The job search begins...

[Radz08]

For those of us entering into the last year of residency, any advice on how to go about finding jobs? Particularly if you would like to stay in a specific region?

Thanks!

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[stephew]

not for private practice, except talk with Daniel Flynn at his yearly resident's astro course. For academia, several things, begining with "start soon" (ie Judy-Aug).

 

[Adawaal]

Steph --

For those of us entering PGY-4 year in July and looking for a strong academic position, is it really a good idea to wait until early PGY-5 year before we start looking?

 

[Radz08]

Anyone know of good private/group practices that may be hiring in the SouthEast? (particularly NC, GA or FL)?

 

[stephew]

Steph --

For those of us entering PGY-4 year in July and looking for a strong academic position, is it really a good idea to wait until early PGY-5 year before we start looking?

well yes, people dont know what their needs will be yet. however you can certainly start networkings.

 

[radonc]

steph-
what does that entail? cold-calling people? there arent many opportunities for residents to meet attendings of diff programs...until astro...what are your thoughts?

 

[stephew]

put together a cv, have your chairman or pd look at it or someone else in the dept you trust, and send them out with a cover letter. that's it.

 

[bobloblaw]

Just a few random observations:

The Flynn guide that is circulated at ASTRO is helpful (though some of the data may be a little dated).

In general, narrowing your job search to a specific geographic area will help you from being too broad in your search. You can look radiation oncologists up by geographic region in the ASTRO directory and make inquiries by phone/email. You can ask around in your department - a lot of jobs are still advertised and filled by networking and word of mouth. The ASTRO job website and the advertisements in the back of the red journal are also options. Recruiters may also be helpful. Alumni from your program may also be useful for networking. Sometimes (varian, elekta, siemens, etc) equipment reps may know about new facilities being built in an area --> practices that are expanding.

Don't be afraid to follow up with phone calls/email/whatever. Some departments and practices are very disorganized when it comes to their recruitment process and they may need a little (polite and non-obnoxious) nudge/reminder.

Printed letters look nice, but emails are faster and easier to forward to colleagues - in my experience, most employers used email for correspondence (including CVs) rather than printed letters. Always bring printed extra copies of your CV with you when you meet a prospective employer in person though.

If a prospective employer contacts you, reply in a timely fashion. (i.e. return phone calls and emails the same day, and definitely don't make someone wait > 1 day to hear back from you). Be nice to the secretaries you talk to.

The summer is a good time to start making initial contacts and preparing your CV. However, the job hunt really accelerates in the months around ASTRO.

After you interview with someone, send them a short email to follow up and express interest in the position (assuming you are interested).

 

[Impressions]

so let's hypothetically say I was FOS when interviewing and have no motivation to go into academics (or we can say internship just beat it out of me):

is doing an impressive research project during residency really that important in getting a good private practice job? what sort of things to PP employers look for when considering new hires?

 

[deringer]

Don't know for sure, but I would imagine number of cases (and possibly variety of cases) might be more important to PP groups than academic publications.

 

[stephew]

for private practice, "fit" is everything. will you be a draw, get referrals and get along. Ability of course is important and refs etc are a must. Publications not as important unless its a hybrid practice.

 

[Thaiger75]

for private practice, "fit" is everything. will you be a draw, get referrals and get along. Ability of course is important and refs etc are a must. Publications not as important unless its a hybrid practice.

Could you expand more on what a "hybrid practice" is like?

 

[stephew]

they are sort of "inbetween" practices. For instance a satalite of an academic program or a private practice where the docs have keept close contacts with the academic community and publish a bit and do work in the radonc community administrativly. Examples of the former include the fall river practice associated with BWH/DFCI and the later would be Daniel Flynn who is very active with astro. Each example is a slightly different variation on the theme. Basically you tend not to get major research out of these groups, or major money, but more than enough of both for most.

 

[Thaiger75]

they are sort of "inbetween" practices. For instance a satalite of an academic program or a private practice where the docs have keept close contacts with the academic community and publish a bit and do work in the radonc community administrativly. Examples of the former include the fall river practice associated with BWH/DFCI and the later would be Daniel Flynn who is very active with astro. Each example is a slightly different variation on the theme. Basically you tend not to get major research out of these groups, or major money, but more than enough of both for most.

How common are these type of practices? Are they hard to come by? Are they competitive? And how does one market oneself for, say, the former?

 

[bobloblaw]

Just an opinion, but my sense was that private practices do not care all that much if you have an extensive research history. One practice I interviewed with actually took it as a negative. "You did this research during residency - are you sure you're really interested in our practice?"

I agree that "fit" is extremely important in private practice. You have to be able to get along with your partners and the referring docs.

From your standpoint, you should also make sure that you are comfortable with the treatment philosophy of the practice you are interviewing at. There are wider variations of what are considered "normal practice patterns" out there than what you may be used to from training. Will you be comfortable with the way that your colleagues treat patients? What kind of influence will they have over your treatment decisions (i.e. will it cause problems if you want to treat a bone met with 8Gy x1 vs 30Gy/10fx)? Though it might not feel like it, you're interviewing them as much as they are you.

 

[stephew]

that is very much true of academics too; you are interviewing them

 

[G'ville Nole]

so let's hypothetically say I was FOS when interviewing and have no motivation to go into academics (or we can say internship just beat it out of me):

is doing an impressive research project during residency really that important in getting a good private practice job? what sort of things to PP employers look for when considering new hires?

One pearl that has come down from several of the senior residents as they have engaged in the job search is this: Academic practices will look favorably upon all research (including writing protocols, grants, etc.), as this will likely be an expected part of your employment. In private practices, they also look at research, but with more of a focus on techniques (e.g. IMRT, brachytherapy, etc.) which stand to make you more marketable, or bring a new or wider patient population into the practice. It's true that they are unlikely to care much about basic science research or protocol writing.

From Steph:
<<for private practice, "fit" is everything. will you be a draw, get referrals and get along. Ability of course is important and refs etc are a must.>>

One of our former attendings had the "three A's" of private practice: Availability, Affability, and Ablility, in that order

Agree with all that's been posted about all practices looking for a good fit. One thing to be mindful of (again, based on oral tradition from those who have been through it) is that while rad onc jobs are currently plentiful, good rad onc jobs may take some effort to ferret out. There are certainly practices out there that will take someone fresh out of residency, work them as "cheap" labor for the initial evaluation period (usually about 2 years), and then cut them loose before offering partner status. Now, some good practices will do this as well, in good faith (if things aren't working out, they aren't working out; that is what the initial trial period is intended to determine), but some practices have a track record of routinely doing it. If you identify one of these practices, it is in your best interest to avoid them.

Academia has a different set of criteria for good vs. not so good, but I think in general most will (or should) provide you with comprehensive expectations regarding the apportionment of your time (clinic, research and teaching). If your goal is to be a researcher, it's in your interest to identify programs that will have strong mentoring, a good (or at least up and coming) track record of productivity, and that allow junior faculty some protected time away from clinic (not universal, even at some good programs).

 

[stephew]

that's an interesting point G'ville.

 

[radonc]

agreed, g'ville.

 

[StanGetz]

I didn't do too much private practice job searching so I can't speak too much about how the process is. The only thing I can say is that it's variable and I can't say there's a dominant trend that helps one get a job because it's so individualized based on personalities of the partners, regional factors, and personal connections.

As for academics, the more research you have the better. Use your faculty to help campaign for you, especially if they know people personally at a program you're interested in. Let your faculty know of particular programs you're interested in. Most importantly, take the first step to contact programs early. Don't wait for the ASTRO website or other advertisements. Good luck!

 

[radonc]

thanks for the advice...

 

[Thaiger75]

Is it too early now to start contacting programs for an academic position to start in July 2009? Particularly in light of ASTRO being way early this year...

 

[stephew]

yes. way too soon for formal applications. However you can certainly make efforts to get to know any one or two places you are seriously intrerested in. Any cv you send now will likely get filed and lost by 2009

 

[Thaiger75]

yes. way too soon for formal applications. However you can certainly make efforts to get to know any one or two places you are seriously intrerested in. Any cv you send now will likely get filed and lost by 2009

So when? June/July? What did you do to get into Harvard?

 

[stephew]

I think july/aug of 2008 is appropriate. Then its all about if they have a spot that you git into and if they think you fit into the group in terms of vision and personality.

 

[StreamTeam]

For those of us entering into the last year of residency, any advice on how to go about finding jobs? Particularly if you would like to stay in a specific region?

Thanks!

I can't give you specific advice on finding jobs, as I am semiretired, happily working part-time. I havent looked for a job for years.

But I can tell you that the job market must be good now, as I have never have so many people cold call me to ask if I am interested in working full time again. And I am the least desirable demographic, an older experienced guy who expects more money than a new graduate. So I assume there must be a shortage out there.

Part of the shortage may be due to an ominous trend in private practice. Most of the people contacting me are opening up uro-rad centers, where a group of urologists hires a radiation oncologist to treat their prostate cancer patients. It is an easy source of referals. But on the other hand it marks a loss in autonomy, as you are working for urologists.

Good luck to all of you who are looking for jobs.

 

[OTN]

Working "for" a urologist usually isn't quite correct when it comes to these uro-rad practices. Usually the radoncs are brought on as equal partners with the urologists, in terms of practice ownership.

 

[Adawaal]

Working "for" a urologist usually isn't quite correct when it comes to these uro-rad practices. Usually the radoncs are brought on as equal partners with the urologists, in terms of practice ownership.

Six urologists. One radiation oncologist. One person = one vote.

End result, you're still working FOR urologists, just getting more money for your soul as a "partner."

 

[radonc]

Working "for" a urologist usually isn't quite correct when it comes to these uro-rad practices. Usually the radoncs are brought on as equal partners with the urologists, in terms of practice ownership.

in smaller practices, yes this is true. in larger uro practices (with 1+ center) only the founding radonc(s) have partnership, while the others are just employees. i know of a practice in ny has 5 centers, and this is how it is setup.

 

[digimon]

I recently met a Urologist who was teaming up with Neurosurgeons to purchase a Cyberknife. Scary.

 

[3dtp]

Six urologists. One radiation oncologist. One person = one vote.

End result, you're still working FOR urologists, just getting more money for your soul as a "partner."

There is also a Stark regulation question with these centers. When a uro-rads owner urologist refers for IMRT-IGRT to a facility owned/operated by the group, it may be considered a prohibited self referral. This is unlike an independent rad-onc practice where a patient is always referred by a physician who has no ownership interest in a rad onc practice and is an arm's length referral. If CMS drops the hammer on these practices, things could get sticky.

And in related news, a opthalmologist has applied for patent protection on a device using an "orthovoltage" x-ray tube mounted on a lasik platform to treat wet macular degeneration, one of his key claims: little or no shielding required since we don't have to have a high energy linac, we can use it in our offices without having to refer to those naughty rad-oncs who can treat with Sr90 and steal our patients. The paraphrasing is mine, but the patent claim specifically stated this, in more eloquent terms.

Now, imagine every opthalmologist treating hither and yon with 50-125 kVp x-rays without having to spend money on shielding, dosimetry, those ever expensive medical physicists and rad oncs with bone blasting x-ray energies? I doubt the patent examiner will give him a patent, since he's basically claiming to have invented an x-ray tube on a gantry, but you never know. I hope the ACR is looking out for these things.

But this topic is a little off track..sorry, OP.

 

[OTN]

There is also a Stark regulation question with these centers. When a uro-rads owner urologist refers for IMRT-IGRT to a facility owned/operated by the group, it may be considered a prohibited self referral. This is unlike an independent rad-onc practice where a patient is always referred by a physician who has no ownership interest in a rad onc practice and is an arm's length referral. If CMS drops the hammer on these practices, things could get sticky.

And in related news, a opthalmologist has applied for patent protection on a device using an "orthovoltage" x-ray tube mounted on a lasik platform to treat wet macular degeneration, one of his key claims: little or no shielding required since we don't have to have a high energy linac, we can use it in our offices without having to refer to those naughty rad-oncs who can treat with Sr90 and steal our patients. The paraphrasing is mine, but the patent claim specifically stated this, in more eloquent terms.

Now, imagine every opthalmologist treating hither and yon with 50-125 kVp x-rays without having to spend money on shielding, dosimetry, those ever expensive medical physicists and rad oncs with bone blasting x-ray energies? I doubt the patent examiner will give him a patent, since he's basically claiming to have invented an x-ray tube on a gantry, but you never know. I hope the ACR is looking out for these things.

But this topic is a little off track..sorry, OP.

ACRO is heavily involved, as is ASTRO (but to a somewhat smaller extent), in lobbying efforts regarding these devices and others (Xoft, most specifically) to protect the future of radiation oncology.

I guess it's just a philosophical difference, but if someone wants to treat 40+ prostate patients all day for the rest of their career, it really doesn't bother me. One of the great draws for ME to the field was the diverse mix of patients we see, so those practices would definitely not be for me. I really think everyone should try and get past the "us vs them" mentality between medical specialties, which is why I try to perceive these groups as urologists and radiation oncologists working together to treat prostate cancer. Maybe I'm just being naive, but I have plenty of friends in plenty of medical specialties and have never seen them as the enemy.

 

[3dtp]

ACRO is heavily involved, as is ASTRO (but to a somewhat smaller extent), in lobbying efforts regarding these devices and others (Xoft, most specifically) to protect the future of radiation oncology.

I guess it's just a philosophical difference, but if someone wants to treat 40+ prostate patients all day for the rest of their career, it really doesn't bother me. One of the great draws for ME to the field was the diverse mix of patients we see, so those practices would definitely not be for me. I really think everyone should try and get past the "us vs them" mentality between medical specialties, which is why I try to perceive these groups as urologists and radiation oncologists working together to treat prostate cancer. Maybe I'm just being naive, but I have plenty of friends in plenty of medical specialties and have never seen them as the enemy.

I don't see this as an us v. them mentality. I do see it as an appropriateness of care issue. As a radiation oncologist, we are trained in the appropriate uses of radiation, not just the mechanics of radiation delivery. It is an issue of various specialty groups placing personal and practice economics above the interest of the patient. My concern is quality medicine and quality treatment, as is, I hope, ASTRO.