Thought experiment

[RickyScott]

What if all residencies were totally shut down, (obviously wouldn’t happen)but allowed current residents to graduate? How many radoncs would there be in early 2030s -when baby boomers (and all their cancers) have died. No residents for an entire decade!

A: job market still would be vastly oversupplied with far more than 3500 radoncs despite universal hypofract- given presently such a disproportionate number of radoncs near start of their career. Just trying to frame magnitude of the problem.

Rad onc: one of the smallest fields in medicine. Which means it is highly sensitive to what would be more drawn out and less tumultuous perturbative effects within the specialty, vis-à-vis supply/demand, versus that of other fields. Things began looking a little over-supplied around 2010-13. So really we have just had ~7 cycles of new rad onc residency cohorts, and new rad onc grads, in that time frame. There were ~3500 rad oncs nationally in 2010 and there are ~5000-5200 now; this growth has not been offset by rising cancer incidence/prevalence, or increase in new rad onc indications. If anything, the opposite on both counts. And, resident numbers exploded (relative to previous class sizes and the number of rad oncs in America) in that period. Also, practice patterns in rad onc substantially changed (patient treatment schedules have substantially shortened). What HAS NOT been fully "baked into the market" yet is: 1) patient treatment schedules have not maximally shortened yet and their national adoption has been weak (NB: even at academic centers)... once fully adopted this will hurt the workforce market more, 2) trend toward decreased "supervision" (historically a rad onc had to mindlessly "babysit" machines with no active oversight/effort by the MD for the treatment... regulators are beginning to see this as needless), 3) reimbursement pressures which will take the form of one lump sum payment for a diagnosis somewhat irrespective of complexity/length of treatment/mode of irradiation.

An interesting book could be written about it all IMHO.

---

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[scarbrtj]

What if all residencies were totally shut down, (obviously wouldn’t happen)but allowed current residents to graduate? How many radoncs would there be in early 2030s -when baby boomers (and all their cancers) are dying. No residents for an entire decade!

A: job market still would be vastly oversupplied with far more than 3500 radoncs despite universal hypofract- given presently such a disproportionate number of radoncs near start of their career. Just trying to frame magnitude of the problem.

Here's another thought experiment for you. Siemens is now ~70% of the rad onc market. But what is the rad onc market to Siemens? They're only going to get a **3% return** on their investment for the next 5-10y. Rad onc is EVERYTHING to us rad oncs obviously. But what is rad onc to Siemens? A very small line item in their budget for as far as the eye can see. What if Siemens one day decides to exit the rad onc market? What if the only high energy therapeutic X-ray supplier in the world is essentially Elekta. That'll be a very weird and barren world. Like Zietman said: we're all hitched to a modality, not an anatomic site. If neurosurgeons own the brain e.g., we own the linac. God makes the brain, and Siemens makes the linacs. I kind of get the sense I'm seeing a weird last gasp from a bubble that started ~10 years ago.

Ah well. Best not to think about such things now!

 

[RickyScott]

If 3500 radoncs in 2010- assuming career length of 30 years- (but it is actually longer) would guess that around 100 retire a year (and why we had around 100 residents year in early 2000s). Presently 1000 residents already in training, so if 100 continue to retire/ year, in 10 years, we will have about same # of radoncs as we do today- following decade -long complete residency ban! (None of large cohort of radoncs created by expansion bubble are eligible to retire). Additionally, in early 2030s, we will have lost many cancers with demise of baby boomers, plus hypofractionation will be universal, and supervision may be optional, and radiation will almost certainly be more centralized.

Sean Carroll's Mindscape: Science, Society, Philosophy, Culture, Arts, and Ideas: Carl Bergstrom on Information, Disinformation, and B******t on Apple Podcasts

Show Sean Carroll's Mindscape: Science, Society, Philosophy, Culture, Arts, and Ideas, Ep Carl Bergstrom on Information, Disinformation, and B******t - Aug 3, 2020

podcasts.apple.com

 

[thecarbonionangle]

Here's another thought experiment for you. Siemens is now ~70% of the rad onc market. But what is the rad onc market to Siemens? They're only going to get a **3% return** on their investment for the next 5-10y. Rad onc is EVERYTHING to us rad oncs obviously. But what is rad onc to Siemens? A very small line item in their budget for as far as the eye can see. What if Siemens one day decides to exit the rad onc market? What if the only high energy therapeutic X-ray supplier in the world is essentially Elekta. That'll be a very weird and barren world. Like Zietman said: we're all hitched to a modality, not an anatomic site. If neurosurgeons own the brain e.g., we own the linac. God makes the brain, and Siemens makes the linacs. I kind of get the sense I'm seeing a weird last gasp from a bubble that started ~10 years ago.

Ah well. Best not to think about such things now!

sorta like when you’re heavily drinking and having a good time with your boys/gurls. You know the hang over is coming later, but you don’t worry about it now. you don’t regret those shots of cheap don julio at the time, but eventually you pay for it. Sooner or later. Like kanye says, whats worst the pain or hang over!? They both suck and they both coming folks!

bottoms up tonight my friends.

 

[Chartreuse Wombat]

 

[Palex80]

What if all residencies were totally shut down, (obviously wouldn’t happen)but allowed current residents to graduate? How many radoncs would there be in early 2030s -when baby boomers (and all their cancers) have died. No residents for an entire decade!

A: job market still would be vastly oversupplied with far more than 3500 radoncs despite universal hypofract- given presently such a disproportionate number of radoncs near start of their career. Just trying to frame magnitude of the problem.

You are asbsolutely correct. There is no short-term solution to the problem. All measures that may be undertaken now (such as limiting positions of new residents) are only going to show differences in the market in 20+ years probably.

From my (European) point of view: We also have quite some concerns about rising numbers of residents completing their training and possible problems in the job market in the coming years (right now it's all still ok, but we do not want to go down that road), but what we have also seen is a rising figure of young attendings not wanting to work full-time. Historically, this was (and still is) a common situation in young women, who opt for a better work-life balance and family, but I am seeing more and more male attendings opting to work only 3-4 days per week. The money is still good and they can start into a prolonged weekend on Friday or extend the weekend into Monday to go sightseeing, snowboarding, sailing, or whatever. And of course, some also like to spend more time at home with the family.
On the other hand, I have the impression that a sizable number of young US doctors prefer to work full time fresh-off residency, hoping to gather enough assets by the age of 50 something and then retire early (the question remains how many would actually do retire then or if having so many assets by the age of 50 will not provoke one to continue working at the same pace to get even more assets), this is a phenomenon you hardly find in Europe.

Who would opt for 300k and 5 days work/ week and who would opt for 180k and 3 days work/week?

I fully understand that many of US attendings still have considerable tuition debts to pay and therefore need to work full time, but perhaps rethinking of the model of when and how much one works should be put more into focus. If half of the young attendings in the US suddenly decided to work 3 days/week, you would immediately have 20% extra open attendings spots.

 

[elementaryschooleconomics]

Here's another thought experiment for you. Siemens is now ~70% of the rad onc market. But what is the rad onc market to Siemens? They're only going to get a **3% return** on their investment for the next 5-10y. Rad onc is EVERYTHING to us rad oncs obviously. But what is rad onc to Siemens? A very small line item in their budget for as far as the eye can see. What if Siemens one day decides to exit the rad onc market? What if the only high energy therapeutic X-ray supplier in the world is essentially Elekta. That'll be a very weird and barren world. Like Zietman said: we're all hitched to a modality, not an anatomic site. If neurosurgeons own the brain e.g., we own the linac. God makes the brain, and Siemens makes the linacs. I kind of get the sense I'm seeing a weird last gasp from a bubble that started ~10 years ago.

Ah well. Best not to think about such things now!

Something else to consider is the Genesis acquisition of 21C.

Whatever you think of 21C - they were/are a large heatsink for the RadOnc job market. From my conversations with people involved with the company currently, it's clear that no one is sure what direction Genesis is headed. They're going to want to make money, that's a given. What's the best way to do that entering the market with looming APM and a vast oversupply of physicians?

"Expand" does not seem like a likely answer...

 

[Mandelin Rain]

Here's another thought experiment for you. Siemens is now ~70% of the rad onc market. But what is the rad onc market to Siemens? They're only going to get a **3% return** on their investment for the next 5-10y. Rad onc is EVERYTHING to us rad oncs obviously. But what is rad onc to Siemens? A very small line item in their budget for as far as the eye can see. What if Siemens one day decides to exit the rad onc market? What if the only high energy therapeutic X-ray supplier in the world is essentially Elekta. That'll be a very weird and barren world. Like Zietman said: we're all hitched to a modality, not an anatomic site. If neurosurgeons own the brain e.g., we own the linac. God makes the brain, and Siemens makes the linacs. I kind of get the sense I'm seeing a weird last gasp from a bubble that started ~10 years ago.

Ah well. Best not to think about such things now!

What if... Siemens made an IR friendly diagnostic/therapeutic integrated CT+/-PET/Linac replete with SUV based autocontouring, an AI based planning using established NTC probability modeling, and adaptive planning. Basically a suped up Tomotherapy unit marketed to the radiologists/radiology groups they're used to doing business with....

 

[randomname2018]

I would gladly entertain a 3 or 4 day schedule.

However, this is a fools errand in the US academic market. Part time pay would immediate translate to full time effort with regards to patient volume. US academic administration has never protected faculty. It is not in their best interest to do so.

Current junior faculty represent the best and brightest over the last 5 to 10 years and I know no one working at a reduced schedule by choice in an academic setting. This is purposeful. We are not foolish. In fact we are objectivity brighter than our leadership.

 

[elementaryschooleconomics]

Siemens buys Varian, Genesis acquires 21C, and:

 

[fiji128]

You are asbsolutely correct. There is no short-term solution to the problem. All measures that may be undertaken now (such as limiting positions of new residents) are only going to show differences in the market in 20+ years probably.

From my (European) point of view: We also have quite some concerns about rising numbers of residents completing their training and possible problems in the job market in the coming years (right now it's all still ok, but we do not want to go down that road), but what we have also seen is a rising figure of young attendings not wanting to work full-time. Historically, this was (and still is) a common situation in young women, who opt for a better work-life balance and family, but I am seeing more and more male attendings opting to work only 3-4 days per week. The money is still good and they can start into a prolonged weekend on Friday or extend the weekend into Monday to go sightseeing, snowboarding, sailing, or whatever. And of course, some also like to spend more time at home with the family.
On the other hand, I have the impression that a sizable number of young US doctors prefer to work full time fresh-off residency, hoping to gather enough assets by the age of 50 something and then retire early (the question remains how many would actually do retire then or if having so many assets by the age of 50 will not provoke one to continue working at the same pace to get even more assets), this is a phenomenon you hardly find in Europe.

Who would opt for 300k and 5 days work/ week and who would opt for 180k and 3 days work/week?

I fully understand that many of US attendings still have considerable tuition debts to pay and therefore need to work full time, but perhaps rethinking of the model of when and how much one works should be put more into focus. If half of the young attendings in the US suddenly decided to work 3 days/week, you would immediately have 20% extra open attendings spots.

In theory I would love to do 3 days a week. But in this specialty it is not a good idea for a new grad in the US. Firstly, if you intend on building a practice and referral base out of residency you need to be around the clinic at least 4 but probably 5 days a week. Secondly, given all the sirens going off about how this specialty, by its own hand none the less, is making itself a non viable for someone hoping to work for 30 more years you best make, save and invest as much money as you can now because in 10 years who knows if you'll even be employable full time.

This is why no current medical student should pursue this field. No other specialty has this type of uncertainty surrounding it.

 

[Mandelin Rain]

Working 3 days/week = 5 days of work for 60% pay

 

[BobbyHeenan]

Working 3 days/week = 5 days of work for 60% pay

Exactly.

Unless you're extremely strict about turning off your phone, etc it's just not feasible. Good luck growing a practice by not taking cell phone calls on your days off either. Unless all specialties go to this kind of culture/model, it's just not do able for most of us.

 

[hbosch]

Yes, there are already a lot of locums jobs that are part-time but 5 consults a week. That’s a full time job. And that’s for 2 days a week! The other issue for the US is you would be a part-time contractor with the hospital or practice because they don’t want to give benefits to 2 different employees...benefits are generally reserved for full time employees.

 

[Tigerstang]

Yes, there are already a lot of locums jobs that are part-time but 5 consults a week. That’s a full time job. And that’s for 2 days a week! The other issue for the US is you would be a part-time contractor with the hospital or practice because they don’t want to give benefits to 2 different employees...benefits are generally reserved for full time employees.

Five consults a week is not a full time job. It used to be, but it's not anymore. I average 10 a week at minimum.

 

[Mandelin Rain]

I feel like I used to see 10, but now see 5.

 

[hbosch]

Five consults a week is not a full time job. It used to be, but it's not anymore. I average 10 a week at minimum.

Right- that’s the point. It used to be part-time. Now part-time is what a full time load used to be...and without the full time pay and full time benefits. Your full workload and how much time you spend also depends on the site. Seeing head and neck and Gyn is a lot more work than breast, prostate and lung SBRTs with lung SBRTs being the easiest. SRS is another easy one- easy to rack up RVUs and not have a head and neck contour...it’s a different world now for sure. And soon SBRT/SRS won’t generate much revenue either. We should all be doing FYRE or whatever that acronym is.

 

[scarbrtj]

Right- that’s the point. It used to be part-time. Now part-time is what a full time load used to be...and without the full time pay and full time benefits.

I feel like I used to see 10, but now see 5.

Gravity. Not this one, but this one ↓. Predictable. Doesn't lose an argument, ever.

 

[Mandelin Rain]

We should all be doing FYRE or whatever that acronym is.

Definitely don't want to do FYRE.

 

[scarbrtj]

Seemed as good a place as any to put these. Siemens, do you read?

Radiation Therapy for Early Breast Cancer Safe in Fewer, Higher Doses

Radiation therapy in fewer, larger doses does not seem to increase the risk of long-term side effects for people with early breast cancer, a study shows.

breastcancer-news.com

Phase II prospective trial "Give Me Five" short-term high precision radiotherapy for early prostate cancer with simultaneous boost to the dominant intraprostatic lesion: the impact of toxicity on quality of life (AIRC IG-13218).

As part of the AIRC IG-13218 (NCT01913717), we analyzed data from patients with low- and intermediate-risk prostate cancer treated with extreme hypofractionated radiotherapy (RT) and simultaneous boost to the intraprostatic lesion.

www.urotoday.com

 

[medgator]

Five consults a week is not a full time job. It used to be, but it's not anymore. I average 10 a week at minimum.

yup... that's what the Dr Oliviers of the academic world don't understand.... hypofx is just going to allow the existing workforce to see more patients per year

 

[randomname2018]

Millennial faculty are starting to realize that the traditional academic model is a poor return on investment. Slaving over department demands and subsidizing nonclinical chairs for decades with the hope of one day being promoted is no longer worth it. This is even more true recently with the complete lack of leadership on a national level.

 

[OTN]

yup... that's what the Dr Oliviers of the academic world don't understand.... hypofx is just going to allow the existing workforce to see more patients per year

Yep. When my partner retires I do not plan on replacing her.

 

[Neuronix]

If half of the young attendings in the US suddenly decided to work 3 days/week, you would immediately have 20% extra open attendings spots.

This would require a complete change in American society to replicate. Our benefits (healthcare, retirement, malpractice insurance in many cases, etc) are tied to full-time employment. By going part-time you lose not only salary, but these benefits.

Many of the salaries in the USA are based on production as well. This leads to a competition for patients among individual doctors. Being available full-time is basically a requirement to have any patients at all because patients and referrings have an expectation that you're at least working full-time in the usa (if not more). If there's an undersupply of docs it's a different story (they have no choice so they will wait for you), but with rad oncs being a dime a dozen you have to be available for referrings at all times to compete for patients and get a reasonable salary at all.

Unfortunately, we also probably all have experience of people who are salaried who go part-time, take a pay cut and/or lose benefits, who then have their 3 days of clinic overstuffed with 5 days of work anyway. You end up putting in notes and orders, taking phone calls, going to mandatory meetings, and doing contours on your off days (all uncompensated). I've seen a number of women go part-time and be very dissatisfied over these issues. This makes part-time not viable in most situations in the usa. I think some segment of the population would be fine with a 3 day a week job that is REALLY 3 days a week (~30 hours), is stable, and includes 60% pay + benefits. But those jobs rarely seem to actually exist.

The long, competitive, and intense college, medical school, and residency training followed by an intense and competitive career leads many to burnout and many at least fantasize about retiring early. In rad onc, there are not jobs to switch to if you don't like yours, so a lot of junior people talk about early retirement. It's really the only way out for a lot of people since being a rad onc only trains you for one possible career.

 

[hbosch]

Yes. I’ve thought about part-time but never committed to it because of the above. It’s not really part-time, and you end up losing benefits.

 

[GapCalc]

Yep. When my partner retires I do not plan on replacing her.

But... I swear I'd take all the cases you don't want to treat. Please?

EDIT: Does this count as 'networking'? Asking for a friend...

 

[thecarbonionangle]

But... I swear I'd take all the cases you don't want to treat. Please?

EDIT: Does this count as 'networking'? Asking for a friend...

i’ll take your 90 demented H&N cancer and skin patients plus any patient with personality disorders and the palliative bone met messes, pretty please!

 

[scarbrtj]

Today's email:


Dr. XXXXX:

I hope you are safe and well! I am reaching out because some of our best radiation oncologists have been impacted by the economic changes brought on by COVID 19. Some have experienced furlough’s and others are out of work altogether due to financial cut backs. In what is typically a “physician light / job heavy market” we find ourselves with more physicians looking for locum tenens opportunities than we’ve seen in recent years.

I wanted to check in and see how things are looking with your facility? Do you have any anticipated coverage needs that we can help with?

Warm Regards,

Tyler Roberts
Client Developer, Locum Tenens Division

CompHealth
Work: 801.930.3975
Mobile: 435.899.8462

 

[fiji128]

Today's email:


Dr. XXXXX:

I hope you are safe and well! I am reaching out because some of our best radiation oncologists have been impacted by the economic changes brought on by COVID 19. Some have experienced furlough’s and others are out of work altogether due to financial cut backs. In what is typically a “physician light / job heavy market” we find ourselves with more physicians looking for locum tenens opportunities than we’ve seen in recent years.

I wanted to check in and see how things are looking with your facility? Do you have any anticipated coverage needs that we can help with?

Warm Regards,

Tyler Roberts
Client Developer, Locum Tenens Division

CompHealth
Work: 801.930.3975
Mobile: 435.899.8462

Maybe they should try posting to #radonc or #radoncrocks on twitter to reach the broadest audience?

 

[DebtRising]

Look at the marketing angle though. Is there any other field with reverse locums? Not only can you cold email to beg for jobs, you can pay a staffing company to do it for you! Rad onc continues to rocket to the top of the charts. Congratulations to everyone who did there part to make this dream possible.

 

[scarbrtj]

This is tragedy in medicine right now. People don't even really know yet. (If they really knew they'd not pen such missives.) The mathematical/economical chickens are about to come home to roost. It is time to think seriously about exiting the rad onc pipeline if you're PGY1-3 and in the pipeline. At least consider it is all's I'm saying. Weigh the hassle of switch versus a 10+% probability of very weak to absent employment prospects after residency. And the 10+% could be a low guess on my part.

 

[medgator]

Look at the marketing angle though. Is there any other field with reverse locums? Not only can you cold email to beg for jobs, you can pay a staffing company to do it for you! Rad onc continues to rocket to the top of the charts. Congratulations to everyone who did there part to make this dream possible.

Path?

 

[RadOncMegatron]

Maybe they should try posting to #radonc or #radoncrocks on twitter to reach the broadest audience?

 

[fiji128]

This is tragedy in medicine right now. People don't even really know yet. (If they really knew they'd not pen such missives.) The mathematical/economical chickens are about to come home to roost. It is time to think seriously about exiting the rad onc pipeline if you're PGY1-3 and in the pipeline. At least consider it is all's I'm saying. Weigh the hassle of switch versus a 10+% probability of very weak to absent employment prospects after residency. And the 10+% could be a low guess on my part.

From above Red Journal letter to the editor in regards to step 1 becoming pass/fail:

Basically now that med students won't be wasting as much time studying biochem and embryology this space can now be used to advocate for earlier exposure to oncology concepts and radiation oncology specifically. Why?

"Given recent trends, this is not a means to simply increase applicant volume, but rather an opportunity to build interest and provide mentorship to a more diverse cohort of students."

This was written by alot of the folks you see on Twitter. These people are truly acedimics that are wondering around left field. It is completely UNETHICAL to "build interest" and provide "mentorship" to anyone looking to go into this field given the dismal long term professional/employment prospects. These authors only have their own professional interest/status in mind and are not the student advocates they sell themselves as.

 

[hbosch]

Yes, self absorbed, self centered and actually cruel to whoever they want to drag into this field. It’s pretty callous when you don’t care about their future ability to find a job.

These are the people who list the names of the students they have mentored on their CVs. They don’t want to lose the gold ⭐️ on their charts.

 

[kimplera]

From above Red Journal letter to the editor in regards to step 1 becoming pass/fail:

Basically now that med students won't be wasting as much time studying biochem and embryology this space can now be used to advocate for earlier exposure to oncology concepts and radiation oncology specifically. Why?

"Given recent trends, this is not a means to simply increase applicant volume, but rather an opportunity to build interest and provide mentorship to a more diverse cohort of students."

This was written by alot of the folks you see on Twitter. These people are truly acedimics that are wondering around left field. It is completely UNETHICAL to "build interest" and provide "mentorship" to anyone looking to go into this field given the dismal long term professional/employment prospects. These authors only have their own professional interest/status in mind and are not the student advocates they sell themselves as.

Completely disagree - building interest and providing mentorship to expose more individuals to the good that radonc can do for cancer patients (regardless or even in spite of their future career path) is time well spent - too many medical students have never heard of our field and think that more chemo is the only answer to cure or palliate cancer patients.

Also - wrt to the post - the list of mentees that we keep is a requirement of the university promotion process (and yes - at some institutions it remains up (i.e. promoted) or out (i.e. find another job))

 

[RickyScott]

Completely disagree - building interest and providing mentorship to expose more individuals to the good that radonc can do for cancer patients (regardless or even in spite of their future career path) is time well spent - too many medical students have never heard of our field and think that more chemo is the only answer to cure or palliate cancer patients.

Also - wrt to the post - the list of mentees that we keep is a requirement of the university promotion process (and yes - at some institutions it remains up (i.e. promoted) or out (i.e. find another job))

While promoting awareness of xrt is great, authors clearly want to lure URM into the field and set them on the path to unemployment. Btw mentoring has exceptionally little impact- (and likely none) on promotion prospects. Job market believe it or not does impact promotions

 

[scarbrtj]

While promoting awareness of xrt is great, authors clearly want to lure URM into the field

Let's see PW continue saying the quality of rad onc applicants and residents is declining then.

 

[fiji128]

Completely disagree - building interest and providing mentorship to expose more individuals to the good that radonc can do for cancer patients (regardless or even in spite of their future career path) is time well spent - too many medical students have never heard of our field and think that more chemo is the only answer to cure or palliate cancer patients.

Also - wrt to the post - the list of mentees that we keep is a requirement of the university promotion process (and yes - at some institutions it remains up (i.e. promoted) or out (i.e. find another job))

It is not wrong to promote what the field does in general. It is wrong to do it in such away as to encourage/mentor med students to apply into this field, that has a high likelihood of causing complete havoc in their life once they are out of residency. It's not like med onc or radiology where you can always fall back on your general training credentials in the worse case scenerio. In rad onc if it doesn't go your way you're just SOL.

 

[scarbrtj]

This was written by alot of the folks you see on Twitter. These people are truly acedimics that are wondering around left field.

Unfortunately, the proportion of radiation oncology that is people "wondering around left field" has become very outsize. And is growing!

 

[thecarbonionangle]

This is tragedy in medicine right now. People don't even really know yet. (If they really knew they'd not pen such missives.) The mathematical/economical chickens are about to come home to roost. It is time to think seriously about exiting the rad onc pipeline if you're PGY1-3 and in the pipeline. At least consider it is all's I'm saying. Weigh the hassle of switch versus a 10+% probability of very weak to absent employment prospects after residency. And the 10+% could be a low guess on my part.

a bad job market hurts us all. Even people in amazing enviable jobs now have little movement if their personal situations change. There is no guarantee you can absolutely find something exactly where you want. Less flexibility. Employed people have to keep head down because losing employment at the moment would be terrible. Nobody can speak up. Its overall a bad environment for everyone even those in amazing jobs. People are basically locked in. The saying was first job is not your last. Is this still the case?

we are on the pirate ship sitting on plank. Only way out is to jump. No other ships around. The sharks feast on your emaciated body from the breadlines if the scurvy does not get you. The shoulder monkey/parrot laughs at you.

 

[RickyScott]

a bad job market hurts us all. Even people in amazing enviable jobs now have little movement if their personal situations change. There is no guarantee you can absolutely find something exactly where you want. Less flexibility. Employed people have to keep head down because losing employment at the moment would be terrible. Nobody can speak up. Its overall a bad environment for everyone even those in amazing jobs. People are basically locked in. The saying was first job is not your last. Is this still the case?

we are on the pirate ship sitting on plank. Only way out is to jump. No other ships around. The sharks feast on your emaciated body from the breadlines if the scurvy does not get you.

key point and why I post.

 

[scarbrtj]

a bad job market hurts us all. Even people in amazing enviable jobs now have little movement if their personal situations change. There is no guarantee you can absolutely find something exactly where you want. Less flexibility. Employed people have to keep head down because losing employment at the moment would be terrible. Nobody can speak up. Its overall a bad environment for everyone even those in amazing jobs. People are basically locked in. The saying was first job is not your last. Is this still the case?

The Most Innovative Lauded Future Guy in the c-suite will be the one who's trimmed the hospital rad onc workforce/rad onc MD salary outlay. "Brilliant, Bob. Why didn't we think of this before?" Don't know why it's always "Bob" but check me. Pretty sure that's right.

"The sharks feast on your emaciated body from the breadlines if the scurvy does not get you."

True.

 

[thecarbonionangle]

The Most Innovative Lauded Future Guy in the c-suite will be the one who's trimmed the hospital rad onc workforce/rad onc MD salary outlay. "Brilliant, Bob. Why didn't we think of this before?" Don't know why it's always "Bob" but check me. Pretty sure that's right.

"The sharks feast on your emaciated body from the breadlines if the scurvy does not get you."

True.

most def an old white guy named “bob”. They are the karens. I see these empty three piece suits all over hospital.

 

[beamotherapy]

most def an old white guy named “bob”. They are the karens. I see these empty three piece suits all over hospital.

I had a meeting with the Bobs. They asked me "what would you say you do here?" I told them "I have people skills!"

 

[Ray D. Ayshun]

I had a meeting with the Bobs. They asked me "what would you say you do here?" I told them "I have people skills!"

I don't remember all the conclusions on your mat. Was one of them "obligatory fellowship?"

 

[Mandelin Rain]

Want to be a board certified doc making less than the residents you are forced to educate? Come to rad onc.

 

[scarbrtj]

View attachment 315543

Want to be a board certified doc making less than the residents you are forced to educate? Come to rad onc.

Maybe try to “redo” or “remediate” a few residency years to stay in the higher earning part of career?

 

[beamotherapy]

I don't remember all the conclusions on your mat. Was one of them "obligatory fellowship?"

Yes, that is how you win "Jump to conclusions: Rad Onc Edition"

 

[metallica81788]

Want to be a board certified doc making less than the residents you are forced to educate? Come to rad onc.

Maybe you could go to dosimetry school while you're doing in house night call in hopes of that future pay raise.