SW issues? 🤮. Going to say that the rads trained folks will do better overall

 

[fiji128]

I have been sitting here searching my memory.

I know stories of people who have quit RadOnc residency, people who have transferred between RadOnc residencies, and people who have transferred to a different specialty residency.

I actually don't know a story of a RadOnc resident being fired in the last 10-20 years.

It must have happened though, right?

I believe residents at both UPMC and MUSC got fired in recent history.

Programs that could be candidates for contracting/closing

Everything you speak is of truth but for this (IMHO). Payors are now pricing all skills at the same level. Preparing a Babbette's Feast vs boiling an egg: same reimbursement. If not now, certainly in the future. Yeah, I have to imagine that this is the death of prostate brachy and Space Oar...

forums.studentdoctor.net

Also came across this nugget as well. "The eight-person jury awarded Gerszten (UPMC Rad Onc) $3.1 million in damages and pay arising from her discrimination lawsuit.

Welcome

archive.triblive.com

 

[elementaryschooleconomics]

I believe residents at both UPMC and MUSC got fired in recent history.

Programs that could be candidates for contracting/closing

Everything you speak is of truth but for this (IMHO). Payors are now pricing all skills at the same level. Preparing a Babbette's Feast vs boiling an egg: same reimbursement. If not now, certainly in the future. Yeah, I have to imagine that this is the death of prostate brachy and Space Oar...

forums.studentdoctor.net

Also came across this nugget as well. "The eight-person jury awarded Gerszten (UPMC Rad Onc) $3.1 million in damages and pay arising from her discrimination lawsuit.

Welcome

archive.triblive.com

I can't believe I forgot about the UPMC story.

I must be losing a step in my old age.

(or had to clear up space in my brain for the new Multiple Myeloma classification system)

 

[evilbooyaa]

I have been sitting here searching my memory.

I know stories of people who have quit RadOnc residency, people who have transferred between RadOnc residencies, and people who have transferred to a different specialty residency.

I actually don't know a story of a RadOnc resident being fired in the last 10-20 years.

It must have happened though, right?

UPMC fired a resident, although the lawsuit mentioned above is not related to the residency program, but rather related to shadiness at the attending level.

 

[taserlaser]

I believe my program fired a resident over a decade ago (and may be closer to two at this point). This was before my time, and I’m sure the story I’ve heard is a bastardization of what actually happened. But allegedly some mental health/social/marital issues culminating with a non-successful remediation. Also something about an outburst of telling a patient it was their fault they had lung cancer that may have had something to do with it.

 

[medgator]

Also something about an outburst of telling a patient it was their fault they had lung cancer that may have had something to do with it.

Not the worst thing I've heard in the world... Usually will come up during the consult if they ask why they got lung cancer, i try to use that discussion to help cross over into the smoking cessation talk before starting tx

 

[jondunn]

Not the worst thing I've heard in the world... Usually will come up during the consult if they ask why they got lung cancer, i try to use that discussion to help cross over into the smoking cessation talk before starting tx

No offense but it seems like you completely misread what taserlaser said if you are equating that with what you just posted

What the actual