Usernameusername1
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I am a rising senior in radiation oncology residency who does not regret my decision to pursue this field.
Like many, I have been surprised to see the dramatic decline in residency applications, and after being made aware of what is being written on these forums, I want to provide an opposing perspective that I feel is not being adequately represented. There are a few thousand radiation oncologists in this country, and the crisis represented on these threads seems to be perpetuated primarily by a small number of active users. I do not feel this necessarily accurately reflects the sentiment of the larger radiation community.
Medical students are tasked with making life-changing specialty decisions with limited information. In the specialty search, there are many specialty-specific concerns to be aware of. The job market is (and has been) tough in rad onc compared to some other specialties, but this is not a new problem facing the field. You will find similar dooms-day type posts in nearly all other specialty-specific forums about how radiologists are being outsourced, or CRNAs taking over in anesthesia, primary care being pushed aside by mid-levels etc. There is almost no specialty without at least one significant threat or drawback.
A recent red journal article/survey found that almost two-thirds of all recent graduates found a job that met ALL of their desired metrics (salary, disease site, geography etc), with most residents finding jobs that met at least most of their top 3 job considerations. https://www.redjournal.org/article/S0360-3016(19)33454-6/fulltext. Nearly all surveyed found a job. Furthermore, anecdotally, the job market this year, right now, has been the strongest it has been in 10 years.
Are there some jobs that are less desirable than others – certainly. However, again, that absolutely holds true in any specialty. I suspect you are hearing disproportionately from those who are not satisfied.
Regarding expansion, at least 2 of the 3 "top programs" are apparently cutting residency slots simply in efforts to combat the expansion this year with many others expected to follow this year and next. Many smaller programs will undoubtedly close as the ACGME is mandating stricter requirements (dedicated rad bio faculty, 6 clinical faculty, etc) on residency programs. The reversal to the over-expansion is going to happen – the market is clearly asking for it.
Another common concern was the low board pass rate last year. The physics/rad bio pass rate this year was 99% after they adjusted the scoring methodology from last year. 2018 was a mistake and an anomaly I doubt the ABR will make again.
Radiation oncology as a cancer treatment is simply not going anywhere – we are simply too important in too many different diseases processes. We absolutely remain in high demand. Med onc's and radiologists simply cannot do this job without the specialty training that we have. We are using radiation more now than ever before with advances in immunotherapy, as patients live longer, we now see the benefits of treating oligometastatic sites. It is a fulfilling specialty with great work hours and excellent compensation. MGMA median compensation in rad onc was nearly 500k in 2018. I often hear of job that surpass this. Nobody regularly works nights, weekends, or holidays. We treat, often cure, cancer patients. To me, this is fulfilling work.
A recent thread stated, “the demand for rad onc just died,” after discussion that CMS is modifying the supervision level required in hospital-associated practices. This view could not be more pessimistic and in my opinion, wrong. While some of the concerns are valid, I am skeptical this will have the catastrophic effect so confidently predicted. Perhaps there will be a decrease in demand/staffing in rural practices - it is just too early to know. However, I suspect many practices will not be interested in the increased liability or operational troubles associated with leaving facilities un-supervised, particularly for SBRTs. I predict this rule is ultimately amended in the future but we will see. Regardless, for many already in established practices, this will be a welcome change due to the increased flexibility.
Medicine is changing – large health systems are taking control and CMS is in control of our future. This is unwelcome; however, the reality is that this issue is again not specific to rad onc. Bundled payments will ultimately extend well beyond radiation. Most specialists are going to make less money. I urge you caution to base long term life decisions on the posts of a few strangers on the internet. In my opinion, a healthy majority of us are happy and would do it again the same way. It is unfortunate to see so many med students who are passionate about radiation ultimately choose other specialties based on what I consider to be a pessimistic vocal minority. Be aware of the issues facing any specialty when you apply, but I would still advocate that there is more good than bad in rad onc, and is still a great career path. I predict SDN ends up damaging the perception and perhaps even the field as a whole onc more than these underlying issues ever would have.
I suspect the majority of replies will disagree with my perspective, but in a sense that is exactly my point.
Like many, I have been surprised to see the dramatic decline in residency applications, and after being made aware of what is being written on these forums, I want to provide an opposing perspective that I feel is not being adequately represented. There are a few thousand radiation oncologists in this country, and the crisis represented on these threads seems to be perpetuated primarily by a small number of active users. I do not feel this necessarily accurately reflects the sentiment of the larger radiation community.
Medical students are tasked with making life-changing specialty decisions with limited information. In the specialty search, there are many specialty-specific concerns to be aware of. The job market is (and has been) tough in rad onc compared to some other specialties, but this is not a new problem facing the field. You will find similar dooms-day type posts in nearly all other specialty-specific forums about how radiologists are being outsourced, or CRNAs taking over in anesthesia, primary care being pushed aside by mid-levels etc. There is almost no specialty without at least one significant threat or drawback.
A recent red journal article/survey found that almost two-thirds of all recent graduates found a job that met ALL of their desired metrics (salary, disease site, geography etc), with most residents finding jobs that met at least most of their top 3 job considerations. https://www.redjournal.org/article/S0360-3016(19)33454-6/fulltext. Nearly all surveyed found a job. Furthermore, anecdotally, the job market this year, right now, has been the strongest it has been in 10 years.
Are there some jobs that are less desirable than others – certainly. However, again, that absolutely holds true in any specialty. I suspect you are hearing disproportionately from those who are not satisfied.
Regarding expansion, at least 2 of the 3 "top programs" are apparently cutting residency slots simply in efforts to combat the expansion this year with many others expected to follow this year and next. Many smaller programs will undoubtedly close as the ACGME is mandating stricter requirements (dedicated rad bio faculty, 6 clinical faculty, etc) on residency programs. The reversal to the over-expansion is going to happen – the market is clearly asking for it.
Another common concern was the low board pass rate last year. The physics/rad bio pass rate this year was 99% after they adjusted the scoring methodology from last year. 2018 was a mistake and an anomaly I doubt the ABR will make again.
Radiation oncology as a cancer treatment is simply not going anywhere – we are simply too important in too many different diseases processes. We absolutely remain in high demand. Med onc's and radiologists simply cannot do this job without the specialty training that we have. We are using radiation more now than ever before with advances in immunotherapy, as patients live longer, we now see the benefits of treating oligometastatic sites. It is a fulfilling specialty with great work hours and excellent compensation. MGMA median compensation in rad onc was nearly 500k in 2018. I often hear of job that surpass this. Nobody regularly works nights, weekends, or holidays. We treat, often cure, cancer patients. To me, this is fulfilling work.
A recent thread stated, “the demand for rad onc just died,” after discussion that CMS is modifying the supervision level required in hospital-associated practices. This view could not be more pessimistic and in my opinion, wrong. While some of the concerns are valid, I am skeptical this will have the catastrophic effect so confidently predicted. Perhaps there will be a decrease in demand/staffing in rural practices - it is just too early to know. However, I suspect many practices will not be interested in the increased liability or operational troubles associated with leaving facilities un-supervised, particularly for SBRTs. I predict this rule is ultimately amended in the future but we will see. Regardless, for many already in established practices, this will be a welcome change due to the increased flexibility.
Medicine is changing – large health systems are taking control and CMS is in control of our future. This is unwelcome; however, the reality is that this issue is again not specific to rad onc. Bundled payments will ultimately extend well beyond radiation. Most specialists are going to make less money. I urge you caution to base long term life decisions on the posts of a few strangers on the internet. In my opinion, a healthy majority of us are happy and would do it again the same way. It is unfortunate to see so many med students who are passionate about radiation ultimately choose other specialties based on what I consider to be a pessimistic vocal minority. Be aware of the issues facing any specialty when you apply, but I would still advocate that there is more good than bad in rad onc, and is still a great career path. I predict SDN ends up damaging the perception and perhaps even the field as a whole onc more than these underlying issues ever would have.
I suspect the majority of replies will disagree with my perspective, but in a sense that is exactly my point.
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