As a med student I had no idea the level of pressure that PDs put on their residents to “spin” the program positively.
Unless you know a resident personally or they are a renegade, there is almost no chance you’ll get an honestly negative opinion out of anyone during interviews.
As a resident you have no idea who these med students are and cannot trust them to keep an opinion in confidence. If you took an applicant aside and whispered “this place sucks,” you’d live in constant fear that this would come back to you and holy hellfire would rain down upon you from above.
LOL...sounds like someone has been burned (maybe a long time ago?)!!! FYI, as student who has rotated in the program and also witnessed this program's "firing squad" first hand, I can positively say the academic standards are exactly what I would want for my training. The "grilling" or reaction from Ralph is like, "make sure you know this" so if that's too rough for you, then by all means find some "lower stress" (lower name) program. Yeah he might be old-school, but Ralph has hooked up their residents with all kinds of research and stuff to help with CVs and jobs.Ralph has been off his rocker for awhile. He would be just a senile old guy to be ignored but for the fact that he runs one of the most malignant radiation oncology departments in the country.
Every week they drag a resident to the front of the room to be grilled by Ralph on oncology trivia. Ensuring along the way that the resident feels terrible about themselves for missing a question. The rest of the department sits back and turns a blind eye despite everyone knowing how their current and former residents feel about the process.
The worst part is when they bring medical students in to interview they make them sit there awkwardly to watch. Ralph is proud of his firing squad.
Since medical students can go anywhere they want I would not even accept an interview from this program. Your mental health is worth more than working with this "big name" at the University of Chicago.
As far as the program goes: NEWS FLASH >>>>THE UNIVERSITY OF CHICAGO PD IS A YOUNG NON-WHITE FEMALE!!!!!
Better yet, I hope people don't apply so I have a better chance of getting in to this program.
Ralph has been off his rocker for awhile. He would be just a senile old guy to be ignored but for the fact that he runs one of the most malignant radiation oncology departments in the country.
Every week they drag a resident to the front of the room to be grilled by Ralph on oncology trivia. Ensuring along the way that the resident feels terrible about themselves for missing a question. The rest of the department sits back and turns a blind eye despite everyone knowing how their current and former residents feel about the process.
The worst part is when they bring medical students in to interview they make them sit there awkwardly to watch. Ralph is proud of his firing squad.
Since medical students can go anywhere they want I would not even accept an interview from this program. Your mental health is worth more than working with this "big name" at the University of Chicago.
medstudents entering the match
- Thread starter RickyScott
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For me, the Socratic method of teaching works, and I was able to deal with any shame/embarrassment that came from not knowing something in front of others. It's not for everyone, though.
"As far as the program goes: NEWS FLASH >>>>THE UNIVERSITY OF CHICAGO PD IS A YOUNG NON-WHITE FEMALE!!!!!"- not sure why you felt the need to be so excited about being both racist and sexist, but I can assure you, given the history of personalities in this profession, that statement means little about how they will act in the future.
"As far as the program goes: NEWS FLASH >>>>THE UNIVERSITY OF CHICAGO PD IS A YOUNG NON-WHITE FEMALE!!!!!"- not sure why you felt the need to be so excited about being both racist and sexist, but I can assure you, given the history of personalities in this profession, that statement means little about how they will act in the future.
why wouldn’t anyone be excited about breaking the old-school tenets of who should be in positions of power? I will always support #heforshe and sounds like this program is going down that path...like I said, I hope this idea of UChicago Rad Onc being a malignant program keeps up with our “buyers market mentality” so that helps my chances this match....
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Actually that # is correct. Confirmed by a resident who interviewed with them that starting is over $350k
I think aspiring radiation oncologists who are not "young, non-white females" would be dismayed to hear gender and race are now important qualifications for professional academic advancement.
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My $0.02.
As far as rules of engagement & common decency go, I don't feel like anyone should be maligning Dr. Jillian Tsai. I don't know her personally but because she stands for herself, while we're anonymous, it's unfair to her; further, it's unfair to be too harsh or to blame any particular attending on job market troubles. Plus Simon Powell (the MSKCC chair) is a good guy from what my mentor's told me, who was a junior attending at the time and not beholden in any way to Simon Powell. If anything, MSKCC has been quite restrained in residency expansion, as it has notoriously high clinical volume per resident.
SDN and other venues have brought about change, in terms of decreasing applicant numbers, and I recognize it's not ideal and is an issue for everyone, even if it is a bigger issue for academic departments. Ideally, we'd have fewer seats rather than fewer applicants, which would maintain applicant quality. It's not fair to solely blame SDN, however, because it's ADROP, ASTRO, and other acronyms that failed to act. The best case scenario is that declining applicant numbers will be an impetus for these organizations to enact meaningful quality control with teeth across existing and recently opened residency programs.
Finally, the negativity can get out of hand on here. Just like the boy who cried wolf, I believe anyone loses credibility if their voices become too negative or vociferous. Honestly, if I were a med student reading over Dr. Jillian Tsai's few messages here, she sounds like a decent, rationale, and open-minded person, and I would assign significant credibility to her statements.
As far as rules of engagement & common decency go, I don't feel like anyone should be maligning Dr. Jillian Tsai. I don't know her personally but because she stands for herself, while we're anonymous, it's unfair to her; further, it's unfair to be too harsh or to blame any particular attending on job market troubles. Plus Simon Powell (the MSKCC chair) is a good guy from what my mentor's told me, who was a junior attending at the time and not beholden in any way to Simon Powell. If anything, MSKCC has been quite restrained in residency expansion, as it has notoriously high clinical volume per resident.
SDN and other venues have brought about change, in terms of decreasing applicant numbers, and I recognize it's not ideal and is an issue for everyone, even if it is a bigger issue for academic departments. Ideally, we'd have fewer seats rather than fewer applicants, which would maintain applicant quality. It's not fair to solely blame SDN, however, because it's ADROP, ASTRO, and other acronyms that failed to act. The best case scenario is that declining applicant numbers will be an impetus for these organizations to enact meaningful quality control with teeth across existing and recently opened residency programs.
Finally, the negativity can get out of hand on here. Just like the boy who cried wolf, I believe anyone loses credibility if their voices become too negative or vociferous. Honestly, if I were a med student reading over Dr. Jillian Tsai's few messages here, she sounds like a decent, rationale, and open-minded person, and I would assign significant credibility to her statements.
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I am encouraged that at least the issue of overexpansion is being recognized, but I am very doubtful it will be sufficiently addressed (cutting back spots to 100-120 or something like that- I just dont see how that can collectively be done) and even so, the waters have been poisoned for 10-15 years minimum as Michael Steinberg said at ASTRO. Lets remember the single most important factor for selecting a job is geography to most residents last year not salary and this is not going to be fixed anytime within the present generation. (I am not sure Ralph gets the geography part)
I really appreciate Dr. Tsai attempting to come on to SDN to try to bridge the gap. Really hate this PP vs academics mentality, as I have good friends on both sides. Hopefully this post can help further bridge the gap.
I may be projecting a little bit, but my take on the decreased number of applications is:
1) The poor job market prospects - over training residents leading to worry about the ability to find a job. Imagine spending 4 years of undergrad, 4-8 years of medical school, then 5 years of residency then worrying about whether you will be able to find a decent job - NO THANKS.
2) Geography - this has always been a problem and only gotten worse since increase in residency positions
3) Compensation - concerns about hypofractionation and APM and what it will do to compensation in the future and the number of radiation oncologists needed
If the residency programs are confused about why the number are down, how hard would it be to send a survey out the 4th year medical students and ask them to rank in order of importance the following in their selection of specialty.
- interest in field
- compensation
- good job outlook
- geographical mobility/flexibility
- prestige
- quality of life/lifestyle
I bet for a lot of people, "interest in field" is at the top, but you can only sacrifice so much for it, before you turn down your "dream" specialty for something you might like a little bit less but with better job prospects, geographic preference, ??compensation - still decent at the moment, but have to work a bit harder and could change a lot in the future.
Also agree that a lot of people on twitter came from top residency programs and are in a bit of a bubble so their experiences with the job search may not be reflective of the majority of residents. Understanding that will help bridge the gap.
A lot of people here are saying that the rad onc department chairs are greedy. I see their points and I think they are valid. I wonder, though, whether this "greediness" specific to radiation oncology chairs. I doubt they are any more or less greedy than chairs of other departments. They are probably just under the same pressures from the president of their institution to expand, increase research productivity for grant money, and increase revenue. So what is the difference with rad onc chairs vs other chairs?
If I understood the other thread on this forum comparing rad onc with derm residencies correctly, what we learned is that that radiation oncology is unique in that it generates a lot of revenue in technical fees. It generates so much revenue that often helps the hospital keep less profitable departments afloat and it can afford to fund residency expansion without the needing to wait for additional CMS funding. Did I understand that correctly? If so, to me, it's a problem with the system. As others have suggested previously, cutting technical fees would help with this problem and likely have less pressure from the hospital admins to expand with satellites and residency position to help keep them going.
Beside the high revenues in technical fees, anyone know what else makes rad onc unique in it's rapid residency expansion? Pressure to publish in academics? The super research focused characteristic of radiation oncology?
I may be projecting a little bit, but my take on the decreased number of applications is:
1) The poor job market prospects - over training residents leading to worry about the ability to find a job. Imagine spending 4 years of undergrad, 4-8 years of medical school, then 5 years of residency then worrying about whether you will be able to find a decent job - NO THANKS.
2) Geography - this has always been a problem and only gotten worse since increase in residency positions
3) Compensation - concerns about hypofractionation and APM and what it will do to compensation in the future and the number of radiation oncologists needed
If the residency programs are confused about why the number are down, how hard would it be to send a survey out the 4th year medical students and ask them to rank in order of importance the following in their selection of specialty.
- interest in field
- compensation
- good job outlook
- geographical mobility/flexibility
- prestige
- quality of life/lifestyle
I bet for a lot of people, "interest in field" is at the top, but you can only sacrifice so much for it, before you turn down your "dream" specialty for something you might like a little bit less but with better job prospects, geographic preference, ??compensation - still decent at the moment, but have to work a bit harder and could change a lot in the future.
Also agree that a lot of people on twitter came from top residency programs and are in a bit of a bubble so their experiences with the job search may not be reflective of the majority of residents. Understanding that will help bridge the gap.
A lot of people here are saying that the rad onc department chairs are greedy. I see their points and I think they are valid. I wonder, though, whether this "greediness" specific to radiation oncology chairs. I doubt they are any more or less greedy than chairs of other departments. They are probably just under the same pressures from the president of their institution to expand, increase research productivity for grant money, and increase revenue. So what is the difference with rad onc chairs vs other chairs?
If I understood the other thread on this forum comparing rad onc with derm residencies correctly, what we learned is that that radiation oncology is unique in that it generates a lot of revenue in technical fees. It generates so much revenue that often helps the hospital keep less profitable departments afloat and it can afford to fund residency expansion without the needing to wait for additional CMS funding. Did I understand that correctly? If so, to me, it's a problem with the system. As others have suggested previously, cutting technical fees would help with this problem and likely have less pressure from the hospital admins to expand with satellites and residency position to help keep them going.
Beside the high revenues in technical fees, anyone know what else makes rad onc unique in it's rapid residency expansion? Pressure to publish in academics? The super research focused characteristic of radiation oncology?
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Why don't you read a chair's words directly from the horse's mouth and decide for yourself?
medstudents entering the match
Not to mention.... How exactly are med oncs in this country magically going to start looking at their own scans for treatment planning? Or magically learn rt tolerances etc. Or is a diagnostic radiologist going to all of a sudden start an oncology clinic? Skillsets are totally different...
forums.studentdoctor.net
Do you think the desire for cheap labor is specific to academic radiation oncology? To me it makes sense that CEOs and hospital admins would benefit from cheap labor of all departments, like it would benefit any company to have cheaper labor. I was just suggesting that there is probably pressure from above these chairs from CEOs/presidents of their instiutions to expand as well. I think for radiation oncology, there is just the right environment for this unchecked expansion to occur, whereas other specialties that do not generate a lot of money from technical fees cannot afford to expand like we have.
Just trying to understand what it is about rad onc that has gotten it into the trouble it's in now. I do not think rad onc chairs are uniquely greedy compared other chairs.
Just trying to understand what it is about rad onc that has gotten it into the trouble it's in now. I do not think rad onc chairs are uniquely greedy compared other chairs.
Radonc is small. Residency programs are small. That makes it difficult to increase #s of residents slowly. If lots of programs add 1-2 residents over a few years and a few new programs open up, that's all it takes.
Don't worry you will get the spot. That is if you are a medical student and not Ralph.
This "idea" that University of Chicago is malignant is not new. There are a half dozen others off the top of my head that are also "critical thinking" residencies. They do not currently have chairs on twitter making asinine comments though.
I see that you just joined SDN. We don't kowtow here. Everyone is free to have an opinion (malignant projection) and everyone is free to disagree. It is a level playing field.
If medical students want "critical thinking" they are more than welcome to go the "critical thinking" programs. The issue for Ralph this year is that they no longer have to, everyone has a choice.
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For being so research focused and so many people supposedly dedicated to carrying it out we have surprisingly little to show for it.
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You know what I find disappointing is this new fixation on gender and race in the rad Onc community. Its just a side show. Why would i rational human being looking at the data really care.
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It's these same people who brainwash med students into thinking they'll be in a bread line after rad onc residency...#ToneDeaf #SMH
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Pretty sure no one actually said bread line, but please feel free to continue the FUD... Downward pressures on the job market because of a resident oversupply isn't good for anyone practicing except certain vested interests.
Being able to afford a home is something most physicians would expect to be able to do. That isn't necessarily a possibility in certain desirable locales with an average rad onc salary.
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Memorial would never interview a schmuck like me, but I got my first main center academic interview in a completely different region than mine after a year of broad applying. The interview was in a large urban location. The pay? $280k--including high rvu target and very difficult to achieve bonus.
So these salary numbers are not coming out of nowhere.
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Lol look at the prior postings...bread lines are explicitly mentioned. Talk about being melodramatic.
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$280k in KC or Cleveland >>>>> $350k at msk in Manhattan
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Wowza.
You guys really love being incredibly active over the weekend.
I encourage you all to do something besides complain about SDN, Twitter, or whatever else ails you during these weekends. Spend time with family, friends, something, anything besides arguing with other people on the internet.
A couple points to this weekend explosion:
Dr. Tsai @cujust I really appreciate you taking the time to come and post your thoughts on SDN. While I do think that criticism of someone who posts their opinion publicly on twitter is fair game, I respect and thank you for coming to SDN to bring your pieces of information and your opinions to the table. I unfortunately strongly disagree with the notion that transferring this discussion to another forum is the right answer. Here on SDN people are allowed to disagree with you and while they aren't allowed to directly call you dumb, they are allowed to call your comments as such. Unlike Twitter, there is no 'upvote' or 'retweet' system that keeps the most 'liked' comments at the top of a thread.
Continuing with the twitter theme - Ralph Weischalbaum seems completely insane. I completely agree with @ROFallingDown that we should be running, not walking, away from people like that having any role as our leadership. He is part of the old guard of radiation oncology that we as a specialty should be forcing out of chairman positions and sending out to pasture. He is an unfortunate byproduct of the fact that you can be old and senile and still be allowed to practice clinical radiation oncology. The worst radiation oncologists I've seen clinically (n=10) are those in their 7th decade of life or greater, work at academic institutions, and have not kept up with how to treat patients in the 21st century.
People are unfortunately allowed to post incorrect statements, especially those that cannot be validated as it's a he-said, she-said. However, people who routinely participate in this look remarkably foolish. Looking at you @NAMthrow in regards to bring wrong about MSKCC salaries. You are one of the most hyperbolic folks on this forum and while I agree with you at times in principle, your complete inability to not let your emotions control your narrative negative influences your potential outlook.
The downside of being anonymous is people have no idea whether you are chronically FoS or not. If you gain a reputation as a *******, it will follow you on this forum. I know this because I have a list of people that are, IMO, hyperbolic or *******es, on this forum, that I do not take as seriously as others who, while I may disagree with them strongly, know what is hyperbole, what is opinion, what is fact, and most importantly, know how to differentiate all 3 of those from one another.
All the crap about lawyer salaries is completely off-topic and I will be pruning the thread in that regard. My goodness folks stop going on wild tangents. If you want to discuss how lawyer salaries are comparable to rad oncs then do so IN A DIFFERENT THREAD. NOT in one (trying) talking about medical students entering the match. A warning to the instigators of that ridiculous off-topic tangent.
Despite all that, you know what I'm most pissed about? It's been a long day in clinic and as a moderator I am spending time cleaning up this crap thread instead of finishing notes and going home. So, on top of all of this 3 pages of non-sense that has been posted in the past 3 days, to catch flak about lack of moderation over a weekend thread that generated zero reports is pretty ****ty. You think somebody needs a warning? Screaming about lack of moderation is NOT helping the issue. Click the report button, explain your issue, and if it's egregious somebody who is active over the weekend will take care of it. At minimum it will keep the thread under some aspect of monitoring.
You guys really love being incredibly active over the weekend.
I encourage you all to do something besides complain about SDN, Twitter, or whatever else ails you during these weekends. Spend time with family, friends, something, anything besides arguing with other people on the internet.
A couple points to this weekend explosion:
Dr. Tsai @cujust I really appreciate you taking the time to come and post your thoughts on SDN. While I do think that criticism of someone who posts their opinion publicly on twitter is fair game, I respect and thank you for coming to SDN to bring your pieces of information and your opinions to the table. I unfortunately strongly disagree with the notion that transferring this discussion to another forum is the right answer. Here on SDN people are allowed to disagree with you and while they aren't allowed to directly call you dumb, they are allowed to call your comments as such. Unlike Twitter, there is no 'upvote' or 'retweet' system that keeps the most 'liked' comments at the top of a thread.
Continuing with the twitter theme - Ralph Weischalbaum seems completely insane. I completely agree with @ROFallingDown that we should be running, not walking, away from people like that having any role as our leadership. He is part of the old guard of radiation oncology that we as a specialty should be forcing out of chairman positions and sending out to pasture. He is an unfortunate byproduct of the fact that you can be old and senile and still be allowed to practice clinical radiation oncology. The worst radiation oncologists I've seen clinically (n=10) are those in their 7th decade of life or greater, work at academic institutions, and have not kept up with how to treat patients in the 21st century.
People are unfortunately allowed to post incorrect statements, especially those that cannot be validated as it's a he-said, she-said. However, people who routinely participate in this look remarkably foolish. Looking at you @NAMthrow in regards to bring wrong about MSKCC salaries. You are one of the most hyperbolic folks on this forum and while I agree with you at times in principle, your complete inability to not let your emotions control your narrative negative influences your potential outlook.
The downside of being anonymous is people have no idea whether you are chronically FoS or not. If you gain a reputation as a *******, it will follow you on this forum. I know this because I have a list of people that are, IMO, hyperbolic or *******es, on this forum, that I do not take as seriously as others who, while I may disagree with them strongly, know what is hyperbole, what is opinion, what is fact, and most importantly, know how to differentiate all 3 of those from one another.
All the crap about lawyer salaries is completely off-topic and I will be pruning the thread in that regard. My goodness folks stop going on wild tangents. If you want to discuss how lawyer salaries are comparable to rad oncs then do so IN A DIFFERENT THREAD. NOT in one (trying) talking about medical students entering the match. A warning to the instigators of that ridiculous off-topic tangent.
Despite all that, you know what I'm most pissed about? It's been a long day in clinic and as a moderator I am spending time cleaning up this crap thread instead of finishing notes and going home. So, on top of all of this 3 pages of non-sense that has been posted in the past 3 days, to catch flak about lack of moderation over a weekend thread that generated zero reports is pretty ****ty. You think somebody needs a warning? Screaming about lack of moderation is NOT helping the issue. Click the report button, explain your issue, and if it's egregious somebody who is active over the weekend will take care of it. At minimum it will keep the thread under some aspect of monitoring.
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Yeah. I got tired of the back and forth. Columbia's paying 280, why would MSK pay 350? Whatever, it's really irrelevant. I had enough of this. People being "targeted," "attacked," and "cyberbullied." Accusations of "unprofessionalism." Everyone wants to be a victim, and are more than willing to destroy your character. It shows the mentality that has become ingrained in our field.
Thankfully this is anonymous. Can you imagine the reaction to that exchange if this was IRL? "That is completely unprofessional! Stop attacking her! Call the police! Help!"
Medical Students, you've been warned. If the field is so amazing, why are people begging you to come in? Ask yourself that. Then ask yourself, if the field is so dedicated to education and training, why would they even care if people matched? Theoretically, if residents weren't merely scut monkeys needed to help chairs expand, it would be a boon to have to train (and waste less resources in doing so) less. If you believe the hype that the academics are sending your way, by all means come into radiation oncology. My advice is to stay away. The field has a lot of problems no one will talk about in academics because its detrimental to an academic career. There are other-less exploitative fields that you will be happy to match in.
Signing out forever,
NAMTHROW
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University of Tennessee had a program?!?! So many new ones in the last few years. No wonder things are so farked. These all need to be nixed and hopefully UTenn goes unmatched again (along with wvu, Arkansas etc).
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Good riddance.
It wasn't an accusation of unprofessionalism- It straight up is. You are entitled to your opinion and so am I. And although it is "fair game" on this forum for us to be able to speak our minds freely and discuss what other people are tweeting - I will repeat that I personally think the way some of you twisted her words to suit your own agenda to be pathetic and a misrepresentation of us trainees who do NOT agree with you. Thats all I have to say about that.
Medical students, you've been warned. There are some people who don't realize how good we have it in the field and they go to sleep at night typing away nonsense, anonymously bashing people right and left with no agenda except to troll. Fact of the matter is radonc is still an incredibly gratifying field with enormous potential moving forward. Cancer diagnoses are increasing, the population is aging, and patients are living longer due to advances in therapy which makes it an incredibly "stable" long-term job market both domestically and internationally (if that is your thing).
Yes, radonc is moving towards an increasingly hospital-based/academic system but the reality is that is happening across nearly ALL medical specialties (private practices are slowly decreasing in number over past few decades - FACT, see Why Private Practice Is Dying). This is multifactorial but is largely driven by changes made and healthcare reform via ACA. So yes, this means more academic satellites etc. but this is not being driven by egotistical 70 year olds who are department chairs, that is so absurb to even say. Anyone trying to convince you otherwise is straight up lying and is incredibly misinformed. Radoncs don't even make the decision to open these satellite clinics... it is being driven by big hospital and academic CEO's who I agree have $$$$ as their #1 priority. I have no earthly idea why people are trying to convince you this is all scheming by Dr. Weischelbaum... seriously, that is the dumbest comment I have ever heard. But hey, this is coming from someone who openly admitted to making up salary numbers without any rhyme or reason so you can choose whether to believe he/she or not.
I urge you to take a look at the ASTRO career center at - Jobs | ASTRO Radiation Oncology Career Center. When I was a medical student I would check it from time to time to see trends in where jobs were opening and were in demand. I haven't done the math officially but I am pretty sure there have been >200 jobs posted in the past 365 days. Also, if you look at how many graduating seniors ended up doing fellowships vs getting jobs right out of residency I would still estimate the rate to be <10% for US senior graduates. That is in stark difference to radiology where that number is well over 80-90%.
There are issues, yes. We as trainees have acknowledged some and have spoken very clearly to our department administrators (which at my program have been incredibly supportive). For example, the biology/physics exam debacle from last year was addressed swiftly by ARRO and our PD's, many of whom were extremely vocal against the ABR to fix the system. Within 1 year, we saw a pretty drastic increase in pass rates (>95% across the board). Let's not forget pass rates for internal medicine/pediatrics etc are well below those numbers.
I don't think we need to move this discussion elsewhere. I wholeheartedly agree with the moderator that this is actually the best place to have these discussions. I am not backing down though. People can say whatever crap they want on this forum, won't change my stance or opinion on all the above. Also, for the record I highly doubt NAMTHROW is "signing out forever" - mark my words he will be back on this forum in no time.
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Pot meet kettle. Your post is full of a lot of misinformation also.
Radiology fellowships are legit and acgme accredited, while many of the recent "fellowships" in radonc (all of which are NON accredited) have appeared to be of questionable value in things like "igrt" and "palliative care."
And trying to equate number of jobs on the ASTRO site the last 365 days to the excessive number of grads (200/year) in RO to argue that the speciality is fine job wise is specious to say the least. Should the goal of every specialty be be to have supply perfectly match demand?
When I was a medical student, the ASTRO site use to have jobs in decent locales in FL, tx, ga, VA, Carolinas etc. Now you see those areas rarely posted outside of the resident mill ones.
The data shows more us rad onc grads taking questionable non-accredited fellowships coinciding with residency expansion. People can interpret that how they wish but most of us with common sense know exactly what is happening. The recent ASTRO panel even acknowledged the job market woes and how the RRC has been rubber-stamping too many programs to open to quickly, hurting the specialty by flooding too many grads into the market, even if you chose to ignore that in your post. The abr fiasco is small potatoes compared to real issues that plague this field.
And while you choose to give a free pass to RW and his ridiculous comments regarding our salary, not sure you can choose to ignore what hallahan said as to why he expanded spots in response to Chirag Shah's editorial.
How about you graduate, get board certified, and find a non-exploitative job in a decent locale and then get back to us about how well folks should sleep at night. Maybe you're thrilled to practice in Quincy, ill or Casper, wy. Not everyone is
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Agree with most of your points, with a couple exceptions:
- In our urorads-dominated market, being able to offer SBRT (they don't have the physics support, technology, desire, or business plan to be able to) has allowed us to claw some patients back from them, and the trend is continuing upwards.
- Oligomets has become a big part of my practice, certainly > 5-10% when it comes to billing. It's why I'll be here from 6:45 am until 6:45 pm today.
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I agree with all of this. At its core, our specialty is one of the best in medicine. You get to work the dermatology hours and earn a great living while curing cancer, palliating symptoms, and working in an interdisciplinary team. No one can take that away. You can argue over the exact $$ amount you earn but ultimately time is more valuable than money and in rad onc you don’t have to hand over your life in exchange for your career.
There is reason for concern with the expansion in residency spots, and SDN is the sole reason people are even talking about this issue out in the real world. If geographic location down to the city or state is really important to you, then rad onc is and always has been a risky choice because we’re so small.
You have to balance geographic preference with what you actually enjoy doing, and IMO picking a specialty you’re not into because it would allow you to live in NYC is way riskier than going with the specialty you love and gambling about whether a job in your city will be available. For me, I could never imaging being a med onc, PCP, or dermatologist and enjoying what I do. That’s why I went into rad onc and over the course of residency I’ve made connections with practices in the states I’d be interested in living in. My first job my not be in the city I really wanted but many people switch jobs after a few years. If you do a specialty you don’t like, your first job may be in your preferred city but you’re stuck doing work you don’t love for the rest of your life. For me that’s a big risk and wasn’t worth it.
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Ehhh... no way rad oncs work derm hours (or get equiv $/hr, whichever metric). Once you factor in their more substantial time off (not only days worked/week but also more vacation time)... fake news! IMHO of course.
Attacking what someone says or does = fair game. Attacking who someone is = unprofessional. Unless you know someone personally and they have confessed their nefarious plot to you like a James Bond villain, assume that people are acting in good faith... except for politicians.
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I don’t think linking to one 100% mohs job tells us anything about derm work hours. The vast majority of dermatologists aren’t mohs surgeons. I can’t imagine the average derm job is substantially different hours than a rad onc.
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Ah, imagination. (You brought up derm not me.) Is there a rad onc Fermi paradox? Where are the 2-3 days/week $350K-plus jobs? Where are the 10-week vacation jobs like in radiology? Do aliens exist? Hours/day? Similar (except the rad onc can't run out for a 2 hour doctor's appt, usually, in reality, e.g.). Hours/career lifetime? Dissimilar.
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Derms don't do as much hospital work/consults from what I can tell and definitely don't have to babysit a linac 5 days a week.
I work longer hours than most of the pp derms that I know
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It’s fun to read the derm forum. Gives perspective
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Yeah the number of clinic patients derm see is crazy in my book. I think med onc clinics are busy - could never cut-it having 6 minutes with each patient going back-to-back-to-back ad infinitum for the whole day.
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I think that is absolutely true. Rad onc is kinda like baseball for the MD. Long periods of inactivity interspersed w/ activity lol. But I digress. @Kruk's point ("You get to work the dermatology hours") was about hours worked. Not difficulty or calories expended per hour etc. I riffed on his point to think about not just hours per day but hours per year.
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Yup, definite plus to this field is the quality over quantity of the patient interactions
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That seems a bit excessive
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That seems a bit excessive
I kinda disagree. I think that's arguably one of the most important diagnoses to have a longer than normal consult. Normal consults being 60 minutes at my institution.
Imagine a low/low-intermediate risk prostate cancer. You have to discuss with them - AS, Surgery, RT (Brachy mono vs EBRT convential frac vs EBRT hypofrac vs SBRT) and the competing toxicities (and incidences) of all 3. Prostate cancer patients with low risk disease are some of the most well read patients as well and you may have to discuss role of hormonal therapy, chances of recurrence with all modalities, etc. The true power of shared decision making is in full force in a good prostate cancer consult.
It's not nearly as simple as like 75% of what we do, where we tell the patient "this is the best thing for you, here's why, here's what the toxicities are but it doesn't really matter b/c this is what we're going to recommend for you".
Similarly, seeing a 40 year old needing WBI is a shorter consult than seeing the 75 year old and having to discuss pros/cons of WBI vs observation and the nuances necessary for shared decision making. More options for the patient = more time scheduled for a consultation.
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I am encouraged that at least the issue of overexpansion is being recognized, but I am very doubtful it will be sufficiently addressed (cutting back spots to 100-120 or something like that- I just dont see how that can collectively be done) and even so, the waters have been poisoned for 10-15 years minimum as Michael Steinberg said at ASTRO. Lets remember the single most important factor for selecting a job is geography to most residents last year not salary and this is not going to be fixed anytime within the present generation. (I am not sure Ralph gets the geography part)
https://www.merritthawkins.com/uplo..._Final_Year_Medical_Residents_Survey_2019.pdf
https://www.merritthawkins.com/uplo..._Final_Year_Medical_Residents_Survey_2019.pdf
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If during the first 2 years of medschool , you cant see yourself being surgeon/surgical specialty im/imspecialtty diagnostic/path/raddiology and possibly anesthesia, there is probrably something wrong with you . None of use were born to be radoncs and it is totally weird to say you couldnt be dooing something else and enjoying it.
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True. Every prostate cancer consult of mine in a nutshell...
Hi, nice to meet you! Over 13 billion years ago the entire universe came into being in a moment known as the Big Bang. It was intensely hot and compact but began expanding rapidly. Within a picosecond after that, the fundamental forces of the universe--gravity, strong, weak, and electromagnetic--had broken apart and photons had formed. (and then blah blah blah rectal blah urinary blah erections blah local control blah hot flashes yada yada)... Thus in summary Neville Chamberlain and appeasement don't necessarily go hand-in-hand, the economic transition of Israel from socialism to a more capitalistic economy has been a success, and Lady Gaga is the greatest artist of her generation. Now, given all this, which seems right for you? Surgery or that other stuff?
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my experience, approach, and training in Radiation Oncology is so much more like Evil's than yours.
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I want to say he's kidding, but sometimes with the scarb ya just don't know
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In fairness - I thought I would go into IM and end up in Cards/GI when I was in the first 2 years of med school. This was after exposure to Rad Onc.
Then I rotated through IM as a 3rd year medical student, realized I would have to do 3 years of caring about CHF and COPD and DM and all those other IM things and noped the hell on out of there. It was a process of elimination for me in regards to what I ended up in.
In regards to the bolded - I really don't think I would enjoy anything else in medicine nearly as much as I enjoy the day-to-day of Rad Onc. Heme-onc is just IM for a cancer patient. I was never going to be a surgeon. Radiology is not enough longitudinal patient contact.
I'm cognizant that others may feel how you feel, Ricky, but there are some (likely a low percentage of the current population) that maybe wouldn't be happy doing something else.
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Being tongue in cheek as I am oft wont to do, I couldn't help but think that we all like to think "I had a completely thorough discussion with the prostate cancer patient." As in, "I have optimized my discussion with the prostate patient covering all possible forms of treatment, side effects, etc." See also: when the dosimetrist tells you the plan is as good as it's gonna get. Reminds me of Webb:
What do we really mean by optimization? Something that is optimum cannot be bettered by definition. Therefore the optimum plan is the best that could ever be obtained for treating a particular patient with a particular external shape, location of disease and arrangement of internal organs. I propose the view that this optimum plan is unachievable and that in practice this does not matter. To arrive at the optimum plan one would have to investigate the use of: (i) all types of irradiation (protons, carbon ions, photons…); (ii) of all energies (continuous not just those we have available); (iii) all possible numbers of beams from 1 to infinity; (iv) all possible ranges of fluence levels; (v) all possible beam geometry shapes; (vi) all possible fractionation schemes …and so on. It is totally apparent that as ‘‘optimizers’’ we cannot and do not do this. We are constrained by: (i) the beams available on our machines; (ii) the need to keep the number of beams deliverable within some specified delivery timeslot; (iii) the delivery mechanics available to us (which links in to the fluence level issue); (iv) the collimation available from the machine; (v) the need to treat in the daytime not at night; (vi) the time available for planning…and so on.
From one viewpoint a 90 minute consult slot is not enough time for a prostate cancer patient. Or maybe a 10 minute consult slot can be. Depends on how much info you want to download and your own personal biases as the treating physician.
