Reasonable approach to Rad Onc for someone who loves field but is aware of job market?

[seper]

Yes, it does.

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[deleted941485]

I’m reading a bit of self delusion in the title. A reasonable approach to Rad Onc? The reasonable approach is to stay away. None of the players in the field are reasonable from the faculty that supposedly teach you to the people that may hire/screw you to the eventual fellowship you will need to do. So what happens when your 3 years into this residency and you “plans” don’t work out? You love the field? Your an intelligent person I’m sure you can find something else to be passionate about and learn to love. I cringe when they faculty Med students to pick a something based on happiness. Med student have little to no data to go on except their own mostly wrong headed idea of what a specialty is like. At the end of he day it becomes a job that you either hate but need the money or you need because you’ll have nothing to do in retirement. Both cases being equally miserable.

 

[deleted969641]

What does a typical "non-compete" look like these days? Defined by city or county or x miles (how many miles and a radius?) or "drive time"? Also does it include just were you work or all satellites of the academic center (so if it's I don't know 10 miles from each center but they have multiple centers spread every 25-50 miles then the no-compete is literally a multiple hundred square mile area?)

Also what's up with the contract being renewed annually? Is that really happening (and if so does that mean they can let you go if the private practice they just acquired and made a satellite for which they hired you sees patient volume drop or only for just cause)?

This is all very new to those of us who are even just 10-15 years out . . .

2 years and basically anything within 1 hour driving distance of an entire metro area. This can include double digit specific counties of 50+ mile radius. In other words, you have to move to a different city. And yes, your hunch is correct: they also like to put in other tricky things that say you can't work within 50 miles of ANY facility they have, and they may have facilities all over the state and often in other states.

The issue with some of these non-competes is that it still holds if they cut your salary. They can cut your salary in half and you have very little recourse. You cant go to a competitor in your area and with the job market, the way it is, you may have to go across the country.

The system is extremely unethical and anti-competitive and basically un-American. A few states explicitly ban non-competes, but most don't. In a few more they are basically non-enforceable, but in most states they are totally enforceable and hospitals keep lawyers on staff to sue disagreeable doctors. They should be illegal, and I would encourage everyone to contact their state representatives about this matter. Imagine in any other industry if they gave you perpetual 1 year contracts and locked you in with whatever ridiculous terms they want with 2 year non-compete agreements.

If you wish to be an employee of a hospital or an academic system, the only avenue you have available to yourself to negotiate fair pay and protect yourself from getting blindsided from a future take-it-or-leave-it contract is to go to a very undesirable area no one else will consider. It is unclear how long this avenue will remain available.

A very important thing that everyone applying for jobs should be aware of: Demand that your contract state that if your employer terminates your contract without cause (almost all have a 90 day termination clause either party can execute without cause), then the non-compete is null and void. You would think this would be automatic, but it's not. Do not allow your employer the legal option of laying you off and preventing you from finding work for the next 2 years. That is unconscionable, and while there are a lot of things you have no choice but to sign these days, such as non-competes, I would still outright refuse to sign a contract that doesn't stipulate that.

 

[20181121]

I swear some of you GET OFF on scaring med students and being downers.

Stanford having an 'instructor' position where you START at 150-180k, which is a KNOWN OUTLIER, is not reason for that to be the EXPECTATION for someone who wants to live in a NON-RURAL area as the OP hypothetical example included - especially 5 years in.

I feel like I'm talking to a wall.

and Medgator - I applied this year and look at the ASTRO job center every day - there have been a number of Texas jobs posted this year, and outside of Texas, plenty of plenty of jobs posted on the coasts and in Chicago.

You guys have become a parody of yourselves. There are many many good reasons to curb residency expansion - I am 100% on board, but I'm also a rational human being and know the facts.


Look OP and any other medical students reading this - the best thing you can do is talk to real people in real life - recent grads if you know them - and ask them about their job experience and what range of locations they were looking at and what range of salaries.

Personally, Im happy with where I ended up. My starting salary is in the mid 300's and I am ending up in a major metropolitan area.



Also - if you spend time looking at the ASTRO site - which I encourage everyone to do - there are honestly not that many 'RURAL' jobs posted. There is a wide range of Top 20 city types, mid-size cities (places like des moines, springfield IL, Charleston SC, etc etc etc) and then the true random rural places with no airport are few and far between). We are at the end of the 'cycle' so less jobs are being posted now compared to the summer/fall when the board was more active

Bottom Line: The truth is, just as it has been for the last 10-15 years in rad onc, that if you want to 100% guarantee that you can stay in City X for a job when you are out of residency, that guarantee is not there. It all depends on the timing of when you graduate. BUT if you are a bit more flexible, you can find a decent job where you will be happy and paid decently well, and hopefully you will be able to get back to City X in a few years if that's your long term plan. Your first job does not have to be your forever job. It is merely the best of what's available your year.

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

 

[radiaterMike]

I agree with 20181121 that the job market is not terrible now and that most radiation oncology attendings have decent job situations (with respect to support from administration, salary, etc.) However, I think the concerns about the future are legitimate. The data on residency expansion is not a secret, and the demand for treatment (with respect to indications for radiotherapy and number of fractions) is declining.

What DukeNukem and Turaco are describing are not what I, or others I know, are experiencing, but I can see where that could be happening in certain locations, and can see where the field could be heading in that direction if there are not changes. One approach would be to expand the indications for radiotherapy (going back to treating benign disease for example). The other approach is to reduce the work force- reduce residency spots (or at least stop expansion) and/or entice people to retire early. I fear the 'enticement' might be what DukeNukem and Turaco are describing though.

 

[deleted969641]

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

I am just curious, what program are you chair of? Just to clear up since you are so critical of anonymity.

Regards from a fake, totally not real, anonymous online radiation oncologist who is scaring away good medical students from filling your new residency spots and fellowships because I have nothing better to do.

A summary of today's lesson, kids: When contemplating your initial salary offer, remember that enjoying your job is a fringe benefit and that it's distasteful and greedy to object to a $250,000 salary offer when the average American household only earns around $80,000.

 

[OTN]

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

I'm a practicing radiation oncologist, and I disagree with you.

We post anonymously because we know how small radonc is as a field and how vindictive the powers-that-be who run academic departments can be.

The fact that fellowships exist is proof enough something has gone awry.

 

[RickyScott]

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

I love my job and salary and so do some of the other 10 posters, but that is really not the point. Are you stating that the job market is fine, will continue to be fine... and there are no issues with residency expansion, because the market is fine?

Please read the ASTRO board, because this sentiment is not just 10 disgruntled internet posters warning of the future here, but some major thought leaders, a bit of an inconvenient truth to your point?

 

[01001000]

I am a senior resident who still has no job, nor do any of my graduating co-residents. We have been very flexible on geography, practice type, compensation, etc., and have gotten very few contracts - none worth signing. In the end, we will all probably get jobs, but certainly not the jobs we envisioned 5 years ago on match day.

I agree that probably the best jobs come from networking. IMO to land a job like that you've got to be really lucky. I've worked on making connections for the last couple of years, but the bottom line is no one is going to make room for you or save you a spot until you graduate. Especially not in a market like this. You can see the saturation happening, with many places having hired a new grad within the last 5 years. A couple of graduating residents from my institution have gotten jobs through networking, but the majority responded to online postings. I wouldn't say those networking jobs are much better, but they did get the locations they wanted.

I was in denial that this job market problem was real until I was slapped in the face with it this year. It's hard to admit you've made a wrong decision when you've dedicated so much time and effort to this career. My regret isn't that I've chosen the wrong field of medicine, it's that I shouldn't have chosen medicine at all. You can be just as successful working in another sector without all the loans and training, and you don't have to be a physician to help people. I suppose that's not very useful for a med student who has already put in 4 years and accumulated loans. If you're going to choose this field, you need to have realistic expectations and know that things can change dramatically from the time you match to the time you are looking for a job (i.e. become much worse than they are now). There are no job guarantees at the end of this.

I've never posted on SDN until recently but feel compelled to warn medical students.

 

[evilbooyaa]

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

The fact that most of the un-anonymous attendings on ASTRO hub agree about concerns about residency expansion and job market refutes this point. Do you feel that the increase in advertised fellowship positions (and graduates doing fellowships) is a good thing? We're just a few steps away from Radiology and Pathology 2.0, both of which essentially MANDATE one fellowship, and doing 2 fellowships is becoming more and more common. Is that what should be expected of our field as well?

Last time there was a job market issue in the 90s, our field, in part, increased training by one year. Is the proposed solution just to wring our hands and say "do another year of training for all"?

 

[medgator]

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

Most would not.

 

[20181121]

I would recommend students talk with residents in programs they’re considering to understand where graduating residents and recent graduates have gone on to work. (I realize this does not forecast decades into the future, but I am personally very skeptical of any future prediction of supply and demand, particularly in the field of medicine, let alone any business. For what it’s worth, I am not in favor of residency/fellowship expansion. I suspect we are going to see more program closures over the coming years, followed by a shortage of rad oncs, but who knows!)

I think it is completely reasonable advice to suggest students considering this field talk with practicing radiation oncologists in person, rather than base career decisions on an anonymous Internet forum.

 

[deleted18755]

I suspect we are going to see more program closures over the coming years, followed by a shortage of rad oncs, but who knows!)

Why do you suspect that this will be the case?

I’m honestly curious and hopefull you have unique information, data, or ideas so that the bottom doesn’t actually fall out and the best and brightest medical students continue to join our magnificent field and advance it even further.

PS: I’m an extremely happy mid-career or so community radiation oncologist who isn’t quite as pessimistic as others on this forum but the future does seem quite clear to me (when I compare my experiences to what I see is the case for current residents and new graduates based on what I see on this forum ... but I’ll readily admit that I do not have much recent direct or personal experiences with either group).

 

[DebtRising]

This is a field based on data. The data about the future employment situation is published and as clear as can be. Predictions can always be off, but the published prediction is oversupply. Full stop. There was a PRO paper that there were more positions posted for 1 year on the affirmative as only rebuttal. There was a survey which said >50% of the practicing work force thought oversupply was the main concern. There is the increased and increasing fellowship numbers. I stopped posting because my emotion diluted the points - but repeating these statements feels like deva ju.

Here is my additional insight. This is a mature industry. The older guys in practice had chances to build from the ground up - not easy. But, and no judgement, those opportunities are no long possible. You always in someone else's shadow in any setting. People 10 yr in practice waiting for guy 20-30 yr in practice to retire. 30 yr guy doesn't want to retire, does good enough job, name known. 30 yr guy not necessarily being parasitic, he/she just enjoys what she does. Guy 20-30 yr in practice also has zero idea how hard to break head in competitive field, how business landscape has changed, does not have the perspective of what it is like today to start. Talking to them may be counter productive.

This is an industry that makes widgets. Large part of industry is doing research on how to make less widgets and cheaper. This is good for society. But already too many company make widgets, and more coming. Some company do special thing to make widget fancier (fellowship), but still there is more senior company with better name recognition making widget. Some company get foot in industry door by making small widget part or helping when senior widget company has downtime (satellite, non partner private practice). Eventually senior company will retire, but the rad onc widget company careerspan longer than most other medical company. By time your company ready, how many other widget companies come before and ready? How long do you want to wait?

The emotion expressed on board, at least mine, realization of above too late. Take chances you want to take, but understand market forces not absolute but hard to overcome.

 

[scarbrtj]

I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.

If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?

With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.

I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.

I honestly would like to agree with you. A rising tide lifts all boats. But one person making arguments like "it's the same 10 people (complaining)" or "most would agree with me" or "I got a job!" is not making an intellectually honest argument in light of:
1) Math.

a)The top two indications for rad onc, breast and prostate, now require ~40% less fractions than in the past. Objectively this means ~40% less patients under beam per day. This means ~40% less revenue per consulted patient. We can quibble over the fine points, but this estimation is likely correct to within +/- one significant digit.
b)There are significantly more rad oncs being produced today than 10-15 years ago. In light of 1(a), this makes 1(b) a valid worry.​

2) There are peer-reviewed journal articles expressing concerns about the rad onc job market in the future. (If you disagree with them, you are free to write letters to the editors.) The ASTRO internet forum has expressed similar concerns as this one too.
3) Rad onc average salaries look significantly less nowadays versus 10-15 years ago (see 1(a))

Like the lady who said "I'd like to vote Democrat but it's cost me a lot of money," as I said I'd like to agree with you, but sadly I can't.

 

[scarbrtj]

This is a field based on data. The data about the future employment situation is published and as clear as can be. Predictions can always be off, but the published prediction is oversupply. Full stop. There was a PRO paper that there were more positions posted for 1 year on the affirmative as only rebuttal. There was a survey which said >50% of the practicing work force thought oversupply was the main concern. There is the increased and increasing fellowship numbers. I stopped posting because my emotion diluted the points - but repeating these statements feels like deva ju.

Here is my additional insight. This is a mature industry. The older guys in practice had chances to build from the ground up - not easy. But, and no judgement, those opportunities are no long possible. You always in someone else's shadow in any setting. People 10 yr in practice waiting for guy 20-30 yr in practice to retire. 30 yr guy doesn't want to retire, does good enough job, name known. 30 yr guy not necessarily being parasitic, he/she just enjoys what she does. Guy 20-30 yr in practice also has zero idea how hard to break head in competitive field, how business landscape has changed, does not have the perspective of what it is like today to start. Talking to them may be counter productive.

This is an industry that makes widgets. Large part of industry is doing research on how to make less widgets and cheaper. This is good for society. But already too many company make widgets, and more coming. Some company do special thing to make widget fancier (fellowship), but still there is more senior company with better name recognition making widget. Some company get foot in industry door by making small widget part or helping when senior widget company has downtime (satellite, non partner private practice). Eventually senior company will retire, but the rad onc widget company careerspan longer than most other medical company. By time your company ready, how many other widget companies come before and ready? How long do you want to wait?

The emotion expressed on board, at least mine, realization of above too late. Take chances you want to take, but understand market forces not absolute but hard to overcome.

Rad onc who fly upside down have big crack up.

 

[RickyScott]

I suspect we are going to see more program closures over the coming years, followed by a shortage of rad oncs, but who knows!) .

Certainly it is sound advice to talk with current residents. But to take the position that doubling of residency spots will have no effect on future demand, is disingenuous. Given the incentive structures in place, and the type of person making the decisions, I actually think we will see more residencies spots open up. In my own experience, a lot of FMGs are very capable, and very hard working, and not very vocal ! so, when spots no longer fill with American grads, programs will just welcome FMGs. This is exactly what happened in pathology. Some of the FMG path residents in my hospital publish 5-10 papers a years, before leaving for multiple fellowships.

I repeatedly post here because as a medstudent, I could not conceive what happened in path was possible in America. Instead of Labcore, Quest, etc, we have large regional Academic centers with satellites whose interests are served by an oversupply. I have had posters argue with me that an oversupply of docs doesnt affect salaries, or that prices paid to insurances by large academic/regional health care are not substantially different from others. Even ARRO deligitimizes this forum, and suggests that medstudents ignore concerns about the job market, when 2 clicks away, on the very same website!, ASTRO ROI hub, has numerous leaders and former program directors stating that we have a real problem.

(I have to believe that ARRO reps themselves are trying to ingratiate themselves to large academic centers for increasingly scarce jobs, even if it means misleading medical students.)

 

[theradiator]

Those who cannot remember the past are condemned to repeat it - George Santayana.

Radiation Oncology Workforce Recruitment Survey of 2000–2010 Graduates: Is There a Need for Better Physician Resource Planning?
http://www.caro-acro.ca/wp-content/uploads/2016/10/Stuckless-2012-Canadian-RO-Workforce-modeling.pdf

 

[medgator]

Those who cannot remember the past are condemned to repeat it - George Santayana.

Radiation Oncology Workforce Recruitment Survey of 2000–2010 Graduates: Is There a Need for Better Physician Resource Planning?
http://www.caro-acro.ca/wp-content/uploads/2016/10/Stuckless-2012-Canadian-RO-Workforce-modeling.pdf

The doubters regarding the current and future state of RO under current leadership simply need a time machine to see how bad things were in the 80s and 90s.

We are literally cycling back to that thanks to our current academic leadership. It may actually get worse than that considering how hypofx /sbrt etc are changing the field

 

[GreyingRadOnc]

Hi all,

M3 here with great board scores, publications, clinical grades etc. who cannot decide on a specialty and hasn't really liked much of anything I have done and keeps circling back to Rad Onc.

I understand the job market is **** and probably only going to get worse. Would it be a reasonable approach to pursue Rad Onc now with the intention of taking a job in the middle of no where and getting paid great $$? I have seen people throw around figures of $650k+ for jobs in rural areas ( is this accurate? will these jobs still exist when/if I would finish residency in 7 yrs?), I don't want to live in one of these places long term but I could see myself living in one of these places for ~5 years and investing enough money to:
1. Get close to retiring
2. Go back and get a MPH or MBA and some lower paying work but with a good schedule
3. Find a very low paying ($100-200k) Rad Onc job in a desirable location with great hours
4. Do something entirely different from medicine that I enjoy (i.e. personal training, opening up a gym, etc.)


Excuse my ignorance but is that a realistic approach for someone like me? I cannot decide what I want to do with my life and have not really found any other field to be acceptable to me for either lack of meaningful/interesting work to me, or terrible schedule etc. and this is the one way I could potentially see myself being fulfilled and proud of what I do (did) and still have an enjoyable life.


Thanks

My advice is not to use this site as a resource for such an important decision. Most of the people here are now unhappy with their job choice and didn't properly analyse the field before joining. Try twitter (#radonc) or other resources for more accurate info about the specialty and it's future. This article is a better barometer to what you'll face: https://www.jacr.org/article/S1546-1440(18)31472-8/fulltext

Notice 200 respondents were new graduates newly in practice and 85% were moderately to very satisfied with their job. That's pretty damn good. The 15% unhappy have come to this forum and post every 3 min hoping to...make the field worse so the options open up? Not sure.

One thing to note, and apparently many here didn't spend enough time to realize this, is that Rad Onc is a small field. As such we don't always get to find the best job in the best city on the first go around. It's very naive to think differently and that part of the field has not changed in more than 20 years that I've been here. You may find a high paying job, or you may find a great location, but it's rare to find both in the same setting as a new graduate. Work your way up in the field, prove your value, and most times you'll get a good combination of location and job quality. That is how 99% of jobs work, btw. The new grad from law school doesn't expect the Boston office with corner spot....especially if they graduate from Nebraska State Law School.

Another thing to note, don't go into this field for money. It's a very good field for it, btw, but don't do that. Cancer patients require a lot of emotional durability and if you're very competitive as a student and mostly want a good lifestyle I would suggest derm or ophthalmology. The patients require less of you and the work hours are still manageable.

Best of luck! I've been doing it for 20 years and I love it. There are other fields I would have also liked, but I enjoy cancer patients and all the new things that Rad Onc can do over 20 years. I have not regretted it for 1 sec, but I did do the research and had reasonable expectations.

 

[GreyingRadOnc]

Cassandra? Hah! I'm not telling you prophecies. This is the way it is NOW.

Let me tell you how it is where I did residency and where I'm faculty. Because they're both basically the same thing.

These places are opening satellites all over the place with the competitive advantage that they get paid higher reimbursements than the private practices in the area.

They then staff them with new grads at half or less of what the established private practice rad oncs are making. There is no private market hiring since they're fighting to survive and being gobbled up by the academic centers.

Where I work they have close to taken over the market in the area. There are no other jobs in the area, and once you sign on you're given a huge area non-compete so you're stuck at this job unless you move far out of the area. You could say "oh that's your fault for signing the non-compete". Yeah ok I applied all over the country and got two job offers, both at academic satellites and both with huge non-negotiable non-completes so what choice did I have?

They are actively decreasing everyone's salary to 25% or less of AAMC academic salary with 100% clinical effort and demanding PP level RVU outputs. They are cutting benefits--healthcare, vacation, etc etc etc. Anyone who makes more than 25th percentile AAMC due to seniority or whatever is getting their salary cut.

If you complain or even ask too many questions, they will threaten to replace you with a desperate new grad. Your contract is at their will--they can and will fire you for any reason and everyone is scared of being let go. They post a job ad on the ASTRO site and get hundreds of applications. Even without posting a job ad, they get dozens and dozens of CVs from qualified people and new grads every year unsolicited. Sometimes they don't even have to take desperate new grads. They can take people from failing PPs or other problematic academic positions and pay experienced faculty the same non-negotiable peanuts as a desperate new grad. At first these suckers are just happy to be employed, given that often times they've been totally unemployed for awhile and like me they have no other options.

So what's it like working rad onc "academics"? They treat us like crap every day. No clinic support. Pay on par with general IM except my pay will never increase--only decrease if I don't make target for whatever reason and I'm losing benefits. 12 hours a day between clinic, machine, and hospital coverages. Made fun of and disrespected by chair, vice chair, administration, etc. We talk among each other about how bad it is and look for new jobs hoping that something else will come up (hint: it doesn't). It's like a game of musical chairs but the music stopped and there's nowhere else to sit.

Hey good news everyone, we're still expanding the residency program! We have all these satellites that could use residents. You think the chair cares that there are no jobs for grads? For them it's great--they'll do fellowships that way. The chair, vice chair, and program director need 100% resident coverage. Maybe the other faculty can have 20-40% coverage (amount depending on how much they kiss up to the chair and residents). It's sold as--if we get more residents, maybe you can have more coverage. They'll never hire midlevels since the department has to pay for them (except for the chair who can't live without a resident and midlevel AT ALL TIMES). Fellows are also great--they can support us to do research. Otherwise the heck with research, that's industry's job to fund med onc immunotherapy trials. The NIH is a waste of time (too little funding, rate of success too low).

I'm a Cassandra? No. This isn't the future. I'm telling you reality as it is NOW. It's only going to get worse. Stay away from this field.

Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

 

[medgator]

My advice is not to use this site as a resource for such an important decision. Most of the people here are now unhappy with their job choice and didn't properly analyse the field before joining. .

Are you going to trash these same job market concerns being posted over at the ASTRO ROhub by well known academic faculty?

Regarding the article you've posted, the response rate per the abstract was as low as 31%. Not exactly a slam dunk conclusion without being able to review the full manuscript

 

[medgator]

Best of luck! I've been doing it for 20 years and I love it. There are other fields I would have also liked, but I enjoy cancer patients and all the new things that Rad Onc can do over 20 years. I have not regretted it for 1 sec, but I did do the research and had reasonable expectations.

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

YMMV, but practitioners 2 decades out are less likely to have a pulse on current dynamics esp when they ignore the combined trends of residency expansion and sbrt/hypofx/surveillance guidelines on clinical practice.

It's also been my experience that many older docs don't hypofx much, if at all, in community practice as someone who trained a decade ago and works with multiple docs who trained 2-3 decades ago.

 

[RO2019]

I keep seeing this mentioned - no one has an issue with job market and residency expansion concerns being discussed on the ROHub because THERE ARE issues that should be discussed. These are important issues to worry about.

The issue is that the discussion over there is quite reasonable and grounded, and over the past year SDN has become a cesspool of extremism and lack of rationality. What is happening at ROHub is what SDN used to be like. I'm not sure what happened over the past year, the whole thing with the rad bio and physics boards really didn't help matters though, and was around the time that this board went full on overboard with negativity.

 

[medgator]

The issue is that the discussion over there is quite reasonable and grounded, and over the past year SDN has become a cesspool of extremism and lack of rationality. What is happening at ROHub is what SDN used to be like.

That's very subjective. The converse to what you said is that SDN provides a level of anonymity that allows for a more comprehensive and open discussion than can ever be had over at ROHub

 

[RO2019]

fair point.

however i would add that I don't think I'm alone at all in feeling like this place has changed.

 

[deleted18755]

Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

Wow, out of curiousity any idea what 75% AAMC is compared to MGMA? Depending on what that comes out to I would literally consider applying for this job if my kids were out of the house.

I just don’t see how it’s financially possible to have 2 MD’s with an NP only treating 20-30 total patients so AAMC must be much lower than MGMA (or the center loses money overall and it’s considered a service to the community/supplemented by the mothership) but yeah that sounds like quite a lifestyle if you don’t mind living wherever it is.

 

[DukeNukem]

Before I post, a big thank you to a few posters on here who have genuinely tried to help me. Nothing has panned out yet, but it's clear that there are some great jobs out there. I hope I get one.

My advice is not to use this site as a resource for such an important decision. Most of the people here are now unhappy with their job choice and didn't properly analyse the field before joining.

That's a completely ridiculous assumption in my case.

Try twitter (#radonc) or other resources for more accurate info about the specialty and it's future.

If my chairman knew I was posting this stuff, I would be fired. I can't let that happen for my family's sake.

Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.

Where is this job? Who is applying to be not "qualified"--non BC/BE rad oncs?

I've applied to 50+ positions over the past year, but I have to admit that I'm no longer applying to academic satellites after a few phone calls and seeing what goes on in my current satellite job. Then again, maybe you looked at my application and decided that a several year practicing BC rad onc isn't qualified.

It's very naive to think differently and that part of the field has not changed in more than 20 years that I've been here.

So which are you: chair, vice chair, or program director?

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

Check my post history friendo. I've been posting about rad onc for years.

You're right though. YMMV. I'm jealous of my friends who got great jobs. Sure I'm going to keep trying. But I'll keep you on SDN updated as to how it's going.

 

[deleted947887]

Sounds like a great job. Post here. I'll apply.

Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

 

[20181121]

GreyingRadOnc’s post is exactly the sort of thing I am referring to when I say it is better to talk with people in real life than to base career decisions on an anonymous Internet forum. GreyingRadOnc’s observations are in line with my own.

It is also an important point to consider that pedigree does matter for PP and academics. I have noticed in the largest cities, the good practices in many fields of medicine take physicians from top residencies - plus graduates of local programs - plus people with really stellar personal attributes (some “x factor”) for a given job. This has been the case for any pediatrician I’ve personally seen as a patient/parent. This is also true of basically any well-compensated white collar field outside of medicine, just like the example in law given above. That Nebraska State Law School graduate could get a job in Omaha, or if his dad is a senator, maybe he could get one in Boston.

That Hopkins Rad Onc graduate could take a high-paying PP job in Texas, or an academic spot in New York.

 

[OTN]

While the emotion and vitrol on this board sometimes can be a bit over the top- I'll admit I've been guilty of that from time to time- the discussions here on SDN are what forced ASTRO "leadership" (couldn't resist) to finally address the issue. Without this board and the strong emotion emanating from it, I doubt anything would have been even discussed.

 

[deleted969641]

You may find a high paying job, or you may find a great location, but it's rare to find both in the same setting as a new graduate. Work your way up in the field, prove your value, and most times you'll get a good combination of location and job quality. That is how 99% of jobs work, btw. The new grad from law school doesn't expect the Boston office with corner spot....especially if they graduate from Nebraska State Law School.

Another thing to note, don't go into this field for money. It's a very good field for it, btw, but don't do that. Cancer patients require a lot of emotional durability and if you're very competitive as a student and mostly want a good lifestyle I would suggest derm or ophthalmology. The patients require less of you and the work hours are still manageable.

I have to call B.S. on this oft-repeated notion of "remember, your first job is not your final job." How many times have we heard that? It's silly on so many levels.

The reality is that grads are lucky to get a good job in a semi-desirable location now. Once you start, you get locked in directly (non-competes) and indirectly (kids, schools, spouse, mortgage, community, etc.). It's fairly unrealistic to expect to be able to pick up and move across town or even the country and also unreasonable to expect that the job you wanted in that certain location is suddenly going to become available if you just wait long enough given the constantly increasing grad pool and junior associates and faculty trying to switch. Additionally if you were lucky enough to get a partnership track job and buy-in as a partner, are you really going to want to leave that and start over from the bottom again? The reality is that grads should be prepared to stay in their first job for a long time as multiple forces will keep you from leaving. And your employer knows that leaving is difficult as has little incentive to make your current job better. So I think it's terrible and borderline exploitative advice to just accept that your first job will be undesirable and not to worry because things will get better.

Regarding not going into the field for money, I agree. But not really for the reason you listed. Rad Onc has an excellent lifestyle, period. Some are more equipped than others to handle it emotionally. This is a personal issue and unrelated to money, and I'm not sure why you're trying to tie it to money, but I think shame is involved somehow. But anyway, don't go into to rad oncs because the money isn't there in competitive locations and may not be there in noncompetitive locations in the future. Compensation is already at primary-care levels in very competitive locations.

The rest of your post reads like something a chair would write to justify offering $250,000 year to new grads to staff satellite locations and lead them down the primrose path thinking that everything will be just fine in the end if they just wait it out. You are basically talking about how new grads have to pay their dues. Tell me, why should a new grad have to pay more dues in order to keep the fruits of his/her independent labor (collections)? What entitles the chair to siphon 50% or more of these off? Technical fees and ownership, fine, of course you have to pay your dues with sweat equity and a buy-in. New grads are in their mid 30s and went through a decade long hazing process after college followed by a multipart pointlessly painful finale by the ABR. Was that not enough?

I would encourage Duke and others who have posted here to summarize their experience on the jobs thread I started a few days ago. A long and running list of recent grad experiences will help combat the kind of attitudes quoted above.

 

[deleted947887]

Ha. Nepotism at its finest. "X factor?" give me a break. That's a joke.

It is also an important point to consider that pedigree does matter for PP and academics. I have noticed in the largest cities, the good practices in many fields of medicine take physicians from top residencies - plus graduates of local programs - plus people with really stellar personal attributes (some “x factor”) for a given job. This has been the case for any pediatrician I’ve personally seen as a patient/parent. This is also true of basically any well-compensated white collar field outside of medicine, just like the example in law given above. That Nebraska State Law School graduate could get a job in Omaha, or if his dad is a senator, maybe he could get one in Boston.

That Hopkins Rad Onc graduate could take a high-paying PP job in Texas, or an academic spot in New York.

 

[20181121]

Ha. Nepotism at its finest. "X factor?" give me a break. That's a joke.

Let me put it another way and more bluntly: some people are a pleasure to work with, great with patients and staff alike, and some people are jerks. Clinical grades and letters of recommendation tease this out for residency applicants, phone calls do for job applicants. Again, true for any job within and outside of medicine.

 

[RickyScott]

Here we go again. These guys would have you believe we are in a "steady state" market where the number of grads matches available jobs, despite the obvious changes/doubling in residency spots, -continued expansion- and radiation indications/hypofractionation. There is no acknowledgment that perhaps the more rural/midwest jobs are filling up now and that in 5 years it could be a lot worse with the current trends. Even if there are some desirable jobs in the midwest today, there is every reason to believe this may not be the case in 5-10 years.

BTW: If you cant make a reasonable guess about the future, you shouldnt be in the business of givning adjuvant radiaiton

 

[radoncradonc]

Let me put it another way and more bluntly: some people are a pleasure to work with, great with patients and staff alike, and some people are jerks. Clinical grades and letters of recommendation tease this out for residency applicants, phone calls do for job applicants. Again, true for any job within and outside of medicine.

I call this BS. The vast majority of rad onc residents are good and nice people who work well with a complex team. What suddenly makes a resident an entitled complainer who doesn't work well with the team is when he/she declines to do a fellowship with the department or accept a low paying instructor job. I agree with the nepotism comment above because I've seen chairs lie for residents that are sub par but for some reason favored because of race or some other factor.

 

[radoncradonc]

I absolutely agree with Duke. If med students can't or don't want to heed the warning that we rad oncs looking for jobs are facing, then they deserve to experience the wrath of ABR when they fail their boards and also can't find a decent job. It is just mean and deceitful telling med students that things are fine with rad onc. You must be getting some serious secondary gain.

 

[20181121]

I agree with the comments above that we do not need more residency slots, new programs, etc.

I am sorry to hear that some people are having a tough time on the job search, but remember that it’s only February, and practices do not operate on an academic schedule. I also think it is important to have realistic expectations.

It is totally reasonable to tell students that they should be geographically flexible, willing to do a fellowship if they need to be in a specific city, and that the better the program they attend, the more options they will have. These were my expectations when I applied, and other posters have indicated that these were their expectations as well.

 

[Burt Radnolds]

What a hilariously myopic view. We have an academic satellite in the middle of nowhere and can't find some chump to fill it, so the job market must be fine!

Unless something proactive happens, in 5 years everyone will be nodding their heads that unfortunately the deranged keyboard warriors on sdn had it right all along.

I wish I could short sell the rad onc job market, because I would.

 

[medgator]

It is also an important point to consider that pedigree does matter for PP and academics.

Wrong. At least for pp in my region. Connections to the area and the 3As are far more important once you are BC

 

[medgator]

willing to do a fellowship if they need to be in a specific city,

At least we've established that the majority of fellowships in RO are not related to self-improvement and further education in the field. Which should shock no one considering none of them are ACGME accredited.

I'm shocked at how many condone this obvious racket called a "fellowship"

Outside of going to a terrible program or needing to do peds or brachy for a focused practice in those areas, fellowships are unnecessary for most grads. Even proton centers that are advertising jobs nowadays state that no proton experience is needed.

 

[20181121]

Wrong At least for pp. Connections to the area and the 3As are far more important once you are BC

Depends on the practice - all other things equal, pedigree can be the tiebreaker.

 

[medgator]

Depends on the practice - all other things equal, pedigree can be the tiebreaker.

Or, more likely, interview.

Honestly the smartest applicant has already made connections with that practice, perhaps even done a locums stint there

 

[RickyScott]

It is totally reasonable to tell students that they should be geographically flexible, willing to do a fellowship if they need to be in a specific city, and that the better the program they attend, the more options they will have. These were my expectations when I applied, and other posters have indicated that these were their expectations as well.

I guess we are in agreement here. If you are willing to be geographically open and willing to consider fellowships, by all means consider radiation. But really what kind of candidate would, if their scores/grades provided them with other options.
It is also fundamentally exploitative and sexist. Women are more likely to have a spouse with a career than visa verse and thus more geographically restricted. (I would love to hear an account from a woman doc taking the job in North Dakota, and her scientist husband becoming a stay at home dad.) Similar constraints hold for disadavantaged minorities who should not be forced into MAGA country. I hope such sentiments on your part are not a dog whistle for women and disadvantaged minorities to avoid the field.

 

[20181121]

I guess we are in agreement here. If you are willing to be geographically open and willing to consider fellowships, by all means consider radiation. That person is not likely to be my cup of tea, if their scores/grades provided them with other options.
It is also fundamentally exploitative and sexist. Women are more likely to have a spouse with a career than visa verse and thus more geographically restricted. (I would love to hear account from a woman about taking the job in North Dakota, and her scientist husband becoming a stay at home dad.) Similar constraints hold for disadavantaged minorities who should not be forced into MAGA country. I hope such sentiments on your part are not a dog whistle for women and disadvantaged minorities to avoid the field.

That was not my intention, but you raise important points I am embarrassed to say I had not considered.

 

[deleted18755]

I guess we are in agreement here. If you are willing to be geographically open and willing to consider fellowships, by all means consider radiation. That person is not likely to be my cup of tea, if their scores/grades provided them with other options.
It is also fundamentally exploitative and sexist. Women are more likely to have a spouse with a career than visa verse and thus more geographically restricted. (I would love to hear account from a woman about taking the job in North Dakota, and her scientist husband becoming a stay at home dad.) Similar constraints hold for disadavantaged minorities who should not be forced into MAGA country. I hope such sentiments on your part are not a dog whistle for women and disadvantaged minorities to avoid the field.

Staffing physicians in rural America is indeed a lot different than it used to be a generation or especially two ago. Think about or ask any of your Indian/Pakistani doctor friends: it used to be the husband was the educated/bread winning father and he took the highest paid job wherever he could find it (going where nobody wanted to go since that was the only way to get VISA support) his wife followed even if it was literally 10,000 miles from her closest relative and 1,000 miles from her closest friend and held it down at home while piecing together whatever local community was available.

That’s not as reasonable these days since the wife usually has a career and/or of course interests/hobbies outside of the home and as noted above I don’t see a man even in the year 2019 giving up his career, friends, and all but his immediate family so his bread winning wife can take an awesome job anywhere let alone the middle of nowhere.

 

[thecarbonionangle]

Our field is filled with some very petty vindictive people. Do not think for a second these continued attacks on the anonymity of SDN are a random thing. It is precisely what makes this community great, the ability of people in all positions and backgrounds to come here and voice their passionate opinions without fear of retribution. We may know who some of us are in person even or identity but respect the anonymity. We got faculty in unhappy positions here with vicehairs who laugh at them. Unhappy residents. This could never happen on ROHUB.

The radbio ABR thing is absolutely disgusting and the way the “leaders” handled it. To this day months away there is no study material. Good luck!

 

[seper]

I'm calling BS on this. I'm personally aware of an open satellite position right now. Midwest, undesirable location, > 80 miles from a major city/tourist spot. Population is in need with high opioid abuse prevalence. This satellite does EBRT only, low patient numbers,and pays about 95% of AAMC. No chance to earn respectable wRVU numbers and thus, likely, no personal bonus ever. No research time, residents, or NP. Vacation coverage is provided by the main center - good. The Chairwoman has so much outside interest, including from physicians with experience, that she decided not even to post it on ASTRO or internally.

Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.

So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.

 

[puahate]

I am a senior resident who still has no job, nor do any of my graduating co-residents. We have been very flexible on geography, practice type, compensation, etc., and have gotten very few contracts - none worth signing. In the end, we will all probably get jobs, but certainly not the jobs we envisioned 5 years ago on match day.

I agree that probably the best jobs come from networking. IMO to land a job like that you've got to be really lucky. I've worked on making connections for the last couple of years, but the bottom line is no one is going to make room for you or save you a spot until you graduate. Especially not in a market like this. You can see the saturation happening, with many places having hired a new grad within the last 5 years. A couple of graduating residents from my institution have gotten jobs through networking, but the majority responded to online postings. I wouldn't say those networking jobs are much better, but they did get the locations they wanted.

I was in denial that this job market problem was real until I was slapped in the face with it this year. It's hard to admit you've made a wrong decision when you've dedicated so much time and effort to this career. My regret isn't that I've chosen the wrong field of medicine, it's that I shouldn't have chosen medicine at all. You can be just as successful working in another sector without all the loans and training, and you don't have to be a physician to help people. I suppose that's not very useful for a med student who has already put in 4 years and accumulated loans. If you're going to choose this field, you need to have realistic expectations and know that things can change dramatically from the time you match to the time you are looking for a job (i.e. become much worse than they are now). There are no job guarantees at the end of this.

I've never posted on SDN until recently but feel compelled to warn medical students.

jesus. this is scary

 

[DucoNonducor]

If I were going through this again, I would give some thought to doing an internal medicine residency (in a cushy program) prior to radonc.

Could you further elaborate on doing a full medicine residency prior to Rad/Onc? Would that be in the event that you needed a backup plan? Interesting thought though, but I guess that would end up lengthening your training by 2 yrs.