I am speaking as a panel member at the upcoming SCAROP meeting in a few weeks on the issue of interest in our field/applicant numbers.
I am struggling to identify and appropriately characterize what the issue is exactly.
Programs want residents to fuel the clinical revenue machine of academic megacenters, but an oversupply of graduating residents limits job choice and professional satisfaction for community physicians.
- Social science papers in the Red Journal don't matter. I don't have a monthly Red Journal subscription. I read the papers that are relevant to my practice.
- Boards & board failures don't matter. I have full faith in the integrity and rigor of the board examination process.
- DEI doesn't matter. It's a manufactured problem, not specific to RO training programs.
- Quirky personalities amongst academic RO leaders don't matter. I don't know these folks personally, and the handful I've interacted with are pleasant & interesting.
It's the job market and labor supply/demand. Everything else is, at best, a sideshow.
Negativity on forums like SDN I believe contributes to the rapid decline in applicant numbers.
In an ideal world, programs would be reducing residency positions. We don't live in that world.
It's far from an ideal solution, but an alternative is to discourage students from pursuing radiation oncology. I don't post on Twitter and I post on SDN infrequently, but in real life, I will continue to tell premed and medical students that shadow me, or that I meet in a social setting, to avoid radiation oncology.
Again, it would be better if programs reduced residency positions, or maintained high standards for residency applicants, or at least abstained from SOAP participation.
By cutting programs in half you may make the already underserved rural communities have no access to radoncs. This is a bad thing.
This was untrue in the past and will be even more untrue in the future, with advancing technology and public embrace of remote connectivity, workplace productivity tools, and telemedicine.
In my experience, rural communities are neither underserved currently, nor are they at risk of losing access to radiotherapy.
You can provide radiotherapy in rural communities without having 1 rad onc with 3 consults/week live in a town of 30,000. Certificate of need, remote supervision, once-weekly presence, telemedicine, many creative possibilities can be explored without flooding the workforce with residency positions.
For rural towns, you often have more problems recruiting RTT's, nurses, LINAC engineers, medical oncologists than radiation oncologists. The limiting factor isn't radiation oncologists.
If anything, overtraining residents worsens care in rural communities, since the 1 rad onc with 3 consults/week is disincentivized to hypofractionate.
In Red Journal opinion pieces [1], other chairs love "protecting access to radiotherapy in rural communities", but how many have actually practiced in rural communities and are attuned to the needs of rural communities? It's like a rhetorical filler.
[1] Falit, Benjamin P., et al. "The radiation oncology job market: The economics and policy of workforce regulation."
International Journal of Radiation Oncology* Biology* Physics96.3 (2016): 501-510.
By the way, I love Ann Arbor. But, Ann Arbor is not rural, Ann Arbor is one of the most cosmopolitan places in the Midwest.
It's also funny to me how in real life, some academic doctors are happy to see patients from 1000 miles away to give routine, widely available treatments. I had a breast surgeon at a top academic center's satellite ask me skeptically if I did "5 fraction breast" like it's something cutting edge. Yes, I appropriately use FAST, Fast-Forward, QOD 5fx apbi, QD 5 fx apbi, IMPORT-LOW apbi, and breast brachytherapy, and I use these regimens way more than I did at my residency program, but please, condescend to me and send the patient to your breast expert for radiotherapy 1000 miles from her home for routine DCIS.
However, the days of private groups owning their equipment and getting the tech revenue is uncommon now, so the >$1m salaries (more than even almost every single Chair makes in the country based on SCAROP data) are hard to come by.
Chairs are great, but there's no rule that Chairs (capital C) have to make the highest salaries. In most other specialties, Chairs do not make as much as the busiest community physicians, let alone busy community physicians that start their own practice or have ownership.
At my medical school, one of the surgery faculty collected at least $5-10 million annually from patent royalties. Some of the IM faculty went to industry in executive roles, and one is an actual billionaire. Academic faculty should be in the business of creating new knowledge and new treatments, and profiting handsomely from that, if they are so inclined. That's my opinion, I hope your Office of Technology Transfer and Commercialization agrees with me.
I am not an enemy. I am someone trying to do my part, imperfect, but trying.
100%. I hope I was direct without being abrasive or offensive. Good luck and best wishes.
