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

[evilbooyaa]

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.

Really? I don't really consider it disrespectful. If I could tolerate doing primary care for the rest of my life I would have. I couldn't, so I didn't.

People keep throwing out disrespectful on this board and it's really just somebody disagreeing with somebody else and therefore both parties get offended. SDN members can disagree with one another without it immediately becoming a disrespectful statement.

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[thecarbonionangle]

Lock thread down its pointles now. Poster already had issue addressed. Theres like 100 job market threads

 

[Krukenberg]

Lock thread down its pointles now. Poster already had issue addressed. Theres like 100 job market threads

I think this thread should stay open. For once we have a thread where med students can see both sides of the debate that isn’t overwhelmed with the 5-8 posters who post alarmist rhetoric all the time. I don’t want this thread to disappear into obscurity.

Edit: actually I take back calling it a debate. Everyone’s in agreement expansion is bad. We just finally have some voices of moderation pushing back against the hyperbole

 

[evilbooyaa]

Thread to remain open. We have done a reasonable job of staying on topic in regards to the OP. Not perfect across 9 pages (which is impossible) but not completely de-railed.

 

[deleted941485]

Most college friends I know well enough to know their salary details who did law, finance or business were partners or principles by their mid - 30s making 500+ with bonus and carry. Guess I have abnormally successful friends, but happy to admit this isn’t the norm.

I know a dude who made managing partner at Morgan Stanley makes 2M a year. Was the smartest kid in our class, he literally laughed Putnam loud when he found out I was was in Med school called me a poor uninformed soul. Guy was arrogant ass but still he wasn’t wrong

 

[Pointless]

I know a dude who made managing partner at Morgan Stanley makes 2M a year. Was the smartest kid in our class, he literally laughed Putnam loud when he found out I was was in Med school called me a poor uninformed soul. Guy was arrogant ass but still he wasn’t wrong

He sounds like a really cool dude. I wish I could be like him.

/s

 

[deleted941485]

He sounds like a really cool dude. I wish I could be like him.

/s

Seriously, I wish there’s was a do over button.

 

[scarbrtj]

Study after study has shown that higher salary (after a certain point) brings diminishing returns when it comes to happiness and quality of life. The actual feasible difference between $500K-$600K and $2M are miniscule.

The studies are invariably foisted upon those folks who are working. Yeah, if you're working, everyone's QOL about the same. But you know what's nice? Make a lot of money... and quit working while the other guy is still working, and getting surveyed, etc. You should show some surveys about amount of vacation time and see if that correlates to QOL, happiness. And, uh, you know, the people who say the difference between $0.5 million and $2 million in terms of "feasible difference" is "miniscule"... have never made $2 million in a year. In my experience.

 

[xrthopeful]

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.

Going back to the original purpose of this thread - one thing I would tell any medical student on the interview trail is to ASK ASK ASK about how former grads have done on their job searches. That's like the most important question. Not at all to cast any aspersions at all on Neuronix (seriously), but what this tells me about a program that has repeatedly not been able to get residents jobs is:

1) Lack of an alumni network. Residents haven't gotten jobs where they've been able to help hire new grads or the culture isn't there to care about where you trained.

2) The program doesn't hire their own. You have to wonder about this.

3) Attendings aren't invested in their residents and aren't helping them establish awesome CVs or going to bat for them to help them get a job.

The job hunt success rate can be independent of program tier IMO. Of course program tier helps, but some places with 'low tier' reps have either 1, 2, or 3 of the above on lock and it goes to show in success rates in the job hunt.

Med students - pick good programs! For lots and lots of reasons, but job search is an important one.

 

[MegaVoltagePhoton]

sorry, I think expansion is dumb and the market is not looking great...but primary care making 300k starting? Sorry that’s not remotely true. Are you comparing top of the line primary care jobs versus lower totem pole rad onc jobs?

Also I’m glad there was pushback about the “should have gone into banking” thing. The people who succeed there have very different skill sets and also are liable to work extremely hard. Not saying we don’t, but it’s the ultimate grass is greener fallacy to throw stuff like that around. Yeah, I also wish I invented YouTube. Guess what, I didn’t, and I wouldn’t have if I were an entrepreneur either.

And finally...I think there’s some cognitive dissonance. On the one hand people insulting our field as “drawing circles” and “babysitting linacs” in one breath and then in another complaining about a poor job market and making 300k? If what we do is so easy why should we make that much even? The answer is because we bring a lot of value and control a potent but toxic tool to cure cancer. Stop devaluing yourself and your field. Particularly ironic to whine about “what would happen if the secret is out!!! About what we do!!!” In a public forum.

And once again—residency expansion is dumb and astro/leadership failure and silence is deafening. Before someone attacks me.

 

[deleted941485]

This. All of this. The field is sick and needs to be fixed... but talking about wanting to go into business because of the money while still making an immeasurable salary to most Americans indicates more about you than it does the field.

Wow yeah real heavy hitter. Someone on sdn likes making money. Oh god what a revelation about my character. Quick let’s brow beat them and shame them.

Money doesn’t buy happiness but it sure as hell buys life long contentment. These other ridiculous arguments about the differences in happiness are a joke. If it were such a burden, my hospitals CEO would dress like Santa Claus and go door to door giving out Christmas bonuses out of his own salary but alas they didn’t they stopped giving bonuses in 2014.

Is this how you keep the peons grinding away these days? I mean it’s a great approach!

 

[xrthopeful]

Imagine being the guy/gal who on one hand can’t figure out how to market themselves in to getting a good happy job in rad onc but on the other hand thinks they could have made millions in business.


You hate to see it.

 

[deleted941485]

It's not a shame to care about money, but it certainly shouldn't be your primary motivation. If it was, then yes, you absolutely entered the wrong field. You say they're a joke, but the data backs me up from multiple studies. Your way of thinking is not everyone's way of thinking.

Never did I say making more money is a burden.

Again, if you're so concerned with making more money, create a startup, learn to code, get an MBA... do something about it.

Honestly What do you know about my primary motivation? Or what it should or should not be?



“The data backs me up” LOL - great send it to MEDPAC. I’m sure CMS would love to save the healthcare system some extra dollars. Again not buying your “data” on happiness which is just become another hamfisted way of shoving nonsense down someone’s throat. The theory itself does nothing to explain how people actually behave.

The remark about just uprooting and leanrjng to code isn’t just tone deaf and ridiculous especially to people on this boards whomare in the middle of residency training.

Didn’t you say you came from wealth. If so you probably already know that it’s not learning to code that makes you rich it’s getting someone else’s to do it now that will make you millions!

 

[deleted941485]

Imagine being the guy/gal who on one hand can’t figure out how to market themselves in to getting a good happy job in rad onc but on the other hand thinks they could have made millions in business.


You hate to see it.

Yup it’s all just marketing. If everyone just figured out that special psychological dog whistle that all those employers are looking for we wouldn’t even be having this conversation. Looking forward to the virtual ASTRO session on this topic in the future. Should be enlightening.

 

[RadOncDoc21]

While marketing is certainly not a fix for everyone, even remotely, it 100% can help. The more someone likes you, the more likely they are to give in to your requests. That's essentially half of business...

While the other half is being cut throat. Maintaining a monopoly making it impossible for fair competition where it doesn’t really matter how much someone “likes” you... business will always be business.

 

[medgator]

The studies are invariably foisted upon those folks who are working. Yeah, if you're working, everyone's QOL about the same. But you know what's nice? Make a lot of money... and quit working while the other guy is still working, and getting surveyed, etc. You should show some surveys about amount of vacation time and see if that correlates to QOL, happiness. And, uh, you know, the people who say the difference between $0.5 million and $2 million in terms of "feasible difference" is "miniscule"... have never made $2 million in a year. In my experience.

 

[medgator]

You, a doctor, who's entire intellectual foundation is based upon scientific studies, are refusing to believe a dozen scientific studies that all came to the same conclusion over your own anecdotes.

Although you've never experienced 2 million a year in your life, you're arguing that you would be much happier... claiming that I, someone who HAS experienced that, am wrong in my beliefs, when you yourself said that people who think more money doesn't = more happiness haven't experienced it themselves. Your logic is collapsing in on itself and hypocritical.

Yes, you are right. My advice was poor... that was part of the point... that it's so hard to make it in any of those fields. Having an MBA doesn't magically give you a job that makes $2M+...


Here is an article based around an immense study: Over nearly 80 years, Harvard study has been showing how to live a healthy and happy life

I'm going to quote part of it:
"Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes. That finding proved true across the board among both the Harvard men and the inner-city participants."

Money does not have the greatest impact on happiness. Friendship, family, and love does.

This study has led to over 30 peer reviewed publications.

I do get all of that, but if the guy making more money is able to retire that much quicker, or go to part time that much quicker, that has to mean something.

Financial freedom shouldn't be underestimated and that's something I think these surveys don't necessarily grasp.... One day it'll be nice to work because you want to, on your own terms, not because you have to.

 

[Sheldor]

So, in the interest of this thread having a diversity of opinions I will go ahead and share mine...

I have held off for a bit because I think a lot of people in our field are in the same weird position as me: My life is amazing. Training was a good experience where I did what I love while working half the hours of many of our co-residents in other fields. I am on my second job now post-residency and love it. I couldn't imagine doing another specialty. The technology, the hours, pay and location are fantastic. So, with all that said, what do you do when you come to the forum you've been a part of for a decade and everyone seems so unhappy? I guess what I'm saying is that this dissonance exists for those of us in practice too.

1. Residency expansion is dumb. Why have we shot ourselves in the foot on purpose? Fix it, asap, we need far less residency spots.
2. What we do is still awesome, even with less fractions. Heck, when I started SBRT for olig-mets wasn't even a thing and now its my favorite thing to do! Quick, minimal side effects, patients love it, and it works!
3. Rad Onc can be both awesome and have problems to fix
4. We can't tell every fourth year med student the field sucks and not to go into it, because then, well, the field will just get worse.

If you can't tell, I struggle with this, I honestly don't know what to tell med students right now. I can certainly tell them about the problems facing Rad Onc (or heck, medicine in general) but then when it comes down to it do I recommend the field or not? (This field that I love, and couldn't imagine doing something else.)

Anyway, I'm rambling. Rad Onc is amazing, but has some problems to fix to prepare itself for a future that will be different than its past.

 

[medgator]

So, in the interest of this thread having a diversity of opinions I will go ahead and share mine...

I have held off for a bit because I think a lot of people in our field are in the same weird position as me: My life is amazing. Training was a good experience where I did what I love while working half the hours of many of our co-residents in other fields. I am on my second job now post-residency and love it. I couldn't imagine doing another specialty. The technology, the hours, pay and location are fantastic. So, with all that said, what do you do when you come to the forum you've been a part of for a decade and everyone seems so unhappy? I guess what I'm saying is that this dissonance exists for those of us in practice too.

1. Residency expansion is dumb. Why have we shot ourselves in the foot on purpose? Fix it, asap, we need far less residency spots.
2. What we do is still awesome, even with less fractions. Heck, when I started SBRT for olig-mets wasn't even a thing and now its my favorite thing to do! Quick, minimal side effects, patients love it, and it works!
3. Rad Onc can be both awesome and have problems to fix
4. We can't tell every fourth year med student the field sucks and not to go into it, because then, well, the field will just get worse.

If you can't tell, I struggle with this, I honestly don't know what to tell med students right now. I can certainly tell them about the problems facing Rad Onc (or heck, medicine in general) but then when it comes down to it do I recommend the field or not? (This field that I love, and couldn't imagine doing something else.)

Anyway, I'm rambling. Rad Onc is amazing, but has some problems to fix to prepare itself for a future that will be different than its past.

Had a pre med student shadow me with ties to the area. He really liked what I did.

Told him the job is great, but that geographic availability can be tough. No one has taken a job in my area in probably 6ish years because there is only so many ROs needed in our geographic area and no one has been hiring during that time

 

[RadOncDoc21]

Had a pre med student shadow me with ties to the area. He really liked what I did.

Told him the job is great, but that geographic availability can be tough. No one has taken a job in my area in probably 6ish years because there is only so many ROs needed in our geographic area and no one has been hiring during that time

This has been my experience as well. No way hypofx, residency expansion and a decline in reimbursements is going to make this any easier for anybody.

I’m actually very fortunate to be doing what I’m doing in the location I’m at but definitely not feeling “good” about our field’s future direction.

 

[RadOncDoc21]

AHEM... Disney... Amazon...

Large academic hospitals with satellites in random parts of the world, 21st century oncology, mega urology groups.

My point is that marketing in certain areas and being nice doesn’t always translate into success. Sometimes there are factors in play beyond your control.

 

[Neuronix]

Not at all to cast any aspersions at all on Neuronix (seriously), but what this tells me about a program that has repeatedly not been able to get residents jobs is:

As if:

1) Things were any different at the program where I trained.

or

2) Residency applicants can walk in and say "hey, have your former grads gotten good jobs?" and expect to hear anything except "OH YEAH THEY GOT GREAT JOBS THEY LOVED IN EXACTLY THE LOCATIONS THEY WANTED."

But sure, first discount and misrepresent what I write, now just try to cast me as a one off. Like there's something wrong with me or where I work. As if this specialty isn't sick in general and residency graduates at multiple programs aren't having serious problems.

Though I have been telling med students that it may be better to look at residency spots in the midwest. Job opportunities tend to be better there, and then you can make "ties to the area". It's not enough to just be open and flexible to go anywhere. Now you need "ties to the area" to get the good jobs.

On the topic of "good jobs"--good jobs are out there, for now, but there aren't 200 a year. You may or may not get one. Everyone knows you need to start marketing for good jobs early. So everyone's doing it. Everyone's trying to make connections as a junior resident. Everyone's touting their "ties to the area" (oh yeah my non-existant girlfriend wanna be wife's family lives here). Good luck. There's a lot of chance involved as to who will actually end up with that job.

When all these SDNers start comparing themselves to people they know in business, an element of chance and luck are expected in business. Medicine was supposed to be the route to job security. In most fields of medicine it still is. In rad onc... Eh?

Study after study has shown that higher salary (after a certain point) brings diminishing returns when it comes to happiness and quality of life. The actual feasible difference between $500K-$600K and $2M are miniscule.

Decent houses where I live without a long commute cost $1.5 million or more. I don't make anywhere close to $500k, but I'd love to be making $500k+/year. My family is getting really cramped in our small place. A bigger house would definitely improve our quality of living.

Also I'm trying to figure out the last time I left here at 5 PM without a stack of notes and other tasks (e-mails, film reviews, etc etc etc). What if this specialty really was $500k for 9-5... Wow. Actually, I can't remember the last time I got here at 9 AM either.

 

[Krukenberg]

So, in the interest of this thread having a diversity of opinions I will go ahead and share mine...

I have held off for a bit because I think a lot of people in our field are in the same weird position as me: My life is amazing. Training was a good experience where I did what I love while working half the hours of many of our co-residents in other fields. I am on my second job now post-residency and love it. I couldn't imagine doing another specialty. The technology, the hours, pay and location are fantastic. So, with all that said, what do you do when you come to the forum you've been a part of for a decade and everyone seems so unhappy? I guess what I'm saying is that this dissonance exists for those of us in practice too.

1. Residency expansion is dumb. Why have we shot ourselves in the foot on purpose? Fix it, asap, we need far less residency spots.
2. What we do is still awesome, even with less fractions. Heck, when I started SBRT for olig-mets wasn't even a thing and now its my favorite thing to do! Quick, minimal side effects, patients love it, and it works!
3. Rad Onc can be both awesome and have problems to fix
4. We can't tell every fourth year med student the field sucks and not to go into it, because then, well, the field will just get worse.

If you can't tell, I struggle with this, I honestly don't know what to tell med students right now. I can certainly tell them about the problems facing Rad Onc (or heck, medicine in general) but then when it comes down to it do I recommend the field or not? (This field that I love, and couldn't imagine doing something else.)

Anyway, I'm rambling. Rad Onc is amazing, but has some problems to fix to prepare itself for a future that will be different than its past.

This perfectly encapsulates my view and the view of the lurkers who have DM’d me recently saying they agree.

I love rad onc and couldn’t imagine doing another specialty. A student’s interest in the specialty doesn’t seem to be a factor for the posters who are really down on the field. We spend the majority of our adult lives at work—life is too short to do something I don’t enjoy (primary care, derm) just to have more geographic flexibility, when in fact it’s fully possible I could have gotten a rad onc job in a good location had I entered the field.

I agree with Sheldor that using scare tactics to turn talented med students is cutting off our nose to spite our face. Tell them the facts about the risk with expansion, and let them decide how important geography is.

 

[Krukenberg]

Thread to remain open. We have done a reasonable job of staying on topic in regards to the OP. Not perfect across 9 pages (which is impossible) but not completely de-railed.

I think it might be a good idea for a moderator or Gfunk to update the FAQ with straight facts about residency expansion, hypofrac, and reasonable concerns about future job market. Enough information to let med students decide how concerned they are.

 

[gmsquid]

And just as a side note re: the critique of academics as lazy is unfair to say (I’m in academics). Where I am, we are never fully covered if we are covered at all. I may have 15-20+ patients under treatment but (probably) make less then private practice guys doing a similar number of patients while treating primarily HN patients, attending tumor boards, meetings, teaching residents in clinic and in lectures and trying to do clinical research/write papers/etc. it’s largely a 7-6 job at least. I chose academia because it’s what I enjoy. I do think residency expansion is silly, but not all of us are lazy people who don’t know how to contour and rely on our residents to do all our work.

 

[medgator]

And just as a side note re: the critique of academics as lazy is unfair to say (I’m in academics). Where I am, we are never fully covered if we are covered at all. I may have 15-20+ patients under treatment but (probably) make less then private practice guys doing a similar number of patients while treating primarily HN patients, attending tumor boards, meetings, teaching residents in clinic and in lectures and trying to do clinical research/write papers/etc. it’s largely a 7-6 job at least. I chose academia because it’s what I enjoy. I do think residency expansion is silly, but not all of us are lazy people who don’t know how to contour and rely on our residents to do all our work.

I think it's a generational thing. I'm guessing you finished training at some point during the last 20-25 years?

 

[xrthopeful]

There are absolutely better residency programs than others. That is very important for medical students reading this to know. This is not controversial at all.

In my experience on the residency interview trial, though for the most part people were on the positive side, there was definitely honesty given about pros and cons of programs when asked especially from current residents. Is anyone really going to argue this? Like people told me the the truth and it was easy to tell where was better and where was worse.

I’m sorry you were offended Neuronix, that wasn’t the intention. Program culture is more than one person

 

[gmsquid]

I think it's a generational thing. I'm guessing you finished training at some point during the last 20-25 years?

One could say the same about the pp docs making lots of money who own practices, won’t retire and don’t know how to contour...

But I digress. I did, but even where I trained and where I’m at now, the attendings do the majority of the work.

 

[xrthopeful]

One could say the same about the pp docs making lots of money who own practices, won’t retire and don’t know how to contour...

But I digress. I did, but even where I trained and where I’m at now, the attendings do the majority of the work.

Brings me to another point.

Med students - don’t go to a program where attendings are always covered by residents.

 

[xrthopeful]

Also Neuronix - across you multiple posts you have indicated you're less than thrilled with your current position. Why not trying to leave? Maybe you have? There are some pretty decent jobs open right now if you're willing to move. Might be nice to hit the reset.

 

[medgator]

One could say the same about the pp docs making lots of money who own practices, won’t retire and don’t know how to contour...

Completely valid point. Watching 2D trained folks trying to practice 3D RO is scary to say the least, whether in pp or academics

 

[medgator]

Also Neuronix - across you multiple posts you have indicated you're less than thrilled with your current position. Why not trying to leave? Maybe you have? There are some pretty decent jobs open right now if you're willing to move. Might be nice to hit the reset.

Sometimes it's not just up to one person to make that decision . Spouses have jobs, kids make friends and social connections etc.

It becomes really difficult for those of us with physician spouses who also are specialists vs those who are in primary care.

 

[Reaganite]

My point is that quality of life doesn't improve that much... $700K can feel like $2M if you're smart with your money and don't live beyond your means, and $2M can feel like $700K if you waste your money and live high and mighty.

To each his own, but I completely disagree. 700k vs 2 million...youre looking at an after tax monthly income difference of at least 50k. Huge difference in lifestyle between those numbers, especially in high cost, high tax states. 2 mill is comfortably affording the 3 million dollar house, saving for retirement, putting your kids through private school...and still having significant leftover cash to blow on exotic cars, first class travel, gucci, etc. I can speak from experience too.

 

[Krukenberg]

Brings me to another point.

Med students - don’t go to a program where attendings are always covered by residents.

+1. Definitely decreases QOL if attendings need constant coverage. Imagine feeling guilty about taking vacation or having a baby because another resident has to cover one more attending. Obviously it’s the norm in most other specialties but in rad onc it’s just not necessary

 

[KHE88]

WOW This thread has really turned into... something.

I'll just say that by being geographically flexible I was able to land the most amazing job out of residency. You all wouldn't believe me if I told you how much money I was making and the quality of my life on the job.

My fear is how long this will last.

I am CONFIDENT I failed the absolutely ridiculous clinical boards (you know... the one that previously had a 97% pass rate and asked basic questions) this year, and am very scared that I will get pushed down the pipe and lose my BE in 6 years and be out of a job. As a result, I am not spending any money and trying to build up as much of a safety net as I can. This is an absolutely horrible feeling and something no one should have worry about. The bar to demonstrate "competence" in this field is unreasonably high and our specialty board seems hellbent on ruining lives. Virtually no other field save for a handful of surgical subspecialities are like this. That alone should be enough to scare students from going into this field, let alone the issues with overtraining and hypofractionation.

 

[xrthopeful]

You’re actually worried you won’t pass boards in the next six years?

Dude.

 

[PointA]

Add me to the alarmist/ fear-mongering/ tin foil hat crowd. Every single poster on this thread agrees that residency expansion is hurting the field and meanwhile ASTRO leadership/ chairs/ PDs are doing NOTHING to address the issue other than hand wringing and making excuses. On top of that, the problem is getting worse because more and more programs are actively trying to expand and we are pumping out record numbers of graduating residents. This is simply not sustainable and the toll on specialty will come due. All I ask is that leadership actually DO SOMETHING proactive to address the issue, then I will gladly remove my tin foil hat.

 

[medgator]

Add me to the alarmist/ fear-mongering/ tin foil hat crowd. Every single poster on this thread agrees that residency expansion is hurting the field and meanwhile ASTRO leadership/ chairs/ PDs are doing NOTHING to address the issue other than hand wringing and making excuses. On top of that, the problem is getting worse because more and more programs are actively trying to expand and we are pumping out record numbers of graduating residents. This is simply not sustainable and the toll on specialty will come due. All I ask is that leadership actually DO SOMETHING proactive to address the issue, then I will gladly remove my tin foil hat.

The first step to solving a problem is acknowledging you actually have one. Outside of a few PDs, the party line is to not even acknowledge it

 

[xrthopeful]

The first step to solving a problem is acknowledging you actually have one. Outside of a few PDs, the party line is to not even acknowledge it

I would love to know how you’re so sure what people think. When’s the last time you talked to a PD?

I can assure you that you’re not correct.

 

[MegaVoltagePhoton]

To each his own, but I completely disagree. 700k vs 2 million...youre looking at an after tax monthly income difference of at least 50k. Huge difference in lifestyle between those numbers, especially in high cost, high tax states. 2 mill is comfortably affording the 3 million dollar house, saving for retirement, putting your kids through private school...and still having significant leftover cash to blow on exotic cars, first class travel, gucci, etc. I can speak from experience too.

I mean, of course a 2 million dollar per year salary is better than 700k, etc. But the questions at hand is the cognitive dissonance.

if what we do is so easy/useless ("oh we just draw circles" "oh we just babysit linacs" "oh its med oncs that do the real science" then why should we ever make 2 million? if the argument is "oh but thats how much we bill!" then either we deserve that much or we dont, and self-hating your own profession while simultaneously complaining about lowering pay is completely dissonant

second, youve posted here before about how you busted ass to make that 2 million (or whatever). that probably wasnt an 8-5 job sitting on your butt.

third, Seinfeld made one million per episode so probably you should have just written comedy instead of doing rad onc.

 

[KHE88]

You’re actually worried you won’t pass boards in the next six years?

Dude.

Have you failed a board exam? Come back and talk to me after you've failed an exam despite consistently getting >80%-tile on inservice.

I'll admit, I'm a worrier by my nature, but it really does something to you.

Yes, there are people who lose their BE. If the ABR continues doing what they're doing with these exams, this number will go up. But hey, good for you guys that got BC anyway. That's one way to reduce the numbers of people competing for jobs.

Reality is the old timers didn't have this "pass your boards in 6 years or KYS" pressure, MOC issues, etc. More and more pointless hoops for us to jump through and cause people like me severe anxiety and stress.

 

[medgator]

I would love to know how you’re so sure what people think. When’s the last time you talked to a PD?

I can assure you that you’re not correct.

Great.

so tell me about all those programs that are contracting down (or at least aren't shamelessly expanding like they had been) for the next match to get us down to the 100 or so spots we need to be at to bring the specialty back into balance.

Look forward to your response

 

[taserlaser]

Hypothetically speaking, what happens if one does lose their BE status? Consider me out of the loop.

And for the record consider me alongside with KHE88 here. There’s a lot of stress and pressure on these boards, and a lot of time needed to study the minutiae that is tested. If one were working a busy practice, there might not be a lot of time afforded to studying if you include family demands at that point too. Not saying it couldn’t be done, but I can only imagine the enormity of the stress and mental health issues that could arise from such a situation. I think one conclusion from all of this is definitely the field is not set up to protect the interests of the practitioners, including wellness. There may be wellness found in pockets of certain jobs, but it is not the bastion held that some people think RO to be. Having to compromise on the 3 job elements does impact this as well.

 

[KHE88]

Hypothetically speaking, what happens if one does lose their BE status? Consider me out of the loop.

You'll either be doing locums or if you're lucky get into a desparate rural practice that doesn't care.
Any hospital or academic center in a desirable location is going to require BE/BC

Or if you're really lucky somehow start your on PP or join a PP where you have a connection.

But mostly locums, and the locums pool is skyrocketing driving compensation and opportunities down.

 

[scarbrtj]

Thread view from biased observer trying to be unbiased:
Negatives of rad onc:
1) Brittle vacation time, lack of flexibility in time off for solos in academic satellites, etc.
2) No chance of increasing reimbursements... the most money you'll ever make will likely be soon after training
3) Passing boards: issues. Severest board cert process of any specialty.
4) More payor uncertainty than in other specialties (APM etc)
5) Severest geographic inflexibility of any specialty
6) Job market: tough. Will only get tougher. Residency expansion.
7) Declining "indications" (fractions...and indications)

Positives of rad onc:
1) Brass ring: 7-6 job making 400K a year w/ 4 weeks vacation
2) Being the greatest and smartest doctor of any specialty
3) Ability to shut out concerns over money, job market, etc. Instills "nose to grindstone" traits.
4) Practicing your love of rad onc if rad onc is all you want to do
5) Welp. It's not primary care.

 

[evilbooyaa]

Lot of discussion overnight - Let's try to keep it on topic to the field of rad onc. I'm going to say that further discussion on life value between rad onc and business (not even a career within medicine) is off-topic enough that future posts about in this thread are strongly discouraged. Long discussions about the contentness value of 500 or 700k vs 2 mil a year can also go off to their own thread.

Looking at you @RadsWFA1900 and @Harrisonkatz124

Great.

so tell me about all those programs that are contracting down (or at least aren't shamelessly expanding like they had been) for the next match to get us down to the 100 or so spots we need to be at to bring the specialty back into balance.

Look forward to your response

I am aware of at least Fox Chase and I believe Henry Ford as well that have had leadership come out and say 'We could expand but we don't think it's right for the field or our current residents, and thus we have chosen not to'.

Props to the chairs and PDs at both of those programs.

So, in the interest of this thread having a diversity of opinions I will go ahead and share mine...

I have held off for a bit because I think a lot of people in our field are in the same weird position as me: My life is amazing. Training was a good experience where I did what I love while working half the hours of many of our co-residents in other fields. I am on my second job now post-residency and love it. I couldn't imagine doing another specialty. The technology, the hours, pay and location are fantastic. So, with all that said, what do you do when you come to the forum you've been a part of for a decade and everyone seems so unhappy? I guess what I'm saying is that this dissonance exists for those of us in practice too.

1. Residency expansion is dumb. Why have we shot ourselves in the foot on purpose? Fix it, asap, we need far less residency spots.
2. What we do is still awesome, even with less fractions. Heck, when I started SBRT for olig-mets wasn't even a thing and now its my favorite thing to do! Quick, minimal side effects, patients love it, and it works!
3. Rad Onc can be both awesome and have problems to fix
4. We can't tell every fourth year med student the field sucks and not to go into it, because then, well, the field will just get worse.

If you can't tell, I struggle with this, I honestly don't know what to tell med students right now. I can certainly tell them about the problems facing Rad Onc (or heck, medicine in general) but then when it comes down to it do I recommend the field or not? (This field that I love, and couldn't imagine doing something else.)

Anyway, I'm rambling. Rad Onc is amazing, but has some problems to fix to prepare itself for a future that will be different than its past.

Agree with everything the bolded. I think having a realistic expectation of the job market is critical for medical students. I completely agree with the approach MG took below with the pre-med. Some, like myself, love Rad Onc as a field more so than any other field and would go into it anyways (like when I was applying to residency and I'd have gone wherever they let me become a Rad Onc). Students that would've been similarly happy in Radiology or med-onc will likely use this information as ONE data point to weigh their future plans.

Had a pre med student shadow me with ties to the area. He really liked what I did.

Told him the job is great, but that geographic availability can be tough. No one has taken a job in my area in probably 6ish years because there is only so many ROs needed in our geographic area and no one has been hiring during that time

Brings me to another point.

Med students - don’t go to a program where attendings are always covered by residents.

QFT. This to me is one of the biggest landmarks of a positive residency experience, especially at places outside the top 3.
An attending that cannot function without a resident will make your residency life much more painful than it needs to (or should) be.

 

[Neuronix]

xrthopeful, I'm not offended. I'm sorry to come off that way. I just post more strongly when people try to minimize the real experiences and issues that I've seen.

I would love to know how you’re so sure what people think. When’s the last time you talked to a PD?

I can assure you that you’re not correct.

Our PD absolutely does not acknowledge a residency oversupply.

Also Neuronix - across you multiple posts you have indicated you're less than thrilled with your current position. Why not trying to leave? Maybe you have? There are some pretty decent jobs open right now if you're willing to move. Might be nice to hit the reset.

This is too complicated and personal to discuss publicly. I will just state that I had very few options when I graduated residency, and that has not changed just because I've been out for a few years. Also things are not all bad here, and some things have improved for me here.

It was discussed at SCAROP this year and residency expansion was dismissed as a non-issue, for what it’s worth. Tanking of the match was blamed on “internet message boards.”

Some friends and I are involved in ASTRO in a number of capacities as well, and this has also been our experience. I've been warned by a few to knock it off before they shoot the messenger, so if I disappear from SDN one of these days you'll know what happened...

 

[Pointless]

So, in the interest of this thread having a diversity of opinions I will go ahead and share mine...

I have held off for a bit because I think a lot of people in our field are in the same weird position as me: My life is amazing. Training was a good experience where I did what I love while working half the hours of many of our co-residents in other fields. I am on my second job now post-residency and love it. I couldn't imagine doing another specialty. The technology, the hours, pay and location are fantastic. So, with all that said, what do you do when you come to the forum you've been a part of for a decade and everyone seems so unhappy? I guess what I'm saying is that this dissonance exists for those of us in practice too.

1. Residency expansion is dumb. Why have we shot ourselves in the foot on purpose? Fix it, asap, we need far less residency spots.
2. What we do is still awesome, even with less fractions. Heck, when I started SBRT for olig-mets wasn't even a thing and now its my favorite thing to do! Quick, minimal side effects, patients love it, and it works!
3. Rad Onc can be both awesome and have problems to fix
4. We can't tell every fourth year med student the field sucks and not to go into it, because then, well, the field will just get worse.

If you can't tell, I struggle with this, I honestly don't know what to tell med students right now. I can certainly tell them about the problems facing Rad Onc (or heck, medicine in general) but then when it comes down to it do I recommend the field or not? (This field that I love, and couldn't imagine doing something else.)

Anyway, I'm rambling. Rad Onc is amazing, but has some problems to fix to prepare itself for a future that will be different than its past.

I will add my endorsement to this excellent post because it also encapsulates all of my thoughts on the field.

I love my job. I get paid an absurd amount of money to work 4 days a week doing things that I love doing with patients that I enjoy treating. Some days are too busy, some days are too quiet, sometimes the referring docs are annoying, sometimes hospital administration can be a pain. Despite all of that, I love 90% of my job and I can't fathom doing anything else in medicine. Cut my salary by 200-300k?? Still would do it and love it.

I will echo one other post that someone made about achieving financial independence. I agree very much that working on your own terms is the holy grail. That 90% I mentioned above would become 100% when I literally don't have a worry in the world about whether or not I have a job tomorrow. And, because of the absurd pay and the extra time I have to read financial books and websites, I'm on track to achieve that before age 50.

So, all in all, I feel like I hit the lottery. I'm genuinely sorry that some of you are not experiencing this aspect of the field, but I encourage you to look with open eyes rather than throwing your hands up and declaring that the game is rigged. There's nothing special about me, I didn't do any real networking, I don't have a decoder ring and nor do my friends in the field who have all found similar situations. Good luck to all of you and if anyone ever feels as though they need some advice or have questions, feel free to DM me.

DISCLAIMER: I do solemnly swear that I agree that residency expansion is bad. Please do not doxx, gaslight, or straw man me, whatever those things are.

 

[Radium Dial Painter]

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.

 

[Reaganite]

I mean, of course a 2 million dollar per year salary is better than 700k, etc. But the questions at hand is the cognitive dissonance.

if what we do is so easy/useless ("oh we just draw circles" "oh we just babysit linacs" "oh its med oncs that do the real science" then why should we ever make 2 million? if the argument is "oh but thats how much we bill!" then either we deserve that much or we dont, and self-hating your own profession while simultaneously complaining about lowering pay is completely dissonant

second, youve posted here before about how you busted ass to make that 2 million (or whatever). that probably wasnt an 8-5 job sitting on your butt.

third, Seinfeld made one million per episode so probably you should have just written comedy instead of doing rad onc.

I wish I had more time to respond and give insight, but I agree with everything people have posted on this board. The trajectory this field is taking is alarming. That being said, many of these complaints date back to my residency days. My PD and Chairman didn't give 2 ****s about me getting a job (or even how good my training was for that matter), and when I came out there were literally no jobs in the areas I wanted to work. When I finally found one (PP, 300k salaried), the owner strung me along for months waiting to sign a contract. In retrospect, I don't think she really even wanted to hire me, but her PSA with the hospital required she have an associate. In the end, it was the best thing that ever happened to me. Pissed me off to the point I took steps to start my own practice. It's by no means easy, and maybe impossible now, but at that time I had the right connections and the right amount of anger at the hospital and boomer docs to make it happen.