You guys got what you wanted

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
The funniest thing on the spreadsheet are people condemning negative comments from residents and attendings as "trolls," with the argument that they're much too busy to ever post on a spreadsheet.

Trust me, they aren't.

Yeah this is like my hobby. If I'm sitting in clinic waiting for the nurses to load the next patient, there's nothing better than spending those 7 minutes pulling up SDN/the Spreadsheet and seeing what's going on. What else am I gonna do? Stare off into space? Read regular depressing news about the planet and American politics? Talk to the nurses about which hand sanitizer I like best?

Ok but I do actually have a favorite hand sanitizer...

Members don't see this ad.
 
  • Like
Reactions: 1 users
How is the Astro leadership selected? Could we put up a candidate that straight up says the job market as a joke, time to cut slots, and all this “research” on decreasing fractions is not innovative enough to be a pathway to academic advancement.
 
  • Like
  • Haha
Reactions: 3 users
If the exams continue to be the same, and we have a new cohort of residents that are not as adept at poorly written MCQ exams (current residents are the masters), is there a concern about physics/bio 4-5 years from now? For ~40% to fail when the average USMLE step I was 250, unless they make some drastic changes (ABR executives cannot yell "Anghoff" every time they get a question they don't like), this could be a new bloodbath. I don't think there will be a 'quality' issue of residents - dedicated young doctors that want to treat cancer patients will do just fine. It's just that the written exams are so poorly conceived/scored and if the perception from attendings is that the newer crop is lesser, than the subjectivity of oral examiners could be problematic, as well.

I wonder if PDs are discussing this in between virtual "meet and greets", their 6 OTVs of the week, and retrospective analyses of rad onc surveys and whether or not gender identity has anything to do with the response rates.
 
  • Like
  • Haha
Reactions: 5 users
Members don't see this ad :)
Interviewed this week. Many folks with genuine problems and life issues are applying.

Looks like rad onc is returning to its roots! No program that acknowledges reality and aggressively recruits warm bodies should go unmatched! But I do find it hard to believe that there are still 113 US MDs willing to roll the dice on their future like this.
 
  • Haha
  • Like
  • Sad
Reactions: 4 users
Yup, failed step 1s, 190-200s, incredibly negative comments on their MSPE...the IMGs/DOs are actually the “good ones” tbh

and there also also AOA, 5 pubs, and 260+ US MDs in this mix for reasons unknown to me
Interviewed this week. Many folks with genuine problems and life issues are applying.
 
  • Haha
  • Like
Reactions: 1 users
There also also AOA, 5 pubs, and 260+ US MDs in this mix for reasons unknown to me
tenor.png
 
Interviewed this week. Many folks with genuine problems and life issues are applying.
MD/PhD resident: "They really scraped the bottom of the barrel to let this one in."
Genuine life problem/low board score resident:
2237s7.jpg
 
Yup, failed step 1s, 190-200s, incredibly negative comments on their MSPE...the IMGs/DOs are actually the “good ones” tbh

and there also also AOA, 5 pubs, and 260+ US MDs in this mix for reasons unknown to me
The way things are looking they may as well let that Ohio state sex offender guy back in field, if everyone with a pulse and multiple arrests is getting in!
 
  • Haha
  • Like
Reactions: 2 users
According to med student posters on the spread sheet it sounds like "good" residents that go to "nice" programs can expect to have a job in 2026 via the secrete hand shake network.

I'm going to make a competitor to the ASTRO job board called the Secret Handshake Network and charge a pretty penny to join.

Anyone want to be my business partner?
 
  • Like
  • Haha
  • Love
Reactions: 3 users
Interviewed this week. Many folks with genuine problems and life issues are applying.

Interviewing for rad onc residency can certainly be considered a genuine problem and life issue
 
  • Haha
  • Like
Reactions: 6 users
Not pertinent to the last few messages, but the title of this thread is so grating and ridiculous. Probably an ASTRO or #radoncrocks plant.

Who wanted this???
 
  • Like
Reactions: 2 users
Members don't see this ad :)
Not pertinent to the last few messages, but the title of this thread is so grating and ridiculous. Probably an ASTRO or #radoncrocks plant.

Who wanted this???

What people want is for these ridiculous so called "academic" programs start cutting residency spots to reflect the current reality on the ground. I'm not talking about the "we are going to take one less resident this year b/c of covid" stuff that I have been seeing. Programs need to cut back their spots by 50% or maybe go back to their 2005 residency compliment numbers for starters. Maybe then if the job out look starts to change the field will start attracting better qualified applicants. But in today's reality it is difficult to even find a decent non explorative rural job. No one with anything going for them is going sign up for that.
 
Last edited:
  • Like
Reactions: 3 users
I love this radonc field, I love my med students and residents, but the Title of this thread makes me feel like...

We are training kamikaze pilots...
(Sorry about my sarcasm but trying to keep dark humor going...)
 
Last edited:
  • Like
Reactions: 2 users
I believe y’all’s field is interesting as it is a microcosm of end stage capitalism, America, and young people in general.

Your leaders seem to be out of touch with reality just like USA political leadership (at least on one side). It seems to be almost impossible to remove them, and the subsidiary chairs are only interested in squeezing out more dollars for themselves before the system collapses. Theoretically, with competent leadership this could be righted by just saying we will only rank strong applicants and will not rank nor SOAP applicants who are not strong. But this will not happen so things will continue to devolve leading to continued chaos. Then at that time leadership will have sucked the field dry and off to the pasture with their loot.

From an applicant point of view, it seems like applying into med school or nsg where people tell you if there is anything you see yourself doing, do that instead. But people will always choose to walk into burning buildings no matter what even though they don’t really understand all the nuisances involved with residency and a career. It seems that a few, or many, poor choices have doomed the field, and instead of righting these, Rad onc has decided to ignore it and “live with it” much like COVID in the US.

All in all, I will be watching this field with great interest over the coming decades.
 
  • Like
  • Haha
Reactions: 7 users
I believe y’all’s field is interesting as it is a microcosm of end stage capitalism, America, and young people in general.

Your leaders seem to be out of touch with reality just like USA political leadership (at least on one side). It seems to be almost impossible to remove them, and the subsidiary chairs are only interested in squeezing out more dollars for themselves before the system collapses. Theoretically, with competent leadership this could be righted by just saying we will only rank strong applicants and will not rank nor SOAP applicants who are not strong. But this will not happen so things will continue to devolve leading to continued chaos. Then at that time leadership will have sucked the field dry and off to the pasture with their loot.

From an applicant point of view, it seems like applying into med school or nsg where people tell you if there is anything you see yourself doing, do that instead. But people will always choose to walk into burning buildings no matter what even though they don’t really understand all the nuisances involved with residency and a career. It seems that a few, or many, poor choices have doomed the field, and instead of righting these, Rad onc has decided to ignore it and “live with it” much like COVID in the US.

All in all, I will be watching this field with great interest over the coming decades.
You’ll drive by the breadlines in your car and think “man i dodged a bullet there”
 
  • Like
Reactions: 2 users
Can anybody confirm or deny the rumors that Kachnic is expanding the columbia program by two spots?
 
Early signals going off in the dermatology forum - Is the demand for dermatologists keeping up with the insane residency growth rate? - radonc/EM referenced as "cautionary tales"
I’ve read through a lot of the EM forum post over the last few months. I would guesstimate their specialty is a few years behind where rad onc is now with covid greatly accelerating existing trends. The root of their field’s problems seems to be the same though, unchecked and unneeded residency expansion with an “academic” leadership that largely seems uninterested/unconcerned with being good stewards of the field.
 
I’ve read through a lot of the EM forum post over the last few months. I would guesstimate their specialty is a few years behind where rad onc is now with covid greatly accelerating existing trends. The root of their field’s problems seems to be the same though, unchecked and unneeded residency expansion with an “academic” leadership that largely seems uninterested/unconcerned with being good stewards of the field.
I thought some of the for profit hospitals were in on that as well...
 
Hii, I'm new to SDN. I was considering a career switch from medical physics to rad onc, but it looks like rad onc is a bad choice. However, I do not understand what is going on. Can someone simplify this discussion? Oversaturation? Too many residents?
 
Hii, I'm new to SDN. I was considering a career switch from medical physics to rad onc, but it looks like rad onc is a bad choice. However, I do not understand what is going on. Can someone simplify this discussion? Oversaturation? Too many residents?

Oh man - can't tell if you're joking or not lol. On the off chance you're not:

1) I would spend more time reading these forums

2) The gist of it is, since the early 2000s, residency spots more than doubled (going from a little less than 100 residents per year to around 200 residents per year). This was fine for a time because of IMRT, which made everyone monster cash. Then the government started to catch on to how much money individual RadOncs were making, which looked bad at first blush but in terms of cost to the system doesn't even touch Keytruda...but I digress. Anyway, things were done, and continue to be done, to reduce reimbursement. CMS keeps dancing around with implementing an Alternative Payment Model, the entire goal of which is to reduce RadOnc expenditures by at least 5%. There were still "linac babysitting" gigs because of puritan American rules, but now these rules are being relaxed. Finally, much of the research that has been done over the last 20 years has been aimed towards reducing (or elimating) the number of fractions patients are given, which is great for patients but considering reimbursement comes from # of fractions, not good for the provider side of the RadOnc equation.

So:
- doubled the number of RadOncs produced per year
- the specialty gets paid by fraction of radiation delivered (over simplification, of course), and cuts were made to reimbursement and more cuts coming
- guidelines have made significant cuts (or eliminated) to the number of fractions needed for common conditions
- supervision rules were relaxed meaning fewer docs needed

I think those are the major brush strokes? Obviously, glossing over a dissertation of nuance.
 
  • Like
Reactions: 4 users
Oh man - can't tell if you're joking or not lol. On the off chance you're not:

1) I would spend more time reading these forums

2) The gist of it is, since the early 2000s, residency spots more than doubled (going from a little less than 100 residents per year to around 200 residents per year). This was fine for a time because of IMRT, which made everyone monster cash. Then the government started to catch on to how much money individual RadOncs were making, which looked bad at first blush but in terms of cost to the system doesn't even touch Keytruda...but I digress. Anyway, things were done, and continue to be done, to reduce reimbursement. CMS keeps dancing around with implementing an Alternative Payment Model, the entire goal of which is to reduce RadOnc expenditures by at least 5%. There were still "linac babysitting" gigs because of puritan American rules, but now these rules are being relaxed. Finally, much of the research that has been done over the last 20 years has been aimed towards reducing (or elimating) the number of fractions patients are given, which is great for patients but considering reimbursement comes from # of fractions, not good for the provider side of the RadOnc equation.

So:
- doubled the number of RadOncs produced per year
- the specialty gets paid by fraction of radiation delivered (over simplification, of course), and cuts were made to reimbursement and more cuts coming
- guidelines have made significant cuts (or eliminated) to the number of fractions needed for common conditions
- supervision rules were relaxed meaning fewer docs needed

I think those are the major brush strokes? Obviously, glossing over a dissertation of nuance.
Thank you!
I'm not a troll or anything. I studied medical physics and rad onc looks like a great career path due to the combination of physics with patient care. Also the interactions with patients on the physician side is much more attractive than the nonexistent interactions as a physicist. I guess the grass is greener on the other side? Is the fewer fractions given to patients due to SRS/SBRT increasing in popularity? Would it be better then to stick to being a physicist? I'm considering taking postbac classes and studying for the MCAT, but if radonc looks like a sinking ship than probably best not to spend the cash for med school
 
Thank you!
I'm not a troll or anything. I studied medical physics and rad onc looks like a great career path due to the combination of physics with patient care. Also the interactions with patients on the physician side is much more attractive than the nonexistent interactions as a physicist. I guess the grass is greener on the other side? Is the fewer fractions given to patients due to SRS/SBRT increasing in popularity? Would it be better then to stick to being a physicist? I'm considering taking postbac classes and studying for the MCAT, but if radonc looks like a sinking ship than probably best not to spend the cash for med school

1) It's actually more due to the change in standard of care for breast and prostate, the most common cancers treated by Radiation Oncology. Breast used to always be like 25 fractions, prostate like 44. Now breast is ~15 and prostate is ~28 (again, grossly over simplifying). SRS/SBRT plays a part, but you could argue that helps us treat more patients than we were 20 years ago (Stage I lung or oligomets, for example). There are multiple other examples as well (active surveillance for low risk prostate etc).

2) RadOnc or not, I would absolutely not recommend going to medical school - it's not a good investment in yourself. This conversation can go in 1,000 different ways, and I'm sure people will disagree with me about this...but I will be actively discouraging my children from going into medicine.

Are you already a board-certified medical physicist or are you still in training?
 
  • Like
Reactions: 3 users
I have just received confirmation through a PM Columbia is expanding by two more spots under Lisa Kachnic. Pretty much sums up this dumpster fire of a field and its “leaders”. For those of you still holding onto any hope some sort of significant change will happen. This is someone who has switched institutions multiple times over the past few years and this is their first order of business.

the breadlines are absolutely coming
 
Last edited:
  • Like
  • Angry
  • Wow
Reactions: 6 users
1) It's actually more due to the change in standard of care for breast and prostate, the most common cancers treated by Radiation Oncology. Breast used to always be like 25 fractions, prostate like 44. Now breast is ~15 and prostate is ~28 (again, grossly over simplifying). SRS/SBRT plays a part, but you could argue that helps us treat more patients than we were 20 years ago (Stage I lung or oligomets, for example). There are multiple other examples as well (active surveillance for low risk prostate etc).

2) RadOnc or not, I would absolutely not recommend going to medical school - it's not a good investment in yourself. This conversation can go in 1,000 different ways, and I'm sure people will disagree with me about this...but I will be actively discouraging my children from going into medicine.

Are you already a board-certified medical physicist or are you still in training?
Ah I see. Are fewer fractions chosen due to radiobiological advantages or due to insurance? What career paths would you recommend your children pursue then? I have looked into tech/finance (popular well paying jobs in nyc) and they also looks extremely toxic/terrible as well but the pay is really great. It seems like every career field has alot of toxicity and is a sinking ship (apart from careers that rely on patrons like twitch gaming or onlyfans).
I actually left Columbia Radonc before Lisa Kachinic became the chair of that department. I read on this forum that she's terrible but I cannot gauge why (is it because she's a lobbyist?).

I am still training and I am curious in other career paths. Thinking about going to get a PhD in medical physics because I like research/teaching but I am not sure if I am digging myself into a hole where radiation physics academia is toxic or something (which is why I am browsing this board).

Are protons going to help this field? Protons seem like an interesting phd topic but not sure how practicals protons are due to insurance and all that.
 
Last edited:
I have just received confirmation through a PM Columbia is expanding by two more spots under Lisa Kachnic. Pretty much sums up this dumpster fire of a field and its “leaders”. For those of you still holding onto any hope some sort of significant change will happen. This is someone who has switched institutions multiple times over the past few years and this is their first order of business.
This is bad because this will lead to more oversaturation in radonc. Correct?
 
  • Like
Reactions: 1 users
I have just received confirmation through a PM Columbia is expanding by two more spots under Lisa Kachnic. Pretty much sums up this dumpster fire of a field and its “leaders”. For those of you still holding onto any hope some sort of significant change will happen. This is someone who has switched institutions multiple times over the past few years and this is their first order of business.

the breadlines are absolutely coming
Was Lisa Kachinic in some “leadership” position in the abr, or something else? Just lays bare the selfishness..
 
  • Like
Reactions: 1 users
Hii, I'm new to SDN. I was considering a career switch from medical physics to rad onc, but it looks like rad onc is a bad choice. However, I do not understand what is going on. Can someone simplify this discussion? Oversaturation? Too many residents?

Welcome to the forum Rip Van Winkle!
 
  • Haha
  • Like
  • Wow
Reactions: 4 users
If you're honest with yourself when you look in the mirror, and are pretty sure that in the next ten years you'll be in prison, deported, or dead, then I'd advise you to seriously consider radiation oncology.
 
  • Like
  • Haha
  • Love
Reactions: 4 users
Ah I see. Are fewer fractions chosen due to radiobiological advantages or due to insurance? What career paths would you recommend your children pursue then? I have looked into tech/finance (popular well paying jobs in nyc) and they also looks extremely toxic/terrible as well but the pay is really great. It seems like every career field has alot of toxicity and is a sinking ship (apart from careers that rely on patrons like twitch gaming or onlyfans).
I actually left Columbia Radonc before Lisa Kachinic became the chair of that department. I read on this forum that she's terrible but I cannot gauge why (is it because she's a lobbyist?).

I am still training (early 20s) and I am curious in other career paths. Thinking about going to get a PhD in medical physics because I like research/teaching but I am not sure if I am digging myself into a hole where radiation physics academia is toxic or something (which is why I am browsing this board).

Are protons going to help this field? Protons seem like an interesting phd topic but not sure how practicals protons are due to insurance and all that.

To my understanding, the experiments/trials were created with the best of biological intentions, but now eviCore is sort of enforcing it. To be clear, I don't have anything against hypofrac/surveillance as a physician or looking at it from a patient perspective, I think it's great. It just means we can do more with fewer doctors, but instead we're doing less with more doctors. Protons are just another tool in the arsenal, they're here to stay but they're not the gamechanger IMRT was.

I mean, I'll support whatever my kids want to do lol, it's their life. But MAN is medicine toxic. It's just constant egos and hurdles and regulations. I try to think about what I would do, if I could do it over again.

If I stayed a doctor, I would have been a hospitalist because of how much I loved intern year.

If I wanted to stay in medicine but skip the medical school crap, I would have been a mid-level (APRN or PA) and gone the inpatient route.

If I had left medicine, I would have gone to trade school and been an electrician.

A lot of academia is toxic, regardless of which path you choose. Is there a "right" answer? Probably not. But since you haven't even done the pre-med requirements, you're at least 10 years out from being a RadOnc attending...that seems the "least right" answer.
 
Last edited:
  • Like
Reactions: 3 users
To my understanding, the experiments/trials were created with the best of biological intentions, but now eviCore is sort of enforcing it. To be clear, I don't have anything against hypofrac/surveillance as a physician or looking at it from a patient perspective, I think it's great. It just means we can do more with fewer doctors, but instead we're doing less with more doctors. Protons are just another tool in the arsenal, they're here to stay but they're not the gamechanger IMRT was.

I mean, I'll support whatever my kids want to do lol, it's their life. But MAN is medicine toxic. It's just constant egos and hurtles and regulations. I try to think about what I would do, if I could do it over again.

If I stayed a doctor, I would have been a hospitalist because of how much I loved intern year.

If I wanted to stay in medicine but skip the medical school crap, I would have been a mid-level (APRN or PA) and gone the inpatient route.

If I had left medicine, I would have gone to trade school and been an electrician.

A lot of academia is toxic, regardless of which path you choose. Is there a "right" answer? Probably not. But since you haven't even done the pre-med requirements, you're at least 10 years out from being a RadOnc attending...that seems the "least right" answer.
gotcha, thank you for clarifying with brute honesty. seems like the rad oncs and residents ive talked to were hesitant to admit this in person.
perhaps, people don't want to admit their career is draining to save face.

I guess I dodged a bullet :oops:
 
gotcha, thank you for clarifying with brute honesty. seems like the rad oncs and residents ive talked to were hesitant to admit this in person.
perhaps, people don't want to admit their career is draining to save face.

I guess I dodged a bullet :oops:

Yeah in real life I'm much more delicate about it, simply because you always must operate under the guise of "professionalism" and if you openly say things like "avoid the dumpster fire" and it gets back to the people who sign your checks - well, we all have bills to pay.

Many of my close friends in this field are brutally open and honest to each other about this stuff, but as soon as a bright eyed med student hops into the department, it's all "well, you know, it's never been easy to get the job you want in RadOnc, but it's the best field in medicine..."
 
  • Like
Reactions: 1 users
I have just received confirmation through a PM Columbia is expanding by two more spots under Lisa Kachnic. Pretty much sums up this dumpster fire of a field and its “leaders”. For those of you still holding onto any hope some sort of significant change will happen. This is someone who has switched institutions multiple times over the past few years and this is their first order of business.

the breadlines are absolutely coming
It's a dumpster fire of a program with exploitative unaccredited trash inpatient fellowships. Likely won't fill
 
  • Like
Reactions: 1 user
It’s a residency program in NYC. 4 years of employment with living wage. They will fill.

It's a dumpster fire of a program with exploitative unaccredited trash inpatient fellowships. Likely won't fill
 
  • Like
Reactions: 3 users
I have just received confirmation through a PM Columbia is expanding by two more spots under Lisa Kachnic. Pretty much sums up this dumpster fire of a field and its “leaders”. For those of you still holding onto any hope some sort of significant change will happen. This is someone who has switched institutions multiple times over the past few years and this is their first order of business.

the breadlines are absolutely coming
If this turns out true, will give credence to the proverb “even a broken clock is right twice a day”
 
  • Haha
Reactions: 1 users
Yeah in real life I'm much more delicate about it, simply because you always must operate under the guise of "professionalism" and if you openly say things like "avoid the dumpster fire" and it gets back to the people who sign your checks - well, we all have bills to pay.

Many of my close friends in this field are brutally open and honest to each other about this stuff, but as soon as a bright eyed med student hops into the department, it's all "well, you know, it's never been easy to get the job you want in RadOnc, but it's the best field in medicine..."
Just to clarify, do you like rad onc?
My impression is that it is a enjoyable field but that the career prospects are bad due to resident oversaturation and risking unemployment or placement in a bad location because of the poor job market. Also the pay is diminishing (?)
Correct?
 
  • Like
Reactions: 1 users
Just to clarify, do you like rad onc?
My impression is that it is a enjoyable field but that the career prospects are bad due to resident oversaturation and risking unemployment or placement in a bad location because of the poor job market. Also the pay is diminishing (?)
Correct?

Oh yes I definitely love the actual practice of RadOnc, it's super cool...how could people not love harnessing the power of the universe to blast cancer?

The inflexibility of the job market is easily the biggest issue, for sure. There is geographic variation - it's easier to find a job in the Midwest than the Northeast, but it's not like you're swimming in options in Oklahoma either - still anchored to the linac. The pay is diminishing, which is somewhat less important to me because the pay is still very good - but data came out this year which shows that we have the worst "wage stagnation" in the 19 specialties examined (#19 of 19, woo).

I think of it like this: whether people openly admit it or not, a huge draw of being a doctor is the economic security. Most doctors in America are almost guaranteed a very high paying job that is nigh recession (not pandemic) proof.

RadOnc is MUCH more similar to other white collar jobs like finance. It's not what you know, it's who you know - and how lucky you are. Some people are OK with that. I would argue if a job needs 4 years undergrad, 4 years medical school, 5 years residency, and 4 ridiculous board exams - it should rely a little less on luck and networking.
 
  • Like
Reactions: 4 users
Top