Hellpits- absolute worst programs in radiation oncology

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Should be the LIJ/Louis potters of the field, also places like wvu, tenn, Mississippi etc but we all know that will never happen
why would vijay, a member of the acgme, ever vote for anything that closed down his program? though i heard he retired. Maybe he'll be replace with some one like Steinberg -- who will never vote to reduce grads otherwise he would have to pay them more.

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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.
It's like he reads SDN but doesn't understand it.

Probably what happened.

Is he really taking credit for @elementaryschooleconomics?
 
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I forgot uc Davis had a program. Valicenti was one of the guys who gave Jeff a malignant rep under Wally. If you need to be in ca for residency, Davis def worst location.
"train 'for the future we want'"

My guess is the future that he wants isn't "highly compensated specialists in hot demand coast to coast."
 
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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.
Not SOAPing is not going to work because there are outside pressures for programs to fill. The spots need to not be offered in the first instance. Programs don't want to CUT spots, but perhaps could be persuaded to PAUSE a spot for one or two Match cycles maybe in alternate years. This would buy some time for tightening the ACGME program requirements to take effect and to take stock of how changes in payment structure, staffing requirements, etc. will affect the specialty. I think it is unlikely that all programs in the country would be willing to do this, but the effects of even a couple dozen programs doing so could be a good start. This of course doesn't stop a lousy program that doesn't fill in the Match from SOAPing a naturopath from Hollywood Upstairs Medical College whose original plan was to be a celebrity dermatologist, but at least the number of grads shrinks a bit. Kind of a "stop the spread" approach.
 
UC davis has always been on my hellpit list, and to this day has not been removed. I have posted list before and can post again, it remains mostly unchanged. These are terrible places which should be avoided
 
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Post it again


IMO Bottom tier programs to avoid due to combination or single issue: poor job placement/lack of help getting jobs, poor residency experience, subpar educational culture, board failures, tons of scut and service component which vastly outweighs education, history of resident firing/ugliness, brand new program in a saturated area/cheap labor expansion, malignancy, nepotism/corruption. This of course does not mean residents from these places are incompetent. My goal is to guide readers in choosing wisely.

NYP Methodist

Columbia

Northshore LIJ

SUNY downstate
SUNY upstate
Dartmouth

Stony Brook

Allegheny
WVU

Arkansas

Oklahoma

MUSC

Univ of Tennessee 

Baylor

UT-San Antonio

UTMB-Galveston

Texas A&M/Baylor Scott and White
Mississippi

Univ. of Kentucky

Louisville 

Case Western

UC Davis

UC Irvine 

Georgetown
Jefferson

Miami
USC
Loma Linda
Cedar Sinai
Wayne State
Iowa
Univ. Of Minnesota
Nebraska

I have removed UPMC after confirming with sources Skinner seems to be turning it around. Georgetown has been added because i forgot to include it in the past, was always in my list but realised it was not in my 2022 list
 
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Solid list. I would take off miami, Jeff, case west and Georgetown. They just aren’t in the same league as Texas am or stony brook. Rest are horrible.
 
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Solid list. I would take off miami, case west and Georgetown. They just aren’t in the same league as Texas am or stony brook.
I understand miami might be “controversial” to some and last time i posted this list even the miami APD and columbia PDs posted in response. Case might be “improving” but they are soaping warm bodies, unnecessary program. Georgetown I have heard from sources very familiar through PM requesting it to be added. I cant share all details not trying to dox anyone and respect peoples privacy, but believe me i am not just randomly lightly adding these places

Feel free to PM me if anyone has feedback/wants to discuss further or wants something added
 
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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.

80% in undesireable areas? Data? Published data suggests that 3-6% of new grads took a job in a county without a metro area across two recent years.
 
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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.

Didn't imagine that boomer with the hot (horrible) take that rural patients were actively being harmed by potential undersupply was actually a chair at an academic program. Sounded (and IMO, tried to come off as) like a rural community guy. Now his comments make sense, dripping with the COI as a chair looking for cheaper faculty at his program.
 
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Didn't imagine that boomer with the hot (horrible) take that rural patients were actively being harmed by potential undersupply was actually a chair at an academic program. Sounded (and IMO, tried to come off as) like a rural community guy. Now his comments make sense, dripping with the COI as a chair looking for cheaper faculty at his program.

I look forward to him leaving his academic practice to join a community clinic in BFE.
 
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IMO Bottom tier programs to avoid due to combination or single issue: poor job placement/lack of help getting jobs, poor residency experience, subpar educational culture, board failures, tons of scut and service component which vastly outweighs education, history of resident firing/ugliness, brand new program in a saturated area/cheap labor expansion, malignancy, nepotism/corruption. This of course does not mean residents from these places are incompetent. My goal is to guide readers in choosing wisely.

NYP Methodist

Columbia

Northshore LIJ

SUNY downstate
SUNY upstate
Dartmouth

Stony Brook

Allegheny
WVU

Arkansas

Oklahoma

MUSC

Univ of Tennessee 

Baylor

UT-San Antonio

UTMB-Galveston

Texas A&M/Baylor Scott and White
Mississippi

Univ. of Kentucky

Louisville 

Case Western

UC Davis

UC Irvine 

Georgetown
Jefferson

Miami
USC
Loma Linda
Cedar Sinai
Wayne State
Iowa
Univ. Of Minnesota
Nebraska

I have removed UPMC after confirming with sources Skinner seems to be turning it around. Georgetown has been added because i forgot to include it in the past, was always in my list but realised it was not in my 2022 list

As much as Case has improved its faculty since Spratt joining, I can't justify it still being on the list.
Somewhat same concept for Oklahoma.

Jefferson for its historical malignancy, unclear if changing. Miami simply for being one of the most aggressive SOAPers in recent history.

Every program should contract by one spot. If you have less than 4 residents after that, you close. The ACGME requirements of 1.5 clinical faculty involved with residents PER resident needs to be enforced, HARD, like yesterday. 3-4 years from now is too long as Vapiwala mentioned at the talk.

IMO, Part of the reason the job market is so good in past 2 years (since ACGME rules) is that many residency programs are hiring more attendings so that they can be compliant with ACGME requirements which are going to be enforced at some point in the next few years.

As Chirag said, we have until 2025 to figure this **** out, otherwise 2030 onwards will 100% be a ****show.

James Bates talkign about the worst case scenario in terms of medicare enrollment DROPPING 8% (and not increasing 1.1% as the model 'predicted') over the 2019-2023 timeframe is already setting us up for significant oversupply by 2030.

But, the Haffty's and other boomer chairs of the world will continue to ignore the problem.
 
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80% in undesireable areas? Data? Published data suggests that 3-6% of new grads took a job in a county without a metro area across two recent years.
Please, please look at the core statistical area map.

This analysis is probably not meaningful.

I am certainly in a rural county (largest town just over 8K and large geographic area). I am bundled into a good sized metro.

There are rural areas within the largest core statistical areas.

You could be in Coldwater, Michigan and have it not be considered rural.
 
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Coldwater is an hour outside of Fort Wayne. Someone could live in a northern Fort Wayne suburb and commute daily to Coldwater.

Not saying Coldwater isn't rural, but is Fort Wayne, IN considered rural/underserved?

I get that the definitions won't be perfect, but the reported statement was that 80% of new grads are going to undesireable areas. I presented some (imperfect) data refuting that and am interested in that user's data supporting 80% underserved (by whatever definition that user is using)
 
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Coldwater is an hour outside of Fort Wayne. Someone could live in a northern Fort Wayne suburb and commute daily to Coldwater.

Not saying Coldwater isn't rural, but is Fort Wayne, IN considered rural/underserved?

I get that the definitions won't be perfect, but the reported statement was that 80% of new grads are going to undesireable areas. I presented some (imperfect) data refuting that and am interested in that user's data supporting 80% underserved (by whatever definition that user is using)
I can't speak to what defines undesirable. To me desirable was hometown and then it would be cities I'm interested in...Fort Wayne would not be on the list of the top 50, although it is certainly desirable to some.

I will leave this here. I am not close to Fort Wayne and know none of the docs. But I was confident before I ever clicked the link that the Radocs in a mid-sized Indiana city would seem pretty baller on paper.


Edit: By the time living in FW with an hour commute is desirable...
 
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Coldwater is an hour outside of Fort Wayne. Someone could live in a northern Fort Wayne suburb and commute daily to Coldwater.

Not saying Coldwater isn't rural, but is Fort Wayne, IN considered rural/underserved?

I get that the definitions won't be perfect, but the reported statement was that 80% of new grads are going to undesireable areas. I presented some (imperfect) data refuting that and am interested in that user's data supporting 80% underserved (by whatever definition that user is using)
Fort Wayne, IN is a not a large city and I would call it undesirable.
 
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As much as Case has improved its faculty since Spratt joining, I can't justify it still being on the list.
Somewhat same concept for Oklahoma.

Jefferson for its historical malignancy, unclear if changing. Miami simply for being one of the most aggressive SOAPers in recent history.

Every program should contract by one spot. If you have less than 4 residents after that, you close. The ACGME requirements of 1.5 clinical faculty involved with residents PER resident needs to be enforced, HARD, like yesterday. 3-4 years from now is too long as Vapiwala mentioned at the talk.

IMO, Part of the reason the job market is so good in past 2 years (since ACGME rules) is that many residency programs are hiring more attendings so that they can be compliant with ACGME requirements which are going to be enforced at some point in the next few years.

As Chirag said, we have until 2025 to figure this **** out, otherwise 2030 onwards will 100% be a ****show.

James Bates talkign about the worst case scenario in terms of medicare enrollment DROPPING 8% (and not increasing 1.1% as the model 'predicted') over the 2019-2023 timeframe is already setting us up for significant oversupply by 2030.

But, the Haffty's and other boomer chairs of the world will continue to ignore the problem.

HEY. Haffty has "mixed feelings" alright? Im glad I watched recorded. If it was live I wouldnt have been able to resist asking him if his feelings about trainee abuse are more or less mixed than his feelings about breast IMRT :rofl:
 
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HEY. Haffty has "mixed feelings" alright? Im glad I watched recorded. If it was live I wouldnt have been able to resist asking him if his feelings about trainee abuse are more or less mixed than his feelings about breast IMRT :rofl:
Haffty’s program is new and totally unnecessary addition to nyc metro. Was not around when I applied.

Jeff has always been a very nasty place. With fox chase around the corner for those who don’t match/don’t like UPenn, not sure why anyone would go there.
 
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Fort Wayne, IN is a not a large city and I would call it undesirable.

I mean... it, on its own, has a population of 250k (not metro area), good for reportedly in the top 100 most populated cities in the US: List of United States cities by population - Wikipedia

Sure, not desireable to me (or you) but what's the definition of desireable? Population the only thing? What's the maximum number of places one can deem to be desireable in the US? Is it 10? 25?

Is it based solely on population? If so, does El Paso beat Boston, or nah?

We all have an individual list of desireable and non-desireable cities. But how do we, as we define the quality of jobs that graduating rad onc residents are getting, try to 'define' what we're actually looking for? How can we make any attempt to be objective about where residents are ending up, if any metric of what is 'desireable' is immediately shot down as being biased?
 
I mean... it, on its own, has a population of 250k (not metro area), good for reportedly in the top 100 most populated cities in the US: List of United States cities by population - Wikipedia

Sure, not desireable to me (or you) but what's the definition of desireable? Population the only thing? What's the maximum number of places one can deem to be desireable in the US? Is it 10? 25?

Is it based solely on population? If so, does El Paso beat Boston, or nah?

We all have an individual list of desireable and non-desireable cities. But how do we, as we define the quality of jobs that graduating rad onc residents are getting, try to 'define' what we're actually looking for? How can we make any attempt to be objective about where residents are ending up, if any metric of what is 'desireable' is immediately shot down as being biased?

There will be some larger MSAs that are generally considered less desirable (eg. Fresno, ~1.2M population, #48) and smaller that are generally considered more desirable (eg. Asheville, ~413k, #131). It's not purely based on population and there's no inherent right or wrong because it will be specific to each individual.

Except for Fort Wayne. That is definitely undesirable. I mean, ew.
 
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I mean... it, on its own, has a population of 250k (not metro area), good for reportedly in the top 100 most populated cities in the US: List of United States cities by population - Wikipedia

Sure, not desireable to me (or you) but what's the definition of desireable? Population the only thing? What's the maximum number of places one can deem to be desireable in the US? Is it 10? 25?

Is it based solely on population? If so, does El Paso beat Boston, or nah?

We all have an individual list of desireable and non-desireable cities. But how do we, as we define the quality of jobs that graduating rad onc residents are getting, try to 'define' what we're actually looking for? How can we make any attempt to be objective about where residents are ending up, if any metric of what is 'desireable' is immediately shot down as being biased?
I could live in 95% of these places for salary in 75%. Probably draw the line at el paso and Tulsa.
 
I know folks working in Fort Wayne and reportedly it's a great gig with great QoL
 
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I know folks working in Fort Wayne and reportedly it's a great gig with great QoL
Maybe, but I bet you they are in the top 1% of docs in ft Wayne in terms of their resume. Years back, had a recruiter pitch something in ft Wayne and the pay was average
 
Maybe, but I bet you they are in the top 1% of docs in ft Wayne in terms of their resume. Years back, had a recruiter pitch something in ft Wayne and the pay was average

Idk man. I’m aware of tons of cities like Ft. Wayne or similar populations with very well trained docs in other specialties who are at the top of their game and who trained in big cities. Rad onc is a bit unique in that most people want to live in larger cities. For whatever reason. I bet there are many urologists ENTs orthos derms who trained at large academic centers who choose to live there and have great lives with their families
 
After walking out of the talk, I heard one boomer-appearing guy talk to a younger female colleague about how "the job market was fine" and "everyone I know has at least 4 offers"...

yada yada the weather and the climate...

We're cooked.
 
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Idk man. I’m aware of tons of cities like Ft. Wayne or similar populations with very well trained docs in other specialties who are at the top of their game and who trained in big cities. Rad onc is a bit unique in that most people want to live in larger cities. For whatever reason. I bet there are many urologists ENTs orthos derms who trained at large academic centers who choose to live there and have great lives with their families
I am sure urologists, ent, ortho in ft Wayne are making obscene salaries
 
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Since the inclusion of Jefferson was seen as controversial by some. I received another PM from someone highly familiar with the program absolutely confirming it belongs in this list as previous DMs have suggested. Here are the paraphrased notes taking out some details to preserve privacy:

The program has had at least 3 different PDs in past decade. The program expanded after swallowing up Drexel spots permanently. The program has been prolific SOAPER taking many outside match and significantly lowering standards (board failures, matching warm bodies without any interest in oncology, other resume red flags which would have killed applications in the past). This last batch of recent grads was the last one to have matched under any sort of rigor or standards.

Keep them coming. I will respect your privacy and expose these warm body loving hellpits. The breadlines are a’ coming folks!
 
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Since the inclusion of Jefferson was seen as controversial by some. I received another PM from someone highly familiar with the program absolutely confirming it belongs in this list as previous DMs have suggested. Here are the paraphrased notes taking out some details to preserve privacy:

The program has had at least 3 different PDs in past decade. The program expanded after swallowing up Drexel spots permanently. The program has been prolific SOAPER taking many outside match and significantly lowering standards (board failures, matching warm bodies without any interest in oncology, other resume red flags which would have killed applications in the past). This last batch of recent grads was the last one to have matched under any sort of rigor or standards.

Keep them coming. I will respect your privacy and expose these warm body loving hellpits. The breadlines are a’ coming folks!
Def a terrible place to be a resident and with fox chase soaping, there is just no good reason to be at Jeff. The chairman is true to his name.
 
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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.

First hand experience with this. I worked at a center that closed during Covid and was forced to take a job in a town I had no connections with a company that was nothing short of predatory (they are hiring now to replace my position as I recently left - beware). These problems are real and unique to our field. I have an on-paper background that is objectively “better” than most of my friends/family in medicine who chose other fields. Yet no one else whom I know outside of rad onc has had to go through what I have in making choices between terrible geography vs terrible pay. I’m impressed that many med students are wise enough to think about these issues when choosing their specialty. Although the job market wasn’t quite as bad as it is now when I was applying to residency, I’m not sure if I would have been savvy enough to consider its significant impact as a student.
 
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First hand experience with this. I worked at a center that closed during Covid and was forced to take a job in a town I had no connections with a company that was nothing short of predatory (they are hiring now to replace my position as I recently left - beware). These problems are real and unique to our field. I have an on-paper background that is objectively “better” than most of my friends/family in medicine who chose other fields. Yet no one else whom I know outside of rad onc has had to go through what I have in making choices between terrible geography vs terrible pay. I’m impressed that many med students are wise enough to think about these issues when choosing their specialty. Although the job market wasn’t quite as bad as it is now when I was applying to residency, I’m not sure if I would have been savvy enough to consider its significant impact as a student.

That is really sad. I’m sorry that happened to you.

It’s really good advice to tell med students to think very carefully about the small field size and geographic restriction of rad onc.

I know a lot of people that have had weird work/life compromises due to geographic restriction in rad onc, including myself. Met several at ASTRO this year that are seeking a job change just because they don’t like where they live.

Yours situation seems way worse than mine ever was and seems like a unique scenario, but can totally see this happening to others in the future with all the financial uncertainty. I can’t imagine having to work away from family and additionally for a predatory group.

We have no data so this is all anecdote and I suspect these kinds of stories are more common than we think.

Hope things are better for you now.
 
The UC Davis chair sounds like a smelly turd. I wish I could’ve attended the session but obliged to be elsewhere Saturday afternoon. What was the response like?

The only actions we can take are unilateral.

Unapologetically telling trainees radiation oncology is a dumpster fire job market and that many programs are hellpits. Voting with your membership dollars for organizations that support community physicians. If there’s ever a legislative opportunity, pushing back PPSE at academic satellites. Absolutely refusing to join so-called academic practices. Tacitly declining to enroll onto trials omitting radiotherapy.

And finally, this is controversial, but I believe it’s part of the solution. Community radiation oncologists should absolutely practice at the top of our license and bandwidth. When you have a busy practice and provide top notch care, that’s one less spot that’s available to a new graduate. It’s easier for all parties (physicians, medical groups, hospital systems) to expand their workforce, cutting headcount is much harder. Look at RO residency programs. Look at bloated big tech/SaaS during post-COVID Fed tightening cycle.

Let’s not make the same mistake as lazy academics who wanted a resident slave to write notes, do scut, contour normals so they could WFH 2-3 days a week without paying a midlevel. The best thing we can do is to be at the top of our game in local markets and take market share from local academic systems.
 
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'And finally, this is controversial, but I believe it’s part of the solution. Community radiation oncologists should absolutely practice at the top of our license and bandwidth. When you have a busy practice and provide top notch care, that’s one less spot that’s available to a new graduate.'

What does this accomplish though? The GOAL isn't to give less jobs to graduates in my view. In fact, it's the problem we need to fix.
 
The GOAL isn't to give less jobs to graduates in my view. In fact, it's the problem we need to fix.

I’d like to see good jobs.

Purely based on compensation from ARRO survey, I don’t think graduates are taking good jobs. Unless those benefits come with a company car and indefinite free use of the chairman’s house.

The surveys put out by ARRO primarily look at whether graduates have “a job” so that’s the metric that has to give a signal.

It’s painful but that’s the rad onc job market.

Of course the most straightforward solution is to close residency programs or sue whoever approves new residency positions or programs. I do love the courts.

Open to your thoughts.
 
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That is really sad. I’m sorry that happened to you.

It’s really good advice to tell med students to think very carefully about the small field size and geographic restriction of rad onc.

I know a lot of people that have had weird work/life compromises due to geographic restriction in rad onc, including myself. Met several at ASTRO this year that are seeking a job change just because they don’t like where they live.

Yours situation seems way worse than mine ever was and seems like a unique scenario, but can totally see this happening to others in the future with all the financial uncertainty. I can’t imagine having to work away from family and additionally for a predatory group.

We have no data so this is all anecdote and I suspect these kinds of stories are more common than we think.

Hope things are better for you now.

Thank you. Things are much better now fortunately but to have to sacrifice additional years after all of the sacrifice we already endured going through the process of becoming board certified physicians certainly was not what I had envisioned when I decided to go to med school.

While my situation was unique in some ways, I personally know several rad oncs stuck in jobs they dislike in locations they dislike even more due to limitations in the job market. I also believe we need a thread discussing hell pit jobs as much as we need this thread on hell pit residencies.
 
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.

While my situation was unique in some ways, I personally know several rad oncs stuck in jobs they dislike in locations they dislike even more due to limitations in the job market. I also believe we need a thread discussing hell pit jobs as much as we need this thread on hell pit residencies.
As a former employee of a predatory practice stuck in a hellpit location in my first job out of training, wholeheartedly agree.

Can't overemphasize enough the importance of talking to previous employees of a group or practice or hospital etc. Google if you have to
 
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I’d like to see good jobs.

agree fully. I guess my point stands in that I'm not sure what partners or employees overworking themselves past where they may want to be in order to purposefully not hire a new junior partner or person is a good thing to help make that happen.
 
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agree fully. I guess my point stands in that I'm not sure what partners or employees overworking themselves past where they may want to be in order to purposefully not hire a new junior partner or person is a good thing to help make that happen.
I know very very very few radoncs who are clinically overworking themselves. (Not counting admin and research) Even docs who consistently average 10-12consults a week, get home by 6 and don’t work most weekends. Furthermore, almost all these docs have less busy partners to whom they could offload pts if they desired.
 
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I know very very very few radoncs who are clinically overworking themselves. (Not counting admin and research) Even docs who consistently average 10-12consults a week, get home by 6 and don’t work most weekends. Furthermore, almost all these docs have less busy partners to whom they could offload pts if they desired.

Sure but not really the point. The point was directly addressing yesmaster’s call to action.
 
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First hand experience with this. I worked at a center that closed during Covid and was forced to take a job in a town I had no connections with a company that was nothing short of predatory (they are hiring now to replace my position as I recently left - beware). These problems are real and unique to our field. I have an on-paper background that is objectively “better” than most of my friends/family in medicine who chose other fields. Yet no one else whom I know outside of rad onc has had to go through what I have in making choices between terrible geography vs terrible pay. I’m impressed that many med students are wise enough to think about these issues when choosing their specialty. Although the job market wasn’t quite as bad as it is now when I was applying to residency, I’m not sure if I would have been savvy enough to consider its significant impact as a student.

I feel these type of scenarios are fairly common in this field. It's not unusual at all to know or hear of docs living away from their families/preferred locations to find decent positions. This type of stuff goes hat in hand with over training/over supply. This is why potential US MD medical students are avoiding rad onc. In the slides I have seen from this year's astro, this dynamic is not even acknowledge by the "academic" thought leaders wondering why the specialty is at the bottom of the match.
 
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I feel these type of scenarios are fairly common in this field. It's not unusual at all to know or hear of docs living away from their families/preferred locations to find decent positions. This type of stuff goes hat in hand with over training/over supply. This is why potential US MD medical students are avoiding rad onc. In the slides I have seen from this year's astro, this dynamic is not even acknowledge by the "academic" thought leaders wondering why the specialties at the bottom of the match.
💯

IMGs FMGs are often geographically agnostic so this isn't a new thing for them
 
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