Hellpits- absolute worst programs in radiation oncology

[temujim]

“Easiest” way would be to increase brachytherapy requirements to the point where graduates would be technically competent in most brachy procedures. This will not happen for obvious reasons.

This might be a good contribution from SDN -- ie what ACGME radiation oncology residency changes would people suggest in order to improve "quality". Which may or may not have the salutary effect of closing programs/reducing overall slots.

1. Increase brachy requirement
2. Minimum 8 residents overall (2 per year)
3. Minimum 1.5-2 (FTE) clinical faculty (at main site) per resident
4. Minimum 1 physics faculty (at main site) per resident

Any other ideas??

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[RadOncMegatron]

This might be a good contribution from SDN -- ie what ACGME radiation oncology residency changes would people suggest in order to improve "quality". Which may or may not have the salutary effect of closing programs/reducing overall slots.

1. Increase brachy requirement
2. Minimum 8 residents overall (2 per year)
3. Minimum 1.5-2 (FTE) clinical faculty (at main site) per resident
4. Minimum 1 physics faculty (at main site) per resident

Any other ideas??

This won’t work because it makes too much sense lol. Seriously, ACGME needs to start closing down some programs.

 

[temujim]

This won’t work because it makes too much sense lol. Seriously, ACGME needs to start closing down some programs.

The other way to get the ACGME to close programs is have the residents flag repeatedly flag violations. Maybe you can get residents to sabotage their own program in this way? Assume eventually probation turns into closure.

 

[elementaryschooleconomics]

The other way to get the ACGME to close programs is have the residents flag repeatedly flag violations. Maybe you can get residents to sabotage their own program in this way? Assume eventually probation turns into closure.

That's logical...but it would require the "system" to work.

I first heard about Cornell (and was warned to stay away) in the mid-2000s. It took almost 15 years for that program to be shut down.

As noted above, Harvard is basically on probation every year. We all know HROP isn't going anywhere.

It is incredibly hard to get residents to cut off their nose to spite their face. In bigger specialties, there is at least some hope of anonymity. In RadOnc, unless you can create a whole I'M SPARTACUS movement, it's very easy to figure out the 1-2 troublemakers. I've watched it happen. There's almost zero incentive to pursue complaints after you graduate, and even if you did, it would be very hard to "prove" anything. Taking it a step further, let's say you collect years of evidence while in residency and file complaints after graduation - then it becomes "why did you say nothing for so long?"

The system is really designed to protect itself.

 

[medgator]

In residency, we had a fully trained guy from India (better than the attendings) who ran a service with 0 oversight from the chair, and the chair pocketed all the professional fees after signing off on everything. Eventually, he was given a residency slot after about 3 years.

Rochester was well known for this years ago iirc

 

[metallica81788]

The other way to get the ACGME to close programs is have the residents flag repeatedly flag violations. Maybe you can get residents to sabotage their own program in this way? Assume eventually probation turns into closure.

That would be assuming the system worked

....so nope

 

[DoctwoB]

That would be assuming the system worked

....so nope

First (and last) 80 hour violation reported:

“PD: what is keeping you from getting your work done as efficiently as everyone else”

 

[elementaryschooleconomics]

First (and last) 80 hour violation reported:

“PD: what is keeping you from getting your work done as efficiently as everyone else”

Ah yes. I remember my first (and last) honest duty hour report. September of my intern year. An email from the PD and a visit from the Chiefs taught me about "the hidden curriculum". For the rest of my graduate medical education, I magically worked the same hours every week.

I did my RadOnc residency at the same institution. I dipped my toes into "the system" in other ways. It doesn't take much to understand the value of keeping things to yourself.

 

[FindMeOnTheLinks]

Ah yes. I remember my first (and last) honest duty hour report. September of my intern year. An email from the PD and a visit from the Chiefs taught me about "the hidden curriculum". For the rest of my graduate medical education, I magically worked the same hours every week.

I did my RadOnc residency at the same institution. I dipped my toes into "the system" in other ways. It doesn't take much to understand the value of keeping things to yourself.

On the annual ACGME surveys now, we are given a pep talk beforehand that if we don’t say that our program is perfect in every conceivable way, we are only hurting ourselves 🙄

 

[deleted1111261]

Why is Harvard always on probation?

 

[elementaryschooleconomics]

Why is Harvard always on probation?

 

[TheWallnerus]

View attachment 358979

not to be picky but I think this is when good Arnold T2 was trying to protect John Connor

 

[elementaryschooleconomics]

not to be picky but I think this is when good Arnold T2 was trying to protect John Connor

I see you like to party at Tech Noir

 

[ramsesthenice]

I love the idea of having a minimum faculty/resident ratio and minimum of 8 residents. But I also like the idea of a maximum of 8-12 as well. Having a high volume and large staff does not inherently justify putting out enormous numbers of residents. Not naming any names, but this would cut up to 40 spots from 3-4 programs. Never going to happen but probably far more efficient at trimming numbers than convincing small programs to close.

 

[thesauce]

not to be picky but I think this is when good Arnold T2 was trying to protect John Connor

Plus that doesn’t really look like Simul and I doubt his height and weight match like it suggests

 

[elementaryschooleconomics]

Plus that doesn’t really look like Simul and I doubt his height and weight match like it suggests

So...a geometric miss, then?

 

[thecarbonionangle]

I love the idea of having a minimum faculty/resident ratio and minimum of 8 residents. But I also like the idea of a maximum of 8-12 as well. Having a high volume and large staff does not inherently justify putting out enormous numbers of residents. Not naming any names, but this would cut up to 40 spots from 3-4 programs. Never going to happen but probably far more efficient at trimming numbers than convincing small programs to close.

I think 2:1 faculty ratio should be minimum and cannot just count other facilities like VA/satellites/other hospitals/other residency attendings who are “adjunct” to boost number up. The main site needs to have the minimum ratio. If you depend on multiple sites to get you there, then you clearly should not have a program

 

[thesauce]

So...a geometric miss, then?

Yes, T2 seems to be operating at the level of those early MIM auto-contouring packages.

 

[TheWallnerus]

But there are many, many employed positions where you can treat 10-15 patients and be home by 430p

These used to not be that common but are far more common these days imho

As long as systems and employers will keep paying rad oncs probably more than another other speciality for $/work product, we are good. Still a great profit margin for these systems even for unbusy rad oncs. ROAPM would have affected this a lot, in some places; that’s yet another respite.

 

[deleted1081396]

Pits of Hell: with match 2023 round the corner, we should revisit the absolute worst programs in radiation oncology. Grads should not expect employment. There is just no legitimate reason for a us md to apply.

Worst of the worst. Us MDs should not attend under any circumstances: West Virgina, Arkansas, Mississippi, MCSC, Tennessee, Baylor Scott and White, Dartmouth, Columbia, SUNY downstate, SUNY upstate, Brooklynn Methodist, Baylor, Stony Brook, Kentucky, Louisville

Garbage: Indiana, Galveston, San Antonio, LIJ, Nebraska, Oklahoma, Mayo-Jack, UC Irvine,

What makes these programs the worst of the worst?

 

[medgator]

What makes these programs the worst of the worst?

Pretty much anything in the bottom 2/3s is probably not worth ranking for a US medical student. Why take the risk with the job market only getting tighter going forward?

 

[RickyScott]

What makes these programs the worst of the worst?

The first worst comes from radonc being the least competitive specialty, and the second is scored by having known issues, or being new and obscure.

 

[resident#]

Pretty much anything in the bottom 2/3s is probably not worth ranking for a US medical student. Why take the risk with the job market only getting tighter going forward?

I agree with this take. There are disadvantages to going to a bottom 2/3 program in this day and age.

#1. Our field is still quite elitest (which is ironic considering the state of affairs) and prestige/who you know/whether someone has heard of your program can affect job opportunities, which is risky with a tight job market. #2. I am a believer that the individual resident who is motivated can succeed beyond a mediocre residency (and there are many examples of people like this), but this does require a lot more work than if you had good education/training to begin with. Why put yourself at a disadvantage these days if you don't need to be? #3. Programs that are in the bottom 2/3s are definitely in the bottom for a reason. There may be problems with lack of opportunities/education, toxic culture, toxic attendings/leadership, or even a combination of these factors. You can have no idea that this is going on from one interview day alone or even a month long rotation. It is very easy for programs to hide these problems because they are motivated to do so.

 

[medgator]

I agree with this take. There are disadvantages to going to a bottom 2/3 program in this day and age.

#1. Our field is still quite elitest (which is ironic considering the state of affairs) and prestige/who you know/whether someone has heard of your program can affect job opportunities, which is risky with a tight job market. #2. I am a believer that the individual resident who is motivated can succeed beyond a mediocre residency (and there are many examples of people like this), but this does require a lot more work than if you had good education/training to begin with. Why put yourself at a disadvantage these days if you don't need to be? #3. Programs that are in the bottom 2/3s are definitely in the bottom for a reason. There may be problems with lack of opportunities/education, toxic culture, toxic attendings/leadership, or even a combination of these factors. You can have no idea that this is going on from one interview day alone or even a month long rotation. It is very easy for programs to hide these problems because they are motivated to do so.

Many of us just sucked it up and matched into whatever bottom half program we could match into because the job market was better back then. Now? No reason to at all. I know many people who graduated from programs that closed years or even over a decade or two ago with decent jobs now.

It won't be the same for new grads going forward given how much excess resident supply is coming out now

 

[deleted1111261]

Well

There has to be a bottom 2/3 of any group.

It’s not Lake Wobegon

 

[RickyScott]

Well

There has to be a bottom 2/3 of any group.

It’s not Lake Wobegon

Top 1/3 probably has 2/3 of all residents

 

[Palex80]

Best residency is SDN.

 

[bigman1]

Best residency is SDN.

4 real, the work you and Wallnerus are putting in the breast topic is award winning.

 

[longshot1710]

Are there any programs on the worst of the worst list that you believe reputable? It is constructive to identify hellpits for future closures.

University of Arizona has excellent culture (one girl left for personal reasons to be near family), a 100% board pass rate, and certainly at least 2-3 experts in their perspective fields. Personal experience from a recent Sub-I rotation. High resident QOL as well

 

[longshot1710]

I love the idea of having a minimum faculty/resident ratio and minimum of 8 residents. But I also like the idea of a maximum of 8-12 as well. Having a high volume and large staff does not inherently justify putting out enormous numbers of residents. Not naming any names, but this would cut up to 40 spots from 3-4 programs. Never going to happen but probably far more efficient at trimming numbers than convincing small programs to close.

Would also bring back the highly competetive atmosphere (some enjoy this but not for me), and prestige that such programs warrant

 

[RickyScott]

University of Arizona has excellent culture (one girl left for personal reasons to be near family), a 100% board pass rate, and certainly at least 2-3 experts in their perspective fields. Personal experience from a recent Sub-I rotation. High resident QOL as well

Don’t know much abt them, but They aren’t on the hellpit list? Probably a great place to attend if you want to work in phoenix, which is one of the more desirable cities.

 

[Radonky]

Don’t know much abt them, but They aren’t on the hellpit list? Probably a great place to attend if you want to work in phoenix, which is one of the more desirable cities.

And where the summer is also like a hellpit

 

[deleted1111261]

Def my favorite hellpit !

 

[Like]

Can someone chime in on Louisville? Why is it on this list?

 

[medgator]

Can someone chime in on Louisville? Why is it on this list?

Definitely not an amazing program by any stretch of the imagination and in the current environment, you can pretty much put the bottom half to two thirds on a list where you don't want to match at all if you are US grad with decent stats

 

[brushbeamscanning]

Interesting that the former PD was named chair. Dr. Shiao Woo seemed like a decent guy when I interviewed ages ago, but seemed like a lot of local competition with private groups.

Neal Dunlap tapped to lead Department of Radiation Oncology — School of Medicine University of Louisville

 

[RadRadRad]

Can someone chime in on Louisville? Why is it on this list?

Historically not strong program. Years ago residents were not happy either . Not sure if anything has changed

 

[HolySmokes]

Interesting that the former PD was named chair. Dr. Shiao Woo seemed like a decent guy when I interviewed ages ago, but seemed like a lot of local competition with private groups.

Neal Dunlap tapped to lead Department of Radiation Oncology — School of Medicine University of Louisville

Local competition is a huge reason for the decline. Norton Healthcare is an absolute behemoth in the area. If you want confirmation, look at their publicly available rad onc salaries...

 

[longshot1710]

Don’t know much abt them, but They aren’t on the hellpit list? Probably a great place to attend if you want to work in phoenix, which is one of the more desirable cities.

Other places that I would steer good candidates away from are Utah, Loma Linda, Kaiser Permanente, City of Hope, Wake Forest and Arizona. Maybe not “hell pits” but these places have culture poor enough to result in residents leaving, poor oral board pass rates, or no experts in the field.

 

[sirspamalot]

Not being around the best and brightest and hardest working folks during the time when you are in your formative years will hurt you for the rest of your career.

Conversely, being in that environment will have a lasting impact on you.. long after the field has changed and moved beyond (ie 3D to IMRT). You will HOLD YOURSELF accountable to this same standard.. even when no one is around to tell you to do it.

 

[theradiator]

Not being around the best and brightest and hardest working folks during the time when you are in your formative years will hurt you for the rest of your career.

Conversely, being in that environment will have a lasting impact on you.. long after the field has changed and moved beyond (ie 3D to IMRT). You will HOLD YOURSELF accountable to this same standard.. even when no one is around to tell you to do it.

I actually accept and agree with your premise that intellectual rigor can put a trainee on a different career trajectory. That may have been valid at some point in time in radiation oncology.

But, what if the 'best and brightest' are focused on building satellites, pushing unnecessary protons and conducting fraction reducing non-inferiority trials instead?

 

[sirspamalot]

But, what if the 'best and brightest' are focused on building satellites, pushing unnecessary protons and conducting fraction reducing non-inferiority trials instead?

The almighty dollar has spoken. And, it says it wants more.

 

[TheWallnerus]

I actually accept and agree with your premise that intellectual rigor can put a trainee on a different career trajectory. That may have been valid at some point in time in radiation oncology.

But, what if the 'best and brightest' are focused on building satellites, pushing unnecessary protons and conducting fraction reducing non-inferiority trials instead?

Then they’re not “truly” the best and brightest, so the theory is still intact

 

[pikachu]

Then they’re not “truly” the best and brightest, so the theory is still intact

No true Scotsman!

 

[RickyScott]

Bumping this thread. Saw on linked in that u of tenessee has a residency program and are looking for a pgy2+ . Not mentioned as a hellpit because no one knows they exist.

 

[sirspamalot]

Bumping this thread. Saw on linked in that u of tenessee has a residency program and are looking for a pgy2+ . Not mentioned as a hellpit because no one knows they exist.

Ah yes LinkedIn... Where all great programs find residents of the highest caliber..

 

[fiji128]

You have programs like U of Tennessee that were amongst the very last to get approved by the acgme during the boom years. These places are likely willing to match just about anyone. However, these matches and their interest in rad onc are not reliable and I believe the applicants have every right to change programs/specialties so long as the show up to day one of their PGY-1 year should something else more to their liking become available. I have seen this mentioned before and that there is a decent amount of this happening with rad onc training positions. However there is really no way to track this with publicly available data.

Even with this happening it’s important to note the goal is still to never decrease the number of people we are training at the end of the day. Fill that spot on Linked In if you have to!

 

[wildernessrunner]

Want to chime in with respect to Pitt - I have a friend in residency there, and it sounds like the culture has improved vastly under the new chair.

 

[sirspamalot]

ASTRO leadership.. Old... New... Incoming... Its all the same. Dennis Leary song should be required singalong by every new ASTRO President.

FASTRO? Nah.. F ASTRO!

 

[sirspamalot]

No no no.. You're right. That song was too harsh.

THIS ONE sums up the SCAROP ASTRO attitude more acccurately. My bad.