What exactly does ranking/prestige matter for? Especially in the current state of rad onc.

[allseasons]

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People talk about this all the time, but can someone share what it actually matters for?

My belief about the importance of prestige in rad onc residency was this: there's a reasonable chance the job market for rad onc in the future dips. The job market is already somewhat constrained. Going to a "high tier" place increases the odds that you can secure a position in the area you want, especially if it is an academic position. Is this accurate?

And if you believe prestige matters, to what extent does it matter? Would it be wrong for me to rank Duke > WashU? UCSD > Michigan? Vanderbilt > Icahn, Emory, Wisconsin, Florida?

Does the ranking difference matter between Yale, Hopkins, UCLA? Actually, is there even a difference in rank there...?

Sincerely,
An M4 that doesn't really know how she should rank programs

 

[OTN]

If you're interested in a particular part of the country, training in that area can significantly help with job placement afterwards. I would argue in that situation location could trump prestige. If not, then I would argue that yes prestige can matter to some extent. As far as ranking programs for that prestige, I'm so far out of the game that I can't really help anymore, sorry.

 

[TheWallnerus]

People talk about this all the time, but can someone share what it actually matters for?

My belief about the importance of prestige in rad onc residency was this: there's a reasonable chance the job market for rad onc in the future dips. The job market is already somewhat constrained. Going to a "high tier" place increases the odds that you can secure a position in the area you want, especially if it is an academic position. Is this accurate?

And if you believe prestige matters, to what extent does it matter? Would it be wrong for me to rank Duke > WashU? UCSD > Michigan? Vanderbilt > Icahn, Emory, Wisconsin, Florida?

Does the ranking difference matter between Yale, Hopkins, UCLA? Actually, is there even a difference in rank there...?

Sincerely,
An M4 that doesn't really know how she should rank programs

“Listen to your heart.”

- Roxette

 

[ivybme]

People talk about this all the time, but can someone share what it actually matters for?

My belief about the importance of prestige in rad onc residency was this: there's a reasonable chance the job market for rad onc in the future dips. The job market is already somewhat constrained. Going to a "high tier" place increases the odds that you can secure a position in the area you want, especially if it is an academic position. Is this accurate?

And if you believe prestige matters, to what extent does it matter? Would it be wrong for me to rank Duke > WashU? UCSD > Michigan? Vanderbilt > Icahn, Emory, Wisconsin, Florida?

Does the ranking difference matter between Yale, Hopkins, UCLA? Actually, is there even a difference in rank there...?

Sincerely,
An M4 that doesn't really know how she should rank programs

It matters primarily for academic jobs, for private practice it does not seem to matter as much. Other factors like geography matter more in that case. What always helps is your network, so generally larger programs that have been open for a longer time will have larger networks.

 

[yesmaster]

As you go back in time, rad onc was smaller and academic leaders were more respected and influential - Perez, Brady, Fletcher. They could help or hurt you more in the job search.

Now, academics doesn't have much influence in community or private practice hiring. There are too many rad onc's and too many practices. Some community or PP docs don't like academic programs, especially the ones with a large satellite network. I may not be representative.

Geography matters for sure.

The residency program's network matters, but it is a double-edged sword. There are a limited number of good jobs and if your residency program has 5+ residents per year, and you have let's say former residents at SERO, Tennessee Oncology, INOVA or another large well-known practice in a decent location, they can't absorb that many resident hires.

Your program's prestige and size help with getting academic jobs. My opinion is the vast majority of these jobs are unappetizing.

 

[RickyScott]

People talk about this all the time, but can someone share what it actually matters for?

My belief about the importance of prestige in rad onc residency was this: there's a reasonable chance the job market for rad onc in the future dips. The job market is already somewhat constrained. Going to a "high tier" place increases the odds that you can secure a position in the area you want, especially if it is an academic position. Is this accurate?

And if you believe prestige matters, to what extent does it matter? Would it be wrong for me to rank Duke > WashU? UCSD > Michigan? Vanderbilt > Icahn, Emory, Wisconsin, Florida?

Does the ranking difference matter between Yale, Hopkins, UCLA? Actually, is there even a difference in rank there...?

Sincerely,
An M4 that doesn't really know how she should rank programs

most jobs are in large nonprofit academic systems. Good research projects, location and endorsement from a prominent faculty member are so much more important than Duke vs UCSD. (historically duke and wash u are nasty places, but they have new chairs who are apparently well liked, so the culture may change)

 

[drowsy12]

As you go back in time, rad onc was smaller and academic leaders were more respected and influential - Perez, Brady, Fletcher. They could help or hurt you more in the job search.

Now, academics doesn't have much influence in community or private practice hiring. There are too many rad onc's and too many practices. Some community or PP docs don't like academic programs, especially the ones with a large satellite network. I may not be representative.

this is kind of the reverse of reality lol. number of independent practices and centers is decreasing wildly with consolidation compared with the past, not increasing

OP - prestige matters to some extent mostly in terms of residency experience. moreso in that you will have a ****ty experience at some of the really terrible programs - will be used for scut, no education etc. you are more likely to have access to resources, larger alumni network at better programs.

nothing is guaranteed and nothing is perfect, but all things considered it's better to go to a name program than non-name on on job hunt, especially for your FIRST job.

that being said, among the programs you name, it's not going to matter much. go by your heart, location, and specifics you liked about each place on interview day.


this idea that private/community doesnt care about name at all is weird/silly. if I get an application from my alumni program (decent name, not amazing) I am more likely to look at them. it's a small field and especially again for first job, it matters. there are grads from MDACC, MSKCC, Harvard all over community practices.

 

[allseasons]

that being said, among the programs you name, it's not going to matter much. go by your heart, location, and specifics you liked about each place on interview day.

Thank you so much for that breakdown.

Regarding this line you said, would it even apply to Vanderbilt > Icahn, Emory, Wisconsin, Florida? I really liked Vandy, but people generally rate the other programs better and idk what to do.

 

[brushbeamscanning]

At the end of the day you have to make your own value judgements, there's something to be said about people staying regionally close after they graduate or tapping into an alumni network.

Keep in mind that half of the residents you interact with during interview day will not be there when you start and a good portion of faculty may not be there as well. Sure pedigree and reputation matter for academics but also do to some extent when applying to private jobs all things being equal. If you aren't a known entity it's really all down to the faculty that will go to bat for you as well as the historic strength of your program that speaks to your training.

 

[drowsy12]

Thank you so much for that breakdown.

Regarding this line you said, would it even apply to Vanderbilt > Icahn, Emory, Wisconsin, Florida? I really liked Vandy, but people generally rate the other programs better and idk what to do.

All of them are similar. Go with the one you liked

 

[ivybme]

Thank you so much for that breakdown.

Regarding this line you said, would it even apply to Vanderbilt > Icahn, Emory, Wisconsin, Florida? I really liked Vandy, but people generally rate the other programs better and idk what to do.

I think this is a very reasonable rank list. Emory might have a larger network in the SE than Vanderbilt, but both are strong programs. The others are about personal preferences related to geography, as they are strong academic programs in different locations.

The overall tier matters (Big 3, then top 10) are when you should consider ranking them above a specific location/area you prefer. Otherwise, personal preferences matter more in your specific case.

 

[TheWallnerus]

What are we ultimately trying to tell the med student here. That if you don’t go to a top 10 program the odds of being an unemployed board certified rad onc could be (infinitesimally to measurably) higher? That seems to be the subtext?

 

[Bequerel]

I agree. This thread seems ridiculous in 2026. If your goal is to work at an academic satellite and make 300k when you graduate then I don’t think it matters. Also, if your goal is to make 7 figures then I don’t think it matters either because that will be such a rarity. The only people able to do that would be the hustlers and entrepreneurs that would make that kind of money no matter what speciality.

 

[Ray D. Ayshun]

Thank you so much for that breakdown.

Regarding this line you said, would it even apply to Vanderbilt > Icahn, Emory, Wisconsin, Florida? I really liked Vandy, but people generally rate the other programs better and idk what to do.

Vandys in a decent town with a connection it would seem to Tennessee oncology, which is a desirable landing place in this day and age.

 

[drowsy12]

I agree. This thread seems ridiculous in 2026. If your goal is to work at an academic satellite and make 300k when you graduate then I don’t think it matters. Also, if your goal is to make 7 figures then I don’t think it matters either because that will be such a rarity. The only people able to do that would be the hustlers and entrepreneurs that would make that kind of money no matter what speciality.

This is a ridiculous and unhelpful post in 2026 or any other year

 

[Neuronix]

What are we ultimately trying to tell the med student here. That if you don’t go to a top 10 program the odds of being an unemployed board certified rad onc could be (infinitesimally to measurably) higher? That seems to be the subtext?

I tell them that if you want to spend the rest of your career at a lower tier academic center wearing a Harvard Radiation Oncology jacket and getting repeatedly promoted for no clear reason, that's the place to be.

This is a ridiculous and unhelpful post in 2026 or any other year

I disagree.

 

[TheWallnerus]

Vandys in a decent town with a connection it would seem to Tennessee oncology, which is a desirable landing place in this day and age.

Tennessee Oncology just got bought out didn’t they

They’ve hired about 4 Vandy grads in the last 10 years but none wound up in Nashville iirc

Has Tennessee Oncology made any new rad onc jobs in the last ten years (buy out or practice acquisition wouldn’t count imho)… maybe one or two?

 

[NotMattSpraker]

Tennessee Oncology just got bought out didn’t they

They’ve hired about 4 Vandy grads in the last 10 years but none wound up in Nashville iirc

Has Tennessee Oncology made any new rad onc jobs in the last ten years (buy out or practice acquisition wouldn’t count imho)… maybe one or two?

I thought they morphed in to or founded OneOncology?

 

[TheWallnerus]

I thought they morphed in to or founded OneOncology?

One oncology bought Tennessee oncology and now cencora bought one oncology

Rad onc: so few treatment modalities, so many corporate acquisitions


You think you’re going into medicine kids… but you’re really going into business

 

[Gfunk6]

One oncology bought Tennessee oncology and now cencora bought one oncology

Rad onc: so few treatment modalities, so many corporate acquisitions


You think you’re going into medicine kids… but you’re really going into business

Not quite, the corpos are going into business with you as the depreciating asset.

EDIT: Or, to be more precise.

Rad Onc is bifurcating.

Tier 1:

• High-skill, referral-driven, externally networked docs.
• Hard to replace.
• Harder to bully.

Tier 2:

• Volume-fed, internally dependent, low-differentiation.
• Replaceable on paper.
• Replaceable in practice.

Corporate/academic medicine thrives on Tier 2.

It tolerates Tier 1 because it must.

 

[CaesarRO]

Not quite, the corpos are going into business with you as the depreciating asset.

EDIT: Or, to be more precise.

Rad Onc is bifurcating.

Tier 1:

• High-skill, referral-driven, externally networked docs.
• Hard to replace.
• Harder to bully.

Tier 2:

• Volume-fed, internally dependent, low-differentiation.
• Replaceable on paper.
• Replaceable in practice.

Corporate/academic medicine thrives on Tier 2.

It tolerates Tier 1 because it must.

Not to pile on because I think the op question is asked in good faith and very reasonable, but I think increasingly Hospital systems are happy to sacrifice tier one for tier two even if it hurts them in the short or medium term.


Re: the OP, I don't know those programs specifically but try to get a sense of how much teaching actually happens in the program and what the case volumes are like. Don't go for the programs that are too low volume. Plan to actually work in residency and learn the field. There's a huge knowledge base to learn, which is all very different from your typical medical school teaching, even if we misanthropes constantly like to complain online about the state of the field.

Like others have said, I think prestige matters more for academics, I do think regional practices know which programs offer a good clinical training and produce clinically competent graduates. Often these are not the same programs as the ones that give the best research opportunities

 

[allseasons]

Not to pile on because I think the op question is asked in good faith and very reasonable, but I think increasingly Hospital systems are happy to sacrifice tier one for tier two even if it hurts them in the short or medium term.


Re: the OP, I don't know those programs specifically but try to get a sense of how much teaching actually happens in the program and what the case volumes are like. Don't go for the programs that are too low volume. Plan to actually work in residency and learn the field. There's a huge knowledge base to learn, which is all very different from your typical medical school teaching, even if we misanthropes constantly like to complain online about the state of the field.

Like others have said, I think prestige matters more for academics, I do think regional practices know which programs offer a good clinical training and produce clinically competent graduates. Often these are not the same programs as the ones that give the best research opportunities

The problem is, it's really hard to figure that out. Especially if you factor in program's malignancy as well.

Like I'm having a hard time ranking Duke, Hopkins, and WashU right now. I actually really liked my WashU interview day, but pretty much every thread online talks about how much that program drains you as a resident.

I'm honestly surprised how easily other applicants seem to be able to make their rank list, because it's so hard to tell what a program is really like outside of my home program.

 

[allseasons]

I think this is a very reasonable rank list. Emory might have a larger network in the SE than Vanderbilt, but both are strong programs. The others are about personal preferences related to geography, as they are strong academic programs in different locations.

The overall tier matters (Big 3, then top 10) are when you should consider ranking them above a specific location/area you prefer. Otherwise, personal preferences matter more in your specific case.

What even are the top 10? From what I can tell, Stanford WashU Michigan Hopkins and maybe Yale/Duke? (Ik there's more just listing the ones I interviewed at)

 

[Ray D. Ayshun]

The problem is, it's really hard to figure that out. Especially if you factor in program's malignancy as well.

Like I'm having a hard time ranking Duke, Hopkins, and WashU right now. I actually really liked my WashU interview day, but pretty much every thread online talks about how much that program drains you as a resident.

I'm honestly surprised how easily other applicants seem to be able to make their rank list, because it's so hard to tell what a program is really like outside of my home program.

What exactly do you mean by malignant?

 

[ramsesthenice]

The problem is, it's really hard to figure that out. Especially if you factor in program's malignancy as well.

Like I'm having a hard time ranking Duke, Hopkins, and WashU right now. I actually really liked my WashU interview day, but pretty much every thread online talks about how much that program drains you as a resident.

I'm honestly surprised how easily other applicants seem to be able to make their rank list, because it's so hard to tell what a program is really like outside of my home program.

I strongly suggest that you and all med students make their own rank list based on your experience. It appears to me that a lot of the truly malignant places have chilled out and as an academic person who has been “volunteered” to chair CCCs for 2 mid tier residency programs, I can tell you there are driving forces from ACGME pushing that change which is overall a good thing. People also have vastly different tolerances of any human interaction and many should just be ignored. Real malignancy is hard to ignore ASSUMING you had unsupervised interaction with the trainees. If you didn’t, that’s a red flag. If you did and it really was a rough place, you would have picked up on it. Residents may hold back, but very few can or will fake genuine happiness.

My other general comment is that the top tier really only matters for academics for 2 reasons: you want to work at a top tier place or you plan to take a position in which you are competing for external funding. I went to grad school at a top tier place and had two mentors whom I really liked tell me it was shocking how successful I was coming from a state school. Those (albeit unintentional) backhanded comments pushed me away from pursuing the top any further. They really do love their own. But if you are applying for grants, especially through NIH or DOD, pedigree matters a lot. More than it should if you ask me. If you plan to be an internally funded academic with at least 60% clinical appointment, it doesn’t matter much where you train. Go where felt happiest and supported.

 

[drowsy12]

I disagree.

whether or not you have a totally nihilistic approach (sounds like you agree with the poster that nothing matters and there's no use even caring where you train) - perhaps a thread where a medical student is genuinely asking for help isn't the place to say it?

it sounds like you and I disagree on this approach.

I remember the SDN Rad Onc forums of yesteryear where this used to be the norm, this kind of thread. it's nice to have once in a while, as there are plenty of real people out there who have the same questions who have moved on to other forums to discuss.

 

[Neuronix]

whether or not you have a totally nihilistic approach (sounds like you agree with the poster that nothing matters and there's no use even caring where you train) - perhaps a thread where a medical student is genuinely asking for help isn't the place to say it?

it sounds like you and I disagree on this approach.

I remember the SDN Rad Onc forums of yesteryear where this used to be the norm, this kind of thread. it's nice to have once in a while, as there are plenty of real people out there who have the same questions who have moved on to other forums to discuss.

I don’t really think where you train matters, especially if you end up in the position of needing to get any job or end up in the lowest tier positions like underpaid academic satellites. My experience has been that baseline competence and spending your time network building create the best opportunities.

If you’re gunning for real academics (I.e. research and “leadership”), institution matters more, but outside of the top 3 I don’t think it matters much, and even then it’s overrated.

If you have a location preference, training in that area will help you make connections there and make people think you’re serious about staying there (which is a double edged sword—it’s easy to get taken advantage of).

All of this was already said, but I’m repeating it.

 

[Bequerel]

whether or not you have a totally nihilistic approach (sounds like you agree with the poster that nothing matters and there's no use even caring where you train) - perhaps a thread where a medical student is genuinely asking for help isn't the place to say it?

it sounds like you and I disagree on this approach.

I remember the SDN Rad Onc forums of yesteryear where this used to be the norm, this kind of thread. it's nice to have once in a while, as there are plenty of real people out there who have the same questions who have moved on to other forums to discuss.

I’m not sure why you are wanting to argue with everyone. If you’ve been reading this thread like you say for years, then it should come as no surprise that people are telling you it doesn’t matter where you train. It isn’t 2010. It’s 2026. It’s easy to get an interview and there are many programs to choose from. Go to the one that felt the best during the interview and is in the place you’d like to be for 4 years. Don’t over think it. That’s essentially the same advice that every seasoned radiation oncology forum member is telling the current class.

 

[ivybme]

The problem is, it's really hard to figure that out. Especially if you factor in program's malignancy as well.

Like I'm having a hard time ranking Duke, Hopkins, and WashU right now. I actually really liked my WashU interview day, but pretty much every thread online talks about how much that program drains you as a resident.

I'm honestly surprised how easily other applicants seem to be able to make their rank list, because it's so hard to tell what a program is really like outside of my home program.

Truthfully I think culture of programs can change pretty fast, so you have to make your best judgment. The residents really are a good gauge for malignancy. WashU and Duke both recently swapped chairs for example, so the reputation in the past may not be the same.

 

[Ray D. Ayshun]

Truthfully I think culture of programs can change pretty fast, so you have to make your best judgment. The residents really are a good gauge for malignancy. WashU and Duke both recently swapped chairs for example, so the reputation in the past may not be the same.

A group of residents in competition with each other for jobs/prestige or who think working >40 hrs a week is unfair can make a program feel malignant. Maybe there was truly a culture issue created by the chair and attendings in the old days, but these days I can't see culture being related to much beyond the residents. Hopefully we're past the few years where "malignant" meant seeing an inpatient consult in person.

 

[CaesarRO]

Since the discussion has turned to weighing your vibes with the current residents, keep in mind that it'll be 2 years before you're in the program after you match. The PGY4 and 5 will be gone and you will probably not see much of the PGY3s (who will be PGY5 and job hunting during your PGY2 year). So it's really the current PGY 2s that you'll overlap a couple years with.

I remember doing med student rotations and I agree that the vibes from the residents really colored my opinion of a program.

 

[allseasons]

A few people here mentioned there’s just a few schools that it might be worth ranking higher despite regional preference. Which are these schools outside of the big 3?

 

[lilshopta]

More "prestigious" programs are those that have been around for longer, are larger in size, and have larger alumni networks. The larger alumni network means that you have access to more connections and possibly have an easier time finding a job. That's it.

 

[ramsesthenice]

A few people here mentioned there’s just a few schools that it might be worth ranking higher despite regional preference. Which are these schools outside of the big 3?

You will get 10 different answers to this question. There is nothing resembling a consensus. In my personal experience (east coast and mid west), regional connection will trump prestige 9/10 times.

 

[yesmaster]

I was talking with a highly paid, highly educated senior person in another industry about healthcare and hospitals and it was enlightening what institutions he considered prestigious.

If you add inflection when saying the institution, it goes a long way.

 

[evilbooyaa]

I was talking with a highly paid, highly educated senior person in another industry about healthcare and hospitals and it was enlightening what institutions he considered prestigious.

If you add inflection when saying the institution, it goes a long way.

Does this count for THE Ohio State University?

Drowsy/Neuronix, I see both sides. I see Drowsy's side of "stop telling this poor med student that nothing matters", when in reality it's not that NOTHING matters, it's just that things don't matter nearly as much asone would think.

OP, I would recommend if you're not going to a top 3 (HROP, MDACC, MSKCC) program, go to a region of the country that you would 1) be interested in living for 4 years and 2) be open to potentially statying in the region as an attending for. If you are local to ar egion you will have better opportunities (in a vaccuum).

It will not matter to future job prospects whether you go to Duke or WashU or Vandy or whatever. Despite my personal dislike for most if not all NYC residency programs, it probably won't matter if you end up at Sinai either.

 

[allseasons]

Does this count for THE Ohio State University?

Drowsy/Neuronix, I see both sides. I see Drowsy's side of "stop telling this poor med student that nothing matters", when in reality it's not that NOTHING matters, it's just that things don't matter nearly as much asone would think.

OP, I would recommend if you're not going to a top 3 (HROP, MDACC, MSKCC) program, go to a region of the country that you would 1) be interested in living for 4 years and 2) be open to potentially statying in the region as an attending for. If you are local to ar egion you will have better opportunities (in a vaccuum).

It will not matter to future job prospects whether you go to Duke or WashU or Vandy or whatever. Despite my personal dislike for most if not all NYC residency programs, it probably won't matter if you end up at Sinai either.

Why does everyone even care about these rankings then?? Does that even apply for academics in your opinion?

I liked Vanderbilt more than Michigan Duke Hopkins UCSD UTSW even (have no regional ties to any of these 4) just because I absolutely adored Nashville and would love to live there over any of the other locations, but most people I talk to irl keep telling me that would be a mistake to rank like that.

I don’t even know if I want to do academics… but I was hoping to keep that door open in case.

 

[ivybme]

Why does everyone even care about these rankings then?? Does that even apply for academics in your opinion?

I liked Vanderbilt more than Michigan Duke Hopkins UCSD UTSW even (have no regional ties to any of these 4) just because I absolutely adored Nashville and would love to live there over any of the other locations, but most people I talk to irl keep telling me that would be a mistake to rank like that.

I don’t even know if I want to do academics… but I was hoping to keep that door open in case.

Can you see yourself living in Nashville / Southeast as your first job? I think that's what this hinges on for your use case. All of the programs place really well in their regions. Michigan, Duke, Hopkins, WashU might slightly place better in their respective non-home regions as a result of having a larger and stronger alumni network, but it's not a nail in the coffin. I think if you're geography-agnostic, then I might personally choose those four programs above Vanderbilt.

The challenge as you've seen is there are two factors people are talking about simultaneously - 1) a questionable job market, which means that every edge would be ideal and 2) whether a national-brand reputation truly is an "edge" or not. All else being equal, getting a job in California will be easier if you go to UCSD, then a big 3, then one of the Michigan/Duke/Hopkins/WashU, then Vanderbilt/UTSW/Emory. But Emory will be stronger in the Southeast. So your geography preference matters too.

I think what you need to do more specifically is to figure out what your priorities are long term, then the ranking will become more clear. Do you want a job in academics vs PP? Do you care about a specific region in the US? Do you care about strong but rigorous training, or are you looking for more of a cush program? Do you want a dedicated research year? Do you want a large program vs small program?

 

[Bequerel]

Why does everyone even care about these rankings then?? Does that even apply for academics in your opinion?

I liked Vanderbilt more than Michigan Duke Hopkins UCSD UTSW even (have no regional ties to any of these 4) just because I absolutely adored Nashville and would love to live there over any of the other locations, but most people I talk to irl keep telling me that would be a mistake to rank like that.

I don’t even know if I want to do academics… but I was hoping to keep that door open in case.

It seems very simple. You liked Vandy the most. Rank Vandy number 1 and don’t look back. Go have fun in Nashville and work your butt off to become the best radiation oncologist you can be.

 

[ramsesthenice]

It seems very simple. You liked Vandy the most. Rank Vandy number 1 and don’t look back. Go have fun in Nashville and work your butt off to become the best radiation oncologist you can be.

Completely agree. It seems to me the OP doesn’t know for sure where they want to be or what they want to do for sure and that’s fine. My (now former) mid tier Midwest program put 3 former residents in Cali jobs (Orange County or the Bay Area, not rural GOP Cali), one in NYE, and a couple in the mid Atlantic in my 8 years there. Mix of PP and academics. Almost all of the rest stayed in state or a neighboring state. I’m not going to say everyone found their dream jobs, but I can only think of 2 people who didn’t end up in their desired region. I’d wager to say we did better at geographic placement than the big 3 if for no otger reason than they are in saturated markets with huge graduating classes.

OP, we are a collection of high achievers who are competitive by nature. We make lists. We rank things. It’s what we do. What we won’t do is have our lives uprooted based on your rank list. Your opinion is the only one that really counts here and it really sounds like you know what you want.

 

[allseasons]

Can you see yourself living in Nashville / Southeast as your first job? I think that's what this hinges on for your use case. All of the programs place really well in their regions. Michigan, Duke, Hopkins, WashU might slightly place better in their respective non-home regions as a result of having a larger and stronger alumni network, but it's not a nail in the coffin. I think if you're geography-agnostic, then I might personally choose those four programs above Vanderbilt.

The challenge as you've seen is there are two factors people are talking about simultaneously - 1) a questionable job market, which means that every edge would be ideal and 2) whether a national-brand reputation truly is an "edge" or not. All else being equal, getting a job in California will be easier if you go to UCSD, then a big 3, then one of the Michigan/Duke/Hopkins/WashU, then Vanderbilt/UTSW/Emory. But Emory will be stronger in the Southeast. So your geography preference matters too.

I think what you need to do more specifically is to figure out what your priorities are long term, then the ranking will become more clear. Do you want a job in academics vs PP? Do you care about a specific region in the US? Do you care about strong but rigorous training, or are you looking for more of a cush program? Do you want a dedicated research year? Do you want a large program vs small program?

Thank you this actually helps a lot. While I loved Nashville… I don’t like much else in the south 😂

 

[TheWallnerus]

Thank you this actually helps a lot. While I loved Nashville… I don’t like much else in the south 😂

Going into rad onc and geographically discounting a quarter of the nation’s land mass may be problematic

 

[allseasons]

Going into rad onc and geographically discounting a quarter of the nation’s land mass may be problematic

You know, why is it that there is such a disconnect between what I see here and what jobs residents are getting 😭 . Every resident I know (granted I've only talked to ones at T20, maybe T30s) is getting a job in the region they want, the type of job they want (academic vs not), and the majority even at the specific place they want not just the region.

The only thing I've seen residents dissatisfied with is that they can't always specialize into their favorite treatment site while having all of the above too.

If any PGY5s are reading this, what are your thoughts? How's the job hunt going

 

[TheWallnerus]

You know, why is it that there is such a disconnect between what I see here and what jobs residents are getting 😭 . Every resident I know (granted I've only talked to ones at T20, maybe T30s) is getting a job in the region they want, the type of job they want (academic vs not), and the majority even at the specific place they want not just the region.

The only thing I've seen residents dissatisfied with is that they can't always specialize into their favorite treatment site while having all of the above too.

If any PGY5s are reading this, what are your thoughts? How's the job hunt going

Isn’t there a disconnect between you seeing “every resident [you] know getting a job… they want” and you stressing over the prestige of where you’ll rank

There was a time in the not distant past where the number one employer of rad oncs was essentially wholly in the southern US btw

 

[NotMattSpraker]

It seems very simple. You liked Vandy the most. Rank Vandy number 1 and don’t look back. Go have fun in Nashville and work your butt off to become the best radiation oncologist you can be.

I think you should take this comment seriously. I wouldn't live where I trained now and I actively tell people not to go where I took my first job. My priorities and mindset have changed a lot. Rad Onc has changed a lot.

But I loved my 4 years in residency and view it as one of the best times of my life. That has never changed.

 

[allseasons]

Isn’t there a disconnect between you seeing “every resident [you] know getting a job… they want” and you stressing over the prestige of where you’ll rank

There was a time in the not distant past where the number one employer of rad oncs was essentially wholly in the southern US btw

If I went slowly by the word of the people I knew then I wouldn’t worry but all the online talk made me anxious 😂. Good point tho

 

[zy42]

If I went slowly by the word of the people I knew then I wouldn’t worry but all the online talk made me anxious 😂. Good point tho

I was in your position 4 years ago as I turned PGY-4, not at a top whatever program. There was less of a disconnect between online and word of mouth then, but rather a general pessimism, likely due to aftermath from COVID. I took it all in and looked aggressively in cities big and small and interviewed for positions of settings ranging from academic (research), satellite, and private practices large and small. That was way overboard. I am now able to fully endorse the statements from others that encourage someone to pick a program/location where he/she can be happy and thrive over 4 years of training. Things (colleagues, mentors, even culture) will inevitably change during training, so if all else equal/meh, pick a location. I lost mentors and made friends unexpectedly along the way, and I want to believe that I helped changing the residency culture slightly in the right direction as a senior (likely wishful thinking), but one thing I knew through and through is the city where I trained is one that I felt for on first sight and still loves, and the 4 years...could not have gone down any better.

 

[ramsesthenice]

You know, why is it that there is such a disconnect between what I see here and what jobs residents are getting

Its 90% context/perspective and 10% truth/confirmation bias.

Your experience matches my own from about 10 years ago and what I have observed from almost every graduating resident from my programs since. Most people do end up in the general region they want at jobs they like. I have not seen anything to support the notion that you will be lucky to end up in a given region and should expect to have to take a landing spot in BFE while you work towards getting where you really want to be. That's the good news. The bad news is that you more than likely will be lucky to have multiple competing offers in a particular region and likely won't be in a strong negotiating position if location really matters. That was not the expectation 10-15 years ago (and almost unheard of 15-20 years ago).

The other thing you have to keep in mind is that employed positions were much less common back then and people who have worked in more traditional settings which offer more autonomy and decision making (among other things) REALLY don't like these positions. Residents now frequently rotate through some of these sites and this model is much more familiar to them. I've met plenty of residents who prefer an employment model which offers a guaranteed salary and 9-5 schedule at the expense of some autonomy (which your generation never really knew in the first place) which would be deeply appalling to many of the frequent posters here. I actually think perceptions on the quality of available jobs is probably the biggest disconnect between training generations. As with everything, it comes down to what is important to you.

 

[OTN]

Its 90% context/perspective and 10% truth/confirmation bias.

Your experience matches my own from about 10 years ago and what I have observed from almost every graduating resident from my programs since. Most people do end up in the general region they want at jobs they like. I have not seen anything to support the notion that you will be lucky to end up in a given region and should expect to have to take a landing spot in BFE while you work towards getting where you really want to be. That's the good news. The bad news is that you more than likely will be lucky to have multiple competing offers in a particular region and likely won't be in a strong negotiating position if location really matters. That was not the expectation 10-15 years ago (and almost unheard of 15-20 years ago).

The other thing you have to keep in mind is that employed positions were much less common back then and people who have worked in more traditional settings which offer more autonomy and decision making (among other things) REALLY don't like these positions. Residents now frequently rotate through some of these sites and this model is much more familiar to them. I've met plenty of residents who prefer an employment model which offers a guaranteed salary and 9-5 schedule at the expense of some autonomy (which your generation never really knew in the first place) which would be deeply appalling to many of the frequent posters here. I actually think perceptions on the quality of available jobs is probably the biggest disconnect between training generations. As with everything, it comes down to what is important to you.

For some it's not only the autonomy with employed positions that's the main problem, it's the dramatic comparative drop in income.

 

[ramsesthenice]

For some it's not only the autonomy with employed positions that's the main problem, it's the dramatic comparative drop in income.

That’s what I meant by “among other things” qualifier 😄

But you can cut and paste my prior points and insert pay for the same reasons. Expectations now are often different because they came up in the new normal.