medstudents entering the match

[FrostyHammer]

Med onc is doing pretty well lately from what I've seen. Lots of new indications for targeted therapy and immunotherapy, metastatic and adjuvant. Stage III lung and melanoma pretty much buys you a year of immunotherapy as an example.

For every med onc that's doing well - for now - please talk to an ophthalmologist or radiologist who have experienced the opposite.

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[medgator]

For every med onc that's doing well - for now - please talk to an ophthalmologist or radiologist who have experienced the opposite.

Rads is supposedly on the way back up. Agree with optho. I dont think any of those 3 specialties will have something similar to deal with like hypofx and APM the way we will in the face of such rampant residency expansion though

 

[Mandelin Rain]

One thing that can't be underestimated about this field is how soul crushingly boring it can be during slow periods. Especially now that we hypofractionate everything, I feel like we have wild vacillations in on treatment patients week-to-week. On down weeks, you end up just starting blankly at a screen for hours.

I think perhaps recent posts on this board have been a symptoms of this.

 

[Lnsean]

Rads is supposedly on the way back up. Agree with optho. I dont think any of those 3 specialties will have something similar to deal with like hypofx and APM the way we will in the face of such rampant residency expansion though

Lots of effort and money being put into implementing AI for rads....while it won't replace radiologists...I feel it will be like the "hypofx" thing that is plaguing rad onc. You'll have more efficiency, less need for radiologists.

 

[deleted573262]

ophtho is a very nice field. there is still an opportunity to start your own practice and make a nice living on 4 day work weeks.

agree about rads having similar concerns to rad onc. the difference in my mind is that rad onc will always require some human interaction (consult, otv, f/u) while DR cannot be given the same credit.

 

[deleted1002574]

Disagree that medicine is terrible.

Facebook is bunch of malcontents. The hospitalists I work with them have a perma-smirk about the hours they work, the number of shifts, and the pay they get. PCPs finally getting the respect they deserve - look at SDN’s FP’s and the salaries and contracts they are comparing. ED remains great. Rads is strong shape. Oncology is in great shape. Anesthesia doing just fine. Optho is incredible for hours worked : income ratio. Procedural medicine specialties crushing it. Psych is a hidden goldmine. Urology and ENT still plugging away, doing very well. Dermatologists feel sorry for me and buy me dinner.

Precision medicine, neat new drugs, AI, patients taking better care of themselves, consideration (if not doing anything to help us) of burnout .. I think it’s a great time to be a doc. Just a terrible time to be a rad onc.

 

[OTN]

Disagree that medicine is terrible.

Facebook is bunch of malcontents. The hospitalists I work with them have a perma-smirk about the hours they work, the number of shifts, and the pay they get. PCPs finally getting the respect they deserve - look at SDN’s FP’s and the salaries and contracts they are comparing. ED remains great. Rads is strong shape. Oncology is in great shape. Anesthesia doing just fine. Optho is incredible for hours worked : income ratio. Procedural medicine specialties crushing it. Psych is a hidden goldmine. Urology and ENT still plugging away, doing very well. Dermatologists feel sorry for me and buy me dinner.

Precision medicine, neat new drugs, AI, patients taking better care of themselves, consideration (if not doing anything to help us) of burnout .. I think it’s a great time to be a doc. Just a terrible time to be a rad onc.

Well, every place is different, but at least in my neck of the woods:

- PCP and psych doing well, I agree. GI and pulmonary also killing it.
- The hospital across from our clinic recently did not extend the contract for the hospitalist group they contract with, instead going with TeamHealth. All the hospitalists suddenly needed to find jobs in the city. Not all of them were able to.
- Derm has come under assault from private equity, to the point where a new grad would have a hard time joining a physician-owned group in this city.
- ED is coming under assault from residency expansion, funded by hospital corporations in order to decrease their costs moving forward. (We've all seen the op-ed). Unclear how academia is going to fight this.
- Rads: The threat from AI is real.
- ENT/Urology docs constantly complain about how much less they get for procedures than they did even a few years ago
- Some of the CT surgeons in town hit our group up to put ports in, as they're hurting for regular business. Cardiology really did them a number over the last 20 years.

 

[w00tz]

Well, every place is different, but at least in my neck of the woods:

- PCP and psych doing well, I agree. GI and pulmonary also killing it.
- The hospital across from our clinic recently did not extend the contract for the hospitalist group they contract with, instead going with TeamHealth. All the hospitalists suddenly needed to find jobs in the city. Not all of them were able to.
- Derm has come under assault from private equity, to the point where a new grad would have a hard time joining a physician-owned group in this city.
- ED is coming under assault from residency expansion, funded by hospital corporations in order to decrease their costs moving forward. (We've all seen the op-ed). Unclear how academia is going to fight this.
- Rads: The threat from AI is real.
- ENT/Urology docs constantly complain about how much less they get for procedures than they did even a few years ago
- Some of the CT surgeons in town hit our group up to put ports in, as they're hurting for regular business. Cardiology really did them a number over the last 20 years.

Yeah, I guess location dependent, but this is exactly what I'm seeing where I'm at (top 5 metro - lots of biryani).

 

[FrostyHammer]

Disagree that medicine is terrible.

Facebook is bunch of malcontents. The hospitalists I work with them have a perma-smirk about the hours they work, the number of shifts, and the pay they get. PCPs finally getting the respect they deserve - look at SDN’s FP’s and the salaries and contracts they are comparing. ED remains great. Rads is strong shape. Oncology is in great shape. Anesthesia doing just fine. Optho is incredible for hours worked : income ratio. Procedural medicine specialties crushing it. Psych is a hidden goldmine. Urology and ENT still plugging away, doing very well. Dermatologists feel sorry for me and buy me dinner.

Precision medicine, neat new drugs, AI, patients taking better care of themselves, consideration (if not doing anything to help us) of burnout .. I think it’s a great time to be a doc. Just a terrible time to be a rad onc.

It cannot make logical sense that our isolated field is practically the ONLY field feeling the burn. Every field will have triumphs and struggles. Fact of life. The question is which triumphs and struggles you want to prioritize. I'm not denying rad onc has its struggles. But at the end of the day, if I want to work regular hours, largely no weekends/evenings, and make an above-average salary curing many cancers, I choose rad onc.

 

[medgator]

But at the end of the day, if I want to work regular hours, largely no weekends/evenings, and make an above-average salary curing many cancers, I choose rad onc.

You're also more likely choosing Quincy, IL, Jasper WY, Walla Walla WA, or Lewisburg WV, than you are Austin TX, SF, DC or Atlanta which is absolutely fine if that is what you want to choose.

 

[RSAOaky]

I mean i'm just a student trying to gauge what is real and what is not. Aren't those guys long time folks who graduated like 10+ years ago and were able to secure positions more easily back then? As a med student, I'm more interested in what folks (residents) are facing when applying for jobs these days. I feel unless you're a graduating resident or currently looking for a new position, you may have a slight bias (it's easy to already be employed and dismiss the other guys' stories out there on the field).

Some of my posts may seem contradictory but I have always loved this field and loved my job, during residency and now as an attending. My qualms are with our leadership, their treatment of community physicians as second class citizens, and their complete apathy to the clear red flags because their interests aren't aligned with those of their constituents.

Medicine ebbs and flows. There was a time when you couldn't give derm positions away. Radiology went through a tough spot and is now bouncing back. Radonc was at one point a completely undesirable field, at one point brutally competitive, and now trending in the wrong direction.

I would never tell someone not to pursue a career they love, but I would say that if there were two fields you loved equally I'd choose the one with better long term prognosis. That being said, we are notoriously bad at predicting these kinds of things so be honest with yourself. I completely lucked into a position that I love in a city that I love that is close to family. Going into the process I told my fiance that it was highly unlikely we would wind up near her family and it wound up happening. It worked out for me, but 1 year later a resident who trained at a respectable program in this city had to leave his wife to finish residency because there were no jobs available.

The job market is bad. Some years it is better than others, some months it is better than others, but there could be 3 jobs available one year and none for the next 5. Just because someone gets a job they are happy with doesn't mean the job market is good. Our expectations have been driven so low that people are happy with jobs that would have been considered awful 5 years ago.

Will things bounce back? They could, but they won't. Our treatments will continue to get shorter, programs will keep expanding, satellites will keep opening up, graduating residents will continue to accept less and less to staff them. It's the clearest example of supply and demand I can think of and the people who control the supply have every interest in having a lack of demand. It means less work for attendings that are salaried anyways and less cost for the hospital system that pays these salaries.

 

[FrostyHammer]

You're also more likely choosing Quincy, IL, Jasper WY, Walla Walla WA, or Lewisburg WV, than you are Austin TX, SF, DC or Atlanta which is absolutely fine if that is what you want to choose.

Sure. Or I can wait a few years till a job opens up in a larger market and go there at that time. Never bad to earn bank at a small place for a few years before going to a larger market.

 

[RSAOaky]

I also want to add that it is easy for me to be an armchair critic of our leadership and to come on here and complain about all the things they're doing wrong. I don't envy the position, but being a leader is rarely an enviable position. It requires people to make difficult decisions. It requires people to tell their colleagues and friends of many years not to do something they want to do or not to do something that will further advance their careers. I'd imagine it would be very difficult to tell Howard Sandler (a kind and amazing dude who has made immense contributions to our field) and Minesh Mehta that LA and Miami don't need another radonc program.

Unfortunately, the easy way out is to just say "there's nothing we can do about it and it is illegal to control residency positions." We've all been there though, the truth is that it's hard to say no to your friends and it's particularly hard when you just don't really care that much, even if you know what they're doing is wrong. There is too much short term thinking with no long term plan. Would it be the end of the world to put a 5 year moratorium on expansion and say "hey guys, there's some early signals that things may be going downhill. Lets hold off on these expansions and see how this shakes out." We do it all the time in clinical trials.

Instead we had career academics saying "there's not a demand problem there's a geographic maldistribution problem." We had Anthony Zietman saying "med students are the canaries in the coal mine, they'll show us the light." Then the canaries chirped and we had Kenny O maligning the doom and gloom of SDN as misrepresenting the prognosis of our field. Academics are afraid to speak out about it because it would be career suicide to go against the old boys club and, frankly, it probably doesn't affect them that much to begin with so what's the point in putting yourself in the crosshairs?

I've cancelled my ASTRO membership even though it's paid for by my CME fund because I don't know what that money pays for anymore. When the people who want the prestige of leadership finally start getting their hands dirty and acting like leaders, I'll happily support them again.

 

[medgator]

Sure. Or I can wait a few years till a job opens up in a larger market and go there at that time. Never bad to earn bank at a small place for a few years before going to a larger market.

Yup, very nice if your social/family situation allows you that type of uncertainty. Having moved with a physician spouse multiple times through training and jobs, i can tell you those moves can get worse every time as it affects multiple people.

Could be 1, a few or several years though for that job to open up.

Fwiw, there hasn't been an open job in our region since 2014, and the larger metros nearby have been much, much tighter the last few years.

I've cancelled my ASTRO membership even though it's paid for by my CME fund because I don't know what that money pays for anymore. When the people who want the prestige of leadership finally start getting their hands dirty and acting like leaders, I'll happily support them again.

After my recert this year, cancelling my membership as well