M4 thinking strongly about applying to Rad Onc: Why is there so much dissonance between opinions real life and the internet?

[TheIllusionist]

I posted before but briefly (STEP1 247, STEP2CK 261, P/F system preclinical, all honors for clinical rotations, 5 abstracts- 4 basic from research year at a Top 3 and all in rad onc). I'm doing aways at good but not elite programs. I have spoken to residents at three institutions: my own (low-mid tier rad onc program), my research year program, and my current away.

All of the residents seem to believe that there are some concerns but they are way overblown. Their friends are doing well and getting good jobs. I have no idea what to believe. I am very confused consolidating opinions. I really enjoyed both the research and clinical side of the field. I like the types of people I have worked with. I like all the interaction with people of different specialties. I like the patient populations, from the very wealthy to the very poor because with oncology, both groups seem to quite interested and attentive about their care, barring a few exceptions. I have enjoyed treatment checks and explaining to patients what radiation is and why it will or won't be done for their cancer (of course under supervision of resident or attending). Yeah I am not a fan of all of the minutia that needs to be learned, but at this stage, I have no idea what parts are truly clinically relevant. But that would probably be my biggest complaint. I thought I wouldn't like the anatomy emphasis way back when I first learned about rad onc in M2. But third year really changed that. I really enjoy anatomy correlates with clinical symptoms, especially for CNS tumors.

Am competitive for the types of programs that would shield from some of the job issues that rad onc is facing?

Just an aside, other specialties I can see myself doing: psych, IM to cardio- electrophysio or heme onc.

Also, some strategies I have considered:

1. Applying broadly to rad onc, and then switching to IM after medicine intern year, if I don't get into the type of program I want that supports its residents and has a good track record placing people into jobs

2. Alternatively, only apply to mid and top tier programs known to place people well and then just double apply to IM.

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[medgator]

Depends on your preferred geographic locale and practice model post residency

 

[deleted947887]

2. Alternatively, only apply to mid and top tier programs known to place people well and then just double apply to IM.

I would do that minus the mid.

No one will tell you how bad the market is in person because they don't want to deal with the consequences from their program (for what? Advising a medical student? Not worth the risk). Apparently an attending was fired for raising some of the job market concerns. I can tell you things are definately not good, otherwise people wouldn't be writing articles about alternative careers (public health, MBA, etc), and they certainly would not be concerned about an online forum of misanthropes. Speak to people in private practice. You may get a more accurate picture. They can speak more freely and honestly than academics.

 

[deleted947887]

Until you get into residency you have no clue how much pressure there is to be a cheerleader for the field and for your program. Say anything perceived as negative and the implications will be made clear to you. I know several people to whom this has happened and it was shocking to me how brazenly threats were made to promote the interests of the department. It’s a small field where everyone knows everyone and any negative opinions of you will matter for your job search.

The other issue is that many residents, particularly at good programs, still get good jobs, in the same way that the planet is ****ed but Miami is still a gorgeous place to live at the moment. The major concerns about the long term viability of the field are real and undeniable with a forthright look at the numbers, but radonc has a long way to fall and people at the top are still above water. But make no mistake: even those at top tier programs will be affected. You may get a job, but you’ll take a salary cut, have worse hours, less vacation, work in a disease site that isn’t your favorite, and without some major change that doesn’t seem to be forthcoming from “leaders,” this will continue to get worse throughout your career. You must realize that the fox is guarding the hen house in this respect: the same people in whose interest it is to tank the bargaining positions of graduating residents also control the supply of residents. Junior people in this field are AFRAID to be honest about how they feel. And that should tell you all you need to know about how sick it truly is.

Another thing is a lot of people in this field are just oblivious to basic economics. People in radonc can be extremely naive about basic concepts from the world outside what they need to memorize for their next board exam.

Agree with this completely. If you're open to medical oncology, I would explore that. Their field is much safer.

 

[Haybrant]

It’s not terrible this minute but it will be by the time you’re out. To me if you’re competitive in something else it’s a no brainer. This is not radiology which after a decade is now back in demand. Radiology positions are plentiful out there, Rad Onc not even close. Radiologists are now being signed in the last two/three years of residency, that’s an amazing feeling. That’s how rad onc used to be, not anymore not by far. So it’s yours choice who you believe but if you want to gamble w your future then go for it w rad onc. At least you’ve had full disclosure, none of us had that.

 

[medgator]

It’s not terrible this minute but it will be by the time you’re out. To me if you’re competitive in something else it’s a no brainer. This is not radiology which after a decade is now back in demand. Radiology positions are plentiful out there, Rad Onc not even close. Radiologists are now being signed in the last two/three years of residency, that’s an amazing feeling. That’s how rad onc used to be, not anymore not by far. So it’s yours choice who you believe but if you want to gamble w your future then go for it w rad onc. At least you’ve had full disclosure, none of us had that.

Radiology does not have the spectre of hypofractionation to deal with. Radiology demand will continue to increase with time as our population ages and more imaging and IR procedures are required.

Hypofractionation and sbrt is great for patients and society at large, but at its heart will allow existing ROs to treat more patients per year.

Which is exactly what you don't want to hear starting training now after oblivious and self-serving RO academia felt it necessary to double spots over the last decade with zero justification other than that they could.

The only thing that will fix RO is a reduction in residency spots to around ~100-110/year. Until then, expect further tightening in the job market and a downward pressure on salaries... Supply vs demand.

It's really a sad fall from grace. RO was the best specialty in medicine last decade imo and the academics have completely ruined it for those going forward.

 

[TheIllusionist]

Thanks for responses. still feel ambiguity

 

[KHE88]

A few comments here:

The discrepancy between online and real-life.
Online you will get opinions that naturally skew towards the negative because people will come to vent anonmyously. This is like Buying a TV on amazon. Sony probably sells one million models of a certain TV. Most people buy it, are totally happy and never think twice. But a handful of people have problems, so they go to write a review that says "This TV sucks. It was so bad it electrocuted my dog, gave me cancer, and my wife left me. 0/5 stars!!!" And then 100 out of 1,000,000 customers come and write scathing reviews, and maybe 200 write positive reviews. So it's got 3/5 stars, but it's missing those 999,700 positive reviews.

Real life you will get opinions that skew towards the positive. It's harmful to your professional image to have a negative attitude about work. Departments are tasked with attracting medical students. Residents want to appear agreeable and happy to cultivate their future. You have to read between the lines as it's rare that someone will outright say "this field sucks" to you in person.

The reality is somewhere inbetween these two, but IMO it lies much farther on the negative side.

You have 6 years before you earn your first rad onc paycheck. 2025. There could be two different presidents after Trump by this time. That's a lot of unknown. The data we have is that we are overtraining and people are getting less radiation. Competitive markets are already very oversaturated and there has been immense downward pressure on salaries so much so that family med docs are making more than rad oncs in these areas (see Stanford's exploitative "instructor" positions).

Rad onc is a great field and has some positives that will always be there:
- Minimal call
- No nights or weekends
- Interesting nature of the work
- Value of providing cancer care

But you have to balance this with the risk that you might not be able to find a job anywhere near where you would like to be and you may be making primary-care level money when you start out. If you're ok with this risk, then I'd say go for it.

Med onc seems to have a brighter future, but it has a lot of downsides:
- IM residency + 3 year fellowship
- Call, inpatient duties
- Much higher clinical workload
- And lets admit it, way less interesting than rad onc

I think radiology is still a safe bet regardless of concerns about AI. Just due to the numbers game, you'll have a better chance getting where you want to be and less downward pressure on salary. (I'm not aware of diagnostic radiologists making 250k in major coastal cities like some rad oncs do).

Good luck.

 

[KHE88]

You must realize that the fox is guarding the hen house

This really sums up neatly this general situation in rad onc better than anything I've read.

 

[medgator]

This really sums up neatly this general situation in rad onc better than anything I've read.

It's almost like a prisoner's dilemma. Too many spots hurts the specialty but neither the MD Anderson's nor the Arkansas's of the world want to be the ones to bring things back into equilibrium.

All of the organizations and thought leaders want to say it is out of their hands, or flat out deny there is even a problem.

Every programs wants their residency program and spots, the specialty be damned

 

[KHE88]

It's almost like a prisoner's dilemma. Too many spots hurts the specialty but neither the MD Anderson's or the Arkansas's of the world want to be the ones to bring things back into equilibrium. And all of the organizations and thought leaders want to say it is out of their hands

Well the genuis at the helm, Paul Wallner, thinks he can fix the problem by shutting down programs with <6 residents (non-evidence based number pulled out of thin air) by failing more people on rad bio and shifting the goal posts for ACGME accreditation by counting rad bio failure and not just oral failures.

I mean, to look at all of the problems in the field and say, "Guys, there is one problem we have to fix first and foremost: These flyover country yokels can't figure out what the Mega Mouse study means and they don't know understand TaqMan assay, or that BLAP75 limits DNA crossover. Totally unacceptable and clinically dangerous! We have to shut these places down. Residents can only learn rad bio at places like MSKCC."

When I am seeing a new patient with prostate cancer, I typically do a DRE, discuss surgery vs. radiation, then debate the results of the mega mouse study for at least a few hours on how I'm going to treat this guy. I don't know about you guys.

It's astonishing. The apologists that support this nonsense are astonishing. The gaslighting is revolting.

 

[medgator]

These flyover country yokels can't figure out what the Mega Mouse.



The gaslighting is revolting.

You mean like implying there are no smaller programs in coastal states? Yeah ok. Ftr, I trained at one

 

[bluebubbles]

All of the residents seem to believe that there are some concerns but they are way overblown.

"Yeah, you'll hear concerns online about the job market, but our residents tend to do well. Our chiefs got several job offers each and they'll be making [lots of money] in [cool city A/B/C]." I've heard other residents say this. I've said this myself to rotating med students. However, I'm not cheerleading for my PD or chair or SCAROP. Even if I have concerns about the job market, rad onc residencies are small. I still want cool, smart, & hardworking junior residents when I'm chief. If I'm talking to a M1-M3, I'll absolutely dissuade them from radiation oncology. But if I see a med student like yourself during away rotations or the interview process who is inevitably going into rad onc, I'll for sure paint a positive picture for you.

radonc has a long way to fall

The issue is that you have no perspective as a med student. As a resident, you realize that if you can easily manage 25-30 patients on-treat as a PGY-3/4/5 with no mid-level and a hands-off attending, you could manage 50+ patients on-treat in private practice with an APP. You also realize that it'd be challenging or impossible to build up that patient volume because the job market is saturated and residencies are overtraining.

You'll still do okay but you could've done much better.

The rad onc residents graduating in the mid-2000's might've had 50+ patients on-treat. You'll have 20 patients on-treat and be making 1/3 of their take-home pay.

The heme onc fellows graduating with you in 2025 will be making more than you in private practice (perhaps much more). If you go into academics, you'll get a startup package of $1-2 million; a heme/onc might get $5 million; mid-career, you might have 1 R01 and 1 foundation grant, whereas your colleague heme onc might have multiple R01's, a U grant, and significant industry funding.

Am I competitive for the types of programs that would shield from some of the job issues that rad onc is facing?

Yes, you're very competitive this application cycle. Even 5 years ago, you would've been competitive.

I've found that the programs best-shielded from job market issues are large, prestigious academic centers with a favorable patient/payor mix, an extensive alumni base, and network/affiliate/satellite cancer centers.

 

[ramsesthenice]

you might have 1 R01 and 1 foundation grant, whereas your colleague heme onc might have multiple R01's, a U grant, and significant industry funding.

I think a lot of what you speculated could reasonably be defended. But not this part. Maybe that was the experience where you trained but off hand I can name 6 rad oncs < 15 years out from training at non-elite programs with 2+ RO1s. I’m personally still too Junior to have an RO1 but industry funding for drug +RT + immunotherapy studies has been easy to come by.

Med Oncs have it a little easier in that most study sections have very little rad onc representation. Incremental rad onc studies are not likely to get high level funding but if the work is based on good science there is zero evidence to suggest rad oncs are going to have more difficulty getting funding in the coming future.

 

[ramsesthenice]

To be fair, While I don’t agree with the specifics of what BlueBubbles had to say about differences in research and funding between rad and med onc, there are some points worth mentioning. Mostly being that true tenure-track positions with enough protected time to realistically compete for multiple R0-1s are harder to come by in rad onc. It’s simple economics. Your chairman has to be willing to accept a financial loss for the greater good of the academic mission to support your research time. Do the math. Assume you are flying high and get 2 RO1s on the order of 3 million dollars over 5 years. Most indirect rates I have seen are in the 55-65% range recently so that means the institution takes in around $375 per year in overhead. The NIH caps your salary at the federal cap of just under 200k annually and if you claim 80% effort that saves them $150 K per year. Those numbers are pennies compared to the clinical revenue they are losing having you out of clinic or worse, having to have an extra rad onc on staff to take up the slack. Med oncs don’t have the same pressure because the revenue/physician is no where near as high.

Not having rad oncs on study section doesn’t help either. I was on the DOD horizon section this year and I can tell you how few sh@ts the other reviewers cared about proposals to use IM proton therapy to enhance abscopal responses (or me for that matter) or advances in MRI guided EBRT. As a rad onc, unless you are doing true basic science, getting high-level funding per grant can have a higher bar because you have to have excellent communication skills and be prepared to move further from your own lane to convince study sections that your proposed work matters. There isn’t great data but I would believe that our per grant funding percentage is lower than equally experienced med oncs. You are very unlikely to learn any of this in residency.

 

[TheIllusionist]

Would it be accurate to say the 400-500k salaries for 60hours work seem they will be a fading memory soon, given the projections made on this board about ongoing supply demand issues?

This is of course talking reasonable metros. Kansas City, Chattanooga, etc are still reasonable to me

 

[deleted947887]

Would it be accurate to say the 400-500k salaries for 60hours work seem they will be a fading memory soon, given the projections made on this board about ongoing supply demand issues?

This is of course talking reasonable metros. Kansas City, Chattanooga, etc are still reasonable to me

Yes. ASTRO sent out an email about this today. Very accurate.

 

[medgator]

Would it be accurate to say the 400-500k salaries for 60hours work seem they will be a fading memory soon, given the projections made on this board about ongoing supply demand issues?

This is of course talking reasonable metros. Kansas City, Chattanooga, etc are still reasonable to me

No, at least for now. Unfortunately no one will know in 6-7 years when you get out and start looking for a job, but honestly, I can't see how oversupplying the market with RO grads will help maintain what we see today

 

[TDDro]

Those numbers are pennies compared to the clinical revenue they are losing having you out of clinic or worse, having to have an extra rad onc on staff to take up the slack. Med oncs don’t have the same pressure because the revenue/physician is no where near as high.

That's the crux of the physician-scientist issue in our field. 1-day a week as a clinician can net 150k/yr as a rad onc...and maybe, what, 50k/yr as a med onc? So the delta for a 4-day vs. 1-day rad onc is 450k to the institution vs. maybe 150k for the med onc. That's three times the revenue lost. And even if you're only paying the rad onc 50k more than the med onc, the value loss is still significant.

If you're really into research, you can't go into a procedure-heavy (revenue high) field these days. Hospitals/admins are too focused on #s now and couldn't care less about the academic mission. Insomuch as they want to support research, it is/will be for cheap low-impact surveys like "patient perspectives on X".

It's sad to hear the leaders complain "We need more hardcore researchers in our field because we're taking a back seat to med onc...but we can't support any rad onc researchers because we're financially supporting med onc".

With this in mind, the best research 'future' for rad onc may be less hardcore basic sci research, and more economics research. It's less expensive to do and I think has more potential to benefit patients and the field -- for patients sake we need to get away from this idea of trying a wildly expensive drug that works half the time to "avoid the toxicities of radiation" when we know radiation will get us >95% local control with a <5% risk of long term tox.

To the OP, I'd say it really comes down to your ultimate goal:
1) See yourself doing lots of research? Med onc
2) Want to make a lot of $$? IM > Cards or GI, Rad onc to some extent
3) Like the idea of seeing the fruits of your labor (i.e. 'cure')? Rad onc or IM > interventional cards (GI? I dunno)
4) I'm not sure about psych...has taken off in popularity recently but I can't see the underlying market that would make it a successful choice (vs. as someone pointed out radiology with the ever expanding # of patients needing scans)
5) Really more interested in living in a particular part of the country? Go generalist; specialists are saturated in every metro area AFAIK

 

[DebtRising]

Online brings a lot of emotional, anonymous opinions and posts that are filled with emotion. I have made so many posts I regret, not because I hurt someone, but because the venue and my choice of words undermined my own points.

In very short order, and without linking, this is my advice. If there was not a problem with employment or job outlook, there would not be so much anger online. This isn't scientific but you can search other sdn forums and see the discordance. Second, the PUBLISHED ASTRO work force survery showed 50%+ of the field shows oversupply is a concern for them - and I doubt any other field has as high a percentage, nor are all those people denizens of this forum. Third, the PUBLISHED supply and demand model projects we are already oversupplied by 9% for the next 10 years. Fourth, there is no way non-accredited ACGME fellowships would expand if employment was healthy. Oh hey, you have ~250-400K in debt but want a position for 70K per year to train you in nothing unique that Rad Onc X can't also practice? No way those positions expand in a healthy labor market. Fifth, hypofractionation [when safe] is great for patients and society, but only in dramatic leaps of logic does less treatments = more. Less treatments = less treatments. Less is less. Sixth, we have no meaningful oversight of training requirements. SBRT is the future, but you only need 10 cases to graduate. ACGME lawyers more concerned about CYA than meaningful oversight - which in real terms that as SBRT indications increase and oligomets increase, and SABR-COMET tells us we can improve survival but also cause grade V toxicity in some pts, any set of 'academics' who want cheap notewriters can throw together a program and bilk medicare for money to staff their department, rinse and repeat. That may be cynical but also true.

I have no idea who tells you what in real life, or how all these arguments come off online, but I challenge you to refute 2 of them and think to yourself 'wow, this field is really secure, my family and I will be taken care of in 20 years' - which after 4 years post college, 5 years after that additional training, and who knows how much debt, is a very reasonable expectation for such a career.

I fully regret entering this field, and it has nothing to do with the work or the patients.

 

[deleted947887]

Online brings a lot of emotional, anonymous opinions and posts that are filled with emotion. I have made so many posts I regret, not because I hurt someone, but because the venue and my choice of words undermined my own points.

In very short order, and without linking, this is my advice. If there was not a problem with employment or job outlook, there would not be so much anger online. This isn't scientific but you can search other sdn forums and see the discordance. Second, the PUBLISHED ASTRO work force survery showed 50%+ of the field shows oversupply is a concern for them - and I doubt any other field has as high a percentage, nor are all those people denizens of this forum. Third, the PUBLISHED supply and demand model projects we are already oversupplied by 9% for the next 10 years. Fourth, there is no way non-accredited ACGME fellowships would expand if employment was healthy. Oh hey, you have ~250-400K in debt but want a position for 70K per year to train you in nothing unique that Rad Onc X can't also practice? No way those positions expand in a healthy labor market. Fifth, hypofractionation [when safe] is great for patients and society, but only in dramatic leaps of logic does less treatments = more. Less treatments = less treatments. Less is less. Sixth, we have no meaningful oversight of training requirements. SBRT is the future, but you only need 10 cases to graduate. ACGME lawyers more concerned about CYA than meaningful oversight - which in real terms that as SBRT indications increase and oligomets increase, and SABR-COMET tells us we can improve survival but also cause grade V toxicity in some pts, any set of 'academics' who want cheap notewriters can throw together a program and bilk medicare for money to staff their department, rinse and repeat. That may be cynical but also true.

I have no idea who tells you what in real life, or how all these arguments come off online, but I challenge you to refute 2 of them and think to yourself 'wow, this field is really secure, my family and I will be taken care of in 20 years' - which after 4 years post college, 5 years after that additional training, and who knows how much debt, is a very reasonable expectation for such a career.

I fully regret entering this field, and it has nothing to do with the work or the patients.

Great summary. This should be a sticky and linked to reddit and twitter. Well done.

 

[scarbrtj]

At your stage, you're trying to make really long-term decisions based on just a few ephemeral pieces of info. I did this too. In the late 90's, I heard a news story on GMA (and they had a rad onc on as a guest) about a hugely increased need for radiation because all lumpectomy patients were going to need radiation. I was wavering between rad onc and something else and thought well this sounds reasonable. There's lots of breast cancer, the radiation needs are increasing, etc. So off I went.

In 2010 they were saying "Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020." Then just 6 years later: "The supply of radiation oncologists is expected to grow more quickly than the demand for radiation therapy from 2015 to 2025... In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline)... attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections." The number of patients treated in the average department per day is decreasing even faster than the use of radiation to treat cancer because of ever shortening treatment schedules. And, the U.S. is producing more radiation oncologists faster than they're retiring (or dying). The amount spent on radiation oncology is stable to declining; this "fixed pie" will be divvied between ever-increasing numbers of hungry, professional, X-ray prescribing mouths. So between 2016 and 2019, it's worse.

Re: your feelings of dissonance, they are spot on. And totally understandable. But I can promise you the struggles are real. Have seen them first hand, second hand, and third hand. I have seen the best, kindest, smartest "kids" treated like crap, lied to, and mistreated professionally. I have had so many friends have lumps and bumps in this field due to extrinsic and intrinsic factors. And then in the last decade I have seen rad onc be a bit of an agent of its own decay. Chris Rose, a leader in the field, has always lamented that rad onc is a field that eats its young more so than any other (he is actually a good guy).

Shrinking rad onc demand. Shrinking indications in the form of shrinking treatment schedules. And at the same time more and more radiation oncologists vying for a fixed, or decreasing, number of jobs. Add in geographic restrictions, a likelihood of winding up in academics given historical and current trends (and there being more turnover in academics than private practice whether by choice or force), and some other weird/unsavory aspects of the field (the work schedule is very brittle, there can be periods of tedious boredom at work, the outside perception problems, etc.)... and you have a complete(ish) picture. I would submit viewing this field through the lens of present residents' opinions and attendings' opinions only DOES NOT give a complete picture... and will lead to the dissonance you're feeling.

 

[DukeNukem]

Would it be accurate to say the 400-500k salaries for 60hours work seem they will be a fading memory soon, given the projections made on this board about ongoing supply demand issues?

This is of course talking reasonable metros. Kansas City, Chattanooga, etc are still reasonable to me

I work 60 hours a week for 300k/year. I did not get a job in my desired geographic location, and my desired location is not east or west coast. I PMed you a lot more details. Stay away from this specialty if you can see yourself doing anything else.

 

[SRC1987]

I posted before but briefly (STEP1 247, STEP2CK 261, P/F system preclinical, all honors for clinical rotations, 5 abstracts- 4 basic from research year at a Top 3 and all in rad onc). I'm doing aways at good but not elite programs. I have spoken to residents at three institutions: my own (low-mid tier rad onc program), my research year program, and my current away.

All of the residents seem to believe that there are some concerns but they are way overblown. Their friends are doing well and getting good jobs. I have no idea what to believe. I am very confused consolidating opinions. I really enjoyed both the research and clinical side of the field. I like the types of people I have worked with. I like all the interaction with people of different specialties. I like the patient populations, from the very wealthy to the very poor because with oncology, both groups seem to quite interested and attentive about their care, barring a few exceptions. I have enjoyed treatment checks and explaining to patients what radiation is and why it will or won't be done for their cancer (of course under supervision of resident or attending). Yeah I am not a fan of all of the minutia that needs to be learned, but at this stage, I have no idea what parts are truly clinically relevant. But that would probably be my biggest complaint. I thought I wouldn't like the anatomy emphasis way back when I first learned about rad onc in M2. But third year really changed that. I really enjoy anatomy correlates with clinical symptoms, especially for CNS tumors.

Am competitive for the types of programs that would shield from some of the job issues that rad onc is facing?

Just an aside, other specialties I can see myself doing: psych, IM to cardio- electrophysio or heme onc.

Also, some strategies I have considered:

1. Applying broadly to rad onc, and then switching to IM after medicine intern year, if I don't get into the type of program I want that supports its residents and has a good track record placing people into jobs

2. Alternatively, only apply to mid and top tier programs known to place people well and then just double apply to IM.

You sound like someone who is truly interested in the field and congrats on the application you've put together.

I am a current resident that shares the opinions similar to those you have spoke with in person. Yes, there are concerns with the job market, especially if you have a specific geographic location in mind. Some people have had difficulty for individual reasons finding a job, but a majority are still finding jobs they are very satisfied with. Have things changed in the last decade, ie salary? Yes, but it is relative and depends what your expectation is. As much as a select group post on here, a lot people are very happy with where they've ended up.

I agree that graduates from upper and mid tier programs likely have a better selection of job offers, so aiming for those programs is the best plan of action. You've invested a lot in the field so I would recommend applying to programs you'd be comfortable with based on reputation. Go to the interviews and talk to everyone you can. Programs can't hide very much anymore with all the info on SDN and the google spreadsheet. For the people on SDN and in person that tell you they're unhappy with their experience make sure you ask them what questions to ask programs where you interview in an effort to tease out negative factors.

I would not recommend the #1 strategy you described with switching programs after one year. It is not as simple as it sounds and you are less likely to get into as good of a program switching one year in. The first rule of making your rank list- if you do not want to go to a specific program DO NOT RANK THEM, no matter the specialty. Also, if you need to be in a specific region (that's not under served) then rad onc may not be the best option.

If you are still unsure come September, it is okay to apply for a back up/second specialty. Make sure it's something you're truly passionate about and would love as much as a rad onc career. The truth is nobody can say exactly what is going to happen in the future, and as you've experienced there is a huge variation in opinions. Would you be just as happy as a psychiatrist in 10 years if you knew that rad onc the job market was going to continue to be reasonable? You have seen the breadth of people we help and rad onc remains a very rewarding field with unique advantages other specialties do not have.

 

[thecarbonionangle]

This post shows you all the different viewpoints. I would say that if you are ok with being in the midwest (no chicago), or in ANY (no choice) midsized to small cities you have a good shot at being ok. Mainly the thing i did not know at your stage is the complete lack of predictability of jobs. We donn’t think about this back then but you pretty much have to be ok with going to other places, because there may not even be a job at all in the city or area you want, even if it is not “desirable”. That to me is a pretty unique problem, that many other fields do not have. Others have highlighted the positives of rad onc. I certainly don’t think it is for everyone. Things can change a lot in 5 years as you get a SO, and life just happens....

This is all a gamble at the end of the day. Nobody can tell you the future. We do have some data which predicts some serious challenges in the field and my personal opinion is we lack the leadership and the general temperamental distribution of most people in the field to address these issues in a meaningful way... we tend to attract a very characteristic personality i see quite often which does not lend itself to making serious changes.

 

[scarbrtj]

Just came across this today. "Real life" vs internet. Real life:
1) Less suburban/urban jobs
2) Less job vacancies in practices, more difficulties finding jobs
3) Shift away from private practice
4) 1/5 rad oncs have changed jobs last 3 years; 2/5 have had compensation changes last 3 years
5) More rad oncs in fixed compensation models
6) More than half of rad oncs have to work at multiple facilities

 

[medgator]

Just came across this today. "Real life" vs internet. Real life:
1) Less suburban/urban jobs
2) Less job vacancies in practices, more difficulties finding jobs
3) Shift away from private practice
4) 1/5 rad oncs have changed jobs last 3 years; 2/5 have had compensation changes last 3 years
5) More rad oncs in fixed compensation models
6) More than half of rad oncs have to work at multiple facilities

The silver lining is if you're looking to practice in a "rural" setting.

Just 13% of radiation oncologists work in rural communities, with many eyeing retirement

The percentage of radiation oncologists in the United States working in urban and suburban communities is on the rise, according to a new survey published in the International Journal of Radiation Oncology • Biology • Physics. What does this mean for patient care in more rural locations?

www.radiologybusiness.com

 

[RadOncG]

There are two main reasons for the discordant viewpoints: Ignorance and Denial.

1. Ignorance- seen heavily in the ivory tower. Academic volume has increased so many do not understand how hypofractionation and omission could possibly be decreasing overall radiation demand because they keep getting busier and busier. They have good jobs with residents doing all of their work. If Lisa Kachnic has been able to secure 3 chair jobs then why so many complaints about the job market? This ignorance to some degree afflicts residents combined with the pressure to always agree with those in power.

2. Denial- seen heavily among residents. Current residents bought high and are going to sell very low. To my knowledge no specialty has bottomed out quite as hard as radiation oncology. This is tough on the psyche not to mention the stress of a poor job market and questionable at best long-term sustainability. The psychological defense mechanism is denial. It is the 5 stages of grief. This forum has attracted more that have moved into anger.

Regardless of differing opinions, I would defy someone to explain how the economics work. Please ask the academics and residents with whom you interact. How can you decrease demand, increase supply, and not affect the job market?

We cannot deny gravity exists just because it sucks to fall on our face. The laws of economics are just as inescapable as the laws of gravity.

 

[scarbrtj]

There are two main reasons for the discordant viewpoints: Ignorance and Denial.

1. Ignorance- seen heavily in the ivory tower. Academic volume has increased so many do not understand how hypofractionation and omission could possibly be decreasing overall radiation demand because they keep getting busier and busier. They have good jobs with residents doing all of their work. If Lisa Kachnic has been able to secure 3 chair jobs then why so many complaints about the job market? This ignorance to some degree afflicts residents combined with the pressure to always agree with those in power.

2. Denial- seen heavily among residents. Current residents bought high and are going to sell very low. To my knowledge no specialty has bottomed out quite as hard as radiation oncology. This is tough on the psyche not to mention the stress of a poor job market and questionable at best long-term sustainability. The psychological defense mechanism is denial. It is the 5 stages of grief. This forum has attracted more that have moved into anger.

Regardless of differing opinions, I would defy someone to explain how the economics work. Please ask the academics and residents with whom you interact. How can you decrease demand, increase supply, and not affect the job market?

We cannot deny gravity exists just because it sucks to fall on our face. The laws of economics are just as inescapable as the laws of gravity.

Heh.
“Reality must take precedence over public relations, for Nature cannot be fooled.”
- Richard Feynman

 

[evilbooyaa]

You have gotten the range of opinions in this thread. Personally, I completely agree with carbonionangle's post (#28) in regards to what you are OK with (based off current trends).

I do think there are still good jobs out there but it's harder and harder to find them than it seemed to have been even in the past 5 years.

 

[PleaseRemainCalm]

Just came across this today. "Real life" vs internet. Real life:
1) Less suburban/urban jobs
2) Less job vacancies in practices, more difficulties finding jobs
3) Shift away from private practice
4) 1/5 rad oncs have changed jobs last 3 years; 2/5 have had compensation changes last 3 years
5) More rad oncs in fixed compensation models
6) More than half of rad oncs have to work at multiple facilities

The reality is that these urban jobs that this spreadsheet references include jobs in small to midsize cities or even large cities that many consider unsexy. Many people when they talk about wanting to be in major metro areas are thinking of Boston, DC, NYC, SF, Chicago, LA. Houston is the 4th biggest city and San Antonio is the 7th in the US but many people are not thinking of those cities when they talk about scarcity of urban jobs. Columbus and Jacksonville aren't top 10 by size but they are both bigger than SF and Boston and I'm sure many aren't thinking about them either not to even speak of even smaller cities

 

[nkmiami]

There are two main reasons for the discordant viewpoints: Ignorance and Denial.

1. Ignorance- seen heavily in the ivory tower. Academic volume has increased so many do not understand how hypofractionation and omission could possibly be decreasing overall radiation demand because they keep getting busier and busier. They have good jobs with residents doing all of their work. If Lisa Kachnic has been able to secure 3 chair jobs then why so many complaints about the job market? This ignorance to some degree afflicts residents combined with the pressure to always agree with those in power.

2. Denial- seen heavily among residents. Current residents bought high and are going to sell very low. To my knowledge no specialty has bottomed out quite as hard as radiation oncology. This is tough on the psyche not to mention the stress of a poor job market and questionable at best long-term sustainability. The psychological defense mechanism is denial. It is the 5 stages of grief. This forum has attracted more that have moved into anger.

Regardless of differing opinions, I would defy someone to explain how the economics work. Please ask the academics and residents with whom you interact. How can you decrease demand, increase supply, and not affect the job market?

We cannot deny gravity exists just because it sucks to fall on our face. The laws of economics are just as inescapable as the laws of gravity.

actually when it comes to supply and demand, there were indeed docs here disputing that supply can affect demand

 

[20181121]

I applied years before job concerns were discussed on SDN. Even back then, medical students were told that our permanent job might not be in our preferred geographic location. We also knew that top tier centers would confer more flexibility down the line. I tell medical students interested in Rad Onc that they should a) be geographically flexible, long term, and b) train at the best center they can. (These considerations hold true in other specialties as well!)

What I read here simply does not reflect my reality. My colleagues and I routinely discuss how privileged we feel to be in a position to make a big difference in our patients' lives (we cure many cancers!), and to spend our time doing work we find interesting, enjoy, and feel good about.

 

[Krukenberg]

The reality is that these urban jobs that this spreadsheet references include jobs in small to midsize cities or even large cities that many consider unsexy. Many people when they talk about wanting to be in major metro areas are thinking of Boston, DC, NYC, SF, Chicago, LA. Houston is the 4th biggest city and San Antonio is the 7th in the US but many people are not thinking of those cities when they talk about scarcity of urban jobs. Columbus and Jacksonville aren't top 10 by size but they are both bigger than SF and Boston and I'm sure many aren't thinking about them either not to even speak of even smaller cities

Wait so a satisfactory job market is one in which anyone who wants to live in a first tier city will get a job there out of residency? That is totally unrealistic for a small specialty. Even before the residency expansion became an issue a few years ago the advice was always that you have to be geographically flexible in rad onc. It was also known back then that many of the PP jobs in desirable cities went to grads from elite residency programs. None of that has changed.

 

[xrthopeful]

Wait so a satisfactory job market is one in which anyone who wants to live in a first tier city will get a job there out of residency? That is totally unrealistic for a small specialty. Even before the residency expansion became an issue a few years ago the advice was always that you have to be geographically flexible in rad onc. It was also known back then that many of the PP jobs in desirable cities went to grads from elite residency programs. None of that has changed.

yep. people are weird to deny this

 

[PleaseRemainCalm]

Wait so a satisfactory job market is one in which anyone who wants to live in a first tier city will get a job there out of residency? That is totally unrealistic for a small specialty. Even before the residency expansion became an issue a few years ago the advice was always that you have to be geographically flexible in rad onc. It was also known back then that many of the PP jobs in desirable cities went to grads from elite residency programs. None of that has changed.

Whether or not you feel that is reasonable, many people are entering the field with these expectations or hopes. Certainly if you are a med onc you can have this expectation, you just may have to make sacrifices on salary.

 

[Shufflin]

...
4) I'm not sure about psych...has taken off in popularity recently but I can't see the underlying market that would make it a successful choice (vs. as someone pointed out radiology with the ever expanding # of patients needing scans)
...

I have found psych to have been an extremely successful choice. Reimbursements continue to increase.

You can achieve the location and salary you desire. You just have to like psych.

 

[deleted947887]

I have found psych to have been an extremely successful choice. Reimbursements continue to increase. For example LA county just doubled its reimbursement rates, yes that's right, doubled.

You can achieve the location and salary you desire. You just have to like psych.

Psych is getting closer to derm

 

[medgator]

Psych is getting closer to derm

Long way to go to having a cash practice like you can in derm.... Outside of rare circumstances

 

[metallica81788]

I would say that if you are ok with being in the midwest (no chicago), or in ANY (no choice) midsized to small cities you have a good shot at being ok. Mainly the thing i did not know at your stage is the complete lack of predictability of jobs. We donn’t think about this back then but you pretty much have to be ok with going to other places, because there may not even be a job at all in the city or area you want, even if it is not “desirable”. That to me is a pretty unique problem, that many other fields do not have.

Another thing to consider about the geographical restriction is that even if you desire an "undesirable" location in midwest or elsewhere is that if someone local has been hired there in the last 3-5 years, you could be screwed. If you are trying to get anywhere near a small/medium sized area that is moderately RadOnc-saturated you could be SOL just by being unlucky. Such is the fate for a field with a low need and long shelf life if someone is happy. Good jobs have a lot to do with timing when it comes to partners retiring, expansions, opening up new centers, etc.

I tried to get back to my southern hometown which is medium-sized, mid-level of desirability (IMO) and has a decent amount of RadOncs for its size. All three of my options had recently hired in the last 2-3 years and so had all the other centers in a three hour radius. I had given up on getting anywhere near until something unexpectedly popped up an hour from home - only made possible because of my persistence staying in touch with people over the years. Timing.

 

[medgator]

Another thing to consider about the geographical restriction is that even if you desire an "undesirable" location in midwest or elsewhere is that if someone local has been hired there in the last 3-5 years, you could be screwed. If you are trying to get anywhere near a small/medium sized area that is moderately RadOnc-saturated you could be SOL just by being unlucky. Such is the fate for a field with a low need and long shelf life if someone is happy. Good jobs have a lot to do with timing when it comes to partners retiring, expansions, opening up new centers, etc.

I tried to get back to my southern hometown which is medium-sized, mid-level of desirability (IMO) and has a decent amount of RadOncs for its size. All three of my options had recently hired in the last 2-3 years and so had all the other centers in a three hour radius. I had given up on getting anywhere near until something unexpectedly popped up an hour from home - only made possible because of my persistence staying in touch with people over the years. Timing.

Can't be emphasized enough. Great post. I will say that there hasn't been a new hire in my region in the last 5 years precisely because of what you've alluded to.

If there is a semi-desirable smaller metro that can only support a certain number of ROs, well that's it for getting a job there, until someone moves or retires.

 

[Burt Radnolds]

Long way to go to having a cash practice like you can in derm.... Outside of rare circumstances

If you are a quality psychiatrist, the sky is the limit.

 

[ramsesthenice]

There are two main reasons for the discordant viewpoints: Ignorance and Denial.

Wow. I don’t know the first thing about you. Which is why I don’t presume to know your point of view. Or get judgey. So let’s try a little exercise here.

In the last 10 years, I have been personally affiliated with 3 programs (2 clearly mid tier, 1 upper mid tier). Between them, they have turned out 6-7 residents per year and I have known 1 that didn’t get a job they were very happy about. The one exception was 6 years ago. That includes a couple folks who were absolute duds on paper. In the last 3 years this includes jobs in Detroit, Boca Raton, San Francisco, Raleigh, and Philly. Not just rural Midwest jobs.

I don’t claim to know all the details but one of our satellites is in a town of 25K and a grand total of 65K in the county. I hate that place. I wish it would burn down because I despise having to provide vacation coverage. Yet they manage to sit at 15-20 on treats and it’s viable enough that even paying someone $300K per year to work 30-40 hours per week it’s viable enough to keep renewing the contract. Many of the posts on this forum suggest that shouldn’t be possible and yet...

I may be in the “ivory tower” of academics but what am I suppose to do? I’ve been in the specialty for almost a decade and have managed to remain almost 100% insulated from the “crashing” job market and none of my personal experiences match the “dire” or “decrepit” state of the field so many of the talking heads on SDN espouse to.

I fully admit the math isn’t good and there are a lot of important issues facing the field. If you look at my prior posts, you will even see my personal experience with a tight job market and what it meant for my wife and her career. But what’s more ignorant, parroting the concerns of people with different experiences online or denying essentially all of my own personal experiences? I could email you countless well-written economic forecasts from expert economists about how Trump was going to tank the economy but...

I think SDN has raised great concerns about issues related to the future of our specialty. But suggesting that the only reasons people question some of the more extreme views are ignorance or denial is, well, presumptive at best and ignorant at worst.

 

[scarbrtj]

Wow. I don’t know the first thing about you. Which is why I don’t presume to know your point of view. Or get judgey. So let’s try a little exercise here.

In the last 10 years, I have been personally affiliated with 3 programs (2 clearly mid tier, 1 upper mid tier). Between them, they have turned out 6-7 residents per year and I have known 1 that didn’t get a job they were very happy about. The one exception was 6 years ago. That includes a couple folks who were absolute duds on paper. In the last 3 years this includes jobs in Detroit, Boca Raton, San Francisco, Raleigh, and Philly. Not just rural Midwest jobs.

I don’t claim to know all the details but one of our satellites is in a town of 25K and a grand total of 65K in the county. I hate that place. I wish it would burn down because I despise having to provide vacation coverage. Yet they manage to sit at 15-20 on treats and it’s viable enough that even paying someone $300K per year to work 30-40 hours per week it’s viable enough to keep renewing the contract. Many of the posts on this forum suggest that shouldn’t be possible and yet...

I may be in the “ivory tower” of academics but what am I suppose to do? I’ve been in the specialty for almost a decade and have managed to remain almost 100% insulated from the “crashing” job market and none of my personal experiences match the “dire” or “decrepit” state of the field so many of the talking heads on SDN espouse to.

I fully admit the math isn’t good and there are a lot of important issues facing the field. If you look at my prior posts, you will even see my personal experience with a tight job market and what it meant for my wife and her career. But what’s more ignorant, parroting the concerns of people with different experiences online or denying essentially all of my own personal experiences? I could email you countless well-written economic forecasts from expert economists about how Trump was going to tank the economy but...

I think SDN has raised great concerns about issues related to the future of our specialty. But suggesting that the only reasons people question some of the more extreme views are ignorance or denial is, well, presumptive at best and ignorant at worst.

In reading this post I see elitism (“hate the place... wish it would burn down”), question the three places in 10 years thing (3 jobs at 3 places in 10 years?), get discomfort about the poor sap being taken advantage of at the center with 15-20 patients (easily generating 4 or more million global, 600K or more professional) only getting paid 300K, and sense a tone deafness about the gulf between academic attitudes, private practice attitudes, and job search realities today versus 10 years ago.
Peace and love #nojudgey
(If you’re treating 15-20 a day and making 300K, someone or something else is making more or equal what you’re making just off your sweat work and that sort of stuff burns me up)

 

[medgator]

(If you’re treating 15-20 a day and making 300K, someone or something else is making more or equal what you’re making just off your sweat work and that sort of stuff burns me up)

I won't comment on the rest of this post suffice to say that this is completely correct but generally just accepted in academics as going to support a "higher mission". I imagine some of that professional revenue is going to help with vacation coverage, cme allowances, resident support (since Medicare funding was frozen decades ago for new slots) etc

 

[medgator]

I may be in the “ivory tower” of academics but what am I suppose to do? I’ve been in the specialty for almost a decade and have managed to remain almost 100% insulated from the “crashing” job market and none of my personal experiences match the “dire” or “decrepit” state of the field so many of the talking heads on SDN espouse to.

I fully admit the math isn’t good and there are a lot of important issues facing the field. If you look at my prior posts, you will even see my personal experience with a tight job market and what it meant for my wife and her career. But what’s more ignorant, parroting the concerns of people with different experiences online or denying essentially all of my own personal experiences?

Once you have a good job, you notice it less. Unless you keep your eyes open. And you certainly aren't going to know the private market as well, being in academics, just like those of us out in practice are less likely to know the academic market as well.

But if you've been paying attention, the number and quality/location of jobs posted at Astro has been steadily going down over the last several years. When was the last time a good Texas or Florida job was posted?

I could email you countless well-written economic forecasts from expert economists about how Trump was going to tank the economy but...

These things take time. The trade war is finally affecting those (think farmers in the midwest, the New balance shoe company etc) who initially thought he was doing the right thing for this country. May job creation was an anemic 27k jobs, so bad to the point that the stock market is anticipating a Fed rate cut this summer to prop up the sagging economy. In fact that's why the stock market has recovered at all. He's created trillion dollar annual deficits thanks to a regressive tax that wasn't paid for with spending cuts, that will need to be addressed by the next president who will likely be walking into the next recession Trump has sown with his policies.... Stop me if you think you've heard this one before.

It's actually a great parallel to what RO leadership has done by collectively oversupplying the market with grads the last several years during the era of increasing surveillance/hypofx/sbrt.
You don't notice the effects right away, but the damage is being done nonetheless, the picture gets ugly and the crows eventually come home to roost, which is happening now.

 

[Krukenberg]

In reading this post I see elitism (“hate the place... wish it would burn down”), question the three places in 10 years thing (3 jobs at 3 places in 10 years?), get discomfort about the poor sap being taken advantage of at the center with 15-20 patients (easily generating 4 or more million global, 600K or more professional) only getting paid 300K, and sense a tone deafness about the gulf between academic attitudes, private practice attitudes, and job search realities today versus 10 years ago.
Peace and love #nojudgey
(If you’re treating 15-20 a day and making 300K, someone or something else is making more or equal what you’re making just off your sweat work and that sort of stuff burns me up)

I’ll start by saying I agree with you that salary is comparatively lower than a PP income. That being said, that’s $300k with probably excellent health insurance, matching 401k with good fund options (not an insignificant thing over the course of a career), all the benefits that come from being part of a large institution.

In economics, higher risk=higher reward, and in a satellite job you hand over much of the economic risk to the institution. That reduces a lot of headaches (hiring, managing the practice, what do you do if a therapist calls out sick, many minutiae, marketing, capturing referral chains), but also means comparatively less money compared to PP.

Finally, the job is 30-40 hours per week. I’d venture to say all the “”desirable “ PP jobs in metros involve at least 50-60 hours of work for all but the most senior partners.

 

[deleted947887]

I’ll start by saying I agree with you that salary is comparatively lower than a PP income. That being said, that’s $300k with probably excellent health insurance, matching 401k with good fund options (not an insignificant thing over the course of a career), all the benefits that come from being part of a large institution.

In economics, higher risk=higher reward, and in a satellite job you hand over much of the economic risk to the institution. That reduces a lot of headaches (hiring, managing the practice, what do you do if a therapist calls out sick, many minutiae, marketing, capturing referral chains), but also means comparatively less money compared to PP.

Finally, the job is 30-40 hours per week. I’d venture to say all the “”desirable “ PP jobs in metros involve at least 50-60 hours of work for all but the most senior partners.

This is hilarious.

 

[ramsesthenice]

In reading this post I see elitism (“hate the place... wish it would burn down”), question the three places in 10 years thing (3 jobs at 3 places in 10 years?), get discomfort about the poor sap being taken advantage of at the center with 15-20 patients (easily generating 4 or more million global, 600K or more professional) only getting paid 300K, and sense a tone deafness about the gulf between academic attitudes, private practice attitudes, and job search realities today versus 10 years ago.
Peace and love #nojudgey
(If you’re treating 15-20 a day and making 300K, someone or something else is making more or equal what you’re making just off your sweat work and that sort of stuff burns me up)

I’m only 2 years out from residency. Between med school, residency, and my first job, 3 places in 10 years is about right

I find the elitism comment about the satellite a little ironic. Dude works from 8:00-3:00 and I’m supposed to feel bad he only makes 300K? I understand from your perspective he should be making more in PP but its hard for me to feel sorry for the guy or see it as a reason to tell people to avoid the field.

And Gator, I agree with you on the parallels with Trumponomics. The problem to me has been estimating the timing or extent of the problem. So far, a lot of us have been pretty wrong and the SOB continues to defy conventional wisdom. History would suggest that the combination of a prolonged trade war and government shutdown should have already wrecked us pretty badly. I still think it will catch up to us, just like unchecked residency expansion. But how much and when, no one knows for sure. Might be a complete melt down, might be a 4-5 year recession. I have made sure here, and in interviews, candidates know this.

The global warming comment hurts. I see where you are coming from. But climate deniers overlook objective, measurable data because they don’t like it. What do I have that’s objective? People at academic satellites have been making $300(ish)K since I was a med student. It’s not PP money but it’s been stable. If your use to making 700-800 I can get your dismay but to us young folks $300K to work 40-50 hours in a job that we find fun and gratifying doesn’t sound like a bad deal. I have people like Duke saying they would go anywhere on the one hand, and a current PGY4 (yes 4) with a contract for $750k near their south east home town to start in 2020.

The only thing objective I have is that the market is tightening. Again, see my previous posts about how, despite me loving my job and getting multiple offers in good places, I didn’t get one in our target area and she had to give up her career.

Some of you make SDN feel like Fox News. Here is my opinion. If you disagree you are either stupid or in denial. I don’t care what your experiences are, I am 100% right and there is no room for disagreement. And I will mock you with a climate denial parallel if you try to share a viewpoint that runs counter to mine.

 

[RickyScott]

I’m only 2 years out from residency. Between med school, residency, and my first job, 3 places in 10 years is about right

I find the elitism comment about the satellite a little ironic. Dude works from 8:00-3:00 and I’m supposed to feel bad he only makes 300K? I understand from your perspective he should be making more in PP but its hard for me to feel sorry for the guy or see it as a reason to tell people to avoid the field.

And Gator, I agree with you on the parallels with Trumponomics. The problem to me has been estimating the timing or extent of the problem. So far, a lot of us have been pretty wrong and the SOB continues to defy conventional wisdom. History would suggest that the combination of a prolonged trade war and government shutdown should have already wrecked us pretty badly. I still think it will catch up to us, just like unchecked residency expansion. But how much and when, no one knows for sure. Might be a complete melt down, might be a 4-5 year recession. I have made sure here, and in interviews, candidates know this.

The global warming comment hurts. I see where you are coming from. But climate deniers overlook objective, measurable data because they don’t like it. What do I have that’s objective? People at academic satellites have been making $300(ish)K since I was a med student. It’s not PP money but it’s been stable. If your use to making 700-800 I can get your dismay but to us young folks $300K to work 40-50 hours in a job that we find fun and gratifying doesn’t sound like a bad deal. I have people like Duke saying they would go anywhere on the one hand, and a current PGY4 (yes 4) with a contract for $750k near their south east home town to start in 2020.

The only thing objective I have is that the market is tightening. Again, see my previous posts about how, despite me loving my job and getting multiple offers in good places, I didn’t get one in our target area and she had to give up her career.

Some of you make SDN feel like Fox News. Here is my opinion. If you disagree you are either stupid or in denial. I don’t care what your experiences are, I am 100% right and there is no room for disagreement. And I will mock you with a climate denial parallel if you try to share a viewpoint that runs counter to mine.

Are the tone and viewpoints here really any that different from the ASTRO RO hub?