FWIW Residency Expansion and Job Market Panel at ARRO Seminar

[scarbrtj]

Need to sketch cartoon with "SDN" written on a windmill and man on horse with lance in hand, "Rad onc twitter crowd" written on his morion, in full gallop looking angrily at the windmill. I think most people, even med students, realize the man on the horse is literally and figuratively missing the point.

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[seper]

RadOnc twitter accounts are so fruity. Perhaps it's the same for any other industry on Twitter, but still is amazing

 

[GapCalc]

Also: in case any med students here were wondering, there was an entire panel at ASTRO with four prominent members of our field who all agreed that there are significant labor market concerns about which nothing substantive will be done for some time and is likely to worsen. If I’d seen that as a medical student I’d have run for the hills.

If UCLA chairman Mike Steinberg is to be believed, this job market issue will sort itself out in "a decade or two." That's a literal quote.

So, if you want to look for the silver lining... a current MS3 interested in rad onc will be done in 6 years, which means only 4-14 more years after that until s/he can look forward to a good job market! Thanks for the honesty, Mike!

 

[deleted774703]

RadOnc twitter accounts are so fruity. Perhaps it's the same for any other industry on Twitter, but still is amazing

Agreed. Some of the residents just seem thirsty for likes from senior attendings.

Please notice meeeeeeee......

 

[deleted956486]

Agreed. Some of the residents just seem thirsty for likes from senior attendings.

Please notice meeeeeeee......

"Thirsty" is the theme of the radonc twitter world. No joke, I heard some of the attendings text each other for retweets and likes.

 

[medgator]

The amount of thinkspeak/alternative facts re: job market and trends on #RadOnc twitter is just mindboggling.

 

[thecarbonionangle]

Original whine

Disgustingly sycophantic. Yuck! Bear had his way for sure!

 

[deleted1002574]

Radonc Twitter needs people from SDN to speak up. When I flip through, it’s the same sycophants. It seems like at least 10-20 disagree. So, disagree with them on Twitter. Can’t have these same people just liking each other’s and retweeting each other’s posts. Get up and tweet!

 

[evilbooyaa]

Radonc Twitter needs people from SDN to speak up. When I flip through, it’s the same sycophants. It seems like at least 10-20 disagree. So, disagree with them on Twitter. Can’t have these same people just liking each other’s and retweeting each other’s posts. Get up and tweet!

Hah. I've read through these twitter threads before. The ones that disagree aren't the ones getting likes and re-tweets.

 

[OTN]

You can tell that they're frustrated by the "power" of SDN, as they'd prefer the information assymetry to stay the way it is, thank you very much. Resorting to ad hominem attacks and calling those you disagree with "trolls" while refusing to address their complaints/points shows the weakness of their position.

 

[deleted956486]

You can tell that they're frustrated by the "power" of SDN, as they'd prefer the information assymetry to stay the way it is, thank you very much. Resorting to ad hominem attacks and calling those you disagree with "trolls" while refusing to address their complaints/points shows the weakness of their position.

Hits the nail on the head.

 

[Chartreuse Wombat]

Hits the nail on the head.

My rhetoric professor taught me if you can't win the argument on its merits you have two options: 1) ad hominem 2) change the argument.

 

[OTN]

Radonc Twitter needs people from SDN to speak up. When I flip through, it’s the same sycophants. It seems like at least 10-20 disagree. So, disagree with them on Twitter. Can’t have these same people just liking each other’s and retweeting each other’s posts. Get up and tweet!

Why would I do that? We're in a field where:

1. The job market is incredibly tight and poised to substantially worsen with continued increases in residency numbers, increasing hypofractionation, and APMs becoming the norm
2. "Job lock" is and always will be a concern
3. Academic programs are growing at a rate much faster than others
4. Academic personalities in our field have shown themselves to be vindictive, dishonest, dismissive, and arrogant (recent Twitter posts calling concerned doctors "trolls", glorifying themselves through ridiculous Teddy Roosevelt quotes, the MDA oral board gyn reviewer who failed all of the Joint Center's residents ~13 years ago for using HDR because she personally disagreed with it, the recent boards fiasco and lack of admission of any fault, "I hope he fails", how Dr. Shah was treated when he brought up the issue years (!) ago, "bait and switch" satellite job listings becoming acceptable), and as a result I have very little faith that anything I bothered to say would have any real impact.

Although I'm in private practice, I still do have a few cooperative projects with academics I'm working on. There's a non-zero chance that engaging with the radonc twitter world could harm either potential future job prospects (if needed, hopefully not) or current research projects. There's a very, very small chance, based on what I've seen from the twitter crowd so far, that they would bother to engage in an actual discussion, but would very quickly resort to name-calling/burning of the heretic at the stake, etc. Why should I bother? I only see potential downsides and no possible benefit.

 

[deleted956486]

Why would I do that? We're in a field where:

1. The job market is incredibly tight and poised to substantially worsen with continued increases in residency numbers, increasing hypofractionation, and APMs becoming the norm
2. "Job lock" is and always will be a concern
3. Academic programs are growing at a rate much faster than others
4. Academic personalities in our field have shown themselves to be vindictive, dishonest, dismissive, and arrogant (recent Twitter posts calling concerned doctors "trolls", glorifying themselves through ridiculous Teddy Roosevelt quotes, the MDA oral board gyn reviewer who failed all of the Joint Center's residents ~13 years ago for using HDR because she personally disagreed with it, the recent boards fiasco and lack of admission of any fault, "I hope he fails", how Dr. Shah was treated when he brought up the issue years (!) ago, "bait and switch" satellite job listings becoming acceptable), and as a result I have very little faith that anything I bothered to say would have any real impact.

Although I'm in private practice, I still do have a few cooperative projects with academics I'm working on. There's a non-zero chance that engaging with the radonc twitter world could harm either potential future job prospects (if needed, hopefully not) or current research projects. There's a very, very small chance, based on what I've seen from the twitter crowd so far, that they would bother to engage in an actual discussion, but would very quickly resort to name-calling/burning of the heretic at the stake, etc. Why should I bother? I only see potential downsides and no possible benefit.

Agree with all of this. Only reason they're calling people to engage in discussion is so they can ID trouble makers and screw them over. This is rad onc.

 

[evilbooyaa]

Where are they calling for people to discuss with SDN out in the open?

 

[RadOncMegatron]

Where are they calling for people to discuss with SDN out in the open?

 

[Chartreuse Wombat]

Basically he is saying that med students are stupid. These are digital natives. They should know to take anonymous postings with a grain of salt. The smart ones will ignore the bombast and focus on the data. It is inarguable that supply is increasing and demand is decreasing.

Oh forgot to mention explicitly that "doctors" is an ad hominem attack. Shameful.

 

[evilbooyaa]

He’s PD at Mayo - he’s probably seen his applicant numbers drop 25-30% this year and faces a very real possibility that he may not fill his program... of course he’s bitter about SDN.

Med students should question the motives of anyone who is directly harmed by the information symmetry that SDN provides.

This. Self-serving interests. This is somebody who has been at one ivory tower institution for the entirety of his radiation oncology career from residency through attendinghood who downplays the issues of the job market on a national level.

Color. Me. Shocked.

Dr. Olivier, I'm confident you (still) read SDN. You are more than welcome to engage in discussion on SDN. Given the quite significant fear of retaliation obviously present in this field on this topic (see Dr. Chirag Shah) you certainly understand the reticence to non-anonymously criticize you and your ilk.

Funny IMO that the folks on here (who are clearly residents and attendings with varying levels of experience) are "doctors", not doctors. I've agreed with him on certain points but this comes off as completely tone-deaf.

 

[Mandelin Rain]

I'm a happy attending doctor, rather than an unhappy attending "doctor".

Still, I have some concerns...

 

[medgator]

He’s PD at Mayo - he’s probably seen his applicant numbers drop 25-30% this year and faces a very real possibility that he may not fill his program... of course he’s bitter about SDN.

Med students should question the motives of anyone who is directly harmed by the information symmetry that SDN provides.

Well he can thank the McMayo programs that opened in FL and AZ for contributing to the problem

 

[medgator]

I'm a happy attending doctor, rather than an unhappy attending "doctor".

Still, I have some concerns...

Ditto. We are such misanthropes

 

[medgator]

This. Self-serving interests. This is somebody who has been at one ivory tower institution for the entirety of his radiation oncology career from residency through attendinghood who downplays the issues of the job market on a national level.

Color. Me. Shocked.

Dr. Olivier, I'm confident you (still) read SDN. You are more than welcome to engage in discussion on SDN. Given the quite significant fear of retaliation obviously present in this field on this topic (see Dr. Chirag Shah) you certainly understand the reticence to non-anonymously criticize you and your ilk.

Funny IMO that the folks on here (who are clearly residents and attendings with varying levels of experience) are "doctors", not doctors. I've agreed with him on certain points but this comes off as completely tone-deaf.

Not sure he will be able to actually win the argument regarding the health of the specialty and I imagine SDN TOS don't allow for ad hominems the way they are being belted out on Twitter apparently.

So no, I don't think Dr Oliver will be interested in coming here and debating if he can't make it personal about who you are

 

[deleted941485]

KO is a tool. He’s so blind to these issues he actually thinks that his vision is perfect And correct.

You’re never going to get a realistic appraisal of any medical specialty from the biggest people in the specialty and most importantly not on Twitter. It just doesn’t make sense logically. Why bash you’re own specialty in public? You can’t! You have to pretend that everything is on the up and up.

Like these Start up founders who burn through VC cash never turn a profit and continue to jerk off investors. I think it’s an apt analogy with chairs and med students. There’s a huge information asymmetry that cannot be bridged on a public non anonymous forum.

 

[RadOncMegatron]

I can't believe the Twitterati are taking it this route. They are basically throwing down the gauntlet and saying there is a huge battle between Twitter & SDN (*inserting my hyperbole here*) for the soul of rad onc!

One thing comes to mind here:

 

[medgator]

I can't believe the Twitterati are taking it this route. They are basically throwing down the gauntlet and saying there is a huge battle between Twitter & SDN (*inserting my hyperbole here*) for the soul of rad onc!

One thing comes to mind here:

View attachment 281450

About time those gaslighters get called out.... Next year's match will be interesting for sure

 

[Gfunk6]

Like these Start up founders who burn through VC cash never turn a profit and continue to jerk off investors.

*cough* Viewray *cough*

 

[Neuronix]

*cough* Viewray *cough*

The only profitable radiation linac manufacturing company is Varian. Rad onc is such a small niche market with such high development costs that it's very hard to turn a profit.

 

[medgator]

The only profitable radiation linac manufacturing company is Varian. Rad onc is such a small niche market with such high development costs that it's very hard to turn a profit.

It's down to a duopoly and elekta still can't make money?

 

[KHE88]

The modus operandi of the Twitter woke-scold clowns is to publicly shame you into agreeing with them and publicly apologizing for any past comments that don't agree with their party line by threatening to drag your name through the mud publicly online and ruin your career. They use twitter as a bully pulpit to force you to agree with their absurd positions and gaslight others without outright lies. It is perhaps the most intellectually dishonest and rotten form of discourse there is.

These same few names on Twitter have repeatedly demonstrated themselves to be self-serving toolbags who post "woke" nonsense to try and further their career.

Maybe they can go back to cheering "diversity" (see what I did there with the quotes?) and spouting such nonsense such as the supposed mass conspiracy among the old white men in radiation oncology to systematically attempt to keep women out of the field despite exactly zero evidence to support this (actually evidence to the contrary supporting systematic efforts to preferentially admit women).

But now they've got something else to gaslight us with with this job market and residency expansion dumpster fire.

The reason certain individuals have a problem with anonymous posts on SDN is that it precludes their normal M.O. from working. Can't drag someone's name through the mud and shame them into agreeing with your lies if there are no names.

If I were a med student reading this, there is NO WAY I would even consider applying to a program led by someone who uses Twitter in such a manner. Especially given the fact you can basically go to any program you want now.

Want a surefire test to determine if someone in rad onc is a complete self-serving smug tool? See if they have a twitter account and simultanouesly post rad onc and woke "look-at-me" virtue signalling stuff to it. Hasn't failed me yet.

 

[Reaganite]

I'm a very happy attending with everything to gain from an influx of cheap new grad labor...and I still strongly urge potential residents to carefully consider the advice of this board. Since we instituted strict hypofx protocols in my practices (thankfully local payors agreed to reward us for value-based care), our volume has dropped 30-40% (30+ pts to low 20s). This ended our need to hire new associates. There are rad oncs in my area making <200k. KO is a tool.

 

[OTN]

How are there radoncs making <$200k? Very small private practice? Not-very-busy hospital practice? Just seems very low.

 

[medgator]

How are there radoncs making <$200k? Very small private practice? Not-very-busy hospital practice? Just seems very low.

SoCal had pp starting associates around 200-225k when I got out a decade ago. Can't even imagine where that's at now thanks to current trends

 

[deleted941485]

SoCal had pp starting associates around 200-225k when I got out a decade ago. Can't even imagine where that's at now thanks to current trends

It’s probably around 225K now. Meaning you probably are down 15% now in real terms. I’m sure the partnership track isn’t even worth the pathetic remuneration. I can’t believe this practices even still exist considered all the consolidation going on.

 

[scarbrtj]

Basically he is saying that med students are stupid. These are digital natives. They should know to take anonymous postings with a grain of salt. The smart ones will ignore the bombast and focus on the data. It is inarguable that supply is increasing and demand is decreasing.

Oh forgot to mention explicitly that "doctors" is an ad hominem attack. Shameful.

What other specialties call radiation oncologists: "doctors." (Except IRL, e.g. in tumor boards, it's the air quotes instead of the "quote quotes.") I always conceptualized this as a microaggression. I'm not being sarcastic or funny... wish that I were. I mention Ed's editorial a lot, but it hits home so hard (and uncomfortably) I like to bring it up a lot. Putting ironic/sarcastic quotation marks around "doctor" in regards to a radiation oncologist is not in the same league as calling a radiation oncologist a bottom-feeding clinical catfish. But both are microaggressions. Now, sadly, these microaggressions have been internalized by Dr. Olivier. He reaches out to "engage," and that's probably the only treatment for internalized microaggressions: the talking cure, aka therapy. If he's not immune to our field's microaggressions, there's no hope for us "doctors" out here in the wild. He has proven a point but it's the opposite one he's trying to make. Were he to look deeply/honestly this one little punctuational, cutesy flourish reveals much that's wrong, nothing that's right.

 

[deleted941485]

I'm a very happy attending with everything to gain from an influx of cheap new grad labor...and I still strongly urge potential residents to carefully consider the advice of this board. Since we instituted strict hypofx protocols in my practices (thankfully local payors agreed to reward us for value-based care), our volume has dropped 30-40% (30+ pts to low 20s). This ended our need to hire new associates. There are rad oncs in my area making <200k. KO is a tool.

There is no reason to hire new people unless older docs are leaving. Otherwise you literally just pick up as many patients as you can. Bundling is literally the only thing that will stop the bleeding. Christ if I have to hear about the new ultrahypofx regimen in phase ii I’m just going to start looking for a new job. Even as an attending in practice I fear for being made redundant by this stuff. I mean the shear number of 5fx Sbrt you need to compensate for all the lost fractions plus all the push back I get for having the audacity to offer srs for a brain met before the Med Onc has the chance to try the 15th tki on them.

 

[medgator]

Other than trying to fix the OBVIOUS OVERSUPPLY PROBLEM, what would any of us possibly have to gain from coming on here and complaining?

Dr O didn't think things through well enough to understand that those of us partnered into existing private practices will benefit as much from excess slack in the RO labor market as much as those in academics who created this problem to begin with. The only difference is we have a conscience?

 

[KHE88]

I think the major difference is most people in pp have a business mind and understand economics 101.

I honestly think some academics live in a fairy world where it’s not absurd to suggest you can half labor demand, double labor supply and everyone magically gees a job.

It's also not surprising that most of these "woke" idiots in academics didn't earn their first dime in life until residency, don't understand how to value their labor, are fine with being underpaid and economically exploited, and are convinced that the private practiontioners who earn triple what they do must being doing something illegal or unethical. It's not surprising that they overwhelmingly support socialist redistributionist political ideologies.

It's simply astonishing how someone can be so brilliant in oncology but so mind-bogglingly cereberally stunted in basic economics. Of course, their overlords who make serious $$$ count on it. Hence, the gaslighting.

 

[medgator]

It's also not surprising that most of these "woke" idiots in academics didn't earn their first dime in life until residency, don't understand how to value their labor, are fine with being underpaid and economically exploited, and are convinced that the private practiontioners who earn triple what they do must being doing something illegal or unethical. It's not surprising that they overwhelmingly support socialist redistributionist political ideologies.

It's simply astonishing how someone can be so brilliant in oncology but so mind-bogglingly cereberally stunted in basic economics. Of course, their overlords who make serious $$$ count on it. Hence, the gaslighting.

Your points are unfortunately hobbled by your desire to drag politics into everything. Sigh.

I'm sure some of them probably support the deficit-bloating crony corporatism of the current administration as well, lead by a guy who would have been better off taking Daddy's money and sticking it into an s&p fund rather than declaring bk 6 times.

Financial and economic illiteracy isn't just confined to socialists....

 

[radiation]

The only profitable radiation linac manufacturing company is Varian. Rad onc is such a small niche market with such high development costs that it's very hard to turn a profit.

Five Year Summary | Investor Financials | Elekta

View our five year summary income statement for investors here, with downloadable statistics. For more information, please contact us

www.elekta.com

Looks profitable to me

 

[Neuronix]

Five Year Summary | Investor Financials | Elekta

View our five year summary income statement for investors here, with downloadable statistics. For more information, please contact us

www.elekta.com

Looks profitable to me

Hmmmm ok nevermind thanks for showing me that.

 

[deleted1002574]

Five Year Summary | Investor Financials | Elekta

View our five year summary income statement for investors here, with downloadable statistics. For more information, please contact us

www.elekta.com

Looks profitable to me

Financial illiteracy and talking out of ones’ tukkus is par for the course of SDN. People just say things and hope no one googles it. “There are no profitable blah blah blah”. “The socialists have ruined medicine.”

It’s so great because in a lot of the conflicts people say one thing, and then say the exact opposite thing when they get cornered.

I wonder if one person has ever been swayed. “Oh, you’re right, this field is screwed. I’ve been wrong the whole time.” Or “Oh, darn it, you’ve convinced me, there really isn’t a conspiracy to ruin this field.” People’s views are fixed. The rest is just wasted clicks and pontification. Im guessing Scarbtj gets paid by the character by someone.

Learn to accept the cesspool of SDN and Radonc Twitter and move on with your life. You’re never going to convince anyone you’re right. Plus, you get the added benefit of non business people just randomly guessing without any background knowledge what companies and how many are profitable, and stating it as fact.

 

[Neuronix]

Financial illiteracy and talking out of ones’ tukkus is par for the course of SDN.

I posted something I thought was true and admitted when I was wrong. Go ahead and rub it in.

That's the best part of posting on an internet forum IMO. If you're wrong, someone will point it out very quickly. It's not the first time I learned something on SDN.

 

[medgator]

Financial illiteracy and talking out of ones’ tukkus is par for the course of SDN. People just say things and hope no one googles it. “There are no profitable blah blah blah”. “The socialists have ruined medicine.”

It’s so great because in a lot of the conflicts people say one thing, and then say the exact opposite thing when they get cornered.

I wonder if one person has ever been swayed. “Oh, you’re right, this field is screwed. I’ve been wrong the whole time.” Or “Oh, darn it, you’ve convinced me, there really isn’t a conspiracy to ruin this field.” People’s views are fixed. The rest is just wasted clicks and pontification. Im guessing Scarbtj gets paid by the character by someone.

Learn to accept the cesspool of SDN and Radonc Twitter and move on with your life. You’re never going to convince anyone you’re right. Plus, you get the added benefit of non business people just randomly guessing without any background knowledge what companies and how many are profitable, and stating it as fact.

I posted something I thought was true and admitted when I was wrong. Go ahead and rub it in.

That's the best part of posting on an internet forum IMO. If you're wrong, someone will point it out very quickly. It's not the first time I learned something on SDN.

Statistically speaking, has anyone been profitable outside of those two? I mean Seimens, phillips etc. all pulled out of this market for a reason. And I still remember when Tomo (ttpy ticker symbol) stock was in the $20s before it collapsed to $2 or so and was bought out by Accuray at a slight premium. And let's not even get into the penny stock that is Accuray. The only reason Elekta has been able to have a prayer now is thanks to all the financial carnage that came before it and allowed it to consolidate the remaining market (buying nucleotron etc.)

And thank God for that, ARIA just seems to be getting ridiculously slower and buggier with each successive upgrade. Monopolies are bad in general, and radiation equipment/software is no exception

 

[deleted1002574]

Profit = Revenues - costs

Profitability is just one aspect of a business’ success. When in growth mode, there may be little profits seems. When in decline, even if a company is “profitable”, that doesn’t mean it’s doing well. Very good companies may take on a lot of debt for the right reasons. Poorly managed companies may hoard cash, to the detriment of the firm.

Radiation Oncology as a business is very, very, good. It is not looking good at all for doctors, as we can see. But, as a business - Varian, Elekta, Isoray, Mevlon, Reflexion, etc. are pretty exciting places to be in the valley, even if not profitable at the moment.

This is where the frustrated and disenfranchised rad oncs should look ... but when a practicing radonc hears the starting salary in industry, the frustrations of the clinic seem to dissipate.

 

[medgator]

Radiation Oncology as a business is very, very, good. It is not looking good at all for doctors, as we can see. But, as a business - Varian, Elekta, Isoray, Mevlon, Reflexion, etc. are pretty exciting places to be in the valley, even if not profitable at the moment.

How excited can one be in the face of bundling/APM and the negative press regarding protons, centers going into receivership, along with pushback from payors.

I think Varian pretty much owns this market and will continue to do so for the foreseeable future. Mri linacs will continue to be in the domain of academic centers as well given the cost and lack of versatility. It's bad enough if a proton manufacturer is losing money, but you don't want your customers going down the same route either.

 

[deleted1002574]

It’s the add ons - frames, immobilization, breath hold, contouring software, planning software, etc. Even though treatments are shorter, you still need the same amount of everything else. The amount of centers opening up worldwide - especially China and India, but think about Africa. As of 3 - 4 years ago, there was 1 linac for 80 million Ethiopians. That country is growing so quickly, that there will be a significant need. Also, there will be need for salesmen, service, people to show them how to use the machines, MSLs to convince them to buy the next best thing with the new bells and whistles.

These companies are in growth mode. Just because the field is capsizing and crashing domestically, don’t believe for a second the worldwide market isn’t incredible. Think about cinema. A movie made here will make $50 million here, and then go on to worldwide sales of $250 million abroad. It’s similar - we are using it less, but the countries in growth mode are thirsty for things we were into 20 years ago.

 

[xrthopeful]

I do agree - over the past 5 years it seems like every single PP center from small hospitals to bigger hospitals have invested money in new tech. If anything I've seen some of the academic places be slower to buy new machines.

It's been a gold rush for these guys and the MIM/Eclipse guys etc. Once they got you on that TrueBeam, then they get you for the ABC, the six degree couch, etc etc etc.

 

[MegaVoltagePhoton]

I really think prostate sbrt is an area where rad inc can significantly expand, but it’s a shame that so many have dumped on it for so long that a lot of potential referring providers can scare patients with the bogeyman of worse toxicity.

As was mentioned, savvy patients can make their own conclusions about five treatments over major surgery. I think as a field we downplay the life impact of nine or even five weeks of Daily treatment.

This is a potential huge demand growth for rt, as long as people don’t crap on it (something the field will come to regret).

 

[thecarbonionangle]

Financial illiteracy and talking out of ones’ tukkus is par for the course of SDN. People just say things and hope no one googles it. “There are no profitable blah blah blah”. “The socialists have ruined medicine.”

It’s so great because in a lot of the conflicts people say one thing, and then say the exact opposite thing when they get cornered.

I wonder if one person has ever been swayed. “Oh, you’re right, this field is screwed. I’ve been wrong the whole time.” Or “Oh, darn it, you’ve convinced me, there really isn’t a conspiracy to ruin this field.” People’s views are fixed. The rest is just wasted clicks and pontification. Im guessing Scarbtj gets paid by the character by someone.

Learn to accept the cesspool of SDN and Radonc Twitter and move on with your life. You’re never going to convince anyone you’re right. Plus, you get the added benefit of non business people just randomly guessing without any background knowledge what companies and how many are profitable, and stating it as fact.

Weren’t you supposed to leave and join back with your cabal? You’ve stated multiple times you leaving yet you still here? You must like the cesspool far more than you state! Embrace the mud and filth brotha

 

[deleted1002574]

Weren’t you supposed to leave and join back with your cabal? You’ve started multiple times you leaving yet you still here? You must like the cesspool far more than you state! Embrace the mud and filth brotha