Match week 2020 discussion

[Reaganite]

What's the vendetta?

Expand at will. 300 residents fine. Not enough? Make it 400. Profess the need for fellowships. Create more academic satellites. Make residents scut workers and scribes for the clinic. Whatever. I don't care. Doesn't matter to me. I'm fine and will be for years.

Agree. Not sure why people are surprised guys in good positions still care about the field outside of their own personal interests. A market flooded with cheap new grads is amazing for current clinic owners. I can get a locum for <$1,000 in my neck of the woods now.

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[radoncgrad2019]

Another recent change is programs that recruit applicants who they think will take satellite jobs as their departments continue to expand. These programs will always act in their self interest.

this is a very interesting and bold claim.

 

[msuxrt]

this is a very interesting and bold claim.

About 6 years ago when I was in residency our business savvy chair would comment on students likeliness to take a position at a rural clinic we operated.

 

[RickyScott]

Does anyone believe that the doubling of residents was by collective intelligent design rather than program self interest? And if it was by program self interest, how could it turn out ok?

Not to beat this horse to death, but thinking about this from philosophical perspective: when drastic action is taken- like doubling resident numbers- without intelligent design, what are the chances that it will randomly work out? It would be like me driving to my job blindfolded. I may get there fine, but most likely I won’t.

 

[efle]

Can someone confirm these 2020 numbers for me because they're so absurd I'm doubting my basic arithmetic:

175 PGY2 RadOnc Positions
128 US MD Senior Applicants
114 US MD Senior Matches

If I'm typing 114/175 into this calculator correctly, that means that >33% of RadOnc PGY2 spots this year went to either a reapplicant, IMG, DO, or SOAPed?

 

[Splenda88]

Radonc is a dumpster fire now. If you want to commit career suicide, go into radonc or pathology...

 

[elementaryschooleconomics]

Can someone confirm these 2020 numbers for me because they're so absurd I'm doubting my basic arithmetic:

175 PGY2 RadOnc Positions
128 US MD Senior Applicants
114 US MD Senior Matches

If I'm typing 114/175 into this calculator correctly, that means that >33% of RadOnc PGY2 spots this year went to either a reapplicant, IMG, DO, or SOAPed?

Sounds right to me.

 

[deleted956486]

Can someone confirm these 2020 numbers for me because they're so absurd I'm doubting my basic arithmetic:

175 PGY2 RadOnc Positions
128 US MD Senior Applicants
114 US MD Senior Matches

If I'm typing 114/175 into this calculator correctly, that means that >33% of RadOnc PGY2 spots this year went to either a reapplicant, IMG, DO, or SOAPed?

Table 2 on page 7 has the breakdown.

 

[efle]

Thanks for confirming. Looks like:

65% US MD Seniors

8% US DO, IMG, Reapplicant
9% FMG
18% SOAP or empty

I can't reconcile this with the board scores and research at all. 250 step and 16 posters/pubs but barely half filled with American MDs? What am I missing here, there is no other specialty with this kind of incongruence, not even close.

 

[RickyScott]

Thanks for confirming. Looks like:

65% US MD Seniors

8% US DO, IMG, Reapplicant
9% FMG
18% SOAP or empty

I can't reconcile this with the board scores and research at all. 250 step and 16 posters/pubs but barely half filled with American MDs? What am I missing here, there is no other specialty with this kind of incongruence, not even close.

Sunk cost fallacy + misplaced faith in academic mentors who are assuring “truthers” that all will be ok despite doubling resident numbers over 15 years. So you have a component of high achievers who are about to be fd.

 

[efle]

Sunk cost fallacy + misplaced faith in academic mentors who are assuring “truthers” that all will be ok despite doubling resident numbers over 15 years. So you have a component of high achievers who are about to be fd.

Is there a big gradient for how terrible job options are, where the big name academic centers are still placing their residents well, and it's the bottom half of residencies that need to worry?

Or is pretty much everyone f***ed?

 

[RickyScott]

Is there a big gradient for how terrible job options are, where the big name academic centers are still placing their residents well, and it's the bottom half of residencies that need to worry?

Or is pretty much everyone f***ed?

It is about adjusting your expectations. I graduated 10+years ago from program that was not a big name. If I had the type of job offers at that time (satellite) that grads from big name places are fighting over today, I would have been quite depressed. Even if you are at big name place going to face severe geographic limitations unlike anything in other specialties.

Also once you get a job, you have a gun to your head. Decreased mobility and lack of meaningful raises today. I have a great job but If lost it would have to leave the state or possibly unemployed.

 

[efle]

It is about adjusting your expectations. I graduated 10+years ago from program that was not a big name. If I had the type of job offers at that time (satellite) that grads from big name places are fighting over today, I would have been quite depressed. Even if you are at big name place going to face severe geographic limitations unlike anything in other specialties.

Also once you get a job, you have a gun to your head. Decreased mobility and lack of meaningful raises today. I have a great job but If lost it would have to leave the state or possibly unemployed.

Appreciate the insights. Online forums are the only way this issue was on my radar at all. Haven't heard a peep about it otherwise.

Looking at things like NRMP and MGMA make it look like the same highly compensated, competitive, lifestyle field of yesteryear, but it sounds like that's only reflective of established RadOncs like yourself and not the situation facing new graduates.

 

[scarbrtj]

NRMP and MGMA make it look like the same highly compensated, competitive, lifestyle field of yesteryear

Even then the 'ol gray mare ain't what she used to be

 

[thecarbonionangle]

Sunk cost fallacy + misplaced faith in academic mentors who are assuring “truthers” that all will be ok despite doubling resident numbers over 15 years. So you have a component of high achievers who are about to be fd.

what i have realized is many of current residents and recent grads have a good amount of their identity wrapped up around the prestige, the competitiveness of the field. It really hurts some egos and identities. They all self assure themselves or believe “mentors” that all will be ok. Like Mike Tyson used to say “everyone has a plan until they get punched in the mouth”

 

[RickyScott]

what i have realized is many of current residents and recent grads have a good amount of their identity wrapped up around the prestige, the competitiveness of the field. It really hurts some egos and identities. They all self assure themselves or believe “mentors” that all will be ok. Like Mike Tyson used to say “everyone has a plan until they get punched in the mouth”

Yup. A lot of status anxiety at play here. Have been thinking about this a lot lately. Many of us may choose private practice partly for financial reasons, but that does not mean that those who chose academics did so mostly for the pursuit of knowledge! In fact, often it is for recognition,
prestige, having an audience of trainees who can appreciate your genius etc. As the field circles the drain- through self inflicted wounds- it is really threatening to the self worth of the pompous.

 

[thecarbonionangle]

Yup. A lot of status anxiety at play here. Have been thinking about this a lot lately. Many of us may choose private practice partly for financial reasons, but that does not mean that those who chose academics did so mostly for the pursuit of knowledge! In fact, often it is for recognition,
prestige, having an audience of trainees who can appreciate your genius etc. As the field circles the drain- through self inflicted wounds- it is really threatening to the self worth of the pompous.

absolutely.You are no longer a “big name” amazingly talented person in a field where you’re lucky to just match ANYWHERE but one in a field where all you need is a pulse and a warm body. It used to be our reality, where people walked into rad onc residency and we took the most undesirable people. Funny enough, these people are our “leaders” now, people like Paul Wallner

 

[medgator]

Yup. A lot of status anxiety at play here. Have been thinking about this a lot lately. Many of us may choose private practice partly for financial reasons, but that does not mean that those who chose academics did so mostly for the pursuit of knowledge! In fact, often it is for recognition,
prestige, having an audience of trainees who can appreciate your genius etc. As the field circles the drain- through self inflicted wounds- it is really threatening to the self worth of the pompous.

Glad i took my pp position in nowheresville when i did, never thought in a million years that rad onc academia would trash the field this bad with expansion going headfirst into APM and now covid

 

[RadDoc11]

Another thing. Many members of our leadership matriculated/graduated in an era where the standard to enter the profession was very low; I'm sure some truly loved the specialty, but many became rad oncs because they didn't have the credentials to enter a more coveted field. In their not very self-critical minds, they "ended up OK". Why would they see the current trend as a decline?
Might they even feel certain schadenfreude that the types that outperformed them in med school (if they even got into med school) are now struggling to get A job?

This is such a valid and under discussed point. Our leadership and the applicants of at least 5-12 years ago are two very different pools..

 

[efle]

Can anyone give the clueless med stud a brief summary of why radonc used to be so much less competitive, and then became so competitive (until now)? I at least have some sense of why it's becoming less competitive right now, but I'm curious what drove the previous peaks and troughs

 

[thecarbonionangle]

Can anyone give the clueless med stud a brief summary of why radonc used to be so much less competitive, and then became so competitive (until now)? I at least have some sense of why it's becoming less competitive right now, but I'm curious what drove the previous peaks and troughs

it used to be a field with all FMGs that had many unfilled spots. It was undesirable because there just wasn’t anything going on with it. 2D XRT was considered outdated and barbaric. It was a bunch of foreigners with chalk and film drawing circles and a weird chain and wire used for breast cases. We were cavemen. Other specialties talked about how we “burned” peoples skin or about how someone they knew died of radiation cystitis. The radiation oncologist did not know much and was not respected. We killed and poisoned people. Most people were old radiologists who did it on the Side. Many died of cancer, themselves from loading too many cesium brachy cases or doing Heyman’s capsules or gold seeds.

Then came IMRT and people made bank like having your own printing press. People made silly silly amounts of money, like MILLIONS (some may post here). the radiation oncologist was mentioned in same sentence as plastics, ENT, Urology, Ophtho, derm etc etc. SBRT came.

then the leaders ruined the field.The bottom of the burnt rice pot took us over the brink, the people like Paul Wallner.

now we are hanging out with pathology and nuc med. Nothing really going on and being phased out. Immunotherapy is hot and booming. Our own are finding ways to not even use XRT in many settings, de-escalate, and phase out rather than expand utilization like chemotherapists. We expanded our ranks without enough demands.

So what is the future? Breadlines? we treat more mets with sbrt and immunotherapy? We take over refractory tachyarrhythmias? Nobody knows but you sure would not want to jump on my ship if i told you it may not stay afloat

 

[efle]

it used to be a field with all FMGs that had many unfilled spots. It was undesirable because there just wasn’t anything going on with it. 2D XRT was considered outdated and barbaric. It was a bunch of foreigners with chalk and film drawing circles and a weird chain and wire used for breast cases. We were cavemen. Other specialties talked about how we “burned” peoples skin or about how someone they knew died of radiation cystitis. The radiation oncologist did not know much and was not respected. We killed and poisoned people. Most people were old radiologists who did it on the Side.
Then came IMRT and people made bank like having your own printing press. People made silly silly amounts of money, like MILLIONS (some may post here). the radiation oncologist was mentioned in same sentence as plastics, ENT, Urology, Ophtho, derm etc etc. SBRT came.

then the leaders ruined the field.The bottom of the burned rice pot took us over the brink, the people like Paul Wallner.

now we are hanging out with pathology and nuc med. Nothing really going on and being phased out. Immunotherapy is hot and booming. Our own are finding ways to not even use XRT in many settings.

Damn. I feel like I came too late to the party. I'm not a fan of the surgical lifestyle and I found derm to be a uniquely horrifying mix of disgusting and boring. Rad onc would have been the perfect alternative. What a shame.

Thanks for the info!

 

[thecarbonionangle]

Damn. I feel like I came too late to the party. I'm not a fan of the surgical lifestyle and I found derm to be a uniquely horrifying mix of disgusting and boring. Rad onc would have been the perfect alternative. What a shame.

Thanks for the info!

there is no free lunch in medicine. Just pick what you like and gives you the flexibility you look for. You will help people in any field. Rad onc is fine for many, but you sacrifice some. Nobody can really tell you what will happen

 

[xrthopeful]

there is no free lunch in medicine. Just pick what you like and gives you the flexibility you look for. You will help people in any field. Rad onc is fine for many, but you sacrifice some. Nobody can really tell you what will happen

Good answer.

There is no free lunch is always important to keep in mind when weighing different field

 

[scarbrtj]

absolutely.You are no longer a “big name” amazingly talented person in a field where you’re lucky to just match ANYWHERE but one in a field where all you need is a pulse and a warm body. It used to be our reality, where people walked into rad onc residency and we took the most undesirable people. Funny enough, these people are our “leaders” now, people like Paul Wallner

Now not to naysay Eli, who was a fabulous, kind man. And super smart. (And a bit Mistra Knowitall but it was part of his charm.) A "giant" in rad onc; yet he was likely kind of one of those that just "walked into" rad onc and became a leader. This kind of performance in med school would have gotten one excluded for consideration for a rad onc residency until just recently:

Medical school brought him to Stanford, where his insightful perspective slightly jeopardized his grades and his progress. He regaled us with a story of how he did not think too much of his Ob-Gyn clerkship, so he wrote single or few-word answers to the essay questions. When his failing grade required a second time through the clerkship, he admitted with a sigh that the answers were more complete. He passed.

 

[elementaryschooleconomics]

Now not to naysay Eli, who was a fabulous, kind man. And super smart. (And a bit Mistra Knowitall but it was part of his charm.) A "giant" in rad onc; yet he was likely kind of one of those that just "walked into" rad onc and became a leader. This kind of performance in med school would have gotten one excluded for consideration for a rad onc residency until just recently:

Medical school brought him to Stanford, where his insightful perspective slightly jeopardized his grades and his progress. He regaled us with a story of how he did not think too much of his Ob-Gyn clerkship, so he wrote single or few-word answers to the essay questions. When his failing grade required a second time through the clerkship, he admitted with a sigh that the answers were more complete. He passed.

Ah, so is this where Olivier et al's perspective comes from? If you have poor objective performance through grades, USMLE scores, publications etc compared to Golden Age RadOnc - it's simply because you're "insightful" and it's a choice?

Message received.

 

[thecarbonionangle]

Now not to naysay Eli, who was a fabulous, kind man. And super smart. (And a bit Mistra Knowitall but it was part of his charm.) A "giant" in rad onc; yet he was likely kind of one of those that just "walked into" rad onc and became a leader. This kind of performance in med school would have gotten one excluded for consideration for a rad onc residency until just recently:

Medical school brought him to Stanford, where his insightful perspective slightly jeopardized his grades and his progress. He regaled us with a story of how he did not think too much of his Ob-Gyn clerkship, so he wrote single or few-word answers to the essay questions. When his failing grade required a second time through the clerkship, he admitted with a sigh that the answers were more complete. He passed.

the guy would later rail against IMRT. Let’s face it, nice or not, he wasn’t the sharpest tool in the shed!

this “walked into RO” generation of leaders, were the bottom of the barrel in their classes. Remember this everytime you see some old white guy at astro showing you pictures of his family.

 

[xrthopeful]

Also consider that being ‘top’ of a med school class isn’t that important or value-defining.

Just saying

 

[RickyScott]

Also consider that being ‘top’ of a med school class isn’t that important or value-defining.

Just saying

It’s not, but it is possible to be a really high achiever and a good person. It is often implied that there is some sort of trade off.

 

[xrthopeful]

It’s not, but it is possible to be a really high achiever and a good person. It is often implied that there is some sort of trade off.

Oh definitely not mutually exclusive

 

[medgator]

Also consider that being ‘top’ of a med school class isn’t that important or value-defining.

Just saying

Ok KO

 

[xrthopeful]

Ok KO

Dude smarten up

 

[elementaryschooleconomics]

It’s not, but it is possible to be a really high achiever and a good person. It is often implied that there is some sort of trade off.

With the field already struggling, and the COVID pandemic causing of tsunami of consequences at all levels of the economy and healthcare system, I expect this rhetoric to be EXTRAORDINARILY cranked up this year.

Excuses I expect to hear a lot about in-person and on Twitter (as well as ASTRO, if it happens):

1) Our normal pool of RadOnc applicants has shrunk further because people couldn't do home/away rotations and "fall in love" with the field
2) The competitiveness of our applicants has decreased because of #1
3) However, while they may be fewer in number and weaker in terms of applications, they DEFINITELY love their patients and are more passionate doctors
4) ...implying prior applicants with stronger applications lacked the "intangibles" we're projecting onto the current crop of kids

Then, with Step 1 becoming pass/fail, it will be difficult to observe the decline in competitiveness, except through application numbers. This will save academic department leadership from having to explain away uncomfortable trends.

COVID is a turning point in RadOnc. We could either 1) embrace the systemic disruption to massively reduce the number of trainees, or 2) embrace the systemic disruption (including the Step 1 change) and rally around the battlecry of "cancer is not elective", changing absolutely nothing about our system and pinning the decline on COVID while saying future applicants are more dedicated to the field - "people became much more interested in Pulm Crit/ED/public health etc and those fields pulled away kids who might otherwise have pursued RadOnc, but that just means we're left with the most dedicated of the dedicated!"

I know which track my money's on.

 

[thecarbonionangle]

IF it happens, Miami ASTRO is going to be very funny. It is worth going just for that.

 

[RickyScott]

As someone who attended a top medschool and college- 1) smartest docs I have come across often did not attend elite places (a lot more of them, so just a numbers game) 2)high achievers in elite places on par - no better-than high achievers at any other institution, but the middle of class is often better at the elites.
This remains a numbers game. Eli was very smart, albeit wrong about so much, maybe everything, but for every “Eli” in his class, there were 5 other dumb incompetent m-f—/ who did not serve the field well. (Btw Henry Kaplan was Eli’s mentor and had huge influence on him)

 

[radiation]

One thing I've noted thrown around is the percent of IMG/DO as a negative predictor of the state of the field, but at the same time noting how well off heme/onc is. Almost 50% of heme/onc fellows are IMG or DO, how does that currently affect their specialty?

Percentage of First-Year Fellows by Gender and Type of Medical School Attended | ABIM.org

ABIM provides accurate data for the percentage of first-year fellows by gender and type of medical school.

www.abim.org

 

[RickyScott]

One thing I've noted thrown around is the percent of IMG/DO as a negative predictor of the state of the field, but at the same time noting how well off heme/onc is. Almost 50% of heme/onc fellows are IMG or DO, how does that currently affect their specialty?

Percentage of First-Year Fellows by Gender and Type of Medical School Attended | ABIM.org

ABIM provides accurate data for the percentage of first-year fellows by gender and type of medical school.

www.abim.org

View attachment 301993

One thing I've noted thrown around is the percent of IMG/DO as a negative predictor of the state of the field, but at the same time noting how well off heme/onc is. Almost 50% of heme/onc fellows are IMG or DO, how does that currently affect their specialty?

fmgs and dos reflect desirability of specIalty
Period. I don’t think many are claiming they make worse docs- at least for fmgs. And medonc has flipped on dime, it is becoming much more competitive as you would expect now that salaries are skyrocketing. Friends who are program directors commented on influx of mdphs and increase in competiveness- as would be totally expected given job market and future outlook.

 

[medgator]

fmgs and dos reflect desirability of specIalty
Period. I don’t think many are claiming they make worse docs- at least for fmgs. And medonc has flipped on dime, it is becoming much more competitive as you would expect now that salaries are skyrocketing. Friends who are program directors commented on influx of mdphs and increase in competiveness- as would be totally expected given job market and future outlook.

Market is tightening in MO also, shift to hiring more extenders/NPs rather than more docs in some markets

 

[PhotonBomb]

Only thing not tightening during COVID is people’s waistlines, that’s for sure

 

[elementaryschooleconomics]

Market is tightening in MO also, shift to hiring more extenders/NPs rather than more docs in some markets

Yeah, folks seem to think we're not aware of this when we talk about the oversupply/worsening job market of RadOnc on these forums.

The whole ship is sinking, we know.

You just have a better chance of survival clinging to the mast as opposed to trapped in the basement...err, engine room.

 

[efle]

Seems hard to judge medical fellowships since roughly half of IM residencies go to DO/IMG in the first place. But glancing at the specialties that one matches straight from medical school, it seems to work well as a rule of thumb