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Looking forward to submitting some SA-CME questions to the red journal myself...
Chirag/Royce Editorial, Goodman Article, Potters Response on Job Market 031121
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Somehow there was never a difficulty in getting med students to know about radiation oncology when I was interviewing with a hoard of AOA all stars 10-15 years ago. But all the sudden we've got an outreach problem?
its coded language for we lost US MDs
Thatās the part that bothers me the most RE the messaging from āacademic leadersā
There is supposedly a big push for diversity (which is a good thing)
But If that is the goal, then the āacademic leadersā wouldnāt care that there is a large influx of IMG
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Will kill his ego when he has to SOAP bottom of the barrel leftovers into his trash low energy program next month
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Bloviating: Louis potters
Flies: ?
I'm going to use the analogy of climate change to illustrate a point.
Perhaps you are not convinced, despite the overwhelming evidence suggesting it to be the case, that excess greenhouse gas emissions [residents] are leading to potentially catastrophic and irreversible changes to our environment [the job market]. We could all agree that too much pollution is bad, though. We have begun to see changes in our environment. Scientists that study the environment [radiation oncologists] have sounded the alarm and regular citizens [medical students] have begun to do what they can to not contribute to the mess by avoiding industries that rely on fossil fuels altogether [radiation oncology]. Nevertheless, there will always be a large enough supply of climate change deniers [FMGs, SOAPers] who aren't quite as capable of understanding the evidence and hold out hope that the reports of the fossil fuel industry's death have been greatly exaggerated.
One of the largest fossil fuel companies in the world [MDACC] has cut emissions slightly and can afford to do so because of their scale, but their competitor [The University of Salina Kansas Department of Radiation Oncology] would struggle to exist if they were unable to pollute. The leadership vacuum that has existed the last few years has permitted things to take place that have accelerated this decline such as the increasing destruction of the Amazon [APM], the rollback of climate regulations [decreasing supervision requirements] and failure to curb our reliance on cheaper single use plastics [hypofractionation].
While many believe that we are too far gone already, there are those that still hold on to hope that we can right the ship. However, doing so requires leaders such Emmanuel Macron [Mudit Choudhary], Angela Merkel [Chirag Shah], and Joe Biden [Robert Amdur] to stand up to the Trumps [Paul Wallner] and Bolsonaros [Louis Potter] of the world and mandate that we cut emissions across the board.
Every legitimate scientist in the world believes that climate change is real and the vast majority of scientific and anecdotal evidence indicates this to be the case. In the unlikely event that this is all fake news perpetrated by a network of Russian Bots [GFunk, Evilbooyah, Medgator] and the deep state [The Student Doctor Network Radiation Oncology Forum], then 5-10 years from now we will realize the changes to our environment were just cyclic all along. We will, however, have cut emissions. Even if it turned out to be unnecessary, I think everyone can agree that this is a good thing for the environment. People will flock back to fossil fuels again and we will have our status quo.
And if we ignore the years of warning signs and overwhelming evidence and turn out to be wrong? The results will be catastrophic and the environment will never recover.
Perhaps you are not convinced, despite the overwhelming evidence suggesting it to be the case, that excess greenhouse gas emissions [residents] are leading to potentially catastrophic and irreversible changes to our environment [the job market]. We could all agree that too much pollution is bad, though. We have begun to see changes in our environment. Scientists that study the environment [radiation oncologists] have sounded the alarm and regular citizens [medical students] have begun to do what they can to not contribute to the mess by avoiding industries that rely on fossil fuels altogether [radiation oncology]. Nevertheless, there will always be a large enough supply of climate change deniers [FMGs, SOAPers] who aren't quite as capable of understanding the evidence and hold out hope that the reports of the fossil fuel industry's death have been greatly exaggerated.
One of the largest fossil fuel companies in the world [MDACC] has cut emissions slightly and can afford to do so because of their scale, but their competitor [The University of Salina Kansas Department of Radiation Oncology] would struggle to exist if they were unable to pollute. The leadership vacuum that has existed the last few years has permitted things to take place that have accelerated this decline such as the increasing destruction of the Amazon [APM], the rollback of climate regulations [decreasing supervision requirements] and failure to curb our reliance on cheaper single use plastics [hypofractionation].
While many believe that we are too far gone already, there are those that still hold on to hope that we can right the ship. However, doing so requires leaders such Emmanuel Macron [Mudit Choudhary], Angela Merkel [Chirag Shah], and Joe Biden [Robert Amdur] to stand up to the Trumps [Paul Wallner] and Bolsonaros [Louis Potter] of the world and mandate that we cut emissions across the board.
Every legitimate scientist in the world believes that climate change is real and the vast majority of scientific and anecdotal evidence indicates this to be the case. In the unlikely event that this is all fake news perpetrated by a network of Russian Bots [GFunk, Evilbooyah, Medgator] and the deep state [The Student Doctor Network Radiation Oncology Forum], then 5-10 years from now we will realize the changes to our environment were just cyclic all along. We will, however, have cut emissions. Even if it turned out to be unnecessary, I think everyone can agree that this is a good thing for the environment. People will flock back to fossil fuels again and we will have our status quo.
And if we ignore the years of warning signs and overwhelming evidence and turn out to be wrong? The results will be catastrophic and the environment will never recover.
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I understand your points, but you guys shouldnāt really attack FMG. A lot of them come from countries with no/little opportunity and even making 200k in Rad Onc in the USA would be better for them than the training they would receive at home. Most of the FMG Iāve met have been incredibly hard working and know they are privileged to even try to train/rotate in the USA, something is AMG lose sight of along the way. They are just finding an opportunity for themselves where the system allows to function.
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"Nothing will stop our field from advancing."
I'm thinking real, real hard right now what CLEAR advancement rad onc has had in the last 10 years except for growth in rad oncs. That's been GREAT. But anything else... indications, treatment amounts, reimbursement, job market, etc., I got nothing. Sorry Louis.
nobody is attacking IMGs
IMGs require visas to work after residency. If they donāt find it they are shipped out
It takes a lot of effort for employers to provide visa opportunities and many choose not to for that reason
In a bad job market, IMG are extra vulnerable
ppl here trying to make sure there isnāt exploitation
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This...
It is not about FMGs/IMGs directly. It is about chairs and leadership like Wallner, Potters, Steinberg, and Randall who have been blessed with a highly competitive applicant pool for 15+ years and enjoyed the fruits of the applicants' labor.
Now that the job market is in the gutter, the competitiveness and interests of the applicants is also down in the gutter. The problem is that now, they are pivoting to discuss diversity (which most if not all of us agree with) when they largely ignored it for 15 years, all in favor for ultra-academic CVs. People like Louis Potters never cared about diversity. They only talk about it now for most likely, only selfish reasons, 1. it is trendy in 2020/2021 to talk about diversity and 2. save face from the dumpster fire they have kindled for 15 years.
Because of how unhealthy the job market is now created by those in leadership positions, it is absolutely crucial for everyone, including women, minorities, and FMGs, to understand the implications of the decisions and investment into their training, including the time for training, dearth of job prospects, downward pressure on income, and decreased negotiating power. Just like Mudit said, these are the groups that are ultra-vulnerable to exploitation, being forced to work more for less money with no ability to speak up for themselves.
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nuggets of wisdom from this sagely humanist who earns nearly 2 mill/year
āOnce we stop counting fractions and start focusing on our patients and the broader opportunities to help them, I remain ferociously bullish that there will be plenty to go around.ā
āwe can take some pride in knowing that our residents are achieving their desired goals up to 82% of the time in a first job. That is a darn good batting average for such a small specialty.ā
āWill physicians retire later because of income lost, or will they retire earlier because of concerns about exposure and workālife balance? To me, it does not seem clear that we are oversubscribed as a specialtyā
āWe know that RO graduates are still obtaining jobs, that the population is still aging, and that new indications for radiation are arising.ā
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Is it really though? Compared to who and what?
Is the ARRO survey that all these job market issue naysayers love really that sensitive to capture meaningful data? I can tell you right now, as a graduating resident wading through the cesspool of the post-expansion RadOnc job market, my personal situation will not be captured by the survey as its written. I'm certain this is true for others.
If ASTRO etc is tired of the "anonymous social media misanthropes" calling attention to the dumpster fire going on right now, please hire an actual economic thinktank like RAND and do a real study. Enough of these resident research projects of databases and surveys resulting in armchair expert bush league predictions and analysis.
I'm sure real economists can tell us if doubling the number of graduating residents in less than 20 years in the absence of doubling demand was a good idea or not.
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Really, I can't emphasize enough - the Shah and Royce article pretty much distills everything we're concerned with here on SDN.
For future medical students (or residents/attendings) looking for data/"the argument", just read that article. It summarizes 8 years of arguments on the internet from people who think there's an oversupply in the job market.
For future medical students (or residents/attendings) looking for data/"the argument", just read that article. It summarizes 8 years of arguments on the internet from people who think there's an oversupply in the job market.
Employment satisfaction is all relative. It has been about a decade since I applied for radonc residency. When I initially became interested in the field, the expectation was $500k+ working 4 days a week with good hours and sky was the limit in a partnership with technical opportunities. At that time, concerns for the job market had just begun to pop up.
By the time I graduated residency I felt like I had won the lottery with my employed position making $350k in a large metro area with little opportunity for advancement.
Now, in the midst of the pandemic and the future demand uncertainty, residents are probably just happy to have a job.
So just because people are satisfied with their job doesn't mean the job market is good. If a radiation oncologist likes the biryani in Minot, North Dakota, it doesn't necessarily mean that the biryani is good. It could just mean that they had such low expectations of said biryani that they were very easily satisfied.
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Precisely.
My definition of success was "getting any job in this multi-state radius in any direction within 3 hours from the central point".
I had zero expectations about salary, workdays, call requirements, etc. Just a job in a large geographic radius.
#radonc!
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deleted941485
No expectations. The way your employers like it!
Does ASTRO put out anything like this every year?
Census Results - American Urological Association
Access the findings of this year's and past year's urology census data.
www.auanet.org
LOL,
Biryani in Minot ND is probably from the frozen section of an American grocery store...
Sadly, the "Mine Operator" only cares about how many coal miners (aka = residents and fresh attendings) they have for that particular mine...
The issue of exploitation is serious:
- It can happen at academic and private.
- This is why there are federal laws to protect VISA workers. Most hospitals have to post in a prominent place the MD positions and approx. range of salary offered. However, I have seen abuse...
- Let's say a rural hospital in Kansas offers a position (no matter what the specialty is).
Let's say a white US grad and an FMG come for an interview for the same position.
In the range of 250K-350K, the hospital offers 250K to the FMG, who is so glad to take it bc he/she left his/her country for different reason, but so glad to have that job. In a way it fills the need for that rural community in KS, but on the long run, it is abuse. In the mean time, the white person is denied the job.
Biryani in Minot ND is probably from the frozen section of an American grocery store...
Sadly, the "Mine Operator" only cares about how many coal miners (aka = residents and fresh attendings) they have for that particular mine...
The issue of exploitation is serious:
- It can happen at academic and private.
- This is why there are federal laws to protect VISA workers. Most hospitals have to post in a prominent place the MD positions and approx. range of salary offered. However, I have seen abuse...
- Let's say a rural hospital in Kansas offers a position (no matter what the specialty is).
Let's say a white US grad and an FMG come for an interview for the same position.
In the range of 250K-350K, the hospital offers 250K to the FMG, who is so glad to take it bc he/she left his/her country for different reason, but so glad to have that job. In a way it fills the need for that rural community in KS, but on the long run, it is abuse. In the mean time, the white person is denied the job.
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Quotes from the Louis Potters, MD, FASTRO, FACR editorial
āIs this market approach something to be proud of, and how can we strive for a better, new normal?ā
Didnāt the FASTRO leadership favor a market approach for rad onc residency positions several years ago? This reminds me of a whiny kid whoās losing the game BADLY, and now wants the rules changed.
āThey come from the top medical schools, with an impressive number of publications and the highest possible test scores. If we look beyond that pride, however, we might ask ourselves whether the need for research and high examination scores might not have actually limited the diversity of the applicant pool.ā
Yes, when my family member develops cancer, Iād much rather they go to a doctor with a 210 Step 1 & 2 score, no publications, who doesnāt know the difference between a preplanned and posthoc analysis. Iām sure that Caribbean graduate didnāt go to UCSF for medical school because of structural racism, and I should account for this when choosing a radiation oncologist for my family.
Itās horribly racist to pivot to ādiversityā now. I had plenty of African-American classmates who were superstars in terms of these traditional metrics (Step 1, grades, publications, leadership) that seem to have fallen out of favor in our field. If radiation oncology was a healthy specialty, we could attract diverse applicants with an exceptional record of achievement, instead of just diverse applicants.
āBut we should not discriminate against SOAP applicants.ā
Thatās great, because Iāll bet $1400 Northwell Health is going to SOAP next week.
āThere remains room for us to flex our inner ātherapeutic radiologistā and broaden our scope of practice beyond external beam radiation therapy into brachytherapy and radionuclide therapy.ā
We already do brachytherapy and radionuclides? Now, if ASTRO wants us to be trained to do the interventional oncology procedures of IR, with viable referral patterns, Iām all ears.
āTrying to āplay the marketā by manipulating resident positions is a risky game because it involves making predictions about the future.ā
The boomer generation already manipulated resident positions with rampant expansion in the 2000ās and 2010ās? It is awfully convenient to advocate for preserving the status quo after youāve already robbed the bank.
āIs this market approach something to be proud of, and how can we strive for a better, new normal?ā
Didnāt the FASTRO leadership favor a market approach for rad onc residency positions several years ago? This reminds me of a whiny kid whoās losing the game BADLY, and now wants the rules changed.
āThey come from the top medical schools, with an impressive number of publications and the highest possible test scores. If we look beyond that pride, however, we might ask ourselves whether the need for research and high examination scores might not have actually limited the diversity of the applicant pool.ā
Yes, when my family member develops cancer, Iād much rather they go to a doctor with a 210 Step 1 & 2 score, no publications, who doesnāt know the difference between a preplanned and posthoc analysis. Iām sure that Caribbean graduate didnāt go to UCSF for medical school because of structural racism, and I should account for this when choosing a radiation oncologist for my family.
Itās horribly racist to pivot to ādiversityā now. I had plenty of African-American classmates who were superstars in terms of these traditional metrics (Step 1, grades, publications, leadership) that seem to have fallen out of favor in our field. If radiation oncology was a healthy specialty, we could attract diverse applicants with an exceptional record of achievement, instead of just diverse applicants.
āBut we should not discriminate against SOAP applicants.ā
Thatās great, because Iāll bet $1400 Northwell Health is going to SOAP next week.
āThere remains room for us to flex our inner ātherapeutic radiologistā and broaden our scope of practice beyond external beam radiation therapy into brachytherapy and radionuclide therapy.ā
We already do brachytherapy and radionuclides? Now, if ASTRO wants us to be trained to do the interventional oncology procedures of IR, with viable referral patterns, Iām all ears.
āTrying to āplay the marketā by manipulating resident positions is a risky game because it involves making predictions about the future.ā
The boomer generation already manipulated resident positions with rampant expansion in the 2000ās and 2010ās? It is awfully convenient to advocate for preserving the status quo after youāve already robbed the bank.
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Trying to āplay the marketā by manipulating resident positions is a risky game because it involves making predictions about the future.ā
The boomer generation already manipulated resident positions with rampant expansion in the 2000ās and 2010ās? It is awfully convenient to advocate for preserving the status quo after youāve already robbed the bank.
key point- this guy was part was part of rampant expansion in a city w a incredulous number of residencies.
The boomer generation already manipulated resident positions with rampant expansion in the 2000ās and 2010ās? It is awfully convenient to advocate for preserving the status quo after youāve already robbed the bank.
key point- this guy was part was part of rampant expansion in a city w a incredulous number of residencies.
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Didn't notice he said that. That's stupid. How can you be a chair and not make predictions about the future? Or a human? Or pretty much any animal?
Btw, yesmaster, I'd do $100. Are you giving odds? 14:1?
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Match stats are appropriate response to reality. Less and less jobs, more and more āfellowshipsā, less indications, less fractions, APM, supervision changes.... come on.
Not even worth posting anymore. If you are young in this field, make sure you are investing money wisely because the future is bleak. If you are a medical student, justify why you would get a job. If you are a resident, God help you.
Not even worth posting anymore. If you are young in this field, make sure you are investing money wisely because the future is bleak. If you are a medical student, justify why you would get a job. If you are a resident, God help you.
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FMG can be white too...
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If there were ~3500 rad oncs in America the future would be bright, everybody would be happy, the patients would still get excellent care, and you could get fired from a job and find another one in a week within the same time zone!
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Yup... Saba, AUC, Ross, grenada, some schools in Poland, India etc have AMGs that flubbed mcats, partied too hard in undergrad etc
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...All stops on Dan Goldenās upcoming recruiting trip.
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Prob could invite some midcareer academic FMG alumni from those schools to make a better connection as things come full circle...
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You need one radonc/one linac for 100k in pre hypofractionation era per varian at the time.
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Yes.
This was all laid out in the Blue Book.
According the the Blue Book (produced by the Intersociety Council on RO by the ACR or some such in 1991), it's about one rad onc per ~120K to yield ~250 new patients annually: Ā½ curative (avg of 35 fractions), Ā½ palliative (avg of 15 fractions). The ideal is about ~6000 fractions per machine annually.
Now just think how the current calculus has changed, and there's been no institutional (ACR or ASTRO) recognition that it has. According to Dr. Potters we need to "stop counting fractions." But it seems like everyone from academics to PP in the 1990s were OBSESSED with counting fractions. Rightly so.
The current calculus is that there are about 2* rad oncs per 120K people in the US. I.e., rad onc is "double over-staffed" versus 1990s levels. The math gets even worse if we make Louis mad and count fractions. The ACR used an average of 25 fractions across all patients, 250 pts per annum, for ~6250 fractions per machine per annum. Now with the average treatment course being 16 fractions, and no real increase in patient numbers since the 1990s (cancer incidence has gone up some, but RT utilization has balanced that), we would expect only 4000 fractions per machine nowadays. If we multiply the fraction ratio (0.64 = 4000/6250) by the rad onc workload ratio (we are at 2 rad oncs per 120K instead of 1 per 120, so the offset ratio is 0.5)........
Radiation oncology in the U.S. may be 1/(0.64*0.5) = ~THREE TIMES OVERSTAFFED WITH MDs.
But this is only according the American College of Radiology. I am sure Dr. Potters has better info and opinions and feelings than they do.
*(5500/330E6)*1.2E5 = 2
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deleted941485
Potterās doesnāt want to count fx thatās fine
Even if we count patients we are still in trouble.
Even if we count patients we are still in trouble.
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You guys could probably teach community college biology or physics if it came to that. May be even able to work up to university level if you work hard enough. And thatās when the big bucks start rollin in š.
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Wow, that is depressing AF. At this alarming rate, there will be less and less teats for future rad oncs to suck on soon.Yes.
This was all laid out in the Blue Book.
According the the Blue Book (produced by the Intersociety Council on RO by the ACR or some such in 1991), it's about one rad onc per ~120K to yield ~250 new patients annually: Ā½ curative (avg of 35 fractions), Ā½ palliative (avg of 15 fractions). The ideal is about ~6000 fractions per machine annually.
Now just think how the current calculus has changed, and there's been no institutional (ACR or ASTRO) recognition that it has. According to Dr. Potters we need to "stop counting fractions." But it seems like everyone from academics to PP in the 1990s were OBSESSED with counting fractions. Rightly so.
The current calculus is that there are about 2* rad oncs per 120K people in the US. I.e., rad onc is "double over-staffed" versus 1990s levels. The math gets even worse if we make Louis mad and count fractions. The ACR used an average of 25 fractions across all patients, 250 pts per annum, for ~6250 fractions per machine per annum. Now with the average treatment course being 16 fractions, and no real increase in patient numbers since the 1990s (cancer incidence has gone up some, but RT utilization has balanced that), we would expect only 4000 fractions per machine nowadays. If we multiply the fraction ratio (0.64 = 4000/6250) by the rad onc workload ratio (we are at 2 rad oncs per 120K instead of 1 per 120, so the offset ratio is 0.5)........
Radiation oncology in the U.S. may be 1/(0.64*0.5) = ~THREE TIMES OVERSTAFFED WITH MDs.
But this is only according the American College of Radiology. I am sure Dr. Potters has better info and opinions and feelings than they do.
*(5500/330E6)*1.2E5 = 2
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Less teats indeed! I read "treat" instead of teat at first.
Can't talk now. Have an on-teat visit to which I must attend.
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And same for Asian - parents could be laborers from a village who immigrated and worked taxi/hotel/small shop; or you could be the 3rd generation of physicians from three continents... marked the same in the statistics!
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Conflating issues. He writes with more prose and class but at the end of the day his ramblings are akin, IMO, to Ralph (RW) on Twitter. He takes great pride in his department's response to COVID, which sure he's in NYC and sure he likely sent his residents off to floor work (don't think I saw LP in scrubs and a N95 though!) and rah rah COVID battles.
But how any of that has anything to do with the FUTURE of Rad Onc.... jury is out on that.
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Just wait until the portable whole lung RT unit is operational!!!!
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That article was a fantastic read, thank you!
Why do you see them differently? The world outside just sees "black".
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this is the type of content we come here for, bravo
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deleted941485
I wonder what Ken Olivier is thinking right now...oh wait
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Graypeace ā Medium
Read writing from Graypeace on Medium. Radiation Oncologist. Every day, Graypeace and thousands of other voices read, write, and share important stories on Medium.
graypeace.medium.com
Wow. Eerily similar writings š. Thanks for sharing.Graypeace ā Medium
Read writing from Graypeace on Medium. Radiation Oncologist. Every day, Graypeace and thousands of other voices read, write, and share important stories on Medium.
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Given the numbers of 1 radonc per 100,000 people. Country is currently at 330000000. Average work life of a RadOnc ~40 years.
330000000/100000/40=82.5 spots per year. Let it rest and see where population growth and decreased utilization is going and then reassess in 10 years.
330000000/100000/40=82.5 spots per year. Let it rest and see where population growth and decreased utilization is going and then reassess in 10 years.
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the 1 per hundred and 20 thousand is pre hypofractionation (and when we treated Gleason 6 ). Probably around 5000-5500+ now with 1000 residents in pipeline. cutting spots will have limited impact.
