So would you advise rising M4s to enter this field at this point?

[soulcity]

I had my heart set on Rad onc for the longest time but all the stuff I've been reading on this forum seriously has been making me *reconsider* everything.

I love the field but I am pretty sure I will be unhappy living in the middle of nowhere. I am a big city girl. I want to live in California if not New York.

My current CV screams RO. I have been scrambling to see what other fields could interest me (anesthesia, dermatology, surgery, radiology?) but I keep circling back to RO. I would appreciate any advice.

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[Gfunk6]

Just keep in mind that both New York and California are big states and even if you get a job in them you can still be "in the middle of nowhere." If you are interested only in big cities on the coasts then going into Rad Onc will be risky. If, on the other hand, you could live in one of the top 50-100 US cities by population (List of United States cities by population - Wikipedia) then Rad Onc would be a reasonable choice.

 

[soulcity]

I currently live in one of the top 50-100 US cities by population. I moved to this city for med school and I hate living here. I've been counting days until I could get out of this place.

Just for clarification, how hard is it to find a job in a big city along the coast? If you did locums for a few years and kept your eyes peeled for an opportunity would you be able to eventually land a job?

 

[Haybrant]

It’s a great field, it really is. Medicine people are waffly though and won’t give you straight answers about career direction. But you’ve made your preference for a big city clear. Don’t do it, don’t think things will change and it’s going to be ok. Just don’t do it, start thinking about something else. It’s hard to fully understand now, but you will come back to us one day and thank us for being so direct with you.

 

[medgator]

I currently live in one of the top 50-100 US cities by population. I moved to this city for med school and I hate living here. I've been counting days until I could get out of this place.

Just for clarification, how hard is it to find a job in a big city along the coast? If you did locums for a few years and kept your eyes peeled for an opportunity would you be able to eventually land a job?

I think you could, but the question is, what kind of job quality and salary could you tolerate? Would you be ok babysitting a dermatology-only or prostate-only type practice, or working as coverage person in an established practice without partnership until that job opens up? Would you be ok making significantly less than the average rad onc elsewhere in the country? Again, there's just a lot of what ifs, and if you are ok taking hits to job quality and or salary, you may (not will) end up getting the job you want in a big coastal city.

A lot of what ifs which will make you weigh doing a different specialty in a city you love, or doing rad onc with a job you may hate (assuming you get said job at all) in a big coastal city.

Those who enjoy rural practice really still have a much more secure prospect long term imo

 

[Fpg1245]

For the amount of time and effort most medical students expend getting to this point, I think it is best to look elsewhere and I advise students accordingly. There are trade offs in all medical specialties but Rad Onc is one where the trade offs are particularly unpalatable. If a student really thinks they would “love” treating cancer patients, it’s probably best to do medicine and then a heme-Onc fellowship or even consider surgery. Pointing students to a more sustainable specialty will give them the best chance at a good long term prospects and arguably a more fulfilling career.

 

[Dare2Dream]

You should get some exposure to the other specialties you listed to make sure you'd be happy with those.

 

[ivybme]

So even if you weren't picky with living in a specific major city, but just wanted to live in ANY top 10 large metro population area (NYC, LA, Chicago, DC, Bay Area, Boston, Dallas, Philly, Houston, Miami), this wouldn't be possible in the current job market?

Combined statistical area - Wikipedia

Yikes, that sounds really scary to me.

 

[medgator]

So even if you weren't picky with living in a specific major city, but just wanted to live in ANY top 10 large metro population area (NYC, LA, Chicago, DC, Bay Area, Boston, Dallas, Philly, Houston, Miami), this wouldn't be possible in the current job market?

Combined statistical area - Wikipedia

Yikes, that sounds really scary to me.

It's possible, with luck, and preparation before your chief year.

It will require more effort than say bagging a hospitalist or urology position where demand is greater and more widespread. The issue is that the powers at be are expanding slots at rapid pace while the field moves towards hypofractionation which will require less docs. Not a great combo for a future job market

 

[Haybrant]

So even if you weren't picky with living in a specific major city, but just wanted to live in ANY top 10 large metro population area (NYC, LA, Chicago, DC, Bay Area, Boston, Dallas, Philly, Houston, Miami), this wouldn't be possible in the current job market?

Combined statistical area - Wikipedia

Yikes, that sounds really scary to me.

That is correct. Go to the Astro job board. See what’s available now. Youngstown, OH; Mequeon, WI; Kansas City; Buffalo,NY. A fake NYC job; Mansfield, OH

There’s always someone that comes here to say “well the good jobs aren’t posted on Astro!!” Good luck tracking down what is available then, you’ll spend years finding something where you want. Why, why anyone would willingly walk into that is beyond me.

 

[kristofer]

Rad onc is the best field in medicine but it sounds like maybe not for you. There is a glut of new grads who only want to work 30 hours of week for straight salary in a very large (top 10) metro city. I personally don’t get it. If you are willing to work your butt off and earn your keep there is vast opportunity in this field in many parts of the country. Your strict requirements virtually preclude this without banking on both a lot of luck and a lot of connections.

 

[Lamount]

I had my heart set on Rad onc for the longest time but all the stuff I've been reading on this forum seriously has been making me *reconsider* everything.

I love the field but I am pretty sure I will be unhappy living in the middle of nowhere. I am a big city girl. I want to live in California if not New York.

My current CV screams RO. I have been scrambling to see what other fields could interest me (anesthesia, dermatology, surgery, radiology?) but I keep circling back to RO. I would appreciate any advice.

I am a graduating PGY-5 and am very happy with my decision to pursue radiation oncology. Despite what is said on this forum, I know many co-residents from numerous training programs who feel similarly. This field offers a rare mixture of basic/translational science, clinical research, and the privilege of having the time and help patients through some of the most difficult decisions of their lives. I couldn't imagine doing anything else.

I think the key is understanding and managing expectations and working toward a goal. The job market has tightened some, though it is not as terrible as many here imply. Nonetheless, champaign will not necessarily flow down upon you the second that you complete residency. Most jobs these days are gotten via word-of-mouth (i.e. not on the ASTRO boards). If you are interested in academics, you should work to establish a clear research narrative during residency by presenting at meetings. Utilize senior attendings at your institution and those you encounter at meetings to help open doors for you. If you are interested in private practice, you should begin networking early. Seek out alumni who are practicing in your target cities.

Reading this forum could lead one to believe that most radiation oncologists are perpetually bitter and morose due to the beleaguered job market...but this has not the experience of the small sample of residents and attendings that I know. Most are grateful to have the chance to use cutting edge technology to treat cancer patients. If you truly enjoy the field and "keep circling back" to it, you likely be happy pursuing RO.

 

[Neuronix]

I'm not bitter--I'm just realistic. The physician mantra used to be "pick two of three of salary, location, and hours". The rad onc mantra is "pick one of salary, location, or hours".

I know plenty of people who have tried to get jobs in big cities and failed. There are plenty of people waiting in positions they consider undesirable for something else to open up.

As a result there are plenty of vultures out there ready to put you in a bad position in a desirable location.

Given the non-compete situations, there are also plenty of people stuck in bad positions in desirable locations because they can't leave their job due to big city + family + non-compete.

I like what I do. But it's insulting to imply that new grads are looking for 30 hour/week cush jobs with fixed salaries in big cities. I'm young and my job is double that in hours plus I don't have a great or fixed salary. I do live in a big city. If I quit or get fired I'll have to leave the area and there will be a line of people waiting for my job.

 

[Gfunk6]

There is a lot of exaggeration on this thread. Also a lot of anecdotal data which, as we know, is the "most inferior form of statistics." Let me state several, indisputable facts:

1. Residency programs are pumping out more and more residents every year. The number has increased something like 40-60% over the last 10-12 years.
2. The JCO article about there being an "acute need" for Radiation Oncologists and a nationwide "shortage" is widely perceived in professional circles as incorrect and based upon faulty data.
3. The average daily treatment (ADT) is dropping in Rad Onc due to better technology, published Phase III data on extreme/moderate hypofractionation, and white papers from ASTRO. This means less patients on-beam at any given time.
4. The leaders in our field have widely acknowledged that there is a market glut of Rad Onc residents. They disagree that it should be corrected (by them).

If you are entering this field for the right reasons and you are flexible about geography, there is no need to change your plans. However, if you are like the OP who wants to only stay in big cities in NY/CA then I would run far away. There will always be stories about your father's brother's nephew's cousin's former roommate getting a job in midtown Manhattan which comes with a summer home in Martha's Vineyard but keep in mind the four facts above.

 

[RickyScott]

There are plenty of great fields in medicine, and at the end of the day, you will probably be no less happy in one than another. 10 years into it, a job is a job. So why choose one that geographically restricts you? I get it -Kansas city may offer a great quality of life, but many of us want to be close to friends and family (they really can be of help when you have kids), or where we grew up, or take into account our spouses preferences. I just dont see why anyone would enter a field with increasing geographic restrictions and, an uncertain future, when there are really great alternatives. In this field, even if you land a job in a desirable location, you will end up being "beholden" to it ,given the employment situation, and that will really grate on you over the long run. ie. when administrators f u, you respond with "thank you sir, may I have another."

 

[evilbooyaa]

If you are adamant about living in a top 10 population city, and would be miserable outside of that locale, this field is not for you. Period. If you can't compromise on that, then find another field as a medical student.

 

[seper]

Just wanted to chime in to say I really liked "rising M4s" expression. Reminds me of being young and promising.

 

[scarbrtj]

My current CV screams RO.

Probably good life advice, and definitely good medical advice: listen to heart noises, not CV noises. And for all of rad onc's sanctimony of intellectual superiority where CVs "scream RO," it's becoming a silly sanctimony. FWIW talking to some large rad onc company executives (the companies are large—not the executives) recently even they are somewhat questioning rad onc (I was a bit surprised).

 

[seper]

I'm not surprised as our professional integrity is very hard to maintain in the face of fee-for-service and technical reimbursement realities.

Probably good life advice, and definitely good medical advice: listen to heart noises, not CV noises. And for all of rad onc's sanctimony of intellectual superiority where CVs "scream RO," it's becoming a silly sanctimony. FWIW talking to some large rad onc company executives (the companies are large—not the executives) recently even they are somewhat questioning rad onc (I was a bit surprised).

 

[scarbrtj]

Nonetheless, champaign will not necessarily flow down upon you the second that you complete residency.

It may not flow down upon you, but you may wind up working there. I hear it's nice though.

 

[kristofer]

But it's insulting to imply that new grads are looking for 30 hour/week cush jobs with fixed salaries in big cities.

In no way did I imply that every new grad is like this. But you are living in a fantasy world if you believe that there isn't a significant number of people who recently went into this field mostly for lifestyle reasons and want to work less than 1.0 FTE. There are certainly plenty of new grads as well willing to put in 60+ hour weeks to establish themselves in the field and don't just want a straight salary with guaranteed time off and cross coverage. Not sure why you took my comment personally.

 

[RickyScott]

Probably good life advice, and definitely good medical advice: listen to heart noises, not CV noises. And for all of rad onc's sanctimony of intellectual superiority where CVs "scream RO," it's becoming a silly sanctimony. FWIW talking to some large rad onc company executives (the companies are large—not the executives) recently even they are somewhat questioning rad onc (I was a bit surprised).

What do you mean by "questioning rad onc," its viability as a specialty?

 

[scarbrtj]

What do you mean by "questioning rad onc," its viability as a specialty?

From their perch they see lots of press given to systemic therapies and growing success there, uncertainties on big-money bets like protons, growing cry for cheaper treating machines, rad onc reimbursement pressures, less patient treatments, declining corporate net incomes... and I hear this second hand somewhat (so who knows) from the people I work under who purchase the machines. They purchase a lot. But I have never heard these sentiments even second hand before so I thought it was a bit different than days past.

 

[nkmiami]

From their perch they see lots of press given to systemic therapies and growing success there, uncertainties on big-money bets like protons, growing cry for cheaper treating machines, rad onc reimbursement pressures, less patient treatments, declining corporate net incomes... and I hear this second hand somewhat (so who knows) from the people I work under who purchase the machines. They purchase a lot. But I have never heard these sentiments even second hand before so I thought it was a bit different than days past.

That is an interesting point. I am reaching back here, but I believe the cost of machine in the early 2000s was 600-900,000, and they were often in use for 15-20 years. (with blocks, not mlcs). Also, systemic therapy improvements may lessen the need for dose escalation/hyper precision as they will undoubtedly have local control benefits. (pacific trial benefitd lung pts, not 74 Gy, and some of this benefit has to be local)

With hypofract, and little in the way of linac game changing technology on the horizon (like cone beam), the vendors will have profitability issues. Varian seems like it is trying to sell more software services. A truebeam with 6 degree couch, is probably going to be over 3 mill, making the number on treatment for roi higher than it was in the past? It certainly is making hospitals/centers think twice about getting a new linac in this environment.

 

[ak6819]

A very disheartening thread to read for current med students interested in RO, almost seems/sounds like the field is going the way of nuc med?

 

[Gfunk6]

A very disheartening thread to read for current med students interested in RO, almost seems/sounds like the field is going the way of nuc med?

No, definitely not so bad. Nuc med went under not only because they were over-training but because another medical specialty (Diagnostic Radiology) was cross-trained in Nuc Med. While RO is overtraining, we have no such existential threat to our existence like Nuc Med.

 

[medgator]

I've been getting pretty much unanimous recommendations to stay away from RadOnc if I had any nightmares about living in flyover country...job offers for the senior residents at our institution have not been pretty (One of the PGY2s actually switched to DR)

It's a risk that anyone going into rad onc has to accept.

If you cannot be geographically flexible when you finish training, do not go into rad onc

 

[ramsesthenice]

I've been getting pretty much unanimous recommendations to stay away from RadOnc if I had any nightmares about living in flyover country...job offers for the senior residents at our institution have not been pretty (One of the PGY2s actually switched to DR)

It is very rare that you get a consensus agreement on this forum. You just got one. If you are geographically constrained do not go into rad onc.

But do your research. Rad onc is not the only geographically-restricted specialty nor the only one with relatively predatory practices for new grads in desirable locations.

 

[deleted18755]

Still the best field in all of medicine as far as I can tell (and I have family or close friends who are everything from neurosurgeons to general pediatricians to medical oncologists) . . . no doubt every single day I can't believe I have such an awesome job but the future is not looking good for anybody, let alone those who are geographically restricted. It's easy for me to sit in my small town I love (or at least don't mind) already with a family and married (to a physician) with no student loans and a solid decade of income under my belt saying I love my job so much I'd happily do it for half the pay rather than anything else. I just can't in good conscious recommend it to the OP or anybody even remotely like her.

Nobody can predict what will happen to any field over the course of an entire 30-35 year career but you're 6-7 years from even graduating. Forget about the old timers, even those of us who have been doing this even for just a decade can tell you things have changed dramatically recently in ways that are great for patients/society but devastating for a fee for service/procedure based specialty. Over the course of my less than 12 year career the standard breast regimen has gone from 33-35 to 20 to 15 to in many cases (appropriately) zero, prostate went from 35-40+ to in many cases 25-28 (or again zero with decreased PSA screening and diagnosis/referrals), lung went from 35 to 30 to SBRT in many cases, and believe it or not I trained with many attendings who were excellent physicians but routinely treated brain and bones mets with 10 or (gasp) 15 treatments for patients for whom I now routinely deliver 1 or 5 treatments. All of this is happened in just 10 or so years and the trend is clear. This doesn't even consider the bundling that has been happening so multiply the decreased number of fractions per patient by decreased compensation per fraction. Then factor in the fact that the residency spots have exploded with no end in site, which will mean a whole lot of desperate graduates with huge loans and only one skill (it's not like other specialties were you can do a fellowship or learn a new skill or adjust even a little as demand changes).

The greedy old timers are filthy rich, a huge chunk of us who aren't geographically restricted and don't have the crazy student loan amounts or rates that you guys have are in love with this field and will just accept pay decreases and/or work increases to maintain income (which will only mean even less demand for new grads) as they come and happily retire after a 30 year career (hopefully) with no regrets, but I just can't imagine telling somebody like the OP to do anything other than run away as fast as she can. Honestly breaks my heart to say...

 

[RickyScott]

Still the best field in all of medicine as far as I can tell (and I have family or close friends who are everything from neurosurgeons to general pediatricians to medical oncologists) . . . no doubt every single day I can't believe I have such an awesome job but the future is not looking good for anybody, let alone those who are geographically restricted. It's easy for me to sit in my small town I love (or at least don't mind) already with a family and married (to a physician) with no student loans and a solid decade of income under my belt saying I love my job so much I'd happily do it for half the pay rather than anything else. I just can't in good conscious recommend it to the OP or anybody even remotely like her.

Nobody can predict what will happen to any field over the course of an entire 30-35 year career but you're 6-7 years from even graduating. Forget about the old timers, even those of us who have been doing this even for just a decade can tell you things have changed dramatically recently in ways that are great for patients/society but devastating for a fee for service/procedure based specialty. Over the course of my less than 12 year career the standard breast regimen has gone from 33-35 to 20 to 15 to in many cases (appropriately) zero, prostate went from 35-40+ to in many cases 25-28 (or again zero with decreased PSA screening and diagnosis/referrals), lung went from 35 to 30 to SBRT in many cases, and believe it or not I trained with many attendings who were excellent physicians but routinely treated brain and bones mets with 10 or (gasp) 15 treatments for patients for whom I now routinely deliver 1 or 5 treatments. All of this is happened in just 10 or so years and the trend is clear. This doesn't even consider the bundling that has been happening so multiply the decreased number of fractions per patient by decreased compensation per fraction. Then factor in the fact that the residency spots have exploded with no end in site, which will mean a whole lot of desperate graduates with huge loans and only one skill (it's not like other specialties were you can do a fellowship or learn a new skill or adjust even a little as demand changes).

The greedy old timers are filthy rich, a huge chunk of us who aren't geographically restricted and don't have the crazy student loan amounts or rates that you guys have are in love with this field and will just accept pay decreases and/or work increases to maintain income (which will only mean even less demand for new grads) as they come and happily retire after a 30 year career (hopefully) with no regrets, but I just can't imagine telling somebody like the OP to do anything other than run away as fast as she can. Honestly breaks my heart to say...

couldnt sum up my present situation and outlook any better.

 

[thecarbonionangle]

The poster is not just geographically restricted, they are severely geographically restricted. I would say if you still want to do rad onc make sure you end up doing residency exactly in that state but that even doesn't guarantee anything but you still have a chance, far more than anybody from a higher tier program does. If your focus is to absolutely end up in a top 10 city you listed, then absolutely without a doubt do residency in one of these cities. I don't think you should absolutely 100% avoid the field if you love it that much but you need to be ok with the possibility of not being in a top ten city. For me honestly, I did not know this, at least not the extent of the situation when i was applying. These threads just did not exist and my advisors had zero clue. Its good to know what you're getting into. Rad onc is a good field but the geographical restrictions is not going away. The filthy baby boomer "old timers" are ruining the field and many will not leave their jobs until they are carried out in a black bag out of their centres.

 

[radiadouken]

I haven't set foot in this forum in years but felt compelled to chime in given the overwhelming negativity directed at medical students regarding the future of our field. Call me naive, but I still think rad onc is one of the best, if not the best, medical specialties out there.

I'm in my first year in practice. I did not go to Harvard/MDACC/MSKCC. I graduated from a well-respected program and I sent my CV to ~15 places (mix of academic and PP) and received 5 hard job offers, all on the east coast. I'm not anything special. I worked hard in med school and residency and felt fortunate to have the choices I had. In the end, my wife and I chose a job that's not in a major city (I did have options in major east coast cities) - but we chose to move to place we've always wanted to live in, where we could have better QOL in a less stressful environment. At least that was the was the perception, and now 9 months in, taking this job was probably the best decision I've ever made. I love my job. I make >Terry Wall median starting salary, my patient load is very reasonable, my dept chair is awesome, my staff is great, I'm home most days ~5pm to see my kids. In short, I love what I do, and I am thankful everyday I went into rad onc.

Are there malignant departments/practices out there that prey on young grads? Yup. I specifically avoided such places in my job search, and turned down more "prestigious" positions as a result. Is the job market tight? Yeah, it is. If you're dead set on living in places with competitive markets like Boston and NYC, be prepared to be overworked/underpaid if you get a job offer in these places. I suspect this is not unique to rad onc though.

At the end of the day, this is such an awesome field - rewarding patient care, intellectually stimulating treatment planning, controlled hours, good compensation. Like I said, I'm not unique. My former co-residents all seem very happy as well - most of them had multiple competitive job offers too. There is considerable selection bias regarding who spends their time on SDN venting...

 

[deleted18755]

I haven't set foot in this forum in years but felt compelled to chime in given the overwhelming negativity directed at medical students regarding the future of our field. Call me naive, but I still think rad onc is one of the best, if not the best, medical specialties out there.

I'm in my first year in practice. I did not go to Harvard/MDACC/MSKCC. I graduated from a well-respected program and I sent my CV to ~15 places (mix of academic and PP) and received 5 hard job offers, all on the east coast. I'm not anything special. I worked hard in med school and residency and felt fortunate to have the choices I had. In the end, my wife and I chose a job that's not in a major city (I did have options in major east coast cities) - but we chose to move to place we've always wanted to live in, where we could have better QOL in a less stressful environment. At least that was the was the perception, and now 9 months in, taking this job was probably the best decision I've ever made. I love my job. I make >Terry Wall median starting salary, my patient load is very reasonable, my dept chair is awesome, my staff is great, I'm home most days ~5pm to see my kids. In short, I love what I do, and I am thankful everyday I went into rad onc.

Are there malignant departments/practices out there that prey on young grads? Yup. I specifically avoided such places in my job search, and turned down more "prestigious" positions as a result. Is the job market tight? Yeah, it is. If you're dead set on living in places with competitive markets like Boston and NYC, be prepared to be overworked/underpaid if you get a job offer in these places. I suspect this is not unique to rad onc though.

At the end of the day, this is such an awesome field - rewarding patient care, intellectually stimulating treatment planning, controlled hours, good compensation. Like I said, I'm not unique. My former co-residents all seem very happy as well - most of them had multiple competitive job offers too. There is considerable selection bias regarding who spends their time on SDN venting...

I 100% agree with everything the poster says above, best field in medicine by far and many of us can't believe we get paid (a lot) to do this; however, the OP isn't asking me what I think about my job but rather should she do it.

How about this advise to medical students and request from everybody:

1. If you speak to any practicing radiation oncologist who says anything other than they love their job and what they do, then immediately disregard everything else they say. This is an objectively miserable person or somebody who made many bad mistakes that you can avoid.

2. If they say they love their job but hate where they work because it's not in the middle of a big city, then since this is subjective take or leave their advice depending on your preferences (realizing that the difficulty finding big city jobs of today will probably be medium city jobs in the future).

3. If you are told that this field is awesome and the future is bright, simply ask: "with the recent rapid adaptation of hyperfractioned regimens and trends towards less screening and/or less adjuvant therapy for prostate/breast, etc and the explosive increase in residency spots in the setting of decreased reimbursement, why are you not concerned not necessarily for the next year or 5 years from now but 10-20+ years from now (when I will still be very early in my career with no ability to do anything other than radiate tumors)?"

If you get a good answer (or if anybody has one) please, please post it asap on this forum. It hurts my heart and soul that I love this field so much but am literally mentoring the next generation to stay away and now I am panicking that maybe there is an answer out there to #3 that I just don't know about. I've thought long and hard about this and can't think of one and have never heard a good answer (other than debunked false projections of increased demand) but I honestly pray that there is and would be the first to reverse my opinion and literally jump for joy.

 

[kristofer]

I 100% agree with everything the poster says above, best field in medicine by far and many of us can't believe we get paid (a lot) to do this; however, the OP isn't asking me what I think about my job but rather should she do it.

Well even though he appeared to offer a dissenting opinion, he actually did not and admitted what everyone else was saying:

"If you're dead set on living in places with competitive markets like Boston and NYC, be prepared to be overworked/underpaid if you get a job offer in these places. I suspect this is not unique to rad onc though."

The last bit is especially important. Highly paid "lifestyle" fields will all be competitive in competitive areas. I still can't wrap my head around the concept of not going into the field because the idea of not being able to live in a top 10 city on the coast is so disagreeable that you would choose an entirely different career. Rad onc brings so much satisfaction for those who really fit with the field, why would you not be willing to compromise on where you live? I just don't get it. I suspect it often has to do with youth, inexperience, and no history of having to search for jobs, or at least growing up with family who had to move around to put food on the table.

 

[Neuronix]

I suspect it often has to do with youth, inexperience, and no history of having to search for jobs, or at least growing up with family who had to move around to put food on the table.

I think your comment is similarly inexperienced.

Maybe the poster comes from an ethnic group with a limited geographic distribution. Maybe the poster has a family who has a fixed location. Maybe the poster has a spouse whose career restricts them to major metro areas.

I have seen all of this and more. I know a guy who is divorced and lost his rad onc job in a major metro. His only options are to stay put and do whatever work he can or move away and never see his children. I know several women from major liberal metro areas who have no dating pool of similarly educated and like-minded individuals in their area and wonder if they will ever find a spouse after their many years dedicated to training. Several other women I know are underemployed or unemployed because their families are tied to a given location and they're stuck there by a non-existent job market and/or non-compete.

It's one thing if you're caucasian and you have a spouse who doesn't work or has a job where it is easy to relocate. It's another thing when your community, children, and family come into the picture.

I didn't take your post earlier personally just like I don't take this post personally. We today don't have the same opportunities in clinical medicine or research that our predecessors ten or even five years ago had. Further, I think having to be ready to go anywhere to work is something relatively unique to radiation oncology. I'm glad my spouse is in a medical specialty with an open job market who could join me in one of the two locations in the country where I got a job offer after a national search. I think to blame the victims of a poor job market due to factors outside of our control is unnecessarily cruel and ridiculous. Just because the problem doesn't apply to you doesn't mean it isn't a problem.

So I don't blame for people for avoiding this specialty due to the job situation. Our predictions are that it's only going to worsen. GFunk gives a great rationale why in post #14 above. It would be very gloomy to look up at this specialty from an MS4 perspective five years into the future.

 

[fiji128]

From a practice standpoint the field is great but there are lots of other MDs who love their chosen field as well. If one of your goals is to live in a top metro area and you still go into rad onc have the expectation that after residency it may take 5 or more years to get a position at least adjacent to the desired location. This is a hugely frustrating fact for many of those just entering the field out of residency especially when you see friends in other specialties landing jobs in NYC/LA/SFO/Seattle/Austin ect... with no particular special effort.

 

[RickyScott]

It is very rare that you get a consensus agreement on this forum. You just got one. If you are geographically constrained do not go into rad onc.

But do your research. Rad onc is not the only geographically-restricted specialty nor the only one with relatively predatory practices for new grads in desirable locations.

Well even though he appeared to offer a dissenting opinion, he actually did not and admitted what everyone else was saying:

"If you're dead set on living in places with competitive markets like Boston and NYC, be prepared to be overworked/underpaid if you get a job offer in these places. I suspect this is not unique to rad onc though."

The last bit is especially important. Highly paid "lifestyle" fields will all be competitive in competitive areas. I still can't wrap my head around the concept of not going into the field because the idea of not being able to live in a top 10 city on the coast is so disagreeable that you would choose an entirely different career. Rad onc brings so much satisfaction for those who really fit with the field, why would you not be willing to compromise on where you live? I just don't get it. I suspect it often has to do with youth, inexperience, and no history of having to search for jobs, or at least growing up with family who had to move around to put food on the table.

I totally disagree. 1) There are many interesting fields in medicine, so why choose one that is so restrictive. It is almost aspergerish to be so dead set on radon as a med student. 2) Spouses do figure into the decision as well, and have their own restrictions, ie many of them with graduate degrees can not work in rural locations. 3) A lot of us like to live near family or where we grew up. I would say majority of residents are minorities (asian, indian, jews) and desire a location with a community 4) Whats getting lost in the discussion is the essence of a tight job market is not just about midwest/rural vs the coasts- The very nature of the job is changed by the fact that you will have great difficulty getting another one if you leave, and unlikely in the same town. This took my about 5-10 years to appreciate, but you may have to put up with a lot in a tight job market because you are not going to move your family to another state. Likewise, Workplaces/departments will not reform "their own behavior" and environment. (just think about when it comes time to ask for a raise! )
For example, a number of the best docs I know left a large academic system w/ many satellites in Baltimore over the past several years because of persistent low level insidious treatment. Increasingly, we are going to be tied down and beholden whether it is midwest or coastal.

 

[kristofer]

I think your comment is similarly inexperienced.

Maybe the poster comes from an ethnic group with a limited geographic distribution. Maybe the poster has a family who has a fixed location. Maybe the poster has a spouse whose career restricts them to major metro areas.

I have seen all of this and more. I know a guy who is divorced and lost his rad onc job in a major metro. His only options are to stay put and do whatever work he can or move away and never see his children. I know several women from major liberal metro areas who have no dating pool in their area of similarly educated and like-minded individuals who wonder if they will ever find a spouse after dedicated a bazillion years to training. Several other women I know are underemployed or unemployed because their families are tied to a given location and they're stuck there by a non-existent job market and/or non-compete.

It's one thing if you're caucasian and you have a spouse who doesn't work or has a job where it is easy to relocate. It's another thing when your community, children, and family come into the picture.

I didn't take your post earlier personally just like I don't take this post personally. But I think having to be ready to go anywhere to work is something relatively unique to radiation oncology. I also think to blame the victims of a poor job market due to factors outside of our control is unnecessarily cruel and ridiculous. Just because the problem doesn't apply to you doesn't mean it isn't a problem.

I respectfully disagree. The situation in rad onc is not so bad that you cannot select the region you want to be in, and I really think it's a stretch to say that in 5-10 years people will be forced to move 300+ miles or more from what they call home if that's where they want to be. There is a lot of hyperbole on this forum -- It's not at the "have to go anywhere" point yet, and it's not quite right to tell people like the OP that. You may not be in the middle of the big city you want to be in, but you can realistically still end up somewhere nearby (whether that's a suburb, small town, or rural center), and of course your first job does not have to be your last job. The specific scenarios you mention happen all the time in every industry, and frankly are much worse in other industries I have worked in. It's part of life and a very shortsighted reason not to choose rad onc IMO. Blaming the victims? Not really what I was trying to do, but well, yeah if you are miserable because you think you can only be happy living in upper end NYC or SoCal, then yeah it's kind of on you. That attitude is completely ridiculous IMO. And of course everyone is different. It doesn't make you a bad person if you absolutely have to live next door to your parents or have your specific religious center nearby. So sure, for these people I totally agree that rad onc may not be the right fit. But, and I know I'm going to get flamed for this, if your only hesitation is a strict requirement to live in the middle of a big city so you can have more restaurants to eat at and more nightlife to choose from, and a perceived higher quality of potential spouses, then I would say your priorities are all screwed up. I am truly honored to be in this field and barely managed to get in and would have gone to Mars to train if I had to. Yet I see people take it for granted all the time. The trade off to be in this field vs. another field of medicine is more than worth it. You'll have your weekends off, often long weekends, and more than enough money to fly anywhere you want if you can't stand small town America in your free time.

 

[evilbooyaa]

@oldking The only thing I can think of as an answer to your question:

Metastatic patients are living longer, thus requiring more courses of palliative radiation (albeit hypofractionated). Utilization of SBRT (which is hypofractionation but at least pays better than 3D for same # of fractions) is increasing, not necessarily always at the cost of long treatment schedules (early stage lung, oligoprogressive lung, likely oligometastatic/oligoprogressive whatever both now and in the future given desire to "be aggressive" with all metastatic patients with a reasonable PS). Obviously some of these are at the cost of old standards (prostate SBRT rather than 9 weeks).

@kristofer - I, personally, agree with your thought process. Best field in medicine (IMO), I'd have gone wherever they wanted me to train, I don't see myself doing any other field.
HOWEVER, not all rad onc applicants are in that state of mind. I remember interviewing with people in NYC as a MS4 that said they wanted to be in NYC above all else, and they were interviewing for both rad onc and rads in NYC. Not all people's priorities are the same as yours (or mine). That doesn't mean that their priorities are "screwed up", but that they have different priorities. People are allowed to have different priorities. To some people, Rad Onc is a cool job with a good lifestyle, but not the end-all be-all of medicine, and usually not the ONLY thing they're interested in.

I can't agree with disparaging people like OP who have their priorities set on geographic availability. Maybe he/she likes Rad Onc and some other fields relatively equally and is trying to figure out the right balance of all these things. To me, there is a big difference in region (north east, south, midwest, etc.) and being driving distance away from the city you want to live in or by (so that you could go to that city for dinner on a weeknight, for example). If I live in upstate NY and am a 2-3 hour drive away from NYC, am I realistically ever going to be able to go into the city for dinner?

 

[Neuronix]

I respectfully disagree. The situation in rad onc is not so bad that you cannot select the region you want to be in, and I really think it's a stretch to say that in 5-10 years people will be forced to move 300+ miles or more from what they call home if that's where they want to be.

I'm seeing people having to live 300+ miles from where they want/need to be now.

There is a lot of hyperbole on this forum -- It's not at the "have to go anywhere" point yet, and it's not quite right to tell people like the OP that. You may not be in the middle of the big city you want to be in, but you can realistically still end up somewhere nearby (whether that's a suburb, small town, or rural center)

We have different experiences here clearly.

The specific scenarios you mention happen all the time in every industry, and frankly are much worse in other industries I have worked in.

This is medicine where there are plenty of other career choices that do have much more flexibility. We're not talking about other industries.

perceived higher quality of potential spouses

It's not perceived. It's real. I've seen that issue firsthand multiple times.

I am truly honored to be in this field and barely managed to get in and would have gone to Mars to train if I had to. Yet I see people take it for granted all the time. The trade off to be in this field vs. another field of medicine is more than worth it. You'll have your weekends off, often long weekends, and more than enough money to fly anywhere you want if you can't stand small town America in your free time.

Evilboyaa and RickyScott are telling you something. RS and I from the attending side. We have different priorities in life. I also think the situation is worse than you realize.

 

[DebtRising]

Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025.
Pan HY, et al. Int J Radiat Oncol Biol Phys. 2016.
Show full citation
Abstract
PURPOSE: Prior studies have forecasted demand for radiation therapy to grow 10 times faster than the supply between 2010 and 2020. We updated these projections for 2015 to 2025 to determine whether this imbalance persists and to assess the accuracy of prior projections.

METHODS AND MATERIALS: The demand for radiation therapy between 2015 and 2025 was estimated by combining current radiation utilization rates determined by the Surveillance, Epidemiology, and End Results data with population projections provided by the US Census Bureau. The supply of radiation oncologists was forecast by using workforce demographics and full-time equivalent (FTE) status provided by the American Society for Radiation Oncology (ASTRO), current resident class sizes, and expected survival per life tables from the US Centers for Disease Control.

RESULTS: Between 2015 and 2025, the annual total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 19%, from 490,000 to 580,000. Assuming a graduating resident class size of 200, the number of FTE physicians is expected to increase by 27%, from 3903 to 4965. In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections. By contrast, the new projected supply of radiation oncologists in 2020 increased by 275 FTEs in comparison with the prior projection for 2020 (a 7% relative increase), attributable to rising residency class sizes.

CONCLUSION: The supply of radiation oncologists is expected to grow more quickly than the demand for radiation therapy from 2015 to 2025. Further research is needed to determine whether this is an appropriate correction or will result in excess capacity

Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025. - PubMed - NCBI


Model does not take into account aggressive adoption of hypofracionation. Residency spots I believe are already over 200.

Enjoy.

 

[medgator]

There are many interesting fields in medicine, so why choose one that is so restrictive. It is almost aspergerish to be so dead set on radon as a med student.

After being in practice for several years now, I disagree. I imagine people like oldking would as well. RO is an awesome and unique field in medicine.

You realistically can't just do MO in the community, or probably even in academia, and I personally find hematology quite boring. I also hate rounding. I'd be bored to tears reading film all day at home for telerads or in the office/hsopital setting, or looking at slide all day etc..

So yes, there are some of us who still feel it is RO or bust. I'm fortunate to be within an hour of a major metro not far from family, but I'd still do RO somewhere else before I'd want to do heme onc or rads in my current location

 

[medgator]

Model does not take into account aggressive adoption of hypofracionation. Residency spots I believe are already over 200.

Enjoy.

RO has turned into a twisted game of musical chairs.

 

[laserbeams]

The leadership in the field needs to get a handle on the supply side of the problem. Then again, if I was a wealthy academic chair and could further pad my salary by underpaying recently graduated ROs to staff community clinics (ahem, sorry, "academic satellites"), I probably would cheer for further expansion.

The demand side of the equation is good for patients (shorter treatment courses, similar toxicity) but poses significant challenges for current and future ROs. For established physicians, they will likely end up seeing more patients per year, with shorter treatment courses.

The only potential upside is expanding indications for RT. Two areas being investigated which may bring more patients are SBRT for v-tach and treatment of oligometastatic disease in breast cancer patients. If the latter pans out, it could be a game-changer for patients and sustain ROs in the future. I'm skeptical playing SBRT whack-a-mole will pan out, but it'll be interesting to find out.

Finally, one area where there's space to improve is getting referrals from urologists for patients with adverse features following prostatectomy. This is known to be beneficial, has little room to be hypofractionated (due to bowel constraints), and is infrequently used despite evidence showing clinical value (source).

 

[kristofer]

After being in practice for several years now, I disagree. I imagine people like oldking would as well. RO is an awesome and unique field in medicine.

You realistically can't just do MO in the community, or probably even in academia, and I personally find hematology quite boring. I also hate rounding. I'd be bored to tears reading film all day at home for telerads or in the office/hsopital setting, or looking at slide all day etc..

So yes, there are some of us who still feel it is RO or bust. I'm fortunate to be within an hour of a major metro not far from family, but I'd still do RO somewhere else before I'd want to do heme onc or rads in my current location

This is basically what I was getting at. Others are just saying do something else in medicine. How many of you would really, honestly, switch to family med or ob-gyn or general surgery to have a better shot to be in a big city? There's nothing really like rad onc. Sure, I'm just a resident, but I'm actively looking for jobs and it's going well, even off cycle. Although I am not applying to anything in a major metro area. Not being able to find any rad onc job within 300 miles of where you want to be? Really? Where? This is just simply not consistent at all with what I'm seeing nor what my peers who recently went through the job hunt saw. And again, I totally agree that if you absolutely refuse to live outside of a major metro area, then you should not go into this field. My point was, I just don't get it. You really don't think there are any young attractive educated people looking for a spouse in places like Kansas City, Louisville, Birmingham, Ann Arbor, Omaha, Milwaukee, Albuquerque, Nashville, etc, etc, etc.? Are those of us not in Manhattan or San Francisco really so stupid and ugly or otherwise undesirable? Is it a racial thing? I'm sorry, but I've seen this attitude so many times and it's just so unfortunate that people think this way.

 

[Neuronix]

For anonymity sake I can't share details of personal stories that I have. If you'd like to meet up at ASTRO, let's have a beer and I can tell you the true stories of people I know.

As for me personally, it turns out that 300+ miles was an exaggeration. It's hard to put a number of miles on things so I went to Google Maps. For my first choice city where I have connections, I did an away rotation there but didn't match there. During and when I graduated residency, I contacted every practice I could find within a 100 mile radius and none were hiring the year I graduated. I don't know past 100 miles, because I gave up going past that. Fortunately, it wasn't critical for me to be in that city, so I lucked out to get a job in another city.

 

[psy3]

This is basically what I was getting at. Others are just saying do something else in medicine. How many of you would really, honestly, switch to family med or ob-gyn or general surgery to have a better shot to be in a big city? There's nothing really like rad onc.

Well, when I was proposing to my wife, who have never lived in a city of less than population of 10 million, I told her "okay, I'm getting into radonc residency in a small city less than one million in the whole metro, and because of the geographical restriction of the field, I cannot guarantee that I will ever be able to find a job in truly big cities (to us limited to NYC, LA, maybe Chicago). So, if you have problem with that, let me know, I will change to IM, ED, or whatever." So, that's me and my kind of people certainly do exist. And whether my wife maintains her sanity in our current city of 2 million-ish is to be seen.

What I notice in this thread and some other job market threads and therefore convey to the medical students who are looking into joining this field is this; just like there are people with big-city bias, there are people with small-city bias. I'm not questioning that American small cities are great place to live, have career, and build family, as I lived last 20 years of my life in cities of 25k, 50k, 200k. However, if you have big-city bias and live and breath big-city life, advice from people with small-city bias doesn't apply to you and mean anything for you. So, you would be better off listening to people like me or Neuronix. And look into other fields. At the end of the day, that's what medical school is all about, right? Learning and knowing about your personality and preferences, be exposed to all kinds of field, and pick a field that works with your and your family's LIFE, NOT Brain (or whatever intellectual stimulation that radiation oncology gives you).

 

[ivybme]

This is basically what I was getting at. Others are just saying do something else in medicine. How many of you would really, honestly, switch to family med or ob-gyn or general surgery to have a better shot to be in a big city? There's nothing really like rad onc. Sure, I'm just a resident, but I'm actively looking for jobs and it's going well, even off cycle. Although I am not applying to anything in a major metro area. Not being able to find any rad onc job within 300 miles of where you want to be? Really? Where? This is just simply not consistent at all with what I'm seeing nor what my peers who recently went through the job hunt saw. And again, I totally agree that if you absolutely refuse to live outside of a major metro area, then you should not go into this field. My point was, I just don't get it. You really don't think there are any young attractive educated people looking for a spouse in places like Kansas City, Louisville, Birmingham, Ann Arbor, Omaha, Milwaukee, Albuquerque, Nashville, etc, etc, etc.? Are those of us not in Manhattan or San Francisco really so stupid and ugly or otherwise undesirable? Is it a racial thing? I'm sorry, but I've seen this attitude so many times and it's just so unfortunate that people think this way.

Don't you think it's just as disparaging to put down family med and ob-gyn and general surgery as it is to put down small cities? Isn't it okay to have different priorities in life?

Maybe to put it in perspective, I had a friend who lived in Bakersfield, CA and had to drive four hours to LA every month to get groceries, since Bakersfield doesn't have a grocery store with her home country's ethnic food (FYI, Bakersfield to LA is only 100 miles, much less than the 300 mile radius criterion). For you, this may not be an issue, but I would definitely reconsider the idea that living in a small city comes with no repercussions whatsoever for some people. I can say many of my friends who are ethnic minorities and have lived in mid sized cities (let alone rural areas) say dating is completely different as compared to a big city. I'm not at all trying to say that small cities suck. It's just that there is a huge detriment to my quality of life such that it would be worth it to consider another field. For me personally, if I can find a job living in a top 10 metro area even with a pay cut and worse hours, I would take it in a heartbeat over a job in a rural town making millions working 30 hrs/week. If rad onc can't give me that opportunity, then I definitely will have to think twice, sadly.

 

[throwaway.radonc]

Living in a small city..like Bakersfield? 365k with metro 850k, 52nd largest city in the US (source:wiki).

Im sorry, but I have watched this conversation over the last 2 years. IVY is an example of what we are dealing with. Please stop hyperbolizing the job market. You are frustrated that you made the wrong decision. You were only interested in living close to home (or the elitist equivalent) and you chose the wrong specialty that would make that easy. Sometimes life is hard and will require you to put in the time to be where you want to be.

 

[medgator]

Don't you think it's just as disparaging to put down family med and ob-gyn and general surgery as it is to put down small cities?

Preferring RO to gen surg or FM =/= disparaging gen surg or FM