How much does it matter where you train if you want to go into private practice?

[Shadowfeet23]

So, for all of us MS-IV's on the interview trail that are wrapping things up and making our Rank Lists, I thought I would pose a couple of questions:

1. If you want to do private practice, does the name recognition (or prestige) of your residency program matter? If so, how much?

Obviously, if you have someone who trained at MDACC versus someone who trained at a "lower tier" program, the MD Anderson guy is going to get the job. But, outside of those extremes, what do you guys/gals think?

2. What kind of questions do prospective employers ask of the PGY-5 residents when they are interviewing them? (e.g. what treatment machines you are proficient on, what are your "numbers"/caseload, etc.)

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[deleted4401]

That's a very good question. I think the short answer is all things being equal, pedigree matters.

However, having just interviewed for jobs, it is a bit murkier than that.

I was told that certain groups are VERY interested in pedigree, but I got some interviews from a few of those groups. It seemed out West, this may have been more pronounced (Seattle, Portland, SF, LA).

Nobody asked me about numbers/caseloads or treatment machines, but everyone was interested in specific modalities. Almost everybody wanted to know if I could/was willing to do prostate implants. Some places were very interested in someone willing to do HDR/Gyn. Everyone seemed impressed with my institution's SRS training/experience, and wanted someone on board to do those cases. They all assume you can do modern treatment planning (3D/IMRT), and it was a non-issue. They did seem to ask about research, but more in a way to start conversations. The older docs don't seem to have a grasp on what the "top" places are and often assume institutions with a big name cancer center or hospital have very strong rad onc training (often true, but not always).

I get the idea that local people are favored for positions, and I got that feeling a lot specifically with Chicago-area groups. I think being nice/friendly meant a lot more than it did during the residency interview process.

I'd say if you like a place in it's in a city/region you want to practice in, that's your best bet. I.e. - regardless of how good or bad Rush is, you will get interviews with Chicago groups if you train there.

 

[subatomicdoc]

Interesting questions, and there are no 'pat' answers. I speak only for myself practicing in community/private practice and trying to decide which candidates may be the best fit.

1. I won't deny that having someone join from a well-recognized academic program may be a nice marketing thing, but more important is clinical skills and being able to function well in a community setting. For those of you that are not familiar with the three As:

Accessibility
Affability
Ability

This is where you matter much more than the training program. Hubris is a bigger negative than MDACC is a positive.

2. Experience is important, not only caseload but degree of actual involvement in the evaluation and treatment process.

I disagree with Simul somewhat about picking a program just because you think you eventually want to settle there. Yes it will help you get the interview but if you know you want to be in a certain area then just make contact earlier with private practices even if it's only preliminary. I'll be interested to see if other community docs respond.

 

[StanleyCup7]

Simul and subatomicdoc, thanks for all of the knowledge. Like shadowfeet, I am also an MS-IV that is agonizing over my rank order list. I have also wondered how much the pedigree of your residency program affects your marketability when looking for a job as you near graduation. Any and all insight would be greatly appreciated...Thanks.

 

[Shadowfeet23]

I appreciate the posts above...anybody else?

 

[medgator]

I appreciate the posts above...anybody else?

It's important to a certain degree. Wherever you end up, you want to make it's a place where you can get up-to-date training with with a full spectrum of oncology patients. As SimulD said above, modalities are an important issue (outside of protons, which for now, will continue to be a non-issue for most PPs). As the more recent grad in a group, you may be the person with the most SBRT experience when it comes to implement/expand the program. It's therefore important that you've had exposure to that in residency.

That being said, a lot of the interview process with a group will boil down to "fit", which isn't that far off from interviewing for residency. Partners want hard-working, friendly folks to join the group who are willing to network and communicate well with referring physicians and provide compassionate, state-of-the-art care to their patients.

 

[TarHeelRadOnc]

It's important to a certain degree. Wherever you end up, you want to make it's a place where you can get up-to-date training with with a full spectrum of oncology patients. As SimulD said above, modalities are an important issue (outside of protons, which for now, will continue to be a non-issue for most PPs). As the more recent grad in a group, you may be the person with the most SBRT experience when it comes to implement/expand the program. It's therefore important that you've had exposure to that in residency.

That being said, a lot of the interview process with a group will boil down to "fit", which isn't that far off from interviewing for residency. Partners want hard-working, friendly folks to join the group who are willing to network and communicate well with referring physicians and provide compassionate, state-of-the-art care to their patients.

Sorry to be late on this post, I haven't checked this site in a while...

I think that the era of location of training affecting job prospects is probably coming to an end. Anecdotally, I trained in the Mountain West and looked at jobs exclusively in the Southeast (NC, SC and Georgia, specifically). I don't feel that my location of training had any bearing on my job prospects in the region I selected to look. I have several other friends who graduated this year and looked for/found jobs in regions remote from where they trained and in which they had no family ties or connections.

My advice to anyone looking next year is to start early. The good jobs tend to fill up with minimal or no advertising. I would suggest reaching out to prospective practices in late May or June to express interest and find out if they are planning to add anyone when you graduate. I agree with the previous posters that the technology that you trained with is probably more important to prospective practices than location. I trained at a place with an extensive experience in SBRT and image-guided RT. This was very appealing to the practices I interviewed with, as the partners who were three or more years out of residency didn't get this as part of their training. Other attractive skill sets/experience are prostate brachytherapy (both LDR and HDR) and SRS. Unfortunately, IMRT experience doesn't really stand out anymore...

The most important part of the job search, IMO, is how you market yourself. Don't be shy about marketing your skill sets and discussing how you would approach challenging cases... You'll be surprised how smart you sound and how much you'll impress prospective employers. Also, drop names when appropriate. Rad Onc is a small field and you are likely to know some of the same people as your interviewers... establishing these common connections can be helpful as well.

 

[medgator]

Unfortunately, IMRT experience doesn't really stand out anymore...

Agreed. It would almost stand out if you didn't receive IMRT experience, although I suspect that's a non-issue for most programs these days.

 

[RadOncLova]

Along the same lines as what the OP was asking: what if you go to a program that almost exclusively puts people into academics (or has that as their main goal). Are your private practice options limited because of this?