re-training and re-boarding into medonc ... worth it or even practical?

[RickyScott]

I don’t see why this should have anything to do with the medonc board. They are not a governmental authority. Gynonc and neuro onc did not ask for their permission.

---

Members don't see this ad.

 

[deleted941485]

I don’t see why this should have anything to do with the medonc board. They are not a governmental authority. Gynonc and neuro onc did not ask for their permission.

Because who/what in the hell is going to add any legitimacy to having a radiation oncologist administering systemic agents? Who would even refer to us?

 

[StIGMA]

Because who/what in the hell is going to add any legitimacy to having a radiation oncologist administering systemic agents? Who would even refer to us?

If we give the agents for the purpose of affecting the primary treatment of radiotherapy - that is enough legitimacy, from ourselves. I am interested in enhancing our therapeutic goals with systemic therapy, which is generally a different goal than medical oncology has. I don't care to keep patients on an ever changing word salad of drugs for years (or I'd be a medonc).

 

[medgator]

Because who/what in the hell is going to add any legitimacy to having a radiation oncologist administering systemic agents? Who would even refer to us?

Absolutely nonsensical for those of us in multi-specialty setups to entertain but may make sense in certain rural situations i would guess. I pretty much see all of the head and neck, and some lung/anal/skin ca before med onc gets a crack, but i am busy enough to have zero interest in getting involved with systemics

 

[deleted941485]

Absolutely nonsensical for those of us in multi-specialty setups to entertain but may make sense in certain rural situations i would guess. I pretty much see all of the head and neck, and some lung/anal/skin ca before med onc gets a crack, but i am busy enough to have zero interest in getting involved with systemics

That being said, options to pursue such an avenue shouldn’t be closed.

 

[Krukenberg]

Has anyone stopped to consider what you’d actually be doing as a med onc? Here is the A/P problem list from a med onc note for a palliative patient of ours. All of the problems had at least an assessment if not active management

stage 4 cancer
Hypothyroidism
Headaches
Shortness of breath
Low back pain
Nausea
Constipation
Hypertension
Tachycardia
Neutropenia
Anemia
Peripheral neuropathy

Anyone still want to be a med onc??? I love the surgery-like problem focus of rad onc, and med onc would be low on my list of alternatives to rad onc if I ever wanted to switch (which I don’t).

 

[RickyScott]

I don’t see why this should have anything to do with the medonc board. They are not a governmental authority. Gynonc and neuro onc did not ask for their permission

Has anyone stopped to consider what you’d actually be doing as a med onc? Here is the A/P problem list from a med onc note for a palliative patient of ours. All of the problems had at least an assessment if not active management

stage 4 cancer
Hypothyroidism
Headaches
Shortness of breath
Low back pain
Nausea
Constipation
Hypertension
Tachycardia
Neutropenia
Anemia
Peripheral neuropathy

Anyone still want to be a med onc??? I love the surgery-like problem focus of rad onc, and med onc would be low on my list of alternatives to rad onc if I ever wanted to switch (which I don’t).

sure, but many residents will be unemployed if they can’t find something else to do.

 

[sloh]

Has anyone stopped to consider what you’d actually be doing as a med onc? Here is the A/P problem list from a med onc note for a palliative patient of ours. All of the problems had at least an assessment if not active management

stage 4 cancer
Hypothyroidism
Headaches
Shortness of breath
Low back pain
Nausea
Constipation
Hypertension
Tachycardia
Neutropenia
Anemia
Peripheral neuropathy

Anyone still want to be a med onc??? I love the surgery-like problem focus of rad onc, and med onc would be low on my list of alternatives to rad onc if I ever wanted to switch (which I don’t).

Is it possible many of these diagnoses have ready made dot phrases to conveniently and easily slip into the note to fulfill sufficient medical complexity so they can submit higher level code/billing?

Headache, low back pain, nausea, constipation, HTN, anemia, peripheral neuropathy all very common in the demographic of patients seen.

 

[Neuronix]

Has anyone stopped to consider what you’d actually be doing as a med onc? Here is the A/P problem list from a med onc note for a palliative patient of ours. All of the problems had at least an assessment if not active management

stage 4 cancer
Hypothyroidism
Headaches
Shortness of breath
Low back pain
Nausea
Constipation
Hypertension
Tachycardia
Neutropenia
Anemia
Peripheral neuropathy

Anyone still want to be a med onc??? I love the surgery-like problem focus of rad onc, and med onc would be low on my list of alternatives to rad onc if I ever wanted to switch (which I don’t).

I manage all of those in my clinic. Some of my notes look like that. The only thing I don't order is factor support like Neupogen. Half of the plan of that list is probably "will monitor" anyway. 90% of that is managed with a CBC, CMP, TSH/Free T4, CXR/EKG, referrals, and a few key meds.

Back when I used to be basically the neuro-oncology service for our hospital that has a lot of brain tumor volume, I would round and have inpatient notes like that too. I've considered going back for neuro-oncology fellowship so I can give Avastin, TMZ, PCV, and run med and combo med/RT trials as well as better understand seizure management and some other points of neuro, but that's probably never going to happen for me. Since a lot of neuro-onc followship spots go unfilled, it certainly seems like something reasonable, though I think it would be a tiny little market for combination neuro-onc/rad onc docs that sure as heck won't solve our overall oversupply problem.

 

[Krukenberg]

I manage all of those in my clinic. Some of my notes look like that. The only thing I don't order is factor support like Neupogen. Half of the plan of that list is probably "will monitor" anyway. 90% of that is managed with a CBC, CMP, TSH/Free T4, CXR/EKG, referrals, and a few key meds.

Back when I used to be basically the neuro-oncology service for our hospital that has a lot of brain tumor volume, I would round and have inpatient notes like that too. I've considered going back for neuro-oncology fellowship so I can give Avastin, TMZ, PCV, and run med and combo med/RT trials as well as better understand seizure management and some other points of neuro, but that's probably never going to happen for me. Since a lot of neuro-onc followship spots go unfilled, it certainly seems like something reasonable, though I think it would be a tiny little market for combination neuro-onc/rad onc docs that sure as heck won't solve our overall oversupply problem.

You specialize in a sick population, and while I commend you for your general medical management, I’d be shocked if a general rad onc is having to spend cognitive load on all these medical issues for standard follow up patients. Med oncs are the PCPs of metastatic cancer patients. If one was never interested in primary care in med school, he/she should run the other way from med onc.

 

[Neuronix]

I’d be shocked if a general rad onc is having to spend cognitive load on all these medical issues for standard follow up patients. Med oncs are the PCPs of metastatic cancer patients. If one was never interested in primary care in med school, he/she should run the other way from med onc.

There's certainly a spectrum of med onc here too. I know med oncs who try to shy away from general medical management of patients and focus on cancer, chemo, and chemo related issues.

 

[medgator]

There's certainly a spectrum of med onc here too. I know med oncs who try to shy away from general medical management of patients and focus on cancer, chemo, and chemo related issues.

There's some med oncs that only send extenders to the hospital and manage things over the phone

 

[Krukenberg]

So what you and neuronix are saying is, if you’re a med onc you have to expend effort and/or money to avoid having to deal with medical issues unrelated or peripherally related to cancer management. Rad onc, like surgery, is inherently problem-focused and you expend effort if you WANT to deal with those issues.

What I’m getting at is, the nature of the two jobs is completely different despite both being specialties of oncology. “Do med onc” is bad one-size fits all advice to med students who are worried about the potential of a tough rad onc job market in the future. I’ve said it a million times and will repeat it: what good is living in a “desirable location” if you don’t like what you do 10-12 hours per day.

 

[drewdog1973]

So what you and neuronix are saying is, if you’re a med onc you have to expend effort and/or money to avoid having to deal with medical issues unrelated or peripherally related to cancer management. Rad onc, like surgery, is inherently problem-focused and you expend effort if you WANT to deal with those issues.

What I’m getting at is, the nature of the two jobs is completely different despite both being specialties of oncology. “Do med onc” is bad one-size fits all advice to med students who are worried about the potential of a tough rad onc job market in the future. I’ve said it a million times and will repeat it: what good is living in a “desirable location” if you don’t like what you do 10-12 hours per day.

What I'm getting at it for some people this is worth it. I would probably be happy doing something else in a city/region I am excited to live in. I think many people would agree. And that doesn't even mean just being in a different specialty. I can imagine doing something non-medical and getting to live somewhere. I'd imagine there are plenty of docs and non-docs that live near the mountains to ski or near the coast to have a boat or kite surf and don't really care that their job/career isn't their dream job/career.

 

[deleted941485]

If we give the agents for the purpose of affecting the primary treatment of radiotherapy - that is enough legitimacy, from ourselves. I am interested in enhancing our therapeutic goals with systemic therapy, which is generally a different goal than medical oncology has. I don't care to keep patients on an ever changing word salad of drugs for years (or I'd be a medonc)

What I'm getting at it for some people this is worth it. I would probably be happy doing something else in a city/region I am excited to live in. I think many people would agree. And that doesn't even mean just being in a different specialty. I can imagine doing something non-medical and getting to live somewhere. I'd imagine there are plenty of docs and non-docs that live near the mountains to ski or near the coast to have a boat or kite surf and don't really care that their job/career isn't their dream job/career.

I find myself firmly in this camp. I may not like what I do but if I have the job security and the ability to move to a more desirable locale then I would pick that over loving my job and finding my options limited.

 

[RadRadRad]

I manage all of those in my clinic. Some of my notes look like that. The only thing I don't order is factor support like Neupogen. Half of the plan of that list is probably "will monitor" anyway. 90% of that is managed with a CBC, CMP, TSH/Free T4, CXR/EKG, referrals, and a few key meds.

Back when I used to be basically the neuro-oncology service for our hospital that has a lot of brain tumor volume, I would round and have inpatient notes like that too. I've considered going back for neuro-oncology fellowship so I can give Avastin, TMZ, PCV, and run med and combo med/RT trials as well as better understand seizure management and some other points of neuro, but that's probably never going to happen for me. Since a lot of neuro-onc followship spots go unfilled, it certainly seems like something reasonable, though I think it would be a tiny little market for combination neuro-onc/rad onc docs that sure as heck won't solve our overall oversupply problem.

order ekg? Do you interpret? What if you interpret incorrectly? Yikes!

 

[Krukenberg]

I find myself firmly in this camp. I may not like what I do but if I have the job security and the ability to move to a more desirable locale then I would pick that over loving my job and finding my options limited.

That’s great and all power to you, but doesn’t describe all of us, so the standard line of “do med onc” is a huge disservice. I would much rather be doing good, fulfilling work that I enjoy, come home to my family happy, have a higher standard of living/purchasing power, and vacation at the so-called desirable locations. I suspect that is the case for many people who aren’t as vocal on this forum.

All of that being said, there were/are damn good academic and community jobs available this cycle, including in “desirable locations” (NYC, Boston, Miami, SF, San Diego, etc), and I think it’d be a mistake for residents to switch out of rad onc due to job market fears that haven’t materialized yet.

 

[deleted941485]

Yeah I mean its already materializing in other specialties thought to be immune. ER even hospital medicine cant get a job in some metro areas without 5 years experience...sound familiar? How safe do you think we are?

https://www.washingtonpost.com/health/2021/01/04/er-doctors-covid-jobs/

I guess would be RO residents should roll the dice in 2021 and see how things shake out in 2025/26 after APM and supervision have completely devastated every practice save for the privileged few working at mega academic centers.

I'm certain it doesn't describe everyone but I dont think having options would be detrimental.

Besides the residents that have matched the last 2 years which consisted of many many SOAP candidates probably would switch out if given the opportunity.

That’s great and all power to you, but doesn’t describe all of us, so the standard line of “do med onc” is a huge disservice. I would much rather be doing good, fulfilling work that I enjoy, come home to my family happy, have a higher standard of living/purchasing power, and vacation at the so-called desirable locations. I suspect that is the case for many people who aren’t as vocal on this forum.

All of that being said, there were/are damn good academic and community jobs available this cycle, including in “desirable locations” (NYC, Boston, Miami, SF, San Diego, etc), and I think it’d be a mistake for residents to switch out of rad onc due to job market fears that haven’t materialized yet.

 

[drewdog1973]

I think it’d be a mistake for residents to switch out of rad onc due to job market fears that haven’t materialized yet.

This is Denialism at its core. When do you switch out? At the trough ? Do you know how to catch a falling knife?

 

[RickyScott]

That’s great and all power to you, but doesn’t describe all of us, so the standard line of “do med onc” is a huge disservice. I would much rather be doing good, fulfilling work that I enjoy, come home to my family happy, have a higher standard of living/purchasing power, and vacation at the so-called desirable locations. I suspect that is the case for many people who aren’t as vocal on this forum.

All of that being said, there were/are damn good academic and community jobs available this cycle, including in “desirable locations” (NYC, Boston, Miami, SF, San Diego, etc), and I think it’d be a mistake for residents to switch out of rad onc due to job market fears that haven’t materialized yet.

There will always be some jobs in Boston, nyc, Miami etc. people die and retire. This would still be the case in a market with negative growth, which will see if hypofract/apm/consolidation start eliminating practices. Most won’t get desirable jobs and AOA types who have experience working in rural locations for several years will snap them up.

 

[Neuronix]

“Do med onc” is bad one-size fits all advice to med students who are worried about the potential of a tough rad onc job market in the future.

I agree. "Do radiology" is also good advice.

Also the job market is tough now, not in the future. The real question is when will significant chunks of graduating classes not have a full-time job to go to anywhere.

 

[medgator]

All of that being said, there were/are damn good academic and community jobs available this cycle, including in “desirable locations” (NYC, Boston, Miami, SF, San Diego, etc), and I think it’d be a mistake for residents to switch out of rad onc due to job market fears that haven’t materialized yet.

Links?

 

[RadOncDoc21]

Links?

A few listed on the ASTRO website but I would love to see the number of applicants for each of those jobs. In either case, the person applying for those jobs has very limited negotiating power if any.

 

[medgator]

A few listed on the ASTRO website but I would love to see the number of applicants for each of those jobs. In either case, the person applying for those jobs has very limited negotiating power if any.

Definitely no community jobs I'm aware of in SD or miami that were widely known or available. And that's how rad Onc has always been.. any given year can be tough in any given geography, esp in pp, but it just seems to worsen with more grads coming out

 

[Krukenberg]

Definitely no community jobs I'm aware of in SD or miami that were widely known or available. And that's how rad Onc has always been.. any given year can be tough in any given geography, but it just seems to worsen with more grads coming out

X-ray medical group posted publicly several months ago and it looked like it was partnership track. No idea if it was publicly posted or not, but Miami Cancer Institute hired this cycle as well. Even if it wasn’t publicly posted.. if you’re someone who’s interested in living in Miami, it would behoove you to cold email practices regardless of whether they post a position publicly or not.

 

[medgator]

X-ray medical group posted publicly several months ago and it looked like it was partnership track. No idea if it was publicly posted or not, but Miami Cancer Institute hired this cycle as well. Even if it wasn’t publicly posted.. if you’re someone who’s interested in living in Miami, it would behoove you to cold email practices regardless of whether they post a position publicly or not.

X ray medical wasn't partnership track afaik and wasn't even in Miami, but further north in broward county

 

[RickyScott]

Was under the impression from these threads that U of Miamo residents have very tough time in job market and almost always have to leave the area or locums.

 

[Krukenberg]

X ray medical wasn't partnership track afaik and wasn't even in Miami, but further north in broward county

I thought you said you weren’t aware of any jobs in SD? The listing mentioned partnership. I have no interest in SD so didn’t inquire further but took note because they’re a good group.

You’re really splitting hairs with broward county vs Miami. I’ve been to Miami/Ft. Lauderdale and it’s all essentially one continuous city. Live half way between Ft. Lauderdale and South Beach and you’ve got a 20 minute drive to work and 20 minute drive to downtown. Can’t think of a better set up

 

[Neuronix]

You are being pretty dense here. The competition for jobs in competitive markets is extreme.

There are four training programs in Florida which put out around 7-8 grads per year, most of whom want to stay in Florida. People pick their residencies in large part based on location and where they want to stay, and even if not they often become attached and want to stay in the area anyway. Everyone knows that the job market is horrible, so everyone is open to whatever they can get, but you ask residents in Florida their preferences and being in a major metro and/or staying in Florida will be in their list of wants.

The larger and more obvious practices in the state get 40+ cold e-mails a year from current residents, most of whom are out of state.

There are dozens of established rad oncs out there trying to break into the Florida market for various reasons, including riding out large non-competes from some of the notoriously bad groups in the state, existing group got destroyed, from Florida originally but could not find a job there, etc. It's not uncommon to encounter rad oncs looking for *anything* in Florida and unable to find *anything*.

I made a phone call recently for a graduating resident to a Florida hospital group job advertised online since I had a friend there. I was told that the competition was "extreme", they had more "well qualified applicants than we know what to do with", and our graduating resident probably does not have a chance. They are likely hiring a mid career doc, and they had numerous such applicants so they can't even figure out who to pick at this point.

So sure, someone has a job in Florida. Someone is employed there. Heck, there are people who have good jobs in Florida (whatever that means to you). Good luck getting one, and good luck finding another one if you don't like the one you get.

There are some notorious churn and burn places if you absolutely need to be in Florida and want to play that game. Even those spots are turning over less because even unhappy rad oncs don't really have any other place to go.

 

[medgator]

I thought you said you weren’t aware of any jobs in SD? The listing mentioned partnership. I have no interest in SD so didn’t inquire further but took note because they’re a good group.

You’re really splitting hairs with broward county vs Miami. I’ve been to Miami/Ft. Lauderdale and it’s all essentially one continuous city. Live half way between Ft. Lauderdale and South Beach and you’ve got a 20 minute drive to work and 20 minute drive to downtown. Can’t think of a better set up

Denial ain't just a river in Egypt

 

[medgator]

You are being pretty dense here. The competition for jobs in competitive markets is extreme.

I made a phone call recently for a graduating resident to a Florida hospital group job advertised online since I had a friend there. I was told that the competition was "extreme", they had more "well qualified applicants than we know what to do with", and our graduating resident probably does not have a chance. They are likely hiring a mid career doc, and they had numerous such applicants so they can't even figure out who to pick at this point.

This is EXACTLY what will happen to the best jobs going forward, and in fact is happening now, as existing practitioners who are BC will get first dibs on anything that opens up. I know 3 FL jobs taken this cycle by grads out a few years from training who are BC. Existing grads never had a chance, as these jobs couldn't wait till July and it was even better to get someone with experience and BC.

Just searched the ASTRO career center for kicks in FL. 40ish physician jobs listed, only 5 rad Onc ones though and THREE of them are chair jobs (Moffitt, baptist jax, and mayo jax). One of the other two is a derm rads position. But yes the job market in Florida is great in January

 

[drewdog1973]

The denialism is so strong within a certain group of people, that they may as well be recommending programs expand. They have no idea what the other end (San Diego practice, Florida practices) is receiving in terms of applications. 100s per spot. Doesn’t matter - if certain people want to think that, it’s fine, and if certain people would rather be a RO in Rhinelander rather than a podiatrist in San Diego, that’s fine, but let’s dispel with the fiction that there is a choice in the matter for the Rad Onc to decide where they will live.

 

[fiji128]

You are being pretty dense here. The competition for jobs in competitive markets is extreme.

There are four training programs in Florida which put out around 7-8 grads per year, most of whom want to stay in Florida. People pick their residencies in large part based on location and where they want to stay, and even if not they often become attached and want to stay in the area anyway. Everyone knows that the job market is horrible, so everyone is open to whatever they can get, but you ask residents in Florida their preferences and being in a major metro and/or staying in Florida will be in their list of wants.

The larger and more obvious practices in the state get 40+ cold e-mails a year from current residents, most of whom are out of state.

There are dozens of established rad oncs out there trying to break into the Florida market for various reasons, including riding out large non-competes from some of the notoriously bad groups in the state, existing group got destroyed, from Florida originally but could not find a job there, etc. It's not uncommon to find people looking for *anything* in Florida and unable to find *anything*.

I made a phone call recently for a graduating resident to a Florida hospital group job advertised online since I had a friend there. I was told that the competition was "extreme", they had more "well qualified applicants than we know what to do with", and our graduating resident probably does not have a chance. They are likely hiring a mid career doc, and they had numerous such applicants so they can't even figure out who to pick at this point.

So sure, someone has a job in Florida. Someone is employed there. Heck, there are people who have good jobs in Florida (whatever that means to you). Good luck getting one, and good luck finding another one if you don't like the one you get.

There are some notorious churn and burn places if you absolutely need to be in Florida and want to play that game. Even those spots are turning over less because even unhappy rad oncs don't really have any other place to go.

In real terms when compared to other medical specialties the amount of opportunity that this field provides is bottom tier now. It is about what you see in pathology and now I guess maybe where ER might be in the near future. Just because there are some desirable jobs in some areas sometimes doesn't mean that there isn't 10 to 40X the demand for these positions. This field's "leadership" has been incredible poor stewards of this specialty over the last 10 years and this continues as they try to trick and manipulate medical students into believing this is not a crisis rather then taking any decisive corrective action.

The only real path forward is for the specialty to completely go down the tubes where you are getting essentially no qualified applicants at even top tier places and to then fold rad onc back into radiology as a fellowship. This will be the only way to keep programs from matching and SOAPing bottom tier applicants and FMGs. We will never take on med onc responsibilities in a significant way for the simple reason we can't admit and don't have that training (unlike Gyn Onc and Neuro Onc).

 

[scarbrtj]

This is EXACTLY what will happen to the best jobs going forward, and in fact is happening now, as existing practitioners who are BC will get first dibs on anything that opens up. I know 3 FL jobs taken this cycle by grads out a few years from training who are BC. Existing grads never had a chance, as these jobs couldn't wait till July and it was even better to get someone with experience and BC

One of the most conscience-shocking things I think that current about-to-be rad onc residents could ever see is the roster of names (and their credentials) applying to one single hospital-associated job in a Miami-type locale. I'm guessing here but it'd easily be 30+ applicants for such a job I'd reckon. Which means any individual, new grad or established, right now in rad onc has a <3-4% chance of landing a job EXACTLY where they'd like to be. Thought of in this way, the probability a rad onc today gets the job they first sight/pick is about is as likely Steph Curry having ~10 consecutive misses from the FT line. I'd like to get a hold of one of these "rosters" just to prove it to myself, and others.

 

[Krukenberg]

You are being pretty dense here. The competition for jobs in competitive markets is extreme.

There are four training programs in Florida which put out around 7-8 grads per year, most of whom want to stay in Florida. People pick their residencies in large part based on location and where they want to stay, and even if not they often become attached and want to stay in the area anyway. Everyone knows that the job market is horrible, so everyone is open to whatever they can get, but you ask residents in Florida their preferences and being in a major metro and/or staying in Florida will be in their list of wants.

The larger and more obvious practices in the state get 40+ cold e-mails a year from current residents, most of whom are out of state.

There are dozens of established rad oncs out there trying to break into the Florida market for various reasons, including riding out large non-competes from some of the notoriously bad groups in the state, existing group got destroyed, from Florida originally but could not find a job there, etc. It's not uncommon to find people looking for *anything* in Florida and unable to find *anything*.

I made a phone call recently for a graduating resident to a Florida hospital group job advertised online since I had a friend there. I was told that the competition was "extreme", they had more "well qualified applicants than we know what to do with", and our graduating resident probably does not have a chance. They are likely hiring a mid career doc, and they had numerous such applicants so they can't even figure out who to pick at this point.

So sure, someone has a job in Florida. Someone is employed there. Heck, there are people who have good jobs in Florida (whatever that means to you). Good luck getting one, and good luck finding another one if you don't like the one you get.

There are some notorious churn and burn places if you absolutely need to be in Florida and want to play that game. Even those spots are turning over less because even unhappy rad oncs don't really have any other place to go.

# of Applications have gone up because residents are panicking due to covid, APM, supervision, and general rhetoric on SDN. Applicants who in normal years wouldn’t have applied to X location jobs due to lack of interest/family connection are still not going to be filling these jobs. Anyone who has some reason they want to be in X location and is proactive in their job search will have their application rise in the pile, and they will be competing against a much smaller group of applicants.

this is getting away from my main point, which is “do med onc” should not be the standard reply from this forum for concerned med students.

 

[Neuronix]

I'm guessing here but it'd easily be 30+ applicants for such a job I'd reckon.

80+

Denial ain't just a river in Egypt

+1. It's been like this for years. 80+ applications wasn't unusual for good sounding jobs in competitive markets posted on ASTRO board even 5 years ago. 40+ cold e-mails wasn't unusual for big places in competitive markets 5 years ago either. COVID didn't change much in the job market IMO. APM hasn't happened yet. Rhetoric on SDN reflects reality.

 

[drewdog1973]

# of Applications have gone up because residents are panicking due to covid, APM, supervision, and general rhetoric on SDN. Applicants who in normal years wouldn’t have applied to X location jobs due to lack of interest/family connection are still not going to be filling these jobs. Anyone who has some reason they want to be in X location and is proactive in their job search will have their application rise in the pile, and they will be competing against a much smaller group of applicants.

Wow. Hi there, Mike Steinberg. Or, Paul Wallner, or Marcus Randall. Or composite. Thanks for joining us!

 

[taserlaser]

Some other numbers to provide some comparisons:

Million+ populated Canadian city jobs in reasonable locale were easily getting ~40 apps in the last handful of years would be my best estimate.
20-30 from Canadians with FRCPCs, and the balance from international MDs. Competition is still fierce for these jobs.

Much smaller market, and less absolute effect of the ’tinder’ phenomenon where everyone applies everywhere inflating numbers as a result, so if taken as a percentage of graduating class of around 20-25 ROs/year, that is where things compare.

So:
- higher percentage in relation to graduating class still applying for positions above 49th parallel
- higher absolute numbers applying for positions below 49th parallel

 

[scarbrtj]

80+



+1. It's been like this for years. 80+ applications wasn't unusual for good sounding jobs in competitive markets posted on ASTRO board even 5 years ago. 40+ cold e-mails wasn't unusual for big places in competitive markets 5 years ago either. COVID didn't change much in the job market IMO. APM hasn't happened yet. Rhetoric on SDN reflects reality.

How old am I? My first job, very desirable location, partnership available, etc. I competed against one other graduate. I'm that old.

# of Applications have gone up because residents are panicking due to covid, APM, supervision, and general rhetoric on SDN

Putting any cause/effect relationship to the goings on in rad onc from SDN is becoming our tiredest rad onc trope.

 

[Krukenberg]

In real terms when compared to other medical specialties the amount of opportunity that this field provides is bottom tier now. It is about what you see in pathology and now I guess maybe where ER might be in the near future. Just because there are some desirable jobs in some areas sometimes doesn't mean that there isn't 10 to 40X the demand for these positions. This field's "leadership" has been incredible poor stewards of this specialty over the last 10 years and this continues as they try to trick and manipulate medical students into believing this is not a crisis rather then taking any decisive corrective action.

The only real path forward is for the specialty to completely go down the tubes where you are getting essentially no qualified applicants at even top tier places and to then fold rad onc back into radiology as a fellowship. This will be the only way to keep programs from matching and SOAPing bottom tier applicants and FMGs. We will never take on med onc responsibilities in a significant way for the simple reason we can't admit and don't have that training (unlike Gyn Onc and Neuro Onc).

I’m not defending leadership, I think expansion has been a huge mistake. I do not think the current or recent job market has been as bad as is advertised here, and my argument is I think it would be a mistake for current residents to switch specialties. Huge disruption to their lives for a problem that we all fear but has not manifested. Look at the terry wall data for last year’s class. 89% of residents were satisfied to very satisfied with the job they signed with, including 86% satisfied to very satisfied with location. Only 13% dissatisfied with partnership opportunity. Only 2 residents were doing a fellowship (1%). 73% will be making >$300k in their first year. Only 11% took a job in a rural area. The only negative you can pick out is 39% agreed with the statement “the job market was tough,” but that is totally subjective, and there are many reasons someone could have a tough job search that don’t relate to the job market itself.

Past performance does not predict future, but to suggest that current residents upend their lives to switch into specialties wholly different than what they enjoy for a job market that may worsen at an unknown time is bad advice, IMO.

 

[RadOncDoc21]

Denial ain't just a river in Egypt

The Denial force is strong with this one. Must be the chosen one!

 

[Krukenberg]

The Denial force is strong with this one. Must be the chosen one!

I’d honestly like anyone to address the terry wall data I included and explain to me how it reflects a bad job market. Please enlighten me!

 

[drewdog1973]

You want me to have confidence that 89% of people that are happy that they signed a contract and haven’t even started the job yet are happy with the job? What an odd way to look at the survey answers.

It’s not great now, but with 200 graduating annually and fractions in half or less than half, how do things improve or stabilize?

 

[medgator]

I’m not defending leadership, I think expansion has been a huge mistake. I do not think the current or recent job market has been as bad as is advertised here, and my argument is I think it would be a mistake for current residents to switch specialties. Huge disruption to their lives for a problem that we all fear but has not manifested. Look at the terry wall data for last year’s class. 89% of residents were satisfied to very satisfied with the job they signed with, including 86% satisfied to very satisfied with location. Only 13% dissatisfied with partnership opportunity. Only 2 residents were doing a fellowship (1%). 73% will be making >$300k in their first year. Only 11% took a job in a rural area. The only negative you can pick out is 39% agreed with the statement “the job market was tough,” but that is totally subjective, and there are many reasons someone could have a tough job search that don’t relate to the job market itself.

Past performance does not predict future, but to suggest that current residents upend their lives to switch into specialties wholly different than what they enjoy for a job market that may worsen at an unknown time is bad advice, IMO.

You're trying to predict the future in 5 years based on this year's data while we know which way the trends have been going for the last few years. 2020 grads had lowered expectations from the getgo and as drewdog alluded to, have no idea of what kind of job they are getting into.

200/y coming out by 2025 is completely unsustainable and nothing has been done to curtail that by ASTRO.

Grads in 2025-2030 don't care that 2020 grads squeaked by.

What do you think about 2014 employment data where 1/3 couldn't find anything in there preferred geography? Or the terrible 1990s data that basically made rad Onc go from a 3 to a 4 year residency? Are you intentionally trying to deny all of that?

 

[deleted941485]

I’d honestly like anyone to address the terry wall data I included and explain to me how it reflects a bad job market. Please enlighten me!

Did terry wall even do the survey in 2020?

 

[deleted941485]

You're trying to predict the future in 5 years based on this year's data while we know which way the trends have been going for the last few years. 2020 grads had lowered expectations from the getgo and as drewdog alluded to, have no idea of what kind of job they are getting into.

200/y coming out by 2025 is completely unsustainable and nothing has been done to curtail that by ASTRO.

Grads in 2025-2030 don't care that 2020 grads squeaked by.

What do you think about 2014 employment data where 1/3 couldn't find anything in there preferred geography? Or the terrible 1990s data that basically made rad Onc go from a 3 to a 4 year residency? Are you intentionally trying to deny all of that?

We were able to get away with so much back then and still have a viable specialty. But the future will not be kind to ROs there’s just too many interests in making grads lives miserable.

 

[Krukenberg]

Grads in 2025-2030 don't care that 2020 grads squeaked by.

What do you think about 2014 employment data where 1/3 couldn't find anything in there preferred geography? Or the terrible 1990s data that basically made rad Onc go from a 3 to a 4 year residency? Are you intentionally trying to deny all of that?

Wait so 2020 job market is not relevant but the 1990s is? Again, I’m not saying expansion wasn’t a mistake, or that students shouldn’t take expansion into consideration. I’m saying there isn’t evidence yet of a bad job market and current residents shouldn’t upend their lives out of fear and switch specialties.

 

[medgator]

Wait so 2020 job market is not relevant but the 1990s is? Again, I’m not saying expansion wasn’t a mistake, or that students shouldn’t take expansion into consideration. I’m saying there isn’t evidence yet of a bad job market and current residents shouldn’t upend their lives out of fear and switch specialties.

33% of grads found no opportunities in their preferred geographic zone in 2014. What has happened to grad numbers and fraction numbers since then? Multiple people had contracts pulled last cycle only to have them reinstated in the nick of time.

Btw 2014 isn't the 1990s. You don't sound like you know the fl market well, but it has absolutely tightened up since 2014-2015. The same is true in Texas and many other sunbelt markets

@RadsWFA1900 brings up a point regarding the lack of Terry walls involvement in the 2020 data.

 

[RadOncDoc21]

Do grads have to work as strippers part time for there to be good “evidence” that the job market is bad?

Now I’m not saying anything is wrong with that but is that where things need to be at going forward?

 

[scarbrtj]

I do not think the current or recent job market has been as bad as is advertised here, and my argument is I think it would be a mistake for current residents to switch specialties. Huge disruption to their lives for a problem that we all fear but has not manifested. Look at the terry wall data for last year’s class. 89% of residents were satisfied to very satisfied with the job they signed with, including 86% satisfied to very satisfied with location. Only 13% dissatisfied with partnership opportunity. Only 2 residents were doing a fellowship (1%). 73% will be making >$300k in their first year. Only 11% took a job in a rural area. The only negative you can pick out is 39% agreed with the statement “the job market was tough,” but that is totally subjective, and there are many reasons someone could have a tough job search that don’t relate to the job market itself.

Thanks for reiterating what has been iterated and iterated and iterated here before: the job market is bad. And "bad" is "totally subjective" as you rightly say. Your assessment and what's been "advertised here" totally track... on paper. All that doesn't track is on SDN it's "quit peeing on my head" and the countering notion is "howdaya like this rain we're having." The numbers are the numbers. How the numbers are couched will be up for debate even when/if we get >10% unemployment.