RadOnc Job Market

[SKR]

Curious how senior residents (or people who know senior residents) are finding the job market this year...both private and academic. Any thoughts of how the market will change over the next few years? I would love to hear each of your thoughts/comments.

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[Gfunk6]

In my opinion, the job search environment has not changed demonstrably over the past four years or so. Recurring themes (to echo wagy27 above) include:

1. Perpetual uncertainty about the future of healthcare economics (ACA, ACOs, CMS cuts)

2. Deferral of retirement by more senior Rad Oncs (evaporation of 401k during recession, decreasing reimbursement compared to the 'good old days,' poor financial planning)

3. Competitiveness in desirable areas to live

4. Current generation of graduates afraid to take the reward/risk which is inherent to private practice in favor of employed models

 

[johnangles]

i am trying to figure out if it is worth it for me to continue in this residency and I wonder if you guys could help. Im pgy-3 now, honestly i don't find it interesting, the leadership is heavy handed and wholly unimaginative. I am at a very good program but the whole job search thing sounds like a real painful experience and it sounds like the ability to be screwed is very high. I have a specific geographic interest and it sounds like the chance to fulfill this is almost zero. To continue is toying with at least another 5 years of life. Talking to a decent number of other people, i know i am not alone in this sentiment. There was an obvious disconnect with what we were seeing/hearing as med students compared to what it turned out to be.

Is there anyone on this message board that left residency or looking 5 years back wish they had? I have no idea how to evaluate this, anyone have advice, gfunk? Thank you

 

[napoleondynamite]

Sorry you are having a crummy time in residency. I think any resident feels your pain to some extent because oftentes being a resident kind of stinks. I enjoy what I do, but the lifestyle of residency can wear you down a bit.

As to your job outlook - I wouldn't let that be a reason to quit your residency. You have a glass half empty paradigm that I think can be a self-fulfilling prophecy. The reality is that there are good jobs in good locations available every year. Someone has to get those jobs - why not you?

 

[rymd]

Sorry you are having a crummy time in residency. I think any resident feels your pain to some extent because oftentes being a resident kind of stinks. I enjoy what I do, but the lifestyle of residency can wear you down a bit.

As to your job outlook - I wouldn't let that be a reason to quit your residency. You have a glass half empty paradigm that I think can be a self-fulfilling prophecy. The reality is that there are good jobs in good locations available every year. Someone has to get those jobs - why not you?

Also, check out the blogs on HBR where articles on "managing up" and dealing with tough work environments abound.

 

[johnangles]

Also, check out the blogs on HBR where articles on "managing up" and dealing with tough work environments abound.

truthfully it isn't a incredibly tough work environment, people are supportive but it is small and political, i think that is common anywhere in any field. It is more that it is not passionate, everyone falls in line and it is not inventive. You get asked these stupid questions from attendings that think it's cool they know some ****ing minutiae in a trial that every criticizes anyway. Thats work, then there is life: I looks at my med school classmates that are residents now and I think they can legitimately say these are some of the best days of their lives. I am so far away from that it isn't even funny. Single, pretty broke, in a rather mediocre city. Its not just me, it's everyone around me, it seems like it is the same for all of them, maybe not the single part. It's no way to live. Do i just accept that?

 

[ReOxygenation]

YOLO, bro. If you aren't happy and don't foresee yourself ever truly enjoying doing this, it might be time for a change. Don't waste your time suffering through the insufferable. Pursue something you are passionate about and do it. There is no such thing as sunken cost in life. If a career change is what you need to be happy, then find that happiness. YOLO and it's to short to spend it being miserable - your patients should have taught you that much.

 

[Cancerdancer]

Well you sound pretty unhappy. In my opinion, if you're at a 'very good program' where people are supportive, I'm guessing there are some smart, interesting people who can teach you some things. But if you don't find the field interesting enough,the patient care rewarding, and are only in it b/c you thought people would be clamoring to throw $500k at you to work 4 days a week in a competitive locale, get out now.

I'm sure you don't intend it this way, but your complaining sounds rather entitled.

 

[johnangles]

Well you sound pretty unhappy. In my opinion, if you're at a 'very good program' where people are supportive, I'm guessing there are some smart, interesting people who can teach you some things. But if you don't find the field interesting enough,the patient care rewarding, and are only in it b/c you thought people would be clamoring to throw $500k at you to work 4 days a week in a competitive locale, get out now.

I'm sure you don't intend it this way, but your complaining sounds rather entitled.

fair enough, my language isn't the best. I don't want to hijack this; basically i want to know how to evaluate this decision appropriately. yolo is not the best way to make this decision, thats how so many people seem to get stuck in medicine

 

[thesauce]

truthfully it isn't a incredibly tough work environment, people are supportive but it is small and political, i think that is common anywhere in any field. It is more that it is not passionate, everyone falls in line and it is not inventive. You get asked these stupid questions from attendings that think it's cool they know some ****ing minutiae in a trial that every criticizes anyway. Thats work, then there is life: I looks at my med school classmates that are residents now and I think they can legitimately say these are some of the best days of their lives. I am so far away from that it isn't even funny. Single, pretty broke, in a rather mediocre city. Its not just me, it's everyone around me, it seems like it is the same for all of them, maybe not the single part. It's no way to live. Do i just accept that?

If you think ours is the only specialty that has to deal with pimping, you are mistaken.

The grass will always seem greener elsewhere, but we have one the best lifestyles in medicine, especially during residency. Most other residents are working more hours and looking forward to equally uncertain job markets.

But if you honestly don't enjoy the work, that's a totally different story. You should know by now if this field is for you.

 

[Gfunk6]

Residency sucks. How much it sucks is dependent on the field, specific institution, PD, and attendings. I had plenty of low points in my residency. Things get better, trust me - much, much better - as an attending.

The job search is stressful and hard work for you, but so is everything else worth having.

What are your options at this point if you drop out of residency? Work in a doc in the box? Work for a medical consulting division (which has a more stressful and difficult job search than Rad Onc)? Go to another speciality with of all of its baggage?

Man up and tough it out, you'll be better off in the end.

 

[kd2]

I looks at my med school classmates that are residents now and I think they can legitimately say these are some of the best days of their lives. I am so far away from that it isn't even funny. Single, pretty broke, in a rather mediocre city.

Have you seriously considered talking to a psychiatrist or a psychologist? Considering it's not just the job that's horrible, but also the lack of relationships, the location, and the perception that everyone else has it better, maybe you're just depressed. Would everything really be better if you were in a different specialty, or would you end up feeling like this about everything in your life again because you're simply prone to it?

You're in a pretty good spot that many med students would love to have, I'd just tough it out yourself or with some psychiatric assistance and reevaluate in a few years when you can make big life changes without throwing away everything you've done to this point.

 

[ReOxygenation]

This isn't a Little Wayne video where you say YOLO and life is a big party. There are a lot of ramifications to making a decision like this including what specialty one wants to do, limited funding as the poster has already used 3/5 years of funding, etc. Sometimes it is easier to finish a residency and have that ace in the hole.

It's actually a Drake track. Good effort, though. Perhaps it would have been more eloquent to say Carpe Diem. Regardless of the lyric, I feel the philosophy applies.

 

[ReOxygenation]

Your a med student, your perspective on the situation is limited seeing that you haven't gone through a rad onc residency and know what it actually entails and the ups and downs. Easy to arm chair quarterback with catchy sayings when you haven't actually been in the game and cant understand the ramications of YOLO/Carpe Diem or whatever.

I respect that. Can't argue with your point. Carry on...

 

[deleted4401]

I'm only 33 but YOLO is something that I say ironically to friends and colleagues such as Randy Waggoner, SRS/MD. Are people saying that for cereal? That's also a phrase that I thought people say ironically.

Anyway. It sucks, I hear you. It's hard, the minutiae is ridiculous, the pompousness is hard to believe, and the pontification is endless. However, even at the low end, you make good money, help people, and it's less annoying then any other field of medicine. I mean, if you can learn to cope with the sadness of oncologic illness, then everything in the field is interesting and awesome. I love everything except the pain, suffering, and death. Not being sarcastic. If that didn't exist, everyone would try to be a rad onc.

I suggest you suck it up. Unless you have independent wealth, there are not many fields where you get the hourly wage we do. If you can't see how fantastic you have it compared to your surgery, medicine, and peds buddies, I'm disappointed.

I wish you the best

Your a med student, your perspective on the situation is limited seeing that you haven't gone through a rad onc residency and know what it actually entails and the ups and downs. Easy to arm chair quarterback with catchy sayings when you haven't actually been in the game and cant understand the ramications of YOLO/Carpe Diem or whatever.

 

[Gfunk6]

However, even at the low end, you make good money, help people, and it's less annoying then any other field of medicine. I mean, if you can learn to cope with the sadness of oncologic illness, then everything in the field is interesting and awesome. I love everything except the pain, suffering, and death.

Sig worthy commentary right there.

Also, I'm a bit too old for the YOLO generation. I prefer:

"You only live twice or so it seems
One life for yourself and one for your dreams"

 

[RadRadRad]

Im pgy-3 now, honestly i don't find it interesting, the leadership is heavy handed and wholly unimaginative.

I wonder if some of the problems you are having are from the lack of autonomy many radonc residencies have. In hindsight, I think this was my biggest problem with our residency. In most non-surgical fields, the resident is making many of the important decisions while the attending is off sight. Even in surgical fields, the residents at least have autonomy on the floor and in clinics (to a larger degree than us).

This autonomy eliminates some of the problems with "unimaginative, heavy handed leadership" because you can make your own decisions. The responsibility that comes with such decision making creates more interest/enthusiasm/excitement in the job. If you can approach your patients as if you are in charge (even if you are not), I think you will appreciate things more.


Good luck

 

[Knucklehead]

If you can approach your patients as if you are in charge (even if you are not), I think you will appreciate things more.

This resonates with me. I have much more fun at work if I fool myself and pretend I'm going to be making the decisions alone. In fact I tell my attending what I think we should do even if they aren't usually the type to ask for it. I know I take a risk, but I learn a lot when my attendings correct me.

 

[HatchetJack]

I agree with prior posters on 2 points.

1. You should consider the fact that you may be depressed or SAD. Can be tough to realize that as a physician, you may still be affected by these conditions that affect huge percentages of the population, across all professions.

2. Rad onc residency is very different from attending life. I'm lucky enough to have very nice attendings and non-malignant residency, but even still now that I'm interviewing for jobs, seeing the light at the end of the tunnel is awesome! It can be tough to think that far into the future but honestly in a year you can begin interviewing and being wined and dined with offers of great jobs will cheer you up.

I strongly suggest you consider your motivations before making drastic change such as giving up a coveted residency position that you will never be able to recover. Hundreds of medicine residents would love your spot.

 

[TarHeelRadOnc]

Interesting editorial on this topic (well at least the initial topic of this thread) just posted at Red Journal in press articles

PMID: 23391815

 

[Sheldor]

Interesting editorial on this topic (well at least the initial topic of this thread) just posted at Red Journal in press articles

PMID: 23391815

Seems like the author just published Wagy and Gfunks post earlier in this thread

 

[subatomicdoc]

Unfortunately, its my opinion that the market will get worse before it gets better. I think we added too many residency positions and new programs without factoring in reimbursement cuts, physicians working later into their careers due to the economic issues, and saturation in high demand areas into the number we need.

I agree with your assessment and think if everything stays the same we're training too many residents. However, many specialties get surprised when positively and negatively about prospects. I was told in '97 not to go into rad onc because everyone was young in the field and weren't going to retire.

Instead, many more senior rad oncs retired because they didn't want to have to adapt to 3DCRT and switching from fluoro simulation. By the time I got to residency in '99 everything had changed for the outlook.

In rapidly evolving healthcare environment in an increasingly complex field like ours, don't be surprised if it happens again.

 

[Haybrant]

http://www.nytimes.com/2013/03/28/h...ies-see-dream-jobs-disappearing.html?hpw&_r=0

Its happening to a specialty that we share a college with. Im curious if radiology residency spots are becoming less competitive or if the number of residency positions available will decrease in years to come.

do we know the statistics of applicant numbers this year? did rad onc drop off substantially? Also, do we have numbers about our starting salaries in rad onc now? Does anyone have an estimate on what we might get paid when cancer care moves to bundle payment?

 

[Gfunk6]

Read the FAQ for the most up to date salary data.

No one knows what Medicare bundled payments will look like, they have not even published proposals at this point.

 

[deleted4401]

That's crazy. I can't believe that hospital wouldn't sort out finding residencies for the trainees before dropping them. Unconscionable.

I love their wording. "The most money for the least grueling work". Spend 9 hours in a reading room cranking out a bajillion studies and tell me it's not grueling. Not saying the salaries weren't somewhat unbalanced (as are ours), but that is a such nonsense. Leave it to the old grey lady to malign another field that has revolutionized modern medicine.

Anyway, they had to see it coming, didn't they? Just like people in rad onc, the writing is on the wall. Anything high tech and highly reimbursed always comes down.

I know it's so altruistic, but an academic department could get each of their docs to put in 2k a year and fund these poor bastards until they finish. I mean, they did cash in on the golden goose.

 

[thesauce]

That's crazy. I can't believe that hospital wouldn't sort out finding residencies for the trainees before dropping them. Unconscionable.

I love their wording. "The most money for the least grueling work". Spend 9 hours in a reading room cranking out a bajillion studies and tell me it's not grueling. Not saying the salaries weren't somewhat unbalanced (as are ours), but that is a such nonsense. Leave it to the old grey lady to malign another field that has revolutionized modern medicine.

Anyway, they had to see it coming, didn't they? Just like people in rad onc, the writing is on the wall. Anything high tech and highly reimbursed always comes down.

I know it's so altruistic, but an academic department could get each of their docs to put in 2k a year and fund these poor bastards until they finish. I mean, they did cash in on the golden goose.

I'm sure they were able to find positions at other programs to finish out their residencies. Similar things have happened to a number of my friends. One matched at St Vincent's just before it was announced that they were closing after 100+ years of being open. Within days he had offers from 3 programs (including 2 ivy leagues). He said similar offers were made to the other residents in the program.

 

[Seldon1985]

I'm sure they were able to find positions at other programs to finish out their residencies. Similar things have happened to a number of my friends. One matched at St Vincent's just before it was announced that they were closing after 100+ years of being open. Within days he had offers from 3 programs (including 2 ivy leagues). He said similar offers were made to the other residents in the program.

This was a DO program I think

 

[thesauce]

This was a DO program I think

I saw that. Not sure how different it is for them. One would hope there would be contingencies in place.

 

[thesauce]

Did anyone see the most recent ASTRO email? It sounds like they're trying to be pro-active in self-regulating XRT in attempt to prevent future arbitrary cuts from CMS. Thoughts?

"ASTRO Submits Proposal to Revise IMRT and Other Treatment Delivery Codes to Protect the Specialty

Radiation oncology is facing unprecedented payment risks. CMS identified twenty-three codes for scrutiny in the 2013 Medicare Fee Schedule Final Rule. The specialty is under intense scrutiny not only by Medicare, but by private payors as well. These concerns about radiation therapy use, cost and other factors have contributed to fluctuations in Medicare reimbursement, including severe cuts to commonly used treatments.**

ASTRO recently submitted a proposal to the American Medical Association CPT Editorial Panel to revise IMRT, IGRT, and other treatment delivery codes to better reflect clinical practice.* This proposal was in response to some very specific issues raised by CMS and developed by ASTRO to protect our specialty and access to care for our patients.*

ASTRO recognizes that this volatile payment environment is extremely challenging for providers and harmful to the provision of high quality cancer care. We are committed to leading the specialty through this difficult period. As you know, ASTRO has led the fight in recent years to protect the specialty from massive proposed payment cuts, and we have succeeded in significantly limiting payment reductions to radiation oncology. The redesign of these key radiation treatment delivery codes are part of a larger ASTRO payment reform action plan, which also includes implementing quality-based incentive payments and incentivizing cost-effective care.

The CPT proposal evolved from ASTRO's attempt to address many interrelated issues.* Radiation treatment delivery has been well described by existing codes for many years; however, as clinical practice has evolved, several issues have arisen that require coding modifications. Rather than attempting piecemeal modifications of individual codes, we intend to address all interrelated issues and revamp the entire treatment delivery family. We have proposed new code descriptors reflecting the way IGRT and tracking are performed, new IMRT code descriptors to recognize both simple and more complex treatment delivery, and a simplification of the conventional treatment delivery codes. The proposed changes are summarized on this chart.

ASTRO's proposal will be presented at the May 2013 AMA CPT Editorial Panel meeting. The earliest any changes to the radiation oncology code set could become effective is January 1, 2015.* It is important to note that the final codes approved by the AMA CPT Editorial Panel may differ from what ASTRO has proposed.

If approved, these necessary coding changes could result in significant payment reductions. However, without this action by ASTRO, recent payment instability will continue and potentially worsen. ASTRO also is working with CMS and Congress to mitigate these reductions to protect patient access to care while creating a more stable system in the long term.*

More information about the CPT Editorial Panel process is available online. Since these codes are only proposed at this stage and can change prior to their final release, ASTRO cannot provide coding guidance at this time. ASTRO welcomes any comments and input on this proposal, which can be submitted to the ASTRO coding questions inbox"

 

[medgator]

That's crazy. I can't believe that hospital wouldn't sort out finding residencies for the trainees before dropping them. Unconscionable.

Anyway, they had to see it coming, didn't they? Just like people in rad onc, the writing is on the wall. Anything high tech and highly reimbursed always comes down.

.

The powers that be in rad onc certainly aren't helping the reimbursement climate right now by expanding programs and spots out of proportion to the job growth rate

 

[Neuronix]

The powers that be in rad onc certainly aren't helping the reimbursement climate right now by expanding programs and spots out of proportion to the job growth rate

ASTRO’s proposal will be presented at the May 2013 AMA CPT Editorial Panel meeting. The earliest any changes to the radiation oncology code set could become effective is January 1, 2015. It is important to note that the final codes approved by the AMA CPT Editorial Panel may differ from what ASTRO has proposed.

If approved, these necessary coding changes could result in significant payment reductions.

All of a sudden I feel like a crash test dummy...

 

[Gfunk6]

The powers that be in rad onc certainly aren't helping the reimbursement climate right now by expanding programs and spots out of proportion to the job growth rate

True. But increased resident complement does help academic attendings move away from revenue-generating activities (clinical care) to research.

Translation- ASTRO is hosing us and not really advocating for the specialty as it should. Why would our national organization put forth coding changes that lead to significant payment cuts, dont the realize that regardless, CMS is always going to be coming back for more. Better to stand your ground, and use lobbying dollars to push for our specialty.

Well, I think ASTRO has to be a little bit realistic. The old strategy for when a rabid dog (CMS) was chasing you was to throw them a bone (Cardiology reimbursement for stents, Oncology reimbursement for erythropoeitin) so that you could get away. Unfortunately, that no long works. As a specialty society, ASTRO is forced to argue to "minimize" cuts rather than eliminate them. If ASTRO simply dug in its heels and said "no!" to any type of reimbursement cut, then I think we would be worse off.

 

[deleted4401]

I think that may be true, but it may not. You give the feds an inch, sometimes they take a mile. I think there is a sense of game theory involved here. Maybe if ASTRO offers this, we will be spared in the long run, but maybe not. Sort of like when a college football team punishes itself so the NCAA is more lenient. Sometimes it works, sometimes you get a $60 million dollar fine and a 4 year death penalty (re: Penn State). It needs to be very strategic and I hope it works out.

 

[IlladeplhNarm]

Maybe I don't belong here, but this thread is very discouraging. I'm a first year medical student with very strong interest in radiation oncology. I don't know if other med students are reading this thread, but it has lead me to reevaluate my career path. I know I'm still very early in the process, but getting a residency in such a competitive field requires early efforts (research, publications, etc.). Working your butt off to get stellar grades and publication during school and getting a decent residency, but then having to scramble to find a job, just doesn't seem worth it to me. On the other hand, RadOnc as a field and what the job entails I find very attractive and seems very worth it.

I've known for a while that I want to be a cancer physician, and I think I would prefer the work in RadOnc than in HemOnc. RadOnc as a career fits me very well, and I have evaluated, read about and seen what the job entails. At the same time I do want to be able to have some sort of freedom as to where I live, particularly I want to live near a bigger city. From what it seems like from the first few posts on this thread is that if I'm not in a top 5 RadOnc residency, then basically have no shot at a job near a bigger city. Am I right in thinking this? Do you think I should reevaluate and give HemOnc a chance if it means I'm closer to a bigger city? What do you guys think?

 

[ramsesthenice]

Do you think I should reevaluate and give HemOnc a chance if it means I'm closer to a bigger city? What do you guys think?

Yes but not because of this thread. Virtually all fields are competative around big cities. HemeOnc may be better but its still going to be hard. You have no idea what your board scores are or what your clinical grades are yet so I wouldn't be set on a competative field if nothing else for practical reasons. More important, you really need to have an open mind from where you are. You may be real suprised by what you find in fields you thought were boring before you showed up. You need to do research and all and getting started early for rad onc just in case, but keep an open mind for everything else as you go along.

Also, a lot of what is going on with this thread is a matter of perspective. Pay is going down but if you were not there to remember the good ole days its still a relatively high paying field in medicine and should continue to be so. Everyone is going to get pay cuts and there is no real way to predict who is going to get hit hardest. The job market is tight but again show me a field where its not tight in a big city.

 

[Gfunk6]

I agree with ramsesthenice.

If you are an MS-1, then it will be at least 7-8 years before you begin to worry about jobs. Who knows what things will look like then? Better to do what you enjoy than latch your dreams to ever-moving targets.

I also agree that you should keep an open mind during medical school. The simple truth is that med students who come in wanting to pursue a certain speciality invariably change their mind. I did.

 

[Neuronix]

Maybe I don't belong here, but this thread is very discouraging.

There are pros and cons to any specialty. Radiation oncology has its disadvantages. Some of those disadvantages are that it's a small competitive field with limited residency positions and with a job market that fluctuates.

You do have to be a very competitive medical student to obtain a position in the field. Even so, you are looking at applying nationally and matching randomly. Location is not something that you get a whole lot of say about.

There are some less than ideal (and outright bad) programs out there. Some of these are the big name programs whose names are thrown around on SDN all the time. This is because the faculty and/or research at some programs are big name, but that doesn't necessarily create a strong teaching or research environment for residents. If the attendings spend all their time generating papers, guess who has to pick up the slack in clinic? Further, most of the contributors to these "rankings" threads are medical students who overvalue location and prestige, and have little clue about what makes a good training program. Nobody has said in this thread that you need to go to a "top 5" residency program to obtain a position near a big city. That is hyperbole. What we have said is that big, desirable cities are competitive job markets. What we have also said is that where you went to residency is just one of many factors (probably a smaller one...) pertaining to what job you get after residency.

Some years there are many jobs, and other years there are not. This is at the whim of the overall job market, and is completely out of our control. Since this is a small specialty, the job market can change a lot within the span of 5 years, for better or for worse.

At the end of the day radiation oncology is an extremely competitive specialty in which to obtain a residency position. The specialty is not for everyone. Of all the medical specialties, I love radiation oncology, and I would do it no matter the drawbacks I listed above. But, I'm not going to try to convince anyone that they need to do radiation oncology. That's something that you have to decide.

If location and lifestyle are most important to you, there are other specialties with good lifestyles that are much less competitive. For example, if you want to match in PM&R with an application competitive for radiation oncology, you will have your pick of positions. Psychiatry is similarly non-competitive, and I hear has a strong job market. Primary care is exploding with demand, and with a strong medical school performance you can go anywhere you like. There are many more examples.

 

[Sheldor]

I agree with ramsesthenice.

If you are an MS-1, then it will be at least 7-8 years before you begin to worry about jobs. Who knows what things will look like then? Better to do what you enjoy than latch your dreams to ever-moving targets.

I also agree that you should keep an open mind during medical school. The simple truth is that med students who come in wanting to pursue a certain speciality invariably change their mind. I did.

While I received this advice many times and did my best to keep an open mind, I knew I wanted to go into Rad Onc as an M1 and nothing came close to taking its place. So while many people change their minds, I'd guess that if you have a niche interest coming in theres at least a chance you won't change your mind! I wouldn't have had the match season I did if I hadn't started doing rad onc research from day 1, I don't think.

Moral of the story: Gfunk is right, but if you think you want to do rad onc don't let keeping an open mind dissuade you from starting to improve your application.

If location and lifestyle are most important to you, there are other specialties with good lifestyles that are much less competitive. For example, if you want to match in PM&R with an application competitive for radiation oncology, you will have your pick of positions. Psychiatry is similarly non-competitive, and I hear has a strong job market. Primary care is exploding with demand, and with a strong medical school performance you can go anywhere you like. There are many more examples.

This! Job markets change, but Rad Onc will always be a unique specialty in that you cant just hang a shingle where you want AND the population to Rad Onc ratio is one of the highest around. In the end, I loved Rad Onc enough to sacrifice complete control over my families location, but feel like in the end you can nearly always get to the region you want, which could place you within a days drive of family. I'd rather be within a days drive of family and doing what I'm passionate about, then be next door and hate my job.

 

[IlladeplhNarm]

While I received this advice many times and did my best to keep an open mind, I knew I wanted to go into Rad Onc as an M1 and nothing came close to taking its place. So while many people change their minds, I'd guess that if you have a niche interest coming in theres at least a chance you won't change your mind! I wouldn't have had the match season I did if I hadn't started doing rad onc research from day 1, I don't think.

This! Job markets change, but Rad Onc will always be a unique specialty in that you cant just hang a shingle where you want AND the population to Rad Onc ratio is one of the highest around. In the end, I loved Rad Onc enough to sacrifice complete control over my families location, but feel like in the end you can nearly always get to the region you want, which could place you within a days drive of family. I'd rather be within a days drive of family and doing what I'm passionate about, then be next door and hate my job.

Good point about the location. I'm a non traditional student have worked many jobs in the healthcare field and interacted with physicians from many different specialties. I've had a lot of time to think about different specialties, but I keep coming back to RadOnc.

 

[ramsesthenice]

I agree with Sheldor (about loving the field) but the reality is most people do change their minds. In my class there were 4 of us that went into med school with PhDs. All in a cancer field. All sure we wanted to be in onc. I'm rad onc, one is med onc, one is psych, one is OB. Even among people with lots of experience who you would think may be less likely to change their minds still half of them found their way into something else that made them happier. You really don't know till you try everything. It's good to have an idea of what you want early if you want to shadow or do research but I think it's a mistake for 99% of M1s or M2s to be dead set on a given specialty.

 

[medgator]

That 2010 jco study is getting airtime again in the red journal this month....

http://www.redjournal.org/article/S0360-3016(13)00082-5/fulltext

Recent evidence suggests that a 2-fold increase in the residency workforce is needed within 5 years to compensate for increases in demand for radiation therapy services

Evaluating the residency workforce has important implications to the future supply of radiation oncologists. Increasing the number of residency training positions serves as the most direct way to address the rising demand for radiation therapy services. According to the NRMP data for the current PGY-1 class (7) and American Board of Radiology data for PGY-2 thru PGY-5 classes (10), there are currently 838 residents in the radiation oncology resident workforce, representing almost no gain from 2011 (837 residents). Without significant increases in the number of training positions, radiation oncologists will face pressure to maintain higher patient volumes and likely rely more on physician assistants and advanced-practice registered nurses to ease the increased clinical burden.

 

[medgator]

If thats the case, where are the jobs? talk to the grads and look at the market in big cities, its not there.

Oh I completely agree. It's like the authors of the JCO article haven't actually gone and tried to look for a job themselves, but rather are just using estimates to guess how things will be in the future.

 

[Seldon1985]

Oh I completely agree. It's like the authors of the JCO article haven't actually gone and tried to look for a job themselves, but rather are just using estimates to guess how things will be in the future.

This med student has been a first author on many of these HSR type papers. I wouldn't be surprised if the actually pulse of the market may be missed...

 

[Sheldor]

This med student has been a first author on many of these HSR type papers. I wouldn't be surprised if the actually pulse of the market may be missed...

Perhaps it's based more on projections of need based on expanding healthcare coverage and an aging population but fails to take into account currently practicing rad oncs willingness to increase workload before hiring additional docs?

 

[jaycar0]

This is article is relevant to this discussion if you haven't seen it:
http://www.ncbi.nlm.nih.gov/pubmed/21493013
There are some nice maps that display the ratio of #rad oncs/100,000 population that illustrate the geographic maldistribution issue.

 

[deleted4401]

I think that sums it pretty well. The way the abstract is written - do they mean places with more minorities have more RO, or the opposite?

 

[medgator]

I think that sums it pretty well. The way the abstract is written - do they mean places with more minorities have more RO, or the opposite?

They have more. From the full-text discussion section:

From 1995 through 2007, although the radiation oncology workforce increased slightly, it remained geographically maldistributed. Radiation oncologists remained concentrated in primarily highly populated metropolitan HSAs of the country, leaving large segments of the United States lacking access to radiotherapy. Additionally, geographic access to radiotherapy is associated with HSAs that have higher socioeconomic characteristics and higher minority makeup.

 

[Gfunk6]

These two papers jibe with my own experiences on the job trail. If you are simply interested in a job, ANY job, then you will have absolutely no problem. It is just that the finding a job in "highly populated metropolitan HSAs of the country" that is challenging.

For what it's worth, MDs and administrators in lesser populated areas of the country are DESPERATE for Radiation Oncologists. I've received some 'informal' offers that involved so much $$$ that they seriously made me consider relocation. But not for long . . .

 

[medgator]

For what it's worth, MDs and administrators in lesser populated areas of the country are DESPERATE for Radiation Oncologists. I've received some 'informal' offers that involved so much $$$ that they seriously made me consider relocation. But not for long . . .

Agree x10000.

That's really what it comes down to. You have 3 aspects to your job..... Job quality, Job location and Job income.

You are going to take a hit somewhere, sometimes in 2 of those areas to make the 3rd one work. You can do quite well running your own center in the middle of nowhere in the middle of the country. Or you can be an employed doc in a highly-desirable HSA on the coast making orders of magnitude less. It's those kind of choices you'll be making when the time comes.

 

[medgator]

agreed, but does increasing the number of graduates do anything to shift people into maldistributed areas, grads have gone up over 50% yet these areas are still desperate. People would rather work for a > 50% reduction in salary in a saturated market than go work there.

It does not. This has been proven time and time again in other specialties. That was the whole rationale for all of these medical schools that have popped up in the US (particularly FL) in the past decade. Without a concomittant increased in medicare funding for residency positions via DME/GME payments, we've basically run into a situation where US medical school graduates go unmatched in any specialty (where this was unheard of a decade ago, with FMGs coming in to pick up the slack). Nothing has improved in terms of rural care in the meanwhile.