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

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I have to say, I just re-read some of the initial posts in the FAQ pinned at the top of this forum from a decade ago, and it's really interesting to see that not much has changed. The small job market has always been the one downside to this field. Credit to GFunk who really is a legend of this forum IMO.

one thing that I think is different, the 2012 starting salary numbers he quotes - salaries are a bit higher now than that, as would be expected I suppose with inflation.

Good that these posts are pinned there for posterity, to sort of knock some sense into those who are enjoying the sky is falling posts. Some of these posters are genuine in their concern and there are real issues to talk about of course. Some other posters just like to troll and/or see the world burn, and thus post nonsensical posts. They know who they are. Some of them are very smart.
 
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xrthopeful said:
I have to say, I just re-read some of the initial posts in the FAQ pinned at the top of this forum from a decade ago, and it's really interesting to see that not much has changed. The small job market has always been the one downside to this field. Credit to GFunk who really is a legend of this forum IMO.

one thing that I think is different, the 2012 starting salary numbers he quotes - salaries are a bit higher now than that, as would be expected I suppose with inflation.

Good that these posts are pinned there for posterity, to sort of knock some sense into those who are enjoying the sky is falling posts. Some of these posters are genuine in their concern and there are real issues to talk about of course. Some other posters just like to troll and/or see the world burn, and thus post nonsensical posts. They know who they are. Some of them are very smart.
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Agreed. Jobs are plenty.
 
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xrthopeful said:
I have to say, I just re-read some of the initial posts in the FAQ pinned at the top of this forum from a decade ago, and it's really interesting to see that not much has changed. The small job market has always been the one downside to this field.
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It's gotten worse. The recent published data supports that as well as the subjective things many of us are seeing

The fact that you think the gradual doubling in residency slots in a decade has not changed the job market is absurd. It's actually been quite a change to those of us who took a job a decade ago.
 
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While residency expansion and draconian board exams don't help, they are not the real problem with our field. The real problem is that we have lost our curiosity about our oncology. We just grind out phase III trials looking at small changes in dose/field and noting small changes in outcome. We are incrementalists.

We should Partner with vendors, partner with pharma, get a carbon ion center, play with FLASH... we need try some crazy stuff and see what sticks. The students we want to recruit are not the ones who are looking to cash in on their 260+ step one scores. The students we want to recruit should be the ones that want to work on the cool projects that we have already started.

It's not Wallner or Kachnic that are the source of the problem with the dipping applicant numbers, it is the rest of us. Before you start calling Wallner and Kachnic names, ask yourself what you have done to inspire the next class of rad oncs. We all own this.
 
medgator said:
It's gotten worse. The recent published data supports that as well as the subjective things many of us are seeing

The fact that you think the gradual doubling in residency slots in a decade has not changed the job market is absurd. It's actually been quite a change to those of us who took a job a decade ago.
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I am totally with you that the residency expansion has been a problem. I also think that the job market may be a bit worse (though if you ask any 2019 grad they will tell you that this year was a good year, so who knows?) though this has not been borne out with objective data like salary decline for starting salaries OR grads needing to take fellowships. BUT continued unchecked expansion is surely going to do that. The bottom just hasn't fallen out yet.

I also think there is some conflation of things here. The job markets across all of medicine has changed in the last 15 years due to corporitization of hospital systems taking over and buying out all the previously private guys. This has affected all fields. Urology, ENT, Rad Onc, Optho - none untouched.

This is a major factor on the loss of autonomy and income potential to a physician, but is not specific in any way to rad onc.
 
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Lamount said:
While residency expansion and draconian board exams don't help, they are not the real problem with our field. The real problem is that we have lost our curiosity about our oncology. We just grind out phase III trials looking at small changes in dose/field and noting small changes in outcome. We are incrementalists.

We should Partner with vendors, partner with pharma, get a carbon ion center, play with FLASH... we need try some crazy stuff and see what sticks. The students we want to recruit are not the ones who are looking to cash in on their 260+ step one scores. The students we want to recruit should be the ones that want to work on the cool projects that we have already started.

It's not Wallner or Kachnic that are the source of the problem with the dipping applicant numbers, it is the rest of us. Before you start calling Wallner and Kachnic names, ask yourself what you have done to inspire the next class of rad oncs. We all own this.
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Not untrue, but none of us were responsible for randomly doubling residency slots in a decade, and driving down the quality of applicant to this field.

You aren't going to inspire people to go into this field by making a traditionally tenuous job market for getting location/quality/salary even worse by exacerbating the problem with excess supply of grads coming out
 
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xrthopeful said:
. The job markets across all of medicine has changed in the last 15 years due to corporitization of hospital systems taking over and buying out all the previously private guys. This has affected all fields. Urology, ENT, Rad Onc, Optho - none untouched.

This is a major factor on the loss of autonomy and income potential to a physician, but is not specific in any way to rad onc.
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Increasing our residency supply is probably the worst thing we could do to our specialty and the best thing that could be done for everyone else's interests, including corporate/hospital interests
 
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Lamount said:
We should Partner with vendors, partner with pharma, get a carbon ion center, play with FLASH... we need try some crazy stuff and see what sticks.
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Definitely agree with your post about raising profile - but to be fair this is exactly what is kind of being looked at in recent research? like weird examples to pick. FLASH if anything is getting too much attention for how early in proof level it is.

It would be near impossible to get a radiation question alone trial (dose escalation or comparing fractionation schemes) through the NRG right now. Everything is about adding in an immunotherapy drug. Which is good and bad, because there are still radiation alone questions that would be nice to be able to answer. But everything has become about drugs. You got to add a drug somewhere in there to get a trial through.

the newest NRG lung trial is adding in immunotherapy to chemoRT for limited SCLC
 
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We keep saying 'double' but would also love it if we had exact numbers for number of residency slot in 2009, 2010, 2019, and 2019
 
xrthopeful said:
We keep saying 'double' but would also love it if we had exact numbers for number of residency slot in 2009, 2010, 2019, and 2019
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That data was posted in one of these threads very recently. I believe the last match was at 200 positions offered and the recent nadir was around 2007-8 at ~110.

Hopefully someone with that data at their fingertips will post it again.
 
When I started residency in the early 2000s there were 90 something and when I left there were around 110
 
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nkmiami said:
When I started residency in the early 2000s there were 90 something and when I left there were around 110
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Forgot how low spots went after the awful job market in the early to mid 90s but yes it was double digits after all the program closures and adding the extra year of residency in.

We could really use that type of academic leadership again.
 
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medgator said:
Forgot how low spots went after the awful job market in the early to mid 90s but yes it was double digits after all the program closures and adding the extra year of residency in.

We could really use that type of academic leadership again.
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90s didn't have academic satellites. That's a recent phenomenon.
 
xrthopeful said:
We keep saying 'double' but would also love it if we had exact numbers for number of residency slot in 2009, 2010, 2019, and 2019
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268921
 
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sphinx2019 said:
90s didn't have academic satellites. That's a recent phenomenon.
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Like I said - that's reflective of medicine as a whole. Conglomerates taking over and buying out previously independent hospitals.
 
xrthopeful said:
Definitely agree with your post about raising profile - but to be fair this is exactly what is kind of being looked at in recent research? like weird examples to pick. FLASH if anything is getting too much attention for how early in proof level it is.

It would be near impossible to get a radiation question alone trial (dose escalation or comparing fractionation schemes) through the NRG right now. Everything is about adding in an immunotherapy drug. Which is good and bad, because there are still radiation alone questions that would be nice to be able to answer. But everything has become about drugs. You got to add a drug somewhere in there to get a trial through.

the newest NRG lung trial is adding in immunotherapy to chemoRT for limited SCLC
Click to expand...

What is our alternative to an immune therapy trial for SCLC?... 45 Gy at 1.5 Gy BID vs. 66 Gy at 2Gy qd? The CONVERT trial could have been designed 30 years ago. Immune therapy is clever and novel... std vs. altered fractionation is not.

Where are the trials testing how the newest radio-sensitivity gene panel informs dose eslcalation/de-eslcalation? Where is the data on which fractionation best enriches TCR repertoire? 3rd, 4th, 5th generation radiosensitizers/protecters? Best sequence of RT and targeted therapies? Synthetic lethality? Heavy ion RTCs? Chemo/targeted therapy + heavy ions? etc...

FLASH may work, and it may not... but it is certainly an interesting interesting and novel idea. My point is that we should have ten FLASH-like projects matriculating through the NRG.

I once had a mentor in medical school who would always ridicule residents who failed to follow up on important clinical questions... he would say "Dr. Smith, you are suffering from a startling lack of curiosity". That's us in a nut shell... and even if prospective residency spots were cut in half and the passing rates on boards doubled overnight, this would remain our fields greatest challenge.

It may be the leadership's fault that finding jobs has been harder than it should be for us new grads... but it is not their fault that ASCO is infinitely more relevant than ASTRO... that falls on us.
 
Lamount said:
What is our alternative to an immune therapy trial for SCLC?... 45 Gy at 1.5 Gy BID vs. 66 Gy at 2Gy qd? The CONVERT trial could have been designed 30 years ago. Immune therapy is clever and novel... std vs. altered fractionation is not.

Where are the trials testing how the newest radio-sensitivity gene panel informs dose eslcalation/de-eslcalation? Where is the data on which fractionation best enriches TCR repertoire? 3rd, 4th, 5th generation radiosensitizers/protecters? Best sequence of RT and targeted therapies? Synthetic lethality? Heavy ion RTCs? Chemo/targeted therapy + heavy ions? etc...

FLASH may work, and it may not... but it is certainly an interesting interesting and novel idea. My point is that we should have ten FLASH-like projects matriculating through the NRG.

I once had a mentor in medical school who would always ridicule residents who failed to follow up on important clinical questions... he would say "Dr. Smith, you are suffering from a startling lack of curiosity". That's us in a nut shell... and even if prospective residency spots were cut in half and the passing rates on boards doubled overnight, this would remain our fields greatest challenge.

It may be the leadership's fault that finding jobs has been harder than it should be for us new grads... but it is not their fault that ASCO is infinitely more relevant than ASTRO... that falls on us.
Click to expand...

100%. Trainees and junior faculty should be focused on novel paradigms, phase III trials, and making ASTRO more relevant.

This really gets to the root of the problem. Can we make this a sticky?
 
Lamount said:
It may be the leadership's fault that finding jobs has been harder than it should be for us new grads... but it is not their fault that ASCO is infinitely more relevant than ASTRO... that falls on us.
Click to expand...

Let us know where that fountain of funding will come from, since Bristol and Merck have plenty for mo trials
 
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Agree that the small cell trial is a good one. PI is a Rad Onc. Point was that Its happening. I’m not sure why you think that sort of research -isn’t- being done.
 
One of the reasons I was attracted to radonc was the similarity to surgery without the bad hours, etc. How many randomized trials are surgeons popping out? They have a scalpel, we have a linac. I can't argue with studying things like FLASH, which may be promising, but expecting radoncs to be PIs on trials testing the efficacy of something well never administer doesn't make sense.
 
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Lamount said:
What is our alternative to an immune therapy trial for SCLC?... 45 Gy at 1.5 Gy BID vs. 66 Gy at 2Gy qd? The CONVERT trial could have been designed 30 years ago. Immune therapy is clever and novel... std vs. altered fractionation is not.

Where are the trials testing how the newest radio-sensitivity gene panel informs dose eslcalation/de-eslcalation? Where is the data on which fractionation best enriches TCR repertoire? 3rd, 4th, 5th generation radiosensitizers/protecters? Best sequence of RT and targeted therapies? Synthetic lethality? Heavy ion RTCs? Chemo/targeted therapy + heavy ions? etc...

FLASH may work, and it may not... but it is certainly an interesting interesting and novel idea. My point is that we should have ten FLASH-like projects matriculating through the NRG.

I once had a mentor in medical school who would always ridicule residents who failed to follow up on important clinical questions... he would say "Dr. Smith, you are suffering from a startling lack of curiosity". That's us in a nut shell... and even if prospective residency spots were cut in half and the passing rates on boards doubled overnight, this would remain our fields greatest challenge.

It may be the leadership's fault that finding jobs has been harder than it should be for us new grads... but it is not their fault that ASCO is infinitely more relevant than ASTRO... that falls on us.
Click to expand...

Much of the research you mentioned is currently going on in early phase investigator initiated trials. It takes time for these concepts to move up to cooperative group trials that get the big headlines.

Having cutting edge and innovative research in rad onc requires that we recruit the best med students. Expansion doesn’t help that cause but neither does the hysteria and hyperbole on SDN right now (not from you btw)
 
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medgator said:
Let us know where that fountain of funding will come from, since Bristol and Merck have plenty for mo trials
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Varian, IBA, Hitachi... to say nothing of pharma. Not saying it is easy to get funding, but we have to do a much better job of selling our utility.
 
Lamount said:
Varian, IBA, Hitachi... to say nothing of pharma. Not saying it is easy to get funding, but we have to do a much better job of selling our utility.
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Hitachi? Are they even still in the business?

Iba would be a good idea but most of the proton research that's been done so far hasn't been a slam dunk
 
US is falling way behind on Carbon Ions. The Japanese, Chinese, Europeans leaving us in the DUST! Meanwhile we stuck on protons convinced there's a benefit. Can't find it!!!! SAD. I know for a FACT (can't say more) that multiple institutions are burying their own data on protons. We drowning in our own corruption. VERY SAD.
 
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thecarbonionangle said:
US is falling way behind on Carbon Ions. The Japanese, Chinese, Europeans leaving us in the DUST! Meanwhile we stuck on protons convinced there's a benefit. Can't find it!!!! SAD. I know for a FACT (can't say more) that multiple institutions are burying their own data on protons. We drowning in our own corruption. VERY SAD.
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Carb, I'm not sure carbon ions are any less toxic than protons.

This small study looks to show about equivalent toxicity. They blame the high fistula rate on hydrogel spacer, but could it be the particle radiation? BTW, they stopped using the spacer.



271524


271525
 
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We found that hypofractionated particle irradiation is feasible and may be safe.
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Well that doesn't really sound like a ringing endorsement. I find most trials do well at Phase I/II level and then fall on their face with Phase III, large scale randomization. If Phase I/II doesn't look good, that does not generally bode well.
 
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For whatever it's worth, I just opened an email from CancerCarePoint (staffing agency) listing large swaths of dates and state licensures for 15(!) different docs needing locums jobs. This email came complete with this line: We have many more candidates with availability.

It doesn't quite have the same impact on this site because the greatly enlarged font size didn't carry over. But yes, bolded, underlined, enlarged... many more.

I've never received such an email before and typically it's the exact opposite, i.e. staffing agencies begging me to work locums. Just another data point for those reading.
 
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Mandelin Rain said:
For whatever it's worth, I just opened an email from CancerCarePoint (staffing agency) listing large swaths of dates and state licensures for 15(!) different docs needing locums jobs. This email came complete with this line: We have many more candidates with availability.

It doesn't quite have the same impact on this site because the greatly enlarged font size didn't carry over. But yes, bolded, underlined, enlarged... many more.

I've never received such an email before and typically it's the exact opposite, i.e. staffing agencies begging me to work locums. Just another data point for those reading.
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Agree. We have multiple local and regional locums contact info, which allows us to avoid those agencies altogether. Seems like a different situation now than a few years ago.
 
Wait - so they list 15(!) docs needing people and say we have many other candidates with availability - and you’re taking that to mean that they are telling you they have many other people looking to locum so you better strike while the iron is hot? That doesn’t really seem to make sense.

It makes more sense that they’re saying ‘and we have other people we work with too that are looking for locums, lots of spots, contact us we have jobs for you!’

Which ones makes more sense for a recruiter who is spam emailing you?

Could be wrong but I think you misinterpreted that
 
xrthopeful said:
Wait - so they list 15(!) docs needing people and say we have many other candidates with availability - and you’re taking that to mean that they are telling you they have many other people looking to locum so you better strike while the iron is hot? That doesn’t really seem to make sense.

It makes more sense that they’re saying ‘and we have other people we work with too that are looking for locums, lots of spots, contact us we have jobs for you!’

Which ones makes more sense for a recruiter who is spam emailing you?

Could be wrong but I think you misinterpreted that
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I usually see emails listing lots of locums gigs, not mentioning lots of candidates available to provide locums coverage. I think that is what Mandelin rain was getting at, and I would agree
 
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xrthopeful said:
Wait - so they list 15(!) docs needing people and say we have many other candidates with availability - and you’re taking that to mean that they are telling you they have many other people looking to locum so you better strike while the iron is hot? That doesn’t really seem to make sense.

It makes more sense that they’re saying ‘and we have other people we work with too that are looking for locums, lots of spots, contact us we have jobs for you!’

Which ones makes more sense for a recruiter who is spam emailing you?

Could be wrong but I think you misinterpreted that
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You are wrong. They listed 15(!) locums docs who are out of work. In need of a job. Willing to travel. They stated they have many more unemployed docs in the same boat. They are searching for locums positions to match all (15(!) + many more) these unemployed docs in. Positions that the market used to have in excess.
 
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Should serve as a warning primarily to those with loans who think they will just locums until their dream job in Destination X opens up. You may be standing in a bread line with 15(!)+many more unemployed radiation oncologists.
 
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oh got it - my mistake.

So it seems like the strategy of just choosing to be a locums person doesn't seem to be as attractive, since there are lots of retired docs trying to do the same?
 
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xrthopeful said:
oh got it - my mistake.

So it seems like the strategy of just choosing to be a locums person doesn't seem to be as attractive, since there are lots of retired docs trying to do the same?
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Correct. Why should I go through an agency when a retired partner is a known quantity and cheaper? Win, win for both parties
 
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xrthopeful said:
oh got it - my mistake.

So it seems like the strategy of just choosing to be a locums person doesn't seem to be as attractive, since there are lots of retired docs trying to do the same?
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I do believe, yes, it's probably just a bunch of old farts taking over the locums market. More rad oncs produced, more rad oncs into practice... ergo more retired rad oncs. If I can't get my false teeth to stay in and get my lumbago to settle down I'll probably be right there with those guys. They're drinking the new grads' locums milkshake.*

* Why do I put so many annoying links in my replies? This is not new. In the early days of the Internet, there was a website: radiotherapy.com. It was owned by 21st Century Oncology. There was a discussion group there. This was in fact radiation oncology's first online discussion forum. It started in the 90's. It was password protected (username Gilbert, password Fletcher) so the discussion pages don't exist in archive form anymore; but the message board was fun, irreverent, non-judgmental. However, all of Dr. Michael Katin's old posts from radiotherapy.com still exist in archive form. He was a contrarian and really funny. He was also liberal with the links; a true radiation oncology innovator in that regard. I've never met him, but I'd like to have. He got wildly rich from 21st Century... though he's now, as Blanche Dubois might say, needing to depend on the kindness of legal strangers. But yes, anytime I link with some tangential reference, it's an homage to Dr. Michael Katin. Mike, hope you read this one day. You were ahead of your time, you were behind the times; it was the age of wisdom, it was the age of foolishness. That's all I have to say about that.
 
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Mandelin Rain said:
You are wrong. They listed 15(!) locums docs who are out of work. In need of a job. Willing to travel. They stated they have many more unemployed docs in the same boat. They are searching for locums positions to match all (15(!) + many more) these unemployed docs in. Positions that the market used to have in excess.
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This is so backwards from how it was for so long that I too thought xrthopeful was correct and Mandelin Rain mis-interpreted the email totally backwards.

If locums staffing agencies have switched from trying to find locums coverage for practices by listing dates for which practices need coverage and trying to find available physicians to listing dates that physicians are available and asking practices if they would like to take a vacation that week so this guy can work (with more where that came from) then oh man oh man, I don't even know.
 
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Backpage.com style ha.

Wonder if the agencies find this to be a more successful strategy to get practices to use their services
 
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this stuff is scary. I have decided to double apply high tier rad onc and IM
 
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TheIllusionist said:
this stuff is scary. I have decided to double apply high tier rad onc and IM
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Re: hi tier residency. Word of advice- dont overestimate benefit of hi tier residency on the arc of your career, It certainly may help you land a dream job at a satellite in a major coastal city. But what then? 35-40 year career ahead of you. After 2-5 years, you will have difficulty getting a raise, and very limited mobility given the oversupply. At that point, and moving forward, the tier of your residency really wont matter. From other thread
Today at 9:11 AM
"My malignant "academic" employer is already increasing my RVU expectations for the same (low) salary and lowering my (meager) bonus potential next year in preparation for the reimbusement changes. Is this happening to anyone else?"

if something like this happens to you 2 years into your career, what are you going to do? Do you think it matters that you did your residency at Harvard. And why wouldnt this happen, hospital can cut your salary and advancement and 100 people will take your place if you dont like it, so they would be kind of stupid not to cut your salary?
 
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Mandelin Rain said:
For whatever it's worth, I just opened an email from CancerCarePoint (staffing agency) listing large swaths of dates and state licensures for 15(!) different docs needing locums jobs. This email came complete with this line: We have many more candidates with availability.

It doesn't quite have the same impact on this site because the greatly enlarged font size didn't carry over. But yes, bolded, underlined, enlarged... many more.

I've never received such an email before and typically it's the exact opposite, i.e. staffing agencies begging me to work locums. Just another data point for those reading.
Click to expand...

Got a similar remark from a recruiter for a full time position. Word is out
 
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NAMthrow said:
www.google.com

Yes, Trump University Was a Massive Scam | National Review

Many people believe that higher education is a de facto scam. Trump University, Donald Trump’s real-estate institution, was a de jure one. First thing first, Trump University was never a university…
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Radiation Oncology=Trump University
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If I had to criticize the field, right now I think I would cite “the narcissism of small differences”. of course, when more large centers are pushing protons for prostate and start lying about outcomes like Nancy ... we will be on our way to Trump u
 
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RickyScott said:
If I had to criticize the field, right now I think I would cite “the narcissism of small differences”. of course, when more large centers are pushing protons for prostate and start lying about outcomes like Nancy from UF... we will be on our way to Trump u
Click to expand...

If IBA or these other places were smart, they’d do what pharma does and start sponsoring trials.
 
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