medstudents entering the match

[xrthopeful]

Torrance radiation oncology. partnership position

'radiation OR oncology OR partnertrack OR job OR STATECODE:"CA"' Jobs | ASTRO Radiation Oncology Career Center

3,179 'radiation OR oncology OR partnertrack OR job OR STATECODE:

careers.astro.org

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Members don't see this ad.

 

[xrthopeful]

So say 140 applications.

Harvard, MDACC, Sloan take their 7-8 each. That's 115 left.

Then the rest of the top 15 programs match their 3 each. that's 36 more spots gone, so about 80 left.

80 people to fill the rest of the 65 programs. Lot of departments are gonna be left HARD UP, OUT IN COLD.

 

[Reaganite]

Torrance radiation oncology. partnership position

'radiation OR oncology OR partnertrack OR job OR STATECODE:"CA"' Jobs | ASTRO Radiation Oncology Career Center

3,179 'radiation OR oncology OR partnertrack OR job OR STATECODE:

careers.astro.org

As legit as they come in all respects. Will be fiercely competitive.

 

[RadOncDoc21]

As legit as they come in all respects. Will be fiercely competitive.

Wow, I’ve haven’t seen a job like this advertised ever!

 

[Lamount]

It's still disingenuous to be a pollyanna about the field if you are in your own little niche and unaware of the bigger issues that are coming into play

It's not disingenuous. Some of us are happy (in fact, a lot of us are), and it's unreasonable to expect everyone to be contrite because you aren't. Things in the field are clearly changing and the small pp business model may no longer be viable, but that isn't everyone's reality. Tell your own story, and let others tell theirs.

 

[medgator]

It's not disingenuous. Some of us are happy (in fact, a lot of us are), and it's unreasonable to expect everyone to be contrite because you aren't. Things in the field are clearly changing and the small pp business model may no longer be viable, but that isn't everyone's reality. Tell your own story, and let others tell theirs.

You don't think I enjoy my job or love this field? I'm in a private practice an hour outside of a desirable growing metro. Those jobs are like unicorns these days.

Clearly you've missed my point. I've stated when I would consider RO a safe specialty to apply to again.

That's fine. my bad. Everything is awesome!

 

[RickyScott]

You don't think I enjoy my job or love this field? I'm in a private practice an hour outside of a desirable growing metro. Those jobs are like unicorns these days.

Clearly you've missed my point. I've stated when I would consider RO a safe specialty to apply to again.

That's fine. my bad. Everything is awesome!

Pretty much everyone I know in the field 10 years out is happy with their job, but recognizes it is reckless and boneheaded to enter the specialty presently. I am personally not disaffected or bitter, just realistic about prospects of those following in my footsteps.

 

[Haybrant]

Confirmed with PD (Doximity top 15 program) that applications are down ~25-30% this year. Usually see in the 180s and have around 140 applying. Ruh roh, Scooby...

Not saying I called it but I called it. 140 with about 15-20% of those applying in medicine as well. Just try to find a good job and you’ll see, it’s simply not there - minimum of 6-12 months to find a new job if lucky maybe many years then credentialing and licensing, you’re basically stuck. People aren’t dumb, they’re not looking to gamble w their future

 

[Mandelin Rain]

Just want to throw out something interesting: I had a patient sent to me pre-surgery with low intermediate risk disease (3+4 in low volume, PSA 6, cT1c). decided to go for surgery and was found to have pT2N0 disease with negative margins, etc.

4 weeks post-op, his PSA was 1.0. Repeat a month later was 2.0. BS and CT was negative. I recommended salvage RT. Patient went to an academic center and they said it was metastatic and start on ADT and Xtandi. Said savage RT would not be helpful because margins were negative.

So I looked it up and there are 5 studies that look at the benefit of salvage RT. Only 2 of the 5 found margin status to be a significant predictor of the benefit of salvage RT. One factor that was consistently seen as a predictor for the benefit of salvage was PSA doubling time and clearly his was short.

I just found this interesting. I heard from I don’t know how many people that margin status was all that mattered, but turns out it isn’t as important as one of the clear factors that he had which wasn't mentioned once...

As legit as they come in all respects. Will be fiercely competitive.

To anyone who hasn't yet hit a solid lead through ASTRO... these types of jobs DO come up sporadically. Sometimes really late in the academic year. It's a dangerous bet, but if you haven't found something satisfactory and you're willing to risk it, the later they're posted the less competition there will be. (I understand that this one is not particularly late)

 

[CidHighwind]

I don’t get it either. I’m going into radiology, which people say will die due to automation, but at least that’s 20-30 years away. To me radonc seems like a dying field, but maybe it will rebound the same way rads did.

 

[medgator]

. To me radonc seems like a dying field

It isn't but it does have finite demand.

Certainly not a growth situation like rads with the aging population

 

[xrthopeful]

I don’t get it either. I’m going into radiology, which people say will die due to automation, but at least that’s 20-30 years away. To me radonc seems like a dying field, but maybe it will rebound the same way rads did.

Dying is not close to accurate.

It's an evolving field, which means the number of people we are training yearly needs to evolve as well.

In the end, this 2,3,4,5 year period of less people going into the field will be good because it will hopefully force some program shutdowns that were needed.

 

[Neuronix]

In the end, this 2,3,4,5 year period of less people going into the field will be good because it will hopefully force some program shutdowns that were needed.

Let's see how programs respond. Last year everyone filled through soap or of the match. If this keeps happening, I don't see how anything will change.

 

[xrthopeful]

I do think there were some places that did not enter the SOAP.

I am not sure if they have other plans to fill.

 

[CidHighwind]

It isn't but it does have finite demand.

Certainly not a growth situation like rads with the aging population

But aren’t most cancer patients older? Aging in population should mean that there’s more potential patients no?

Dying is not close to accurate.

It's an evolving field, which means the number of people we are training yearly needs to evolve as well.

In the end, this 2,3,4,5 year period of less people going into the field will be good because it will hopefully force some program shutdowns that were needed.

I wish I was applying to radiology 3-4 years ago when even top programs were taking IMGs. Seems like it has gone back to being competitive again. IMO something similar will happen with radonc, where now it’s not competitive, but in several years when either the market improves or residencies get smaller it will pick up again. It can’t stay awful forever if many consider it in the same grouping as derm and ortho, right?


So the field is fine, but the job market is crap? Well if that’s the case, doesn’t that make getting into a “top program” more of a priority? It’s not like derm, ortho or in some cases rads where a less prestigious program will still get you a great job right? Seems like in radonc you guys come from decent residencies and still have trouble getting a job in even “okay” places.

 

[medgator]

But aren’t most cancer patients older? Aging in population should mean that there’s more potential patients

Sure, but less demand. What used to take 3-7 weeks can take 1-3 weeks so existing physicians can treat more patients.

While the above has been happening, instead of cutting residency slots, they've basically also nearly doubled them

 

[RickyScott]

But aren’t most cancer patients older? Aging in population should mean that there’s more potential patients no?



I wish I was applying to radiology 3-4 years ago when even top programs were taking IMGs. Seems like it has gone back to being competitive again. IMO something similar will happen with radonc, where now it’s not competitive, but in several years when either the market improves or residencies get smaller it will pick up again. It can’t stay awful forever if many consider it in the same grouping as derm and ortho, right?


So the field is fine, but the job market is crap? Well if that’s the case, doesn’t that make getting into a “top program” more of a priority? It’s not like derm, ortho or in some cases rads where a less prestigious program will still get you a great job right? Seems like in radonc you guys come from decent residencies and still have trouble getting a job in even “okay” places.

Problem with radonc is that residency expansion coincided with decreased demand (hypofractionation, change in patterns of care, payment reform etc) . In rads, historically excess supply was just cyclic. Field of radonc is not dying per se, but most of what you say is accurate. You can now go to a solid mid tier program today and still face geographic job restrictions unlike that seen in any other field in medicine.

 

[CidHighwind]

Sure, but less demand. What used to take 3-7 weeks can take 1-3 weeks so existing physicians can treat more patients.

While the above has been happening, instead of cutting residency slots, they've basically also nearly doubled them

So then how do you decide which residencies to shut down? If it’s done by who doesn’t fill, then programs might be smart and just take IMGs, interview more people, or use SOAP to take on whoever.

 

[medgator]

So then how do you decide which residencies to shut down? If it’s done by who doesn’t fill, then programs might be smart and just take IMGs, interview more people, or use SOAP to take on whoever.

No one decides. Just like no one stopped all these unnecessary (and sometimes substandard) programs from opening

 

[RickyScott]

So then how do you decide which residencies to shut down? If it’s done by who doesn’t fill, then programs might be smart and just take IMGs, interview more people, or use SOAP to take on whoever.

This is why we have a real disaster here, and providers 10 years out like myself are going out of there way to post on medstudent message boards.

 

[redalert]

MS4 originally interested in rad onc but decided on radiology instead out of concerns for jobs/geographic limitations/competitiveness. I'm still questioning if I made the right choice because I think rad onc is a better field with more patient interactions, meaningful interventions, and lower risks for displacement by AI. To look on the bright side I think those entering rad onc at this time may actually be buying low and reap profits later when the field turns around in a few years like rads did.

 

[deleted573262]

MS4 originally interested in rad onc but decided on radiology instead out of concerns for jobs/geographic limitations/competitiveness. I'm still questioning if I made the right choice because I think rad onc is a better field with more patient interactions, meaningful interventions, and lower risks for displacement by AI. To look on the bright side I think those entering rad onc at this time may actually be buying low and reap profits later when the field turns around in a few years like rads did.

Besides SDN, where did you gather information leading you to decide against rad onc?

FWIW - my hospital system has implemented at least three machine learning driven systems within the last year to detect PE, cervical fracture, and pulmonary disease.

 

[medgator]

MS4 originally interested in rad onc but decided on radiology instead out of concerns for jobs/geographic limitations/competitiveness. I'm still questioning if I made the right choice because I think rad onc is a better field with more patient interactions, meaningful interventions, and lower risks for displacement by AI. To look on the bright side I think those entering rad onc at this time may actually be buying low and reap profits later when the field turns around in a few years like rads did.

Could possibly occur. The folks that matched in the mid to late 90s got in when it was fairly easy and did well after.

The problem now is that, unlike that period of time, there has been no appetite so far to shut down programs/reduce spots etc and they did not have the spectre of hypo fractionation to deal with

 

[RadOncDoc21]

MS4 originally interested in rad onc but decided on radiology instead out of concerns for jobs/geographic limitations/competitiveness. I'm still questioning if I made the right choice because I think rad onc is a better field with more patient interactions, meaningful interventions, and lower risks for displacement by AI. To look on the bright side I think those entering rad onc at this time may actually be buying low and reap profits later when the field turns around in a few years like rads did.

I don’t think we’ve reached our bottom yet.

 

[redalert]

Besides SDN, where did you gather information leading you to decide against rad onc?

FWIW - my hospital system has implemented at least three machine learning driven systems within the last year to detect PE, cervical fracture, and pulmonary disease.

Mostly from residents at my home program who have difficulty finding jobs in their desired locations. Geographic limitation is a big deal breaker for me due to family issues.

I have no doubt that AI will be more and more commonplace in rads and in my mind that's a game changer that challenges the foundation of radiology. If AI truly delivers its promises radiology will be in much bigger trouble than rad onc now. It seems that the current problems in rad onc are mostly due to decreased demand compounded by leadership missteps that could be corrected. Exactly when/how that could happen I'm not sure but at least nobody, including AI, can do the job rad oncs do.

 

[medgator]

Exactly when/how that could happen I'm not sure but at least nobody, including AI, can do the job rad oncs do.

Agree.

Pretty sure a robot isn't going to counsel, discuss prognosis or write narcotics for my patients.

The issue is that there is only so much demand for radiation, and it that demand certainly doesn't warrant anywhere close to 200 grads/year

 

[deleted573262]

Mostly from residents at my home program who have difficulty finding jobs in their desired locations. Geographic limitation is a big deal breaker for me due to family issues.

I have no doubt that AI will be more and more commonplace in rads and in my mind that's a game changer that challenges the foundation of radiology. If AI truly delivers its promises radiology will be in much bigger trouble than rad onc now. It seems that the current problems in rad onc are mostly due to decreased demand compounded by leadership missteps that could be corrected. Exactly when/how that could happen I'm not sure but at least nobody, including AI, can do the job rad oncs do.

Excellent choice the job market concerns are not going away any time soon.

 

[deleted1002574]

Why is he ostracized? He seems to have a very good job at a top institution, is very vocal on MedNet, presents at conferences, does not seem to be in a cage of any sort.

(Looked up ostracized in case I was missing another definition)

 

[medgator]

Why is he ostracized? He seems to have a very good job at a top institution, is very vocal on MedNet, presents at conferences, does not seem to be in a cage of any sort.

(Looked up ostracized in case I was missing another definition)

I believe the rebuttal published in the red journal to his original 2013 letter was pretty harsh iirc.

But yes it seems like he still did end up finding another job at a different academic institution

 

[deleted1002574]

Go read the thread “bloodbath in the red journal.”

I did... Isn’t he still considered a thought leader in our field?

 

[Lamount]

A couple points regarding this debate

1) Posters on SDN and twitter alike should hold themselves to the same standard as they hold others. Are personal attacks fair game (i.e. those on twitter calling SDN posters misanthropes vs. those on SDN calling academic docs selfish, greedy etc...)? If you find this tactic unbecoming (as I do), resist the urge to engage. Attacking ideas >> Attacking those in a different practice type (PP vs. academic) >> Attacking individual people by name.

2) Both sides contribute to our poor image (one has its head in the sand, and the other thinks its head is on fire). Those in academics (such as myself) shouldn't insult students' intelligence by claiming there are no issues in the field. Those on SDN should decide whether it is helpful to actively dissuade students from choosing radiation oncology (it isn't). Many here will will say "worst field ever" in one post and in the next, claim that SDN plays no role in decreasing student interest -if you think your negative comments are having an impact, admit it... if you do NOT think they are having an impact, why bother?

3) There are structural problems in this field. Problems that are very frustrating, and some venting is necessary. Let's keep the venting to one thread rather than allowing it to take over every single discussion. Back in the day, this forum was dominated by discussion of difficult cases, interesting studies, and was a great resource of aspiring students to learn about the complex MEDICAL issues encountered by actual rad oncs. I became interested in rad onc watching these nuanced clinical debates.

Rant over.

 

[eggeggeggegg]

Honestly, as a med student, I just wish there was some open discussion regarding the future of rad onc. Having some actual discussion on how bad/good it actually is would be so helpful. For all the complaints about the doom and gloom that's posted, I don't really see any rebuttals to the points. We have the thread saying "RadOnc is still the best field", but even that doesn't refute any concerns about the job market, expanding residency spots etc. Wish the folks on twitter would come and have a discussion here.

Personally, I do think SDN has made RadOnc a difficult choice for me. It's an amazing field, and if I had started med school 10 years earlier without a family, then I might have taken the plunge. Don't think I can take that same risk today with kids depending on me though.

 

[bluebubbles]

Those on SDN should decide whether it is helpful to actively dissuade students from choosing radiation oncology (it isn't).

Why isn't it helpful to actively dissuade students, when we're just conveying our personal experiences honestly?

Let's pretend for a moment that radiation oncology has been overtraining students. I know that's not the party line for ADROP and others, but for the sake of argument, let's pretend we lived in an alternate universe where we were training 1000 residents per year.

If we don't actively dissuade students, and just discuss it behind closed doors without action, then a number of graduating residents 5 years down the line will be unhappily employed (e.g. due to lack of bargaining power in contract negotiation, etc.), underemployed, or unemployed.

If we do actively dissuade students, then a number of graduating residents 5 years down the line will be happy in other fields (internal medicine, surgery, etc.), and there'll be fewer graduating residents 5 years down the line that are unhappily employed, underemployed, or unemployed in radiation oncology. It's a win-win.

I'm not including all the reasons why patients would be better served, nor am I including all the evidence that we're overtraining; other threads cover this.

Most importantly, when we dissuade students, we don't say that the field is terrible. It's a great field with meaningful patient relationships, tech, and collaboration. We just say that the job market outlook is concerning. I'm sorry if I sound like an entitled millennial, but medical training is competitive, demanding, expensive, and protracted, and it's crazy that many residents in radiation oncology are worried about getting a good job afterwards.

Back in the day, this forum was dominated by discussion of difficult cases, interesting studies, and was a great resource of aspiring students to learn about the complex MEDICAL issues encountered by actual rad oncs.

Nowadays, Mednet exists and is far superior to SDN of days-past or future-present for discussion of cases, studies, and difficult clinical scenarios. Anonymity is a bug when discussing MEDICAL issues; anonymity is a feature when discussing controversial structural issues in radiation oncology.

 

[deleted956486]

Why isn't it helpful to actively dissuade students, when we're just conveying our personal experiences honestly?

Let's pretend for a moment that radiation oncology has been overtraining students. I know that's not the party line for ADROP and others, but for the sake of argument, let's pretend we lived in an alternate universe where we were training 1000 residents per year.

If we don't actively dissuade students, and just discuss it behind closed doors without action, then a number of graduating residents 5 years down the line will be unhappily employed (e.g. due to lack of bargaining power in contract negotiation, etc.), underemployed, or unemployed.

If we do actively dissuade students, then a number of graduating residents 5 years down the line will be happy in other fields (internal medicine, surgery, etc.), and there'll be fewer graduating residents 5 years down the line that are unhappily employed, underemployed, or unemployed in radiation oncology. It's a win-win.

I'm not including all the reasons why patients would be better served, nor am I including all the evidence that we're overtraining; other threads cover this.

Most importantly, when we dissuade students, we don't say that the field is terrible. It's a great field with meaningful patient relationships, tech, and collaboration. We just say that the job market outlook is concerning. I'm sorry if I sound like an entitled millennial, but medical training is competitive, demanding, expensive, and protracted, and it's crazy that many residents in radiation oncology are worried about getting a good job afterwards.



Nowadays, Mednet exists and is far superior to SDN of days-past or future-present for discussion of cases, studies, and difficult clinical scenarios. Anonymity is a bug when discussing MEDICAL issues; anonymity is a feature when discussing controversial structural issues in radiation oncology.

Agree with this post 100%. The notion that we shouldn't be discussing real world issues because it scares academia is ridiculous. Academia want more cheap labour even if it means the death of the specialty. Why any doctor would be okay with misleading medical students is beyond me. Yes, great job. No, you won't get geography, and you probably won't get a job in PP, and you may not even get a job. This is after 5 years of post graduate training. The tradeoff is not worth it despite what academics tell you. I'd have done IM: more pay, more geographical flexibility, less training, etc, etc.


Academic Chairs are elated for the 150 applicant to satellite position ratio that currently exists. They have literally starved the specialty.

 

[DebtRising]

But aren’t most cancer patients older? Aging in population should mean that there’s more potential patients no?



I wish I was applying to radiology 3-4 years ago when even top programs were taking IMGs. Seems like it has gone back to being competitive again. IMO something similar will happen with radonc, where now it’s not competitive, but in several years when either the market improves or residencies get smaller it will pick up again. It can’t stay awful forever if many consider it in the same grouping as derm and ortho, right?


So the field is fine, but the job market is crap? Well if that’s the case, doesn’t that make getting into a “top program” more of a priority? It’s not like derm, ortho or in some cases rads where a less prestigious program will still get you a great job right? Seems like in radonc you guys come from decent residencies and still have trouble getting a job in even “okay” places.

The difference between the fields is utilization and 'indications', these things aren't necessarily cyclical like the traditional business cycle or on the same time frame.

I don't know the radiology job market well enough, but I do no clearly that indications and usage of radiology procedures is increasing. IR at my institution has expanded dramatically, prostate MRIs, specialized PET being used on high volumes of patients when this did not exist where I practice ~4 years ago and specifically mpMRI increasing exponentially. And still need 'standard imaging' in most of those cases. I posit that the radiology rebound is in part due to increased utilization / new services, with organic increased utilization due to expanding services / indications.

In this field, there are multiple more protocols testing if we can treat prostate cancer shorter than if treating pelvic nodes matter. An extremely large part of Rad Onc's academic efforts in breast and prostate cancer are finding ways to do less radiation, totally fine as a goal. But those trends don't contribute to thinking the same 'length' of business cycle for demand will occur in this field compared to radiology, particularly because those cancers have the highest volume utilization due to their high prevalence, and the effectiveness of radiation intervention in them. Maybe protons will take off exponentially at some point. Brachytherapy could be used more but seems to be poorly taught and requires significant infrastructure . SBRT is great and a true novel add on that will increase utilization. SBRT will also decrease revenue on some traditional indications and does not necessarily increase utilization enough to offset this. Some posit that SBRT could for instance take surgical volume and turn it into rad onc volume - I counter that the benefits of potential salvage in younger men, full pathologic info, and the comfort of people with 'surgery' all are real things, and there is a very plausible scenario where SBRT say for prostate only decreases revenue by usurping longer courses. Great thing overall - bad thing for medical student looking at field with ~50% expansion in residency volume over a decade. All of us could be 100% wrong, but the underlying indicators will drive the cycle and there are some clear differences in pure increased rate in services between the fields.

 

[maruchan]

Why isn't it helpful to actively dissuade students, when we're just conveying our personal experiences honestly?

Let's pretend for a moment that radiation oncology has been overtraining students. I know that's not the party line for ADROP and others, but for the sake of argument, let's pretend we lived in an alternate universe where we were training 1000 residents per year.

If we don't actively dissuade students, and just discuss it behind closed doors without action, then a number of graduating residents 5 years down the line will be unhappily employed (e.g. due to lack of bargaining power in contract negotiation, etc.), underemployed, or unemployed.

If we do actively dissuade students, then a number of graduating residents 5 years down the line will be happy in other fields (internal medicine, surgery, etc.), and there'll be fewer graduating residents 5 years down the line that are unhappily employed, underemployed, or unemployed in radiation oncology. It's a win-win.

I'm not including all the reasons why patients would be better served, nor am I including all the evidence that we're overtraining; other threads cover this.

Most importantly, when we dissuade students, we don't say that the field is terrible. It's a great field with meaningful patient relationships, tech, and collaboration. We just say that the job market outlook is concerning. I'm sorry if I sound like an entitled millennial, but medical training is competitive, demanding, expensive, and protracted, and it's crazy that many residents in radiation oncology are worried about getting a good job afterwards.



Nowadays, Mednet exists and is far superior to SDN of days-past or future-present for discussion of cases, studies, and difficult clinical scenarios. Anonymity is a bug when discussing MEDICAL issues; anonymity is a feature when discussing controversial structural issues in radiation oncology.

Honestly I mostly agree with the sentiment overall but just want to point out that it's incorrect to say there will be fewer graduating residents 5 years down the line. There will be the same number more or less, due to people SOAPing into spots. Even if it becomes so undesirable that people don't want to SOAP, IMGs will fill the spots. So the lose part of the "win-win" is that the quality of physicians in the field declines.

Also more overall, I think people are underestimating how drastically APM is going to change the economics of the field. I agree that the sheer volume of expansion and oversupply of labor probably outweighs in the end, but everything you and I know about rad onc economics will get turned on its head by APM. A couple years ago, I agreed 110% with the negative future outlook, now...I probably agree like 80%. I think the future is a lot more fuzzy that people here believe.

 

[medgator]

Also more overall, I think people are underestimating how drastically APM is going to change the economics of the field. I agree that the sheer volume of expansion and oversupply of labor probably outweighs in the end, but everything you and I know about rad onc economics will get turned on its head by APM. A couple years ago, I agreed 110% with the negative future outlook, now...I probably agree like 80%. I think the future is a lot more fuzzy that people here believe.

I honestly would have expected you to say 130%. I don't see APM helping the residency overexpansion issue at all, quite the opposite frankly as there is a lot of overfractionation/utilization that may get addressed with APM/bundling.

To maintain income and workload, existing practitioners will simply see more patients. I easily see way more per year than the 150-250 consults/SIMs that were required annually in residency, and that number has been going up in the era of hypo-fx and SBRT. I imagine I am not alone there.

And if the physician supervision requirement ever got nixed, look at below.....

 

[medgator]

SBRT is great and a true novel add on that will increase utilization. SBRT will also decrease revenue on some traditional indications and does not necessarily increase utilization enough to offset this. Some posit that SBRT could for instance take surgical volume and turn it into rad onc volume - I counter that the benefits of potential salvage in younger men, full pathologic info, and the comfort of people with 'surgery' all are real things, and there is a very plausible scenario where SBRT say for prostate only decreases revenue by usurping longer courses.

Not to mention 2nd malignancy risk in a younger man, which is likely not insignificant, given what we know about standard fx and brachy.

https://ascopubs.org/doi/abs/10.1200/jco.2014.32.15_suppl.5034

Second malignancies after prostate brachytherapy: incidence of bladder and colorectal cancers in patients with 15 years of potential follow-up - PubMed

There may be an increased but small risk of developing a second malignancy after radiation therapy for prostate cancer. This outcome could be related to radiation carcinogenesis, but more vigilant screening and thorough workup as a result of radiation side effects and predisposing conditions...

www.ncbi.nlm.nih.gov

 

[deleted941485]

Agree with this post 100%. The notion that we shouldn't be discussing real world issues because it scares academia is ridiculous. Academia want more cheap labour even if it means the death of the specialty. Why any doctor would be okay with misleading medical students is beyond me. Yes, great job. No, you won't get geography, and you probably won't get a job in PP, and you may not even get a job. This is after 5 years of post graduate training. The tradeoff is not worth it despite what academics tell you. I'd have done IM: more pay, more geographical flexibility, less training, etc, etc.


Academic Chairs are elated for the 150 applicant to satellite position ratio that currently exists. They have literally starved the specialty.

I have heard that these academic health systems that have been acquiring systems left and right have now been trying to incorporate resident coverage into their satellite systems.

I know the programs in our area are trying to get residents out to more satellites and using it as an excuse to expand their programs. They do this under guise of better incorporating them into the system.

BS you bought them to prevent competition and don’t want to hire new attendings.

 

[deleted956486]

The difference between the fields is utilization and 'indications', these things aren't necessarily cyclical like the traditional business cycle or on the same time frame.

I don't know the radiology job market well enough, but I do no clearly that indications and usage of radiology procedures is increasing. IR at my institution has expanded dramatically, prostate MRIs, specialized PET being used on high volumes of patients when this did not exist where I practice ~4 years ago and specifically mpMRI increasing exponentially. And still need 'standard imaging' in most of those cases. I posit that the radiology rebound is in part due to increased utilization / new services, with organic increased utilization due to expanding services / indications.

In this field, there are multiple more protocols testing if we can treat prostate cancer shorter than if treating pelvic nodes matter. An extremely large part of Rad Onc's academic efforts in breast and prostate cancer are finding ways to do less radiation, totally fine as a goal. But those trends don't contribute to thinking the same 'length' of business cycle for demand will occur in this field compared to radiology, particularly because those cancers have the highest volume utilization due to their high prevalence, and the effectiveness of radiation intervention in them. Maybe protons will take off exponentially at some point. Brachytherapy could be used more but seems to be poorly taught and requires significant infrastructure . SBRT is great and a true novel add on that will increase utilization. SBRT will also decrease revenue on some traditional indications and does not necessarily increase utilization enough to offset this. Some posit that SBRT could for instance take surgical volume and turn it into rad onc volume - I counter that the benefits of potential salvage in younger men, full pathologic info, and the comfort of people with 'surgery' all are real things, and there is a very plausible scenario where SBRT say for prostate only decreases revenue by usurping longer courses. Great thing overall - bad thing for medical student looking at field with ~50% expansion in residency volume over a decade. All of us could be 100% wrong, but the underlying indicators will drive the cycle and there are some clear differences in pure increased rate in services between the fields.

The "cyclical" argument does not apply to rad onc IMO. Rad onc has always been non-competitive, with one exception-the IMRT era. In fact, it got so bad that to temporarily fix things (common theme in RO), they decided to extend residency training. All this did was it put a temporary band-aid on the problem.

I said one exception. I would posit that IMRT was such an innovative contribution to the field, that it turned a non-competitive field into a competitive one-albiet, temporarily. In fact, I would posit that the advent of IMRT is responsible for the bubble that was RO 5-10 years ago-the likes of which we are paying for now. IMRT not only made academic centers richer, it made the professional side of RO poorer-prior to IMRT professional fees were higher than technical fees for a treatment course (for the most part) because, naturally, more professional effort was involved in cutting blocks, shaping fields, etc-more manual labor was involved. With the coming of IMRT, technical side went up and professional side went down. While this was a blessing for academic centers, it was terrible for individual rad oncs -with one exception, people who owned their machines. Let's think about this for a second. Residency expansion only started after IMRT. Why is that? Because IMRT allows the residents to do many more minor things (contour, write notes, etc) and an attending to treat more patients for the institution. It also took the specialty from the practitioner to the institution.

People who owned machines benefited temporarily because academic centers started massive marketing. In addition, reimbursement was higher for the same services when delivered at academic centers-even if the only thing connecting the satellite to the academic center is a sign.

So really, it's not cyclical. RO was always on a decline. The increase in competition was a minor bump on the downward slope. A bump that can be attributed to two temporary things: 1) extending training by one year and 2) IMRT.

These two things will not happen again. Odds of them extending residency by another year are practically nil and last I checked, there isn't anything remotely close to IMRT-despite what is being promoted (protons, flash, blah, blah, blah). In fact, not only would I argue that rad onc was never in a "cyclical state," but has always been on a decline, I will argue that rad onc will follow nuclear medicine and this will happen over the next 10-15 years or so. If you don't know what happened to nuclear medicine, take a look at their message boards. I don't see why RO is any stronger than that specialty.

My 0.02

 

[RickyScott]

The "cyclical" argument does not apply to rad onc IMO. Rad onc has always been non-competitive, with one exception-the IMRT era. In fact, it got so bad that to temporarily fix things (common theme in RO), they decided to extend residency training. All this did was it put a temporary band-aid on the problem.

I said one exception. I would posit that IMRT was such an innovative contribution to the field, that it turned a non-competitive field into a competitive one-albiet, temporarily. In fact, I would posit that the advent of IMRT is responsible for the bubble that was RO 5-10 years ago-the likes of which we are paying for now. IMRT not only made academic centers richer, it made the professional side of RO poorer-prior to IMRT professional fees were higher than technical fees for a treatment course (for the most part) because, naturally, more professional effort was involved in cutting blocks, shaping fields, etc-more manual labor was involved. With the coming of IMRT, technical side went up and professional side went down. While this was a blessing for academic centers, it was terrible for individual rad oncs -with one exception, people who owned their machines. Let's think about this for a second. Residency expansion only started after IMRT. Why is that? Because IMRT allows the residents to do many more minor things (contour, write notes, etc) and an attending to treat more patients for the institution. It also took the specialty from the practitioner to the institution.

People who owned machines benefited temporarily because academic centers started massive marketing. In addition, reimbursement was higher for the same services when delivered at academic centers-even if the only thing connecting the satellite to the academic center is a sign.

So really, it's not cyclical. RO was always on a decline. The increase in competition was a minor bump on the downward slope. A bump that can be attributed to two temporary things: 1) extending training by one year and 2) IMRT.

These two things will not happen again. Odds of them extending residency by another year are practically nil and last I checked, there isn't anything remotely close to IMRT-despite what is being promoted (protons, flash, blah, blah, blah). In fact, not only would I argue that rad onc was never in a "cyclical state," but has always been on a decline, I will argue that rad onc will follow nuclear medicine and this will happen over the next 10-15 years or so. If you don't know what happened to nuclear medicine, take a look at their message boards. I don't see why RO is any stronger than that specialty.

My 0.02

Right. I have always argued that the high technical fees for imrt thAt fueled expansion of satellites and departments was ultimately a negative for practioners and that it is really in our long term interest for lower technical reimbursements given the harm done.

Just wanted to add that In terms of dissuading medstudents, I think it is unethical to advise them to act against their own interests, which is I why have a real moral problem with the twitter crowd.

Even a student poised to enter mdacc or Harvard programs generally does not understand how the job market will lock them down in their first job and the insecurity and lack of proffesional advancement that will follow. jobs in prestigious department can be fraught with politics and backstabbing of hyper competitive (will be colleagues of those vocal on Twitter, and I can personally assure you that there are some petty backstabbers among the virtue signallers) to have no outlet/possibility of lateral movement and severe geographic restriction is tough.

If you are a junior attending in let’s say rads at Harvard, you will get a lot of competitive offers from similar institutions or lucrative private offers on a much more regular basis than radonc, and this leverage can mean a lot to how you are treated, or proffesional advancement.

 

[medgator]

," but has always been on a decline, I will argue that rad onc will follow nuclear medicine and this will happen over the next 10-15 years or so. If you don't know what happened to nuclear medicine, take a look at their message boards. I don't see why RO is any stronger than that specialty.

My 0.02

Don't see that happening, who else is going to sign plans? Med oncs? Nuc med became obsolete by rads that could do what they do.

Who will do what we do?

 

[medgator]

The "cyclical" argument does not apply to rad onc IMO. Rad onc has always been non-competitive, with one exception-the IMRT era. In fact, it got so bad that to temporarily fix things (common theme in RO), they decided to extend residency training. All this did was it put a temporary band-aid on the problem.

Happened in the mid 90s. Well before imrt was out, let alone close to mainstream.

I think RO would have continued to be an amazing field if we kept the supply tight at 110-130 Max. Would have continued to attract the best and brightest and the job market would continue to be healthy. Sbrt and hypofx would have allowed us to treat more pts with the same number of grads every year

 

[deleted956486]

Happened in the mid 90s. Well before imrt was out, let alone close to mainstream.

I think RO would have continued to be an amazing field if we kept the supply tight at 110-130 Max. Would have continued to attract the best and brightest and the job market would continue to be healthy. Sbrt and hypofx would have allowed us to treat more pts with the same number of grads every year

Exactly. IMRT was a temporary blip. We've always been on a decline.

 

[medgator]

Exactly. IMRT was a temporary blip. We've always been on a decline.

They weren't connected though. People were getting semi decent jobs a decade ago when we were closer to 120/year and imrt had been out for awhile.

This issue was entirely created by academic folks.

We aren't nuc med. No one else is taking over our role

 

[deleted956486]

They weren't connected though. People were getting semi decent jobs a decade ago when we were closer to 120/year and imrt had been out for awhile.

This issue was entirely created by academic folks.

We aren't nuc med. No one else is taking over our role

I think we're going to have to agree to disagree on that (which, contrary to what happens on twitter, is okay).

 

[deleted956486]

Right. I have always argued that the high technical fees for imrt thAt fueled expansion of satellites and departments was ultimately a negative for practioners and that it is really in our long term interest for lower technical reimbursements given the harm done.

Just wanted to add that In terms of dissuading medstudents, I think it is unethical to advise them to act against their own interests, which is I why have a real moral problem with the twitter crowd.

Even a student poised to enter mdacc or Harvard programs generally does not understand how the job market will lock them down in their first job and the insecurity and lack of proffesional advancement that will follow. jobs in prestigious department can be fraught with politics and backstabbing of hyper competitive (will be colleagues of those vocal on Twitter, and I can personally assure you that there are some petty backstabbers among the virtue signallers) to have no outlet/possibility of lateral movement and severe geographic restriction is tough.

If you are a junior attending in let’s say rads at Harvard, you will get a lot of competitive offers from similar institutions or lucrative private offers on a much more regular basis than radonc, and this leverage can mean a lot to how you are treated, or proffesional advancement.

Bingo. Unless you're a professor, expansion is bad for you.

 

[Mandelin Rain]

I could see radiology and Med Onc collectively taking our role. PET and MRI guided IGRT with auto match. AI to contour. Computers to plan with NTCP based dose limits. It's all pretty automated already. Especially as we move toward tinier volumes and shorter courses.

Med Oncs become "Oncologists". They "order" radiation. Patient gets a scan and rads/computers do the rest. Med onc handles toxicity, etc...

 

[deleted941485]

We have a lot of things to be worried about, but I don’t think this is one of them. Too many administrative and regulatory barriers to this ever happening.

Also the trend in medicine is toward increasing, not decreasing, specialization.

If you can make $500k+/yr prescribing immunotherapy, what would be the incentive to lengthen fellowship to train in an additional modality?

Europe seems to have no problem allowing physicians in oncology delivering both XRT and Systemic agents to that end. None of the other hocus pocus being proposed on here will make this field better. If RO is truly dying , Im not really sure what else we have to lose as ROs.

Forget about working in the middle of no where. Maybe accepting the fact that new attendings like myself and others a good percentage of us will probably be forced to Re train in something else.

 

[medgator]

We have a lot of things to be worried about, but I don’t think this is one of them. Too many administrative and regulatory barriers to this ever happening.

Also the trend in medicine is toward increasing, not decreasing, specialization.

If you can make $500k+/yr prescribing immunotherapy, what would be the incentive to lengthen fellowship to train in an additional modality?

Not to mention.... How exactly are med oncs in this country magically going to start looking at their own scans for treatment planning? Or learn xrt tolerances/doses etc. Or is a diagnostic radiologist going to all of a sudden start an oncology clinic? Skillsets are totally different. Rad onc isn't going anywhere.

The extent of their head and neck knowledge is cisplatin vs, decreasingly, erbitux. Ask your med onc how often they stage their anal ca pts with a dre at consult.

Not even close to as analogous as nuc med which essentially was an offshoot of what diagnostic rads already do and was very easy to turn their specialty into a fellowship off diagnostic rads.

What the current oversupply will do though, is eventually turn us in pathologists, from a workforce standpoint. Jobs with crap geography rivaled only by the increasingly crap salaries, exploitative fellowships and Junior faculty/pp positions to go with it. Best of all, loss of autonomy as some academic mothership will vet your plan during weekly peer review.