Aug 25, 2016
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Resident [Any Field]
I agree with everything said on this board regarding the impending doom of our speciality / medicine in general and the forces (academic greed and indifference) that have produced our unfortunate situation, but I'm dismayed that nobody has suggested a solution.

The consensus seems to be that we all run around like Chicken Littles while we wait for Academic Chairs/Attendings to act in DIRECT OPPOSITION to their own financial and professional interests because we're creating a stink on an internet message board. The fact is, as residents, we have all the power we need to effect this change for ourselves. We simply have to make curtailing the resident supply relative to the financial and professional interests of our PDs/chairs. Here's how:

We, the united Radiation Oncology Residents of the United States kindly request:
1. That all Chairs/Program Directors immediately halt the expansion of US residency spots and, further, cut their current number of trainees by 10% (in line with the projected oversupply). i.e. For a program with 5 residents/year this would involve cutting 1 spot every 2y; for a 4 resident program, 2 spots averaged over 5y, etc.*
2. Any future expansion of US Residency Programs shall be undertaken only in response to strong evidence that the job market can sustain such expansion (evidence-based expansion) and with >50% approval by survey of all US Radiation Oncology residents.

*Some might suggest that it's unfair to require this of all programs (rather than specifically targeting those that have expanded most aggressively), but I think making it universal is essential for a couple of reasons. First, it ensures that all residents and all program directors have skin in the game. For this to work the number one most essential element is that we are all united in this front. Otherwise residents who advocate for this 'Red Manifesto' will be blacklisted by the programs. But they can't blacklist EVERYONE. Second: We don't want this to foster resentment between residency programs. Everyone stands to benefit; everyone participates.

Pursuant to the above, we the undersigned pledge that any program not agreeing to the above demands will be subject to the following:

1. A letter will be composed and, in a packet including both the relevant labor market articles and the recent Red Journal commentary) will be distributed to all invited applicants on interview day. The article will honestly and forthrightly outline how this specific program director and chair have failed both their own residents and the community as a whole by not acting proactively to ensure the job prospects for the trainees whose labor and research output they all too happily guzzle down to advance their own interests. The letter will further recommend that, as a future radiation oncologist with an interest in the collective success of the community, such applicants decline to rank such abusive programs on NRMP.
2. This will be the one and only interaction we have with the interviewing applicants. No presentations, no "recruitment dinners;" nothing.

The specter of losing top applicants would be enough for all but the most unscrupulous and sketchy program directors (think about who much they love to sit around bragging about how competitive their programs are or that they match their top 7/7 every year). Additionally, none of it would violate any ethical or contractual obligations; we as residents would simply be voicing our honest opinion of our programs and their leadership on interview day. Maybe someone more legally versed than I could opine whether this violates some labor law, as PD's have suggested they would, but I doubt it would: program directors would voluntarily and individually cut spots in their programs in response to resident preferences.

The caveat to all of this is that, of course, it only works if it's near-100% collective. Akin to the problem of forming a Union, this movement is dead in the water until it has unanimous support. Nobody is going to act alone, effectively nullifying their chair's support and career prospects.

But together this, or something like it, is doable. If curtailing residency expansion really does have support among residents as strong as this board (and ASTRO's "standing-room-only panel") suggests it does, then this has a chance of taking off. We have the virtue of a very small, very highly accomplished group of residents/applications. Organizing this might be impossible in a residency as huge and unwieldy as IM or Surgery, but in radonc (and other smaller fields like Derm, Ophtho, ENT, etc., who I hope will follow our example) I think we have the chance to achieve the levels of support necessary.

The barrier will of course be the merciless competitiveness that has been nurtured in us throughout our decade+ odyssey of training ; but we're residents now. We've matched. We should be able to get over that and not take every action to undercut each other. Are we capable of collective action?

Part of this feels very self serving, but it really shouldn't be so. The medical system is the furthest thing from a free market, and top-down controls are present on literally everything from delivery to payment to training. The only interest WITHOUT representation or control over the process are the trainees themselves. We would simply be asserting that we have a voice in our own futures.

Furthermore, it is not merely in our own individual and collective interests, but in the interests of patients. American medicine has led the world in innovation because for the last hundred years our salaries (never equal to but at least on par with those in law and business) have attracted the best and brightest from our top colleges into medical school (a tradeoff of 30% lower salary for increased job security and satisfaction is one thing, but 80%, 90% 99%? Where is the breaking point?). We can see this happening: how many of us would still recommend a medical career to someone with the academic chops to nab a spot at a top law firm, consulting firm, or tech company, where six figure salaries start right out of college and "grad school" (to the extent an MBA can even be considered school) involves 2 years of international weddings and exchanging business cards? I categorically tell young, bright students to sell out ASAP. If we continue down this path - bitching on message boards while incompetent government agencies, greedy insurance companies, and blithe self-interested academics conspire to drive our salaries down to a sliver of what many of us would be able to attain in other fields - why would anyone intelligent be drawn to American medicine? The result will be a doctoriate of assiduous EMR box-checkers, devoid of the drive and spark that produce great patient care and practice-changing innovations.

We have the power to secure our futures. The only question is: are we united enough to use it?
 

Krukenberg

2+ Year Member
Jun 18, 2015
231
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Resident [Any Field]
Purely anecdotal and written by someone involved in reaident unions, but they report that at least one ortho residency told its residents that if they joined a resident union the ACGME would think there were problems within, and would refuse to expand the resident pool. For overworked ortho residents that may be a downside but not for rad onc... http://www.kevinmd.com/blog/2014/01/patients-lose-resident-physicians-afraid-unionize.html


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thesauce

Senior Member
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Aug 5, 2005
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Attending Physician
I have posted the solution before and it's even easier. Just don't log more than the minimum 450 cases!

The committees that approve expansion must justify this based on volume and they look at resident case logs to prove there are enough cases.
 
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mpdoc2

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Apr 2, 2009
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I have posted the solution before and it's even easier. Just don't log more than the minimum 450 cases!

The committees that approve expansion must justify this based on volume and they look at resident case logs to prove there are enough cases.
Better yet tell your program directors and chairs that you have enough residents and you don't need to expand any more. That might involve doing some extra work but at least you'll have work once you get out.
 

evilbooyaa

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Oct 10, 2011
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I have posted the solution before and it's even easier. Just don't log more than the minimum 450 cases!

The committees that approve expansion must justify this based on volume and they look at resident case logs to prove there are enough cases.
That's actually a really good idea. Any possible recourse from PDs besides auditing every single case log for every resident?
 

thesauce

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Aug 5, 2005
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That's actually a really good idea. Any possible recourse from PDs besides auditing every single case log for every resident?
Too much of a pain in the ass IMO. Worst case scenario, they ask you and you say whoops, forgot to log some. Then you can do it if they take it really seriously. But I would bet only 5% or so of PDs would actually care enough to do it.
 

thesauce

Senior Member
10+ Year Member
Aug 5, 2005
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Better yet tell your program directors and chairs that you have enough residents and you don't need to expand any more. That might involve doing some extra work but at least you'll have work once you get out.
I don't think that's better at all. That goes back to relying on their Goodwill when they are the ones who got us into this mess in the first place.

If you only log 450 cases, their hands are tied.
 
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Krukenberg

2+ Year Member
Jun 18, 2015
231
229
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Resident [Any Field]
I have posted the solution before and it's even easier. Just don't log more than the minimum 450 cases!

The committees that approve expansion must justify this based on volume and they look at resident case logs to prove there are enough cases.
This is clearly the easiest and most effective solution AND it is the only one that is in our control. Even if PDs catch on it also conveys the depth of our disagreement with their "expand until the labor market collapses and medical students turn their nose up at the field" approach.


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