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I was able to catch most of this since some folks in the department had it playing in a conference room. Much of the webinar was geared towards advice for medical students in navigating this year’s match. In regards to the practical points, I thought it was very sound and consistent with other meetings I’ve been in exploring the 2020-2021 away rotations/interview process/match issues. I figured I could paraphrase some “hot button” points that were touched upon that I believe warrant further discussion (I took a lot of notes). I’ve been on the fence about doing this, since it feels unfair that I can swoop in and “get the last word” on these things - but maybe Dr OIivier, Dr Fields, or anyone else could chime in on this thread? While I may disagree with them on certain points, I think they’re fantastic physicians and people and I appreciate that they’re in a tough spot. So...for any ACRO folks who read this, please know that this is coming from a purely professional standpoint, and is NOT meant to be directed at anyone personally.

Dr Fields started with a brief introduction PowerPoint:

“There’s been lots of talk about...residency expansion and...it’s not great.”
“15% of the incoming resident class...were not people who initially wanted Radiation Oncology.”

(These are known points but it’s worth repeating that PDs took whoever they could to fill their ranks.)

She moved on to the job market: “unfortunately, Student Doctor Network seems to be the resource everyone looks to for this...I have to say I am happy with my job...every single day so I don’t really understand a lot of the things people write...there’s lots of people...who really know that our specialty is important...and we’ve been continuing to work at pretty much full capacity during the pandemic...I think there will be jobs available in the same sort of pattern…”

(I think many of us have said this before but I’ll say it again - the discontent has literally nothing to do with the actual job itself. I am pretty confident in stating that virtually everyone who posts on SDN and elsewhere loves the actual practice of RadOnc, the patients, the outcomes, the day-to-day...this argument misses the point. Loving RadOnc is immaterial if you can’t find a job in an entire geographic region that you’re interested in.)

Dr Olivier: “[medical students]...are in the driver’s seat...if you’re on this call and you are making your way through medical school doing reasonably well...you will match in this specialty...in the past people have gone into the specialty for maybe reasons that are not all positive, maybe reimbursement issues or because it was competitive at points and they just wanted to be in a competitive specialty...but now I think a compassionate, trained physician that was trained in a US medical school, DO or MD, will match, PERIOD, and it’s just a question of showing enthusiasm for the specialty so that we don’t wonder what your interests are…”

(So, if you can graduate medical school, you can match in RadOnc. While he has Tweeted this opinion out before, I am disheartened that those of us who matched in the last ~15 years are being painted as “less compassionate” than those matching now - that our motivations are in question. I can say for certain that this specialty’s competitiveness was a huge negative for me when I was applying. I personally don’t care about RadOnc’s “fall from grace” as I don’t tie my self-worth to my job, but I recognize I might be in the minority there. Regardless...ouch.)

More Dr Olivier: “Residents would tell you...that although the field is not perfect...that the field is good...otherwise they would not be doing meet-and-greets with students.”
“The noisiest voices are sometimes not people who are residents...and don’t, I think, necessarily understand the field comprehensively and so...if it was all bad...residents wouldn’t be advocating for fellow students to join…”

(A lot to unpack there. I can 100% promise you, medical students, that I am doing meet-and-greets because it is expected of me by the department. If I don’t, I will be viewed as someone who “isn’t a team player”, and I’m good enough at academic politics to realize how I need to handle myself. Also, this hints at KO’s previous statements about “anonymous posters...are they even doctors?” or whatever it was he Tweeted last year. Seriously, read the majority of the posts in this forum - it is clear that MOST people on SDN are attendings or residents in RadOnc, with a smattering of students. Sure, we get our share of drive-by randos on trending threads (i.e. whenever something provocative is posted in “Dare you to reply!”), but it’s pretty clear that most of the discussions which take place are driven by informed stakeholders).

More KO: “some of those...stupid criteria...like Step 1 score, number of publications, letters of recommendation from big names...are going to be diminished [in importance] this year...and probably always should have been diminished…”

("Stupid criteria" is verbatim. I'm glad I worked so incredibly hard for my Step 1 score.)

There was a question about if there were plans to reduce the number of residency spots. They explicitly said “there is no way to cut back spots”, and acknowledged that the desire to do so was over the “worry that if the trajectory continues, there will be a job shortage”. Dr Olivier said that he has “talked to everyone” he could about how to cut back spots, and said that he was uniformly told that it would violate antitrust laws. He said that “we all know it needs to happen”. They talked about how they want to use the ACGME RRC platform to force more stringent requirements on programs for residency training, in the hopes that this would force a reduction of spots/programs as a consequence (similar to the extension of training from 3 to 4 years done in the 90s).

Then, there was the question: “what do you anticipate the job market will be like for students matching this year” (so, the residency class of 2026).

KO confidently stated: “I think it’s going to be good”. He justified this by talking about “new” or expanded indications for XRT, including oligomets and...cardiac ablation [editor's note: cardiac ablation is not going to save RadOnc]. He believes that how we’ve stayed relatively busy during the pandemic has “expanded how other specialties thought of us”. He then recalled that, when he was a medical student, he was also warned to stay away from the specialty by senior residents, and he graduated residency in 2002 and his career has been great.

(Medical students reading this, in case you’re not familiar with the history of this field: there were similar concerns about oversupply in the 1990s. As a result, in the late 90s, RadOnc training was changed from 3 years (post-intern) to 4 years, which resulted in an immediate decrease of graduating residents. Additionally, programs closed or cut spots (in 2001, there were only 81 residency spots, compared to the almost 200 now). Then, a new technology called IMRT was released in the early 2000s which significantly increased the reimbursement for Radiation Oncology (the demand side of supply/demand). It was a perfect confluence of events. However, this has caused everyone from that era - Dr Olivier’s era - to have this warped perception of the past, because all they remember is the warnings they received but then it “all worked out”. Feel free to read my ridiculously long post about it.)

Dr Olivier then said, for the current PGY-5’s (class of 2021):

The job market is garbage because of COVID.” He also said that “over time, you can migrate [into a good job]”, and getting a job in RadOnc is “like your friends with MBAs or lawyers”.

In conclusion, here is my question: how can you reconcile the statement that “the job market is garbage” for the residency class of 2021 with “the job market will be good” for the residency class of 2026? Those are intertwined!

Regardless of whether or not you think there’s an oversupply, or the job market is worsening, or whatever - I think everyone has always agreed that in such a small specialty, the job market is tight. With COVID, there will almost certainly be a higher percentage of residency graduates 1) taking undesirable jobs, 2) taking fellowships, or 3) just straight up being unemployed. Those folks are then going to enter the job search with the residency class of 2022, placing undue pressure on those folks as well...leading to the same 3 scenarios. This cycle will then repeat, for years. Sure, specialties like GI and Optho were harder hit by COVID in terms of canceled procedures and lost RVUs, but they have much more elasticity/capacity to bounce back than RadOnc.

So, unless you anticipate a large portion of 2021 graduates just giving up and leaving medicine altogether - if this year’s job market is “garbage”, and we’re still producing ~200 new graduates a year, and there’s no increase in retirement of current attendings, and the Alternative Payment Model is still going to be implemented, and we still reduce the indications for XRT as well as the length of treatment courses, and general supervision remains in place...how in the world can you believe that the job market “will be good” in 2026. It’s literally not a logical position to take - unless you’re trying to recruit medical students into a specialty.
 
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hbosch

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Thank you for sharing this. I have nothing to add that has not already been said 5000 times.

LOL. Step 1 board scores are stupid, but written boards and oral boards are of excruciating importance. There needs to be a basic logic test for those wishing to be academic radiation oncologists. It's amazing how a field so intensely based on reasoning consists of so many *****s lacking basic reasoning skills.

If you have a pulse, and did not die or drop out of medical school, you can become a radiation oncologist because you're a nice person!!!! Gooo team!!

Just think of this everyone- when we start getting sick with cancer our radiation oncologist might be a person who didn't die in medical school and has compassion- that is if they find a job.
 
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It’s funny how we constantly bash those who are “inferior candidates” yet for years the “top notch” have led our field to where we are today. Let’s all pat our shoulders!
 
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I was able to catch most of this since some folks in the department had it playing in a conference room. Much of the webinar was geared towards advice for medical students in navigating this year’s match. In regards to the practical points, I thought it was very sound and consistent with other meetings I’ve been in exploring the 2020-2021 away rotations/interview process/match issues. I figured I could paraphrase some “hot button” points that were touched upon that I believe warrant further discussion (I took a lot of notes). I’ve been on the fence about doing this, since it feels unfair that I can swoop in and “get the last word” on these things - but maybe Dr OIivier, Dr Fields, or anyone else could chime in on this thread? While I may disagree with them on certain points, I think they’re fantastic physicians and people and I appreciate that they’re in a tough spot. So...for any ACRO folks who read this, please know that this is coming from a purely professional standpoint, and is NOT meant to be directed at anyone personally.

Dr Fields started with a brief introduction PowerPoint:

“There’s been lots of talk about...residency expansion and...it’s not great.”
“15% of the incoming resident class...were not people who initially wanted Radiation Oncology.”

(These are known points but it’s worth repeating that PDs took whoever they could to fill their ranks.)

She moved on to the job market: “unfortunately, Student Doctor Network seems to be the resource everyone looks to for this...I have to say I am happy with my job...every single day so I don’t really understand a lot of the things people write...there’s lots of people...who really know that our specialty is important...and we’ve been continuing to work at pretty much full capacity during the pandemic...I think there will be jobs available in the same sort of pattern…”

(I think many of us have said this before but I’ll say it again - the discontent has literally nothing to do with the actual job itself. I am pretty confident in stating that virtually everyone who posts on SDN and elsewhere loves the actual practice of RadOnc, the patients, the outcomes, the day-to-day...this argument misses the point. Loving RadOnc is immaterial if you can’t find a job in an entire geographic region that you’re interested in.)

Dr Olivier: “[medical students]...are in the driver’s seat...if you’re on this call and you are making your way through medical school doing reasonably well...you will match in this specialty...in the past people have gone into the specialty for maybe reasons that are not all positive, maybe reimbursement issues or because it was competitive at points and they just wanted to be in a competitive specialty...but now I think a compassionate, trained physician that was trained in a US medical school, DO or MD, will match, PERIOD, and it’s just a question of showing enthusiasm for the specialty so that we don’t wonder what your interests are…”

(So, if you can graduate medical school, you can match in RadOnc. While he has Tweeted this opinion out before, I am disheartened that those of us who matched in the last ~15 years are being painted as “less compassionate” than those matching now - that our motivations are in question. I can say for certain that this specialty’s competitiveness was a huge negative for me when I was applying. I personally don’t care about RadOnc’s “fall from grace” as I don’t tie my self-worth to my job, but I recognize I might be in the minority there. Regardless...ouch.)

More Dr Olivier: “Residents would tell you...that although the field is not perfect...that the field is good...otherwise they would not be doing meet-and-greets with students.”
“The noisiest voices are sometimes not people who are residents...and don’t, I think, necessarily understand the field comprehensively and so...if it was all bad...residents wouldn’t be advocating for fellow students to join…”

(A lot to unpack there. I can 100% promise you, medical students, that I am doing meet-and-greets because it is expected of me by the department. If I don’t, I will be viewed as someone who “isn’t a team player”, and I’m good enough at academic politics to realize how I need to handle myself. Also, this hints at KO’s previous statements about “anonymous posters...are they even doctors?” or whatever it was he Tweeted last year. Seriously, read the majority of the posts in this forum - it is clear that MOST people on SDN are attendings or residents in RadOnc, with a smattering of students. Sure, we get our share of drive-by randos on trending threads (i.e. whenever something provocative is posted in “Dare you to reply!”), but it’s pretty clear that most of the discussions which take place are driven by informed stakeholders).

More KO: “some of those...stupid criteria...like Step 1 score, number of publications, letters of recommendation from big names...are going to be diminished [in importance] this year...and probably always should have been diminished…”

("Stupid criteria" is verbatim. I'm glad I worked so incredibly hard for my Step 1 score.)

There was a question about if there were plans to reduce the number of residency spots. They explicitly said “there is no way to cut back spots”, and acknowledged that the desire to do so was over the “worry that if the trajectory continues, there will be a job shortage”. Dr Olivier said that he has “talked to everyone” he could about how to cut back spots, and said that he was uniformly told that it would violate antitrust laws. He said that “we all know it needs to happen”. They talked about how they want to use the ACGME RRC platform to force more stringent requirements on programs for residency training, in the hopes that this would force a reduction of spots/programs as a consequence (similar to the extension of training from 3 to 4 years done in the 90s).

Then, there was the question: “what do you anticipate the job market will be like for students matching this year” (so, the residency class of 2026).

KO confidently stated: “I think it’s going to be good”. He justified this by talking about “new” or expanded indications for XRT, including oligomets and...cardiac ablation [editor's note: cardiac ablation is not going to save RadOnc]. He believes that how we’ve stayed relatively busy during the pandemic has “expanded how other specialties thought of us”. He then recalled that, when he was a medical student, he was also warned to stay away from the specialty by senior residents, and he graduated residency in 2002 and his career has been great.

(Medical students reading this, in case you’re not familiar with the history of this field: there were similar concerns about oversupply in the 1990s. As a result, in the late 90s, RadOnc training was changed from 3 years (post-intern) to 4 years, which resulted in an immediate decrease of graduating residents. Additionally, programs closed or cut spots (in 2001, there were only 81 residency spots, compared to the almost 200 now). Then, a new technology called IMRT was released in the early 2000s which significantly increased the reimbursement for Radiation Oncology (the demand side of supply/demand). It was a perfect confluence of events. However, this has caused everyone from that era - Dr Olivier’s era - to have this warped perception of the past, because all they remember is the warnings they received but then it “all worked out”. Feel free to read my ridiculously long post about it.)

Dr Olivier then said, for the current PGY-5’s (class of 2021):

The job market is garbage because of COVID.” He also said that “over time, you can migrate [into a good job]”, and getting a job in RadOnc is “like your friends with MBAs or lawyers”.

In conclusion, here is my question: how can you reconcile the statement that “the job market is garbage” for the residency class of 2021 with “the job market will be good” for the residency class of 2026? Those are intertwined!

Regardless of whether or not you think there’s an oversupply, or the job market is worsening, or whatever - I think everyone has always agreed that in such a small specialty, the job market is tight. With COVID, there will almost certainly be a higher percentage of residency graduates 1) taking undesirable jobs, 2) taking fellowships, or 3) just straight up being unemployed. Those folks are then going to enter the job search with the residency class of 2022, placing undue pressure on those folks as well...leading to the same 3 scenarios. This cycle will then repeat, for years. Sure, specialties like GI and Optho were harder hit by COVID in terms of canceled procedures and lost RVUs, but they have much more elasticity/capacity to bounce back than RadOnc.

So, unless you anticipate a large portion of 2021 graduates just giving up and leaving medicine altogether - if this year’s job market is “garbage”, and we’re still producing ~200 new graduates a year, and there’s no increase in retirement of current attendings, and the Alternative Payment Model is still going to be implemented, and we still reduce the indications for XRT as well as the length of treatment courses, and general supervision remains in place...how in the world can you believe that the job market “will be good” in 2026. It’s literally not a logical position to take - unless you’re trying to recruit medical students into a specialty.

Also, after rereading what I wrote - I now realize that both Dr Fields and Dr Olivier said that residency expansion was bad and that they were looking into how to address it...but they both think the job market is/will be good?

You can't hold both opinions simultaneously.
 
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thecarbonionangle

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Sometimes a broken clock is right. Similarly KO spoke and warned of “garbage” 2020/2021 job market. This same sentiment was echoed by the ASTRO president when he recently said basically just be happy you even get A job. Every leader is finally saying man the canary is dead, we better gtfo but it is too late. We got the black lung. Trump ain’t gonna save us, neither is Hahn. We are doomed! And so like sand in the hourglass, so are the days of our life. Our time is running out folks! I may or may not see you at the bread line. They are damn sure coming, however.
 
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medgator

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KO has been on every panel it seems lately whether for jobs or med students. Gaslighting and alternative facts seem to be his MO on every one of them
 
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KO has been on every panel it seems lately whether for jobs or med students. Gaslighting and alternative facts seem to be his MO on every one of them

He's the president of ADROP. I would say the professional responsibilities of anyone in that position is towards the residency programs, not the individual medical student/resident. A cynical view, sure, and probably not how he views himself - but knowing what stakeholders motivate behavior is important.
 
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scarbrtj

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KO confidently stated: “I think it’s going to be good”. He justified this by talking about “new” or expanded indications for XRT, including oligomets and...cardiac ablation
KO has been on every panel it seems lately whether for jobs or med students. Gaslighting and alternative facts seem to be his MO on every one of them
If KO had pointed out some of the key elephants in the room eg...

Indications for XRT have been steadily falling and are predicted to slightly fall some more over the next 5 years...

He might be able to be called completely truthful and honest. Once again, missed his chance. This is what gets me. I never hear anyone in these things acknowledging facts which have been published again and again. And it's not like some counterfactual publications exist.

Oh and let's say radiation oncology is now becoming a field of metastatirradiation and cardioradiotherapeutics. In other words, the field is completely changing (so that whatever it is we do/are as "radiation oncologists" will still be relevant/needed)? And current training is moot/passé? Yay. And we need a 4 yr residency and a separate cancer biology exam to learn how to zap a met or two, or a heart focus that an electrophysiologist points out? We've got a lot of clutter to clear in our field then. And it starts with all the clutter of warm bodies we're accumulating.

Prediction: once the rank, fetid, putrescence of the problem which they continue to foist on everyone's heads begins to affect them somewhat, our leaders will somehow magically find a way to correct oversupply. 'Til then, fasten your seat belts.
 
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scarbrtj

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Dr Olivier said that he has “talked to everyone” he could about how to cut back spots, and said that he was uniformly told that it would violate antitrust laws.
BREAKING NEWS:
FBI/SEC/ACGME joint task force raids CPMC and MD Anderson in early morning ambush. "We will not tolerate there being an attempt at decreasing the number of American radio oncologists," the director of the FBI stated. "Radio oncology resident numbers and absurdity are our organization's top priority."
 
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RadsWFA1900

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Sometimes a broken clock is right. Similarly KO spoke and warned of “garbage” 2020/2021 job market. This same sentiment was echoed by the ASTRO president when he recently said basically just be happy you even get A job. Every leader is finally saying man the canary is dead, we better gtfo but it is too late. We got the black lung. Trump ain’t gonna save us, neither is Hahn. We are doomed! And so like sand in the hourglass, so are the days of our life. Our time is running out folks! I may or may not see you at the bread line. They are damn sure coming, however.

Duplicity, one of the hallmarks of a great leader...KO knows this.
 
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radiation

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Recently read an excellent article in the Atlantic about cognitive dissonance and how shaming people is not an effective way to change minds or behavior. Trying to meet people where they are through empathy seems to be the best approach for realistic behavioral change, but it takes a bit of an ego hit to do so. If we try to meet people where they are and assume one thing - that it is practically and logistically (perhaps even illegal, taking KO at his word) too difficult at the current time to reduce the number of spots by more than 30%, what sort of solutions do we have to the oversupply problem?

- Actively discourage med students from applying (preferred strategy of this board). This will increase the number of residents that get accepted through SOAP without decreasing total numbers, as we have seen many programs will continue to do this even if not matching multiple years. Eventually if the number of applications get low enough, this will be successful, but there will be a painful period of a high percentage of unmatched residents and will not effect job availability for at least 5+ years (likely longer)
- Increase training length by essentially forcing fellowship - similar to what happened in Canada and in other specialties like radiology
-? honestly can't think of any other realistic solutions

I think SDN clearly is being heard - but the question is what is the best message that will actually force chairs to change behavior. "You are greedy and manipulative and need to change your evil ways?" Even if we are correct in pointing it out, if it doesn't ultimately lead to meaningful change it may not be the best strategy.
 
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Recently read an excellent article in the Atlantic about cognitive dissonance and how shaming people is not an effective way to change minds or behavior. Trying to meet people where they are through empathy seems to be the best approach for realistic behavioral change, but it takes a bit of an ego hit to do so. If we try to meet people where they are and assume one thing - that it is practically and logistically (perhaps even illegal, taking KO at his word) too difficult at the current time to reduce the number of spots by more than 30%, what sort of solutions do we have to the oversupply problem?

- Actively discourage med students from applying (preferred strategy of this board). This will increase the number of residents that get accepted through SOAP without decreasing total numbers, as we have seen many programs will continue to do this even if not matching multiple years. Eventually if the number of applications get low enough, this will be successful, but there will be a painful period of a high percentage of unmatched residents and will not effect job availability for at least 5+ years (likely longer)
- Increase training length by essentially forcing fellowship - similar to what happened in Canada and in other specialties like radiology
-? honestly can't think of any other realistic solutions

I think SDN clearly is being heard - but the question is what is the best message that will actually force chairs to change behavior. "You are greedy and manipulative and need to change your evil ways?" Even if we are correct in pointing it out, if it doesn't ultimately lead to meaningful change it may not be the best strategy.

I believe we are pursuing our only strategy.

Starting ~7 years ago with "bloodbath in the Red Journal", SDN has been pretty consistent with its messaging. It took a long time for that message to be received, with the ABR board exam debacle being the tipping point.

If left to their own devices, academic departments will not do anything except publish the occasional manuscript. Why? Because they're a system involved in the "economy of residents". As academic institutions swallow up private practices, they will perceive an increase in patient load. Of course it made/makes sense to expand. The institution wins - more patients means more residents which means a bargain labor force to generate more RVUs.

However, what happens after those residents graduate? More importantly - why should academic departments care? It does not affect their bottom line at all if there's an oversupply. As has been argued in the Red Journal previously by an academic chair, an oversupply means lower attending salaries - great for the institution and the system, not great for the individual doctor. Therefore, the only intrinsic incentive to change is the altruism of an academic institution. However...an institution cannot love you back.

Therefore, the only way to effect change is to connect directly to the medical students and actively discourage them from applying. If departments are forced to either go unmatched or SOAP kids who clearly wanted to do Derm or Ortho - that is actually "hitting them where it hurts". It's what we're seeing right now. If we stop with the noise - I can guarantee ASTRO/ADROP etc will stop addressing oversupply. They will have no incentive.

I, like most of us, am tired of talking about this. However, I can see no other viable strategy to help Radiation Oncology. Despite the talking point that we're all on here because we hate our job or our patients or whatever - I absolutely love this field, and these people, and what I do on a day-to-day basis. It's why I want to fix it. It's why I will just be on SDN saying the same things over and over again, talking with each new class of medical students, until our Academic Overlords figure out a way to cut spots back to 2001 levels (~80 residents/year).
 
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RickyScott

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Recently read an excellent article in the Atlantic about cognitive dissonance and how shaming people is not an effective way to change minds or behavior. Trying to meet people where they are through empathy seems to be the best approach for realistic behavioral change, but it takes a bit of an ego hit to do so. If we try to meet people where they are and assume one thing - that it is practically and logistically (perhaps even illegal, taking KO at his word) too difficult at the current time to reduce the number of spots by more than 30%, what sort of solutions do we have to the oversupply problem?

- Actively discourage med students from applying (preferred strategy of this board). This will increase the number of residents that get accepted through SOAP without decreasing total numbers, as we have seen many programs will continue to do this even if not matching multiple years. Eventually if the number of applications get low enough, this will be successful, but there will be a painful period of a high percentage of unmatched residents and will not effect job availability for at least 5+ years (likely longer)
- Increase training length by essentially forcing fellowship - similar to what happened in Canada and in other specialties like radiology
-? honestly can't think of any other realistic solutions

I think SDN clearly is being heard - but the question is what is the best message that will actually force chairs to change behavior. "You are greedy and manipulative and need to change your evil ways?" Even if we are correct in pointing it out, if it doesn't ultimately lead to meaningful change it may not be the best strategy.
Completely agree with you here about cognitive dissonance and the effect we have on convincing chairs. Posting on sdn and twitter is likely to change as many chairs minds as Mary trumps book will sway voters. Would add, however, that message to medical students is not so much to effect change in radonc, as to genuinely warn them about the disaster in this field. I think medstudents are being lied to and that entering radonc is against the interests of most candidates, who will be totally screwed when they graduate.

Honestly, feel we will see an absolute disaster in job supply in 5 years. I doubt this can be avoided with extending residency or cutting slots. IMO it can only be addressed by redeploying labor into medonc.
 
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scarbrtj

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If you're training people for a job simply to train them, and they're knowingly unemployable on the other side because everyone can agree that the skill you're training them for is undoable because no one can get a job using that skill, for the trainers to stop or cut back training because it's "illegal" is about the most absurd legal argument I've ever heard a layperson make. So the government will come in and force programs to knowingly ruin people's lives and waste residency training dollars to produce unemployable physicians?

If the unemployment rate is >50% one year for a class, rad onc as a whole deciding to cut back on training numbers is anti-trust? And if it's not... then why wait 'til we get to >50%. Swerving to avoid a pedestrian can't get one charged with illegal crossing of a double yellow line can it.
 
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hbosch

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Elementaryschooleconomics wrote their argument beautifully. Thank you for writing that.

I don't have an intention of changing the minds of chairmans and residency directors or ASTRO. Perhaps I'm depressed, but I find that to be a lost cause. They have no incentive to change and we should all know from human existence that the majority of people are selfishly driven not morally driven.

My intention is to contribute to potential medical students hearing our experiences. We are ruining their lives by giving them a skill that too many people have for a terrible job market. I don't care that I don't know who the medical students are, I just care that there is no reason why we should ruin them. If there is a true undersupply of other types of physicians, it makes sense for our society (our American society) to push them to go follow those pathways, rather than being jobless after 200k+ debt, or being stuck somewhere thousands of miles from your family or having a depressed spouse. We shouldn't even have FMGs coming into this field. We would be ruining their lives too, or wasting their time until they find something else. They too should be funneled into specialties that America needs. Make America great again.

I'm all for the anti-racist movement, but I think attracting anyone to this field is an immoral act of ruining people's lives be they a white man or a black female. So white man and black female, don't be a radiation oncologist. Neither cardiac ablation nor COVID will save this specialty.

Also, a terrible job market isn't just bad for the people without jobs. It's also bad for the people with jobs. In groups where the power is concentrated, those without the power (because there are even partnered people without power) are more likely to be abused because the ones in power know they are easily replaceable, and the new hire would be cheaper. There is reduced incentive for practices to be fair.

A bad job market is bad for everyone who is not the chair of a department or not the best friend /son/daughter/relative of the chair of a department.
 
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Chartreuse Wombat

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Elementaryschooleconomics wrote their argument beautifully. Thank you for writing that.

I don't have an intention of changing the minds of chairmans and residency directors or ASTRO. Perhaps I'm depressed, but I find that to be a lost cause. They have no incentive to change and we should all know from human existence that the majority of people are selfishly driven not morally driven.

My intention is to contribute to potential medical students hearing our experiences. We are ruining their lives by giving them a skill that too many people have for a terrible job market. I don't care that I don't know who the medical students are, I just care that there is no reason why we should ruin them. If there is a true undersupply of other types of physicians, it makes sense for our society (our American society) to push them to go follow those pathways, rather than being jobless after 200k+ debt, or being stuck somewhere thousands of miles from your family or having a depressed spouse. We shouldn't even have FMGs coming into this field. We would be ruining their lives too, or wasting their time until they find something else. They too should be funneled into specialties that America needs. Make America great again.

I'm all for the anti-racist movement, but I think attracting anyone to this field is an immoral act of ruining people's lives be they a white man or a black female. So white man and black female, don't be a radiation oncologist. Neither cardiac ablation nor COVID will save this specialty.

Also, a terrible job market isn't just bad for the people without jobs. It's also bad for the people with jobs. In groups where the power is concentrated, those without the power (because there are even partnered people without power) are more likely to be abused because the ones in power know they are easily replaceable, and the new hire would be cheaper. There is reduced incentive for practices to be fair.

A bad job market is bad for everyone who is not the chair of a department or not the best friend /son/daughter/relative of the chair of a department.
@hbosch
Exactly. RO is a microcosm of how the elites have destroyed this great republic. Hyperbolic perhaps. The degree of nepotism in this field is disgraceful. Overtraining hurts everyone except employers.
 
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Recently read an excellent article in the Atlantic about cognitive dissonance and how shaming people is not an effective way to change minds or behavior. Trying to meet people where they are through empathy seems to be the best approach for realistic behavioral change, but it takes a bit of an ego hit to do so. If we try to meet people where they are and assume one thing - that it is practically and logistically (perhaps even illegal, taking KO at his word) too difficult at the current time to reduce the number of spots by more than 30%, what sort of solutions do we have to the oversupply problem?

- Actively discourage med students from applying (preferred strategy of this board). This will increase the number of residents that get accepted through SOAP without decreasing total numbers, as we have seen many programs will continue to do this even if not matching multiple years. Eventually if the number of applications get low enough, this will be successful, but there will be a painful period of a high percentage of unmatched residents and will not effect job availability for at least 5+ years (likely longer)
- Increase training length by essentially forcing fellowship - similar to what happened in Canada and in other specialties like radiology
-? honestly can't think of any other realistic solutions

I think SDN clearly is being heard - but the question is what is the best message that will actually force chairs to change behavior. "You are greedy and manipulative and need to change your evil ways?" Even if we are correct in pointing it out, if it doesn't ultimately lead to meaningful change it may not be the best strategy.
There is also a disconnect here between “knowledge”and “belief”. KO types “know” about the oversupply but they totally “believe” in the inherently noble, knowledge-seeking mission of large academic centers. (How could these temples of knowledge and healing possibly be ruining this wonderful field? Must be heresy.) Things may change next year if price transparency mandates come into effect, and the extent of their price gouging is public. Negotiated rates of 100k for prostate radiation is going to be very delegitimizing- there will not be anything “noble” about working for one of these organizations that are harming the social good. Residency expansion will more likely to be viewed through the lens of this greed/expansion of satellites.
 
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Just out of curiosity, should we try contacting our congressional representatives to see if someone would be willing to introduce a bill that prevents an oversupply of doctors in a specialty (spefically our specialty). The spots are paid for by the government, so why should tax money go to waste? Med schools also argue that they "lose money" by teaching- but they get federal support to teach- so in effect, the federal support to teach medical students that are then funneled into a specialty that they won't even practice because they can't find a job, while simultaneously taking away medical students from specialties that are in need is wasteful. It's a double hit. And those double hits are awful as we know. Terrible prognosis.
 
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Nepotism in this field is disgusting. I remember hearing about NYC program that matched the chairman’s son. Ive heard of daughters and sons of chairmen gaining significant advantage in this field over the last few years. One of these people is at a Penn place where they trying to start a new program. One was in Florida. Maybe some people see nothing wrong with this/business as usual but it deeply disgusts me! Elitism and corruption has been very common in RO and we are paying for this good old boy culture now. The pitchforks will come. Maybe they are here already. The breadlines will only accelerate this.
 
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Nepotism in this field is disgusting. I remember hearing about NYC program that matched the chairman’s son. Ive heard of daughters and sons of chairmen gaining significant advantage in this field over the last few years. One of these people is at a Penn place where they trying to start a new program. One was in Florida. Maybe some people see nothing wrong with this/business as usual but it deeply disgusts me! Elitism and corruption has been very common in RO and we are paying for this good old boy culture now. The pitchforks will come. Maybe they are here already. The breadlines will only accelerate this.
Cedars Sinai and Wisconsin as well
 
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scarbrtj

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Nepotism in this field is disgusting. I remember hearing about NYC program that matched the chairman’s son. Ive heard of daughters and sons of chairmen gaining significant advantage in this field over the last few years. One of these people is at a Penn place where they trying to start a new program. One was in Florida. Maybe some people see nothing wrong with this/business as usual but it deeply disgusts me! Elitism and corruption has been very common in RO and we are paying for this good old boy culture now. The pitchforks will come. Maybe they are here already. The breadlines will only accelerate this.
Not hiring any residents for program: anti-trust.
Hiring your own son as resident for program: a-ok.
 
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How can you reconcile the statement that “the job market is garbage” for the residency class of 2021 with “the job market will be good” for the residency class of 2026? Those are intertwined!

If we assume that radiation oncologists are stuck with their initial post-residency job, then this is plausible. Class of 2021 will be stuck with rural, exploitative, low pay, no incentive jobs, or fellowships, or unemployment. It's fitting because we obviously chose radiation oncology for prestige and money. Class of 2026, post-COVID, might graduate into a decent job market. This, too, would be fitting because they'll choose radiation oncology with the sort of lifelong dedication to cancer patients that my cohort of residents simply lack. We're just soulless AOA, 260+, MD/PhD bookworms, after all. Karma at work, folks!
 
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You're right about it not just being a concern for new grads - it's a concern for all of those not very near retirement.
At my hospital-employed position (at which I am very happy so far), being there only for about year, I am incredibly worried about my hire-friendly admin just overhiring new RadOncs when they don't need them that will drive my work and pay down. They've already hired multiple peds GI when they can't get more than four gen peds in the area, so they're seeming quite missing-forest-for-trees or cart-before-horse to me. I'm not necessarily in a great geographic place, but it's "A job" for a new grad.
I hopefully have ~30 years left of work in this field and I'm already scared about my job security and/or maintaining income level? Not good.
 
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You're right about it not just being a concern for new grads - it's a concern for all of those not very near retirement.
At my hospital-employed position (at which I am very happy so far), being there only for about year, I am incredibly worried about my hire-friendly admin just overhiring new RadOncs when they don't need them that will drive my work and pay down. They've already hired multiple peds GI when they can't get more than four gen peds in the area, so they're seeming quite missing-forest-for-trees or cart-before-horse to me. I'm not necessarily in a great geographic place, but it's "A job" for a new grad.
I hopefully have ~30 years left of work in this field and I'm already scared about my job security and/or maintaining income level? Not good.

The unfortunate thing is that your hospital admin would be doing their job - I would even argue doing their job well. If you ran a hospital, what's a more sound business decision: hiring 1-2 RadOncs with both a high base salary and production bonus, or 3-4 RadOncs with half the base salary and similar or reduced production bonuses? Having more RadOncs (or any doctor really) spreads out the risk. With a stable of 4 docs, if one quits then the other 3 are more than capable of producing at the same volume - especially when the job used to be done by only 1-2 people. On balance, the hospital wins - which means the admin is doing their job. No one is the villain in this story, and patients certainly don't receive worse care. The only ones who lose in this scenario are the Radiation Oncologists at the individual level.

That's why people get so heated about this topic. Chairs/academicians feel "attacked" when oversupply is laid at their feet, as if it was an intentional outcome conducted with malice and forethought.

It was not. Chairs were only acting in the best interest of their department...which is their literal job. I have personally asked a couple of Chairs of old programs (who expanded during the "127% increase" era) why they grew their residency. I received the exact same answer - their patient volumes were up, and they expanded the resident cohort because they had "need". I know at least one of those programs had increased patient volumes because they bought up ALL of the private practices in the region. The size of the pie remained the same - their slice just got bigger. Their response of expansion was reasonable at the local level - and inappropriate at the global level.

But no one is the villain in their own story.
 
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The unfortunate thing is that your hospital admin would be doing their job - I would even argue doing their job well. If you ran a hospital, what's a more sound business decision: hiring 1-2 RadOncs with both a high base salary and production bonus, or 3-4 RadOncs with half the base salary and similar or reduced production bonuses? Having more RadOncs (or any doctor really) spreads out the risk. With a stable of 4 docs, if one quits then the other 3 are more than capable of producing at the same volume - especially when the job used to be done by only 1-2 people. On balance, the hospital wins - which means the admin is doing their job. No one is the villain in this story, and patients certainly don't receive worse care. The only ones who lose in this scenario are the Radiation Oncologists at the individual level.

That's why people get so heated about this topic. Chairs/academicians feel "attacked" when oversupply is laid at their feet, as if it was an intentional outcome conducted with malice and forethought.

It was not. Chairs were only acting in the best interest of their department...which is their literal job. I have personally asked a couple of Chairs of old programs (who expanded during the "127% increase" era) why they grew their residency. I received the exact same answer - their patient volumes were up, and they expanded the resident cohort because they had "need". I know at least one of those programs had increased patient volumes because they bought up ALL of the private practices in the region. The size of the pie remained the same - their slice just got bigger. Their response of expansion was reasonable at the local level - and inappropriate at the global level.

But no one is the villain in their own story.
Everyone is doing their job except... ASTRO. Whether stated or not, they are supposed to represent the interests of their membership (radiation oncologists) not act against them.
 
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Everyone is doing their job except... ASTRO. Whether stated or not, they are supposed to represent the interests of their membership (radiation oncologists) not act against them.
Between eichlers ridiculous statement on finding a job this year on Twitter and hararis statement last year, ASTRO has no interest in addressing that

 
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hbosch

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It's a conflict of interest issue when these chairs and academics are the ones who become leadership in ASTRO. They won't shoot their own foot to for the greater good of a bunch of people who are meaningless to them [both the newly minted rad ones and the greater good of American society]. The problem is that they are bringing in residents who might not be as good as they hoped them to be. I mean the quality, ability and motivation of the residents won't be the same. They may end up doing more work than expected no matter how many residents they have, or providing worse quality treatment (if for ex the attending is not closely reviewing contours, or residents are slower at getting contours done and the treatment gets delayed)...but they aren't able to see that.

Regardless of the quality of the residents, It is unquestionably immoral to trick medical students into learning a skill that is oversupplied and leaving those residents jobless after 5 years of training! That's unquestionably heartlessly viciously immoral.

This is why this problem needs to be dealt with in 2 ways: 1. convincing med students on this forum to find a another specialty and 2. asking the government to get involved because at the end of the day resident salary is government money and overproduction of one type of doctor at the cost of another type of doctor is a waste of government money, tax payer dollars, and a detriment to American society and patients all over the country (not just rad onc patients, but the patients who need the type of doctors who are in shortage).

We've gotten to the point of waste. If the chairs are buying out private practices, then pay those doctors like private practices and don't give them residents. Keep the residents for the academic main facility. Funnel the med students into specialties with shortages. But you know that's laughable to the chairmans. There definitely needs to be someone outside of ASTRO monitoring their filth. They won't monitor themselves. They have become a swamp.
 
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thecarbonionangle

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It's a conflict of interest issue when these chairs and academics are the ones who become leadership in ASTRO. They won't shoot their own foot to for the greater good of a bunch of people who are meaningless to them [both the newly minted rad ones and the greater good of American society]. The problem is that they are bringing in residents who might not be as good as they hoped them to be. I mean the quality, ability and motivation of the residents won't be the same. They may end up doing more work than expected no matter how many residents they have, or providing worse quality treatment (if for ex the attending is not closely reviewing contours, or residents are slower at getting contours done and the treatment gets delayed)...but they aren't able to see that.

Regardless of the quality of the residents, It is unquestionably immoral to trick medical students into learning a skill that is oversupplied and leaving those residents jobless after 5 years of training! That's unquestionably heartlessly viciously immoral.

This is why this problem needs to be dealt with in 2 ways: 1. convincing med students on this forum to find a another specialty and 2. asking the government to get involved because at the end of the day resident salary is government money and overproduction of one type of doctor at the cost of another type of doctor is a waste of government money, tax payer dollars, and a detriment to American society and patients all over the country (not just rad onc patients, but the patients who need the type of doctors who are in shortage).

We've gotten to the point of waste. If the chairs are buying out private practices, then pay those doctors like private practices and don't give them residents. Keep the residents for the academic main facility. Funnel the med students into specialties with shortages. But you know that's laughable to the chairmans. There definitely needs to be someone outside of ASTRO monitoring their filth. They won't monitor themselves. They have become a swamp.

you best get used to the swamp. Get that mud nicely all over your skin like the fellow hippos and elephants. The blistering sun is yet to come.

i think we have to embrace the swamp. Gotta enjoy the wrestling in the mud.
 
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RadRadRad

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The unfortunate thing is that your hospital admin would be doing their job - I would even argue doing their job well. If you ran a hospital, what's a more sound business decision: hiring 1-2 RadOncs with both a high base salary and production bonus, or 3-4 RadOncs with half the base salary and similar or reduced production bonuses? Having more RadOncs (or any doctor really) spreads out the risk. With a stable of 4 docs, if one quits then the other 3 are more than capable of producing at the same volume - especially when the job used to be done by only 1-2 people. On balance, the hospital wins - which means the admin is doing their job. No one is the villain in this story, and patients certainly don't receive worse care. The only ones who lose in this scenario are the Radiation Oncologists at the individual level.
I can think of one downside from hospital standpoint of employing more docs to do same amount of work...you are now paying for 4 doctors worth of benefits instead of 2. So even if you cut salary in half you’ve got more expenses.
 
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I can think of one downside from hospital standpoint of employing more docs to do same amount of work...you are now paying for 4 doctors worth of benefits instead of 2. So even if you cut salary in half you’ve got more expenses.

Totally agree, I'm mostly just pontificating here. What I was thinking about after I posted was that many of us receive those recruitment flyers advertising the ultra-rural jobs (3+ hours from any town larger than 25k) for ~$500k/year with the potential for more based on RVU. If we continue to just absolutely churn out RadOncs at this rate, and I were an admin flooded with applications, I would try to hire two docs at $200k base with the same (or reduced) production bonus. I imagine, right now, those hospitals are stuck paying a lot of money for locums work, and this arrangement would, at worst, have them break even. Plus, two docs with RVU incentives might work harder to generate more RVUs than a single hard-working doc, bumping up hospital technical fees. But, when someone goes on vacation - no need to hire locums, the machine chugs along like normal.
 
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RickyScott

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I can think of one downside from hospital standpoint of employing more docs to do same amount of work...you are now paying for 4 doctors worth of benefits instead of 2. So even if you cut salary in half you’ve got more expenses.
Will be more than offset by docs beating the bushes/over utilizing, running up charges. Suddenly when it is 50/50 treat or not treat, when something is discretionary, guess what happens? had a chair (of major nci cancer center) actually say this to me as a 2nd year attending.
 
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seper

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The unfortunate thing is that your hospital admin would be doing their job - I would even argue doing their job well. If you ran a hospital, what's a more sound business decision: hiring 1-2 RadOncs with both a high base salary and production bonus, or 3-4 RadOncs with half the base salary and similar or reduced production bonuses? Having more RadOncs (or any doctor really) spreads out the risk. With a stable of 4 docs, if one quits then the other 3 are more than capable of producing at the same volume - especially when the job used to be done by only 1-2 people. On balance, the hospital wins - which means the admin is doing their job. No one is the villain in this story, and patients certainly don't receive worse care. The only ones who lose in this scenario are the Radiation Oncologists at the individual level.

That's why people get so heated about this topic. Chairs/academicians feel "attacked" when oversupply is laid at their feet, as if it was an intentional outcome conducted with malice and forethought.

It was not. Chairs were only acting in the best interest of their department...which is their literal job. I have personally asked a couple of Chairs of old programs (who expanded during the "127% increase" era) why they grew their residency. I received the exact same answer - their patient volumes were up, and they expanded the resident cohort because they had "need". I know at least one of those programs had increased patient volumes because they bought up ALL of the private practices in the region. The size of the pie remained the same - their slice just got bigger. Their response of expansion was reasonable at the local level - and inappropriate at the global level.

But no one is the villain in their own story.

In my experience, patients and referrings do like a stable, ever-present radiation oncologist at their site. They prefer to go to a particular doctor rather than to a “stable” that you are describing.
Can we demostrate this point by data? I don’t know.
 
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In my experience, patients and referrings do like a stable, ever-present radition oncologist at their site. They prefer to go to a particular doctor rather than a “stable” that you are describing.
Can we demostrate this point by data? I don’t know.

Err sorry yeah - in this Doomsday Thought Experiment, the "stable" is the same 4 docs, not a rotating cast of characters.
 
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theradiator

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In terms of avoiding breadlines in 2026, the only viable option for the truly unemployed is a 1 year fellowship in Palliative and Hospice. No joke think about it...
 
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deleted774703

If I could go back to PGY3, I would quit RO

Job search has been a disaster in desirable areas so far for every PGY5 I know
 
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If I could go back to PGY3, I would quit RO

Job search has been a disaster in desirable areas so far for every PGY5 I know

This has been my/my friend's experience as well (@radoncdoc16 while we may unknowingly know each other in real life I don't think you're in my immediate circle of buddies).

Obviously COVID has put a ton of pressure on an already bad situation, but I can say with 100% certainty my backup plans have me directly trying to snatch jobs from the class of 2022 if things don't work out this year.
 
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Chartreuse Wombat

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Hypothetical conversation
Recruiting Chair-We tell candidates that they are in clinic four days a week with one day protected.
Junior Faculty-Hmm. I got two days protected when you recruited me two years ago.
Recruiting-Yeah. Times have changed...ain't it great
 
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medgator

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This has been my/my friend's experience as well (@radoncdoc16 while we may unknowingly know each other in real life I don't think you're in my immediate circle of buddies).

Obviously COVID has put a ton of pressure on an already bad situation, but I can say with 100% certainty my backup plans have me directly trying to snatch jobs from the class of 2022 if things don't work out this year.
Yep... Will be a domino effect. I was hired out of training a decade ago into a big pp, not sure i see places taking risks on new grads anymore if there will be BC folks available to take jobs who have experience
 
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Yep... Will be a domino effect. I was hired out of training a decade ago into a big pp, not sure i see places taking risks on new grads anymore if there will be BC folks available to take jobs who have experience

Yes, in some of the conversations I've seen take place over the past ~two months I'm worried this is the case. I get the impression there's a lot of folks out there interested in lateral movement, which means the best opportunities are unlikely to go to new grads. Why would a large PP hire a new grad who hasn't finished board certification when they can hire someone ~3 years out of training for virtually the same cost and none of the risk? Same goes for academics. If someone is unhappy because, hypothetically, their RVU bonus potential was taken away due to COVID, why wouldn't they try to get into a better situation? Then, the institution they left can hire a new grad on a significantly worse contract (less protected time, less pay, less/no bonus, etc).

The new grads who are forced into unfavorable situations are then going to do the exact same things 1-3 years out of training.

But yeah, Ken, class of 2026 will have a banging job market.
 
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RadsWFA1900

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Yes, in some of the conversations I've seen take place over the past ~two months I'm worried this is the case. I get the impression there's a lot of folks out there interested in lateral movement, which means the best opportunities are unlikely to go to new grads. Why would a large PP hire a new grad who hasn't finished board certification when they can hire someone ~3 years out of training for virtually the same cost and none of the risk? Same goes for academics. If someone is unhappy because, hypothetically, their RVU bonus potential was taken away due to COVID, why wouldn't they try to get into a better situation? Then, the institution they left can hire a new grad on a significantly worse contract (less protected time, less pay, less/no bonus, etc).

The new grads who are forced into unfavorable situations are then going to do the exact same things 1-3 years out of training.

But yeah, Ken, class of 2026 will have a banging job market.

Rule number 1

When a specialty goes to **** the last people you should be talking to are the ones in charge.
 
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DukeNukem

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Hypothetical conversation
Recruiting Chair-We tell candidates that they are in clinic four days a week with one day protected.
Junior Faculty-Hmm. I got two days protected when you recruited me two years ago.
Recruiting-Yeah. Times have changed...ain't it great

We tell candidates that they're in clinic four days a week. We don't tell them that the fifth is for procedures and covering other docs vacations.
 
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RickyScott

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We tell candidates that they're in clinic four days a week. We don't tell them that the fifth is for procedures and covering other docs vacations.
Why bother misleading? Since there are no jobs, I doubt it would make a difference.
 

DukeNukem

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Why bother misleading? Since there are no jobs, I doubt it would make a difference.

Out of the 100+ applications we want the top tier residency grads, preferably MD/PhD. My chair has told me that you have to lie to them to get them to come.
 
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