FUTURE RESIDENT, DO NOT BECOME A RADIATION ONCOLOGIST!!!

[DrfluffyMD]

I actually agree with nearly everything in this thread, but this seems a little extreme. People I talk to mention that job market not being open in big cities, but no one I talk to thinks the field is in its death throes. During my job search I got more interviews that I could go on, all in locations I loved, all for great money. Maybe it just doesn't jive with my personal experience, but for the record, not all residents this last year had a hard time finding jobs. Many I know are quite happy with where they are going and are making double/triple what you would make as a hospitalist.

UCSF or MSK grad?

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[medgator]

UCSF or MSK grad?

Very common misconception. Pedigree matters much less than you think for many good PP jobs. In fact, I bet in some places, it might be even be negative.

 

[RickyScott]

Very common misconception. Pedigree matters less than you think for many good PP jobs.

agree

 

[Sheldor]

I agree as well but as exaggerated as it may have been the OP's intent (or what I think the take away from this thread should be) was not to say how bad things are now or for practicing radiation oncologists to leave their jobs try to switch to become a hospitalist (which would be insane) but to make it clear that the finances of such a small field with relatively limited services can change literally overnight (a single change in compensation for something like IMRT planning, or especially IGRT review, on treatment weekly management, etc) or more slowly but surely and cumulatively over the course of a few years on a fundamental level with less treatments per patient (hypofractionation) AND less payment per treatment in a fee for service model right when a tsunami of new residents are graduating with no end in sight.

For a student with 2-3 years left of school plus maybe a research year plus 5 years residency and maybe even a fellowship the entire game can easily change in 7-10 years with decreased patient volume, decreased compensation per patient, and literally another few thousands residents entering the work force between now and when the medical student graduates (200-250 residents per year x 7-10 years = terrifying and game changing) with nowhere near that number retiring.

Most medical students who seek guidance and advice are probably talking with their academic adviser who has advised thousands of students but like mine had <1% of them go into radiation oncology and had no idea what he was talking about or just basing everything a few random students who matched 5-7+ years before me or a radiation oncologist in an academic center who has been practicing for a decade and may be well intentioned but is somewhat insulated from all of this and is likewise providing information that is outdated by a decade instead of giving a reasonable forecast for a decade from now. . . I'm afraid current medical students are going to enter the workforce in 2028 not only shocked that it isn't like it was in 2018 but having expected it to be like their advisers described it was in 2008!

Absolutely, I would never refute this. It infuriates me that no one seems to care about the fact that they're flooding the market with new grads who will have less and less power in the negotiation process. It seems insane that in such a small field someone can't fix this.

I'd be curious to talk offline about where you were looking. My job search was not like this at all.

That's fair, and obviously it always matters where you are looking. I was not looking in NYC/LA, which obviously helped. I also didn't just wait until it was time to apply and cannonball it, but instead networked in the areas I was interested over time.

UCSF or MSK grad?

Sadly no. Or maybe not sadly? I've enjoyed my residency and don't think I would change to one of those even if I could go back in time and make it happen.

So, whats the end results of all this guys? I feel like we've all been saying how crappy it is for while. Is there any hope? Any person or committee that we can work on improving this?

As an aside, in general I'm not a fan of bundled payments, but one small upside is that in the world of hypofrac, it would help relieve our constant focus on numbers on treat, and make it more about number of patients treated.

 

[medgator]

As an aside, in general I'm not a fan of bundled payments, but one small upside is that in the world of hypofrac, it would help relieve our constant focus on numbers on treat, and make it more about number of patients treated.

Astro isn't a fan either but there are merits to it, especially when combined with the concept of a site-neutral payment. That would help bring the balance of power back towards freestanding centers, where they have been losing ground to the hospitals for several years now

 

[evilbooyaa]

I believe that site-neutral payments are the first step to avoiding further consolidation and power grabs within the Rad Onc market. When a facility can buy up previous private practices and charge 3x what they did for the same thing? That's not fair, increases expenses, and doesn't help patients.

 

[nkmiami]

I believe that site-neutral payments are the first step to avoiding further consolidation and power grabs within the Rad Onc market. When a facility can buy up previous private practices and charge 3x what they did for the same thing? That's not fair, increases expenses, and doesn't help patients.

And physicians, I might add (except chairs)
Absolutely correct. There was an article several months ago about how Mayo clinic was clearing 3000$ for an MRI and how when they started aquiring some regional community hospitals, the damage this was doing to the communities because of their extortionistic rates. This is a subject ASTRO is desperate to avoid given the interests of its leadership at obscuring price transparency. What is MDACC/MSKCC charging for a course of prostate hypofrac?

Tax-exempt Mayo Clinic grows, but rural patients pay a price

" Mayo has countered that its high prices — like $2,647 for a routine MRI of a knee, a price that's more than double what many other hospitals and imaging centers charge — are necessary to subsidize its high-quality care."

 

[medgator]

I believe that site-neutral payments are the first step to avoiding further consolidation and power grabs within the Rad Onc market. When a facility can buy up previous private practices and charge 3x what they did for the same thing? That's not fair, increases expenses, and doesn't help patients.

I can't find the citation now, but I thought I saw a Medicare rule come across last year to try and curtail that practice by only allowing the hospital to charge free-standing rates for any centers purchased after X date.

 

[RickyScott]

I can't find the citation now, but I thought I saw a Medicare rule come across last year to try and curtail that practice by only allowing the hospital to charge free-standing rates for any centers purchased after X date.

I understand there is a lot of controversy about this and I think those original NCI designated centers are exempt. (just like they still are able utilize 340B drug pricing.) In South Florida, I am told the major academic center is ignoring this.

Ultimately, if this rule does take effect, it will provide strong incentive in our field to have pts funneled to main center for boosts/stereo/anything that they can think of etc.

 

[samysmiley]

I know everyone's experience is different, and I believe I was luckier than most. I just went through the most recent application cycle. I signed on as an academic attending at my first-choice institution in January. I have known that I wanted to do academic medicine since I started residency. I have worked toward that goal from the get-go (basic science research on nights/weekends, Red Journal article, oral presentations at ASTRO, etc). I had 15 interviews at ASTRO (12 academic, 3 private practice). I went to 9 onsite interviews. I got job offers from my top 2 choices. I am not from a top 10 program. If anyone wants more details they can PM me. I think there is still hope.

 

[Burt Radnolds]

I know everyone's experience is different, and I believe I was luckier than most. I just went through the most recent application cycle. I signed on as an academic attending at my first-choice institution in January. I have known that I wanted to do academic medicine since I started residency. I have worked toward that goal from the get-go (basic science research on nights/weekends, Red Journal article, oral presentations at ASTRO, etc). I had 15 interviews at ASTRO (12 academic, 3 private practice). I went to 9 onsite interviews. I got job offers from my top 2 choices. I am not from a top 10 program. If anyone wants more details they can PM me. I think there is still hope.

I am genuinely happy for you and your altruistic offer to offer others guidance in obtaining a similar outcome to you is noble. I'm sure there are many other success stories similar to your own. As has been stated many times however, this is a pure and simple numbers game of (over)supply vs demand, and eventually just giving a good solid effort and being a pretty nice and smart individual is not going to cut it. The current paradigm of networking, busting your tail, three A's, etc will be replaced by who is willing to come be a grunt for the lowest cost, or possibly being extremely well connected in the academic world.

 

[RickyScott]

I am genuinely happy for you and your altruistic offer to offer others guidance in obtaining a similar outcome to you is noble. I'm sure there are many other success stories similar to your own. As has been stated many times however, this is a pure and simple numbers game of (over)supply vs demand, and eventually just giving a good solid effort and being a pretty nice and smart individual is not going to cut it. The current paradigm of networking, busting your tail, three A's, etc will be replaced by who is willing to come be a grunt for the lowest cost, or possibly being extremely well connected in the academic world.

I know someone who smoked a lot, and they did not get cancer, and they are 85... (actually most smokers dont get lung cancer, but that doesn't mean there isnt a major problem with smoking?) I dont get the logic here. Let's say 3 years from now 3/4 residents still get jobs, and one of 4 is locumsing or doing part time bs (not out of choice), that is still a real issue...
One thing I can tell you anecdotally that job offers at many academic programs are equal to or less what I was offered around 10 years ago at those same programs. No one is escaping market forces...

 

[MADD!!!]

@Carbon090

 

[ohthewonderment]

What is triple A?

 

[DrfluffyMD]

Zero letters

Last minute switcher applied to radonc, matched with 2 interviews.

Many posters here on this forum told him that he wouldn’t match due to complete lack of demostration of interest or research. Good thing he was able to! As I predicted he would due to unfortunate fall of radonc competitiveness.

 

[Ray D. Ayshun]

Zero letters

Last minute switcher applied to radonc, matched with 2 interviews.

Many posters here on this forum told him that he wouldn’t match due to complete lack of demostration of interest or research. Good thing he was able to! As I predicted he would due to unfortunate fall of radonc competitiveness.

Clearly a good strategy. If there are a few in this same boat next year I’ll gladly bet you $10k each against their success.

 

[DebtRising]

Zero letters

Last minute switcher applied to radonc, matched with 2 interviews.

Many posters here on this forum told him that he wouldn’t match due to complete lack of demostration of interest or research. Good thing he was able to! As I predicted he would due to unfortunate fall of radonc competitiveness.

Thank you for posting this. I added a pic of his post in case he deletes it.

If his post his true, this is the embodiment of the ASTRO strategy. We have made the bottom of our field so noncompetitive that people who did not do a radiation oncology rotation were able to match. Think about that. This guy has no genuine idea what the field is like and matched. A program, program director, and chair thought free notewriting labor was worth taking someone who didn't even bother to give him or herself the chance to evaluate the specialty.

Further, that program, chair, and PD took money from Medicare, from tax payers, to help train a person who couldn't possibly know if they will enjoy or even have a passion for the field, and while the only published, accepted model of employment shows we have an overuspply of Rad oncs up until 2025. How can you justify using tax payer funds to train specialty physicians that are not needed? And to anticipate the rebuttals - no one has published or made an argument that the Smith employment model and projections are wrong. No one. The ASTRO response statement only said some vagueries about the previous Smith model predicting something different. The previous model did predict a different outcome, but it was at a different point in time, and is now outdated. Just like the Census, we don't go back to the old one to disprove the new numbers, unless you're ASTRO of course. So the field has tacitly accepted the model, but continues to accept tax payer dollars for positions that are not needed. Sounds legit.

If you worked hard to get here, are passionate about rad onc, and take pride in what you do, ask yourself how you feel about that, and how you feel about ASTRO endorsing 'trashing' of the reputation of the field as a model to balance residency training slots. Congratulations, this may be the first match by an applicant who never did a radiation oncology rotation.

 

[MADD!!!]

Thank you for posting this. I added a pic of his post in case he deletes it.

If his post his true, this is the embodiment of the ASTRO strategy. We have made the bottom of our field so noncompetitive that people who did not do a radiation oncology rotation were able to match. Think about that. This guy has no genuine idea what the field is like and matched. A program, program director, and chair thought free notewriting labor was worth taking someone who didn't even bother to give him or herself the chance to evaluate the specialty.

Further, that program, chair, and PD took money from Medicare, from tax payers, to help train a person who couldn't possibly know if they will enjoy or even have a passion for the field, and while the only published, accepted model of employment shows we have an overuspply of Rad oncs up until 2025. How can you justify using tax payer funds to train specialty physicians that are not needed? And to anticipate the rebuttals - no one has published or made an argument that the Smith employment model and projections are wrong. No one. The ASTRO response statement only said some vagueries about the previous Smith model predicting something different. The previous model did predict a different outcome, but it was at a different point in time, and is now outdated. Just like the Census, we don't go back to the old one to disprove the new numbers, unless you're ASTRO of course. So the field has tacitly accepted the model, but continues to accept tax payer dollars for positions that are not needed. Sounds legit.

If you worked hard to get here, are passionate about rad onc, and take pride in what you do, ask yourself how you feel about that, and how you feel about ASTRO endorsing 'trashing' of the reputation of the field as a model to balance residency training slots. Congratulations, this may be the first match by an applicant who never did a radiation oncology rotation.

Regardless of this post, the match was still as hard as ever. about 92% US MD's matching Rad Onc with more US MD applicants than positions.

 

[medgator]

Regardless of this post, the match was still as hard as ever. about 92% US MD's matching Rad Onc with more US MD applicants than positions.

What was the ratio of matched to unmatched US MDs?

 

[kristofer]

Thank you for posting this. I added a pic of his post in case he deletes it.

If his post his true, this is the embodiment of the ASTRO strategy. We have made the bottom of our field so noncompetitive that people who did not do a radiation oncology rotation were able to match. Think about that. This guy has no genuine idea what the field is like and matched. A program, program director, and chair thought free notewriting labor was worth taking someone who didn't even bother to give him or herself the chance to evaluate the specialty.

Further, that program, chair, and PD took money from Medicare, from tax payers, to help train a person who couldn't possibly know if they will enjoy or even have a passion for the field, and while the only published, accepted model of employment shows we have an overuspply of Rad oncs up until 2025. How can you justify using tax payer funds to train specialty physicians that are not needed? And to anticipate the rebuttals - no one has published or made an argument that the Smith employment model and projections are wrong. No one. The ASTRO response statement only said some vagueries about the previous Smith model predicting something different. The previous model did predict a different outcome, but it was at a different point in time, and is now outdated. Just like the Census, we don't go back to the old one to disprove the new numbers, unless you're ASTRO of course. So the field has tacitly accepted the model, but continues to accept tax payer dollars for positions that are not needed. Sounds legit.

If you worked hard to get here, are passionate about rad onc, and take pride in what you do, ask yourself how you feel about that, and how you feel about ASTRO endorsing 'trashing' of the reputation of the field as a model to balance residency training slots. Congratulations, this may be the first match by an applicant who never did a radiation oncology rotation.

I completely disagree. I have no doubts this guy would have matched 5 years ago. There have always been programs that will rank based on step scores and grades alone. He probably wasn’t at the top of any rank lists, but there is no denying that plenty of people match into this field with a last minute switch and ride their step scores into the speciality. I guarantee you there are a handful of us MDs with step scores 210-220, DOs, and FMGs who have a strong demonstrated interest and high aptitude for this profession who did not match. It is a sad truth that image, prestige, and scores on a essentially unrelated exam are enough to get into this field for some programs. This guy should never have been offered an interview. But he was, got his foot in the door, and was successful. This is nothing new and has absolutely zero to do with the job market.

 

[medgator]

There have always been programs that will rank based on step scores and grades alone.

Few and far between unless something changed since I applied last decade

 

[kristofer]

Few and far between unless something changed since I applied last decade

Agree, this guy only got a handful of interviews. And like I said, I’m sure he wasn’t at the top of the rank lists. getting the foot in the door is the biggest hurdle. But it’s enough to match somewhere. You may like to believe that programs would rank a guy with a 210 step 1, three rad onc letters, and a few quality rad onc pubs above his, but that is just not reality. My point was it has zero to do with the current job market affecting competitiveness. This would have happened before. Shotgunning every program with nothing other than a 250 step 1 and AOA will get you at least a couple of interviews, both now and 5-10 years ago. Anybody who thinks otherwise is in denial. As another poster mentioned, this was still a very competitive match, and I think it will take at least a few more cycles to see it become less competitive.

 

[Ray D. Ayshun]

It's also possible his chair, etc, called this or that program. Lots can happen...

 

[maruchan]

It's been about 6 months since the original post. I hope hbosch is happier now, whether that's at his original job or elsewhere.

 

[dukeresident]

UNLESS YOU CAN MATCH INTO A TOP 3 PROGRAM.

I will share my experience of job finding so that prospective applicants and medical students have a clear understanding of “job opportunities” in radiation oncology when you graduate from a mediocre/nobody program. I graduated from a small program with no name recognition. It was essentially a private practice group with a university name backing it up, that had somehow tricked the ACGME into giving them a program. They had little to no connection to potential work places, and on top of that, showed no interest in helping you find a job (which actually is more common across the nation than you may suspect despite their warm smiles during residency interview days. They got what they wanted of you- what happens afterwards is of no concern to them). In a 4 year period of graduating residents, not one person got a job in a reasonable metropolitan area. In fact, one of the people graduating after me couldn’t even find a job in a largely homogenous, unexciting, culturally devoid area of American society, which is even sadder because you would think it shouldn’t be so hard to find a job there. She didn’t even get interviews in the area and she wasn’t dumb or awkward, and she was chief! She had to go to another unexciting area, one farther away from her family. Two others quit their first jobs suddenly because it was so bad.

I applied to over 50 jobs in every part of the country. I got 3 interviews. I interviewed in one place in a remote town on the east coast. The town was very small but the landscape was beautiful, so I figured I could live with a small town as long as I could walk among the beautiful landscape. I did not get that job.

My second interview was in a larger metropolitan area in the Midwest (not Chicago), but the group was kind enough to make it clear that my work hours would be 6:30-7 am (tumor boards) to 7pm-8 pm, with multiple inpatient consults per week, and covering multiple facilities, and a starting salary of 220k. I don’t actually care about only 220k but I went into radiation oncology because I do care about my personal life. Most importantly, I know that I get tired after 8-9 hrs of work, and 12 hrs would lead to burnout fast. While the city was larger, it was definitely not my ideal location. I could not imagine being a pleasant doctor to my patients feeling burnt out so early on in my career. While it may be easy for some to poo poo those of us who care about our schedule, I would assume that the majority of radiation oncology applicants apply to rad onc because of both the actual job and the promised work schedule. There were multiple other specialties I would have liked but this one won out because I liked the combination of content and lifestyle (including potentially living in AWESOME locations!)

I was offered an interview at a place (4 hrs from Minneapolis, 3 hrs from an airport) where the recruiter on the phone literally told me that my salary was guaranteed for 2 years, after which I would have to come up with a “creative” solution to supporting my salary. Was I going to sell cupcakes?

The last place (and current job) I interviewed at, I ONLY got the interview because of a connection (not through residency). The recruiter told me he got hundreds of applications (many from new grads) and the only reason he interviewed me was because he recognized the name of the person/connection. I actually love my job and co-workers. What I don’t love, and can be extremely depressing is the location. It has one of the highest rates of poverty and violence for a town of its size (it’s not big). The strip malls are becoming empty and closing down. There are many small depressing gambling places with slot machines and strip bars with neon signs with red legs that criss cross (they’re not even a sleek strip bars). There are parks where people flash you (yes, they pull their pants down) as you are taking a stroll, enjoying the flowers, and you hear conversations in the distance consisting of “Don’t do it, don’t do it” and the response “But I don’t want to live anymore.” It’s not funny. It’s sad. The school system is atrocious. The same bank got robbed 3 times in 6 months by a guy on foot (no getaway car) and a knife (no gun). Property taxes are high because the town has no economy. Buying property is a sure way to lose money and good luck trying to sell it a few years later. The closest reasonable city is 90-120 min away. The only reason people live here is because they are too poor to move. It is one of those towns that the New Yorker does a story on because of how depressed it is- the anguish of non-urban middle of nowhere America.

While I actually like my job, if I die in 5-10 years and I have spent every day of the last 5-10 years of my life in this town, I may on my death bed wonder why didn’t I die before radiation oncology residency, or even before medical school? I gave up so much of my life trying to build a dream that is not remotely attainable, and it wasn’t something absurd like “I want to be a rock star, or actor and live in a penthouse in Tokyo.” Medicine is supposed to be dependable and open up opportunities not limit your life drastically. That is why we make such a huge sacrifice with regards to our time and money. I not only wanted one job opportunity in a great location with good hours but RATHER (gasp! Oh my!) I wanted multiple options from which I could choose. That is every intelligent hardworking person’s expectation. That is why we work hard. That after years and years of studying and accumulating debt you have multiple opportunities, not worsening limitations. I got an MD and went into radiation oncology. I did not get a PhD in medieval art history.

Even if you don’t live in an impoverished area, you probably will end up in a mediocre area at best where the most exciting store is a Barnes and Noble. The majority of 21 year olds who take on medical school debt, and the majority of 25 years graduating with 120K (probably more like 200k) of debt never say, "I want to live in a place where Barnes and Noble is the hot spot in town." The once a month coupon I get for a free latte for being a B&N member doesn’t cut it for me. That was not my dream. It is still not my dream. I still look out for jobs in reasonable locations (like suburbs of a large metropolis, I would accept a 220k salary, but I can’t work 12-13 hr days).

You know what I dream of? I dream of living in a community where people read and have intellectual discussions and are cultivated and interested in things beyond sports and hunting. I dream of school systems that produce educated children. I dream of neighborhoods that are actually lovely. I dream of parks where I won’t be flashed. I dream of a town where the best restaurant is not Paneras and the most interesting store is not Micheals. I dream of banks that get robbed by men (or women) with guns and getaway cars. I truly with all of my heart when I applied to residency did not think this was a wild dream- apparently it is a wild farfetched dream.

Those of you who are guaranteed entry into MSK, MD Anderson and Harvard- by all means, apply! Because you probably will get your (esp non-academic) dream job. You can get a job in Hawaii, in California, in New York City, in Boston, in the DC area and in Sedona. These programs do have amazing opportunities. BUT MOST OF YOU ARE NOT GOING TO GO THERE FOR RESIDENCY. For the rest of you, especially ones who are going to match in middle of the road to unheard of programs (the vast majority despite the empty promises at interview time), you will not capture the life you have imagined.

I remember when I was an intern and like a dumba**, thought to myself, I am so much better than these people going into internal medicine. Those people live in San Francisco, New York, and the DC area with good schedules and decent salaries (not 500k, but above 200). They have awesome personal lives! They are laughing at me. Actually, they are not thinking of me because they have better things to do, such as take part in the liveliness of their communities. I could never find a job that pays over 200k with a decent schedule in those areas- absolutely NEVER. Can Harvard grads? Yes. But not me nor my kind.

I actually considered aerospace medicine but I didn’t apply (not sure I would’ve gotten in) because the job opportunities were limited to maybe 3 cities. I couldn’t commit to that. I feel like I ended up with worse.

The friends I know, none of whom went to top 3 programs, all have mediocre jobs at best- by no means a dream job. Either the location is terrible or the work load is insane, often coupled with an internist salary (like 250k max).

I don’t understand the legal details of why we are in this situation. The reasons why it’s happening is not at ALL remotely important to those of you who are applying to rad onc residency right now. What is important is that this is the reality, and that it is extremely unlikely to change soon as no one is working on a solution. And you deserve to know (as I severely wish I had known) before you throw away the rest of your life.

This is my day: I wake up, I go to work, arriving at 7:45 to 8 am, and I leave around 5 pm. I read, watch tv, and/or do some “hobby” to pass the time. I have no friends outside of work. There are no restaurants that are exciting. There are no cultural events. There is zero reason to leave my apartment other than to put gas in my car or go to the grocery store. The closest Whole Foods and Trader Joes are more than an hour away. Sometimes I play the lottery to throw excitement into my life. I don’t win. My most interesting thoughts this winter have been 1.) in response to seeing rabbit tracks in the snow, “Oh my. A bunny has passed this way.” And 2.) in response to the light pattern cast by the sun through the cheap plastic blinds on my beige apartment wall, “Well, isn’t the morning light lovely today.” These thoughts are only truly exciting if you are Beatrix Potter or a 17th century Dutch master painter who specializes in light and shadow.

My bank account is growing and growing but it does not make me happy because I have nothing to spend it on. Seriously, the money is not even exciting because I have nothing to spend it on. Married physicians leave town within 2-3 years because the spouses get depressed or the children need to actually go to decent schools.

My only goal (because doubtful in 7 – 10 years, I’m going to find a good job because contrary to popular belief the market will not fix itself) is to save aggressively and “retire” in 10 years (and live frugally), and say good bye to radiation oncology (not even because I hate it- I don’t hate the job itself, but because I simply can’t find a job in a good enough location, and money is not the end all of my life). Do I want to retire early? No, I wanted to have a long fulfilling career which includes a cultivated personal life. I can’t get that, and so therefore, I’m just going to “transition” out. I will be the unemployed physician, the physician no longer using their MD.

No matter how kind and wonderful of a human being you are, no matter how much you love radiation oncology (and it is interesting but so are other specialties, and so are other non-medical fields), it is extremely difficult to live in a depressing town. That is why depressing towns have lower life expectancies- it takes its toll on you.

My other option is to do locums- but that’s not a great way to start your career and obviously not stable. Perhaps I could do a “fellowship?” Absolutely not. Fellowships are jokes and in my opinion delays your growth as a physician because you just continue to be the baby doctor. And I’m not even sure it would have helped.

Please be wise. Looking back on it, after not having matched in a top program, I wish I had dropped out of radiation oncology all together and done some other field with much better living opportunities. Just rank the programs whose alumni do have amazing jobs. Don’t be fooled by promises at interviews from smaller institutions. If they tell you people have great jobs, they are lying to you. Alumni who graduated even 4 years ago don’t count. Be wise, prudent and suspicious; be wary that some people say they are part of a larger system in a big city but in reality work in the middle of nowhere at a satellite facility, making half of what the main institution makes. Only accepting residency in a top tier program is sort of like the people who apply to law school, but will ONLY go to law school if it’s a top 5-10 program esp when the economy was bad- those people were brilliant. They didn’t want to graduate from a medicore law school and end up in the middle of nowhere just so they could have a job and pay off their debt and catch up on retirement saving. Our problem is not even related to the S&P 500 index.

The moral obligation falls on the residency programs. I don’t know the details of anti-trust laws but do know Congress often grants lobbyists from various industries exemptions. Are the people who benefit from residency expansions going to spend time lobbying Congress to stop it? Of course not. Not to mention it is usual that a group of supposedly intelligent human beings are approaching a problem in such an uninspiring manner- basically saying there is no solution. There is alway a solution- you just have to work on it. Even if it is basically impossible to fix this situation, the exact reasons why we can’t fix the problem are not at all important for the prospective applicant. The only thing that is important is that a deplorable job market is the reality, and going into radiation oncology limits your life opportunities, rather than expanding it. It is sad and hard to say this but it is true. Radiation oncology for me has been more of a prison rather than an expansion of my life.

The problem is that people want you to be grateful for an opportunity that you never wanted. We are all intelligent- we never had to go into this field, but they want us to be relieved just to get a job, no matter where it is. We are not unskilled laborers- our prospects should not be poor. As intelligent human beings with aspirations, we SHOULD expect jobs in nice areas as we DO deserve it. If that is not available, then the FUTURE applicants should clearly know this. We should not present them with false hope. That’s immoral.

I wanted to live in a real metropolitan area- that was a basic need for me. The FUTURE should look for other opportunities when they don’t match somewhere that will provide them with hopeful opportunities, and the very basics for their life goals.

Seriously, PROSPECTIVE APPLICANTS, if you don’t match into a top program, don’t bother doing it. It is NOT worth it. There are ways to have back-up specialties. Someone from my med school applied to both plastic surgery and family medicine- she was a great applicant- nobody had an issue with it. Another applied to both orthopedics and derm- no one had an issue with him either. It is POSSIBLE and REASONABLE and INTELLIGENT to have multiple interests and end up with the residency program that gives you the BEST opportunity to live the life you want, including your personal life. That is how I would have done it on retrospect. Or just apply to rad onc and if you don’t match to an awesome program, re-apply to a different specialty the next year.

I'm not just disgruntled. I’m massively disappointed in myself that I did not have a better understanding of what I accepted several years ago. I feel tricked, but mostly I feel stupid. How could I have been so foolish? I was an adult yet so blind to my future. I feel ashamed for not being able to project myself far enough into the future to understand how little control I would have over my occupation (including the where) and how much it would affect my daily life. I’m ashamed that I allowed my debt to accumulate and my retirement goals to be ignored for this career that is essentially a prison, that now I have no choice but to stay in this job for another 10 years just to catch up on repaying debt and saving for retirement. I can’t just walk away now because I have no other skills. Dr. Zeitman has hope for the future because he does not have to feel the pain of the present, nor do his residents. I wish the best for Dr. Zeitman but far more importantly, I wish the best for our current young future, who should not make the same mistake I made or many others of us have made. We should not lie to them about their future. Going to a top 3 institution may still get you an amazing job in an ideal location (esp non-academic); going to a nobody institution gets you misery.

I know that a lot of people convince themselves by trite sayings, “but still we are aren’t in internal medicine, “ “hey, there’s still nothing else better out there,” but, yes, there are better things out there and they do provide a better tomorrow. Many people just do not want to admit to themselves that they made a mistake. It is extremely hard to tell yourself you made a mistake by choosing this field. It makes you feel like your entire essence is a failure, that all your hard work and rationality was a mistake and a failure, but I did make a mistake and I want you, the future applicant to know this. For those of who us who did not go to Harvard/MSK/MDAnderson, we don’t want to call ourselves stupid and makes ourselves feel bad compared to them, so we pep talk ourselves in all sorts of ways so that we can keep on with our lives…whatever, future applicant, don’t make the same mistake we did.

I may love radiation oncology, I may enjoy my actual job, but every time I drive home and pass the neon criss-crossing legs, I do recognize I made a massive mistake and it will affect the remainder of my future. If you all are okay with living 2 hrs outside of Saint Louis, 90 min outside of Kansas City, 2hrs outside of Cincinatti, 2 hours outside of Indianopolis, somewhere in Nebraska or Abilene, TX, by all means become a radiation oncologist! (And I’m not EVEN sure I saw jobs in these locations). Otherwise, do not be lured by the money. It’s not worth it.

Best wishes to all of you. With all of my heart, I hope everyone ends up with a well rounded wonderful life. May your local bank robberies not be successful with just a knife and shoes. (By the way, there are plenty of guns here, but not everyone can afford them).

I will now return to convincing myself that bunny tracks in the snow are mind blowing.

If you can’t make it into the MSTP program forget about radiation oncology. You need a PhD to compete into the top places.

 

[Dro133]

The OP said do not go into rad onc if you cannot get into a top residency, so this begs the question...what counts as a top residency? Is it literally Harvard/MSKCC/MD Anderson or bust? What about Stanford/UCSF? U Washington? OHSU? At what "tier" does it become hard to find good opportunities after residency?

 

[Neuronix]

If you can’t make it into the MSTP program forget about radiation oncology. You need a PhD to compete into the top places.

That's not true. Look at the resident lists and see how many of the residents at the big name places have PhDs. I doubt it's even 50%.

 

[medgator]

The OP said do not go into rad onc if you cannot get into a top residency, so this begs the question...what counts as a top residency? Is it literally Harvard/MSKCC/MD Anderson or bust? What about Stanford/UCSF? U Washington? OHSU? At what "tier" does it become hard to find good opportunities after residency?

The whole premise of the OP is false in most cases as it relates to PP opportunities, which depend far more on networking and personality/"the 3 A's"

 

[evilbooyaa]

If you can’t make it into the MSTP program forget about radiation oncology. You need a PhD to compete into the top places.

Eh, that's not really true. Yes, a lot of this field is MD PhDs but it's not like they're excessively concentrated at the topic.

 

[dukeresident]

That's not true. Look at the resident lists and see how many of the residents at the big name places have PhDs. I doubt it's even 50%.

What’s a big name place in your book? And who has the permanent jobs in radiation oncology at the big name places for radiation oncology? Every “big name place” is NOT a big name place for radiation oncology.

 

[bluebubbles]

I was one of those med students who thought it's important to go to a top X program. I wish I could go back in time and tell myself the things that actually do matter.

 

[Dro133]

I was one of those med students who thought it's important to go to a top X program. I wish I could go back in time and tell myself the things that actually do matter.

Can you elaborate?

 

[deleted18755]

I was one of those med students who thought it's important to go to a top X program. I wish I could go back in time and tell myself the things that actually do matter.

I'm interested to hear as well but I can tell you from a private practice/community practice standpoint that we are not AT ALL impressed with multiple page CV's with abstracts and poster presentations (even to ASTRO . . . we have all been there and have seen the miles of posters every year and most of us slapped together at least an abstract or two so we could attend conferences as residents!) or even multiple peer reviewed original manuscripts published in the Red Journal from retrospective reviews or SEERs analysis. We are not impressed by "big names" in the field or "top programs" and you can see from the tone of this forum that we are actually increasing frustrated with and/or resentful of them. In fact, many would wonder why you put so much time and energy into a PhD, masters degree, research fellowship or whatever it took to get into a "top program", or why you are even applying outside of academics and assume that you see us as a "back up" after a failed job search for what you really wanted to do (or thought you wanted to do).

More specifically, many would assume that you spent literally thousands of hours on your (at least to me) worthless research throughout medical school to get that "top academic program" where you wasted even more time on it rather than developing your clinical skills, which is all most of us care about. This would be especially true if your research was in something especially irrelevant for 98% of radiation oncologists like pediatrics or non-solid tumors (lymphoma, myeloma) or even very rare cancers like sarcomas, especially if it's retrospective or SEER data or other very low level data.

Your time would be much better spent on obtaining excellent clinical skills and knowledge. It is so hard to differentiate yourself from the army of brilliant young residents who are graduating, but you're not going to do it with research. Unfortunately, not much new has been developed clinically recently (when I was applying for jobs having ANY experience with SBRT/SRS was highly sought after but now you're expected to be highly proficient by the end of training) . . . the only thing I can think of is being proficient in HDR brachytherapy.

True story: I have a colleague (who occasionally posts on here so maybe he will elaborate) who last year was hiring and really wanted somebody to help him transition from LDR to HDR brachytherapy for prostate and develop the program. After going through CV's he noted many with pages of research publications with regards to prostate cancer but when he called for an initial phone interview most didn't have any significant experience with HDR (so obviously didn't even get an interview).

Whatever you do, do not spend countless hours on prostate cancer research to get into your top residency where you continue piling on publications and present at ASTRO, prostate cancer conferences, etc and then graduate looking for a job and expect to get hired because of your research and big name residency when you lack clinical expertise (especially in that exact disease site . . . it's not just going to prevent you from getting hired but will just plain make you look like a fool!)

 

[medgator]

Whatever you do, do not spend countless hours on prostate cancer research to get into your top residency where you continue piling on publications and present at ASTRO, prostate cancer conferences, etc and then graduate looking for a job and expect to get hired because of your research and big name residency when you lack clinical expertise (especially in that exact disease site . . . it's not just going to prevent you from getting hired but will just plain make you look like a fool!)

As a busy PP clinician, I'll take a hungry grad with a good personality who trained at a busy mid tier program every time over the dual degree M.D./PhD with pubs in nature who did holman at a top 5 program

 

[deleted18755]

As a busy PP clinician, I'll take a hungry grad with a good personality who trained at a busy mid tier program every time over the dual degree M.D./PhD with pubs in nature who did holman at a top 5 program

Couldn't agree more but at least that guy did something impressive . . . nothing impresses me less (or depresses me more) than a resident with pages of abstracts, presentations, or even full manuscripts of restrospective reviews and SEER analyses that everybody other than he knows are basically worthless. If you're going to do research please at least do something meaningful and focus on a few well thought out and developed projects and publications based on solid data rather than the endless garbage that gets published in the increasing number of journals that literally nobody reads or cares about!

 

[RickyScott]

What’s a big name place in your book? And who has the permanent jobs in radiation oncology at the big name places for radiation oncology? Every “big name place” is NOT a big name place for radiation oncology.

It also depends on expectations and the job. Today, being in a top program may help with getting a job at a satellite of a large academic center. 10 years ago, those were jobs that many would avoid, or just take until something better came up. Today, I get the sense that a dream job for a resident at a large prestigious academic center would be one of those spots in the satellite clinics. (For instance,10-15 years ago very few MSKCC residents would accept a position in their own satellites) The ASTRO resident session would actually warn against taking jobs at quasi academic pay away from the benefits of the main center. Expectations have certainly diminished in this job market.

 

[Neuronix]

Couldn't agree more but at least that guy did something impressive . . . nothing impresses me less (or depresses me more) than a resident with pages of abstracts, presentations, or even full manuscripts of restrospective reviews and SEER analyses that everybody other than he knows are basically worthless. If you're going to do research please at least do something meaningful and focus on a few well thought out and developed projects and publications based on solid data rather than the endless garbage that gets published in the increasing number of journals that literally nobody reads or cares about!

This is why we advise residents who did a lot of research to clean up their CV for private practice group applications. The resident should have two CVs, one with most of their research productivity removed and instead focusing on cover letter and clinical skills.

Much of the private practice world is pretty out of touch with the job market reality for residents today. That is, a lot of the academic jobs are basically private practice jobs. Real academics barely exists anymore for new grads (like RickyScott posted above me). But a lot of private groups will say "oh that guy should be in academics." Even in academics nowadays there are plenty of practices that say "that guy is too academic for us, we're basically just a private practice." I interviewed at several "strong" academic places that were only looking for new faculty to be 100% clinical.

In any case, since the residents don't know if they're going to have a job in academics or private when they're done (basically doing the same job but with different CV expectations), they do their best to prepare for both. Also, they will often have a lot of pressure from the program to produce papers with their faculty. Some academic places will still look for someone with a strong CV because they think the faculty member will publish once and awhile and accrue on clinical trials to drive patient flow for the patients who want to believe they're getting academic docs for whatever benefit that could provide.

So many residents nowadays do their best in residency to prepare for both worlds--academic and private. They don't realize that too much research on the CV hurts them for a lot of the private groups as per the posts above. I think screening this way is short-sighted, since I personally know some very clinically adept MD/PhDs and some very research adept MDs and vice-versa. I also know plenty of academic docs who have gone to private and vice versa. But when an employer gets 100-200 applications per position, they have to screen somehow...

 

[evilbooyaa]

Couldn't agree more but at least that guy did something impressive . . . nothing impresses me less (or depresses me more) than a resident with pages of abstracts, presentations, or even full manuscripts of restrospective reviews and SEER analyses that everybody other than he knows are basically worthless. If you're going to do research please at least do something meaningful and focus on a few well thought out and developed projects and publications based on solid data rather than the endless garbage that gets published in the increasing number of journals that literally nobody reads or cares about!

What else do you want a resident to do in a 4 year time span to qualify as "impressive" research? I agree that the volume and frequency of publications can become outrageous with database analyses and low impact factor and unknown journals who publish them, but besides those and retrospective chart reviews what do you expect to develop the bulk of a resident's research CV? A resident isn't going to routinely get on a clinical trial publication as anything but a middle of the pack author unless he/she is very lucky and the PI is very generous.

I do agree that research like that doesn't necessarily have to be a huge positive, but do private practice guys really consider the fact that somebody has research (and the thought that residents that are research heavy are poor clinically or not affable is an absolute logical fallacy, IMO) as a NEGATIVE? Like a private practice would rather interview somebody with no or minimal research (of similar quality to above) than somebody that is extensively published?

 

[evilbooyaa]

True story: I have a colleague (who occasionally posts on here so maybe he will elaborate) who last year was hiring and really wanted somebody to help him transition from LDR to HDR brachytherapy for prostate and develop the program. After going through CV's he noted many with pages of research publications with regards to prostate cancer but when he called for an initial phone interview most didn't have any significant experience with HDR (so obviously didn't even get an interview).

You know that the number of residency programs in the US that are actively doing HDR brachytherapy for prostate can likely be counted on just two hands, right? So to have a job posting that is looking for this one extremely specific skill and then guffawing about it is somewhat silly. Granted, if the job posting itself said "must have experience with HDR brachytherapy for prostate" then so be it.

 

[RollTideRadOnc]

Have to disagree with some of the prevailing wisdom on this thread.

I do believe -- at least in the competitive coastal cities -- pedigree does absolutely matter for private practice.

All prospective residents need to look at the websites of the major private practices in these areas. They are chock full of grads from Harvard (etc) on the East coast, and UCSF/Stanford, MDA (etc) on the West coast. As has been mentioned on other threads, if you want a good shot at a coastal job (whether PP or academic), you pretty much have to go to a top 10 program.

 

[Mandelin Rain]

I always like to see a couple first author publications on a CV (read: not a sea of abstracts. They are useless. I know how little effort I put into my own sea of abstracts.). I like to see this because I know what a pain in the butt is is to publish a paper in any peer reviewed journal. You have to write the damn thing, negotiate an author line, format all the graph and charts correctly, use their particular citation method, and go through revision processes with multiple authors who either don't care to respond or have conflicting input. It sucks for the most part. But if you are willing/able to see it through to completion, it tells me a little something about you even if the content of the article is nonsense (spoiler alert: it's nonsense).

I certainly wouldn't hold a couple papers against anyone.

 

[deleted18755]

You know that the number of residency programs in the US that are actively doing HDR brachytherapy for prostate can likely be counted on just two hands, right? So to have a job posting that is looking for this one extremely specific skill and then guffawing about it is somewhat silly. Granted, if the job posting itself said "must have experience with HDR brachytherapy for prostate" then so be it.

But that is what makes one marketable, having a skill set that is relatively rare that employers are looking for . . . my point is if you enjoy treating prostate cancer and want to sub-specialize in it, instead of working on your 10th SEER analyses and retrospective review that literally nobody cares about (except your “mentor” since it advances his career and he will tell you will somehow help you as well) and thinking that this somehow elevates you above the sea of other applicants, use one of your research months to go out to one of the programs that is actively doing HDR brachytherapy or acquire another actual useful skill, knowledge, whatever that may actually help you get a job!

HDR prostate is in no way an “extremely specific skill” despite what your 1.8 Gy x 40+ fraction x academic mark up or proton therapy peddling attending tells you ... for multiple reasons it is (very appropriately) the future of prostate radiation and one of the very few exceptional advances in radiation oncology for both patients and society/cost containment in the past decade and for what it’s worth (which may not be much) the only skill I can think of that would set you apart from the pack.

Whatever you do, don't apply to a job that states that they are hiring and would like somebody to sub-specialize in prostate (or whatever it may be), claim you are very interested in prostate or whatever, and prove it by saying it's your research interest, submit a CV with garbage research that nobody cares about related to the disease site like you're some kind of expert or even any more knowledgeable on the topic than the other 100 people who are applying for the job but then lack the actual skills for the job, which you could have acquired with a little initiative after your 10th SEER analysis but instead you thought spending 60 hours a week grinding out another few nonsense "research" papers on yet another month of a research elective would somehow put you ahead of the pack of ravenous wolf residents also desperately applying for the job, which will be given to the guy without a single abstract who instead spent those months acquiring more clinical skills, especially very specific and needed ones like HDR.

 

[deleted18755]

What else do you want a resident to do in a 4 year time span to qualify as "impressive" research? I agree that the volume and frequency of publications can become outrageous with database analyses and low impact factor and unknown journals who publish them, but besides those and retrospective chart reviews what do you expect to develop the bulk of a resident's research CV? A resident isn't going to routinely get on a clinical trial publication as anything but a middle of the pack author unless he/she is very lucky and the PI is very generous.

I do agree that research like that doesn't necessarily have to be a huge positive, but do private practice guys really consider the fact that somebody has research (and the thought that residents that are research heavy are poor clinically or not affable is an absolute logical fallacy, IMO) as a NEGATIVE? Like a private practice would rather interview somebody with no or minimal research (of similar quality to above) than somebody that is extensively published?

Definitely, as noted above by Neuronix. It may sound crazy to you guys who have drank the koolaid for so long (don't worry many of us did too, I'm just trying to help you see the truth) but you should "clean up" your CV by literally DELETING the citations of those publications that I know you worked so hard on but honestly literally nobody cares about (and many may view as negative).

 

[Reaganite]

Have to disagree with some of the prevailing wisdom on this thread.

I do believe -- at least in the competitive coastal cities -- pedigree does absolutely matter for private practice.

All prospective residents need to look at the websites of the major private practices in these areas. They are chock full of grads from Harvard (etc) on the East coast, and UCSF/Stanford, MDA (etc) on the West coast. As has been mentioned on other threads, if you want a good shot at a coastal job (whether PP or academic), you pretty much have to go to a top 10 program.

Not sure where you are getting this info from. I'm on one of the coasts in a "prime" area, and when I look around at the other rad oncs in about a 60 mile radius, it's mostly guys who graduated locally. There are very few people from top 10s. Connections way more important than pedigree here.

 

[maruchan]

I spent 10 min looking up where alumni from some programs go (going by the alumni list mostly, or by googling their name)

To summarize:
Harvard - vast majority go into academic jobs, vast majority at one of the harvard hospitals. handful go into (best i can tell) nice PP jobs
MSKCC - vast majority go to academic jobs, decent mix of placements throughout the country: Radiation Oncology Residency: Alumni | Memorial Sloan Kettering Cancer Center
UCSF - comparatively few go into academics, those that do are at UCSF. PP placement mostly in desirable locations in cali but somewhat variable
Stanford - Essentially everyone goes into academics (consistent with their reputation of frowning upon PP). Placement throughout the country: Past Residents | Radiation Oncology | Stanford Medicine
Yale - mix of academics and PP: Alumni > Therapeutic Radiology | Yale School of Medicine
Penn - majority into academics, placement throughout the country: Alumni | Department of Radiation Oncology | Perelman School of Medicine at the University of Pennsylvania
UCLA - majority in PP, placement throughout the country: Alumni | Radiation Oncology Residency Training Program
Duke - mix of PP and academics, Placement | Duke Radiation Oncology

It's an imperfect sample. Someone with more time can make a more complete list than me. My takeaway is that pedigree seems to matter a LOT for academics. There are very few academic jobs per year and yet the top programs residents are consistently landing academic placements. For PP, connections and regional reputation are likely way more important as said by Reaganite et al.

 

[medgator]

. My takeaway is that pedigree seems to matter a LOT for academics. There are very few academic jobs per year and yet the top programs residents are consistently landing academic placements. For PP, connections and regional reputation are likely way more important as said by Reaganite et al.

You nailed it. Once you are board-certified, you've cross the hurdle in terms of academic qualifications for PP. Beyond that it is about personality, connections and the 3 "A's"

 

[MegaVoltagePhoton]

Ok, I'm compelled to respond. Caveat -- I work in academics.

There's way too much bashing of academics on this forum from private practice veteran posters who just want to pile on. It's easy to pile on academics, but let's be real. You think private practice docs can just "was their hands" of the issues facing radiation oncology? Yes, hypofractionation (the devil!) came out of academia. But not only is hypofractionation not a bad thing in general, it's just one of several things to come out of academia. Are we going to argue that SBRT for lung cancer is bad? That de-escalation for HPV+ oropharynx cancer is bad? That unilateral treatment for tonsil cancer is bad? That IGRT for prostate cancer is bad? That ADT for prostate cancer is bad?

"The academics have failed us by not researching the abscopal effect!" Why? because all the other advances made by academics don't matter? Because research into the abscopal effect would jack up revenue in private practice world by bringing metastatic patients to the table, whereas hypofractionation would maximize patient convenience instead? By the way folks--spoiler alert: people in academics are ****ing looking into the abscopal effect. Unfortunately, it's a rare effect and not all studies are going to pan out or will pan out, and will take time.

Oh and as far as pedigree, again, fun to pile on by depicting the classic "this guy is a research nerd" stereotype. Yes, I work in academics and I hate anti-social, poor clinical skill rad oncs, too. But guess what? If I get an outside referral or second opinion and I look up where that doctor is coming from, why is it very frequent to see private practice doctor websites that list "has published xxx number of abstracts, papers, and presentations" etc.? Or to highlight educational credentials? Because guess what it's marketing. Yes, it doesn't matter for research, but it matters to create the illusion of a well-trained expert because in the eyes of the public, that's (wrongly) equated with competence. So, yes, pedigree still matters, but to a lesser degree than not being a douchebag.

 

[deleted18755]

I spent 10 min looking up where alumni from some programs go (going by the alumni list mostly, or by googling their name)

To summarize:
Harvard - vast majority go into academic jobs, vast majority at one of the harvard hospitals. handful go into (best i can tell) nice PP jobs
MSKCC - vast majority go to academic jobs, decent mix of placements throughout the country: Radiation Oncology Residency: Alumni | Memorial Sloan Kettering Cancer Center
UCSF - comparatively few go into academics, those that do are at UCSF. PP placement mostly in desirable locations in cali but somewhat variable
Stanford - Essentially everyone goes into academics (consistent with their reputation of frowning upon PP). Placement throughout the country: Past Residents | Radiation Oncology | Stanford Medicine
Yale - mix of academics and PP: Alumni > Therapeutic Radiology | Yale School of Medicine
Penn - majority into academics, placement throughout the country: Alumni | Department of Radiation Oncology | Perelman School of Medicine at the University of Pennsylvania
UCLA - majority in PP, placement throughout the country: Alumni | Radiation Oncology Residency Training Program
Duke - mix of PP and academics, Placement | Duke Radiation Oncology

It's an imperfect sample. Someone with more time can make a more complete list than me. My takeaway is that pedigree seems to matter a LOT for academics. There are very few academic jobs per year and yet the top programs residents are consistently landing academic placements. For PP, connections and regional reputation are likely way more important as said by Reaganite et al.

Look a bit further: instead of just looking at lists that say somebody got a job as an “assistant professor” at university of whatever look at their contact/office address and put it in google maps or go to any large academic center’s website and search for their satellites or affiliated offices. It’s crazy ... many of these “assistant professors” in “academics” are working in satellite centers l 1.5 to 2 or literally over 2.5-3 hours away, (sometimes not even in the same state!) from the actual main campus in offices that very clearly were private practices within the past few years. Does anybody consider this an “academic” position?

Man when I was applying some who went into academics complained about having to treat two disease sites or occasionally covering the vacation of another office, then it was impossible to fill positions at the satellite 20 minutes away then 45 minutes away and now residents are fighting for “academic” jobs at little private practices hours and hours away that were bought out, then I assume the doctor was kicked out, the academic centers sign put on the door, the rates jacked up, and some sad little “senior instructor” or “associate Professor” with PhD brought in.

 

[medgator]

Ok, I'm compelled to respond. Caveat -- I work in academics.

There's way too much bashing of academics on this forum from private practice veteran posters who just want to pile on. It's easy to pile on academics, but let's be real. You think private practice docs can just "was their hands" of the issues facing radiation oncology?

PP folks aren't the ones who have shamelessly ramped up residency spots by >50% over the last decade, nor have they opposed common sense payment reform like case/bundled payment and site-neutral payment models.

It's hard not to want to pile on when you see your local nci center getting paid way more for the exact same thing you're doing and pushing protons unnecessarily, while pumping out grads that the job market doesn't need.

I personally have not experienced this but others on this forum also indicate that the academic practices in their areas will denigrate the PP nearby in terms of quality of care.

 

[RickyScott]

I spent 10 min looking up where alumni from some programs go (going by the alumni list mostly, or by googling their name)

To summarize:
Harvard - vast majority go into academic jobs, vast majority at one of the harvard hospitals. handful go into (best i can tell) nice PP jobs
MSKCC - vast majority go to academic jobs, decent mix of placements throughout the country: Radiation Oncology Residency: Alumni | Memorial Sloan Kettering Cancer Center
UCSF - comparatively few go into academics, those that do are at UCSF. PP placement mostly in desirable locations in cali but somewhat variable
Stanford - Essentially everyone goes into academics (consistent with their reputation of frowning upon PP). Placement throughout the country: Past Residents | Radiation Oncology | Stanford Medicine
Yale - mix of academics and PP: Alumni > Therapeutic Radiology | Yale School of Medicine
Penn - majority into academics, placement throughout the country: Alumni | Department of Radiation Oncology | Perelman School of Medicine at the University of Pennsylvania
UCLA - majority in PP, placement throughout the country: Alumni | Radiation Oncology Residency Training Program
Duke - mix of PP and academics, Placement | Duke Radiation Oncology

It's an imperfect sample. Someone with more time can make a more complete list than me. My takeaway is that pedigree seems to matter a LOT for academics. There are very few academic jobs per year and yet the top programs residents are consistently landing academic placements. For PP, connections and regional reputation are likely way more important as said by Reaganite et al.

As pointed out , this is misleading. There is a difference in "Academics" between working at the main center vs a satellite. Yes, being a top grad will help you obtain one of these satellite positions. Ironically, few top grads desired these positions 10 years ago. I wish I kept the transcript from ARRO when I finished , where they basically warned you against taking satellite positions at an academic salary without the main center benefits

Today, with hospital consolidations in the northeast, how many decent private groups are left in the NYC area, philly, (none in the boston area were desirable when I was applying) and how often do they hire?