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

[RickyScott]

Just some thoughts. Moderator here has a program director/instn that will not acknowledge residency expansion, yet graduating residents have to take up full time locums or have great difficulty finding job. That is just malice.

ASTRO weighs in strongly on policy/reimbursement issues such as protons and technical fees, yet has complete silence on supply/demand, which has
a much greater impact on the majority of its membership. Almost none of the radoncs I know (and every single resident) are strongly affected by technical reimbursement, or protons, but are entirely impacted by supply and demand. Why is supply and demand not their number one policy priority?

I have a great job, but would absolutely not recommend this field to anyone who doesnt already have a good job. (enlightening?) Right now, that is my caveat to medical students: its a great field to be in if you have a great job lined up in medical school, otherwise supply demand issues could really lead you to a bad place.

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[deleted956486]

The value of $2M vs $700k is, in my most humble of opinions, a debate for another thread. If you find yourself disappointed that you’re not pulling in seven figures... well, I just don’t know what to say. Good luck?

Putting aside good vs insane income, I will say this: the fundamentals of this field are sideways. That’s it. That’s the headline for potentially interested medical students.

Compared with 5 years ago:

• On average, there are fewer fractions per treatment
• On average, there are fewer/stable indications for treatment
• On average, reimbursement for treatments is decreasing (accounting for inflation)

But:

• More residents are graduating per year, and there is no evidence this trend is reversing

That’s it. Those are facts.

Now, the calculus of how that affects your probability of finding a “good job” (however you define it) after residency or your post-residency income is a matter of considerable debate. But the above four bullet points are actual, real, look-up-able facts.

Now for my editorial point: Like others, I enjoy being a radiation oncologist. I love my patients, and I enjoy the work I do on a daily basis (except justifying it to EviCore). But I think our future, as a field, looks regrettably significantly worse than our past or even present. Sure, many individuals will have professional satisfaction in locations they enjoy. But the math does not favor this outcome for most or all applicants, in my opinion.

I trust medical students are smart enough to look at the aforementioned facts and editorial points and make an informed decision.

Should be a sticky.

 

[taserlaser]

Of note, top three most replied threads in SDN RO: physics and radbio, this thread, and FUTURE MED STUDENT DO NOT BECOME A RADIATION ONCOLOGIST. That says something I think

 

[medgator]

Should be a sticky.

In the FAQ

 

[Pointless]

Back to the OP's original question. If I were to offer my advice, it would be that radiation oncology is currently a fantastic field but we have some issues that might cause the job market to become unnecessarily tight in coming years. There is very likely to be accelerated downward pressure on pay, perhaps out of proportion to other specialties, but I can't think of a single specialty where I would expect outsize positive gains in pay going forward.

Acknowledging those potential pitfalls, its a great field and, if you have rotated through and have truly enjoyed the work more than you do any other specialty, I would advise you to pursue it. If geographic location and ease of finding work are your highest priorities above everything else (and it's fine if it is), then radiation oncology is unlikely to be a good fit for you.

Me, I wouldn't want to do anything else in medicine. Every time I get a good look at what other doctors do, I shudder and say a quiet hallelujah to myself that I don't do that.

 

[Pointless]

If that question was directed at me, I would say that if magically we went back to 150 spots a year, then this little overtraining fiasco would be nothing more than a blip. It might even be offset by an exodus of baby boomers who finally were able to suck the last bit of sweet nectar from the system, aided of course by a ten year bull market for their retirement accounts. I think we'd be fine in that scenario. As it stands, I don't see programs opting to reduce their complements en masse, nor do I see programs shutting down to offset all the brand new programs... so, we have some work to do.

All this negative energy on SDN, I wonder if we could funnel it into some type of positive force for good? Who ultimately sets the number of residents per year? SCAROP? Is there an actual human person who has some influence over these numbers or is it just left up to the programs (if they can justify a program with patient volume, then voila). How do other specialties watch their numbers?

 

[medgator]

If residency trends reverse, how quickly do you think the field could return to “relatively normal”?

Personally, my gut reaction is that an all clear signal would be a tacit acknowledgement by RO leadership that we have a problem followed by a contraction in spots to around 100-120/year

 

[medgator]

That's a good point. Radiation Oncology is a small field, and the posters on here surely make-up a non-insignificant portion of the field... is there truly nothing we can do?

We are doing plenty.. Just look at the last match followed by ASTRO finally waking up and acknowledging the problem, followed by the red journal publishing studies about SDN and the residency application spreadsheet

 

[Pointless]

I wonder if it would be possible to literally sponsor a panel discussion at ASTRO on the job market and residency training requirements? One that is not being coordinated by the usual suspects. I'd chip in for the room rental and finger sandwiches!! I'm sure there are some respected people in our community who could speak (Amdur?)

 

[beamotherapy]

Back to the original poster's question: dissonance between real-life word of mouth vs. anonymous internet / message boards - I think a lot of it comes down to saving face in public. A lot of people will want to look good publicly - "I love my job", "all my residents have gotten great jobs", "I was happy to do a palliative radiation fellowship" - when it's not the full story. Even when asked a survey question, self-report data is biased. Of course, some people will tell the good and the bad to anyone, but there is a definite bias toward sugar-coating one's situation publicly (see: all of your friends' facebook posts)

I think the value of an anonymous message board is that people can tell their real life experiences without really being judged. Some things you have to take with a grain of salt - secondhand info, etc. But I mostly believe people's firsthand accounts here. Especially the posts about negative experiences with residency, boards, job searching. Why would somebody bother to lie about that in a forum like this? That information is invaluable for people to hear.

 

[Pointless]

Make it for SA-CME credit!! They'd all come then!

 

[xrthopeful]

There’s a private practice panel on Saturday at ASTRO this year

I think effforts cutting back at have to be realistic. I don’t think it’s going to be feasible to cut slots by half in one fell swoop.

I don’t know the right answer. How do you decide if a program like Harvard should cut back from 8 a year to 6 a year or if a program like City of Hope should be shut down? Who should decide that

A freeze seems like the least that we can do though

 

[Pointless]

It would just be nice if the situation were simply acknowledged openly by leadership... that is a necessary first step. Then we can talk about solutions. So long as they keep with the party line that everything is just fine, we're not going to get anything done.

 

[evilbooyaa]

Deleted all posts continuing the 700k vs 2mil argument. Move it to a different thread. Next posts I delete will be accompanied by warnings.

Otherwise, carry on

 

[xrthopeful]

What would be the effects of a shock to the system if we actually had 100 less rad oncs entering the job market?

Imagine there are 200 grads a year. We know the vast majority are getting jobs. Say 190 are, and ten are deciding to do fellowships, quit rad onc, or deciding to locum or go into medicine adjacent fields like insurance or consulting. Now instead of 190 jobs that need to be filled getting filled, there are 90 jobs open and left open. This isn’t ideal either.

Interesting to think about.

 

[taserlaser]

When Canada cut their number of trainees, it was around early 2010s they went from ~30 annually to ~20. They blocked internal transfers as well. It’s only about now that they’ve only started considering slowly adding a few. So it took a 33% reduction about 10 years. And the market has been tight this whole time and remains tight.

 

[xrthopeful]

What would be the effects of a shock to the system if we actually had 100 less rad oncs entering the job market?

Imagine there are 200 grads a year. We know the vast majority are getting jobs. Say 190 are, and ten are deciding to do fellowships, quit rad onc, or deciding to locum or go into medicine adjacent fields like insurance or consulting. Now instead of 190 jobs that need to be filled getting filled, there are 90 jobs open and left open. This isn’t ideal either.

Interesting to think about.

 

[medgator]

I wonder if we could count this as continuing medical education

Considering what gets published in the IJROBP these days, I don't see why not....

 

[medgator]

What would be the effects of a shock to the system if we actually had 100 less rad oncs entering the job market?

Imagine there are 200 grads a year. We know the vast majority are getting jobs. Say 190 are, and ten are deciding to do fellowships, quit rad onc, or deciding to locum or go into medicine adjacent fields like insurance or consulting. Now instead of 190 jobs that need to be filled getting filled, there are 90 jobs open and left open. This isn’t ideal either.

Interesting to think about.

Your analysis ignores increasing surveillance, Hypofx, sbrt, and number of pts treated per physician. I easily exceed 300-350 sims/yearly, way more than I ever treated per year in residency. Ignoring brachy and xofigo/i-131 etc

Radiation was still being delivered in the 90s with half the slots and way more patients getting 1.8-2/day

 

[RadOncDoc21]

Considering what gets published in the IJROBP these days, I don't see why not....

Agree 100%! PRO is so much better.

 

[xrthopeful]

Your analysis ignores increasing surveillance, Hypofx, sbrt, and number of pts treated per physician. I easily exceed 300-350 sims/yearly, way more than I ever treated per year in residency. Ignoring brachy and xofigo/i-131 etc

Radiation was still being delivered in the 90s with half the slots and way more patients getting 1.8-2/day

My ‘rough’ analysis takes in the current job market and number of jobs people are taking per year though. It was a simple math problem. There would be 90 unfilled jobs

 

[medgator]

Okay but also consider population. In the 90s, the US population was ~250 million... now it's 330 million... 25% more.

With fractions per course dropping in number and more surveillance happening in early stage breast and prostate. APM will only accelerate the above

 

[medgator]

My ‘rough’ analysis takes in the current job market and number of jobs people are taking per year though. It was a simple math problem. There would be 90 unfilled jobs

Assuming everyone is getting a job. We do know more fellowships are being taken by AMGs and more are being created, none of which are acgme accredited...

 

[medgator]

Still, especially considering the age demographics, I think it's a significant point. A larger and larger percentage of the population is older relative to younger (more cancer) each year.

If that were true, we wouldn't be having these discussions about AMGs taking garbage non accredited fellowships and the sickness within the job market on the whole

 

[medgator]

I'm not discrediting your argument, just pointing out that as time has progressed, a larger percentage of the population is older, which will be especially true in the future.

Sure, but think of how many 75yo now get 6 weeks of breast rt now vs back then. Now it it's 0-4 weeks typically. Allows existing physicians to treat more patients per year

 

[xrthopeful]

If that were true, we wouldn't be having these discussions about AMGs taking garbage non accredited fellowships and the sickness within the job market on the whole

I mean this is where the division between classic SDN hyperbole and the real world comes in.

In my example I was GENEROUS in my math problems and said maybe ten grads are taking fellowships when there is no evidence to suggest this is the case. As has been explained before, all you have to do is look who is taking the mdacc fellowships etc

Again back to my point - even if we could cut slots by half in one year, I don’t know if the impact would be a good one, with 90 places needing people. Don’t know how to do it correctly

 

[xrthopeful]

Also - obviously BOTH are true - there are more patients needing cancer care and there are less fractions of RT being given for a course compared to before.

‘If that was true’ come on man. This is where you lose people

 

[medgator]

Let’s say on average treatments are 1/3rd as long, which I think is a fair if not generous estimate. The population of the US grew by 1/3rd, and the ratio of older to younger people doubled. That about evens out.

Which basically proves we were in a good place at ~100-120 spots a year and there was zero justification for residency expansion/near doubling of slots

 

[xrthopeful]

What happens tho if we cut residency slots in half now and there are 90 unfilled spots?

 

[medgator]

What happens tho if we cut residency slots in half now and there are 90 unfilled spots?

Looks like someone decided to indulge in a little hyperbole...

 

[xrthopeful]

Looks like someone decided to indulge in a little hyperbole...

Honest question. How it it hyperbole. I want to figure out a way to cut slots in the right way

 

[medgator]

Honest question. How it it hyperbole. I want to figure out a way to cut slots in the right way

Cut the slots to 100-120 and they will fill. With high quality AMGs that want to do RO

 

[xrthopeful]

Cut the slots to 100-120 and they will fill. With high quality AMGs that want to do RO

Recap - we’re talking job market not residency

 

[medgator]

Recap - we’re talking job market not residency

Recap, the job market doesn't need excess supply. We did not have a shortage of ROs prior to this recent decade of expansion.

It's preventing people from leaving their current jobs for greener pastures and allowing some employers to exploit existing employed physicians

 

[xrthopeful]

Recap, the job market doesn't need excess supply. We did not have a shortage of ROs prior to this recent decade of expansion.

It's preventing people from leaving their current jobs for greener pastures and allowing some employers to exploit existing employed physicians

I'm trying to have an actual conversation. It's not an excess supply yeah if there are 90 unfilled jobs, it's a unfilled demand, patients that need radiation, patients that are going to have to wait weeks to start their care, leading to decreased outcomes.

Hopefully people can figure out the right way to do this, because it matters. Unfortunately it's no one's full time job to think about this.

 

[medgator]

I'm trying to have an actual conversation. It's not an excess supply yeah if there are 90 unfilled jobs, it's a unfilled demand, patients that need radiation, patients that are going to have to wait weeks to start their care, leading to decreased outcomes.

Hopefully people can figure out the right way to do this, because it matters. Unfortunately it's no one's full time job to think about this.

Where did you get 90 unfilled jobs from?

There is a maldistribution problem. Not a supply problem. Oversupply into the market will just hurt the specialty, not fix the maldistribution of ROs

 

[xrthopeful]

Where did you get 90 unfilled jobs from?

There is a maldistribution problem. Not a supply problem. Oversupply into the market will just hurt the specialty, not fix the maldistribution of ROs

Recap - Back to the original ‘analysis’ as you called it. Rough estimate - 200 grads a year, conservative estimate 190 taking jobs. If you cut slots to 100, that’s 90 unfilled jobs.

 

[xrthopeful]

Personally I think immediate freeze is the way to go. maybe a slight cut, but more than that will be an absolute nightmare in deciding who to cut A freeze allows the market a few years to catch up.

 

[medgator]

Recap - Back to the original ‘analysis’ as you called it. Rough estimate - 200 grads a year, conservative estimate 190 taking jobs. If you cut slots to 100, that’s 90 unfilled jobs.

Not sure we've established 190/year are actually getting non fellowship jobs.

 

[xrthopeful]

Yeah, wish we had better data on this stuff

 

[CaesarRO]

Relevant survey. 31% response rate, but includes Chairs, PDs, New Grads and those a year out from training

Overall, 85% of new graduates were moderately to very satisfied with their future employment, and 78% of new practitioners were moderately to very satisfied with their current employment.

Chairpersons were more likely to consider expanding their residency programs compared with program directors. Fellowship remained low on the job search, with less than 10% ofnew graduates and new practitioners interested in fellowship positions

 

[CidHighwind]

M4 here, quick question. How much do you guys enjoy the actual day-to-day job? I get it’s good money and lifestyle if you can get a job, but I shadowed one not too long ago and to me it just seems boring. I want to make sure it wasn’t just a bad day or if there’s more to the job that I wasn’t seeing.

 

[CidHighwind]

By the time you finish residency training in any speciality, 95% of what you do is going to be routine and boring, and, by a few years of independent practice, 99%. Such is the nature of medicine. Top notch care necessitates repetition until what you’re doing is essentially muscle memory. The enjoyment comes from the patient interactions. If you don’t enjoy that, you won’t enjoy anything in medicine after enough time. If you do, radonc will give you higher quality patient interaction than most.

How do rads and gas people enjoy their jobs then? I get being able to help people with their cancer must be fulfilling, it just seemed liked the day dragged on during shadowing.

 

[CidHighwind]

I’d argue there’s still enough variety in any specialty (especially the brain-related fields) to make it not nearly as routine as most other careers.

Would you say the same is true in RadOnc?

 

[CidHighwind]

Honestly, it seems like you’ll be more interested in something surgical. However, I’d shadow one more RadOnc just to be sure.

I really wanted to love/do surgery. Just did not like it during my rotation. More to do with the culture and people more than anything else. I’ll try to shadow another doctor.

 

[CidHighwind]

The culture can definitely be intense... but keep in mind what you experienced may not be the norm or always true! The neurosurgeon friend I keep mentioning didn’t like it at first. Everyone in Neurosurgery seemed like a workaholic... and although he loved the field, he also loved family and his hobbies too. Well, he ended up shadowing a neurosurgeon that told him that although it wouldn’t be a walk in the park, finding a Neurosurgery job working relatively low hours was by no means impossible. That set him over the edge and he hasn’t looked back since, even during the rough 7 year residency.

You’d be surprised how many stereotypes don’t always hold up.

I think it’s all relative right. Even if that person finds a “chill” job, that’s still after 7 years of a ridiculous call schedule. I do agree that doing something you at least like is important. For me, it was everything about surgery that I didn’t like. I wouldn’t be happy doing that job for a living.

 

[scarbrtj]

Still, especially considering the age demographics, I think it's a significant point. A larger and larger percentage of the population is older relative to younger (more cancer) each year.

Incidence of cancer significantly dropping year after year. In and of itself, no biggie. But certainly a caution re: increasing the growth rate of rad oncs.

 

[scarbrtj]

Recap - Back to the original ‘analysis’ as you called it. Rough estimate - 200 grads a year, conservative estimate 190 taking jobs. If you cut slots to 100, that’s 90 unfilled jobs.

If I have a guy walk through the door willing to make 200K a year, he gets a job. Attractive applicant, or cheapened labor, will generate job market expansion (at the expense of job seekers’ job quality). “Unfilled jobs” are inchoate. Theory: Increased number of job seekers will increase jobs offered/accepted.

 

[Neuronix]

M4 here, quick question. How much do you guys enjoy the actual day-to-day job? I get it’s good money and lifestyle if you can get a job, but I shadowed one not too long ago and to me it just seems boring. I want to make sure it wasn’t just a bad day or if there’s more to the job that I wasn’t seeing.

What do you like doing in medicine and what attracted you to rotate in rad onc?

I'm in it for the tech, the imaging, and the procedures. I do plenty of research in those areas as well. But if I hadn't done rad onc I would have done rads for sure.

 

[medgator]

What do you like doing in medicine and what attracted you to rotate in rad onc?

I'm in it for the tech, the imaging, and the procedures. I do plenty of research in those areas as well. But if I hadn't done rad onc I would have done rads for sure.

I like the pt interaction and imaging. I'd probably have done med onc I think