2022 Match Game

[yesmaster]

A lot of speculation and logical contortions to say that this year’s radiation oncology crop, at Harvard or elsewhere, is as qualified as that of 2010.

It does not help that there are a few suddenly woke boomer chairs that believe every no-name foreign medical school must be graduating Srini Ramanujan’s of oncology. In my experience, DO and Caribbean schools for instance, still have hefty tuitions, so the students that attend often come from upper middle class families, but they studied too little and partied too much in college.

The question is whether top radiation oncology programs can take a medical school graduate with lesser “traditional institutionalized metrics of competency with hidden biases” and train him/her to be equally competent as his/her predecessors. Time will tell!

---

Members don't see this ad.

 

[deleted941485]

A lot of speculation and logical contortions to say that this year’s radiation oncology crop, at Harvard or elsewhere, is as qualified as that of 2010.

It does not help that there are a few suddenly woke boomer chairs that believe every no-name foreign medical school must be graduating Srini Ramanujan’s of oncology. In my experience, DO and Caribbean schools for instance, still have hefty tuitions, so the students that attend often come from upper middle class families, but they studied too little and partied too much in college.

The question is whether top radiation oncology programs can take a medical school graduate with lesser “traditional institutionalized metrics of competency with hidden biases” and train him/her to be equally competent as his/her predecessors. Time will tell!

I think we already know the answer to this if you strip away the utter nonsense that gets wrapped in a typical RO residency.

What are you actually doing day to day. See consult sim contour manage on treatment and send off. Memorize target volumes, dose constraints and nccn guidelines. Throw in some statistics to memorize and presto. The rad bio rad physics nowadays is a joke at most places especially the biology portion as nobody is actually actively looking at it.

So back to the question, how qualified do you need to be to competently perform this specialty. On the spectrum of physician tasks that are performed day in and day out…we really aren’t special.

Like hypofrac, not hogging true scientific talent the way we have and allowing thr more qualified students to seek out other fields we are doing everyone else in medicine and society a favor.

 

[jondunn]

I think we already know the answer to this if you strip away the utter nonsense that gets wrapped in a typical RO residency.

What are you actually doing day to day. See consult sim contour manage on treatment and send off. Memorize target volumes, dose constraints and nccn guidelines. Throw in some statistics to memorize and presto. The rad bio rad physics nowadays is a joke at most places especially the biology portion as nobody is actually actively looking at it.

exactly right. this is what hellpits do now anyways - the bare minimum. thats all you need. the 70 year olds have the bare minimum too.

thats the great thing about the bare minimum - at the end of the day its totally good enough.


and our colleagues dont know the diff

 

[deleted1111261]

A lot of speculation and logical contortions to say that this year’s radiation oncology crop, at Harvard or elsewhere, is as qualified as that of 2010.

It does not help that there are a few suddenly woke boomer chairs that believe every no-name foreign medical school must be graduating Srini Ramanujan’s of oncology. In my experience, DO and Caribbean schools for instance, still have hefty tuitions, so the students that attend often come from upper middle class families, but they studied too little and partied too much in college.

The question is whether top radiation oncology programs can take a medical school graduate with lesser “traditional institutionalized metrics of competency with hidden biases” and train him/her to be equally competent as his/her predecessors. Time will tell!

It is a failure of training programs that the presumption is that you need all the glossy **** to be good at this job. If you can do medical school, you can do this. But the education is so bad that these classes may struggle to complete certification.

 

[deleted941485]

It is a failure of training programs that the presumption is that you need all the glossy **** to be good at this job. If you can do medical school, you can do this. But the education is so bad that these classes may struggle to complete certification.

I wonder what it’s like for say surgical residents in terms of education.

I don’t think what any of my attendings did for me in residency would even qualify as teaching per se. You were just afraid to screw up so you studied on your own and they would yell at you when you did something wrong. Rinse repeat for 4 years.

 

[yesmaster]

You’re pissed that you published those retrospective reviews as a medical student 10+ years ago, I get it. But I feel like those of us who applied to radiation oncology 2005-2015, when research and publications and extra degrees were in vogue, sometimes conflate that extra, probably-extraneous-for-community-practice research stuff with a higher standard in general for applicants.

For example, we used to do 3-4 radiation oncology rotations as 4th year medical students. You can’t tell me those rotations are useless and someone who SOAPed from psychiatry is just as likely to be a good fit for radiation oncology.

Similarly, was it necessary to have a 260+ Step 1 score? No, but it’s a good indicator for someone who can independently study for clinic and boards, which may be more necessary in some residency programs than others.

 

[jondunn]

PGY2 is hard even if you did 4 rotations as an MS3.

i dont think its a major difference.

ive known some real ****ty residents that did 3 rotations.

anyone can learn.

a good person/doc/worker is a good person/doc/worker. that will be the determinant, not how many rottions they did

 

[yesmaster]

anyone can learn

a good person/doc/worker is a good person/doc/worker

The warm body hypothesis

 

[jondunn]

The warm body hypothesis

warm and willing.

my point is that if youre willing you can be totally fine.

 

[shill5604]

There’s no shortage of rad onc doctors. If current Uber qualified graduating residents are saying: I’m having a hard time finding a job and a program says: Let’s fill our spots with FMGs to make it harder, I think you’re not doing the field any favors.

 

[jondunn]

There’s no shortage of rad onc doctors. If current Uber qualified graduating residents are saying: I’m having a hard time finding a job and a program says: Let’s fill our spots with FMGs to make it harder, I think you’re not doing the field any favors.

dont think anyones on the other side of this issue here!

 

[shill5604]

Instead of lowering your standards, decrease your spots and let the market correct itself.

 

[jondunn]

Instead of lowering your standards, decrease your spots and let the market correct itself.

What a great idea

 

[shill5604]

What a great idea

Isn’t it? That’s why these programs need to be shamed.

 

[thecarbonionangle]

Look at all the hellpits who SOAPED and congratulated themselves in so called “match parties”. Warm bodies is all that matters. The chairs can drink their don perignon with tortured baby cow, cooked rare and sleep well tonight. Maybe one day the widowmaker will do us all a favor. It is gonna take these people dying off so we can fix this. I see no solution in sight. Eat more steak, please.

 

[temujim]

I think we already know the answer to this if you strip away the utter nonsense that gets wrapped in a typical RO residency.

What are you actually doing day to day. See consult sim contour manage on treatment and send off. Memorize target volumes, dose constraints and nccn guidelines. Throw in some statistics to memorize and presto. The rad bio rad physics nowadays is a joke at most places especially the biology portion as nobody is actually actively looking at it.

So back to the question, how qualified do you need to be to competently perform this specialty. On the spectrum of physician tasks that are performed day in and day out…we really aren’t special.

Like hypofrac, not hogging true scientific talent the way we have and allowing thr more qualified students to seek out other fields we are doing everyone else in medicine and society a favor.

But far more difficult in daily practice than many other oncologic specialties. If anything we should play that up to dissuade more med students from entering the field.

Rad onc turning back the clock to the 70s-90s.

 

[yesmaster]

We can’t simultaneously complain that some of the older docs do IMRT poorly (docs that matched in the last era of minimal competitiveness), and then open the floodgates wide today to whomever with what passes for a medical degree

Once you’re in, you’re in for life

 

[jondunn]

We can’t simultaneously complain that some of the older docs do IMRT poorly (docs that matched in the last era of minimal competitiveness), and then open the floodgates wide to whomever or whoever with what passes for a medical degree

so you think the reason that someone who trained in the 80s cant do IMRT has to do with them not being smart enough? and not because they trained in an older tech era and as we become older it becomes harder to learn new things, the same way that happens to any of us the longer we are in practice?


get real

 

[medgator]

so you think the reason that someone who trained in the 80s cant do IMRT has to do with them not being smart enough? and not because they trained in an older tech era and as we become older it becomes harder to learn new things, the same way that happens to any of us the longer we are in practice?


get effing real, dude.

Have you met some of the docs that graduated from the 70s-90s? Did you see the desirability (or lack thereof) of the field back then? China pen skills on a conventional simulator are nothing like the skill set needed for contouring, generating and evaluating an IMRT or SBRT plan.

 

[jondunn]

China pen skills on a conventional simulator are nothing like the skill set needed for contouring, generating and evaluating an IMRT or SBRT plan.

you're making my point for me.

 

[thecarbonionangle]

How do older surgeons master the robot? Have you met some of the docs that graduated from the 70s-90s? China pen skills on a conventional simulator are nothing like the skill set needed for contouring, generating and evaluating an IMRT or SBRT plan

True story. After residency i needed money so i did a locum in a middle of nowhere place. The guy who was there covering the other half was one of these guys. He asked me for help daily. He did not even feel comfortable approving a breast plan. I basically did most of the work so someone would not be killed.

 

[jondunn]

'How do older surgeons master the robot?


the same way many older rad oncs have mastered modern rad onc.

the same way many older surgeons DON'T do robotic cases.

 

[medgator]

you're making my point for me.

There you, arguing with yourself again!

 

[medgator]

'How do older surgeons master the robot?


the same way many older rad oncs have mastered modern rad onc.

the same way many older surgeons DON'T do robotic cases.

Except some of them do, because surgical residencies are less apt to match warm bodies and have actual standards for case logs

 

[jondunn]

i legit can't believe some of you are so high on your own supply that you think your extra 20 points on Step 1 improved your skills as a radiation oncologist.

 

[medgator]

i legit can't believe some of you are so high on your own supply that you think your extra 20 points on Step 1 improved your skills as a radiation oncologist.

How about the fact we didn't have to take it multiple times? Or didn't go partying hard before the MCAT?

 

[jondunn]

How about the fact we didn't have to take it multiple times?

sure if there is someone that has had multiple step 1 failures, they may struggle to do well on inservice, pass boards, maybe yes, it could indicate they are bad at tests.

but they would also struggle in IM. or path. or any field.

 

[elementaryschooleconomics]

I think we already know the answer to this if you strip away the utter nonsense that gets wrapped in a typical RO residency.

What are you actually doing day to day. See consult sim contour manage on treatment and send off. Memorize target volumes, dose constraints and nccn guidelines. Throw in some statistics to memorize and presto. The rad bio rad physics nowadays is a joke at most places especially the biology portion as nobody is actually actively looking at it.

So back to the question, how qualified do you need to be to competently perform this specialty. On the spectrum of physician tasks that are performed day in and day out…we really aren’t special.

This needs to be repeated, over and over.

RadOnc is not special. It is not any more or less difficult than any other specialty in medicine. However, we're not born knowing how to treat people with radiation. It's a skill that needs to be learned.

For 20 years now, RadOnc has been filled with people with excellent grades and tests scores. While those metrics don't predict who will or will not be a "good" physician (however that's defined), grades/scores generally predict who will be better able to teach themselves from books/papers with little guidance. Being able to "easily" memorize a textbook isn't inherently "good" or "bad". It's like how some people can sing or paint while others can't - it is what it is.

However, being able to memorize a textbook means you are more equipped to survive an environment where few are interested in actually teaching you. I did my intern year in a traditional Internal Medicine program. The difference in my experience there vs RadOnc was ASTOUNDING. I remember PulmCrit fellows had these 5 minute chalk talks they would give unprompted on rounds. Senior medicine residents would randomly have short teaching sessions in the team room. Attendings on service would come to the floors after their clinics to check in and do their own 5 minute chalk talks.

That almost never happened in my residency. Most of the time it was just me, my laptop, and eContour. Like the majority of people who Matched before the bubble burst, I have a natural ability to memorize books on my own. I made it work. It wasn't ideal, and it wasn't what I thought residency would be.

This is my concern for the incoming classes of FMG/IMG/people with lower board scores and grades. Do I think they can be great Radiation Oncologists? Yes, absolutely. But MOST PEOPLE require teaching and guidance to learn a profession, and the more complicated a profession is (like modern medicine), the more teaching and guidance is required.

I'm glad RadOnc crashed in competitiveness. It's the start of a wake up call after many years of resting on laurels. However, I think the pain is only beginning. I'm worried people who would otherwise be amazing Radiation Oncologists are going to struggle because residency programs haven't had much pressure to focus on the "education" side of the "service for education" equation that was supposed to be the agreement between institutions and trainees.

The next decade is going to be interesting.

 

[yesmaster]

so you think the reason that someone who trained in the 80s cant do IMRT has to do with them not being smart enough? and not because they trained in an older tech era and as we become older it becomes harder to learn new things, the same way that happens to any of us the longer we are in practice?


get real

My experience with some super competent 60-70+ year old rad oncs suggest that being “smart enough” or conscientious enough or humble enough to learn something new is, indeed, a factor.

 

[deleted941485]

This needs to be repeated, over and over.

RadOnc is not special. It is not any more or less difficult than any other specialty in medicine. However, we're not born knowing how to treat people with radiation. It's a skill that needs to be learned.

For 20 years now, RadOnc has been filled with people with excellent grades and tests scores. While those metrics don't predict who will or will not be a "good" physician (however that's defined), grades/scores generally predict who will be better able to teach themselves from books/papers with little guidance. Being able to "easily" memorize a textbook isn't inherently "good" or "bad". It's like how some people can sing or paint while others can't - it is what it is.

However, being able to memorize a textbook means you are more equipped to survive an environment where few are interested in actually teaching you. I did my intern year in a traditional Internal Medicine program. The difference in my experience there vs RadOnc was ASTOUNDING. I remember PulmCrit fellows had these 5 minute chalk talks they would give unprompted on rounds. Senior medicine residents would randomly have short teaching sessions in the team room. Attendings on service would come to the floors after their clinics to check in and do their own 5 minute chalk talks.

That almost never happened in my residency. Most of the time it was just me, my laptop, and eContour. Like the majority of people who Matched before the bubble burst, I have a natural ability to memorize books on my own. I made it work. It wasn't ideal, and it wasn't what I thought residency would be.

This is my concern for the incoming classes of FMG/IMG/people with lower board scores and grades. Do I think they can be great Radiation Oncologists? Yes, absolutely. But MOST PEOPLE require teaching and guidance to learn a profession, and the more complicated a profession is (like modern medicine), the more teaching and guidance is required.

I'm glad RadOnc crashed in competitiveness. It's the start of a wake up call after many years of resting on laurels. However, I think the pain is only beginning. I'm worried people who would otherwise be amazing Radiation Oncologists are going to struggle because residency programs haven't had much pressure to focus on the "education" side of the "service for education" equation that was supposed to be the agreement between institutions and trainees.

The next decade is going to be interesting.

By interesting it will probably get worse. There isnt anything redeeming about RO now. No new tech or drug. The bright ones were willing to drink the kool aid because they can have a chill attending life and make surg sub money for far less work. When that **** dried up and the dept chairs lost the little goodies to entice these pathologcal overachievers, the jig was up and they moved on to what was always an acceptable alternative the not so bright members of the medical establishment and FMGs that want to practice in the states.

 

[jondunn]

My experience with some super competent 60-70+ year old rad oncs suggest that being “smart enough” or conscientious enough or humble enough to learn something new is, indeed, a factor.

conscientious and humble are very different than 'smart' though.

 

[jondunn]

No new tech

come again?

 

[jondunn]

I used to hear back in the day Yale was quite cush - is that still true?

 

[temujim]

This needs to be repeated, over and over.

RadOnc is not special. It is not any more or less difficult than any other specialty in medicine. However, we're not born knowing how to treat people with radiation. It's a skill that needs to be learned.

For 20 years now, RadOnc has been filled with people with excellent grades and tests scores. While those metrics don't predict who will or will not be a "good" physician (however that's defined), grades/scores generally predict who will be better able to teach themselves from books/papers with little guidance. Being able to "easily" memorize a textbook isn't inherently "good" or "bad". It's like how some people can sing or paint while others can't - it is what it is.

However, being able to memorize a textbook means you are more equipped to survive an environment where few are interested in actually teaching you. I did my intern year in a traditional Internal Medicine program. The difference in my experience there vs RadOnc was ASTOUNDING. I remember PulmCrit fellows had these 5 minute chalk talks they would give unprompted on rounds. Senior medicine residents would randomly have short teaching sessions in the team room. Attendings on service would come to the floors after their clinics to check in and do their own 5 minute chalk talks.

That almost never happened in my residency. Most of the time it was just me, my laptop, and eContour. Like the majority of people who Matched before the bubble burst, I have a natural ability to memorize books on my own. I made it work. It wasn't ideal, and it wasn't what I thought residency would be.

This is my concern for the incoming classes of FMG/IMG/people with lower board scores and grades. Do I think they can be great Radiation Oncologists? Yes, absolutely. But MOST PEOPLE require teaching and guidance to learn a profession, and the more complicated a profession is (like modern medicine), the more teaching and guidance is required.

I'm glad RadOnc crashed in competitiveness. It's the start of a wake up call after many years of resting on laurels. However, I think the pain is only beginning. I'm worried people who would otherwise be amazing Radiation Oncologists are going to struggle because residency programs haven't had much pressure to focus on the "education" side of the "service for education" equation that was supposed to be the agreement between institutions and trainees.

The next decade is going to be interesting.

Trained back in the day with people who got into rad onc in the 70s-90s during the transition to IMRT. Other than a few bright spots, residents trained each other/themselves.

Now that strong cohort of late 90s - mid 2010s is going to train the next generation of residents with declining scores/grades/english skills/etc. Folks who will struggle to understand inverse square law, selecting electron/photon/etc energies or other physics basics, identification of CT/MR based anatomy, or what have you (unfortunately all real examples). Real education institutions have already started pulling back on spots because they recognize the weak quality of many applicants. Hellpits gonna hellpit though.

 

[medgator]

. Real education institutions have already started pulling back on spots because they recognize the weak quality of many applicants. Hellpits gonna hellpit though.

Can't be said enough... Ccf, mdacc etc vs Columbia, Iowa etc

 

[madchemist89]

Learning to contour, evaluate plans, real technical rad onc stuff is not that hard to learn how to do for most disease sites. Econtour, books, articles can teach you all of this and you can reference these when needed. What is a lot more difficult is being the only oncologist in the community and people relying on you from diagnosis to follow up for proper care. Where I work there are no oncologic trained surgeons. There's med onc, but they are unfortunately a little weaker outside of their field. They don't understand surgery well or anatomy, and they don't do physical exam like we do. Practicing oncology well isn't easy. There are a lot of different cancers, and you have to have some idea about how to treat all of them because the people around you don't understand cancer like we do. Our only hope to survive is to continue to be looked upon in our communities as oncologists. Its easy to be a technician, but its really hard to be a good doctor. That's what I'm afraid these weaker students will have trouble with.

 

[TheWallnerus]

I used to hear back in the day Yale was quite cush - is that still true?

Cush?... teaching faculty have 100% resident coverage year round and 100% cross coverage existed until only recently. In fact it still exists if a resident calls out sick or gives less than month's notice. So really only eliminated for pre-planned vacations. There is actually limited faculty teaching. A lot of junior faculty turnover recently. Several 2:1 attending:resident rotations, and 3-4:1 at one satellite.

 

[Baws]

Couple of fallouts from our staff meeting Friday:

-Nearby programs that are not SOAPing/failed to SOAP fully intend to fill their spots outside the match
-We are hiring 3 new faculty as soon as possible and then will freeze hiring for the immediate future, as the quality of radiation oncologists "is now clearly downtrending"
-Instructor positions will remain open (2-3 year contracts, ~$200,000 salary), and is likely how any vacancies will be filled

Current staff bonuses are increasing by 3-5% though

 

[temujim]

Learning to contour, evaluate plans, real technical rad onc stuff is not that hard to learn how to do for most disease sites. Econtour, books, articles can teach you all of this and you can reference these when needed. What is a lot more difficult is being the only oncologist in the community and people relying on you from diagnosis to follow up for proper care. Where I work there are no oncologic trained surgeons. There's med onc, but they are unfortunately a little weaker outside of their field. They don't understand surgery well or anatomy, and they don't do physical exam like we do. Practicing oncology well isn't easy. There are a lot of different cancers, and you have to have some idea about how to treat all of them because the people around you don't understand cancer like we do. Our only hope to survive is to continue to be looked upon in our communities as oncologists. Its easy to be a technician, but its really hard to be a good doctor. That's what I'm afraid these weaker students will have trouble with.

My guess is many new residents coming in will think these basic rad onc concepts are hard...

But otherwise absolutely agree with you. That's the old joke - surgeons know anatomy but don't know staging, and med oncs don't know either. As a rad onc you should know both anatomy and staging -- and know oncologic surgeries and systemic therapies and their underlying evidence, and of course everything about radiation oncology in order to be, and seen to be, a "complete" oncologist. And that is where these new lower tier candidates will really fail. And relegated to the back of the tumor board; not heard or respected.

 

[medgator]

My guess is many new residents coming in will think these basic rad onc concepts are hard...

But otherwise absolutely agree with you. That's the old joke - surgeons know anatomy but don't know staging, and med oncs don't know either. As a rad onc you should know both anatomy and staging -- and know oncologic surgeries and systemic therapies and their underlying evidence, and of course everything about radiation oncology in order to be, and seen to be, a "complete" oncologist. And that is where these new lower tier candidates will really fail. And relegated to the back of the tumor board; not heard or respected.

Catfish in the basement like the good ol' days

 

[RADONC4285]

i am a bit confused on why people from Mayo Clinic, Stanford, Yale etc. are trying to enter what many on here seem to call a “dying speciality.” Surely these people could have had their picks?

if you absolutely love rad onc and will only accept an academic job, now is the time to apply. In a few years, these top grads will be competing for legit academic jobs with residents who could barely pass their boards and little to no research experience. They'll get their pick. Last year, a very average academic program explicitly told me how shocked they were to get so many over qualified applicants. In like 4 years, things are going to be very different.

 

[RickyScott]

if you absolutely love rad onc and will only accept an academic job, now is the time to apply. In a few years, these top grads will be competing for legit academic jobs with residents who could barely pass their boards and little to no research experience. They'll get their pick. Last year, a very average academic program explicitly told me how shocked they were to get so many over qualified applicants. In like 4 years, things are going to be very different.

Those programs provably won’t be hiring in 5 years. Very well may be cutting, but will probably love some fellows

 

[RADONC4285]

Those programs provably won’t be hiring in 5 years. Very well may be cutting, but will probably love some fellows

You might be right. Or they might hire at a super low starting salary. I personally advise everyone to stay away from rad onc. But there is a small percentage of top med students who just won't be dissuaded.

 

[jondunn]

 

[Ray D. Ayshun]

 

[medgator]

Any commentary? Neither of their medical schools was mentioned in the tweet and i think that was intentional

 

[deleted941485]

Any commentary? Neither of their medical schools was mentioned in the tweet and i think that was intentional

South America? I had one interview from brazil a few years back who was basically an attending who wanted to come to the states.

 

[medgator]

South America? I had one interview from brazil a few years back who was basically an attending who wanted to come to the states.

Googling one of them yielded a CV that's from the University of Venezuela, looks like she was a research fellow previously at CCF

 

[jondunn]

Cush?... teaching faculty have 100% resident coverage year round and 100% cross coverage existed until only recently. In fact it still exists if a resident calls out sick or gives less than month's notice. So really only eliminated for pre-planned vacations. There is actually limited faculty teaching. A lot of junior faculty turnover recently. Several 2:1 attending:resident rotations, and 3-4:1 at one satellite.

interesting, had heard it was a pretty happy group of residents

 

[RadRadRad]

An FMG may be a Luka Doncic and a MD PHD may be a Greg Oden. Please let’s not shame fmgs dos and people not with 300s on step 1

To be fair. Greg oden was number one draft pick with excellent credentials. Just ended up with bad knees. This would be like getting a stellar applicant who ended up with traumatic brain injury or early onset dementia after matching

The Greg Odens aren’t doing radonc anymore

I have no conflict of interest to report and didn’t attend OSU