State of radiation oncology

[foosballhero95]

Hi all,

I'm a soon-to-be second year medical student who is considering rad onc. However in real life and on this thread, I've been hearing doom and gloom about the specialty.

I know it's been asked ad nauseam, but can someone shed some light on the future prospects of the field and also some pros and cons?

Thanks so much!

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[RadOncDoc21]

 

[creamfreesh]

If you love the field Rad Onc above all other options in medicine...meaning you love the science behind, process of, and relationship developed by giving patients radiation for their cancer, then it wont matter what the state of the field is at some point in time or how much you get paid for doing so. If the specialty itself is what interests you, then by all means go for it. Use your M2, M3 and M4 to explore this field more to be able to make that assessment, or something approaching it to the greatest extent possible.

Most Radiation Oncologists are happy and satisfied with their career choices, as there is a lot that is great about this field. But it's nevertheless true that the statistics and logistics of the employment market in Rad Onc are increasingly strained, and the specialty is still difficult to match into despite the expanding number of residency positions. Again, if Rad Onc truly turns out to be your passion, then you will be happy in regardless of the environment you find yourself in as a residency and eventual job applicant. Please don't have your first point of assessment of any field of medicine be the lifestyle/compensation aspect of it. I'm not quixotic in this regard; those things are important points of consideration to be sure, but what actual aspects of medicine interest you should be your first and major concern at this juncture.

 

[KHE88]

As you admitted, you've asked about a topic that has already been heavily discussed, and I don't think you are going to generate any new revelations here. If you don't want to move for work as radiation oncologist, you'll have to settle for getting paid less, often a lot less, and having a less desirable work environment. Oddly (to me), most people in this field would prefer to make $300k as associates in revolving door private practices in an expensive big coastal city than $700k+ in dirt cheap flyover country. For the rare applicant who likes living in the boonies, this field is a real home run.

 

[RickyScott]

There are very few jobs in expensive big coastal cities, so dont count on getting a 300k revolving private practice slot, and the 700k in the boonies is not something I have encountered. Lots of specialties have peaks and troughs, We just have a huge peak (more than doubling in 12 years residency slots) while demand in terms of the number of fractions- is going down. 10 years ago, palliative xrt used to be 250 x 15, prostate 180 x44, breast- 33 treatments etc. Palliative care is 50% of most practices, so that alone is a big hit. Yes, we are treating a bit more oligo mets, but oligo fractionation for a few extra oligomets will in no way offset the decline in total number of fractions. Our professional society leadership,ASTRO, actually receive short term benefits from this situation. I just dont know of an analagous situtation in another specialty.

Anthony Zeitman, program director at MGH, invoked syphilology - the specialty treating syphilis- when discussing our future, and then falsely claimed that the "free market" would solve the problem, despite the fact that once a residency slot is opened up, a horrible job market will not close it down, but just lead to it being filled by a desperate FMG.

At the end of the day, it is about your expectations. When I entered the field, I expected (basically felt entitled) to a good job in the city of my choosing, and that is what I got and the field has been very good to me, but I would not go into it today.. As has been said before, medicine has a lot of interesting specialties....

 

[KHE88]

There are very few jobs in expensive big coastal cities, so dont count on getting a 300k revolving private practice slot, and the 700k in the boonies is not something I have encountered.

Your point about the competition for these otherwise bad jobs in desirable areas is apt. However, I will say that I encountered numerous good offers in "the boonies." Guaranteed base >500k with production bonuses such that 11,000-12,000 wRVUs paying 700k+ was common. 50-100k signing bonuses. These jobs had difficulty filling and they were recruiting hard for them. So I disagree that that option is not out there. It's just that nobody wants it.

 

[medgator]

Your point about the competition for these otherwise bad jobs in desirable areas is apt. However, I will say that I encountered numerous good offers in "the boonies." Guaranteed base >500k with production bonuses such that 11,000-12,000 wRVUs paying 700k+ was common. 50-100k signing bonuses. These jobs had difficulty filling and they were recruiting hard for them. So I disagree that that option is not out there. It's just that nobody wants it.

I know experienced BC docs who left less than stellar PP situations who walked into hospital employed positions at $450-500K+ incentives in a Southeast metro a few years ago.

The jobs filled quickly as word got out when the positions became available. I don't think those positions made it to the astro job center.

The rural "boonie" rural position 1.5 hours from the main center took forever to fill and did eventually remain on the astro site for several months fwiw.

The bottom line is that good positions nowadays will likely fill through internal connections.

 

[Dro133]

Question from an MS3 --- on the ASTRO job board, I see what look like three decent job postings within the last week -- a private practice job in Phoenix, a faculty position at the University of Washington and another faculty position at UC Davis. Do these jobs get obscene amounts of applicants, or is it actually possible to land one of them?

 

[evilbooyaa]

Question from an MS3 --- on the ASTRO job board, I see what look like three decent job postings within the last week -- a private practice job in Phoenix, a faculty position at the University of Washington and another faculty position at UC Davis. Do these jobs get obscene amounts of applicants, or is it actually possible to land one of them?

A fair number of jobs feel compelled to post on ASTRO, but there is frequently already a known or internal candidate who is essentially a lock for the job, is what I've heard from multiple people in situations like that. However, they have to at least put up appearances to make it seem like they're doing a real national search.

 

[Dro133]

A fair number of jobs feel compelled to post on ASTRO, but there is frequently already a known or internal candidate who is essentially a lock for the job, is what I've heard from multiple people in situations like that. However, they have to at least put up appearances to make it seem like they're doing a real national search.

So would it be accurate to say that decent jobs exist, but are pretty much exclusively attained via word-of-mouth/networking?

 

[Neuronix]

Depends what you mean by decent.

You have no way of knowing from looking at the ad whether they already know who they're hiring or not. Those postings will probably get about 100-200 applications. Someone has to get the job, but your odds go way up if you have connections.

Connections are also really helpful to let you know whether you have a chance at the position before you apply. It's really annoying to have to submit letters of recommendation or institution specific personal statements just to be rejected from a position you never had a chance at.

 

[DebtRising]

Question from an MS3 --- on the ASTRO job board, I see what look like three decent job postings within the last week -- a private practice job in Phoenix, a faculty position at the University of Washington and another faculty position at UC Davis. Do these jobs get obscene amounts of applicants, or is it actually possible to land one of them?

There are 200 residents. Most postings will be between now and October, right before ASTRO. A second, smaller grouping happens in January / February when some private practices better know the financial situation of the last year, though now most are cycled up to ASTRO.

Postings now are generally not for graduating residents, unless specified. And not everyone who leaves a position has that vacant position rehired.

It's good you are looking at postings as a piece of feedback. But there are publications on the supply demand mismatch, regional job shortage, and the annual survey in which 53% of the respondents identified over supply concerns as the biggest issue facing the field. The point of rehashing that is to make sure you include the entire objective data set before making conclusions.

To add icing to the cake, ASTRO email indicates CMS has accepted MedCalc or whoever's recommendation and proposing a 2% across the board cut and additional cuts to RO reimbursement. If RO employment is a company or stock, every single indication is pointing negative.

 

[seper]

Or cold-calling. If you have a specific skill, e.g. prostate HDR, you can just figure out who may need you and find a job by calling chairmen.

So would it be accurate to say that decent jobs exist, but are pretty much exclusively attained via word-of-mouth/networking?

 

[Fpg1245]

Hi all,

I'm a soon-to-be second year medical student who is considering rad onc. However in real life and on this thread, I've been hearing doom and gloom about the specialty.

I know it's been asked ad nauseam, but can someone shed some light on the future prospects of the field and also some pros and cons?

Thanks so much!

Have you considered other oncologic specialties? If you must be an oncologist, then why not a medical oncologist? They seem to be making all the big spashes in oncology with their pharma back research. Honestly, I don’t even recommend oncology in general. Government is in the process of slowly killing it (review the 2019 proposal from CMS). If you want your to be considered part of the cost problem in healthcare and held in contempt by your peers, by all means do oncology. Otherwise steer clear.

 

[Dro133]

Depends what you mean by decent.

You have no way of knowing from looking at the ad whether they already know who they're hiring or not. Those postings will probably get about 100-200 applications. Someone has to get the job, but your odds go way up if you have connections.

Connections are also really helpful to let you know whether you have a chance at the position before you apply. It's really annoying to have to submit letters of recommendation or institution specific personal statements just to be rejected from a position you never had a chance at.

So if someone is a competent resident at a reputable institution, are the chances good that they would have developed enough connections during their residency to find one of these word-of-mouth jobs?

 

[Neuronix]

So if someone is a competent resident at a reputable institution, are the chances good that they would have developed enough connections during their residency to find one of these word-of-mouth jobs?

What distinguishes one job applicant from another in this field?

 

[Neuronix]

This myth that there is a plethora of good 'word of mouth' jobs is preposterous. Chairs and partners know the score when their email boxes are filled with cold emails.

This is a good point. I know one academic place that was looking to hire. They got 40 cold call applications in the few months before they decided to hire. They found the 20 they liked the most and interviewed them at ASTRO. The job was never posted.

 

[DebtRising]

This is a good point. I know one academic place that was looking to hire. They got 40 cold call applications in the few months before they decided to hire. They found the 20 they liked the most and interviewed them at ASTRO. The job was never posted.

Sorry, I deleted my post. Not due to vulgarity or anything improper, simply lack of energy. Can't keep saying the same things over and over again to medical students. People will make their own mistakes. Shame on the chairs and programs who don't better inform them of their future.

In short, there are multiple high achieving, confident rad onc residents who want a position in area X and are actively making connections early, through outreach, well before the job search. There is no magic pool of word of mouth jobs just waiting for your cold email at the end of PGY-4 year. My current job is partly due to 'connections' and I interviewed in my year at 3 positions not posted on the job site, some of which never filled. None of them were special or magical compared to posted positions. They all had other people doing the same thing.

 

[RadOncgal]

I do agree that it is concerning that our specialty is graduating so many new grads and that positions in highly sought out cities like SF and NYC are almost non-existent but I have to disagree with the complete gloom and doom.

In the last 5 years, residents from my program have had a lot of success with their job search including both in the academic and PP arena. We have had residents find partnership positions and great academic jobs in cities like Atlanta, Dallas, Houston, Chicago, Seattle, etc.

I come from a higher tier solid program with faculty who are advocates for the residents. I think that if you come from a program with faculty who will make calls for you, a solid alumni base, and you have a decent CV, you can still do ok. You may have to sacrifice on salary to be in a big city and aggressively pursue opportunities, but they exist. it’s not completely undoable. Also, the majority of residents have found their positions from cold emailing/calling or through a referral from faculty or an alum working in the area of interest.

So if I was applying as a med student now, I would really try to stay away from newer or lower tier programs if possible (even if it’s in a location you would want to live in during training). I would ask where prior residents got jobs in the prior years and faculty/PD involvement in the process. Besides being a “good fit” for a position, the next best thing is likely to have connections and come from a place with a reputation of training residents well.

 

[Burt Radnolds]

In the last 5 years, residents from my program have had a lot of success with their job search including both in the academic and PP arena.

The major problem in your post is your assumption that trends you have observed in the last 5 years will hold going forward. Highly unlikely and it's simple supply and demand. I work in a large private practice group in a noncoastal but decent city and have been involved in our recruitment process. A phone call from your faculty is not going to get you a leg up on my end. I love rad onc dearly, but it's a sinking ship unless something changes.

 

[deleted18755]

The major problem in your post is your assumption that trends you have observed in the last 5 years will hold going forward. Highly unlikely and it's simple supply and demand. I work in a large private practice group in a noncoastal but decent city and have been involved in our recruitment process. A phone call from your faculty is not going to get you a leg up on my end. I love rad onc dearly, but it's a sinking ship unless something changes.

Exactly! Not much is going to change in 2-3 or even 5 years but in such a small field with so much supply of new grads (who I am sure plan on working 25-30+ years) and stable or decreasing demand a whole lot can change in 8-10 years. The senior faculty and “leaders” couldn’t care less since they will be retired and those of us in mid career truly care (since we are decent people who love this field and what it has offered us and want the next generation to have what we had) but it honestly won’t affect us much, especially since many of us work in “undesirable” locations that are relatively sheltered by on the supply side. If I were a new grad I would be terrified and if I were a 20 something year old medical student graduating from residency in 2025-2030 and planning to hang my hat on a field with such a narrow skill set with limited options outside of clinical radiation oncology and work into the 2060’s I would consider the clear long-term outlook vs “don’t worry a resident from a solid program said from 2013-2018 his friends found jobs so it’s not that bad”

 

[medgator]

So if I was applying as a med student now, I would really try to stay away from newer or lower tier programs if possible

Totally irrelevant IMO for finding a PP job. The 3 A's and connections matter for PP once you are BE/BC more than pedigree/age of program. For academic jobs you are probably correct.

Nothing will save new grads from the shameless 50%+ expansion in residency slots in the last decade

 

[RickyScott]

Look past your first job, which all the residents fixate on. Your career will be 40+ years. It will be hard to move laterally, get a promotion/ raise/ leave a toxic department etc in the future (yes, radiation departments can be political).. It used to be that the first job was rarely the last, but why should anyone give you a raise etc, make you partner, when there are a hundred well qualified docs to take your place..I dont care if you went to MSKCC or the joint center, 5 years into your career, no one in a cash strapped academic hospital is giving you a promotion/raise in this job market because of your Ivy league privilege.

At yesterday's tumor board, they introduced the new pathology fellow. She had been a resident in the program several years ago, then went to MD Anderson for 2 years, and was now back for another fellowship. As a med student, I had no idea this kind of exploitation was even possible in our system: the chair seemed genuinely excited to have her back, almost like he had found a great deal on a tv at costco.

I though my WASP/ ivy league privilege secured me to a good job/location, and it has, but it wont for the next generation.

 

[Bloor]

40+? When do people plan to retire? Never?

 

[atomi]

That's part of the problem. The nature of the work allows people to keep working well past normal retirement age. I met an older rad onc who said he might consider retirement in the next few years but didn't feel financially secure enough right now and would probably need to work another 5 years or so before starting to "cut back." He then said he was carrying a 50+ patient load and making around a million/year. Not financially secure enough to retire? What planet are these people living on?

 

[deleted18755]

That's part of the problem. The nature of the work allows people to keep working well past normal retirement age. I met an older rad onc who said he might consider retirement in the next few years but didn't feel financially secure enough right now and would probably need to work another 5 years or so before starting to "cut back." He then said he was carrying a 50+ patient load and making around a million/year. Not financially secure enough to retire? What planet are these people living on?

I’ve never met somebody managing 50+ patients (outside of short term coverage) but I know more than a few people in and out of medicine who make insane amounts of money and have done so for decades but would riot if they had to take a 0.5% pay cut (and more recently complained that they only got a 2 vs 3% “cost of living increase” on their huge base salary) and drive out of their way to save $0.07/gallon on gas to fill up their $75,000 car ... it’s just how it is for some people.

With regards to not retiring, as long as my mind is intact I’m pretty sure I could keep doing >90% of my job in a wheelchair with my T spine severed, paralyzed in both legs with my left arm also amputated, nearly deaf, with one glass eye and just the index finger and opposable thumb on my dominant hand (preferably with my middle finger intact so I could flip the bird to anybody trying to come take my job but that’s optional) ... I’ve met more than a few 80+ year old radiation oncologists who almost fit the above description with very strong relationships with med oncs and urologists who will be referring patients to them until they are in the grave.

Seriously new grads should not count of a mass retirement of baby booming radiologist oncologists anytime soon.

 

[medgator]

... I’ve met more than a few 80+ year old radiation oncologists who almost fit the above description with very strong relationships with med oncs and urologists who will be referring patients to them until they are in the grave.

To play devil's advocate, I have seen that as well, but often, their referral sources are as old as they are, and will eventually retire.

In my current practice, the old timers refer to my older partners and the newer docs in town tend to send to me. It's all about being on the same wavelength in terms of following data, guidelines/ebm and general rapport etc

Seriously new grads should not count of a mass retirement of baby booming radiologist oncologists anytime soon.

Completely agree

 

[nkmiami]

Why a drug for aging would challenge Washington

cellular senescence doesn’t seem to be taught in radiobiology even though it is key to what we do

 

[tuberose]

I’ve never met somebody managing 50+ patients (outside of short term coverage) but I know more than a few people in and out of medicine who make insane amounts of money and have done so for decades but would riot if they had to take a 0.5% pay cut (and more recently complained that they only got a 2 vs 3% “cost of living increase” on their huge base salary) and drive out of their way to save $0.07/gallon on gas to fill up their $75,000 car ... it’s just how it is for some people.

With regards to not retiring, as long as my mind is intact I’m pretty sure I could keep doing >90% of my job in a wheelchair with my T spine severed, paralyzed in both legs with my left arm also amputated, nearly deaf, with one glass eye and just the index finger and opposable thumb on my dominant hand (preferably with my middle finger intact so I could flip the bird to anybody trying to come take my job but that’s optional) ... I’ve met more than a few 80+ year old radiation oncologists who almost fit the above description with very strong relationships with med oncs and urologists who will be referring patients to them until they are in the grave.

Seriously new grads should not count of a mass retirement of baby booming radiologist oncologists anytime soon.

 

[tuberose]

How often is a cost of living increase considered for your base salary?

 

[scarbrtj]

That's part of the problem. The nature of the work allows people to keep working well past normal retirement age.

"So what do you have to do at work, like, today?"
"I need to go there... and sit there for a few hours."
"And do what?"
"Nothing, today."
"Wait. You won't see any patients?"
"Nope."
"Not even briefly?"
"No, I won't even know if or when they come in to get treated. I don't treat them in the physical sense, you see."
"So they just need you to sit there. That's boring! Can't anyone do that?"
"You'd think. You know... it's kind of a weird specialty, I admit that."

 

[deleted18755]

"So what do you have to do at work, like, today?"
"I need to go there... and sit there for a few hours."
"And do what?"
"Nothing, today."
"Wait. You won't see any patients?"
"Nope."
"Not even briefly?"
"No, I won't even know if or when they come in to get treated. I don't treat them in the physical sense, you see."
"So they just need you to sit there. That's boring! Can't anyone do that?"
"You'd think. You know... it's kind of a weird specialty, I admit that."

To be fair my leg less, one armed, one eye, half deaf and two fingers on dominant hand scenario above was with regard to a full time position.

For the “babysitting” position noted above you literally just need a pulse. No joke, when I was a resident (before SBRT/CBCT when we just used mostly 3DRT and even IMRT didn’t use IGRT) we had two 80+ year guys like that who were trained as diagnostic radiologist then just became rad oncs when the field started and were (great) grand-fathered in so they had a license for life without ever needing to take a test. They would come in and pass out in the chair and it was our job to walk by the office to make sure we could still hear them breathing/snoring then wake them up at the end of the day and call the one guy’s wife (he was way to old to drive but apparently ok to be the “supervising” attending at the center!).
I’m sure these guys still exist and aren’t going anywhere anytime soon.

PS: Hospital based positions usually treat physicians differently with regard to compensation but there are some (maybe academic centers are more frequently this way as well) where everything is the same for all or at least many full time employees, but obviously physicians make more (for example same healthcare plans, 401 match to gov limit, parking, cost of living too I guess and it’s usually 3% but was 2.5% last year ... this dude makes a fortune but would complain if the cafeteria started charging $0.10 for water cups or something).

 

[nkmiami]

There would be even less jobs if not for these presence regulations. A lot of practices could get by with less docs if there was ever reform...

 

[deleted18755]

There would be even less jobs if not for these presence regulations. A lot of practices could get by with less docs if there was ever reform...

I totally agree. There are plenty of clinics that provide excellent care while doing consults, follow-ups, and OTV's 2-3 times a week by highly competent physicians then pay somebody as I described above $1000+ dollars a day because they have to (or have a completely competent physician just sit in the office like scar outlined above working on volumes, notes, or surfing the internet and for a few minutes every hour or two answering a question a physician could have done remotely or prescribing pain meds or something simple an NP could do).

I have worked in or are aware of more than a few community practices where the medical oncology practices have physicians rotate 2-4 days a week at each center opposite an NP who manages things on other days. I'm actually not sure if they are just seeing follow-ups or whatever or if they are allowed to be alone while infusions are taking place analogous to when patients are "under beam" for us (but I've never noticed a geriatric medical oncologist just sitting in his office all day just because of some similar rule).

I'm sure sooner than later payers are going to realize this and that will be fine by me and many others since there is no medical reason for it and it will save the system money. Another reason NOT to increase residency spots though!

 

[scarbrtj]

I totally agree. There are plenty of clinics that provide excellent care while doing consults, follow-ups, and OTV's 2-3 times a week by highly competent physicians then pay somebody as I described above $1000+ dollars a day because they have to (or have a completely competent physician just sit in the office like scar outlined above working on volumes, notes, or surfing the internet and for a few minutes every hour or two answering a question a physician could have done remotely or prescribing pain meds or something simple an NP could do).

I have worked in or are aware of more than a few community practices where the medical oncology practices have physicians rotate 2-4 days a week at each center opposite an NP who manages things on other days. I'm actually not sure if they are just seeing follow-ups or whatever or if they are allowed to be alone while infusions are taking place analogous to when patients are "under beam" for us (but I've never noticed a geriatric medical oncologist just sitting in his office all day just because of some similar rule).

I'm sure sooner than later payers are going to realize this and that will be fine by me and many others since there is no medical reason for it and it will save the system money. Another reason NOT to increase residency spots though!

An NP presence is adequate to give chemo, which depending on the agent, could give you an immediate reaction and even cause death acutely (rarely).

No MD (or NP) presence is required when 10-20 cGy is given to patient via a kV X-ray unit inside a CT at radiologist's office; that dose could never cause any immediate reaction of any sort, and the risk of death is nil.

Full MD presence is required when 1-10 cGy is given to a patient via a kV CT X-ray unit at a rad onc's office; the risk of immediate reaction/death is of course equal that of the diagnostic CT.

Go figure.

 

[medgator]

An NP presence is adequate to give chemo, .

Not true, according to some med oncs I talk to.

Again, it might meet the legal standard in some locales, but good luck if you end up in court

Edit, found this link: interesting to see what practitioners are doing when surveyed, vs what was published as the minimum standard. It seems like the majority of both chemo and (especially) XRT are supervised by actual physician specialists, not extenders/NPs/PAs.

What you need to know about Medicare's physician supervision requirements

 

[nkmiami]

To me, Medoncs combined with Arnp 43% means sometimes an np will cover, usually vacation, someone out sick and the cms regulations explicitly allow it. They explicitly say an np can do this- how is it even open to interpretation/debate that they can’t?


This has been my experience and I have always worked for very conservative organizations.

 

[medgator]

To me, Medoncs combined with Arnp 43% means sometimes an np will cover, usually vacation, someone out sick and the cms regulations explicitly allow it. They explicitly say an np can do this- how is it even open to interpretation/debate that they can’t?


This has been my experience and I have always worked for very conservative organizations.

The guys I work with are in freestanding settings, like I am. Maybe that is the difference. Again, that 53% number is likely there for a reason.

Some on this forum believe any non-RO MD can cover igrt too as Medicare isn't quite clear on the issue (as much as the ASTROs position and white paper is).

 

[scarbrtj]

Not true

Per the link you provided:

In the hospital, it can be NP for rad onc. And again for diagnostic tests, like non-contrast CT (EDIT: non-CBCT lol), it's general, i.e. doctor doesn't have to be on-site at all.

 

[scarbrtj]

Medicare isn't quite clear on the issue (

The courts have stayed out of "clinically appropriate" arguments when it comes to billing fraud etc. That is, an argument of billing fraud couldn't be made that a bona fide MD covering any radiation therapy service was fraud because the MD was not clinically appropriate (he or she may not be "clinically appropriate," and there could be liabilities etc., but not federal ones... IMHO).

Plaintiff argues that the rules governing billing for services includes a presumption of meeting a certain standard of care. The Medicare incident to billing requirements do not contain a qualitative standard of care element. The Court agrees with the reasoning in Mikes v. Straus, 274 F.3d 687, (2d Cir. 2001), which held that billing for medical services that do not meet the standard of care does not give rise to a FCA violation. The Mikes court reasoned that the False Claims Act is an inappropriate vehicle for policing quality of care, which is better left to local regulation and enforcement.

 

[maxxor]

An NP presence is adequate to give chemo, which depending on the agent, could give you an immediate reaction and even cause death acutely (rarely).

No MD (or NP) presence is required when 10-20 cGy is given to patient via a kV X-ray unit inside a CT at radiologist's office; that dose could never cause any immediate reaction of any sort, and the risk of death is nil.

Full MD presence is required when 1-10 cGy is given to a patient via a kV CT X-ray unit at a rad onc's office; the risk of immediate reaction/death is of course equal that of the diagnostic CT.

Go figure.

What CT scanners are you using that give 20 cGy? That’s a lot of mSv...

However, we absolutely have a physician on site for all contrast administration. So we have a similar “weirdo role” for radiologists, though we can be reading scans while covering contrast.

 

[emt409]

What CT scanners are you using that give 20 cGy? That’s a lot of mSv...

However, we absolutely have a physician on site for all contrast administration. So we have a similar “weirdo role” for radiologists, though we can be reading scans while covering contrast.

IIRC, any multi-phase abdominal CT is usually on the order of 20mSV

 

[RickyScott]

IIRC, any multi-phase abdominal CT is usually on the order of 20mSV

really? 20 cgy does seem high- you could treat a spleen with that dose- i guess most dose absorbed on surface.

 

[maxxor]

IIRC, any multi-phase abdominal CT is usually on the order of 20mSV

20 centigray would be 200 mSv, no?

That’s a lot for a CT. Our modern exposure controlled CT abdomen pelvis are around 7 mSv for a single phase.

Edit: I just pulled up a restating CT CAP. DLPs
Chest - 130 * 0.014 = 1.82 mSv
Abdomen Pelvis - 291 * 0.015 = 4.37 mSv

Admittedly this was a thin patient, but CT doses have come down a lot.

 

[scarbrtj]

What CT scanners are you using that give 20 cGy? That’s a lot of mSv...

However, we absolutely have a physician on site for all contrast administration. So we have a similar “weirdo role” for radiologists, though we can be reading scans while covering contrast.

Notice I said non contrast

 

[emt409]

20 centigray would be 200 mSv, no?

That’s a lot for a CT. Our modern exposure controlled CT abdomen pelvis are around 7 mSv for a single phase.

Edit: I just pulled up a restating CT CAP. DLPs
Chest - 130 * 0.014 = 1.82 mSv
Abdomen Pelvis - 291 * 0.015 = 4.37 mSv

Admittedly this was a thin patient, but CT doses have come down a lot.

I said - multi-phase, i.e. a 3 phase liver, or modified pancreatic protocol. Yes, 20mSv would be high for a single phase scan.

 

[medgator]

https://www.advancesradonc.org/article/S2452-1094(18)30039-3/fulltext

Most RO residents reported satisfaction with their choice of residency program, but seniors had higher rates of dissatisfaction. Possible interventions to improve professional satisfaction include incorporating constructive resident feedback to enhance the program. The potential impact of job market pressures on seniors should be further explored.

 

[nkmiami]

"Residents were more likely to regret their choice of RO residency program if they were seniors. Figure 1 shows a pattern of increasing dissatisfaction with increasing postgraduate year. Almost 1 in 3 seniors (29.1%) would not choose the same training program again.In addition to examinations and clinical and family responsibilities, senior residents are uniquely faced with the responsibility of securing employment for the upcoming year."

 

[medgator]

"Residents were more likely to regret their choice of RO residency program if they were seniors. Figure 1 shows a pattern of increasing dissatisfaction with increasing postgraduate year. Almost 1 in 3 seniors (29.1%) would not choose the same training program again.In addition to examinations and clinical and family responsibilities, senior residents are uniquely faced with the responsibility of securing employment for the upcoming year."

Should have asked whether they would have chosen a different specialty too, while they were at it...

 

[Fpg1245]

Should have asked whether they would have chosen a different specialty too, while they were at it...

Likely intentional. They are not willing to ask the real hard hitting questions. “Would you choose this specialty again?” “Why or why not?”. The ones we would all be more than just a little interested in hearing. Likewise, perhaps those surveyed tempered their responses out of fear for being identified. At any rate, I’ve gotten more successful at talking some med students out of being slaughtered in this field.