The High Number of Unfilled Positions in the 2019 Radiation Oncology Residency Match: Temporary Variation or Indicator of Important Change?

radiation

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The number and characteristics of the residents we train will have major implications for the
future of our field and the patients we serve. Something unusual happened in 2019 regarding
the number of unmatched residency positions. Our goal in writing this editorial is to alert
stakeholders and provide information they need to evaluate the issues. We are concerned
about the trend of increasing number of residency positions relative to the number of U.S.
senior applicants. Our colleagues in Otolaryngology are similarly concerned about this trend in
their specialty (5). We strongly recommend that our professional organizations make it a top
priority to closely monitor the data and to develop action plans should unfavorable trends
continue.
 
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RSAOaky

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"We strongly recommend that our professional organizations make it a top
priority to closely monitor the data and to develop action plans should unfavorable trends
continue. "

This is already a trend. Applications and quality of applications have been down for a few years now. Now that radonc seems easier to get into than it has in the past, it is likely that there will be more applicants with inferior qualifications applying. The number of medical school graduates is increasing fairly rapidly. By virtue of this, one would expect the number of graduates with stellar resumes to be increasing as well. If the overall talent pool is increasing, then why is the talent of the radonc applicant pool DECREASING? If we call it an issue of poor publicity, how do we resolve that? Perhaps by acknowledging and fixing our problems rather than sticking our heads in the sand and blaming them on a group of anonymous malcontents.

The pivotal question is, now that the writing is on the wall, will programs stick to their guns and maintain their high standards of entry at the risk of not matching? I don't think it takes an e-mail survey with a 5% response rate to figure out the answer to that one...
 

fiji128

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"Based on discussions with our program director colleagues, resident colleagues, and potentially interested medical students, our understanding is that the primary trepidation about the field is a perception that the job market for radiation oncologists is unfavorable. This view is held by a small majority of the ASTRO membership. A 2017 ASTRO survey of the radiation oncology workforce showed that a majority of those completing the survey (52.9%) had “concerns” regarding a future oversupply of practitioners, which was up 19.3% from 2012."

As we all know, that's the crux of it. For those medical students out there, it's not some made up issue by a bunch of internet trolls.
 
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A small majority? Even now you can sense that they are trying to downplay it even in the face of the data. Why not just say a majority?

Clearly the solution is to fail more residents and expand slots. Seems to be priority number 1 as far as I can see.

They are a real slick bunch.
 

thecarbonionangle

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Im sure many among the deplorable misanthropes are looking forward to read the Paul Warner almost expected accompanying editorial where he dismisses the whole thing stopping barely short of calling everyone flat out dumb and nothing is done at all. PW will not be around to care, it simply will not affect him. He will sneak out back door with ABR/21st century $$ while house burns down.
 
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thecarbonionangle

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"Based on discussions with our program director colleagues, resident colleagues, and potentially interested medical students, our understanding is that the primary trepidation about the field is a perception that the job market for radiation oncologists is unfavorable. This view is held by a small majority of the ASTRO membership. A 2017 ASTRO survey of the radiation oncology workforce showed that a majority of those completing the survey (52.9%) had “concerns” regarding a future oversupply of practitioners, which was up 19.3% from 2012."

As we all know, that's the crux of it. For those medical students out there, it's not some made up issue by a bunch of internet trolls.
I wonder a lot about applicants. Department is filled with med student peons trying to get in, doing useless retrospective reviews, rotator spots full, people straight up ignoring issues. Lemmings will come if you let them. It all comes down to the warmth of the body. Does it have a pulse? You betcha!

Attendings funneling tons of med students into field at my institution.
 
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I wonder a lot about applicants. Department is filled with med student peons trying to get in, doing useless retrospective reviews, rotator spots full, people straight up ignoring issues. Lemmings will come if you let them. It all comes down to the warmth of the body. Does it have a pulse? You betcha!

Attendings funneling tons of med students into field at my institution.
Same at our institution. It’s total nonsense. They’ve been working on these retrospective projects with some academic faculty but non of them has any idea wtf we do on a daily basis but theyre interested. How can you spend months on a project in a field you are interested in and yet not have a clue?

“Oh the research is so interesting” really? The umpteenth urinary symptoms post LDR prostate brachy report from a single institution that no one cares to hear about again. What makes it interesting? They can’t really tell me but it’s interesting. God help them if they can actually tell you what the hell LDR means.

In the Med student psyche, I bet hey look at RO and see a buyers market so now they’re gonna rush right back in. Numbers go up and ASTRO gets to forget about it like a bad dream.

I never realized the extent of the information asymmetry when I was a Med student.

I pray for their sake I am wrong.
 

medgator

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I never realized the extent of the information asymmetry when I was a Med student.

I pray for their sake I am wrong.
Not as much assymetry as you think. The most recent match proved that, much to the chagrin of ASTRO/RO leadership
 
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Mandelin Rain

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Being a medical student is hard. You're so naive to everything. You get conflicting information from various sources. You're doing your best to impress literally everyone around you. Most of them are still idealistic and have yet to realize that in the end medicine is a job pretty much like any other, and even when they do... rad onc has been a highly compensated, easy life style specialty for well over a decade. It's unsurprising you're coming across eager, motivated med students.

If you share the concerns posted on this board, it is incumbent on you to give them your 2 cents.
 
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evilbooyaa

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Same at our institution. It’s total nonsense. They’ve been working on these retrospective projects with some academic faculty but non of them has any idea wtf we do on a daily basis but theyre interested. How can you spend months on a project in a field you are interested in and yet not have a clue?

“Oh the research is so interesting” really? The umpteenth urinary symptoms post LDR prostate brachy report from a single institution that no one cares to hear about again. What makes it interesting? They can’t really tell me but it’s interesting. God help them if they can actually tell you what the hell LDR means.

In the Med student psyche, I bet hey look at RO and see a buyers market so now they’re gonna rush right back in. Numbers go up and ASTRO gets to forget about it like a bad dream.

I never realized the extent of the information asymmetry when I was a Med student.

I pray for their sake I am wrong.
I don't at all blame medical students for this. I have a research project from medical school that I didn't really understand the significance of until I was a PGY-3. It was just some retrospective review that somebody told me to do that got published.

We all think Rad Onc is so easy because we are going through it as residents or have already graduated into attendinghood. Don't forget how foreign this entire field was when we were medical students.... at least it was for me. I didn't understand every little thing about what a rad onc did because the focus was to impress literally everybody in the department.

Being a medical student is hard. You're so naive to everything. You get conflicting information from various sources. You're doing your best to impress literally everyone around you. Most of them are still idealistic and have yet to realize that in the end medicine is a job pretty much like any other, and even when they do... rad onc has been a highly compensated, easy life style specialty for well over a decade. It's unsurprising you're coming across eager, motivated med students.

If you share the concerns posted on this board, it is incumbent on you to give them your 2 cents.
Completely agree with this entire post, especially the bolded. Any medical students through my department have and will get the "it's a great, fulfilling field with good hours, a vulnerable patient population that will mostly greatly appreciate what you do for them and no overnight call, but well the job market is pretty crap nationwide due to residency expansion and hypofractionation, and there's some, in my opinion, weaknesses in leadership, and there appears to be a large focus on eliminating or reducing indications/fractions rather than expanding it (for the most part), and we're at the end of the referral chain so we have to play nice in the sandbox with people that we may feel are oncologically stupider than us"
 

beamotherapy

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I give Amdur & Lee a lot of credit for publishing their opinion. First they called out the ABR process (Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):17-20) and now the residency expansion issue. It takes some guts to publicly speak out against the establishment in regrards to these major issues. It may be the first step toward actually making changes.
 

Gfunk6

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I give Amdur & Lee a lot of credit for publishing their opinion. First they called out the ABR process (Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):17-20) and now the residency expansion issue. It takes some guts to publicly speak out against the establishment in regrards to these major issues. It may be the first step toward actually making changes.
Agree 100%. We needed a couple of strong advocates on our side to stop the misconception that job market concerns were merely the view of the lunatic fringe. I really appreciate not only their courage to take the position that they did, but the time/effort to publish it in the Red Journal for widespread dissemination.
 
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Agree 100%. We needed a couple of strong advocates on our side to stop the misconception that job market concerns were merely the view of the lunatic fringe. I really appreciate not only their courage to take the position that they did, but the time/effort to publish it in the Red Journal for widespread dissemination.
Better than nothing I guess. It’s not a taboo anymore.

Sdn Been sounding the alarm since 2015 at least. We are just now getting around to having these concerns out of the shadows? 4 yrs behind the 8 ball.

While we wait for new leaders to get around to changing things. There has to be something the average RO can do on the ground. I just don’t know what.
 
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Neuronix

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I have a lot of respect for Bob Amdur. He has been resisting expanding UF's residency program for some time. He has been for years publicly concerned about the overexpansion of residency positions.

Not to diminish from this, but the chair at UF has also been accommodating in that regard. I'm sure that there are chairs who would replace their PDs if they stood in the way of expansion.
 

medgator

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“What’s old is new again?”

Why do I feel like PW is talking about himself and all the other dinosaurs who are ruining the field in the title?
Because what's old is, in fact, new again to a whole generation of RO applicants and academics, namely lots of unfilled spots and unmatched programs, coupled with a field rapidly gaining interest from DOs and IMGs...

Just like the 70s/80s and into the 90s
 
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Because what's old is, in fact, new again to a whole generation of RO applicants and academics, namely lots of unfilled spots and unmatched programs, coupled with a field rapidly gaining interest from DOs and IMGs...

Just like the 70s/80s and into the 90s
You think the research we publish now is useless Just picture the what the red journal will be accepting 10 years from now.

Music therapy and Radiation

Hypofractionated Keloid Treatment: when 3 fx just isn’t short enough

Sexual Harassment in the Radiation Clinic: A retrospective review

Twitter and the Radiation Oncologist

Job Market Projections: SHORTAGE! Still can’t fill those spots in the dessert of Nevada.

Global Health: Radiation Planning over Skype.

Classifieds

6 Yr SBRT fellowship at Stanford starting salary 80K. Must bring your own funding

5yr fellowship in pediatric radiation oncology -

PRN Program director for new ACGME Radiation Oncology residency for 60 new spots! Must have at least 20 years experience and published extensively in SBRT for merkel cell of the anus. We are an Equal opportunity employer.
 
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Shout out to Dr Amdur for standing up for the young people entering the field.
Lee and Amdur have shown themselves the only true leaders and resident advocates that this field has on the issues of boards and oversupply. The SCAROP meeting this year was full of hand wringing about “bad publicity on message boards” and continued denial that there is a true underlying problem. In a just world, the few strong residency applicants that remain in this field would reward Lee and Amdur for their advocacy by ranking their programs highly. The leaders of prominent programs who have been silent while the field is run into the ground would have to SOAP for second-tier dermatology applicants.
 
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10 years ago, the starting salary for med oncs were in the mid 200s and rad oncs in the mid 300s. Now, the starting salary for med oncs are in the mid 400s and rad oncs in the high 200s for a partnership track position in a desirable city. Fortunes have changed.
 
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10 years ago, the starting salary for med oncs were in the mid 200s and rad oncs in the mid 300s. Now, the starting salary for med oncs are in the mid 400s and rad oncs in the high 200s for a partnership track position in a desirable city. Fortunes have changed.
I think the Terry wall surveys and MGMA back up those claims.
 
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The pivotal question is, now that the writing is on the wall, will programs stick to their guns and maintain their high standards of entry at the risk of not matching?
The fundamental problem is that residents bring tremendous value to a department, much more so than a mid-level PA or NP:

-Residents will accept extra work assignments and are often too afraid or reluctant to even complain about it
-Residents can write book chapters/ manuscripts that attendings literally need for promotion. How many NPs will spend nights and weekends writing manuscripts?
-Residents take call without any additional compensation
-Residents can contour target volumes
-Residents bring prestige and stature to a department

So the temptation to have residents and more of them is too strong. The incentives are misaligned which explains how got into this mess in the first place.
 

thecarbonionangle

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Our field is in a TERRIBLE state currently. There is almost no leaders. Many sycophants and people in bubbles talking about “misanthropes” and “echochambers” and finger pointing, what an Embarrassment. Meanwhile EM, derm, urology do what they need to do to secure their field. Our field is busy finding ways to get rid of our modality even more. Most recent “exciting” trial is a hypothesis generating non significant trial with a p value predicting a likely dud in phase II-III. Not looking good folks!
 
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Lamount

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There are some very legitimate concerns with:
1) The change of board exam curriculum with a lack of transparency and/or willingness involve educators in the process ;
2) Residency expansion without consideration of the job market;
3) lack of imagination with recent clinical trials (though this may be changing).

...but there is also a degree to which the attitude of some on this forum is negatively impacting our field as well. The elitism expressed by some vis a vis DOs, lamenting our compensation with respect to other fields, and calling our colleagues 'sycophants'... not a good look. I depended on this forum for information when I was applying for residency. When med students come on here these days and see... this (see above)... many will be discouraged about their future in our field, and still others will be discouraged about how angry everyone seems because no one wants to be around angry people..

You warn med students that they shouldn't apply, and say that everything is just terrible... and then when applications are down, you say "see, I told you so!"... completely neglecting that this is all a self-fulfilling prophecy. I know many recent graduates such as myself who faired alright finding a well-paying job in a reasonable location (both academic and private practice), but many are discouraged from mentioning it on SDN because they don't want to be shouted at... and that's a shame, because med students are only seeing one side of the picture here.
 
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There are some very legitimate concerns with:
1) The change of board exam curriculum with a lack of transparency and/or willingness involve educators in the process ;
2) Residency expansion without consideration of the job market;
3) lack of imagination with recent clinical trials (though this may be changing).

...but there is also a degree to which the attitude of some on this forum is negatively impacting our field as well. The elitism expressed by some vis a vis DOs, lamenting our compensation with respect to other fields, and calling our colleagues 'sycophants'... not a good look. I depended on this forum for information when I was applying for residency. When med students come on here these days and see... this (see above)... many will be discouraged about their future in our field, and still others will be discouraged about how angry everyone seems because no one wants to be around angry people..

You warn med students that they shouldn't apply, and say that everything is just terrible... and then when applications are down, you say "see, I told you so!"... completely neglecting that this is all a self-fulfilling prophecy. I know many recent graduates such as myself who faired alright finding a well-paying job in a reasonable location (both academic and private practice), but many are discouraged from mentioning it on SDN because they don't want to be shouted at... and that's a shame, because med students are only seeing one side of the picture here.
I feel like where I am med students get fed a real load of BS from the attendings regarding RO. They still talk about it like it’s extremely competitive despite the data. I think they do because it allows them to Segway into their next point: they need a warm body to do data entry and write manuscript for their ridiculous studies

On the other hand, Med students are especially dense. For a group of people who are supposed to have a brain they sure don’t seem to be using it. I find that if one already has their heart set on it there is no use talking to them.
 

medgator

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There are some very legitimate concerns with:
1) The change of board exam curriculum with a lack of transparency and/or willingness involve educators in the process ;
2) Residency expansion without consideration of the job market;
3) lack of imagination with recent clinical trials (though this may be changing).

...but there is also a degree to which the attitude of some on this forum is negatively impacting our field as well. The elitism expressed by some vis a vis DOs, lamenting our compensation with respect to other fields, and calling our colleagues 'sycophants'... not a good look. I depended on this forum for information when I was applying for residency. When med students come on here these days and see... this (see above)... many will be discouraged about their future in our field, and still others will be discouraged about how angry everyone seems because no one wants to be around angry people..

You warn med students that they shouldn't apply, and say that everything is just terrible... and then when applications are down, you say "see, I told you so!"... completely neglecting that this is all a self-fulfilling prophecy. I know many recent graduates such as myself who faired alright finding a well-paying job in a reasonable location (both academic and private practice), but many are discouraged from mentioning it on SDN because they don't want to be shouted at... and that's a shame, because med students are only seeing one side of the picture here.
I don't see this as any worse than the complete oblivion many med students will get from talking with those directly in academia and in ASTRO. It's why multiple sources of information should be sought out before making a final decision, as with anything.

No one is trying to put down imgs and DOs, but stats on them are used as a marker/yardstick of competitiveness.

As for the self fulfilling prophecy, I am going to call bs on that one. The recently published job market and residency surveys support the job market getting more difficult in the last few years. I'm sure people are still getting good jobs in decent locales, there are just less of them to go around
 
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A recent Red Journal (link) article explored job market patterns amongst recent residencuy program graduates. The authors evaluated outcomes with regard to location (divided into 4 multi-state regions), practice setting, and city size. When I saw this in the email blast TOC, I thought this might provide useful information, but the beginning of the discussion states, “Furthermore, 52.5% received a job offer in their preferred region, city size, and job type (combined). Which this suggests a lower level of concern than suggested in prior reports.”[sic]

So about half of people found a job in a multi-state region where there was a city of small or large size, where they found an academic or PP job (because applicants applied to both). Fascinating. And if someone didn’t get all three, don’t fret — 75% at least got a job in their preferred geographic region. That means 1 in 4 didn’t even get to live in their desired multi-state region.

The authors go on to say that trainee preferences may be contributing to maldistribution of jobs. Just imagine the self-importance to have a preference of choosing where you want to work and maybe even raise a family after 4 years of medical school (plus maybe a gap year), and 5 years of residency! You want to live in California? How about Oklahoma?

Kidding aside (and no offense meant to OK residents), but I don’t think this article really captures the extent of which trainee preference and outcome in the current job market. For example, if someone wanted at academic job at one of the many fine programs in Los Angeles and instead got a job working at a satellite in the suburbs of Phoenix, this would be interpreted by the study’s authors as going 3 for 3. Not technically incorrect, but also somewhat misleading.

It’s stuff like this that I point out to our eager visiting medical students. Sure, there’s data. Yes, we still need radiation oncologists. And yes, there are people getting jobs. But the data we have says you have a coin flip’s chance of ending up in a city size you want with the kind of job your want (maybe) in a multi-state region. If that sounds like something you’re excited about, by all means, fire up that ERAS.
 
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A recent Red Journal (link) article explored job market patterns amongst recent residencuy program graduates. The authors evaluated outcomes with regard to location (divided into 4 multi-state regions), practice setting, and city size. When I saw this in the email blast TOC, I thought this might provide useful information, but the beginning of the discussion states, “Furthermore, 52.5% received a job offer in their preferred region, city size, and job type (combined). Which this suggests a lower level of concern than suggested in prior reports.”[sic]

So about half of people found a job in a multi-state region where there was a city of small or large size, where they found an academic or PP job (because applicants applied to both). Fascinating. And if someone didn’t get all three, don’t fret — 75% at least got a job in their preferred geographic region. That means 1 in 4 didn’t even get to live in their desired multi-state region.

The authors go on to say that trainee preferences may be contributing to maldistribution of jobs. Just imagine the self-importance to have a preference of choosing where you want to work and maybe even raise a family after 4 years of medical school (plus maybe a gap year), and 5 years of residency! You want to live in California? How about Oklahoma?

Kidding aside (and no offense meant to OK residents), but I don’t think this article really captures the extent of which trainee preference and outcome in the current job market. For example, if someone wanted at academic job at one of the many fine programs in Los Angeles and instead got a job working at a satellite in the suburbs of Phoenix, this would be interpreted by the study’s authors as going 3 for 3. Not technically incorrect, but also somewhat misleading.

It’s stuff like this that I point out to our eager visiting medical students. Sure, there’s data. Yes, we still need radiation oncologists. And yes, there are people getting jobs. But the data we have says you have a coin flip’s chance of ending up in a city size you want with the kind of job your want (maybe) in a multi-state region. If that sounds like something you’re excited about, by all means, fire up that ERAS.
Would getting a consulting firm to do this type of evaluation have been a better option? I mean honestly they probably get asked to do this kind of study all the time and they probably don’t really have a dog in the race just want to get paid and move onto another project.

I just think that academia has too much of an expansionary bias to truly do a study that captures what is going on here. They’ll obfuscate and manipulate data to really make it look like there isn’t a problem.
 
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...but there is also a degree to which the attitude of some on this forum is negatively impacting our field as well.
Back when I was a med student applying to RO, the vibe on SDN was very positive. Gfunk would post stats of matched applicants and I was in awe of the people going into this field. It was a dynamic and thrilling time to enter the field. I honestly don't recall any of these doom and gloom job market threads. Then residency expansion happened, the job market tanked, and the mood on SDN soured. Note that it happened in that order. IMHO the vibe on SDN is a reflection of the decline in the field, not the other way around.
 

medgator

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Back when I was a med student applying to RO, the vibe on SDN was very positive. Gfunk would post stats of matched applicants and I was in awe of the people going into this field. It was a dynamic and thrilling time to enter the field. I honestly don't recall any of these doom and gloom job market threads. Then residency expansion happened, the job market tanked, and the mood on SDN soured. Note that it happened in that order. IMHO the vibe on SDN is a reflection of the decline in the field, not the other way around.
My same take, as a med student last decade who used SDN as a resource prior and during the residency application process.

Many of us did not match, but managed to find spots outside the match before nrmp took over that process as well. It was a far different time back then... 110-120/spots a year
 
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My same take, as a med student last decade who used SDN as a resource prior and during the residency application process.

Many of us did not match, but managed to find spots outside the match before nrmp took over that process as well. It was a far different time back then... 110-120/spots a year
Which is probably all the new ROs we need until 2100
 

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DebtRising

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in 2100 the coasts will be underwater shifting the supply and demand of RO greatly.
Exciting offshore satellite opportunity coming soon! Enjoy the calm seas of the ocean as you commute out to our beautiful floating island facility. Hurricane coverage required. Salaried, incentive bonus. Boat only comes twice a day, if you miss it must stay overnight. Exciting, dynamic opportunity for highly motivated/ indebted individuals. Cross coverage at second island facility may be required.
 

Haybrant

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Back when I was a med student applying to RO, the vibe on SDN was very positive. Gfunk would post stats of matched applicants and I was in awe of the people going into this field. It was a dynamic and thrilling time to enter the field. I honestly don't recall any of these doom and gloom job market threads. Then residency expansion happened, the job market tanked, and the mood on SDN soured. Note that it happened in that order. IMHO the vibe on SDN is a reflection of the decline in the field, not the other way around.
You leave out an important component; it’s not just residency expansion that soured the mood. It’s the money hungry academics that act like they are doing a favor to mankind when serving only their interest, the same thing with private practitioners. Honestly to me this was the biggest tipping point. It also made clear the reasons for residency expansion. It’s a global issue obviously, medicine is messed up from top to bottom by it but when the academics went down this rabbit hole it was even more glaring bc these were the luminaries we looked up to.

At the end of the day they took stellar applicants and great people and then used them treated them like trash blocked them from practices put them at useless satellite position hoping they could treat them like trash forever and so now we ended up here to expose them bc it’s a double edge sword taking smart people and not just yes men - We’re introspective and understand when we are getting screwed and have enough empathy to warn the next generation.
 
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collegestud2013

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There's actually a significant SHORTAGE of physicians in the United States, and that shortage is only going to get worse in the next few decades as the U.S. population ages. The issue is that is currently NOT ENOUGH residency spots since there is increasing numbers of medical school graduates due to all the new medical schools opening (both MD and DO), and you end with with many qualified applicants that go unmatched simply because they weren't rockstars. That's why you have petitions such as these popping up:


Given that cancer is mostly a disease of the elderly and most cases are unpreventable, an aging population in the U.S. means that there should be a greater demand for radiation oncologists, not less. So a rapid residency expansion is appropriate to meet the future demands of this country.
 
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There's actually a significant SHORTAGE of physicians in the United States, and that shortage is only going to get worse in the next few decades as the U.S. population ages. The issue is that is currently NOT ENOUGH residency spots since there is increasing numbers of medical school graduates due to all the new medical schools opening (both MD and DO), and you end with with many qualified applicants that go unmatched simply because they weren't rockstars. That's why you have petitions such as these popping up:


Given that cancer is mostly a disease of the elderly and most cases are unpreventable, an aging population in the U.S. means that there should be a greater demand for radiation oncologists, not less. So a rapid residency expansion is appropriate to meet the future demands of this country.
VTB.

Let me guess, Caribbean medical student?
 

bronx43

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There's actually a significant SHORTAGE of physicians in the United States, and that shortage is only going to get worse in the next few decades as the U.S. population ages. The issue is that is currently NOT ENOUGH residency spots since there is increasing numbers of medical school graduates due to all the new medical schools opening (both MD and DO), and you end with with many qualified applicants that go unmatched simply because they weren't rockstars. That's why you have petitions such as these popping up:


Given that cancer is mostly a disease of the elderly and most cases are unpreventable, an aging population in the U.S. means that there should be a greater demand for radiation oncologists, not less. So a rapid residency expansion is appropriate to meet the future demands of this country.
Lol there is no shortage. There MAY be a maldistribution depending on what specialty you are but shortage is a myth.

If you drastically increase the number of residency spots, all you’ll end up with are worse trained unemployed physicians.
 
May 17, 2019
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Lol there is no shortage. There MAY be a maldistribution depending on what specialty you are but shortage is a myth.

If you drastically increase the number of residency spots, all you’ll end up with are worse trained unemployed physicians.
There's actually a significant SHORTAGE of physicians in the United States, and that shortage is only going to get worse in the next few decades as the U.S. population ages. The issue is that is currently NOT ENOUGH residency spots since there is increasing numbers of medical school graduates due to all the new medical schools opening (both MD and DO), and you end with with many qualified applicants that go unmatched simply because they weren't rockstars. That's why you have petitions such as these popping up:


Given that cancer is mostly a disease of the elderly and most cases are unpreventable, an aging population in the U.S. means that there should be a greater demand for radiation oncologists, not less. So a rapid residency expansion is appropriate to meet the future demands of this country.
You’re clearly mis-informed about the state of the job market and demand projections for radiation oncology. The most recent published projections, the ASTRO workforce report, etc all confirm that we have an oversupply.

That being said, yes, most health policy folks also believe we generally have a physician shortage that will be exacerbated over the next decade. The AMA specifically advocates for increased funding for GME (and this is because physicians in the AMA have strongly advocated for this and believe this to be true, both in PP and academics). The AMA used to advocate for a stable supply ~20-30 years ago. But while that may be true in primary care and many speciaties, it’s definitely not true in rad onc.
 

bronx43

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You’re clearly mis-informed about the state of the job market and demand projections for radiation oncology. The most recent published projections, the ASTRO workforce report, etc all confirm that we have an oversupply.

That being said, yes, most health policy folks also believe we generally have a physician shortage that will be exacerbated over the next decade. The AMA specifically advocates for increased funding for GME (and this is because physicians in the AMA have strongly advocated for this and believe this to be true, both in PP and academics). The AMA used to advocate for a stable supply ~20-30 years ago. But while that may be true in primary care and many speciaties, it’s definitely not true in rad onc.
That’s because the AMA is not an advocate for physicians. They simply don’t understand that instead of redistributing themselves to low access geographies, physicians are just driving each other’s salaries down in metros. Meanwhile, hospital corporations are skimming off the top by hiring more and more mid level providers.

There is no good outcome for physicians by increasing positions. The only people it benefits are the admin overlords.
 
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medgator

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There's actually a significant SHORTAGE of physicians in the United States, and that shortage is only going to get worse in the next few decades as the U.S. population ages. The issue is that is currently NOT ENOUGH residency spots since there is increasing numbers of medical school graduates due to all the new medical schools opening (both MD and DO), and you end with with many qualified applicants that go unmatched simply because they weren't rockstars. That's why you have petitions such as these popping up:


Given that cancer is mostly a disease of the elderly and most cases are unpreventable, an aging population in the U.S. means that there should be a greater demand for radiation oncologists, not less. So a rapid residency expansion is appropriate to meet the future demands of this country.
Sounds like someone who has no idea what the demand and indications for Radiation oncology labor is, nor has examined any recent published data on the manner.

Borderline trolling imo. An increase in RO spots would actually be to the detriment of other specialties where demand is far greater throughout the country where that funding should be going
 
May 17, 2019
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Resident [Any Field]
That’s because the AMA is not an advocate for physicians. They simply don’t understand that instead of redistributing themselves to low access geographies, physicians are just driving each other’s salaries down in metros. Meanwhile, hospital corporations are skimming off the top by hiring more and more mid level providers.

There is no good outcome for physicians by increasing positions. The only people it benefits are the admin overlords.
I’m a member of the AMA and go to meetings so I can fill in you in on how the process actually works.

AMA members from state and specialty societies propose policies (such as increased funding for GME), voting delegates debate the issue in the open, and then vote on the issue. It’s an open and democratic process. Membership is a mix of private and academic docs and Med students/residents also have a block of voting rights.

So it’s not some secret cabal of power brokers in the AMA who don’t care about doctors and want to increase supply. It really is the membership which pretty accurately reflects what most physicians believe.

AMA is the most powerful physician lobby in DC and has been critical in reducing burdensome reporting requirements (a lot more to do on this), keeping payment rates higher than would be otherwise (ie overturning the SGR), etc. Having more rad oncs involved is important if we don’t want to be steamrolled
 

Neuronix

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This article popped up in my inbox today:

Enhancing Career Paths for Tomorrow’s Radiation Oncologists


Discussions of practitioner supply/demand imbalance often focus on the numerator – are there too many? Better solutions may reside in a broadening of the denominator – the talent and contributions that ROs bring to cancer care and greater society (7, 8).
In summary--we should use the oversupply of rad oncs to work in global health, "frontier medicine" (indian reservations? Rural?), policy/FDA, government, industry, epidemiology, informatics/biology (i.e. research), and palliative care.

I have experience in many of these areas myself and I find the article tone deaf. There are careers for a single digit number of rad oncs in most of these areas, at best, or stiff competition with other, larger medical specialties or degree programs (PhD, etc). Also, most of these positions are far less lucrative than clinical radiation oncology, or indeed clinical medicine at all. An oversupply of rad onc grads certainly would help a handful of established people in those alternate areas who have a hard time recruiting people for the low salaries or fellowships offered.

The article is suggesting that we should have flexible residencies to train our rad onc residents for these alternative careers. I find it very difficult to believe that such alternative pathway training will happen outside of a small number of programs. I also find it very difficult to believe that these non-clinical careers will put a dent in the radiation oncology job market issues given that we are currently probably training several dozen rad oncs per year more than we actually need. Further, why train MD radiation oncologists for jobs that are currently typically filled with MBAs, MHAs, MPHs, PhDs, etc...
 

OTN

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Can anyone paste a copy of the article? Not an ASTRO member, of course.

Did they increase the # of authors by an order of magnitude above what would be reasonable to help with the job market? Practicing what they preach at least.
 
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seper

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Dr. Vapiwala has received speaker honoraria from Varian Medical Systems.
Dr. Goldwein is a full-time employee of Elekta AB.
Dr. Kupelian is an employee of Varian Medical Systems.
Dr. Weidhaas reports other from MiraDx, outside the submitted work, and a patent KRASvariant in cancer with royalties paid to MiraDx.
Dr. Fuller has received industry-funded institutional grant support, speaker honoraria, and travel funding from Elekta AB.
Dr. Okunieff is an inventor and founder of a company that markets biomarker technologies, DiaCarta.com.
Dr. Formenti reports grant/research support from Bristol Myers Squibb, Varian, Janssen, Regeneron, Eisai, Merck, Celldex and honoraria form Bristol Myers Squibb, Varian, Elekta, Janssen, Regeneron, GlaxoSmithKline, Eisai, Dynavax, AstraZeneca, Merck, Viewray, Bayer.
Dr. Mitin reports personal fees from UpToDate, Inc. and Janssen and grants from Novocure, Inc.
 

medgator

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Dr. Vapiwala has received speaker honoraria from Varian Medical Systems.
Dr. Goldwein is a full-time employee of Elekta AB.
Dr. Kupelian is an employee of Varian Medical Systems.
Dr. Weidhaas reports other from MiraDx, outside the submitted work, and a patent KRASvariant in cancer with royalties paid to MiraDx.
Dr. Fuller has received industry-funded institutional grant support, speaker honoraria, and travel funding from Elekta AB.
Dr. Okunieff is an inventor and founder of a company that markets biomarker technologies, DiaCarta.com.
Dr. Formenti reports grant/research support from Bristol Myers Squibb, Varian, Janssen, Regeneron, Eisai, Merck, Celldex and honoraria form Bristol Myers Squibb, Varian, Elekta, Janssen, Regeneron, GlaxoSmithKline, Eisai, Dynavax, AstraZeneca, Merck, Viewray, Bayer.
Dr. Mitin reports personal fees from UpToDate, Inc. and Janssen and grants from Novocure, Inc.
Drive down the cost of RO labor, you can increase the spend on machines/tech and MBA/executive salaries....
 
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Dec 21, 2018
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Manuscript keywords: "Radiation oncology; radiation oncologist workforce; oversupply; innovation; expertise"

The closing line: "We posit that our specialty is at an inflection point; the imperative is on us to determine which direction we are headed."

If only there was a group of influential people committed to the future of our specialty and our trainees, who could somehow limit the ongoing residency expansion or perhaps even cut back so we didn't have to worry about finding new ways not to use our clinical training. Maybe a chairperson, or someone who sits on the on the ACGME Residency Review Committee, and/or have been program directors.

If only...