Hellpits- absolute worst programs in radiation oncology

[sirspamalot]

It should take less than one hour of internet sleuthing to come to a reasonable conclusion about the state of our specialty.

If you're saying they aren't capable of doing this.. then I guess a hellpit is rightfully theirs, although I think that is a very harsh punishment.

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[drowsy12]

there always have been and always will be people who choose to apply to non-competitive fields out of interest

 

[deleted1111261]

that’s strange

there always have been and always will be people who choose to apply to non-competitive fields out of interest

otherwise we’d have mass shortages in major IM specialties and path and others that are lower in competitiveness

 

[Lamount]

Really? Not hard for a med student to look at spots offered now vs a decade or two ago and see that many more are offered now, along with RO being bottom of the barrel for SOAP 3 years in a row now.

Not normal things and certainly would require more investigation than just jumping in headfirst

Picking a specialty is not like picking a mutual fund. I am sure you chose this field for more than it’s favorable predicted ROI.

 

[medgator]

Picking a specialty is not like picking a mutual fund. I am sure you chose this field for more than it’s favorable predicted ROI.

Sorry but job prospects matter. Are you telling me the competitiveness of the field in 1996 vs 2006/2016 vs 2023+ was because medical students weren't taking that into account?

No different than why dozens of ER spots are going unfilled as well lately

 

[RickyScott]

Picking a specialty is not like picking a mutual fund. I am sure you chose this field for more than it’s favorable predicted ROI.

For me, the most important factor in choosing a specialty would be completely avoiding the worst possible outcome ie unemployment. Medicine is filled with great specialties . The possibility of being unemployed, even if it is low, after all those years of medschool and training, should drop any field to the bottom. I dont know any field other than radonc that carries this risk. Other past oversubscribed specialties like CT surgery always had somethin to fall back on.

 

[medgator]

For me, the most important factor in choosing a specialty would be completely avoiding the worst possible outcome ie unemployment. The possibility of being unemployed, even if it is low, after all those years of medschool and training, should drop any field to the bottom. I dont know any field other than radonc that carries this risk. Other past oversubscribed specialties like CT surgery always had somethin to fall back on.

Some would say "well you can find a job somewhere". Terrible criteria almost no other specialty has to resort to.

If i have to work in a certain city or metro/region, and i can't, unemployment it is. Geography is a big thing for most people

 

[RickyScott]

Some would say "well you can find a job somewhere". Terrible criteria almost no other specialty has to resort to.

If i have to work in a certain city or metro/region, and i can't, unemployment it is. Geography is a big thing for most people

some doctors actually have spouse with their own careers and family preferences. It is almost like astro is winking and pushing radoncs to marry stay at home spouses while hosting "women who curie" presentations and paying lip service to "burnout"

 

[Mandelin Rain]

The entire reason rad onc became a competitive specialty was the Salary : Demand : Lifestyle triune boon that occurred in the early to mid 00s.

Yes. I'm a rad onc. I understand it is also a cool job, with a rewarding patient population, and has become less toxic/more precise within that same timeframe. But that is pretty much every other medical specialty as well. Those conditions are not unique to rad onc. It was the economic factors that drove the interest. You're deluding yourself if you disagree.

Salary is still decent, but dropping. [see: salary down 30% in past 17 years, while inflation up 60% over past 21 years. Calculate that loss of purchasing power and your head will explode])
Demand is shaky, but bottom hasn't fallen out. Lots of boomer docs dropped out during COVID. Academic expansion creating new (but worse) jobs, etc... Lots of geographic restriction, but jobs are available out there.
Lifestyle is still top notch for a US physician.

Put it all together and the current picture isn't terrible (yet). I can see why people are still going into this field. Projecting anything 5 years out is nearly impossible. I don't forecast a rosy future, but who knows.

My 2 cents is, and I've been saying this for probably 4-5-years so take with multiple grains of salt:
The current picture isn't as bad as many here make it out to be.
The future picture is worse than many here have suggested.

I would strongly avoid if I were a 3rdor 4th year med student who needs to make a 30-35 year career decision. But I also could be completely wrong and a deus ex machina could be coming.

EDIT: To be fair, if I were a 3rd or 4th year undergrad making a 40 year career decision, I'd STRONGLY(!) avoid medicine altogether. It's a ****ing **** show at this point.

 

[sirspamalot]

Unless you a) love it and will make any sacrifice necessary to be in it b) plan on being an academic wage slave or c) can't wait to move to rural america (and if unacceptable to family, get a pilots license)...

DO. NOT. CHOOSE. THIS. FIELD.

Use the AVOID technique, same as with gel.

 

[evilbooyaa]

The answer is somewhere between "everything is fine" and "If you are a US MD who goes to the wrong residency program as per my view I will immediately blacklist you for having horrible judgment". Not everything has to be an extreme. Focus the anger and resentment for where it SHOULD be, which is the people who run 'hellpits'.

Those who blame the students.... IDK man, that just sucks.

 

[NotMattSpraker]

The answer is somewhere between "everything is fine" and "If you are a US MD who goes to the wrong residency program as per my view I will immediately blacklist you for having horrible judgment". Not everything has to be an extreme. Focus the anger and resentment for where it SHOULD be, which is the people who run 'hellpits'.

Those who blame the students.... IDK man, that just sucks.

I wish I could love this 10 times. There was a genuine mainstream effort to make SOAPing culturally unacceptable in our field, but that effort is now dead. Very few people still care. I am one of them.

I love that you care, but you are causing real harm. The med students are interested in the genuine issues of this field but they are confused because there is so much hyperbole and drama online.

If someone thoroughly investigates RO and still decides to apply, they are smart, not dumb. There is still a handful of exceptional trainees that love this field and choose it voluntarily despite the uncertainty. They will be good radiation oncologists and we want these people in the field. The median number of applications sent by med students has been cut in half over the last few years. They are being discerning and acting more rational than most of our leaders. You couldn't pick a worse group to direct your totally valid anger.

If you instead go online (and out IRL) and give clear information, trash the hellpits for all the valid reasons, emphasize the workforce issues, ASTROs dishonest approach to controversial issues, etc etc.. they will totally listen to you. It could help, in theory. What is happening now is definitely not helping. It gives validity to the bad leaders that tell everyone to disregard all criticism because it comes from "misanthropes".

They are way smarter than the boomers give them credit for and the internet is an important resource for them. Use it wisely.

 

[Lamount]

Sorry but job prospects matter. Are you telling me the competitiveness of the field in 1996 vs 2006/2016 vs 2023+ was because medical students weren't taking that into account?

No different than why dozens of ER spots are going unfilled as well lately

No... but I am telling you that, knowing what I know, I would do it again... today. It's one thing to argue that the job market should matter in the choice of specialty, it's another to imply that it is ALL that matters.

Would I have more job prospects if I went into med/onc, a better lifestyle with derm, make more money with NSG? Sure. But putting in the order set for a chemo regimen doesn't excite me, and I don't want to look at gross rashes or be hovering over a bovie, smelling burnt flesh everyday.

Our job is a lot of fun and very rewarding. There are bright med students with their eyes wide open who still want to go into rad onc. Pretending this isn't the case is no better than pretending their isn't an oversupply problem.

 

[Lamount]

For me, the most important factor in choosing a specialty would be completely avoiding the worst possible outcome ie unemployment. Medicine is filled with great specialties . The possibility of being unemployed, even if it is low, after all those years of medschool and training, should drop any field to the bottom. I dont know any field other than radonc that carries this risk. Other past oversubscribed specialties like CT surgery always had somethin to fall back on.

Do you know any rad oncs who CAN'T get a job (not asking tongue and cheek)?

We are all in our little microcosms... but I just haven't seen that. Things were definitely slow during COVID, but these days, our residents usually have multiple offers. Not to say that there aren't geographic constraints that you wouldn't see in many other specialities, but in my (albeit limited) experience, "unemployment" isn't a concern.

 

[RickyScott]

Do you know any rad oncs who CAN'T get a job (not asking tongue and cheek)?

We are all in our little microcosms... but I just haven't seen that. Things were definitely slow during COVID, but these days, our residents usually have multiple offers. Not to say that there aren't geographic constraints that you wouldn't see in many other specialities, but in my (albeit limited) experience, "unemployment" isn't a concern.

I know of radoncs who lost their job/center closed who were forced to take a job hundreds of miles from kids/spouse and only see their family several times per month. This is a total disaster as far as I am concerned and encourages a malignant workplace. You can really make a docs life hell with this hanging over their head.


There are jobs presently available somewhere for everyone, but I think it is entirely possible that some radoncs will face sustained unemployment in the next 10 yrs. We may debate the likelihood of this risk, but it simply doesn’t exist for others specialties.

 

[Doctorer]

Do you know any rad oncs who CAN'T get a job (not asking tongue and cheek)?

We are all in our little microcosms... but I just haven't seen that. Things were definitely slow during COVID, but these days, our residents usually have multiple offers. Not to say that there aren't geographic constraints that you wouldn't see in many other specialities, but in my (albeit limited) experience, "unemployment" isn't a concern.

Why is “getting a job” the only criteria that matters? I know of radoncs who aren’t able to work in the geographic area they want to be in, even after being in practice for several years. And even more who are in their preferred geographic area yet are unhappy in satellite gigs.

 

[drowsy12]

Why is “getting a job” the only criteria that matters? I know of radoncs who aren’t able to work in the geographic area they want to be in, even after being in practice for several years. And even more who are in their preferred geographic area yet are unhappy in satellite gigs.

I agree, but the comment was directly in response to the concept of unemployment proper.

 

[RadOncDoc21]

I agree, but the comment was directly in response to the concept of unemployment proper.

Are residents considered employed? If so, our field is doing exceptionally well!

 

[radoncftw]

There is a lot of ebb/flow.
My hometown (decent metro, we have all the sports teams if that helps) had 1 job when i was applying. my job.
This year there are like 7 jobs.

 

[fiji128]

I sent out my CV to about 5 places recently. No license issues or red flags. Stable employment history. Heard nothing back. There are jobs available but at the end of the day we still have amongst the worst job prospects in all of medicine. Keep in mind that in most other medical specialties one can find a job in a few weeks. Especially if you use rad onc style “geographically flexible” metric. But in rad onc to finding a new position becomes a year long odyssey and we are told this is fine and normal.

 

[RickyScott]

Seems like a lot of the academic centers and their satellites prefer new grads because they are cheaper and they don’t intend to raise their salaries. Community hospitals tend to prefer experience.

 

[fiji128]

Seems like a lot of the academic centers and their satellites prefer new grads because they are cheaper and they don’t intend to raise their salaries. Community hospitals tend to prefer experience.

Ya “academic” satellite or even mother ship is a hard pass.

 

[dieABRdie]

I sent out my CV to about 5 places recently. No license issues or red flags. Stable employment history. Heard nothing back. There are jobs available but at the end of the day we still have amongst the worst job prospects in all of medicine. Keep in mind that in most other medical specialties one can find a job in a few weeks. Especially if you use rad onc style “geographically flexible” metric. But in rad onc to finding a new position becomes a year long odyssey and we are told this is fine and normal.

For med students choosing a specialty with high demand and low supply; looking for a job might be like.....

Those choosing rad onc will find "a" job... but might find themselves like....

 

[sam1234567]

new grads are being offered average 320k, i would assume >80% of them found those jobs in undesirable areas according to a new report I recently came across ,if that’s not alarming I don’t know what to say.
Its very sad seeing fam med new grads signing contracts for >300k left and right while our new grads are struggling to even find a job in a decent place.

 

[medgator]

new grads are being offered average 320k, i would assume >80% of them found those jobs in undesirable areas according to a new report I recently came across ,if that’s not alarming I don’t know what to say.
Its very sad seeing fam med new grads signing contracts for >300k left and right while our new grads are struggling to even find a job in a decent place.

Supply and demand

 

[RickyScott]

new grads are being offered average 320k, i would assume >80% of them found those jobs in undesirable areas according to a new report I recently came across ,if that’s not alarming I don’t know what to say.
Its very sad seeing fam med new grads signing contracts for >300k left and right while our new grads are struggling to even find a job in a decent place.

I think radonc new grads may have such Low expectations that they are “elated” and “satisfied” when they find any job.

 

[medgator]

I think radonc new grads may have such Low expectations that they are “elated” and “satisfied” when they find any job.

Wasn't that eichlers answer? Find "a" job being the goal

 

[thecarbonionangle]

Wasn't that eichlers answer? Find "a" job being the goal

The hellpit moto is we just need to find “a” resident warm body

 

[sirspamalot]

 

[GapCalc]

I'd just like to offer that UC Davis should be added to the 'hellpit' category of programs. The UC Davis chair, Dr. Richard Valicenti, spoke at Q&A during the workforce talk at ASTRO and suggested that we continue to train 'for the future we want' and that an undersupply will cause rural patients to suffer.

Newflash, Dick: we're making more residents than ever and people still don't want rural jobs. By saying "train more", what you're really saying is "let's make sure people are forced into jobs they don't want because they won't have other options." That's a ****ty thing to say to trainees, and med students know it.

Here's the answer to solving rural access (for all of medicine, not just RO): pay more.

That's it.

 

[sirspamalot]

They do pay more. Way way moar. I'm #'ing it with 10 on treatment working (and I use that term lightly) about 3 and half days or so a week.

You just have to live in the middle of nowhere (2+ hours from major metro) to get these types of gigs. Negotiate hard. There are plenty of them from what I see..

"But I don't want to live in the middle of nowhere"

 

[RickyScott]

I'd just like to offer that UC Davis should be added to the 'hellpit' category of programs. The UC Davis chair, Dr. Richard Valicenti, spoke at Q&A during the workforce talk at ASTRO and suggested that we continue to train 'for the future we want' and that an undersupply will cause rural patients to suffer.

Newflash, Dick: we're making more residents than ever and people still don't want rural jobs. By saying "train more", what you're really saying is "let's make sure people are forced into jobs they don't want because they won't have other options." That's a ****ty thing to say to trainees, and med students know it.

Here's the answer to solving rural access (for all of medicine, not just RO): pay more.

That's it.

Problem with many rural jobs in this field is that they have few pts on beam, not just their location. Valicenti had a very non malignant rep at Jeff (not)

 

[sirspamalot]

Its true, rural locations don't typically have 20, or even if they're lucky, 15 on treatment. My experience ranges from 3 to 24 average 12 ? maybe? and as of today its half that... with a handful starting.

Lots of free time to.... comment on SDN lol.

 

[RickyScott]

Its true, rural locations don't typically have 20, or even if they're lucky, 15 on treatment. My experience ranges from 3 to 24 average 12 ? maybe? and as of today its half that... with a handful starting.

Lots of free time to.... comment on SDN lol.

I am sure there are rural places that pay well, but there are certainly some that dont (they feel salary should reflect the 7 pts on beam) and those are the ones that don’t fill and are held up as a evidence of a shortage!

https://x.com/jbcarmody/status/1707109673634050270?s=46&t=bNjInwwyz2DPnd4UFJOtbg

 

[sirspamalot]

Well, they can pay or close.

 

[RickyScott]

Well, they can pay or close.

Or just permanent low quality low paying locums

 

[pikachu]

I'd just like to offer that UC Davis should be added to the 'hellpit' category of programs. The UC Davis chair, Dr. Richard Valicenti, spoke at Q&A during the workforce talk at ASTRO and suggested that we continue to train 'for the future we want' and that an undersupply will cause rural patients to suffer.

Newflash, Dick: we're making more residents than ever and people still don't want rural jobs. By saying "train more", what you're really saying is "let's make sure people are forced into jobs they don't want because they won't have other options." That's a ****ty thing to say to trainees, and med students know it.

Here's the answer to solving rural access (for all of medicine, not just RO): pay more.

That's it.

That was… a vigorous discussion
I thought Pinnix did a great job shooting down that argument, though

 

[Mandelin Rain]

workforce talk at ASTRO and suggested that we continue to train 'for the future we want'

 

[Mandelin Rain]

When someone in a leadership position unironically and publicly states that "we should train for the future we want," you should immediately realize just how ****ed we all are.

 

[NotMattSpraker]

When someone in a leadership position unironically and publicly states that "we should train for the future we want," you should immediately realize just how ****ed we all are.

That was… a vigorous discussion
I thought Pinnix did a great job shooting down that argument, though

Agree. I didn't catch who that was, but at best that person is grossly misguided by their COI and at worse they are a horrible person.

I'd strongly suggest everyone watch the session if possible. If you haven't been following closely, it was an excellent summary of the important points and it was all framed really well.

It is so shameful that 75% of the SOAPs are people who don't match in their desired, other field. We are a predatory field in the SOAP.

Chirag should be applauded for getting us here and putting this message out so clearly. Programs need to close or contract.

So who will close? Maybe Sameer can step up. Michalski? (lol) Vapiwala? Pinnix? What about in Cleveland where there are two good programs? Spratt?

In my opinion, this is the best chance for ASTRO insiders to step up and act selflessly in line with their words.

 

[TheWallnerus]

That was… a vigorous discussion
I thought Pinnix did a great job shooting down that argument, though

Pinnix don’t play glad to hear it

 

[CaesarRO]

Agree. I didn't catch who that was, but at best that person is grossly misguided by their COI and at worse they are a horrible person.

I'd strongly suggest everyone watch the session if possible. If you haven't been following closely, it was an excellent summary of the important points and it was all framed really well.

It is so shameful that 75% of the SOAPs are people who don't match in their desired, other field. We are a predatory field in the SOAP.

Chirag should be applauded for getting us here and putting this message out so clearly. Programs need to close or contract.

So who will close? Maybe Sameer can step up. Michalski? (lol) Vapiwala? Pinnix? What about in Cleveland where there are two good programs? Spratt?

In my opinion, this is the best chance for ASTRO insiders to step up and act selflessly in line with their words.

We've previously discussed the irony of the "best" programs being the ones to contract and the "worst" being least likely.

Just wanted to point out that Pinnix @ MDACC has already taken the step of contraction, and in Cleveland from what I recall Tendulkar @ Cleveland Clinic did as well.

 

[medgator]

Agree. I didn't catch who that was, but at best that person is grossly misguided by their COI and at worse they are a horrible person.

I'd strongly suggest everyone watch the session if possible. If you haven't been following closely, it was an excellent summary of the important points and it was all framed really well.

It is so shameful that 75% of the SOAPs are people who don't match in their desired, other field. We are a predatory field in the SOAP.

Chirag should be applauded for getting us here and putting this message out so clearly. Programs need to close or contract.

So who will close? Maybe Sameer can step up. Michalski? (lol) Vapiwala? Pinnix? What about in Cleveland where there are two good programs? Spratt?

In my opinion, this is the best chance for ASTRO insiders to step up and act selflessly in line with their words.

We've previously discussed the irony of the "best" programs being the ones to contract and the "worst" being least likely.

Just wanted to point out that Pinnix @ MDACC has already taken the step of contraction, and in Cleveland from what I recall Tendulkar @ Cleveland Clinic did as well.

Should be the LIJ/Louis potters of the field, also places like wvu, tenn, Mississippi etc but we all know that will never happen

 

[NotMattSpraker]

We've previously discussed the irony of the "best" programs being the ones to contract and the "worst" being least likely.

Just wanted to point out that Pinnix @ MDACC has already taken the step of contraction, and in Cleveland from what I recall Tendulkar @ Cleveland Clinic did as well.

It should be but it wont be, that is really what I am saying. R-spots and SOAPs are up this year. This is despite the local (small) efforts of Pinnix and Tendulkar.

If they want to be heroic, they should do the very selfless move of closing their programs... even though we all know that would probably be a net negative for medical education in this field. If they don't, of course they personally should not be blamed. The people in that session have already done more than their fair share on this issue.

We just happen to have an adequate supply of good medical education and a critical shortage of selfless leaders.

 

[sirspamalot]

Somebody please post the vid for this... and also the ROCR if ya have it.

I would really like to hear how it went down.

 

[sirspamalot]

So who will close? Maybe Sameer can step up. Michalski?

The only thing, and I do mean THE ONLY thing JMM is interested in... is JMM.

 

[pikachu]

Programs here and there randomly going down a spot or two is not going to solve the problem. As people on here have astutely pointed out in the past this is a classic problem of collective action and will require concerted effort across the specialty to address it.

 

[pikachu]

Programs here and there randomly going down a spot or two is not going to solve the problem. As people on here have astutely pointed out in the past this is a classic problem of collective action and will require concerted effort across the specialty to address it.

One could also speculate that the programs most in need of closing are the ones least likely to do so. Again, a couple programs falling on their swords will not do the trick here.

 

[NotMattSpraker]

One could also speculate that the programs most in need of closing are the ones least likely to do so. Again, a couple programs falling on their swords will not do the trick here.

Why do people fall on swords though?

We know all this already. I don't disagree with what you are saying, but what do you suggest we do? Spots and SOAPS are up.

 

[fiji128]

I'd just like to offer that UC Davis should be added to the 'hellpit' category of programs. The UC Davis chair, Dr. Richard Valicenti, spoke at Q&A during the workforce talk at ASTRO and suggested that we continue to train 'for the future we want' and that an undersupply will cause rural patients to suffer.

Newflash, Dick: we're making more residents than ever and people still don't want rural jobs. By saying "train more", what you're really saying is "let's make sure people are forced into jobs they don't want because they won't have other options." That's a ****ty thing to say to trainees, and med students know it.

Here's the answer to solving rural access (for all of medicine, not just RO): pay more.

That's it.

So useless and yet destructive at the same time. The reality we don't like needs to be ignored and we only need to manifest the reality we want. With vision like this I can't imagine why US grad med students are choosing to stay away.