2022 Match Game

[RADONC4285]

Boomers gonna boom.

I mean look at Jay friggin Loeffler coming down to Naples after being chair at MGH to take his "retirement" PP gig. Guess that's another "job" that isn't going to someone up and coming, then again southwest FL hasn't exactly been the easiest place to find a job since it essentially has been run by boomers from the getgo

Many of these people will literally have to be carried out of their offices

Is Loeffler the same guy who would practically cut all ties with any MGH resident who took a PP job? Or was that some other Harvard snob?

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[TheWallnerus]

Is Loeffler the same guy who would practically cut all ties with any MGH resident who took a PP job? Or was that some other Harvard snob?

There are about 3 to 3.5 times as many (200 to 250% more) academic rad oncs today as 25 years ago but only about 1.25 times as many (25% more) PP rad oncs. So prior to about 25 years ago, the large majority of graduating residents headed to PP. it was around 2000-5 when this rapidly flipped. If you were PP and graduated prior to 2000 Jay, and most academic people, liked the PP guys. Then things got elitist.

 

[Mandelin Rain]

When I was in my first week of residency, I was rotating with a breast attending who had seen/contoured an oropharyngeal (tonsil) patient on his own for whatever reason during the change over between classes. I was asked to review the finished plan by dosimetry. I didn't know much about H&N radiation at the time, but I did know you probably should treat the neck. And you should also treat the correct tonsil.

Saved a HUGE med mal case on like my 3rd day of residency.

 

[SubserviantToABR]

Man the state of our field is depressing and I don't see a solution in sight. I've repeatedly implored the leadership of our residency program to cut down a spot. My pleas have fallen on deaf ears. They care more about attendings not having to do their own contours or put in their own orders. We are not going to have a correction in the market until those in leadership start to feel the impact in their salaries. that won't happen until the current junior people become decision makers. It's hard to convince a current chair/PD making 600K+ without having to write a single note that there is a problem in our field. Their salaries won't be cut, but the ceiling for those just entering the field will keep falling.

I have done the same with pleading with leadership to cut down our spots. Instead, leadership is celebrating this week because we matched our full complement this year, after interviewing 75% of the applicants, just to avoid being on the unmatched/SOAP list.

 

[Mandelin Rain]

There are about 3 to 3.5 times as many (200 to 250% more) academic rad oncs today as 25 years ago but only about 1.25 times as many (25% more) PP rad oncs. So prior to about 25 years ago, the large majority of graduating residents headed to PP. it was around 2000-5 when this rapidly flipped. If you were PP and graduated prior to 2000 Jay, and most academic people, liked the PP guys. Then things got elitist.

And the PP guys liked and respected the academic guys.

 

[deleted1111261]

Just got confirmation that a dirty no good hellpit just SOAPed their open spot.

 

[thecarbonionangle]

And the PP guys liked and respected the academic guys.

The way to bridge this divide is to increase PP engagement in our organizations. ASTRO is mostly dominated by academic circle jerks. Has there been a PP ASTRO president recently or multiple people in leadership? Im not sure?
With the latest rule changes for ASTRO, they essentially codified and made it harder for non-academic docs to run for leadership positions.

 

[ramsesthenice]

There are a lot of possible solutions but slow moving problems are sadly left to their own devices to play out in real time...

 

[deleted1111261]

Recently? Tom Eichler. Less recents? Williams from Florida. Beyer from AZ
Can also switch over to ACRO. I’m musing about how to get more of us there.

 

[zapzapzap]

Just got confirmation that a dirty no good hellpit just SOAPed their open spot.

Is it one of the programs on the applicant Google doc already? Just saw the Georgetown SOAP spot on spreadsheet is actually a physician spot for this summer; Georgetown filled 1/1 advanced. So the sheet is likely 6+ unfilled places (likely those programs not SOAPing...for one reason or another) short.

 

[deleted1116990]

I suppose with surgery incompetece is much more difficult to hide. In radiation it's easy to just give these dinasaurs a resident to do their job. Even worse, with RT, the impact of our mistakes is often delayed and not easily linked to RT. The poor patient doesn't know their cancer recurred because the doctor didn't contour the tumor properly. We should have known. If our leadership has no issues overlooking serious patient safety issues, they sure as heck have no problem with trainees suffering for jobs. The messed up thing is most of these incompetent attendings have way more money than they need to retire. The two incompetent attendings in my program are worth in the 10s of millions. One of them has multiple vacation homes. The other's 1 million plus worth of Apple shares only make up a "small portion of my portfolio".

The old guys have all kinds of one-off sweetheart deals with stupid amounts of vacation, high salaries, bonuses, etc. Meanwhile the young guys doing the heavy lifting have equitable contracts where they all get paid the same. That's the thing about equity. It doesn't care about what the outcome is. As long as everybody ends up with the same. If you are all equally miserable and underpaid, that's a win for equity. The boomers on the equity committee declare success from their dachas in Naples.

The ABR can fix the boomer problem tomorrow by requiring re-certification and getting rid of lifetime cert/grandfathering (ie. holding us all to the same standards/equity/not being a hypocrite). Of course, the ABR is run by the boomiest boomer of them all. So we just get snarls and lectures instead about respecting the giants that came before us.

 

[RADONC4285]

The old guys have all kinds of one-off sweetheart deals with stupid amounts of vacation, high salaries, bonuses, etc. Meanwhile the young guys doing the heavy lifting have equitable contracts where they all get paid the same. That's the thing about equity. It doesn't care about what the outcome is. As long as everybody ends up with the same. If you are all equally miserable and underpaid, that's a win for equity. The boomers on the equity committee declare success from their dachas in Naples.

The ABR can fix the boomer problem tomorrow by requiring re-certification and getting rid of lifetime cert/grandfathering (ie. holding us all to the same standards/equity/not being a hypocrite). Of course, the ABR is run by the boomiest boomer of them all. So we just get snarls and lectures instead about respecting the giants that came before us.

well said. In my department, the new attendings literally make less than half the senior attendings' salary. Guess who gets the resident coverage? guess who is harassed about RVUs? we have an RVU pool structure. As long as the group target is met, the hospital is happy. The chair doesn't go after those dinosaurs who get like 50% of their target. He comes after the young guys making half the salary with minimal resident coverage. You could say it's our fault for taking the job, but I was very geographically restricted for family reasons.

 

[temujim]

The old guys have all kinds of one-off sweetheart deals with stupid amounts of vacation, high salaries, bonuses, etc. Meanwhile the young guys doing the heavy lifting have equitable contracts where they all get paid the same. That's the thing about equity. It doesn't care about what the outcome is. As long as everybody ends up with the same. If you are all equally miserable and underpaid, that's a win for equity. The boomers on the equity committee declare success from their dachas in Naples.

The ABR can fix the boomer problem tomorrow by requiring re-certification and getting rid of lifetime cert/grandfathering (ie. holding us all to the same standards/equity/not being a hypocrite). Of course, the ABR is run by the boomiest boomer of them all. So we just get snarls and lectures instead about respecting the giants that came before us.

ABR can't fix it. Those lifetime certs can't be withdrawn -- guaranteed lawsuit ABR would lose. And even if they could, do you really think MoC would get rid of boomers hanging on? I know some boomers (who I wouldn't let touch anyone I cared about) that gave up their lifetime cert for a variety of reasons -- they're having no problems with MoC. Would rather go back to the lifetime cert for everyone and keep my money and time.

 

[deleted1116990]

I was very geographically restricted for family reasons.

That is literally their favorite thing. Like a Pavlovian response when a chair or Hospital CEO knows a new grad is geographically restricted due to family.

ABR can't fix it. Those lifetime certs can't be withdrawn -- guaranteed lawsuit ABR would lose. And even if they could, do you really think MoC would get rid of boomers hanging on? I know some boomers (who I wouldn't let touch anyone I cared about) that gave up their lifetime cert for a variety of reasons -- they're having no problems with MoC. Would rather go back to the lifetime cert for everyone and keep my money and time.

No, i mean bring back the 10 year test. There is absolutely no way my boomer would pass an honest exam testing minimal competence. Sometimes I wonder if he would pass a mini-mental status exam. I hear your argument about the lawsuit though. That's unfortunate. Getting rid of 50% or more of the dino-crowd overnight would open up a lot of jobs.

 

[jondunn]

He comes after the young guys making half the salary with minimal resident coverage.

what sort of stuff does he/she say? this is interesting to me. When i was in residency our chair was pretty academic focused, clinical volume was something the hospital cared about, so he had to care at times, but he never came after the faculty too hard.

its not like any of us can control referrals THAT much.

 

[RADONC4285]

what sort of stuff does he/she say? this is interesting to me. When i was in residency our chair was pretty academic focused, clinical volume was something the hospital cared about, so he had to care at times, but he never came after the faculty too hard.

its not like any of us can control referrals THAT much.

If our RVUs are not on track to meet the target, he will basically pressure us to get more patients somehow. TBH it hasn't been bad because as a group we're meeting our target, so as long as we're in the ball park he's fine. But if the group numbers start to dip, it's a different story.

I agree not much we can do about the referrals, but try to convince our corporate overlords of that. The chair understand, but not much he can do when the pressure is coming from the hospital administration. To them, our combined salaries have to be generated from the total wRVUs of the group. They don't care how it happens or whether we have any control over it. It's not unique to my hospital. Unfortunately that's the case with many big health systems

 

[SubserviantToABR]

well said. In my department, the new attendings literally make less than half the senior attendings' salary. Guess who gets the resident coverage? guess who is harassed about RVUs? we have an RVU pool structure. As long as the group target is met, the hospital is happy. The chair doesn't go after those dinosaurs who get like 50% of their target. He comes after the young guys making half the salary with minimal resident coverage. You could say it's our fault for taking the job, but I was very geographically restricted for family reasons.

Are you me? This is exactly my situation at my shop, located in a large, metropolitan location. I would leave, if it was not for family/personal reasons or the poor job market. I would have to go far away for better pay (currently well below median MGMA for academic assistant professor).

 

[deleted1111261]

Not asking to be a jerk, but with sincerity as I have moved a **** ton BUT I'm very family-centered.

Is it something about the field that selects for so many people saying "I have to live in XXX because of YYY". My parents never really thought that way (India, NE Pennsylvania, Toronto, Long Island, Michigan) and found jobs that suited them until they found "home". I have a sense of adventure and love to live in various places, but it was time to come home.

On this board and in real life I have met so many people unhappy at their job. I just can't fathom being unhappy at the place you spend most of your awake time and feel that I couldn't do anything about it. I am sure some have legit reasons and I was in their particular situation, I would be stuck, too, but I suspect that some level of inertia or fear of change exists? Maybe I'm wrong at 100% of the people that are unhappy at their job truly have no other option, but it seems unlikely.

 

[RADONC4285]

Are you me? This is exactly my situation at my shop, located in a large, metropolitan location. I would leave, if it was not for family/personal reasons or the poor job market. I would have to go far away for better pay (currently well below median MGMA for academic assistant professor).

haha . we are the same person. I make well below median as well. more likek 25th percentile

 

[RADONC4285]

Not asking to be a jerk, but with sincerity as I have moved a **** ton BUT I'm very family-centered.

Is it something about the field that selects for so many people saying "I have to live in XXX because of YYY". My parents never really thought that way (India, NE Pennsylvania, Toronto, Long Island, Michigan) and found jobs that suited them until they found "home". I have a sense of adventure and love to live in various places, but it was time to come home.

On this board and in real life I have met so many people unhappy at their job. I just can't fathom being unhappy at the place you spend most of your awake time and feel that I couldn't do anything about it. I am sure some have legit reasons and I was in their particular situation, I would be stuck, too, but I suspect that some level of inertia or fear of change exists? Maybe I'm wrong at 100% of the people that are unhappy at their job truly have no other option, but it seems unlikely.

I mean different people will give different answers. To me, as someone with young kids, and as someone who spent the last 20 years away from my family, I've reached a point where being close to family and in a place where my wife and kids can be happy is priority number 1. Having said that, I am not miserable in my job. I am unhappy with my salary and the fact that I have an RVU target over which I have 0 control. But it's not malignant or causing me non-stop stress. If it ever got to that point God forbid, I would leave.

 

[deleted1111261]

I mean different people will give different answers. To me, as someone with young kids, and as someone who spent the last 20 years away from my family, I've reached a point where being close to family and in a place where my wife and kids can be happy is priority number 1. Having said that, I am not miserable in my job. I am unhappy with my salary and the fact that I have an RVU target over which I have 0 control. But it's not malignant or causing me non-stop stress. If it ever got to that point God forbid, I would leave.

That makes sense. I know the market is not ideal or optimal by any means, but I am pretty sure most people with 5 years experience can make up and move and make the median in a relatively decent part of the country (like better than, uh, southeast MI)

 

[RADONC4285]

That makes sense. I know the market is not ideal or optimal by any means, but I am pretty sure most people with 5 years experience can make up and move and make the median in a relatively decent part of the country (like better than, uh, southeast MI)

haha. you're in royal oak bro. That's a nice area!

 

[Mandelin Rain]

In my travels, I have found that roughly 90% of this country is beautiful and imminently inhabitable if you're open to it.

 

[communitydoc13]

Not asking to be a jerk, but with sincerity as I have moved a **** ton BUT I'm very family-centered.

I think the staying close to family is a trending priority for younger folks (not that I'm that young). I think this is good. Nobody from my very academically oriented training program was very sympathetic to my priorities and I was not going to get hired by my home program. The expectation was that you do a national academic job search.

By staying close, I closed doors professionally but got to care for my elderly in-laws and got to see family and have them be a positive influence on my children regularly.

From personal experience, once your kids are teens, you usually don't want to move them. Their friends are super important.

The fact that radonc hours are good dovetails with the priority on family. Certainly a selection bias here.

 

[Doctorer]

Not asking to be a jerk, but with sincerity as I have moved a **** ton BUT I'm very family-centered.

Is it something about the field that selects for so many people saying "I have to live in XXX because of YYY". My parents never really thought that way (India, NE Pennsylvania, Toronto, Long Island, Michigan) and found jobs that suited them until they found "home". I have a sense of adventure and love to live in various places, but it was time to come home.

On this board and in real life I have met so many people unhappy at their job. I just can't fathom being unhappy at the place you spend most of your awake time and feel that I couldn't do anything about it. I am sure some have legit reasons and I was in their particular situation, I would be stuck, too, but I suspect that some level of inertia or fear of change exists? Maybe I'm wrong at 100% of the people that are unhappy at their job truly have no other option, but it seems unlikely.

It's a function of the type of applicants that this field selected for over the past 10-15 years. The crowd that applied to radonc (and derm, ortho, etc) tended to be the higher achieving type, who were more likely to come from the same suburbs of Boston/NY/Philly/DC/Chicago/Detroit/Dallas/LA/SF/etc, went to similar colleges, med schools, married similar spouses, etc. Many of them would prefer to live in those same areas as opposed to Salina, KS. Obviously that's not everyone in the field, but I have a feeling it's a good number of them.

The frustration you see on this board is when those attendings realize that moving to those areas may not be possible for them, or may require taking a job where they feel exploited. It leaves a bad taste in your mouth, especially after years of working towards a dream that you find out may not be possible.

 

[deleted1111261]

Because I'm old AF, as long as market doesn't apocalypse, I won't be working a full time job when they are teens.

 

[RickyScott]

T

I'm fairly certain we don't know each other in real life -

I can say the same thing, that I know multiple attendings both in academia and private practice that I also wouldn't trust with a bone met.

Nothing we can do about it, I guess.

(well, in my current role - I can edit cases between treatment planning and VSIM, but not everyone has that luxury)

The worst are attendings who suck clinically in their own field of expertise and have national reputations. I am thinking of one (former Astro president w/ a disturbing appearence) who was a pi on well known negative rtog dose escalation trial for esophagus.

 

[deleted1116990]

T

The worst are attendings who suck clinically in their own field of expertise and have national reputations. I am thinking of one (former Astro president w/ a disturbing appearence) who was a pi on well known negative rtog dose escalation trial for esophagus.

I have heard horror stories about the individual I assume you are talking about, without naming names. Gross incompetence.

 

[gyngyn]

I'm hoping someone here can answer a question I have regarding this year's SOAP.
I have a student who didn't match in plastics. She had a strong application, a year of productive research and Step scores in excess of 260.
She decided to change her focus and noticed a boatload of open positions at well-recognized universities in your specialty.
She didn't get a single interview in radiation oncology in this year's SOAP.
Can someone explain this to me?

 

[Doctorer]

New chair of Moffit is 4 years out of residency. I think this is good. As much as the guy at the Allegheny of Cleveland don’t get along, excellent decision for them to grab a young star rather than wait til he’s decrepit and no longer hungry. This is good for RO - new fresh blood!

He's more than 4 years out, but yes, young blood is good.

 

[deleted1111261]

He's more than 4 years out, but yes, young blood is good.

Deleted - I was in error!

 

[RSAOaky]

It's a function of the type of applicants that this field selected for over the past 10-15 years. The crowd that applied to radonc (and derm, ortho, etc) tended to be the higher achieving type, who were more likely to come from the same suburbs of Boston/NY/Philly/DC/Chicago/Detroit/Dallas/LA/SF/etc, went to similar colleges, med schools, married similar spouses, etc. Many of them would prefer to live in those same areas as opposed to Salina, KS. Obviously that's not everyone in the field, but I have a feeling it's a good number of them.

The frustration you see on this board is when those attendings realize that moving to those areas may not be possible for them, or may require taking a job where they feel exploited. It leaves a bad taste in your mouth, especially after years of working towards a dream that you find out may not be possible.

Not only this, but also for radonc, historically programs have been concentrated in big cities. In the competitive days, you needed exposure to the field to decide if you wanted to do it, and research in the field to open the door. If you had no home program, you were going to have a tough time getting either.

So in sum, historically you were more likely to get into radonc coming from a good med school or one with a home program. The best med schools and most radonc programs, until the recent boon in rural radonc hellpits, are concentrated in metropolitan areas. As a result, if radonc applicants aren't already the above mentioned high achievers who grew up in these areas, then they're still very likely to wind up in these areas for 4-9 years of training. As a result, they either decide they can't move away from the big cities or meet significant others that can't move away from the big cities, and the result is that everyone wants to be in the places that there are no jobs.

 

[communitydoc13]

the higher achieving type, who were more likely to come from the same suburbs of Boston/NY/Philly/DC/Chicago/Detroit/Dallas/LA/SF/etc

A larger and non-radonc specific cultural issue, but I am amazed at the consolidation of hard charging, professional, upper middle-class or recent immigrant middle-class types nationally. This is not to say this is the most healthy milieu to grow up in as a young person, particularly if you are not that good at school, but it is the environment that produces stellar young career CVs on average.

Just look at how national merit finalists are distributed or how score cut-offs differ by state. In any given state, there are a few schools that produce the overwhelming majority of these folks, then solid suburban schools producing 1-2 per year and rural schools having the occasional one-off super smart kid who never needed to prep.

I suspect that this alone is a major factor that impedes recruiting of young docs away from major (or at least semi-major) cities.

....also, part of that whole civil war thing.

 

[gyngyn]

Hope things work out for her and judging from her accomplishments, they will.

Yes! She landed on her feet.

 

[Reaganite]

A larger and non-radonc specific cultural issue, but I am amazed at the consolidation of hard charging, professional, upper middle-class or recent immigrant middle-class types nationally. This is not to say this is the most healthy milieu to grow up in as a young person, particularly if you are not that good at school, but it is the environment that produces stellar young career CVs on average.

Just look at how national merit finalists are distributed or how score cut-offs differ by state. In any given state, there are a few schools that produce the overwhelming majority of these folks, then solid suburban schools producing 1-2 per year and rural schools having the occasional one-off super smart kid who never needed to prep.

I suspect that this alone is a major factor that impedes recruiting of young docs away from major (or at least semi-major) cities.

....also, part of that whole civil war thing.

This is not meant to be a political post in any way...just an observation. The irony is that the private practice owners in these typically liberal-to-very-liberal areas where all the educated millenials live are some of the hardest-core Trump supporters out there. This isn't restricted to the old guard either. I sometimes feel the need to change my screen name here after meeting other PP owners!

 

[dieABRdie]

I'm hoping someone here can answer a question I have regarding this year's SOAP.
I have a student who didn't match in plastics. She had a strong application, a year of productive research and Step scores in excess of 260.
She decided to change her focus and noticed a boatload of open positions at well-recognized universities in your specialty.
She didn't get a single interview in radiation oncology in this year's SOAP.
Can someone explain this to me?

The program directors know that with that kind of CV she will beat feet to another specialty the moment she discovers what a hellpit she fell into.

They want a note monkey without options.

Its actually a blessing.

 

[elementaryschooleconomics]

This is not meant to be a political post in any way...just an observation. The irony is that the private practice owners in these typically liberal-to-very-liberal areas where all the educated millenials live are some of the hardest-core Trump supporters out there. This isn't restricted to the old guard either. I sometimes feel the need to change my screen name here after meeting other PP owners!

I also don't mean to be political other than to say:

this is exactly my observation as well. It's very strange.

 

[deleted1116990]

The program directors know that with that kind of CV she will beat feet to another specialty the moment she discovers what a hellpit she fell into.

They want a note monkey without options.

Its actually a blessing.

Correct.

This student is not going to be happy SOAPing into a program where her post-residency job option is going to be rural feedlot town with underpaid exploitative contract that prohibits her from leaving. Once she realizes that is her future probably early on in PGY-2, she will bail into a different specialty. Programs don't want to bring on a flight risk and she's about as high of a flight risk as you can get. A stellar applicant who could literally do any other specialty if she wanted.

Ironically, if her step scores were 200 and she had some red flags, she would have probably SOAPed fine. Agree they did her a massive favor. If she still really wants to go into rad onc after researching the field and spending all of next year thinking about it, she will have plenty of opportunity to do so and get into a top program, not one on the SOAP list.

 

[thecarbonionangle]

T

The worst are attendings who suck clinically in their own field of expertise and have national reputations. I am thinking of one (former Astro president w/ a disturbing appearence) who was a pi on well known negative rtog dose escalation trial for esophagus.

This person cannot function without a resident

 

[medgator]

This is not meant to be a political post in any way...just an observation. The irony is that the private practice owners in these typically liberal-to-very-liberal areas where all the educated millenials live are some of the hardest-core Trump supporters out there. This isn't restricted to the old guard either. I sometimes feel the need to change my screen name here after meeting other PP owners!

Tax cuts Trump all for some once you're in that top bracket

 

[RadOncDoc21]

Tax cuts Trump all for some once you're in that top bracket

This is true… I was all for socialism until I saw the tax rates.

 

[medgator]

This is true… I was all for socialism until I saw the tax rates.

The real kicker is when you find out who has the highest effective tax rates/burden (hint: it isn't the ultra rich or the impoverished) and you can thank both parties for that

 

[jondunn]

when do we find out who WHIFFED in the soap?

 

[CurbYourExpectations]

176 spots in the match, plus an additional 9 R spots
143 matched for the PGY-2 people starting in 2023, 6 matched for R spots
115 USMD, 9 DO
Unclear about SOAP

 

[deleted1111261]

How many IMG/FMG?

 

[CurbYourExpectations]

9 US IMG for PGY2 starting in 2023, 2 US IMG for R positions starting in 2022. 14 NON-US IMGs starting in 2023

 

[deleted1111261]

Thanks Larry

 

[deleted1116990]

The real kicker is when you find out who has the highest effective tax rates/burden (hint: it isn't the ultra rich or the impoverished) and you can thank both parties for that

I highly doubt anybody pays back a greater percentage of their income to the govt as taxes than specialist physicians earning 500k+ as W-2 wages.
This is an unbelievably raw deal, yet we are villainized as greedy and the general public thinks we are getting off without paying our fair share. I paid nearly 300k in taxes last year, and I earned just a little above MGMA median. Anybody who claims I did not "pay my fair share" can suck it.

The evicore clowns in their 5M mansions no doubt have all sorts of various tax dodges and schemes to reduce their taxable income that W2 wage earners do not have.

Hell, you can live in Puerto Rico, pay 4% federal income tax, and answer Evicore calls through your LLC, and this would be totally legal.

 

[communitydoc13]

I highly doubt anybody pays back a greater percentage of their income to the govt as taxes than specialist physicians earning 500k+ as W-2 wages.

I believe this is true. Any arrangement where you get money via distribution gives you much more leeway to avoid tax. Most of this tax avoidance is immoral but not illegal.

 

[deleted1116990]

I believe this is true. Any arrangement where you get money via distribution gives you much more leeway to avoid tax. Most of this tax avoidance is immoral but not illegal.

If someone wants to make me feel better, they can tell me that the eviclowns are forced to be W2 employees, but I suspect they all do this part time as 1099 or through their LLCs and thus pull all kinds of shady tax stuff as immoral and Evicore are basically a given. Hell, wouldn't surprise me if they would agree to pay them in bitcoin if it meant it could save evicore a few bucks.