Do you have a job that leaves you feeling intellectually fulfilled?
I envy you. Clearly you are somewhere, doing something that challenges you intellectually and feels progressive and important.
I have a good community job. I like seeing patients and there is some thought there. But for the last 10 years and for the foreseeable future, when someone asks me "What's new at work?", my reply has been and will be, "nothing". Sometimes I talk to them about advances in medical oncology.
We have gotten some new machines that make RTT's lives better. We hypofractionate more and SBRT a little more. We PCI less and treat post-op lung way less. Our hippocampal sparing plans (rarely used) are better now than 5 years ago. I read the big radonc papers (there are not many) and some medonc papers (these are innumerable).
We are in a field where progress is largely technical and hard to scale. In fact, given our single modality and diminishing indications, it is in the interest of larger centers to leverage anything incremental they have (protons, MRI_linac... and yes, I view these as incremental) to try to expand market share. I am also not a believer in the great value of ions or even marginal improvements in conformality at this point (happy to be proven wrong). To me, it is just not that stimulating a field to be in intellectually unless you are actively doing some sort of hard cancer research. (retrospective reviews, cost analysis and equity research would just not do the job for me). That the MDACC grads almost uniformly chose community careers makes me wonder if this is a common sentiment.
That we share cancer centers with docs that can't keep up with the standard of care (because the change is so dizzying) doesn't help. I was briefly excited that our role in metastatic disease was about to blossom, but the oligo trials have been tiny and the results spotty (less breast oligo SBRT than a year ago). Every new advance in systemic therapy re-contextualizes our role in ways that are largely out of our control and not immediately clear in terms of evidence based medicine. Usually it means less or deferred XRT and typically medoncs are making this decision.
The stats and numbers of applicants now are fine and leadership should just take what they get. By my reasoning, the following people should still be applying to radonc.
1. Real physics nerd types (may be you) who believe in ion therapy or flash and are really pretty facile with physics and can at least push the physics work forward some from a position of being a physician. (Probably 10-20 folks like this per year).
2. Truly elite wet lab folks with a strong track record of onc research preceding residency. (The Tim Chan model). Probably 10 folks like this per year. We were recruiting a lot of folks who looked like aspirants to this model ten years ago and many are underemployed now.
3. Average med students who like onc and hate inpatient call and can't stand the thought of doing a medicine residency. They are fine being third of three in importance regarding oncology and are fine not driving global clinical decision making. They are fine with declining reimbursement and limited geographic flexibility.
About 80 US grads applying sounds right.
