Sure, settle in.
The fear that there are not enough jobs for the amount of trainees is based on objective information as well as subjective.
1) The 2014 resident survey, published in 2015, which showed 33% of graduates did not get the region they wanted, 16% could not get academics, and 7% felt they were forced into fellowship (citation,
http://www.redjournal.org/article/S0360-3016(15)00337-5/abstract).
2) The updated supply and demand forecast (citation
http://www.redjournal.org/article/S0360-3016(16)00233-9/abstract).
3) Since both the survey and the model, residency expansion has only continued! Hello to SUNY Stony Brook and new Stanford position.
4) The explosion of fellowships, which are not accredited, including such blatant manipulative ones as 'in-patient rad onc' courtesy of columbia. There is no major subspecialization in our field outside pediatrics, which is contracting. Maybe you can educate me on the value of SBRT, SRS and 'palliative care' fellowships. I would truly like your opinion as an attending in a field that allows programs to graduate such substandard residents / adhere to substandard ACGME guidelines as to make it even possible that such basic parts of our field become a fellowship.
5) The fact that the labor market has already been destroyed in similiar situations (delayed entry into workforce in Canada
https://www.ncbi.nlm.nih.gov/pubmed/26238955, the lengthening of residency in the mid 1990s in the US)
6) The rise of exploitative positions. It has been mentioned in this thread about the 90K stanford job. That is pretty well known in the field at this point, and it was real (if it still is I cannot vouch). But it was 90K for scut attending work without even the veneer of education that these fake fellowships apply, meant to take maximal advantage of a desirable location.
7) The fact that hypofractionation requires less manpower and is here to stay, and is good for patients.
8) That all of this is occuring as student debt increases year after year, reimbursement is decreasing year after year, and payment models are being explored whose cost savings rely on a gatekeeper who is incentivized not to refer patients out (Oncology home model)
Guaranteeing a great salary? The previous generation had that feast. When trainees are forced into fellowship carrying $200K plus debt, already with 5 years of residency, fighting for crumbs from an older generation not inclined to retire and no central body (ASTRO / ACGME / SCAROP) is even bothering to detail this is happening or providing objective information on the inability to work in large parts of the country, then fear is clearly justified. And the fear is amplified by anger of the blatant disregard of at least part of the older generation who could care less about the new grads by continuing expansion, as Stanford has decided with all this information available. I did not notice in their advertisement they were screening for people to serve in 'undesirable' parts of the country where there is a labor shortage (or so is claimed), did you? Also did not see any guidance from then on any of the published points I cited. When the supply/demand model from 2007 showed an increased demand, it was plastered pretty predominately on the ASTRO website. Now that the model predicts oversupply the same gravitas does not seem to be given to that information, and I sure don't hear the faculty where I am discussing this or being honest with medical students.
To top all this off, this is bad not only for residents and new graduates but for society. It is a waste of tax payer money on some level, because not all these positions are self funded. It increases health expenditures by increasing utilization (people with 200K debt can't survive on 90K, nor should they after 8 years of schooling and 5 years of residency), which is a known phenomenon and a generally accepted driver of health costs by CMS (and in response to radiatormike in the other thread - I sent the email and concede your points, but have a follow up call to an aide). Most of all people, like myself, feel betrayed. This isn't hunger games - if the field is bloated and the only jobs are in out of the way places, make that known broadly and honestly, recruit accordingly, and don't grind bright people down into your little scut monkey, accepting half the salary of 5 years ago with more work, and then throw your hands up when they complain. And while you may not control this directly, funding for research and research positions have also been cut as reimbursements are cut, so that having an academic career today is substantially harder than even 10 years ago, but infinitely so compared to 20, or roughly the generation of seniors making the choices now.
If you want to have an open competition for jobs, and not entrenched seniority, be my guest and your argument may have merit. But that is not how radiation oncology works. You may do well for yourself, but the guy who took the 90K job at Stanford that year, or the people forced to fellowship, or the new residents who work hard and publish and get satellite jobs when a senior physician who is coasting will not be forced out until they retire may disagree with you. That is not a function of ability, that is a function of an entrenched senior work force using residency expansion to pad their lifestyle as long as possible. Ability has nothing to do with it.
