Guessing # unmatched spots

[fiji128]

Ya you would have to have the required case load to get approved for further residents, can't just go from 4 to 6 residents without showing you have the case load to support it. By my count there are about 15 programs with under six residents. Closing these would push the number of total yearly spots down to about 185. I think if "they" are going to go down that route a case could be made for shutting down programs with fewer then 8 residents. By shutting down I mean phasing out so as not to completely f over those residents in those programs.

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[evilbooyaa]

How can they without caseload to support it?

Numbers can be fudged in this regard with inclusion of satellites, elective rotations, "collaboration" with nearby private practices, etc. in regards to meeting case requirements.

 

[OTN]

Numbers can be fudged in this regard with inclusion of satellites, elective rotations, "collaboration" with nearby private practices, etc. in regards to meeting case requirements.

Would need to find funding for those residents, though, which might not be easy. It's going to be interesting to see whether this has the intended effect or precisely the opposite.

 

[medgator]

Numbers can be fudged in this regard with inclusion of satellites, elective rotations, "collaboration" with nearby private practices, etc. in regards to meeting case requirements.

I imagine the ACGME/rrc would be expecting that if they passed such an edict. I trained in a smaller program and I don't think they could pull that off

Let's see what happens, at least someone is taking their head out of the sand and trying to do something

 

[evilbooyaa]

Would need to find funding for those residents, though, which might not be easy. It's going to be interesting to see whether this has the intended effect or precisely the opposite.

Nearly every RO program that is create or expanding does so through institutional funds, not Medicare money. I agree that places with 4 attendings might not have a use for 6 residents, but any place with 6 attendings or more? Or hires even a single PA/NP? Cheaper to hire 2 additional residents than 2 additional PAs.

I imagine the ACGME/rrc would be expecting that if they passed such an edict. I trained in a smaller program and I don't think they could pull that off

Let's see what happens, at least someone is taking their head out of the sand and trying to do something

You might be right, but I want some element of confirmation to that statement before we start running based on a rumor anyways.

Based on the programs that failed to fill, the issue is mostly NOT with 1/year programs. Most programs that failed to fill positions this year have 2 or more spots per year.

 

[MegaVoltagePhoton]

you know i used to be more of an optimist but i'm sad to say i was wrong.

regarding twitter it is an embarrassment what these people are saying. if anyone is interested you CAN make an anonymous twitter account and i would encourage some of you here to do so. they bullied someone who took a swipe at wallner into deleted his posts and apologizing, while talking wallner up. unacceptable.

 

[KHE88]

you know i used to be more of an optimist but i'm sad to say i was wrong.

regarding twitter it is an embarrassment what these people are saying. if anyone is interested you CAN make an anonymous twitter account and i would encourage some of you here to do so. they bullied someone who took a swipe at wallner into deleted his posts and apologizing, while talking wallner up. unacceptable.

Twitter/social media culture in America is a virus. Grown adults behaving like cliquish teenagers on a platform with a childish name and a cartoon bird as a logo. They will often say whatever popular comment they think will adorn them with the most praise or public validation and lead to career and social advancement. Say something that goes against the theme from the popular crowd ("politically incorrect") regardless if true? You will be gaslit, publicly shamed (because shaming people is the way to demonstrate your moral superiority now), and have your career threatened.

They take swipes at SDN because they are frustrated they can't throw a specific individual under the bus of shame so they just shame the whole thing.

Real mature and honest system of discourse we've created here in the 21st century.

 

[xrthopeful]

Based on the programs that failed to fill, the issue is mostly NOT with 1/year programs. Most programs that failed to fill positions this year have 2 or more spots per year.

This has always been the unsaid thing - everyone wants something to be done about the residency expansion problem - but this reveals the real meat of it - if anything ever was to actually happen - LOTS of people would be upset no matter how it was done. There's no clean way to do it.

the reality is in order to make a real change, someone's feelings are going to have to get hurt.

I think closing down smaller programs is not a bad way to go about it tbh. Not all small programs, no of course not, but a lot of the programs that DO need to go are small. I don't care if they're old or new. they gotta go.

 

[medgator]

They take swipes at SDN because they are frustrated they can't throw a specific individual under the bus of shame so they just shame the whole thing.

Many in the academic sphere are unwilling to accept the truth being discussed here on a range of topics regarding issues with the specialty, whether it be the shameless and unnecessary expansion of protons, ASTROs silence on promoting site neutral payments to cut healthcare costs and level the playing field, or the recent issues with unwarranted expansion of residency slots.

This match was a wakeup call

 

[metview]

I would go as far as shutting down programs that are < 8 residents. I was just looking at Rad Onc programs, and even though there aren't many (compared to other specialities), there are some programs that I have never even heard of and are pretty much community programs. I would question the training at those places.

 

[RadOncG]

I would go as far as shutting down programs that are < 8 residents. I was just looking at Rad Onc programs, and even though there aren't many (compared to other specialities), there are some programs that I have never even heard of and are pretty much community programs. I would question the training at those places.

Academic snobbery at its finest.

 

[RadOncG]

For a forum that was rightfully so repulsed by Paul Wallner's opinion piece regarding residency size and its non-proven correlation with anything, it is surprising that many have you have really turned to promoting the ABR company line.

 

[PointA]

For a forum that was rightfully so repulsed by Paul Wallner's opinion piece regarding residency size and its non-proven correlation with anything, it is surprising that many have you have really turned to promoting the ABR company line.

If you don't like the idea to close small programs, that is OK and there are valid criticisms of that approach, but there is no solution that will make everyone happy. Rather than just critiquing, please provide an alternative solution.

 

[deleted950463]

For a forum that was rightfully so repulsed by Paul Wallner's opinion piece regarding residency size and its non-proven correlation with anything, it is surprising that many have you have really turned to promoting the ABR company line.

Could this just be a long game for Paul Wallner, DO to get more DO into radonc?

 

[thecarbonionangle]

Have always disliked tweeter for this reason. Seems like it attracts the worst of the worst narcissists, self promoters, divas in our field. Lots of abonoxious “clickish” behaviour is amplified, something already inherently wrong with our field, this small “club” of people who act and feel superior to everyone else. I find it disgusting and such a turn off. Even some of the residents on there are on their way to be just as obnoxious as their attending counterparts. To me its a great way to identify people i’d never want to work with..

 

[thecarbonionangle]

Someone is going to be hurt no matter what. I hope whatever happens, we make sure the current residents are not hurt and bigger programs step up and absorve them. The ABR leadership is disgusting, arrogant, out of touch, corrupt, criminal. Anything associated with their views is repulsing to me at this point.

 

[metview]

Academic snobbery at its finest.

Like others have mentioned, there is no perfect solution. Someone is gonna be upset regardless of what is done. Shutting down smaller residencies is far from ideal, but it is better than what is occuring now (residency expansion, new programs) in our field. Making a minimum resident requirement also discourages universities/hospitals from creating brand new rad onc programs.

 

[OTN]

My favorite part of the Twitter discussion is how SDN is right about too many residents, but that's all that we're right about. How, exactly, does that work? We have too many residents, but there's not going to be any consequence of that? The intellectual shallowness and lack of logical reasoning among the virtue-signaling crowd is astounding.

 

[medgator]

Like others have mentioned, there is no perfect solution. Someone is gonna be upset regardless of what is done. Shutting down smaller residencies is far from ideal, but it is better than what is occuring now (residency expansion, new programs) in our field. Making a minimum resident requirement also discourages universities/hospitals from creating brand new rad onc programs.

Should couple that with a moratorium of expansion at any remaining program for at least a few years while the issue is further studied.

That would make it fairer

 

[imhopeful432]

Should couple that with a moratorium of expansion at any remaining program for at least a few years while the issue is further studied.

That would make it fairer

ACGME/RRC can't just call for a blanket stop on expansion (what issue needs to be studied? the job market? Can't legally take that into account). But there are smaller programs out there that probably do not provide adequate training and, as other posters have stated, this would result in some programs that don't have the numbers to shut down + prevent new programs from opening up...so it would address some over-expansion concerns without this publicly being about over-expansion.

@OTN - I shared data on sdn on job market, salary, share of spending on radiation oncology in a previous post on this thread. It was largely ignored.

SDN has many virtues, but discounting anything said on twitter completely and instead believing everything on an anonymous internet forum seems ridiculous to me.

 

[medgator]

.

SDN has many virtues, but discounting anything said on twitter completely and instead believing everything on an anonymous internet forum seems ridiculous to me.

What was said on that that Twitter thread that should have not been discounted?

 

[deleted947887]

The same can be said about twitter. The only difference is the folks on twitter have something to gain in the slave labor of residents. Why is it that no academic on twitter wants to acknowledge the embarrassment that is the ABR? You do know the ABR is being sued as I type this? Yet radiation oncology academics are still ignoring all of this and are trying to lead medical students to a dead end. Dont believe me? Ask any of the residents who failed that exam. It's easy to be positive when your looking at the situation from miles away. Why is there so much dishonesty from these so called physicians? The job market is great? Who is the best source for this? People applying for jobs or an academic trying to lure Medical students? Or better yet, their puppet resident? Give me a break.

The fact that academics are still unwilling to discuss the real issues in this field speaks to the culture in radiation oncology: passive-aggressive, entitled, cowardly and self-centered. Except for the few academics with integrity (Zietman, Amdur, Lee) the field is filled with panderers afraid to discuss the real issues. Good luck to everyone.

ACGME/RRC can't just call for a blanket stop on expansion (what issue needs to be studied? the job market? Can't legally take that into account). But there are smaller programs out there that probably do not provide adequate training and, as other posters have stated, this would result in some programs that don't have the numbers to shut down + prevent new programs from opening up...so it would address some over-expansion concerns without this publicly being about over-expansion.

@OTN - I shared data on sdn on job market, salary, share of spending on radiation oncology in a previous post on this thread. It was largely ignored.

SDN has many virtues, but discounting anything said on twitter completely and instead believing everything on an anonymous internet forum seems ridiculous to me.

 

[SneakyBooger]

Believing the job market is only going to get worse over time with the increasing use of hypofractionation, how can one in good manner encourage another to pursue this specialty? I have not seen more pts choose to have XRT because I offer them hypofractionation and therefore do not "buy in" to that claim. The jobs aren't going to be there - and many centers serving rural patients are likely to close. How can they survive?

How will this profession survive?

How is rad onc going to get out from under this bus?

Where is rad onc leadership?

 

[imhopeful432]

The same can be said about twitter. The only difference is the folks on twitter have something to gain in the slave labor of residents. Why is it that no academic on twitter wants to acknowledge the embarrassment that is the ABR? You do know the ABR is being sued as I type this? Yet radiation oncology academics are still ignoring all of this and are trying to lead medical students to a dead end. Dont believe me? Ask any of the residents who failed that exam. It's easy to be positive when your looking at the situation from miles away. Why is there so much dishonesty from these so called physicians? The job market is great? Who is the best source for this? People applying for jobs or an academic trying to lure Medical students? Or better yet, their puppet resident? Give me a break.

The fact that academics are still unwilling to discuss the real issues in this field speaks to the culture in radiation oncology: passive-aggressive, entitled, cowardly and self-centered. Except for the few academics with integrity (Zietman, Amdur, Lee) the field is filled with panderers afraid to discuss the real issues. Good luck to everyone.

Re: what should not be discounted on twitter: I personally use it to connect with other folks in the field, have discussions about new published/interesting data, and connect with my elected officials to advocate for issues we all care about (i.e. prior auth, cuts to reimbursement, insurance coverage, etc). I believe those are good uses of Twitter Also, I still believe radiation oncology is a great field/would advise medical students to go into it personally. Yes, I want students to know some of the uncertainties regarding the job market/geographic restrictions (and I do tell them that) but don't I also want to attract the smartest students to the field who will continue to innovate, serve as leaders in policy areas/clinical trials/drug companies, and overall raise the profile of the field in the long run. Don't we all want that?

Also, no I don't think the job market is amazing. But again my senior residents got multiple offers from amazing places (I'm a mid-tier program) and many PGY-5s I talk to did as well. And as I've stated before MGMA/AAMC data and Millman/CMS data do support the fact that spending on rad onc is still up (our salaries are not crashing).

We should call out academic places taking over satellites and then paying 220k and call out programs that are expanding just so they get more people to write notes (Especially if their graduates go on to fellowship or don't have great job prospects), but I believe twitter and other mediums provide a more balanced discussion of these issues than sdn

Edit: And yes, I do believe the ABR screwed people over. They basically admitted it in their last letter when they stated that 2018 failed test takers performed better than 2017 failed test takers. They didn't do it on purpose, but they should have owned up to it when their data showed that the results were way out of line with previous years (kudos for ARRO for pushing them on this issue). I think this is a failure of the ABR.

 

[RickyScott]

My favorite part of the Twitter discussion is how SDN is right about too many residents, but that's all that we're right about. How, exactly, does that work? We have too many residents, but there's not going to be any consequence of that? The intellectual shallowness and lack of logical reasoning among the virtue-signaling crowd is astounding.

It was only a month or 2 ago that ARRO had posted on their website that "nothing was wrong" and perspective medical students should ignore the malcontents online!

 

[RickyScott]

Have always disliked tweeter for this reason. Seems like it attracts the worst of the worst narcissists, self promoters, divas in our field. Lots of abonoxious “clickish” behaviour is amplified, something already inherently wrong with our field, this small “club” of people who act and feel superior to everyone else. I find it disgusting and such a turn off. Even some of the residents on there are on their way to be just as obnoxious as their attending counterparts. To me its a great way to identify people i’d never want to work with..

A lot of them were employed as "fluffers" in former lives.

 

[deleted947887]

It's great that you are willing to admit this on a protected forum. But you and your board certified colleagues are afraid to admit this in public. Instead, it becomes a "contentious" issue. Don't you think there is something wrong with that? Doesn't it say something about the rad onc culture? I mean the fact that you don't want to publically admit that was the nail in the coffin is y'all's problem. You think it's a marketing issue? Seriously? That's what you think it is? In one year, that's what changed?

Y'all need to cut the BS.

Edit: And yes, I do believe the ABR screwed people over. They basically admitted it in their last letter when they stated that 2018 failed test takers performed better than 2017 failed test takers. They didn't do it on purpose, but they should have owned up to it when their data showed that the results were way out of line with previous years (kudos for ARRO for pushing them on this issue). I think this is a failure of the ABR.

 

[levels]

The discussion on twitter is hilariously tone deaf. We have staff physicians from top 10-20 programs say there is no issue with the job market because their residents all get nice job offers. Someone on the thread said something to the effect of "academic centers NEED more residents." No one in our field needs a resident. If you can't function without a resident, you shouldn't be practicing. If your program can't handle the clinical load without more residents, maybe consider hiring more physicians? Expanding residency programs to deal with higher patient load will only exacerbate the problem. Just because people don't feel comfortable discussing these issues openly in as small of a field as ours doesn't make the opinion any less valid. There's no risk in publicly posting milquetoast solutions like "increasing awareness."

 

[deleted18755]

I would go as far as shutting down programs that are < 8 residents. I was just looking at Rad Onc programs, and even though there aren't many (compared to other specialities), there are some programs that I have never even heard of and are pretty much community programs. I would question the training at those places.

There is clearly an oversupply of residents/recent graduates at the same time that there is at least some degree of maldistribution. Justification for smaller programs in non-coastal areas is often that residents who train in these relatively "undesirable" locations are more likely to then pursue a job in a similar undesirable/undeserved location. Is anybody aware if there are actual data to support this (particularly in radiation oncology but even just in general)?

 

[deleted18755]

Should couple that with a moratorium of expansion at any remaining program for at least a few years while the issue is further studied.

That would make it fairer

Is anybody aware if any of the programs that did not fill in the match are also ones that are also simultaneously and actively trying to expand their residency spots? Does this raise any red flags to the hospital/University/whatever organization it is that grants residency expansions?

I'm just curious.

 

[fiji128]

List of programs by year founded with number of ACGME approved residency spots:

Dartmouth (2018) 4
University of Arkansas (2017) 4
West Virginia University (2016) 4
Stony Brook (2016) 4
University of Tennessee (2015) 4
Drexel (2014) 4
Medical College of Georgia (2013) 4
Cedars Sinai (2013) 4
Mayo Clinic Arizona (2013) 4
Hofstra (2012) 8
Texas A and M (2011) 8
University of California San Diego (2010) 12
University of Nebraska (2010) 4
University of Mississippi (2010) 4
City of Hope (2008) 6
University of Oklahoma (2007) 6
University of South Florida (2007) 10
University of Texas Southwestern (2005) 14
Rutgers (2005) 9
Mayo Clinic Jacksonville (2005) 4
University of California Davis (2004) 7
University of Colorado (2003) 8
Harvard Combined Program (2002) 30
Vanderbilt (2001) 10
University of Pittsburgh (2001) 8
Case Western Reserve (2000) 6
Cornell (1995) 6
University of Kentucky (1994) 6
Allegheny Health Network (1994) 4
University of Buffalo (1993) 6
Emory (1993) 16
Fox Chase (1992) 9
Mount Sinai (1991) 10
Kaiser Permanente Los Angeles (1985) 8
University of Chicago (1985) 12
National Capital Consortium (1981) 6
Baylor College of Medicine (1981) 8
Georgetown (1981) 6
University of Kansas (1977) 6
University of Texas San Antonio (1976) 6
Indiana University (1976) 9
Medical University of South Carolina (1976) 7
University of Louisville (1974) 8
Medical College of Wisconsin (1974) 8
Loyola (1974) 8
Cleveland Clinic (1974) 12
John Hopkins (1974) 16
Brooklyn Methodist (1974) 5
Beaumont (1974) 12
Wayne State (1973) 8
Thomas Jefferson (1973) 9
University of Pennsylvania (1973) 18
University of Wisconsin (1973) 8
Loma Linda (1973) 5
University of Miami (1973) 12
University of Alabama (1973) 12
University of Arizona (1973) 7
California Pacific Medical Center (1973) 4 Closed in 2019
Columbia (1973) 6
University of North Carolina (1973) 8
University of Utah (1972) 10
University of Virginia (1972) 6
University of Texas Medical Branch (1972) 5
Northwestern University (1972) 8
Mayo Clinic Rochester (1972) 12
Henry Ford (1972) 6
University of Cincinnati (1972) 8
University of California San Francisco (1971) 13
Tufts (1971) 9
SUNY Upstate (1971) 6
University of Rochester (1971) 8
Wake Forrest (1971) 7
University of Michigan (1971) 11
Washington University (1971) 16
Memorial Sloan Kettering (1971) 24
New York University (1971) 10
Ohio State University (1971) 10
University of Southern California (1970) 7
University of Washington (1970) 10
Stanford (1970) 17
Oregon Health and Science University (1970) 6
Albert Einstein (1970) 7
MD Anderson (1970) 28
University of Minnesota (1970) 6
University of California Los Angeles (1970) 12
Yale (1969) 14
Duke University (1969) 13
University of Florida (1969) 9
Virginia Commonwealth University (1969) 8
SUNY Downstate (1969) 8
Rush (1969) 6

 

[fiji128]

List of residency programs by number of ACGME approved residency slots. There are a total of 833 residency spots across 93 programs.
Places with 4 residents make up 6% of total pool, 5 to 6 residents 18%, 7 to 10 residents 36%, 11 to 16 residents 25%, 17 to 30 residents 14%.


Dartmouth (2018) 4
University of Arkansas (2017) 4
West Virginia University (2016) 4
Stony Brook (2016) 4
University of Tennessee (2015) 4
Drexel (2014) 4
Medical College of Georgia (2013) 4
Cedars Sinai (2013) 4
Mayo Clinic Arizona (2013) 4
University of Nebraska (2010) 4
University of Mississippi (2010) 4
Mayo Clinic Jacksonville (2005) 4
Allegheny Health Network (1994) 4
California Pacific Medical Center (1973) 4 Closed in 2019
Brooklyn Methodist (1974) 5
Loma Linda (1973) 5
University of Texas Medical Branch (1972) 5
City of Hope (2008) 6
University of Oklahoma (2007) 6
Case Western Reserve (2000) 6
Cornell (1995) 6
University of Kentucky (1994) 6
University of Buffalo (1993) 6
National Capital Consortium (1981) 6
Georgetown (1981) 6
University of Kansas (1977) 6
University of Texas San Antonio (1976) 6
Columbia (1973) 6
University of Virginia (1972) 6
Henry Ford (1972) 6
SUNY Upstate (1971) 6
Oregon Health and Science University (1970) 6
University of Minnesota (1970) 6
Rush (1969) 6
University of California Davis (2004) 7
Medical University of South Carolina (1976) 7
University of Arizona (1973) 7
Wake Forrest (1971) 7
Albert Einstein (1970) 7
University of Southern California (1970) 7
Hofstra (2012) 8
Texas A and M (2011) 8
University of Colorado (2003) 8
University of Pittsburgh (2001) 8
Kaiser Permanente Los Angeles (1985) 8
Baylor College of Medicine (1981) 8
University of Louisville (1974) 8
Medical College of Wisconsin (1974) 8
Loyola (1974) 8
Wayne State (1973) 8
University of North Carolina (1973) 8
University of Wisconsin (1973) 8
Northwestern University (1972) 8
University of Cincinnati (1972) 8
Virginia Commonwealth University (1969) 8
University of Rochester (1971) 8
SUNY Downstate (1969) 8
Rutgers (2005) 9
Fox Chase (1992) 9
Indiana University (1976) 9
Thomas Jefferson (1973) 9
Tufts (1971) 9
University of Florida (1969) 9
University of South Florida (2007) 10
Vanderbilt (2001) 10
Mount Sinai (1991) 10
University of Utah (1972) 10
New York University (1971) 10
Ohio State University (1971) 10
University of Washington (1970) 10
University of Michigan (1971) 11
University of California San Diego (2010) 12
University of Chicago (1985) 12
Cleveland Clinic (1974) 12
Beaumont (1974) 12
University of Miami (1973) 12
University of Alabama (1973) 12
Mayo Clinic Rochester (1972) 12
University of California Los Angeles (1970) 12
University of California San Francisco (1971) 13
Duke University (1969) 13
University of Texas Southwestern (2005) 14
Yale (1969) 14
Emory (1993) 16
John Hopkins (1974) 16
Washington University (1971) 16
Stanford (1970) 17
University of Pennsylvania (1973) 18
Memorial Sloan Kettering (1971) 24
MD Anderson (1970) 28
Harvard Combined Program (2002) 30

 

[Church of Radiontology]

List of residency programs by number of ACGME approved residency slots. There are a total of 833 residency spots across 93 programs.
Places with 4 residents make up 6% of total pool, 5 to 6 residents 18%, 7 to 10 residents 36%, 11 to 16 residents 25%, 17 to 30 residents 14%.


Dartmouth (2018) 4
University of Arkansas (2017) 4
West Virginia University (2016) 4
Stony Brook (2016) 4
University of Tennessee (2015) 4
Drexel (2014) 4
Medical College of Georgia (2013) 4
Cedars Sinai (2013) 4
Mayo Clinic Arizona (2013) 4
University of Nebraska (2010) 4
University of Mississippi (2010) 4
Mayo Clinic Jacksonville (2005) 4
Allegheny Health Network (1994) 4
California Pacific Medical Center (1973) 4 Closed in 2019
Brooklyn Methodist (1974) 5
Loma Linda (1973) 5
University of Texas Medical Branch (1972) 5
City of Hope (2008) 6
University of Oklahoma (2007) 6
Case Western Reserve (2000) 6
Cornell (1995) 6
University of Kentucky (1994) 6
University of Buffalo (1993) 6
National Capital Consortium (1981) 6
Georgetown (1981) 6
University of Kansas (1977) 6
University of Texas San Antonio (1976) 6
Columbia (1973) 6
University of Virginia (1972) 6
Henry Ford (1972) 6
SUNY Upstate (1971) 6
Oregon Health and Science University (1970) 6
University of Minnesota (1970) 6
Rush (1969) 6
University of California Davis (2004) 7
Medical University of South Carolina (1976) 7
University of Arizona (1973) 7
Wake Forrest (1971) 7
Albert Einstein (1970) 7
University of Southern California (1970) 7
Hofstra (2012) 8
Texas A and M (2011) 8
University of Colorado (2003) 8
University of Pittsburgh (2001) 8
Kaiser Permanente Los Angeles (1985) 8
Baylor College of Medicine (1981) 8
University of Louisville (1974) 8
Medical College of Wisconsin (1974) 8
Loyola (1974) 8
Wayne State (1973) 8
University of North Carolina (1973) 8
University of Wisconsin (1973) 8
Northwestern University (1972) 8
University of Cincinnati (1972) 8
Virginia Commonwealth University (1969) 8
University of Rochester (1971) 8
SUNY Downstate (1969) 8
Rutgers (2005) 9
Fox Chase (1992) 9
Indiana University (1976) 9
Thomas Jefferson (1973) 9
Tufts (1971) 9
University of Florida (1969) 9
University of South Florida (2007) 10
Vanderbilt (2001) 10
Mount Sinai (1991) 10
University of Utah (1972) 10
New York University (1971) 10
Ohio State University (1971) 10
University of Washington (1970) 10
University of Michigan (1971) 11
University of California San Diego (2010) 12
University of Chicago (1985) 12
Cleveland Clinic (1974) 12
Beaumont (1974) 12
University of Miami (1973) 12
University of Alabama (1973) 12
Mayo Clinic Rochester (1972) 12
University of California Los Angeles (1970) 12
University of California San Francisco (1971) 13
Duke University (1969) 13
University of Texas Southwestern (2005) 14
Yale (1969) 14
Emory (1993) 16
John Hopkins (1974) 16
Washington University (1971) 16
Stanford (1970) 17
University of Pennsylvania (1973) 18
Memorial Sloan Kettering (1971) 24
MD Anderson (1970) 28
Harvard Combined Program (2002) 30

This is very interesting. Where did you get all of this data?
Thanks.
CoR

 

[fiji128]

This is very interesting. Where did you get all of this data?
Thanks.
CoR

Public information on the ACGME website. Had to put it together by hand but wanted some real numbers out there to guide discussions. Would be interesting to see what the same list would've looked like in 2010 in regards to number of residents but don't have that info.

ACGME - Accreditation Data System (ADS)

 

[mikezab]

People are referring to this recent match as a wake up call. I would have thought that the ABR screwing over an entire class of residents on their physics and rad bio exams would have been a wake up call but our leadership did absolutely nothing and the ABR won. What makes us think this is any different? People taking to twitter won’t solve the problem and we are doing this to ourselves.

Just in case anyone wants a refresher on the ludicrous events of the ABR Rad Bio/Physics fiasco here as a brief summary:

• Dr. Amdur/Lee write an article in PRO noting that residents are spending an inordinate amount of time studying for Rad Bio and Physics minutiae rather than focusing on clinically relevant training
• The ABR (Dr. Wallner and Kachnic) write a reply--which can be found on this thread several pages back-- in which they state with no supporting evidence that residents aren’t getting smarter, they are actually getting dumber. They blame small programs for this.. Again, with no supporting evidence.
• Rad Bio/Physics Exam 2018: 3 months later current PGY-5’s take the Rad Bio and Physics exam. Scores come out with a Physics pass rate of 70% and Rad Bio Pass rate of 74%. These scores are 3-5 standard deviations off of what they have been in the past 15 years for Rad Bio and Physics.
• The ABR accepts no responsibility that the exam they administered may have been at fault. They instead shift the blame claiming that is multifactorial. They blame worse teaching as a cause (Worse teaching which occurred in ONE YEAR and would have to occur in nearly ALL the programs in the country?) and say the angoff scoring method is flawless and could not have played a role. They additionally do analysis to look at ‘small programs’ to show that they performed worse (albeit with some likely twisting of the numbers, and it was only programs of 4 or less, which make up 6% of the resident pool). This ignores the fact that large programs have question banks, but that is a conversation for another day. Resident programs with 6 or more did not do worse to any statistically significant degree yet are being lumped in as ‘small programs are worse’.
• The end result of this debacle: no resolution, no changes are made. The ABR publishes what they refer to as a ‘new Study Guide’ for Rad Bio and physics in March of 2019 which is simply nothing more than a list of all the major textbooks and topics in the field (McDermott, Hall, Kahn, etc).
• Match Day 2019: we have the worst match in recent memory. The most obvious thing that has happened in the last year is the ABR Rad Bio and Physics exam and the pathetic handling of it. But rather than crediting medical students for recognizing a sinking ship we blame SDN for our woes as a field. Med students likely said, ‘I’m smart and have great scores, why would I bust my butt for 5 years in Rad Onc and only be guaranteed a 70% pass rate on TWO of the qualifying exams.. only to have to then take a written AND oral board exam? I can just go into another specialty…’. On Twitter our leaders are again refusing to acknowledge the source of the problem. They instead blame a lack of exposure to our field (something that hasn’t changed in decades.. it didn’t change all of a sudden) and that SDN was the culprits.
• Currently:
  • This has sparked some good debate as to the issues in our field. Residency expansion is certainly one. However, small programs are not the only ones to blame for the excessive numbers of residents. Some small programs may need to be shut down— but others are high quality programs and these are the institutions that train our Rad Oncs taking jobs in rural and undesirable locations (how many MSKCC, MD Anderson, UCSF grads end up in small town Missisippi, Kansas or West Virginia?). Large programs should also be trimming the fat and potentially reducing their numbers of residents.
  • Our Leadership: Our ABR leadership has already hurt our field. They have caused serious damage to our current PGY-5’s and now it is reflected in our incoming residents at this last match. Maybe it is time for a change.
  • Our Qualifying Exams: Maybe now is the time to reassess our qualifying exams. Should they be consolidated? Medical oncology only has 1 written exam (after passing Internal Medicine), do we really need 4 including oral boards?

 

[levels]

Feel free to report/delete this anecdote if inappropriate, but I think it tells a lot about Dr. Wallner's attitude towards the boards issue and his response to it. He was organizing the oral boards session when I took it. On the morning of the exam, a physics resident was lost and came into the medical resident group room. He was re-directed and, as soon as he left the room, Dr. Wallner was visibly annoyed and said "I hope he fails." There were a few nervous chuckles throughout the room. I was mostly shocked he would so casually joke about someone failing on the morning of (likely) the most important exam they've taken.

 

[deleted950463]

In any case, Dr. Wallner will certainly get less competitive residents on average from this year. So that’s wish fullfilled

 

[thecarbonionangle]

Feel free to report/delete this anecdote if inappropriate, but I think it tells a lot about Dr. Wallner's attitude towards the boards issue and his response to it. He was organizing the oral boards session when I took it. In the morning of the exam, a physics resident was lost and came into medical resident group room. He was re-directed and, as soon as he left the room, Dr. Wallner was visibly annoyed and said "I hope he fails." There were a few nervous chuckles throughout the room. I was mostly shocked he would so casually joke about someone failing on the morning of (likely) the most important exam they've taken.

True or not he showed his cards with his arrogance, dismissive attitude. So did Lisa. I have zero faith in their abilities and it is depressing they are in charge. I fully agree with great summary posted above of the issues. I’ve seen screenshots of tweeter wherein theres a Mayo guy saying “the only” thing sdn gets right is the expansion thing. Really man? The “only thing”? Just embarassing. It isnt just the people at the ABR, we have a crisis of leadership in this field. When people like Dr. Shah speak up about expansion theres a coordinated “bloodbath” hose job by “leaders” in our field. Just AMDUR/LEE speaking out? Everyone else quiet? No opinion? Pandering? Scared? Looking to benefit from it? What have we become?

 

[thecarbonionangle]

In any case, Dr. Wallner will certainly get less competitive residents on average from this year. So that’s wish fullfilled

21st century oncology will continue its fraudulent crimimal behavior under his leadership and massive conflicts of interests leading the ABR. Im sure the company will love more desperate grads.

 

[pikachu]

Ask and you shall receive...

View attachment 253656

I'll play

 

[RadOncG]

If you don't like the idea to close small programs, that is OK and there are valid criticisms of that approach, but there is no solution that will make everyone happy. Rather than just critiquing, please provide an alternative solution.

Someone is going to be hurt no matter what. I hope whatever happens, we make sure the current residents are not hurt and bigger programs step up and absorve them. The ABR leadership is disgusting, arrogant, out of touch, corrupt, criminal. Anything associated with their views is repulsing to me at this point.

I am absolutely in favor of decreasing the number of spots. The issue is that there is no data about using only the number of residents as a surrogate of quality. The only support you have is Paul Wallner's editorial where he postulated with no data that programs with 6 or fewer residents are responsible for this great decline in resident intelligence. He then produced an exam that "proved" his point to no statistical significance.

If this is enough data to justify using resident number as your only marker then go for it. Just understand that you are making the same argument as Paul Wallner and helping to prove his point.

 

[KHE88]

Feel free to report/delete this anecdote if inappropriate, but I think it tells a lot about Dr. Wallner's attitude towards the boards issue and his response to it. He was organizing the oral boards session when I took it. On the morning of the exam, a physics resident was lost and came into the medical resident group room. He was re-directed and, as soon as he left the room, Dr. Wallner was visibly annoyed and said "I hope he fails." There were a few nervous chuckles throughout the room. I was mostly shocked he would so casually joke about someone failing on the morning of (likely) the most important exam they've taken.

I am fairly certain I know who this individual is. Or else it happened more than once. This individual did in fact fail.

I have never met Paul Wallner. I hope I never do. He clearly has no shame in completely f---ing with young people's lives based on his own prejudices and hatefulness.

 

[PointA]

There is clearly an oversupply of residents/recent graduates at the same time that there is at least some degree of maldistribution. Justification for smaller programs in non-coastal areas is often that residents who train in these relatively "undesirable" locations are more likely to then pursue a job in a similar undesirable/undeserved location. Is anybody aware if there are actual data to support this (particularly in radiation oncology but even just in general)?

There is data published in JAMA that married physicians with highly educated spouses are less likely to work in a rural area (PMID: 26934264). Younger, female, black, and hispanic physicians are less likely to take rural positions. Unfortunately, this is a major problem for our field with it's strict geographic limitations as more women enter the specialty, since women are far less likely to have a stay at home spouse than men are. I don't know of any evidence regarding location of residency training and rural practice; that would be a good project for someone to tackle.

 

[rdoctor1234]

Can someone please post the list of unfilled radiation oncology positions (location and number of available positions) now that SOAP is complete? Thanks

 

[ARRO]

ARRO is trying to find a spot in which we can have programs post unfilled positions. Right now we will be using ROhub for positions that we are emailed about.

 

[nkmiami]

There is data published in JAMA that married physicians with highly educated spouses are less likely to work in a rural area (PMID: 26934264). Younger, female, black, and hispanic physicians are less likely to take rural positions. Unfortunately, this is a major problem for our field with it's strict geographic limitations as more women enter the specialty, since women are far less likely to have a stay at home spouse than men are. I don't know of any evidence regarding location of residency training and rural practice; that would be a good project for someone to tackle.

This is such a key point and one that is consistently ignored. Personally true for many that I know.

 

[Neuronix]

ARRO is trying to find a spot in which we can have programs post unfilled positions. Right now we will be using ROhub for positions that we are emailed about.

ARRO/ASTRO Bulletin Board for Residency/Fellowship Openings

 

[RickyScott]

Numbers can be fudged in this regard with inclusion of satellites, elective rotations, "collaboration" with nearby private practices, etc. in regards to meeting case requirements.

yes, like drexel where they have only about 20 pts on treatment at the hospital, but send out to various practices in the area.

 

[RO28]

This is such a key point and one that is consistently ignored. Personally true for many that I know.

This is also personally true for me. There are lots of challenges for the above mentioned groups in rural areas, but it’s a difficult problem to address.

 

[OTN]

Additionally, studies consistently show that Millennials want to work in urban/non-rural settings even more than prior generations.