medstudents entering the match

[RickyScott]

" there was an entire panel at ASTRO with four prominent members of our field who all agreed that there are significant labor market concerns about which nothing substantive will be done for some time and is likely to worsen. "

After the acknowledgement at ASTRO by RRC chairwoman/ASTRO treasurer as well as other presenters regarding the perfect storm of residency overexpansion/hypofractionation/advanced payment model, extreme geographic restrictions and limited available remedies to correct the issue, I am genuinely curious why a medstudent would choose to enter radonc, over other specialties. Would love to hear some feedback from those entering the match about their reasons for proceeding/taking on the risk?

---

Members don't see this ad.

 

[deleted774703]

I totally agree that there are significant concerns but I don’t support the idea of all med students withdrawing from RO

One simply can like the subject matter and that’s enough reason

At the same time, I strongly want residency spots to be contracted. Absolutely no need for 190+ spots

 

[medgator]

I think if I truly loved the work more than anything else in medicine, and was completely location/practice type agnostic, I'd consider rolling the dice even now, knowing full well I might end up in Quincy, Illinois, or El Centro, California.

Barring that, not on your life

 

[RickyScott]

I totally agree that there are significant concerns but I don’t support the idea of all med students withdrawing from RO

One simply can like the subject matter and that’s enough reason

At the same time, I strongly want residency spots to be contracted. Absolutely no need for 190+ spots

I agree, I dont want all medstudents withdrawing either. I love this field, but could never see myself entering it today- its not like every other specialty sucks-, so I how do I expect that of others.

 

[evilbooyaa]

If I was a MS4 right now I would still end up in this field. The content of the job is more interesting to me than any other field I experienced. Despite my beefs with the trajectory of the field, I am still happy with my career choice.

If I had to, I would do this at 250k/year take home (no bonus) as an attending, even in the middle of nowhere. If I had to, I would do a fellowship to make myself more marketable.

Fortunately, I don't have to do either of those things based on my experiences with the job search thus far this year. Yes, I'm never going to hit 7 figures on a yearly salary, and it may be unlikely I ever crack 500k (depending on where I end up), but just to give a sense of where my cut-points are.

That being said, I certainly understand the people who were deciding between a few different fields that they enjoyed equally or semi-equally. To steal the line from surgery "If you can see yourself doing anything besides Radiation Oncology, do that", with the caveats of importance of geography (more so than in the past).

 

[Mandelin Rain]

I absolutely love my job and my work, but rad onc currently sits on the edge of "would I/wouldn't I" do it again if I had to start over today.

I'm just not sure that the same opportunities I had nearly a decade ago exist today, much less in 5 more years.

 

[radoncradonc]

I am not a med student so I can't answer your question. I am a new attending that just graduated this year. You can look up my previous posts to see my job search history. If I had known about the job market for rad onc as a med student, I would never have entered this field. All my med onc friends are being offered mid 400s to start in a large city and 500s-600s in small towns. My salary is in the mid 200s in a small town. For comparison, the IM hospitalist FMG who's doing a visa waiver job in my hospital is making 280K with a contract limiting his work to 40 hours/week.

 

[WanderingRad3]

Rad onc is not nearly as attractive as it was 5 years ago and we need to contract the number of residency positions...but the work, the people, the pay, and the hours are still pretty good. You could ask why would anyone go into gen surg (hours, job market, 2 years of research before getting into a good fellowship), or do an IM chief year (attending at 90k salary), or go into neurosurgery (goodbye personal life for 7 years), etc as well. The fact is, as a resident, I have a better QOL than most of my friends in medicine and outside of medicine, I love my job every day, and my seniors just got offered jobs for 500k for one, and 3 years to partnership with 8-10 weeks vacation for the other...so yes I would still apply today.

 

[Chartreuse Wombat]

Based on my unscientific survey of 6 programs regionally distributed the number of US Senior applicants in ERAS is down 30-35% from last year. Those who did apply are almost guaranteed to match. Forecasting 50-60 unmatched spots this year.

 

[Mandelin Rain]

Based on my unscientific survey of 6 programs regionally distributed the number of US Senior applicants in ERAS is down 30-35% from last year. Those who did apply are almost guaranteed to match. Forecasting 50-60 unmatched spots this year.

Pretty epic fall from grace.

 

[deleted573262]

Based on my unscientific survey of 6 programs regionally distributed the number of US Senior applicants in ERAS is down 30-35% from last year. Those who did apply are almost guaranteed to match. Forecasting 50-60 unmatched spots this year.

IMO - unmatched spots should NOT be filled. The people trying to fill these spots will be unmatched applicants from derm, ent, ortho, etc. The field is better served by self-regulating through med student selection (aka the Zietman approach) while we decide how to limit residency expansion and make field more appealing for future medical students with a real interest in radiation.

 

[deleted573262]

Good luck to malignant programs. They’ve gotten away with it (and gotten good students) because the field was so competitive (in my day you needed a 250+ to be considered for a top program), but it is a buyer’s market this year. If I were applying I’d ask every PD some pointed questions. Most important question to ask IMO:

Are your rotations designed to ensure 100% clinical coverage of your attending physicians, or are they designed to maximize resident education? If there are NO uncovered faculty this is likely the sign of a malignant program (or one who has expanded its residency far too aggressively).

Also: who does most of the teaching? Residents or faculty?

Nobody should have to go to a scut factory in this environment.

Invite others to chime in regarding questions to ask.

How often do attendings work uncovered?

A program with attendings who never work without a resident are more difficult to work under, in my experience.

 

[xrthopeful]

Fortunately, I don't have to do either of those things based on my experiences with the job search thus far this year. Yes, I'm never going to hit 7 figures on a yearly salary, and it may be unlikely I ever crack 500k (depending on where I end up), but just to give a sense of where my cut-points are.

you're too logical and reality-based for this thread.

 

[Krukenberg]

Based on my unscientific survey of 6 programs regionally distributed the number of US Senior applicants in ERAS is down 30-35% from last year. Those who did apply are almost guaranteed to match. Forecasting 50-60 unmatched spots this year.

This is astounding and highly concerning. My guess is we’re still getting lots of top US seniors but fewer by number.

As an aside, Tbh the level of Schadenfreude among some here is off putting and doesn’t win us allies among the leaders up top who could act on this if they wanted to.

 

[deleted956486]

This is astounding and highly concerning. My guess is we’re still getting lots of top US seniors but fewer by number.

As an aside, Tbh the level of Schadenfreude among some here is off putting and doesn’t win us allies among the leaders up top who could act on this if they wanted to.

Leaders at the top have done nothing so far. In fact, there isn't even a problem apparently. There are no leaders in rad onc -only followers...and they're all on twitter. Chickens are coming home to roost. No reason for anyone to be angry.

 

[thecarbonionangle]

Had tons of interviews at ASTRO, so much i had to turn some down. The funny thing is many bobbleheads are claiming the job market is “fantastic”. The fact is many places interviewed over multiple days due to overwhelming level of applications. There were multiple academic jobs advertised as main site but turned out to be a satellite at ASTRO. Some places had already filled but were interviewing for unclear reasons. I kept seeing the same people coming in and out of interviews. I saw some of you from a distance. We are all interviewing for the same jobs. Until the number of interviews translates to offers or site visit/second look visit, we ain’t have nothing and cant claim the job market is great this year.

 

[Haybrant]

Few years into practice I would unequivocally never choose to do this again. Love the medicine, really love it. Make a huge difference for patients. But the field has changed my life in so many negative ways; there is zero leverage bc you can’t up and move which is a massive thing for young people and this alone is devastating - I’ve sporadically looked for jobs with 0 success in many years. You feel trapped and stuck. I’ve made the most of the situation and things are pretty good overall but that’s all lipstick on an utterly broken feeling of having damaged where I would have preferred to be in life. But thats just me, everyone has a different story and hey it’s not thaat bad.

 

[deleted1002574]

Original question was to hear from a student applying. Not one person has responded. A lot of people have responded, but sort of not answering the OP’s question. Which is pretty typical, as people want to grind the same axe they’ve grinded (sp?) for years. Could have just cut and pasted these answers from prior posts.

Would love if a student applying would answer the question.

 

[medgator]

As an aside, Tbh the level of Schadenfreude among some here is off putting and doesn’t win us allies among the leaders up top who could act on this if they wanted to.

Some of these so called "leaders" don't think there is a problem. Still.

 

[Sheldor]

Guys, the purpose of this thread was to hear about things from a medical students perspective. Maybe keep the ire about the job market from those who frequently post about it in one of the other threads on the front page? Hard for a medical student to jump in when all of the residents/attending's are filling up all the space.

 

[nkmiami]

If I was a MS4 right now I would still end up in this field. The content of the job is more interesting to me than any other field I experienced. Despite my beefs with the trajectory of the field, I am still happy with my career choice.

If I had to, I would do this at 250k/year take home (no bonus) as an attending, even in the middle of nowhere. If I had to, I would do a fellowship to make myself more marketable.

Fortunately, I don't have to do either of those things based on my experiences with the job search thus far this year. Yes, I'm never going to hit 7 figures on a yearly salary, and it may be unlikely I ever crack 500k (depending on where I end up), but just to give a sense of where my cut-points are.

That being said, I certainly understand the people who were deciding between a few different fields that they enjoyed equally or semi-equally. To steal the line from surgery "If you can see yourself doing anything besides Radiation Oncology, do that", with the caveats of importance of geography (more so than in the past).

I hear you, but have difficulty believing that a medical student could not find another specialty they would also like. As a student you dont understand much about radiation as it really is its own little world. I enjoy the field, but likely could have developed a strong interest in something else as well. Looking back and trying to be objective is tough, but I am pretty sure that is true. The field of positive psychology studies happiness, and within a range, income, and career choice dont have a a strong impact.

 

[evilbooyaa]

Original question was to hear from a student applying. Not one person has responded. A lot of people have responded, but sort of not answering the OP’s question. Which is pretty typical, as people want to grind the same axe they’ve grinded (sp?) for years. Could have just cut and pasted these answers from prior posts.

Would love if a student applying would answer the question.

Guys, the purpose of this thread was to hear about things from a medical students perspective. Maybe keep the ire about the job market from those who frequently post about it in one of the other threads on the front page? Hard for a medical student to jump in when all of the residents/attending's are filling up all the space.

I agree with this. I've deleted 18 posts that were completely off-topic, especially for repeating the same issues mentioned ad nauseum before. I've allowed current residents/attendings reflecting on whether they would still apply today - I feel it is at least tangentially related to the OP.

Things that are new and/or relevant to current medical students (about applicant numbers this year, questions for prospective MS4s to ask residencies, etc.) have been maintained.

Of course I would like to hear from any current medical student with plans to apply. If any medical student would like to PM me privately (rather than post publicly) their thoughts I am happy to post on your behalf. Paging @TheIllusionist for his thoughts as a current medical student (I believe)

 

[PleaseRemainCalm]

Some places had already filled but were interviewing for unclear reasons.

This phenomenon really irritates me. Maybe my time isn't worth anything but isn't your time worth something? Why go through this charade?

 

[thecarbonionangle]

This phenomenon really irritates me. Maybe my time isn't worth anything but isn't your time worth something? Why go through this charade?

field is filled with arrogant dismissive petty individuals. Why show anybody interviewing any respect? Absolutely, complete waste of time and makes no sense. Happened multiple times to me.

 

[Corgi4Prez]

Had tons of interviews at ASTRO, so much i had to turn some down. The funny thing is many bobbleheads are claiming the job market is “fantastic”. The fact is many places interviewed over multiple days due to overwhelming level of applications. There were multiple academic jobs advertised as main site but turned out to be a satellite at ASTRO. Some places had already filled but were interviewing for unclear reasons. I kept seeing the same people coming in and out of interviews. I saw some of you from a distance. We are all interviewing for the same jobs. Until the number of interviews translates to offers or site visit/second look visit, we ain’t have nothing and cant claim the job market is great this year.

That is horrible to hear, sorry that happened to you. Were these mainly academic, private, both?

 

[Mandelin Rain]

I hope this is germane enough to this discussion. If not, feel free to move it.

This week, my NP came to me and said, "I miss spending 9 weeks with our prostate guys." It really did strike me that one of the big draws of this specialty to me initially as a med student (and early career) was the connections that you can form with patients over the course of their treatment. If you wanted, you could take on a psuedo-primary care, health maintainence, best friend, confidant, etc... role with these folks while they were under your care. 6 weeks with a breast patient and 9 weeks with a prostate guy. You'd get to know their whole family, bother them about their weight/smoking/blood pressure until they did something, discuss their short game on the links, try to get them insured or into a shelter, whatever they needed. Sometimes it was just listening to the 80 year old widower talk about nothing for 15 minutes because he had no one else to talk to. If I'm being honest, It's what I liked best about this job and probably what I am best at.

Now, by the time you get to know them, their treatment is ending and you're discussing follow up plan. From a purely selfish standpoint (beyond the pay/job crunch concerns that HAVE been discussed ad nauseum), losing some of this connection with patients has more greatly reduced the luster of this field to me personally. That too will get worse as we move everything to 1-5 fractions. I didn't sign up to be a technician, but I think that's where we're heading.

 

[deleted1002574]

I hope this is germane enough to this discussion. If not, feel free to move it.

This week, my NP came to me and said, "I miss spending 9 weeks with our prostate guys." It really did strike me that one of the big draws of this specialty to me initially as a med student (and early career) was the connections that you can form with patients over the course of their treatment. If you wanted, you could take on a psuedo-primary care, health maintainence, best friend, confidant, etc... role with these folks while they were under your care. 6 weeks with a breast patient and 9 weeks with a prostate guy. You'd get to know their whole family, bother them about their weight/smoking/blood pressure until they did something, discuss their short game on the links, try to get them insured or into a shelter, whatever they needed. Sometimes it was just listening to the 80 year old widower talk about nothing for 15 minutes because he had no one else to talk to. If I'm being honest, It's what I liked best about this job and probably what I am best at.

Now, by the time you get to know them, their treatment is ending and you're discussing follow up plan. From a purely selfish standpoint (beyond the pay/job crunch concerns that HAVE been discussed ad nauseum), losing some of this connection with patients has more greatly reduced the luster of this field to me personally. That too will get worse as we move everything to 1-5 fractions. I didn't sign up to be a technician, but I think that's where we're heading.

This. It is becoming wham-bam-thank-you-ma'am. Truly feel like a technician. I know it's right to HF and it is even better for certain things, but it has attenuated the long term care aspect of radonc. Thank you for putting it in those words. I've been feeling 'something' and that is it.

 

[taserlaser]

This. It is becoming wham-bam-thank-you-ma'am. Truly feel like a technician. I know it's right to HF and it is even better for certain things, but it has attenuated the long term care aspect of radonc. Thank you for putting it in those words. I've been feeling 'something' and that is it.

It is a loss. But if anything I’m doing a lot lore oligomet treatment now so get repeat patient cisits that way. But certainly the context is different

 

[Sheldor]

This. It is becoming wham-bam-thank-you-ma'am. Truly feel like a technician. I know it's right to HF and it is even better for certain things, but it has attenuated the long term care aspect of radonc. Thank you for putting it in those words. I've been feeling 'something' and that is it.

I agree with the overall sentiment, I also enjoyed getting to know guys over 9 months. That said, i'm not sure why you guys go straight to technician. By that logic surgeons are technicians? What about med oncs doing one IV drop per month?

Doing SBRT makes me feel slightly more like a proceduralist, but that really doesn't mean technician to me (or my referring providers.)

 

[FrostyHammer]

I hope this is germane enough to this discussion. If not, feel free to move it.

This week, my NP came to me and said, "I miss spending 9 weeks with our prostate guys." It really did strike me that one of the big draws of this specialty to me initially as a med student (and early career) was the connections that you can form with patients over the course of their treatment. If you wanted, you could take on a psuedo-primary care, health maintainence, best friend, confidant, etc... role with these folks while they were under your care. 6 weeks with a breast patient and 9 weeks with a prostate guy. You'd get to know their whole family, bother them about their weight/smoking/blood pressure until they did something, discuss their short game on the links, try to get them insured or into a shelter, whatever they needed. Sometimes it was just listening to the 80 year old widower talk about nothing for 15 minutes because he had no one else to talk to. If I'm being honest, It's what I liked best about this job and probably what I am best at.

Now, by the time you get to know them, their treatment is ending and you're discussing follow up plan. From a purely selfish standpoint (beyond the pay/job crunch concerns that HAVE been discussed ad nauseum), losing some of this connection with patients has more greatly reduced the luster of this field to me personally. That too will get worse as we move everything to 1-5 fractions. I didn't sign up to be a technician, but I think that's where we're heading.

Understand that patients hate coming to the doctor. Doesn't matter who. Your thoughts aside, shortening treatment courses are music to patients' ears. At the end of the day, the patient should be #1 even if it's associated with a sacrifice on our end.

 

[Mandelin Rain]

I'd liken it more to an IR doctor.

 

[Mandelin Rain]

Understand that patients hate coming to the doctor. Doesn't matter who. Your thoughts aside, shortening treatment courses are music to patients' ears. At the end of the day, the patient should be #1 even if it's associated with a sacrifice on our end.

Obviously. That's why I have shortened treatment courses, despite the impact it's had on my pay and professional satisfaction.

 

[deleted1002574]

Nobody saying patient care / convenience isn't first. It's just that the job changed so rapidly in ten years. Literally the same guy who used to get 38-44 treatments is getting 0, 4, or 28 treatments. The same breast patient is going from 30 fractions to 16 or 0. The same lung patient is going from 35 fractions to 3. Not only is there economic changes, there is significant change to our practice.

Yes, my opinion is that it is more of a technician-feeling like an IR doc rather than the pseudo-PCP feeling.

 

[Mandelin Rain]

As annoying as it can be at times, there is a certain satisfaction that my patients call me first when they have (literally) any problem, because of all their doctors I have spent the most time with them, listened to them the best, and they feel most comfortable talking to me.

 

[SneakyBooger]

I didn't sign up to be a technician, but I think that's where we're heading.

Agreed.

And that is where we are heading.

 

[scarbrtj]

I hope this is germane enough to this discussion. If not, feel free to move it.

This week, my NP came to me and said, "I miss spending 9 weeks with our prostate guys." It really did strike me that one of the big draws of this specialty to me initially as a med student (and early career) was the connections that you can form with patients over the course of their treatment. If you wanted, you could take on a psuedo-primary care, health maintainence, best friend, confidant, etc... role with these folks while they were under your care. 6 weeks with a breast patient and 9 weeks with a prostate guy. You'd get to know their whole family, bother them about their weight/smoking/blood pressure until they did something, discuss their short game on the links, try to get them insured or into a shelter, whatever they needed. Sometimes it was just listening to the 80 year old widower talk about nothing for 15 minutes because he had no one else to talk to. If I'm being honest, It's what I liked best about this job and probably what I am best at.

Now, by the time you get to know them, their treatment is ending and you're discussing follow up plan. From a purely selfish standpoint (beyond the pay/job crunch concerns that HAVE been discussed ad nauseum), losing some of this connection with patients has more greatly reduced the luster of this field to me personally. That too will get worse as we move everything to 1-5 fractions. I didn't sign up to be a technician, but I think that's where we're heading.

In rad onc, we love equations.
New rad onc equation:

Q ∝ 1/f

Where Q = quality of patient care, f = frequency of doctor/patient contact.
Bummer. But, hence, the headlong rush to lower f.

 

[Mandelin Rain]

Any word on what's happening with applications this week?

 

[FindMeOnTheLinks]

Any word on what's happening with applications this week?

rumor is applications are down 20-30% from last year

 

[deleted774703]

rumor is applications are down 20-30% from last year

Even lower...

 

[medgator]

Even lower...

I wouldn't even think about applying to RO until we see <150 spots offered in the previous year's match.

 

[radOresident]

My program receives between 160-180 applications most years but word from our program coordinator is we only got around 75 this year. This years match is going to be big problem for many programs

 

[xrthopeful]

it's going to be VERY interesting to see. I really can't wait to see it play out tbh

 

[deleted956486]

My program receives between 160-180 applications most years but word from our program coordinator is we only got around 75 this year. This years match is going to be big problem for many programs

I doubt it will be a big problem. Don't get me wrong, it is a step in the right direction. But this is a minor bump in the road for most places. Most of our former jobs are being taken over by academic satellites. That's never gonna reverse-in my view. So long as that is the case, you will have no negotiating power--regardless of the match.

 

[VivaElBirdos]

I doubt it will be a big problem. Don't get me wrong, it is a step in the right direction. But this is a minor bump in the road for most places. Most of our former jobs are being taken over by academic satellites. That's never gonna reverse-in my view. So long as that is the case, you will have no negotiating power--regardless of the match.

Does this mean there are fewer PP opportunities? Like institutions are taking over practices?

 

[evilbooyaa]

Does this mean there are fewer PP opportunities? Like institutions are taking over practices?

Yes and yes.

 

[deleted941485]

Does this mean there are fewer PP opportunities? Like institutions are taking over practices?

Even if you manage to get a job at PP shop despite all the headwinds unless it’s in the boonies expect that you’ll be employed in the next 3-5 years anyway.

Plus this year we have the added bonus of being on the cusp of a recession, a new APM rollout which I’m sure will finish off small private groups, political instability!

It honestly doesn’t get much worse.

Even with sharp declines in applications. It’s still not enough! We can talk just go back to 100 spots a year. We need several years of <75 people and no dirtbag programs trying to squeeze an FMG in somewhere to even think that things will get better.

To many idiots are still applying.

 

[scarbrtj]

Does this mean there are fewer PP opportunities? Like institutions are taking over practices?

Shift from private practice to academic hubs: Radiation oncologists also are shifting from working primarily in private practice to treating patients at academic centers and hospitals. The 2017 survey marks the first time that fewer than half of these doctors work in private practice (38 percent), with 41 percent practicing at academic/university centers and 17 percent at non-academic hospitals. *

* The drop from 53% PP in 2012 to 38% in 2017 is ridiculously big.

 

[deleted941485]

Shift from private practice to academic hubs: Radiation oncologists also are shifting from working primarily in private practice to treating patients at academic centers and hospitals. The 2017 survey marks the first time that fewer than half of these doctors work in private practice (38 percent), with 41 percent practicing at academic/university centers and 17 percent at non-academic hospitals.

And I’m sure all those PP groups became employed willingly. No coercion or threats by hospital admin whatsoever. In fact they were welcomed as liberators!

 

[medgator]

Does this mean there are fewer PP opportunities? Like institutions are taking over practices?

Yup.... Biggest risk are the professional groups at existing hospitals where the hospital partners up with a nearby academic center

 

[VivaElBirdos]

Yup.... Biggest risk are the professional groups at existing hospitals where the hospital partners up with a nearby academic center

So this takeover isn't limited to rural/far suburbia locations but is also happening in metro areas?