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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.
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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