Why the increasing number of spots?

[RadOncRules]

Anyone know why the spots in Radiation Oncology have been steadily increasing?

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[medgator]

New programs in the last few years that have opened (Mayo Jax, UTSW, Moffitt, City of Hope Cancer Center to name a few) combined with expansion of existing programs.

Now as for why? Demand for radiation oncologists is one thing I've heard. Back in the early-to-mid 90s, apparently the job market was terrible and that's what lead to a sharp contraction in spots as people thought radiation was going to go extinct and chemo was going to cure everything. I've also heard that around that was when the decision was made to make it a 4-year program, thereby slowing the number of new grads each year.

Of course demand for services has only gone up as chemo has made local control that much more important (Breast CA is a good example) and now we're in a situation where more and more patients need radiation, especially as our population grows older.

 

[Butch]

Residents are cheap labor.

 

[deleted4401]

This ain't medicine... Staff can make a lot more RVUs without residents. I'm not sure why the steady increase.
-S

 

[Gfunk6]

For sub-speciality fields, like Radiation Oncology and Dermatology, the number of residency spots is overseen by the RRC (Residency Review Committee) for that respective field. This is done to tightly regulate the number of graduates produced each year to make sure there is not a market glut. If there is any inkling that the number of jobs may be contracting then the RRC will cut spots.

 

[deleted4401]

These committees do a lousy job of predicting the future. And the lag time to slow/accelerate the number of graduating specialists/i.e. respond to current conditions is an obstacle to planning for the future.

There were somewhere under a 100 spots in the early 90s. We are now at ~150. I'm just not sure where "they" are getting the idea that we need so many more rad oncs. The market wasn't great this year (does anyone feel otherwise?) and I can't imagine that it will get much better with an even greater number of graduates next year.

There is a whole lot of rad oncs in Florida and Texas treating 10-15 patients per linac. We're not short on docs. Just poorly distributed.

-S

 

[RadOncRules]

wasn't there a report from asco reporting a shortage of oncologists in 2020? that could be possibly why they are increasing spots?

 

[Onc99]

wasn't there a report from asco reporting a shortage of oncologists in 2020? that could be possibly why they are increasing spots?

Yes, ASCO is projecting that the incidence in cancer will nearly double by 2020 as the population grows and gets older, and therefore there will be a shortage of oncologists in the near future. I'm not sure if this largely pertains to medical oncologists, or if all oncologists are included in this prediction (although it would make sense that everyone who treats cancer would be impacted).

I think from discussions that I've had with program directors, the total amount of spots in rad onc is not solely tied to future supply and demand issues of the rad onc job market (although this certainly plays a role- hopefully a major role). Each time a program applies for more residency spots, their application is considered on an individual basis. If program X gets approved for more spots, it doesn't have to correspond with a decrease in spots at program Y. Overall, no one wants to grow too fast, but I think that generally, radiation oncology is seen as a growing field.

One of the major criteria for approving additional spots is the clinical volume of the institution. If the volume of the academic institution is felt to be inadequate to support additional trainees, then their application will be rejected. Because many academic institutions are growing, treating more patients, building new facilities, buying new equipment, opening new cancer centers, hiring more faculty, etc., many are also applying for additional residency spots.

Additionally, more and more programs are offering dedicated research time during residency. Therefore, the clinical volume can be spread across more residents. For example, MSKCC now offers one full year of protected research instead of 3 months. Therefore, they have increased their residency program from 16 residents to 20 residents (20-5 in lab = 15). I actually am not positive that this is the sole reason that they increased the size of their residency class (I have no inside information), but it makes sense given the timing of the increase and the hiring of Simon Powell. As more programs support research tracks and the Holman pathway, they can make an argument that they can support more residents for a given clinical volume.

The job market was extremely tight this year from what I understand, but I think this had as much to do with economic uncertainty as it did with an over-supply of graduating PGY-5's. I think that many private practices and academic institutions were reluctant to hire new docs given the overall state of the economy, the uncertainty of the Obama health care reform, and the pending CMS cuts (that later were dodged). In addition, many practicing rad oncs had their 401k's decimated by the stock market, and therefore were less likely to retire. There were many reasons for the tight job market, especially in certain areas of the country.

I think that job saturation is a major concern in certain markets. However, I think that there are more indications and therapeutic options in radiation oncology than ever before, and I think that the field will continue to grow in the forseeable future.

 

[medgator]

The market wasn't great this year (does anyone feel otherwise?) and I can't imagine that it will get much better with an even greater number of graduates next year.

I think, in the end, it was better than I expected, given the "end is nigh" sentiment that people had earlier in the season with the political climate and possible legislative moves that were being considered. There were definitely areas that I know of, though, where people had a tough time (SoCal and the west coast in general).