FWIW Residency Expansion and Job Market Panel at ARRO Seminar

[bluebubbles]

FMG's can do 4 years of fellowship in radiation oncology to obtain licensure & board-eligible status. It is called the ABR Alternative Pathway for radiology and radiation oncology.

FMG's help with the physician shortage in other specialties. Of course, the home countries of the FMG's are getting screwed over because of brain drain. For radiation oncology, there's not a good rationale from a resource utilization perspective for FMG's, since the primary purpose of allowing this backdoor is not to improve the earning potential of those select FMG's, or to line the pockets of the institutions offering FMG fellowships, but to address a physician shortage. No such physician shortage exists in radiation oncology.

In fact, a fellowship filled by a US graduate doesn't worsen the job market because it just delays their full employment by 1 year. A fellowship filled by an FMG worsens the US job market, and is equivalent to expanding the number of residency slots nationally, while simultaneously pulling a radiation oncologist from a country with arguably greater need for that individual.

tl;dr: Programs opening fellowships for FMG's are bad. BAD in all caps.

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[deleted774703]

FMG's can do 4 years of fellowship in radiation oncology to obtain licensure & board-eligible status. It is called the ABR Alternative Pathway for radiology and radiation oncology.

FMG's help with the physician shortage in other specialties. Of course, the home countries of the FMG's are getting screwed over because of brain drain. For radiation oncology, there's not a good rationale from a resource utilization perspective for FMG's, since the primary purpose of allowing this backdoor is not to improve the earning potential of those select FMG's, or to line the pockets of the institutions offering FMG fellowships, but to address a physician shortage. No such physician shortage exists in radiation oncology.

In fact, a fellowship filled by a US graduate doesn't worsen the job market because it just delays their full employment by 1 year. A fellowship filled by an FMG worsens the US job market, and is equivalent to expanding the number of residency slots nationally, while simultaneously pulling a radiation oncologist from a country with arguably greater need for that individual.

tl;dr: Programs opening fellowships for FMG's are bad. BAD in all caps.

You’re right. Moreover, the FMG is getting a poor shake going for rad onc.

4 yrs of fellowship is akin to repeating residency. The radonc job market is not great for US grads, but even worse for FMG bc they still need a visa to work.

Employers don’t want to go through sponsoring someone that when there is no shortage of ppl to hire.

Thus, the FMG who comes thinking they will have a better life may just do extra labor and end up going back to their country anyways.

Unlikely that’s what their aim was coming in to these fellowships...

 

[medgator]

Sounds like Canada may be where some need to go...

https://www.redjournal.org/article/S0360-3016(19)30699-6/fulltext

The Canadian RO workforce demonstrated incremental growth, but rising annual caseloads suggest that radiation therapy demand outpaced RO supply gains.

 

[Neuronix]

Sounds like Canada may be where some need to go...

https://www.redjournal.org/article/S0360-3016(19)30699-6/fulltext

I applied for a job in Canada that I was particularly well qualified for and was told that no Americans would be considered. I was told that the government gives strong preference in hiring to Canadians and that it's very hard to overcome that. I suppose this could change if the supply-demand balance changes, but it's been very bad (worse than the US) for Canadian grads for years.

 

[Mandelin Rain]

Sounds like Canada may be where some need to go...

https://www.redjournal.org/article/S0360-3016(19)30699-6/fulltext

Caseload was up 10 cases per year (less than 1 per month), or about 4%. They are expecting an 8.4% growth in physician FTE this year. Unfortunately, they are once again saturated.

 

[Mandelin Rain]

I applied for a job in Canada that I was particularly well qualified for and was told that no Americans would be considered. I was told that the government gives strong preference in hiring to Canadians and that it's very hard to overcome that. I suppose this could change if the supply-demand balance changes, but it's been very bad (worse than the US) for Canadian grads for years.

True. Less than a decade ago, Canadian rad oncs literally could not find jobs. They were lining up to get board certified in the US. That is not a two way street however.

 

[taserlaser]

I applied for a job in Canada that I was particularly well qualified for and was told that no Americans would be considered. I was told that the government gives strong preference in hiring to Canadians and that it's very hard to overcome that. I suppose this could change if the supply-demand balance changes, but it's been very bad (worse than the US) for Canadian grads for years.

I doubt it changing in the short to medium term future. All hiring preferences are for citizens or permanent residents, although if someone had Canadian citizenship they could apply. The vast majority of jobs would be academic up North. From what I hear still, the market is still relatively tight despite those papers.

 

[bluebubbles]

Close programs that can’t meet higher case minimums, big or small. Downsize big programs. 600 definitive external cases, at least 5x increase in interstitial brachytherapy and SBRT minimums to 25 and 50, respectively, double the intracavitary and SRS minimums with cap on cylinders. Help current residents at those programs to meet case minimums by arranging rotations at more robust programs. Halt acceptance of new residents at those programs, however, and once current residents have graduated, shut them down. Halt program expansion across the board while we grapple with the existential crisis of having 50% of program spots go unfilled in 2019-2020 NRMP, pre-SOAP.

I have full confidence that RRC can update requirements of training programs to reflect current practice patterns and accepted standards of care, while increasing the quality of training programs & their graduates.

Wasn’t 50 percent. But agree

Edit: you’re guessing for 2020 match, never mind. My mistake

Just a wildly speculative, inflammatory guess from a semi-anonymous internet troll

 

[medgator]

Just a wildly speculative, inflammatory guess from a semi-anonymous internet troll

Well, Kenneth O was freaking out this am about the 25% yoy drop in applications to Mayo Rochester when ERAS opened today and the fact they didn't fill with their first round picks last year.

Maybe he shouldn't have been maligning all those know nothing "misanthropes" on SDN all this time.

 

[xrthopeful]

Mayo filled last year in the regular match.

when he said 'we' didn't fill, he meant Rad Onc programs as a whole.

 

[medgator]

Mayo filled last year in the regular match.

when he said 'we' didn't fill, he meant Rad Onc programs as a whole.

Yes but not in the first round match.

He was very clear about this in his tweet. When I applied over a decade ago, Mayo Rochester was the only Mayo residency around and and it routinely filled with top tier candidates. Didn't even get an interview there

 

[xrthopeful]

Yes but not in the first round match.

He was very clear about this in his tweet. When I applied over a decade ago, Mayo Rochester was the only Mayo residency around and and it routinely filled with top tier candidates. Didn't even get an interview there

Dude.

You misinterpreted the tweet, that's why I clarified. Mayo DID match in the first round last year. That's public information. Everyone here knew what the SOAP spots were last year.

 

[medgator]

Dude.

You misinterpreted the tweet, that's why I clarified. Mayo DID match in the first round last year. That's public information. Everyone here knew what the SOAP spots were last year.

The tweet is confusing considering he probably doesn't have access to eras numbers to every program. Why would he talk about applications to Mayo and then switch gears in the same sentence to discuss first round matches for all programs?

Either way, it's good news that folks like Oliver are finally getting with the program and seeing the issues that trouble the specialty

 

[Neuronix]

The buzz around Astro is that the job market is better this year with numerous academic and private places hiring, interviewing for dozens of positions at the conference. Can anyone going through this now confirm?

 

[xrthopeful]

The buzz around Astro is that the job market is better this year with numerous academic and private places hiring, interviewing for dozens of positions at the conference. Can anyone going through this now confirm?

That's what I hear from my former co-residents who are applying this year.

 

[deleted956486]

The buzz around Astro is that the job market is better this year with numerous academic and private places hiring, interviewing for dozens of positions at the conference. Can anyone going through this now confirm?

Many academic jobs. Mostly satellites. Little PP jobs

 

[OTN]

Satellite academic jobs are the worst jobs in radonc. You get paid 1/2 to 1/3rd what you would have been paid from a pp group, you have no real decision-making power when it comes to the department/treatment protocols, and you have no real chance at either income growth or career advancement.

 

[Krukenberg]

The buzz around Astro is that the job market is better this year with numerous academic and private places hiring, interviewing for dozens of positions at the conference. Can anyone going through this now confirm?

Can confirm from our seniors it’s one of the best job markets in years. Many academic spots in the most desirable cities (nyc, LA, Seattle, boston). Talked to a guy who is just interested in PP and he had a bunch of interviews too.

 

[medgator]

Can confirm from our seniors it’s one of the best job markets in years. Many academic spots in the most desirable cities (nyc, LA, Seattle, boston). Talked to a guy who is just interested in PP and he had a bunch of interviews too.

The decent locales from what I've heard and seen appear to be mainly in academics, a lot of which are satellite jobs.

The high income, autonomous pp jobs are still mainly in the boonies

 

[medgator]

Satellite academic jobs are the worst jobs in radonc. You get paid 1/2 to 1/3rd what you would have been paid from a pp group, you have no real decision-making power when it comes to the department/treatment protocols, and you have no real chance at either income growth or career advancement.

Yup, really the worst of both worlds. PP workload and hours for academic level pay with lower autonomy

 

[bluebubbles]

My guess is that a combination of factors is driving a higher # of interviews:
- Increased # of jobs
- Increased anxiety & awareness of job market realities, as evidenced by the astro presentations & discussions on this topic; whereas in the past graduating residents might've just applied to a couple cities close to their or their spouse's hometown, now they're applying much more broadly
- Increased hiring from academic practices due to concern that resident quality will go down a few years down the line; this is likely a minor factor but it's food for thought

 

[medgator]

- Increased hiring from academic practices due to concern that resident quality will go down a few years down the line; this is likely a minor factor but it's food for thought

Interesting reasoning, never thought about that, but it would make sense

 

[evilbooyaa]

The buzz around Astro is that the job market is better this year with numerous academic and private places hiring, interviewing for dozens of positions at the conference. Can anyone going through this now confirm?

I have been overall happy with the market for this specific year. A large number of academic places looking to hire, some of which have at least 1 or 2 'main campus' positions out of their total number (at least 5 or 6 programs that I at interviewed at), while a few (n=2-3) academic places are essentially hiring for 'satellites' or 'regional care centers' (b/c that sounds better).

Decent private practice outlook as well in mostly small cities/large towns.

 

[radOresident]

I just got back home from ASTRO. My thoughts about the PP job market since I did not even consider academics:

Any available PP job in a moderately sized city (>1mil population) was inundated with 50+ applications. A large percentage of people in my class had a majority of their interviews with small town clinics in undesirable areas. I'm unsure how that compares to years prior, but if the open positions are the same jobs no one has wanted to take for years, does that truly represent a better market?

I probably applied to 20-25 different positions and ended up with 5 interviews, one of which got canceled at the last second. I'm not seeing the uptick in the market that others seems to see. Admittedly, I limited my applications to large cities or towns within commuting distance of large cities.

 

[medgator]

I just got back home from ASTRO. My thoughts about the PP job market since I did not even consider academics:

Any available PP job in a moderately sized city (>1mil population) was inundated with 50+ applications. A large percentage of people in my class had a majority of their interviews with small town clinics in undesirable areas. I'm unsure how that compares to years prior, but if the open positions are the same jobs no one has wanted to take for years, does that truly represent a better market?

I probably applied to 20-25 different positions and ended up with 5 interviews, one of which got canceled at the last second. I'm not seeing the uptick in the market that others seems to see. Admittedly, I limited my applications to large cities or towns within commuting distance of large cities.

Not everyone wants to go into academics and it's a damn shame those who wish to do full spectrum pp are becoming more geographically constrained each year

 

[Sheldor]

I just got back home from ASTRO. My thoughts about the PP job market since I did not even consider academics:

Any available PP job in a moderately sized city (>1mil population) was inundated with 50+ applications. A large percentage of people in my class had a majority of their interviews with small town clinics in undesirable areas. I'm unsure how that compares to years prior, but if the open positions are the same jobs no one has wanted to take for years, does that truly represent a better market?

I probably applied to 20-25 different positions and ended up with 5 interviews, one of which got canceled at the last second. I'm not seeing the uptick in the market that others seems to see. Admittedly, I limited my applications to large cities or towns within commuting distance of large cities.

FWIW, 5 interviews is almost double what you'd hear from folks over the last few years who were getting 2-3. One can argue about if 5 interviews is a lot, but most of my friends when I was applying a few years ago got less than that both in and out of Rad Onc.

 

[evilbooyaa]

5 ASTRO interviews? I'd consider 5 on-site interviews to be a decent number, but I'd be anxious as well with 5 ASTRO interviews and nothing else under my belt.

 

[Sheldor]

5 ASTRO interviews? I'd consider 5 on-site interviews to be a decent number, but I'd be anxious as well with 5 ASTRO interviews and nothing else under my belt.

Oh, good point. 5 ASTRO interviews is not a huge amount, though that does seem consistent with some of my friends the year we were applying for ASTRO. As I recall Terry Wall's survey my PGY-5 year said that 0% of the respondents got jobs from ASTRO interviews, so not the be all end all to be sure.

 

[goodbyeABR]

I just got back home from ASTRO. My thoughts about the PP job market since I did not even consider academics:

Any available PP job in a moderately sized city (>1mil population) was inundated with 50+ applications. A large percentage of people in my class had a majority of their interviews with small town clinics in undesirable areas. I'm unsure how that compares to years prior, but if the open positions are the same jobs no one has wanted to take for years, does that truly represent a better market?

I probably applied to 20-25 different positions and ended up with 5 interviews, one of which got canceled at the last second. I'm not seeing the uptick in the market that others seems to see. Admittedly, I limited my applications to large cities or towns within commuting distance of large cities.

Also had some PP job interviews at ASTRO - while I got the sense they were "busy" based on the availability of their interview time slots, how do you know how many applications they had? Did you outright ask them?

 

[Gfunk6]

Glad to hear job market this year is good. Keep in mind that we are looking at long-term trends and analytics that leave us falling off a cliff in the future. Best to consider it like global warming - the trend is bad even if the day-to-day weather is good.

 

[RickyScott]

One of the issues is falling pay in the academic centers is somewhat of incentive to hire, leading to "dead cat bounce". Many are offering 250-320, and there is little advancement during career right now. You can get a radonc for not much more than primary care in many cases.

 

[deleted941485]

One of the issues is falling pay in the academic centers is somewhat of incentive to hire, leading to "dead cat bounce". Many are offering 250-320, and there is little advancement during career right now. You can get a radonc for not much more than primary care in many cases.

It’s probably why there were so many more openings this year. What I wanna know If was this expansion of demand in the areas hiring OR replacement of retiring ROs?

My first instinct was that hospitals and ins companies finally gave these boomers the raw deal they had anticipated and had enough retirement money to finally say adios. Hence the job openings.

I mean why is Cali such a big hit spot this year on the job boards. Beverly Hills?? Wtf?

 

[radOresident]

Also had some PP job interviews at ASTRO - while I got the sense they were "busy" based on the availability of their interview time slots, how do you know how many applications they had? Did you outright ask them?

I did not directly ask but a few that I interviewed with told me in person and a few mentioned the number of applications they received in the generic email reply

 

[deleted941485]

Is Terry wall still doing his thing? What did he show this year?

 

[DebtRising]

The residents at my former program applied to and had more ASTRO interviews than I did for jobs. The majority of them have no offers (yet) and also encountered mainly academic satellite jobs.

Increased interviews in this small group reflects anxiety rather abundance of options- they weren’t fielding multiple interviews in good locations, they were applying to more places because they felt they had to.

 

[Gfunk6]

It’s probably why there were so many more openings this year. What I wanna know If was this expansion of demand in the areas hiring OR replacement of retiring ROs?

My first instinct was that hospitals and ins companies finally gave these boomers the raw deal they had anticipated and had enough retirement money to finally say adios. Hence the job openings.

I mean why is Cali such a big hit spot this year on the job boards. Beverly Hills?? Wtf?

I suppose it's all pure speculation at this point, but I would suggest that the inevitable RO APM may have scared some older docs into retirement. Not a bad thing frankly.

 

[deleted941485]

I suppose it's all pure speculation at this point, but I would suggest that the inevitable RO APM may have scared some older docs into retirement. Not a bad thing frankly.

The retirement part yes the APM no

 

[TDDro]

@RadsWFA1900 , PM me

 

[deleted18755]

I suppose it's all pure speculation at this point, but I would suggest that the inevitable RO APM may have scared some older docs into retirement. Not a bad thing frankly.

Don't forget about the ridiculous literally 10+ year bull market. I know of many family and friends (oddly enough not many rad oncs at all) who have had solid 25 year careers and could easily go another 5-10 but after making bank for 25 years with double digit annual returns on investments for the past decade (not to mention the job getting harder and harder and more and more annoying every year) have decided that even though they are only 55-60ish this is a perfect time to retire and enjoy life or other pursuits.

I'm old enough to remember 2008 and even 1999 when many doctors who had one foot out the door planning to retire within 1-2 years stayed on another 5-7 at least. I have no idea when the next stock market crash or correction or whatever is going to happen but it will sooner then later and once older established physicians see their 401k drop by 15-30% or more they will definitely stay around for many more years.

 

[Mandelin Rain]

Don't forget about the ridiculous literally 10+ year bull market. I know of many family and friends (oddly enough not many rad oncs at all) who have had solid 25 year careers and could easily go another 5-10 but after making bank for 25 years with double digit annual returns on investments for the past decade (not to mention the job getting harder and harder and more and more annoying every year) have decided that even though they are only 55-60ish this is a perfect time to retire and enjoy life or other pursuits.

I'm old enough to remember 2008 and even 1999 when many doctors who had one foot out the door planning to retire within 1-2 years stayed on another 5-7 at least. I have no idea when the next stock market crash or correction or whatever is going to happen but it will sooner then later and once older established physicians see their 401k drop by 15-30% or more they will definitely stay around for many more years.

I have posted this exact thing on this forum multiple times.

If/When a repeat of 2008 happens, that's when you'll see graduating rad onc residents in bread lines. Rad oncs love our money, and our decade of ever decreasing reimbursement has been buoyed by a decade of WAY above average portfolio returns. The latter IS going to stop at some point. I firmly believe that is when the overexpansion house of cards will completely fall apart.

EDIT: This is likely not rad onc specific and would apply to many fields of medicine if they have also doubled residents while halving treatments. However, rad onc is somewhat unique in that it is literally one of the least physically taxing jobs in the world and there is essentially no peer oversight in single doc setups because it's practiced essentially in a black box from the rest of our colleagues. As such it can be practiced until the corpse is rolled out. (actually, I'm not sure if CMS specified if the supervising physician or non-physician provider must actually be alive. Exploitable gray area, IMO.)

 

[seper]

Another danger of an economic downturn is closure of satellite RadOnc clinics. In the part of Midwest I'm in now, hospital profits are up and they are investing in real estate and machines. That will not last.

I have posted this exact thing on this forum multiple times.

If/When a repeat of 2008 happens, that's when you'll see graduating rad onc residents in bread lines. Rad oncs love our money, and our decade of ever decreasing reimbursement has been buoyed by a decade of WAY above average portfolio returns. The latter IS going to stop at some point. I firmly believe that is when the overexpansion house of cards will completely fall apart.

 

[OTN]

Another danger of an economic downturn is closure of satellite RadOnc clinics. In the part of Midwest I'm in now, hospital profits are up and they are investing in real estate and machines. That will not last.

As long as the major academic medical centers are exempt from all of CMS's b.s. (and they are, crony capitalism at it's best), academic centers likely will continue to grow and expand even through an economic downturn. In fact, there's a good chance they would see it as an opportunity to buy out struggling practices.

 

[seper]

My impression is that academic medical centers derive a lot of revenue from elective procedures. As that dries up (temporarily), administration will seek to cut expenditures by consolidating money-losing satellite services.
At my place, I know firsthand that the board keeps an eye at RadOnc patient count at the satellites.

As long as the major academic medical centers are exempt from all of CMS's b.s. (and they are, crony capitalism at it's best), academic centers likely will continue to grow and expand even through an economic downturn. In fact, there's a good chance they would see it as an opportunity to buy out struggling practices.

 

[deleted18755]

I have posted this exact thing on this forum multiple times.

If/When a repeat of 2008 happens, that's when you'll see graduating rad onc residents in bread lines. Rad oncs love our money, and our decade of ever decreasing reimbursement has been buoyed by a decade of WAY above average portfolio returns. The latter IS going to stop at some point. I firmly believe that is when the overexpansion house of cards will completely fall apart.

EDIT: This is likely not rad onc specific and would apply to many fields of medicine if they have also doubled residents while halving treatments. However, rad onc is somewhat unique in that it is literally one of the least physically taxing jobs in the world and there is essentially no peer oversight in single doc setups because it's practiced essentially in a black box from the rest of our colleagues. As such it can be practiced until the corpse is rolled out. (actually, I'm not sure if CMS specified if the supervising physician or non-physician provider must actually be alive. Exploitable gray area, IMO.)

Excellent points. I can honestly say that my income has increased over the years as my salary has decreased because it's more than offset by these obviously unsustainable and ridiculous market gains. When the market does what markets do and eventually normalize or of course crash older doctors will reconsider retiring but of course it's easier to hang on to your job for another 3-5+ years when your a 68 year old radiation oncologist who works in the clinic seeing patients and in the office in front of computer with minimal call vs the 58 year old ED doctor or surgeon or whomever on your feet all day and getting woken up or called in while on call. Not so sure about the "black box" part but we all now physicians who are only in practice because they have a few very close referring physicians (sometimes of similar questionable clinical judgement/practice) who feed them patients exclusively.

 

[evilbooyaa]

Out on the street? Bread lines? C'mon guys. Let's limit the hyperbole to some extent. It's OK to say that the job market will continue to worsen if the market tanks, but no Rad Onc is going to be homeless or under the poverty line on Medicaid before or after completion of residency.

 

[Mandelin Rain]

NOTE: There are not actual bread lines in America in 2019. I thought this may be obvious.

However, being unemployed and several hundreds of thousand dollars in non-defaultable debt is not an enviable position.

 

[scarbrtj]

Don't know if they're "on the street" or not but there's a sh**-ton of folks, evidently, "pounding the pavement" for locums work these days. I can neither confirm nor deny whether said pavement is possibly street associated.
*googly eyes emoji*

 

[randomname2018]

Don't know if they're "on the street" or not but there's a sh**-ton of folks, evidently, "pounding the pavement" for locums work these days. I can neither confirm nor deny whether said pavement is possibly street associated.
*googly eyes emoji*

I wouldn't give much credence to locum availability as a predictor of the current job market, at least not today. The current crop of locums are mostly semi retired or retired mds rather than fresh young grads looking for a living.

 

[deleted956486]

I wouldn't give much credence to locum availability as a predictor of the current job market, at least not today. The current crop of locums are mostly semi retired or retired mds rather than fresh young grads looking for a living.

I know 4 on that list that are fresh young grads looking for a living. Also have a look at the fellows in a month or so (not hard to compile a list). You'll find they are mostly American Grads this year.

 

[nkmiami]

The salary for locums has fallen over the last 10 -20 years. It is now about 1200-1500/ day.