what could we learn from the oversupplied Canadian radonc job market?

[FreakFlag]

What could we learn from the oversupplied Canadian radonc job market to help correct our US job market? If I recall correctly, the Canadian radoncs I've chatted with (mostly at various conferences pre-COVID) mentioned:

1. Canadian government(?) mistakenly over-allocated training spots for radoncs in Canada
2. some Canadian grads have completed *multiple* fellowships due to ongoing lack of job availability post-residency
3. some Canadian grads proactively took American oral boards in addition to their own Canadian boards

I personally remember multiple Canadian senior residents joining our online ABR oral board study groups around 2013. Very well-trained, sharp folks - they were serious about taking ABR orals and they passed. I don't know where they secured jobs after that though.

Even though our two countries' healthcare systems are different, understanding the Canadian experience may help to better shape ours.

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[deleted605854]

- You are correct. The Canadian government overestimated the number of rad oncs they needed.

-Rad Onc fellowships are not new. They've been common in the Canadian system since the 90s. But now more folks are doing 2 years of it and I've met a couple of people who've done 3.

-Keep in mind that Canadian programs started decreasing their intake in 2011 until all programs halved their intake or so in 2015. The positions that go unmatched have their funding distributed to other more deserving specialties. No SOAP equivalent. All programs have difficulty filling their spots. Even with all this Canadian grads have a tough time getting a job.

-Taking the American boards is something that Canadians have always done in all specialities. It opens up doors for the future and the American board is viewed as more prestigious. However, the number of Canadians doing the ABR exam has decreased. I know that in 2018 the number of people doing the written exam was only a single digit number. Remember folks, no need to sponsor visas if you have lots of people in the US willing to settle for whatever job. So why would Canadians continue to bother with the ABR ? Might as well do a fellowship in a nice city in Canada and try your luck next year.

 

[RickyScott]

The difference between here and Canada: Canada was not faced with concurrent /sudden change in utilization/hypofract/supervision changes. They simply trained too many radoncs. US also acted as bit of a safety valve for Canadians as a number of them ended up here.

 

[deleted605854]

The difference between here and Canada: Canada was not faced with concurrent /sudden change in utilization/hypofract/supervision changes. They simply trained too many radoncs. US also acted as bit of a safety valve for Canadians as a number of them ended up here.

True, but in Canada payments have always been bundled hence why Whelan did his breast hypofrac trial.

Supervision rules are different. Advanced practice radiation therapists can look at CBCTs and therapists can look at EPID and Orthogonals. While the patients are being treated you just need a rad Onc MD in the facility even if that MD is a resident.

Looking at the Royal college directory it seems that Rad Onc has one of the lower attrition percentages into the US compared with ENT, Neurosurgery, Orthopedics and Radiology.

 

[RickyScott]

True, but in Canada payments have always been bundled hence why Whelan did his breast hypofrac trial.

Supervision rules are different. Advanced practice radiation therapists can look at CBCTs and therapists can look at EPID and Orthogonals. While the patients are being treated you just need a rad Onc MD in the facility even if that MD is a resident.

Looking at the Royal college directory it seems that Rad Onc has one of the lower attrition percentages into the US compared with ENT, Neurosurgery, Orthopedics and Radiology.

I guess my point is Canada had no change in demand- they always had hypofrac, centralized hospitals, different supervision, advanced practioners etc. Nothing suddenly changed from a demand standpoint. Demand remained constant, they just had an ill advised increase in supply. Here, we have both major changes in supply and demand simultaneously.

 

[deleted605854]

I guess my point is Canada had no change in demand- they always had hypofrac, centralized hospitals, different supervision, advanced practioners etc. Nothing suddenly changed from a demand standpoint. Demand remained constant, they just had an ill advised increase in supply. Here, we have both major changes in supply and demand simultaneously.

Correct. Which is why everything that was said about jobs during ASTRO is BS IMO.

Will be nice to see what happens in the next couple of years. I need to figure out a way to get out of medicine in the meantime

 

[JivTor]

What could we learn from the oversupplied Canadian radonc job market to help correct our US job market? If I recall correctly, the Canadian radoncs I've chatted with (mostly at various conferences pre-COVID) mentioned:

1. Canadian government(?) mistakenly over-allocated training spots for radoncs in Canada
2. some Canadian grads have completed *multiple* fellowships due to ongoing lack of job availability post-residency
3. some Canadian grads proactively took American oral boards in addition to their own Canadian boards

I personally remember multiple Canadian senior residents joining our online ABR oral board study groups around 2013. Very well-trained, sharp folks - they were serious about taking ABR orals and they passed. I don't know where they secured jobs after that though.

Even though our two countries' healthcare systems are different, understanding the Canadian experience may help to better shape ours.

I am just a lowly med student but maybe I can give some insight as a Canadian. This is my impression from talking to PGY-4/5 residents, fellows, and newly hired (past year) staff:

1. You seem to be right about this. Up until 2011, there were around 20 spots per year in the match, but unlike the situation with ASTRO, the Canadian government made an effort to correct this (By 2017, it had dropped to just 9 seats). But now, they've ramped up seats once again to around with around 20-22 seats per year, so who knows where the job market will be in another decade. It is perhaps important to note though that several of the academic staff that I've spoken with say that they are overworked (i.e., despite contracts of 75% clinical, 25% research, they are taking on the patient load of somebody who is 100% clinical and have to do research beyond that time as well). This is esp. the case in Ontario where the remuneration model is fee-for-service (I guess the upside of this is you make very good money, but ultimately, many people chose RO for the lifestyle and hate working 70hrs/week as staff). Given all this, perhaps the extra seats truly are needed.

2. I believe this is also the case, 75% of graduates do one fellowship, with something like 40% needing to complete a second fellowship to get a full-time staff position. Correction: the newest data shows that 86% of graduates find a job within one year of graduating, so perhaps my information is outdated.

3. I think the attrition rate from Canada to the US for rad onc is still relatively low compared to many other specialties (esp. surgical).

 

[deleted941485]

I am just a lowly med student but maybe I can give some insight as a Canadian. This is my impression from talking to PGY-4/5 residents, fellows, and newly hired (past year) staff:

1. You seem to be right about this. Up until 2011, there were around 20 spots per year in the match, but unlike the situation with ASTRO, the Canadian government made an effort to correct this (By 2017, it had dropped to just 9 seats). But now, they've ramped up seats once again to around with around 20-22 seats per year, so who knows where the job market will be in another decade. It is perhaps important to note though that several of the academic staff that I've spoken with say that they are overworked (i.e., despite contracts of 75% clinical, 25% research, they are taking on the patient load of somebody who is 100% clinical and have to do research beyond that time as well). This is esp. the case in Ontario where the remuneration model is fee-for-service (I guess the upside of this is you make very good money, but ultimately, many people chose RO for the lifestyle and hate working 70hrs/week as staff). Given all this, perhaps the extra seats truly are needed.

2. I believe this is also the case, 75% of graduates do one fellowship, with something like 40% needing to complete a second fellowship to get a full-time staff position.

3. I think the attrition rate from Canada to the US for rad onc is still relatively low compared to many other specialties (esp. surgical).

So from a US new attending POV it seems

1. Canadian Central Planners attempted to correct that problem 10 years ago which although helpful to some degree took years manifest as an improved market BUT now they want to increase the supply...again for reasons that I am not sure. Perhaps the attendings feel they are overworked and need a surplus army of sycophants and perpetual fellows to help out. Or whatever. but its clear demand is probably not changing. Did they learn their lesson? No. But then again who are we trying to teach here? If anything they are as dense as ASTRO when it comes to addressing these issues and they run the entire health system!

2. If 75% of grads need a fellowship to continue, honestly why not just add another year to the residency? It also remains fascinating that while RO attendings seem to despise working harder - their residents seem to have no trouble taking multi-year fellowships doing attending level work for resident pay just to get a job,

3. The Low attrition rate is likely a combination of "well Ive already invested what amounts to 7 years in a specialty" and by that time many of these young whipper snappers have gotten married, had children, and want some of the other things that don't involve a publishing retrospective outcomes. Im guessing jumping from RO to say Rads, IM or surgery is not easy in Canada and would likely just require another significant time investment not to mention the shear number of asses that would need to be kissed to pull it off.

If the Canadian story of RO is one to be emulated in the US (Which I think it will be), then there are much much darker days ahead for US grads. As if it needed to be emphasized again. Lets not forget the shear size of the RO work force on the US side, the shear displacement, lack of opportunities, and long stretches underemployment for physicians will be overwhelming.

 

[elementaryschooleconomics]

2. If 75% of grads need a fellowship to continue, honestly why not just add another year to the residency? It also remains fascinating that while RO attendings seem to despise working harder - their residents seem to have no trouble taking multi-year fellowships doing attending level work for resident pay just to get a job,

This confuses me about the US situation as well - the residents and fellows I know work hard despite being coaxed with the carrot that "RadOnc is cush". I wonder if it's a form of "pulling the ladder up behind you"?

"I was promised a chill lifestyle, I did not experience a chill lifestyle, we need more residents to spread out the work so I can finally get what's owed to me!"

 

[drewdog1973]

Interesting they went from 9 back up to 22. Seems like same thing will happen. But, maybe since they have the planning ability to make such drastic changes, I guess they can wait til it saturates again and then drop again.

 

[JivTor]

Interesting they went from 9 back up to 22. Seems like same thing will happen. But, maybe since they have the planning ability to make such drastic changes, I guess they can wait til it saturates again and then drop again.

Well, this was the final conclusion slide from the 2020 human resources report:

"Radiation Oncologist workforce at risk for an undersupply with current trainee numbers and rising service demand if more retirements occur than expected compared to the graduate pool. Higher workload [among current residents/staff] compensates for provider shortages in the interim."

"Recommendation: Increase CaRMS PGY1 intake from 21/yr to 23/yr by 2023 with further increases by 2025/26."

So it seems that CARO may be digging itself into a hole once again.

 

[medgator]

Well, this was the final conclusion slide from the 2020 human resources report:

"Radiation Oncologist workforce at risk for an undersupply with current trainee numbers and rising service demand if more retirements occur than expected compared to the graduate pool. Higher workload [among current residents/staff] compensates for provider shortages in the interim."

"Recommendation: Increase CaRMS PGY1 intake from 21/yr to 23/yr by 2023 with further increases by 2025/26."

So it seems that CARO may be digging itself into a hole once again.

Throughout recent decades of history, rad onc has been more likely to be oversupplied than under, yet the powers at be ignore this

 

[FreakFlag]

wow...so in Canada as of 2016-2018, residency graduates had a <60% chance of securing attending or LOCUMS work within TWO years of completing training. The majority of the remaining 40% of grads wound up in fellowships.

Employment outcomes for recent Canadian radiation oncology graduates​

Curr Oncol. 2019 Aug;26(4):e510-e514

"Methods: Results of the survey administered to ro program directors in 2016 and again in 2018, both with 100% response rates, are presented here.

Results: In both surveys, approximately 57% of ro graduates had attained staff or locum employment in Canada or abroad within 2 years from graduation...

...Most trainees without staff positions were employed as fellows."

Employment outcomes for recent Canadian radiation oncology graduates - PubMed

Employment challenges for newly certified Canadian-trained radiation oncologists continue. However, compared with the situation 2 years ago, trends in the Canadian ro job market suggest a modest improvement, with more staff employment in Canada and lower emigration rates for jobs abroad.

pubmed.ncbi.nlm.nih.gov

see also:

Radiation Oncology Resident and Program Director Perceptions of the Job Market and Impact on Well-being - PubMed

Background Radiation oncology graduates occasionally experience difficulties obtaining employment. The purpose of this study was to explore the perceptions of radiation oncology residents (RORs) and program directors (PDs) about the job market and the potential impact on their well-being...

pubmed.ncbi.nlm.nih.gov