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

[evilbooyaa]

Was outrage really what you read from that? It’s referring to the tone, and I can assure you from receiving many private messages thanking me for bringing it up, it isn’t only me that feels that way.

You can run it to have polite informative discussions or it can be a complete free for all. You can have discussions that only restrict vulgarity and racial slurs, or they can use a light hand that facilitates healthy discussion of weighty matters.

Moderators on other forums set the tone. Here, the inmates run the asylum, now. It’s the Lord of Flies down here, insults and recriminations about how people practice and about their motivations and how specific individuals aren’t doing enough. There isn’t a less supportive, insult laden forum like this on SDN.

I hope the tone eventually gets back to where it was in years past. The board was incredibly informative to me in the past and I have great appreciation for that.

Best of luck. Hopefully things get better in our field! Feel free the delete the account, as I’ve said my piece.

Again, the goal of SDN is to have moderators do the least amount that is necessary. You are more than welcome to continue posting your opinions, as are any of those agreeing with you.

The tone will natrually improve once the field itself improves. Hopefully those that have the power to change it do so. This is not in anyway to denigrate those who are actively fighting against the current path - I have nothing but admiration for folks like ARRO, Amdur and Lee who challenge the ABR on their non-sense.

At the same time, the folks who make it seem like residency expansion is only correctable by market forces (surprise, it's not, even when 10% of your incoming class goes unmatched, there will be rad oncs who failed to match, failed derm/ENT/ortho/ophtho/urology candidates, and IMGs who will come fill those spots) have offered no solutions, stating that their hands are tied by the fear of lawsuits. While I and anyone else can have an opinion as to what to do, that doesn't really matter.

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[xrthopeful]

Still going to act like an ostrich in the sand when it comes to residency expansion, huh?

You don’t read posts. Have said a million times that residency expansion needs to stop.

 

[evilbooyaa]

You’re always blaming ‘academicians’ as if they’re some malevolent force when in reality they are just like any of us who instead just happened to go with an academic job after training for whatever reason be it location or right fit or what. I’m not sure why you’re so singularly focused as such.

Your bigger issue/complaints/screams into the night should instead be targeted at:

1) Hospital CEOs who buy out practices/hospitals
2) Medicare for payment reform.

I think medgator's issue with 'academicians' is the rampant expansion of residency expansions over the past decade (done exclusively at academic centers).

That being said, I think demonizing 'academicians' is silly as well. Most attendings in academics dont have any power in that regard over residency expansion. Only people that actually have control on a per-institution level are chairmen and chairwomen. Program directors might to some extent but any dissenting opinions are likely to be ground under the boot of the chairman/woman.

 

[medgator]

I think medgator's issue with 'academicians' is the rampant expansion of residency expansions over the past decade (done exclusively at academic centers).

That being said, I think demonizing 'academicians' is silly as well. Most attendings in academics dont have any power in that regard over residency expansion. Only people that actually have control on a per-institution level are chairmen and chairwomen. Program directors might to some extent but any dissenting opinions are likely to be ground under the boot of the chairman/woman.

My ire is mainly directed at the department heads who are allowing this to occur. It is far more damaging to the specialty than APM or hospital acquisitions ever could be

 

[scarbrtj]

Moderators on other forums set the tone. Here, the inmates run the asylum, now. It’s the Lord of Flies down here, insults and recriminations about how people practice and about their motivations and how specific individuals aren’t doing enough. There isn’t a less supportive, insult laden forum like this on SDN.

I hope the tone eventually gets back to where it was in years past. The board was incredibly informative to me in the past and I have great appreciation for that.

Tone. You have a problem with tone and an "insult laden forum like this?" And then you're all Lord of Flies, inmates in an asylum, and so on and so forth.
I think the worst SDN can be accused of is sensationalism, but who cares. Sometimes worry breeds sensationalism. It's a free country bub. But it's only one tiny corner of the Internet and one minor information point for anyone interested in radiation oncology. Boo-hoo, they ruined SDN with all their sour persimmons. Leave SDN and its posters alone. OK, worst case, it's an abattoir*. But it's a virtual one. Better to experience this one than the real abattoir that is the focus of so many SDN discussions... discussions which are still incredibly informative but not in the way everyone might wish.
*another freebie

 

[DebtRising]

When you think someone should do something against their own interest to make things better, and say he’s not part of the solution, that’s rather condescending. This generation really expects a lot to be given to them.

This is where objectivity is important. There are clear structural advantages that previous generations in medicine and radiation oncology enjoyed compared to current. These include
1. Less debt from training
2. Diminished training time [depending on era] which lead to greater earnings potential
3. Greater autonomy in decision making and billing - no 'prior auth' maze like it exists today
4. Less documentation requirements / less administrative tasks as it relates to a record
5. Lower capital investment for medical equipment as a percentage of earnings - it is not a reasonable financial plan to take out loans to buy a linac
6. Less developed markets; academic centers have been around since the 70s and 80s, but there were geographic areas that were not covered. That is no longer the case now - the only markets unserved are remote (as a general statement)
7. Easier billing and collections

The generations that have come before, whether baby boomer, or generation X, have had objective, clear advantages in financial pay out, undeveloped market, and better autonomy with less administrative tasks. Full stop. Not a debate.

Whether this leads to questions of morality 'Should the baby boomers recognize their advantage and help future generations?' for instance, is a completely different issue than factual illustration of the clear significant advantages in their situation compared to starting today, and that is not including issues like ease of NIH funding.

400 posts later, we are still training 200 residents when back in 2015 we already projected oversupplying the market by 9%, we keep hypofractionating [which can be great for society but is less treatments, less is less is less is less!], the oligomet picture has not yet had a positive national phase III trial, and we are being dictated to by a former drug company executive to have mandatory bundling of payments. Definitely a field going in the right direction, please apply.

 

[thecarbonionangle]

This is where objectivity is important. There are clear structural advantages that previous generations in medicine and radiation oncology enjoyed compared to current. These include
1. Less debt from training
2. Diminished training time [depending on era] which lead to greater earnings potential
3. Greater autonomy in decision making and billing - no 'prior auth' maze like it exists today
4. Less documentation requirements / less administrative tasks as it relates to a record
5. Lower capital investment for medical equipment as a percentage of earnings - it is not a reasonable financial plan to take out loans to buy a linac
6. Less developed markets; academic centers have been around since the 70s and 80s, but there were geographic areas that were not covered. That is no longer the case now - the only markets unserved are remote (as a general statement)
7. Easier billing and collections

The generations that have come before, whether baby boomer, or generation X, have had objective, clear advantages in financial pay out, undeveloped market, and better autonomy with less administrative tasks. Full stop. Not a debate.

Whether this leads to questions of morality 'Should the baby boomers recognize their advantage and help future generations?' for instance, is a completely different issue than factual illustration of the clear significant advantages in their situation compared to starting today, and that is not including issues like ease of NIH funding.

400 posts later, we are still training 200 residents when back in 2015 we already projected oversupplying the market by 9%, we keep hypofractionating [which can be great for society but is less treatments, less is less is less is less!], the oligomet picture has not yet had a positive national phase III trial, and we are being dictated to by a former drug company executive to have mandatory bundling of payments. Definitely a field going in the right direction, please apply.

Exactly. One of those baseless cannards about how back in the day blah blah we walked up the snow hill, payed our way to college, then walked into rad onc when it was filled with IMGs , did a 3 year residency and did not deal with abr bs and have been raking it in for decades, lived the golden days and partook in ruining the field, i like to complain about hipster millennials who drink a capuccinno with a 10 dollar avocado toast instead of just pulling myself up by Bootstraps. Rugged individualism. You’re meaningless and not special. Ok thanks for the contribution. I can take it. We can agree to disagree.

My take is we have to do right by eachother. You are right about morality and unfortunately not everyone shares that. All we can do is live our truth and be kind to eachother.

 

[thecarbonionangle]

Fluffer. Ha. Cant believe someone is posting their offense at that. Have you been on twitter? Every radonc is a fluffer. They fluff anything and everything. Nothing offensive about it. Truth. Rad onc is made up mostly of fluffers.

Gotta agree. Someone already alluded to it but theres a lot of fake people on tweeter, one of the reasons i stay away it makes me sick to see people i know to be petty backstabbers self promote themselves into something they are not. The tweeter rad onc is not our field just like sdn is not our field. Sdn is a unique thing because it allows for honest discussion. Can’t be a snowflake here, go to ROBUB for that, where dissenting views are moderated away, people are shamed by hienas who all agree someone said something BAD. I already feel bad i should not offend hienas like that. I saw a special the other day and they are pretty cool.

 

[Krukenberg]

Tone. You have a problem with tone and an "insult laden forum like this?" And then you're all Lord of Flies, inmates in an asylum, and so on and so forth.
I think the worst SDN can be accused of is sensationalism, but who cares. Sometimes worry breeds sensationalism. It's a free country bub. But it's only one tiny corner of the Internet and one minor information point for anyone interested in radiation oncology. Boo-hoo, they ruined SDN with all their sour persimmons. Leave SDN and its posters alone. OK, worst case, it's an abattoir*. But it's a virtual one. Better to experience this one than the real abattoir that is the focus of so many SDN discussions... discussions which are still incredibly informative but not in the way everyone might wish.
*another freebie

See I think it’s much more than a minor source of info for med students interested in rad onc. For me it was a significant influencer and I’m sure that’s true for many of today’s med students.

If you admit sensationalism then you admit that the rhetoric on this board could be hurting the field without full merit. Who are we to create sensationalism to actively dissuade students? Let them know the facts and decide for themselves if geography is important enough to not apply.

 

[Sheldor]

My biggest concern is the oversized impact this board can have. To me, it is incredible that ~10-20 vocal posters can have such a large impact on a field of thousands. Now, again, this isn't to minimize the problems we have, but hypothetically, what if things were bad for a small percentage of rad oncs, and they all come post here, which causes the match to tank, making things worse, etc. etc. The beginnings of a vicious cycle. Something to think about I suppose.

 

[medgator]

My biggest concern is the oversized impact this board can have. To me, it is incredible that ~10-20 vocal posters can have such a large impact on a field of thousands. Now, again, this isn't to minimize the problems we have, but hypothetically, what if things were bad for a small percentage of rad oncs, and they all come post here, which causes the match to tank, making things worse, etc. etc. The beginnings of a vicious cycle. Something to think about I suppose.

Except we have data to back us up. Back in 2014, before expansion really ramped up, there was a 1/3 in chance of a graduate not getting their preferred geographic region.

There is also data to suggest we are in an oversupply, not to mention the several anecdotes that those of us in practice as well as those applying for jobs are seeing.

I feel fortunate I got 2/3, and now many graduates are lucky to get 1/3 when it comes to finding a job

 

[deleted956486]

My biggest concern is the oversized impact this board can have. To me, it is incredible that ~10-20 vocal posters can have such a large impact on a field of thousands. Now, again, this isn't to minimize the problems we have, but hypothetically, what if things were bad for a small percentage of rad oncs, and they all come post here, which causes the match to tank, making things worse, etc. etc. The beginnings of a vicious cycle. Something to think about I suppose.

The match tanking was caused by Lisa Kachnik and Paul Wallner. And dont get me wrong, I commend them for bringing people together to discuss these issues.

 

[thecarbonionangle]

Narrative 1: 20 online vocal misanthropes crashed the match.

Narrative 2: failure of specialty leadership over decade, corruption in ABR leadership, lack of plan to address our serious problems crashed the match ?

Which one keeps us up at night?

 

[Sheldor]

Except we have data to back us up. Back in 2014, before expansion really ramped up, there was a 1/3 in chance of a graduate not getting their preferred geographic region.

There is also data to suggest we are in an oversupply, not to mention the several anecdotes that those of us in practice as well as those applying for jobs are seeing.

I feel fortunate I got 2/3, and now many graduates are lucky to get 1/3 when it comes to finding a job

Sure! I'm not saying the data doesn't. And honestly, my thoughts weren't a comment on the state of the field at all. I was only commenting on the influence that a relatively small SDN forum can have. Likely a result of our small field all together, but definitely a unique issue.

 

[medgator]

Sure! I'm not saying the data doesn't. And honestly, my thoughts weren't a comment on the state of the field at all. I was only commenting on the influence that a relatively small SDN forum can have. Likely a result of our small field all together, but definitely a unique issue.

I see SDN as the only resource out there to get what's happening out in IRL, outside the ASTRO bubble and academic Ivory towers where most are training and applying to now.

It's not perfect, but if I was strongly considering this field now, I'd be looking at it to get viewpoints I'm not seeing much of anywhere else

 

[RickyScott]

My biggest concern is the oversized impact this board can have. To me, it is incredible that ~10-20 vocal posters can have such a large impact on a field of thousands. Now, again, this isn't to minimize the problems we have, but hypothetically, what if things were bad for a small percentage of rad oncs, and they all come post here, which causes the match to tank, making things worse, etc. etc. The beginnings of a vicious cycle. Something to think about I suppose.

It is simple facts, not obnoxious posters like me. Number of residents doubled since early 2000s + hypofrac/APM. How is this not really really bad? And getting a decent job was not a cakewalk in this small field in the early 2000s before expansion/hypofrac.

 

[Sheldor]

It is simple facts, not obnoxious posters like me. Number of residents doubled since early 2000s + hypofrac/APM. How is this not really really bad? And getting a decent job was not a cakewalk in this small field in the early 2000s before expansion/hypofrac.

But I didn't say you were obnoxious? And I didn't say it wasn't really really bad? I'm so confused as to why me just commenting on how SDN is able to move and effect a field even though it is small is some how seen as anything other than just that. Maybe it is that tone can't be conveyed as well in writing, but still.

 

[xrthopeful]

But I didn't say you were obnoxious? And I didn't say it wasn't really really bad? I'm so confused as to why me just commenting on how SDN is able to move and effect a field even though it is small is some how seen as anything other than just that. Maybe it is that tone can't be conveyed as well in writing, but still.

I feel like things have become quite politicized here where it can easily turn into team ‘there’s a problem’ versus all when essentially everyone Including vast majority of people in Evil Academics know that there are problems

 

[medgator]

when essentially everyone Including vast majority of people in Evil Academics know that there are problems

Really? I guess except for the ones that matter...

 

[RickyScott]

But I didn't say you were obnoxious? And I didn't say it wasn't really really bad? I'm so confused as to why me just commenting on how SDN is able to move and effect a field even though it is small is some how seen as anything other than just that. Maybe it is that tone can't be conveyed as well in writing, but still.

Space is created for a forum like SDN when leaders in the field/ASTRO have interests, positions that are so divergent from those of most residents/practioners. As we move towards a workforce that is increasingly salaried and employed, supply and demand is everything.

 

[scarbrtj]

My biggest concern is the oversized impact this board can have. To me, it is incredible that ~10-20 vocal posters can have such a large impact on a field of thousands. Now, again, this isn't to minimize the problems we have, but hypothetically, what if things were bad for a small percentage of rad oncs, and they all come post here, which causes the match to tank, making things worse, etc. etc. The beginnings of a vicious cycle. Something to think about I suppose.

For anyone thinking SDN is the cause versus a side effect...
Go and look up number of residency slots today versus 15 years ago. They're way higher now. That uptick started before SDN.
Hypofractionation, aka decreasing indications for EBRT, started before SDN.
The trend toward rad onc workers more likely being in academics vs private practice (the majority of rad oncs are now in academics vs PP) started before SDN. The trend toward there being more and more jobs in academics vs private practice started before SDN. The maxim that academics pays less than PP was true before SDN.
That board fail rates spiked happened after SDN. I don't think SDN can be blamed for the board fiasco; but give it time I suppose.
I would hope that if med oncs started giving ~90% less chemo, doing 90% less chemo infusions, and there then being a massive surge in med onc fellowship positions, it wouldn't take an Internet message board to highlight the potential problems. Well it wouldn't. That it does for rad onc highlights yet another problem in rad onc!

 

[OTN]

It's telling to me that, while this is an open forum in which anyone can post opinions and engage in the discussion, academic "leaders" in our field have chosen not to do so. If we're such an important voice and are so influential, well, shouldn't they join in?

My speculation: they know the facts aren't on their side, and they know they would lose the debate. Better to throw shade from afar and try to cast doubt on SDN's claims rather than engage and verify them.

 

[scarbrtj]

If you admit sensationalism then you admit that the rhetoric on this board could be hurting the field without full merit. Who are we to create sensationalism to actively dissuade students? Let them know the facts and decide for themselves if geography is important enough to not apply.

Geography???
That's the issue? SDN's rhetoric about geography? Or worries about geographic restriction? Can I call this gaslighting? At least tone deaf? I don't want to offend, but how is this not gaslighting a med student. Btw, med students: OF COURSE geography is not important enough not to apply. But just like in Trivial Pursuit with the blue wedge, it's one important piece of the pie.

 

[medgator]

See I think it’s much more than a minor source of info for med students interested in rad onc. For me it was a significant influencer and I’m sure that’s true for many of today’s med students.

If you admit sensationalism then you admit that the rhetoric on this board could be hurting the field without full merit. Who are we to create sensationalism to actively dissuade students? Let them know the facts and decide for themselves if geography is important enough to not apply.

Geography was a problem even when I was applying when the market was orders of magnitude more in balance. Remember we all took a hit on 1/3 when it came to taking a job, and that has been true for decades. Now it's getting 0-1/3 if you're lucky

As scarbrtj alluded to, that's pretty much gaslighting us at this point.

 

[radoncgrad2019]

There IS a disconnect. Here's the disconnect:

You have people on this forum (really a group of about 5-10 regular posters) who have jobs they love - they are private guys making bank and have for a few years or many years. Some have made million(s) a year and this is public information. They see the rad onc world THEY know changing and also see the increase in employed docs, less autonomy, etc. They have fears about the future of the field, rightfully so, but are also disconnected from the current job market/job hunt.

On the other hand, med students in real life are talking to residents who are graduating, and most seem happy with the jobs they are getting. Obvious exceptions of course, but all you have to do is look at the two threads that were created, and one has WAY more posts. Many many people are happy with their jobs.

That's the disconnect. I wish some of you would understand this. yes, by all means, worry about the future. But the reality is many people are still happy with their job and their lives Maybe it makes YOU sick to your stomach because you never would have gone into rad onc if you were going to max out making 400k in some academic satellite working 9 - 5. But for a lot of people they are happy with that. And many more people are getting great PP group jobs clearly than you understand perhaps.

Everything would make a lot more sense here if everyone just accepts/understands this disconnect. Especially since that was the initial basis of this thread.

 

[evilbooyaa]

There IS a disconnect. Here's the disconnect:

You have people on this forum (really a group of about 5-10 regular posters) who have jobs they love - they are private guys making bank and have for a few years or many years. Some have made million(s) a year and this is public information. They see the rad onc world THEY know changing and also see the increase in employed docs, less autonomy, etc. They have fears about the future of the field, rightfully so, but are also disconnected from the current job market/job hunt.

On the other hand, med students in real life are talking to residents who are graduating, and most seem happy with the jobs they are getting. Obvious exceptions of course, but all you have to do is look at the two threads that were created, and one has WAY more posts. Many many people are happy with their jobs.

That's the disconnect. I wish some of you would understand this. yes, by all means, worry about the future. But the reality is many people are still happy with their job and their lives Maybe it makes YOU sick to your stomach because you never would have gone into rad onc if you were going to max out making 400k in some academic satellite working 9 - 5. But for a lot of people they are happy with that. And many more people are getting great PP group jobs clearly than you understand perhaps.

Everything would make a lot more sense here if everyone just accepts/understands this disconnect. Especially since that was the initial basis of this thread.

What do you say about current attendings at academic centers who report that their residents are getting crap (or no) job offers, leading to some people doing permanent locums? Or current attendings who post here that they have a crap job and zero ability to move, and have to just accept diminishing compensation?

The argument is not that there are not good jobs out there (albeit with diminished expectations as you describe). There certainly are. The issue is whether we are OK as a field, having some percentage of jobs be not good jobs that people (especially new grads) are stuck in. What is an acceptable percentage? I would argue for < 10%, but if your threshold is 25 or 33% then we're just going to have to agree to disagree.

 

[deleted956486]

My speculation: they know the facts aren't on their side, and they know they would lose the debate. Better to throw shade from afar and try to cast doubt on SDN's claims rather than engage and verify them.

This post nails it.

 

[scarbrtj]

Some have made million(s) a year and this is public information. They see the rad onc world THEY know changing and also see the increase in employed docs, less autonomy, etc. They have fears about the future of the field, rightfully so, but are also disconnected from the current job market/job hunt... Maybe it makes YOU sick to your stomach because you never would have gone into rad onc if you were going to max out making 400k in some academic satellite working 9 - 5.

... is being disconnected from the current job market public info too? "Yeah, he's disconnected from the job market. It's public info. Therefore, take his opinion with a grain of salt." Be careful of assigning motivation to, or trying to define the status of, total strangers. I am always suspect when anyone does this. There seem to be many intensely associated with the current job market (I only know because they publicly have said so) who have expressed concerns here. In rad onc, today's happily-employed is tomorrow's hit-the-bricks-pal. We're all in it together... or we should be. There is no this group/that group. That we can all accept a certain level of survival is certainly one way to view things. But why should we? We are optimizers at heart. Maxing out at 400K in some academic satellite... Funny. ~20 years ago, 500K was the bare rad onc minimum bandied about... about 750K in today's dollars. It would be like saying the maximum was ~300K 20 years ago.

 

[scarbrtj]

I would argue for < 10%, but if your threshold is 25 or 33% then we're just going to have to agree to disagree.

Depends on the music you listen to on the way to your job interviews...

 

[radoncgrad2019]

Evil - I am aware that Neuronix has posted about some people in his program having a tough time because they had specific ties and needed to stay in that state where they trained, which he has said is a tough market and a desirable place. This type of situation has always been hard in rad onc and will always be hard. I tell every single medical student that I meet - if you need to be in Place X 100%, just know that may be quite hard in any given year.

But I think you are being dishonest if you think this type of thing is approaching 25-33%. just think about the people you know, the people you trained with. Maybe your experience is different than mine and many of the other new grads and graduating residents that OP spoke to.

I wish you luck on your search. I am confident you will be here a year from now posting good news. You seem like a go-getter.

 

[TheIllusionist]

It may absolutely be true that there are plenty of medical students excited about a middling salary in the mid west. But this is going to be a very different group than those who matched into radonc in the last 10-20 years.

These were, by and large, people who could have been making $300k+ at a bank or consulting firm within a few years of graduating college, let alone 9-10 years later after accumulating $200k+ of debt.

At the end of the day, these greedy academics won’t have ruined the field, they’ll simply have made it unpalatable to anyone with a competitive application who isn’t susceptible to the specious nonsense that wanting to make a good living in a nice place while also doing good for patients makes you a morally inferior physician.

wish it was only 200...

 

[radoncgrad2019]

It may absolutely be true that there are plenty of medical students excited about a middling salary in the mid west. But this is going to be a very different group than those who matched into radonc in the last 10-20 years.

These were, by and large, people who could have been making $300k+ at a bank or consulting firm within a few years of graduating college, let alone 9-10 years later after accumulating $200k+ of debt.

At the end of the day, these greedy academics won’t have ruined the field, they’ll simply have made it unpalatable to anyone with a competitive application who isn’t susceptible to the specious nonsense that wanting to make a good living in a nice place while also doing good for patients makes you a morally inferior physician.

Talk about strawman.

 

[RickyScott]

Talk about strawman.

Are you willing to acknowledge a doubling of residency numbers since early 2000s and increasing hypofract?

 

[seper]

I wonder if anyone has seen data on senior-junior wage gap in RadOnc compared to other specialities. Perhaps salary variation would be another way to look into this. Personally, it feels like it's unusually large in our field.

 

[radoncgrad2019]

Are you willing to acknowledge a doubling of residency numbers since early 2000s and increasing hypofract?

...yes?

Did you think that I would not?

disconnect.

 

[xrthopeful]

I wonder if anyone has seen data on senior-junior wage gap in RadOnc compared to other specialities. Perhaps salary variation would be another way to look into this. Personally, it feels like it's unusually large in our field.

I luckily didn’t experience any really unfair practices but some of these older private guys hoard the cash.

But that probably happens more often than we think even in non medicine fields. Pay your dues blah blah blah.

 

[evilbooyaa]

It may absolutely be true that there are plenty of medical students excited about a middling salary in the mid west. But this is going to be a very different group than those who matched into radonc in the last 10-20 years.

These were, by and large, people who could have been making $300k+ at a bank or consulting firm within a few years of graduating college, let alone 9-10 years later after accumulating $200k+ of debt.

At the end of the day, these greedy academics won’t have ruined the field, they’ll simply have made it unpalatable to anyone with a competitive application who isn’t susceptible to the specious nonsense that wanting to make a good living in a nice place while also doing good for patients makes you a morally inferior physician.

While I agree with your points in general, I mostly disagree with this and agree that it's a strawman. The trope about medical students being able to go easily make 6 figures outside of medicine is overplayed IMO. Different skill sets and I don't think it's nearly as much of a slam dunk as you think.

Again, would caution against saying 'greedy academics'. Rank and file academic attendings are not the issue here (unless they demanded 24/7 resident coverage, thus leading to expansion). It's chairmen/women who are the folks who decide whether a residency program is going to expand or not.

 

[medgator]

You have people on this forum (really a group of about 5-10 regular posters) who have jobs they love - they are private guys making bank and have for a few years or many years. Some have made million(s) a year and this is public information. They see the rad onc world THEY know changing and also see the increase in employed docs, less autonomy, etc. They have fears about the future of the field, rightfully so, but are also disconnected from the current job market/job hunt.

You do realize those of us already partnered in to existing practices will benefit equally as much from the resident oversupply as the academic chairs that have created it, right? Lower starting salaries, longer tracks to partnership, employee only situations etc for our future new hires

 

[evilbooyaa]

Evil - I am aware that Neuronix has posted about some people in his program having a tough time because they had specific ties and needed to stay in that state where they trained, which he has said is a tough market and a desirable place. This type of situation has always been hard in rad onc and will always be hard. I tell every single medical student that I meet - if you need to be in Place X 100%, just know that may be quite hard in any given year.

But I think you are being dishonest if you think this type of thing is approaching 25-33%. just think about the people you know, the people you trained with. Maybe your experience is different than mine and many of the other new grads and graduating residents that OP spoke to.

I wish you luck on your search. I am confident you will be here a year from now posting good news. You seem like a go-getter.

I will agree with you that the part about ties ot a specific region or area frequently seem to be the confounding variable in many of these cases. Perhaps my stance is softening in this regard.

In regards to the actual number, no I don't think it's 25 or 33% right now. I think it's somewhere in the 10, maybe 15%ish range now. As others have stated, the concern is not necessarily about where exactly we are right now, but what can medical students expect in 5 years that I think we are routinely getting conflated. I think that posters who basically say "well it's a 50/50 coin flip whether the job market will worsen or rebound" are mostly being disingenuous, because as others have stated, if you draw a straight line on the job path trajectory, it leads down, not up.

Thanks for the encouragement - I expect that I'll be OK - I am trying to look out for the welfare of all residents rather than solely my own goals.

 

[radoncgrad2019]

You do realize those of us already partnered in to existing practices will benefit equally as much from the resident oversupply as the academic chairs that have created it, right? Lower starting salaries, longer tracks to partnership, employee only situations etc for our future new hires

I never said you guys had ill intentions in posting about the future of the field. I agree you guys mean well for the most part. I was just posting about where I see the disconnect - which is what OP asked.

 

[RickyScott]

...yes?

Did you think that I would not?

disconnect.

so, we may be heading towards a disaster here- can I get you to agree with that? I think chances are a lot higher than 50/50, but even if they were lower, a lot of medstudents would not be comfortable taking that kind of risk with their career, because they dont need to with many other specialties.

 

[Krukenberg]

These were, by and large, people who could have been making $300k+ at a bank or consulting firm within a few years of graduating college, let alone 9-10 years later after accumulating $200k+ of debt.

This is the hyperbole and sensationalism people are finally calling out. Do you actually know anyone in I banking or consulting? They make $100k working 60-110 hours per week for years. You don’t make $300k+ until you’re in management or a rainmaker in sales (which the vast majority of doctors wouldn’t be suited for). My friend in venture capital is working on a deal funding a startup that makes vending machines in pharmacies. My friend in consulting is working with a sugary beverage company to redesign their packaging.

I’ll take a $300k starting salary to work 50 hours a week at a satellite curing cancer, thank you.

 

[RickyScott]

Geography???
That's the issue? SDN's rhetoric about geography? Or worries about geographic restriction? Can I call this gaslighting? At least tone deaf? I don't want to offend, but how is this not gaslighting a med student. Btw, med students: OF COURSE geography is not important enough not to apply. But just like in Trivial Pursuit with the blue wedge, it's one important piece of the pie.

"LOCATION, LOCATION, LOCATION Residents were asked to rate those factors they look for when assessing practice opportunities, with one being the most important factor and three the least important. Clearly reflecting the priorities of today’s medical residents, 77% indicated that “geographic location” is their most important consideration when evaluating a practice opportunity, a higher ranking than any other factor. It superseded “adequate personal time”, which was rated the number one factor physicians look for in a practice in Merritt Hawkins’ 2017 Survey of Final-Year Medical Residents. "

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_Final_Year_Medical_Residents_Survey_2019.pdf

 

[medgator]

"LOCATION, LOCATION, LOCATION Residents were asked to rate those factors they look for when assessing practice opportunities, with one being the most important factor and three the least important. Clearly reflecting the priorities of today’s medical residents, 77% indicated that “geographic location” is their most important consideration when evaluating a practice opportunity, a higher ranking than any other factor. It superseded “adequate personal time”, which was rated the number one factor physicians look for in a practice in Merritt Hawkins’ 2017 Survey of Final-Year Medical Residents. "

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_Final_Year_Medical_Residents_Survey_2019.pdf

Ironically, location has always been the toughest of the 3 factors to land a preferred RO job imo.

That was true before the recent residency expansion and doubly true now.

 

[Neuronix]

Evil - I am aware that Neuronix has posted about some people in his program having a tough time because they had specific ties and needed to stay in that state where they trained, which he has said is a tough market and a desirable place.

That's not what I wrote or meant. We have had numerous grads (both where I trained and who I have trained) who have tried to go back to where they're from or where their spouse or family lives now and failed to find full time and/or full salary employment there. Most of these locations are not the big name types of places you would think about. They haven't been taking some huge pay raise as a compromise either.

Of course I'm talking about at time of graduation. Some have moved on since then and others just stick around and accept it. Not like there are a lot of choices. The job market doesn't just magically open up because you've been practicing for a few years.

As for percentages, it's just a question of how close you consider acceptable. Some end up hours away in the same state. Some end up in a different state. Some end up in a different region like me.

But yes it's true, the job market here is horrible. Few of our grads stick around this area. The one who tried last year did not have a job at time of graduation. Not sure how they're faring now. That's not counting the other one who was willing to go anywhere and is now doing locums.

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_Final_Year_Medical_Residents_Survey_2019.pdf

Medical residents completing their training are inundated with recruiting offers. Two thirds (66%) received 51 or more recruiting offers during their training, while 45% received more than 100.

I couldn't even imagine what this is like after "networking" for jobs for years as a resident.

 

[RickyScott]

This type of situation has always been hard in rad onc and will always be hard. I tell every single medical student that I meet - if you need to be in Place X 100%, just know that may be quite hard in any given year.

1) given the ascendance of geography as the overwhelming job factor for 4 out 5 med students/residents, perhaps you are kind of disconnected from them and certainly explains the evaporating interest in this field, not posters on SDN. Does your department warn them before wasting their time with a rotation?

2) radonc starting salaries are not much different than primary care, which has 2 less years of training (500,000k amortized over 40 years is huge)?

 

[xrthopeful]

Adequate personal time is surely h

1) given the ascendance of geography as the overwhelming job factor for 4 out 5 med students/residents, perhaps you are kind of disconnected from them and certainly explains the evaporating interest in this field, not posters on SDN. Does your department warn them before wasting their time with a rotation?

2) radonc starting salaries are not much different than primary care, which has 2 less years of training (500,000k amortized over 40 years is huge)?

good for you that you like primary care.

I wish you would have done it. It’s never too late. It wasn’t for me, at all.

 

[deleted956486]

Adequate personal time is surely h


good for you that you like primary care.

I wish you would have done it. It’s never too late. It wasn’t for me, at all.

This response is disrespectful. It also seems to be a common one when presented with data refuting the notion that rad onc is a healthy specialty for medical students to enter: "retrain, or leave if you dont agree with my narrative."

Ricky brings up a very valid point.

That's not how you speak to a colleague with legitimate concerns. That seems to be the problem these days in rad onc. Gaslighting and disrespect.

 

[bluebubbles]

Expectations and anchoring do play a role.

Radiation oncology is a hodgepodge. You have students that went to top 10 colleges, top 10 medical schools, etc. Obviously their peers & friends in software, finance, consulting, law, etc. are going to be very different from the peers & friends of those that went to Main Street higher education but also have jobs that are nominally dubbed software, finance, consulting, law, etc.

That’s just another argument for people with high expectations (that is, those from the top of their class and/or from top medical schools) to avoid radiation oncology. DO/FMG students whose peers would be happy to land a family medicine or pathology residency slot, these students should apply to radiation oncology.

 

[xrthopeful]

This response is disrespectful. It also seems to be a common one when presented with data refuting the notion that rad onc is a healthy specialty for medical students to enter: "retrain, or leave if you dont agree with my narrative."

Ricky brings up a very valid point.

That's not how you speak to a colleague with legitimate concerns. That seems to be the problem these days in rad onc. Gaslighting and disrespect.

No it’s disrespectful and a straw man to ignore interest in a specialty. That is relevant as well as adequate free time and location. Seems to be ignored in the discussion.

For anyone that wants to do primary care and is interested as such and also wants to prioritize location preference first, that is ABSOLUTELY the way to go. No argument from me/