FWIW Residency Expansion and Job Market Panel at ARRO Seminar

[xrthopeful]

‘Judge a program not by the number of residents within it, but by the quality of the education that those residents receive, IMO.’

Absolutely agree. In my experience and from what I’ve seen and discussed with friends at smaller programs, it often goes hand in hand. Smaller programs rely on residents more. They need you in clinic more. When a VP comes you only get an hour out of clinic. Your attendings are covered more often by residents. Etc etc etc

If there are small programs that are able to prioritize residents like some of the bigger programs have the luxury of doing, then awesome.

And yes there are some bigger programs that don’t do a great job with this either of course.

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[xrthopeful]

But evil - regardless this speaks to my point about how it would be quite difficult to cut slots by half like some have argued for. How do you decide who loses spots?

 

[evilbooyaa]

I don't think any of your statements are necessarily true across the board when comparing larger and small programs. There are many larger programs that only allow 6 months for research. Larger programs mandate all attendings to be covered, requiring cross-coverage when a resident takes vacation. Larger programs have an attending (usually multiple attendings) that have 24/7 resident coverage. I don't necessarily see how big programs automatically means that residents are prioritized. Again, this is dependent on the culture, not on the size, of the program.

There are actually some programs that have an equal number (or more residents) than they do attendings, which blew my mind. Not all in small (<6 per ACGME) programs either.

Again, I'm not doubting that your statements are true for some, and I'll even go ahead and say more than 50% of the 'small' programs. I don't know or have enough experience with small programs to comment more than that. But to rely on a univariate analysis and make sweeping changes based on number of residents when the actual answer is based on a multivariable model based on factors that are much, much more involved than just resident number, is not the right way to do things.

I think cutting slots by half would be hard, even with the most aggressive models. The folks who post that don't seem to have a plan to actually get it down to that number. My hope would not necessarily be a halving, but something to at least lead to SOME residency contraction (and definitely freezing). I'm trying to be a centrist and a realist between "everything is fine, continue expansion" and "we're already past the point of no return, we need to cut spots to 1/2 of current".

But here's the thing, despite what people may post, let's think about what's happening in the real world.
I think MOST on this board would agree that continued residency expansion is a bad thing and would consider a residency expansion freeze as a realistic first step.
How many chairmen/women or folks of the RRC agree with that statement? Enough to even want to put it into effect? Where there's a will (let's be realistic and say a freeze), there's a way (overhauling ACGME requirements substantially).

 

[deleted774703]

In the short term, the financial incentive of residency expansion is too much for chairs to stop residency expansion.

In the long term, programs will become unhappy when they realize that the people they need to hire are watered down since our usual great applicants have gone to other specialties.

 

[GapCalc]

I'll wait and reserve judgement on how the discussion goes. For one thing, one of GapCalc's summaries/expectations is dead wrong, which I know for a fact, ha. I'm glad ARRO decided on this as one of their panels, and glad these people agreed to participate. It's a open forum for anyone to ask questions. Hopefully current residents will report back on how it went down.

Beware judging opinions or biases of someone just based on a blurb. One could google some of the prolific posters here and come to some potentially unfair judgements as well, right?

You’re right. I wrote the post mostly in jest. I am appreciative of ARRO’s efforts, and that these invited speakers are willing to get up on stage and potentially take questions. It wasn’t too long ago that they (invited leader types) weren’t even asking if there was an issue with residency expansion.

Anyway, that’s all. I don’t want to be too much of a misanthrope! Just moderately so.

 

[deleted18755]

This is going back almost two decades, but there used to a gentleman who I believe was a practicing attorney and radiation oncologist who would come talk at the resident's meeting the day before ASTRO. He provided incredibly useful advice and honestly appeared to do it just to help out the next generation. Is this gentleman still around?

This "anti-trust" issue always gets thrown around when it comes to halting residency expansion but wouldn't it be great to hear his take on the matter (or another person with a true and deep understanding of the law, and of course our specialty, and preferably towards the end of their career or even retired so no need to hold back and no conflicts of interest, but I doubt another such unique individual exists).

 

[xrthopeful]

Looks like Ben Falit who is on the panel is an MD/JD for what it’s worth

 

[Mandelin Rain]

Re: Anti-Trust... who is bringing the suit to court? Who are they suing? Functionally, I can't even imagine how it'd work.

A more obvious red herring, there has never been.

 

[medgator]

This is going back almost two decades, but there used to a gentleman who I believe was a practicing attorney and radiation oncologist who would come talk at the resident's meeting the day before ASTRO. He provided incredibly useful advice and honestly appeared to do it just to help out the next generation. Is this gentleman still around?

This "anti-trust" issue always gets thrown around when it comes to halting residency expansion but wouldn't it be great to hear his take on the matter (or another person with a true and deep understanding of the law, and of course our specialty, and preferably towards the end of their career or even retired so no need to hold back and no conflicts of interest, but I doubt another such unique individual exists).

Looks like Ben Falit who is on the panel is an MD/JD for what it’s worth

Terry J. Wall, JD, MD

TRI, P.A. is a radiation oncology group of 15 doctors, dedicated to providing diverse radiation therapy and related services throughout the Kansas City metropolitan area

www.tridocs.com

 

[xrthopeful]

pretty sure as of last year Terry Wall still does the yearly talk on Saturday with ARRO. likely on the docket again this year

 

[Gfunk6]

As I understand it ASTRO refuses to tackle residency expansion even though it's bad for our field and bad for our trainees because "anti-trust."

Therefore, if they truly desire to curtail expansion they have only a few mechanisms:

1. Create artificial barriers to expansion by increasing the breadth and volume of resident caseload along with strict didactic requirements. This will have the effect of closing smaller programs which is apparently a stated goal of the ABR anyway. I think this has the highest chance for implementation.

2. Rely on the "goodwill" of chairs to reduce their resident complement for the good of the field. This is about as good as doing nothing IMO.

3. Canaries in a coal mine - the backlash about residency expansion reaches the ears of potential MS-4's who wisely opt for other specialties. Although it would seem on the surface that this would "organically" reduce resident complement, what is more likely is that the empty spots will be filled by FMGs or others which would simply exacerbate the problem.

 

[fiji128]

Re: Anti-Trust... who is bringing the suit to court? Who are they suing? Functionally, I can't even imagine how it'd work.

A more obvious red herring, there has never been.

It drives me nuts that the whole future health of the specialty is based off this "antitrust!" argument that's never even been tested. As if some guy who has a JD and has probably never practiced antitrust law has any clue about what would in all likelyhood be an incredibly complicated case. Kinda like asking a new medical intern what his approach to treating brain metastases is and just saying ya lets go with that they have a MD so they must know what they are talking about.

 

[scarbrtj]

It drives me nuts that the whole future health of the specialty is based off this "antitrust!" argument that's never even been tested. As if some guy who has a JD and has probably never practiced antitrust law has any clue about what would in all likelyhood be an incredibly complicated case. Kinda like asking a new medical intern what his approach to treating brain metastases is and just saying ya lets go with that they have a MD so they must know what they are talking about.

Indeed. Seems so specious from afar. Of course doctors talking about the minutiae of antitrust are about as good as lawyers discussing the minutiae of brain mets management. That said,
1) Antitrust lawsuits and enforcements are on the decline in the U.S.
2) To wit, a rather clear-cut case of antitrust was the NRMP. "Everyone" thought that had a good chance of prevailing. While not really failing on the lack of its legal merits, the antitrust challenge against the NRMP did fail. If that one failed, how likely would it be that an antitrust against ASTRO or the ABR would succeed? Would take a whole lot of satisfying of some pretty far out "what ifs."

 

[RollTideRadOnc]

It's pretty clear that chairs (at least the ones I've interacted with) don't really care about this situation. The bottom line for them, is that the more residents they can get for their programs, the better. More cheap labor. And the more attractive their department is for the recruitment of faculty, as those recruited can be offered full coverage without *any* exceptions. Why would a chair put the interest of the field ahead of that of their own department? Anti-trust seems to be a convenient straw man argument so that the people who lead our field don't have to see culpability in the mirror each morning.

 

[Chartreuse Wombat]

It's pretty clear that chairs (at least the ones I've interacted with) don't really care about this situation. The bottom line for them, is that the more residents they can get for their programs, the better. More cheap labor. And the more attractive their department is for the recruitment of faculty, as those recruited can be offered full coverage without *any* exceptions. Why would a chair put the interest of the field ahead of that of their own department? Anti-trust seems to be a convenient straw man argument so that the people who lead our field don't have to see culpability in the mirror each morning.

Tragedy of the commons - Wikipedia

en.wikipedia.org

Too bad we don't have an Elinor Ostrom to demonstrate to Chairs how to manage a solution.

Of course I am cynical enough to believe that most Chairs could care less. Residency expansion ensures lower wages for faculty.

Overtraining is a plus for all of the stakeholders (ASTRO (more dues), ABR (more dues), employers (lower wages)).

 

[seper]

AAEM Position Statement on the Emergency Medicine Workforce | AAEM - American Academy of Emergency Medicine

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care.

www.aaem.org

 

[Doctorer]

AAEM Position Statement on the Emergency Medicine Workforce | AAEM - American Academy of Emergency Medicine

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care.

www.aaem.org

Good question for the Q and A on Saturday.

 

[Krukenberg]

Good question for the Q and A on Saturday.

A few weeks ago came across a thread about this in the EM board, and someone said “I’m glad they’re raising this issue, but I hope they never again say anything about it in public. “

 

[scarbrtj]

“I’m glad they’re raising this issue, but I hope they never again say anything about it in public. “

Sounds exactly like what some in the emperor's council were whispering re: the emperor's clothing during that unfortunate period of his nakedness.

 

[xrthopeful]

A few weeks ago came across a thread about this in the EM board, and someone said “I’m glad they’re raising this issue, but I hope they never again say anything about it in public. “

Did they say why they felt that way?

 

[Krukenberg]

Did they say why they felt that way?

They thought the optics of doctors releasing statements of concern over their own employability weren’t good.

 

[Krukenberg]

They thought the optics of doctors releasing statements of concern over their own employability weren’t good.

My opinion is we’re a tiny specialty that no one outside of rad onc understands and the public largely isn’t paying attention to us relative to EM.

 

[RadOncDoc21]

My opinion is we’re a tiny specialty that no one outside of rad onc understands and the public largely isn’t paying attention to us relative to EM.

I don’t care how if it fixes the problem.

 

[deleted941485]

As I understand it ASTRO refuses to tackle residency expansion even though it's bad for our field and bad for our trainees because "anti-trust."

Therefore, if they truly desire to curtail expansion they have only a few mechanisms:

1. Create artificial barriers to expansion by increasing the breadth and volume of resident caseload along with strict didactic requirements. This will have the effect of closing smaller programs which is apparently a stated goal of the ABR anyway. I think this has the highest chance for implementation.

2. Rely on the "goodwill" of chairs to reduce their resident complement for the good of the field. This is about as good as doing nothing IMO.

3. Canaries in a coal mine - the backlash about residency expansion reaches the ears of potential MS-4's who wisely opt for other specialties. Although it would seem on the surface that this would "organically" reduce resident complement, what is more likely is that the empty spots will be filled by FMGs or others which would simply exacerbate the problem.

3 isn’t working very well. It’s just that they’ve switched out the high achieving students with lower achieving ones who by some miracle are now good enough to get through a rad Onc residency

Killing small programs can happen but probably too slowly to make a big difference

 

[Lamount]

3 isn’t working very well. It’s just that they’ve switched out the high achieving students with lower achieving ones who by some miracle are now good enough to get through a rad Onc residency

Comments like this make a compelling argument for the admixture of FMGs and DOs into our field, if for no other reason than to dispel this bitter and misplaced elitism.

 

[medgator]

Comments like this make a compelling argument for the admixture of FMGs and DOs into our field, if for no other reason than to dispel this bitter and misplaced elitism.

What elitist about taking in residents with higher step scores, more research and who are AMGs vs FMGs?

Sounds like someone has got a chip on their shoulder...

 

[MegaVoltagePhoton]

Comments like this make a compelling argument for the admixture of FMGs and DOs into our field, if for no other reason than to dispel this bitter and misplaced elitism.

Oh please. I’m sure you’re about to regale us with the anecdote of a superstar fmg or do, as if that’s common?

Tired of this snowflake crap. Sorry if it triggers you, but elite fields are elite because they attract the best and the brightest. It’s painstakingly obvious that the quality of the applicant pool is objectively sinking.

 

[bluebubbles]

Comments like this make a compelling argument for the admixture of FMGs and DOs into our field, if for no other reason than to dispel this bitter and misplaced elitism.

I hate to break it to you, but FMG's and DO's will be still be elitist and entitled. After all, they'll be in rad onc. The few. The proud. All that.

They'll still be elitist and arrogant, but they'll be thinking those elitist thoughts in another language.

 

[Lamount]

Oh please. I’m sure you’re about to regale us with the anecdote of a superstar fmg or do, as if that’s common?

Tired of this snowflake crap. Sorry if it triggers you, but elite fields are elite because they attract the best and the brightest. It’s painstakingly obvious that the quality of the applicant pool is objectively sinking.

I am not offended. It's just been my experience that the best and brightest don't need to call themselves elite. To each his/her own

 

[xrthopeful]

Oh please. I’m sure you’re about to regale us with the anecdote of a superstar fmg or do, as if that’s common?

Tired of this snowflake crap. Sorry if it triggers you, but elite fields are elite because they attract the best and the brightest. It’s painstakingly obvious that the quality of the applicant pool is objectively sinking.

Objectively sinking for one year.

Also before the 10-15 years or so where rad onc was very competitive, ending perhaps in 2018, it used to not be competitive at all. Many people who are currently still working matched rad onc when it wasn’t competitive. Yeah we all want to be in a field where we feel like it’s ‘exclusive’ but stop acting like many rad oncs you know (or maybe even some of you yourselves) didn’t march into rad onc when it wasn’t that competitive and then got to BANK in during the bubble of the 2000s

 

[medgator]

Objectively sinking for one year.

Also before the 10-15 years or so where rad onc was very competitive, ending perhaps in 2018, it used to not be competitive at all. Many people who are currently still working matched rad onc when it wasn’t competitive. Yeah we all want to be in a field where we feel like it’s ‘exclusive’ but stop acting like many rad oncs you know (or maybe even some of you yourselves) didn’t march into rad onc when it wasn’t that competitive and then got to BANK in during the bubble of the 2000s

You can tell the quality of rad oncs has changed over the decades, whether it be academics or out in pp.

When you graduate and get into the real world, you'll figure this out

 

[xrthopeful]

You can tell the quality of rad oncs has changed over the decades, whether it be academics or out in pp.

When you graduate and get into the real world, you'll figure this out

I mean yeah if you're saying that people who trained in the last 10-15 years you trust more and are more capable than some of the older dinosaurs, then duh, I agree. IMO that has more to do with training in a more advanced era than 'intelligence' though. But I see what you're saying.

also I've told you multiple times that I'm already out in the 'real world'.

 

[scarbrtj]

Comments like this make a compelling argument for the admixture of FMGs and DOs into our field, if for no other reason than to dispel this bitter and misplaced elitism.

Oh please. I’m sure you’re about to regale us with the anecdote of a superstar fmg or do, as if that’s common?

Tired of this snowflake crap. Sorry if it triggers you, but elite fields are elite because they attract the best and the brightest. It’s painstakingly obvious that the quality of the applicant pool is objectively sinking.

The "degree of difficulty" for a rad onc residency was never above 9 on a scale of 1 to 10. The only thing that would be elite about the residency nowadays is the worry of passing boards. "Oh, you didn't fail a section? You're elite!" After residency the modern rad onc is facing iffy job prospects, geographic immobility, and (relative to specialist peers) middling salaries with brittle vacation/time-off possibilities. (We have the cushest job with the some of the worst flexibility!) And >50% chance the rad onc grad will wind up on the academic treadmill vs charting (to semi-charting) a more lucrative path. I'm not real sure >50% of American medical graduates want to be academicians, but one had better be prepared for that in rad onc. So 1) either rad onc attracts a "different" candidate, or 2) rad onc somewhat imposes awkward choices on the traditional American grad. ("I never thought about academics until I started thinking about rad onc"... heard that one a few times.) All in all and on its face rad onc doesn't sound that elite if putting oneself in a med student's shoes. So I agree the elitism/superiority mentality is increasingly delusional. We don't want to become the Norma Desmonds of medicine.

Beyond that, and I know I'll catch flak for this, it's somewhat difficult to be a "bad" rad onc these days if you're a recent grad IMHO. Most of the things we do are increasingly guideline based, palliative or curative. Especially when the insurance company gets its say there's a guideline and no space for "creativity" either in a good or bad way. At the least there's scant wiggle room to show one's brilliant teletherapeutic/brachytherapeutic flair relative to guy across street (ignoring technology differences between docs/clinics). So FMGs could do modern American rad onc fine. Obviously we're probably gonna find out!

 

[xrthopeful]

I mean FMGs are matching into top Cards, GI, Onc, Pulm/CritCare fellowships on a very regular basis and are thriving. I don't know what would make anyone think that the field would be less 'capable' if more FMGs matched Rad Onc lol. Other than the optics of it and your ego.

like maybe some of you just aren't in spheres where you come across it, but there is a huge difference between an America-born FMG from the Carribean versus one from India, Pakistan, the Middle East, East Asia, Canada etc who absolutely destroyed the steps.

and reality is if some Carribean grad ever matches Rad Onc (or Rads, good IM program etc etc etc) they probably also destroyed the Steps.

 

[medgator]

reality is if some Carribean grad ever matches Rad Onc (or Rads, good IM program etc etc etc) they probably also destroyed the Steps.

Rads yes. RO, remains to be seen, in this new era

 

[xrthopeful]

RFA’s post pretty clearly implies that FMGs are inherently lower achieving. I was responding to that mindset.

I agree with you that if more FMGs Match rad onc it’s an overall indicator of the competitiveness of the application cohort

I also don’t think that having the residency application cohort be ‘less competitive’ on paper does anything to affect the job market or supply/demand issues. Maybe it attracts attention to have people in charge reconsider the dynamics of the number of residency slots, but that’s also being optimistic.

 

[evilbooyaa]

RFA’s post pretty clearly implies that FMGs are inherently lower achieving. I was responding to that mindset.

I agree with you that if more FMGs Match rad onc it’s an overall indicator of the competitiveness of the application cohort

I also don’t think that having the residency application cohort be ‘less competitive’ on paper does anything to affect the job market or supply/demand issues. Maybe it attracts attention to have people in charge reconsider the dynamics of the number of residency slots, but that’s also being optimistic.

RFA suggests 'lower achieving' students. He does not specifically mention FMGs, although he is quoting a post that mentions 'FMGs and others' (emphasis mine)

It is not untrue that the admission statistics for getting into rad onc likely decreased last year when including SOAP positions. Those admission statistics will likely continue to trend down, as most US MD grads with a pulse, any interest in the field, and no failures on Steps will be able to get into middle or high tier residency programs.

The field will likely accept more US MDs with worse stats than historical, as well as more DOs and FMGs. It is to be determined whether the DOs, US-IMGs, and FMGs will require the same 'killing' of the steps (like 250-260+) that was historically required to even secure an interview (before oftentimes failing to match).

I actually think the number of SOAP spots will be lower this year as PDs and departments lower the threshold for interview and ranking prospective applicants. You have to imagine that groups that historically wouldn't have even bothered with Rad Onc (US MD with very poor stats or step failures, DOs, US-IMGs, and FMGs) were paying attention to the increased SOAP numbers, have noted a decrease in competitiveness of the field, and some increased percentage will be applying this year.

On an individual level, this is not necessarily a bad thing - I've certainly met good DOs and FMGs in Rad Onc. But for a field that at its senior leadership (who went into Rad Onc when it was one of the least competitive fields, which to me is the largest irony in all this) cares about 'prestige' and 'competitiveness' of residency, this is not ideal.

 

[xrthopeful]

I don't disagree that it's not ideal. However, I do think that as long as people are entering the field (and there always will be), I don't know if there's going to be any impetus for change.

If senior leadership sees this as a stab at their prestige, then good, maybe I'm wrong and it will lead to them changing the rules for residency slots.

 

[RickyScott]

Beyond that, and I know I'll catch flak for this, it's somewhat difficult to be a "bad" rad onc these days if you're a recent grad IMHO. Most of the things we do are increasingly guideline based, palliative or curative. Especially when the insurance company gets its say there's a guideline and no space for "creativity" either in a good or bad way. At the least there's scant wiggle room to show one's brilliant teletherapeutic/brachytherapeutic flair relative to guy across street (ignoring technology differences between docs/clinics). So FMGs could do modern American rad onc fine. Obv

I completely agree with this, plus the fact that if I can do it, almost everyone entering the field in lay 10 years was more qualified. This is what has me questioning value of affiliations apart from marketing. I also feel that you should be fine no matter what training program you come from, but we do need an excuse to shutdown whatever we can. Lastly, I don’t think there will be much of a drop off if any in quality of candidates- they will just be more fmgs, and we will still face terrible supply and demand. What does surprise me is that someone like zeitman would be make such a spurious argument about free market regulation here.

 

[deleted774703]

I mean FMGs are matching into top Cards, GI, Onc, Pulm/CritCare fellowships on a very regular basis and are thriving. I don't know what would make anyone think that the field would be less 'capable' if more FMGs matched Rad Onc lol. Other than the optics of it and your ego.

like maybe some of you just aren't in spheres where you come across it, but there is a huge difference between an America-born FMG from the Carribean versus one from India, Pakistan, the Middle East, East Asia, Canada etc who absolutely destroyed the steps.

and reality is if some Carribean grad ever matches Rad Onc (or Rads, good IM program etc etc etc) they probably also destroyed the Steps.

Totally agree with you. I spent my prelim year at a hospital where the categoricals were 70% true IMG and 30% American Caribbean grads and the true IMGs were 10000% better than the American caribbs. The only disadvantage they initially had was the culture change and EMR use.

The american caribs had an easier time talking to pts, but they didn't know their medicine.

Nonetheless, the measure of competitiveness of a field is by its % matched american schooled grads, whether some ppl like it or not. And Rad Onc was definitely one of the top fields maybe 6-7 yrs ago, but now is on a slow, progressive decline.

 

[medgator]

Totally agree with you. I spent my prelim year at a hospital where the categoricals were 70% true IMG and 30% American Caribbean grads and the true IMGs were 10000% better than the American caribbs. The only disadvantage they initially had was the culture change and EMR use.

The american caribs had an easier time talking to pts, but they didn't know their medicine.

Nonetheless, the measure of competitiveness of a field is by its % matched american schooled grads, whether some ppl like it or not. And Rad Onc was definitely one of the top fields maybe 6-7 yrs ago, but now is on a slow, progressive decline.

Good summary. All of it.

Whether the thought leaders will care to admit it or not, RO is going full circle back to where it came from at this rate, in terms of competitiveness and who matches into it

 

[xrthopeful]

Totally agree with you. I spent my prelim year at a hospital where the categoricals were 70% true IMG and 30% American Caribbean grads and the true IMGs were 10000% better than the American caribbs. The only disadvantage they initially had was the culture change and EMR use.

The american caribs had an easier time talking to pts, but they didn't know their medicine.

Nonetheless, the measure of competitiveness of a field is by its % matched american schooled grads, whether some ppl like it or not. And Rad Onc was definitely one of the top fields maybe 6-7 yrs ago, but now is on a slow, progressive decline.

Oh I agree.

 

[deleted941485]

For a lot of these IMGs it ain’t their first time at the rodeo. Many of them could be repeating residency to get into the states. We had one in my class...residency in Pakistan. There wasn’t anything she didn’t already know. Ran circles around the new AMGs basically treated like a peer among attendings.

 

[deleted941485]

IMGs that have been attendings in other countries are a good way to keep crappy residency programs going. You basically stock them with people that basically already know this stuff and require little to no direction or education.

They pass their boards and no one complains because they don’t want to get deported. It a win for everyone!

 

[scarbrtj]

For a lot of these IMGs it ain’t their first time at the rodeo. Many of them could be repeating residency to get into the states. We had one in my class...residency in Pakistan. There wasn’t anything she didn’t already know. Ran circles around the new AMGs basically treated like a peer among attendings.

In a way, how racist of the American system is it to require 4 years of residency if you’re already competent.

 

[RickyScott]

IMGs that have been attendings in other countries are a good way to keep crappy residency programs going. You basically stock them with people that basically already know this stuff and require little to no direction or education

They pass their boards and no one complains because they don’t want to get deported. It a win for everyone!

The way to maximize exploitation is to have fmgs, already trained in another country, do a fellowship for several years -where they basically run a service -with the promise that they get a residency. This was a common approach when I was in training. I ended up getting 90% of my training from one of these fellows. This is a common luxury for programs in less competitive fields in that they can now exploit fmgs.

 

[deleted18755]

The way to maximize exploitation is to have fmgs, already trained in another country, do a fellowship for several years -where they basically run a service -with the promise that they get a residency. This was a common approach when I was in training. I ended up getting 90% of my training from one of these fellows. This is a common luxury for programs in less competitive fields in that they can now exploit fmgs.

I heard second hand accounts of this situation but assumed it was an exaggeration.

How can one be a “fellow” without having completed a residency (or least one that “counts”). Is it because the fellowship is not accredited?

After a year or two the “fellow” becomes a resident!?!

Can you imagine being a 25-30ish year old US graduate who completed intern year and shows up for residency to find out the other PGY-2 coresident is not just somebody who completed residency abroad but literally a gray haired Indian former professor who also has spent the last few years as a “fellow” in the department learning all the ins and outs of the department/hospital?

 

[deleted573262]

In a way, how racist of the American system is it to require 4 years of residency if you’re already competent.

Not really. Medical school is largely subsidized in foreign countries. FMGs are willing to go through residency a second time because the pay-off is much larger for docs in the US. This will drive salaries down because 200k without debt (FMG) looks better than 200k with 200k of debt (avg american grad debt load). There is a huge incentive for FMGs to go through another residency. You may not be familiar with any foreign grads but many of the attendings are treated like gods/billionaires when they visit family in their home country. I'm not advocating for this system but it's not racist and there are incentives for foreign grads to move to the usa to re-train.

 

[deleted956486]

I heard second hand accounts of this situation but assumed it was an exaggeration.

How can one be a “fellow” without having completed a residency (or least one that “counts”). Is it because the fellowship is not accredited?

After a year or two the “fellow” becomes a resident!?!

Can you imagine being a 25-30ish year old US graduate who completed intern year and shows up for residency to find out the other PGY-2 coresident is not just somebody who completed residency abroad but literally a gray haired Indian former professor who also has spent the last few years as a “fellow” in the department learning all the ins and outs of the department/hospital?

Don't let a resident oversupply go to waste!

'advanced OR radiotherapy OR fellowship OR STATECODE:"FL"' Jobs | ASTRO Radiation Oncology Career Center

1,915 'advanced OR radiotherapy OR fellowship OR STATECODE:

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[qwerty89]

I heard second hand accounts of this situation but assumed it was an exaggeration.

How can one be a “fellow” without having completed a residency (or least one that “counts”). Is it because the fellowship is not accredited?

After a year or two the “fellow” becomes a resident!?!

Can you imagine being a 25-30ish year old US graduate who completed intern year and shows up for residency to find out the other PGY-2 coresident is not just somebody who completed residency abroad but literally a gray haired Indian former professor who also has spent the last few years as a “fellow” in the department learning all the ins and outs of the department/hospital?

In radiology there is an alternative pathway by which FMGs who are radiology trained in their home countries can come to the US and do 4 consecutive fellowships at the same institution to get board eligible. These grads tend to stay in academia I've noticed.

Alternatively I know of one radiology attending who did only 1 year of fellowship and then was required to stay on as faculty for a number of years to become board eligible.

This pathway provides a nice employment pool for many academic departments.