More and more programs using SOAP to fill

[Radonc90]

It means we are going to SOAP. Otherwise, the institution will flag us as an incomplete residency program, Chair will be questioned and some resources may be pulled from us

@seper is correct bc the sponsoring institution and/or Dean will ask.
Good chairs are those who discuss this issue at SCAROP level to contract program resident quota.
Then convince Dean (does not have to be the main Dean but GME Associate Dean) to reduce program quota.
On the long run, this should be done bc it locks the program into a quota.

All, we need is roughly 80-90 training spots for the whole country, which is 50% of the current number!

There are some 180 PGY-5's coming out this year.

As someone posted recently, the 1990's estimate (probably still true today, but I may be wrong...) showed
that you need 1 radonc per 100K-120K population to have about 250 consults/year.

Considering US population is 328M, you can tell that all we need is some 3,300-3,500 radoncs.
We are way above that figure in 2021.

This is the time for ALL Chairs to get together and have a concerted effort to shrink program quota.
Yes, it is legal to shrink program size, as much as it is legal to increase program quota.
It is a little too late though...

---

Members don't see this ad.

 

[taserlaser]

When Canada decreased residency slots they also ’forbade’ round to matching, or the equivalent of the SOAP, as well as transfers from other specialties. Round one match or nothing.

 

[Radonc90]

Canada in recent years has about 8-9 spots (from the usual 20 spots/yr).
Canada has 1/10 of US population, so you can see that the US only needs some 80-90 PGY-5's/year.

 

[Radonc90]

UNC did not match.
Interesting, it is such a good program...
I wonder what is going on...

---

 

[w00tz]

View attachment 332590

The future of the field, folks.

AHAHAH. Reading all the med students' comments on the spreadsheet gives me anti-vaxxer Facebook group vibes. Anti-evidence, lots of delusions, and anyone not apart of their echo chamber is a troll.

 

[Mandelin Rain]

They're excited. Let them be excited. I was. You were. It's a great feeling, regardless of what it might look like in 5 years.

Maybe they sober up during intern year when they realize some cruel realities and find an exit strategy.

Everyone remember, "It doesn't love you back."

 

[metview]

UNC did not match.
Interesting, it is such a good program...
I wonder what is going on...

---

What's going on is that quality of applicants have plummeted, especially the mid 50% (25%-75%), knowing this, some programs like LIJ, TJU, NY Presby, Baylor are lowering their standards, while reputable programs like UNC, UF, Vandy are not and are going unfilled. It's the former programs that are the problem children and need to be shut down. They are horrible programs with more faculty than residents, poor teaching, or malignant work environment.

 

[thecarbonionangle]

The programs lowering standards and matching any warm bodies clearly do not five a F about their graduates or anything regarding the field beyond having SOMEONE to do scut and write notes. Take note of the faculty in these burning manure hellpit places who are involved in these decisions. They do not care. The calculus was “we just need to match” and most warm bodies were ranked. So the question is what will the field do regarding these places? They are a huge problem. The field is either going to extirpate the cancer, or sink with it.

places like UNC or Emory being on SOAP is a completely different explanation than any hellpit place in my list who “matched”

 

[RickyScott]

The programs lowering standards and matching any warm bodies clearly do not five a F about their graduates or anything regarding the field beyond having SOMEONE to do scut and write notes. Take note of the faculty in these burning manure hellpit places who are involved in these decisions. They do not care. The calculus was “we just need to match” and most warm bodies were ranked. So the question is what will the field do regarding these places? They are a huge problem. The field is either going to extirpate the cancer, or sink with it.

Incoming ASTRO president chairs one such program that is so bad, still does not match even with 0 standards. Rumor has it is that her residency program is a front for a moonshine operation.

 

[thecarbonionangle]

Incoming ASTRO president chairs one such program that is so bad, that with 0 standards still does not match. Rumor has it is that her residency program is a front for a moonshine operation.

I’ll look for their episode at the next moonshiner marathon. Hmmmmm apple pie moonshine ! Now we talking my language!

 

[Neuronix]

I'm curious how many of the positions will truly go unfilled. We will have some sense of this after SOAP.

Programs that don't use SOAP or fail to SOAP can still fill those positions outside the match. They can also put a foreign trained fellow on a path to board certification totally outside the match, but that essentially fills a resident position. The only way to find out the number of these positions filled outside the match is to contact the programs directly, though I doubt they're talking. At some point we should be able to see the number of positions filled through the match and cross reference that to current number of residents.

I'm very concerned that many of the 35-40 non-filled positions will still SOAP or fill outside the match. Thus, we will still end up with 170-180 residents this year, and possibly more, which does nothing to address the oversupply problem. As long as there are jobs anywhere at any rate people will still take these positions. There are a lot of desperate medical students out there from within the US or from other countries (e.g. US Caribbean grads) with hundreds of thousands in debt to pay who will take a chance at anything.

I'm a bit of a fatalist like KO. Nobody will agree to fix this problem, and there is no will to fix this from leadership. I am an academic, and I have met with numerous academics over Zoom/Teams over the past year who refuse to contract but put it in diplomatic terms like "We won't SOAP but we won't contract and deny a position from someone who wants to train with us" or "we're holding a spot back from this year's match" with no guarantee that they won't just open up another spot next year. There's plenty of talk about how applicants now are more diverse, care more about cancer patients, etc nowadays.

Good luck everyone. I'll be up here rearranging deck chairs with you all. At least current med students can't say that we didn't warn them.

 

[fiji128]

I'm curious how many of the positions will truly go unfilled. We will have some sense of this after SOAP.

Programs that don't use SOAP or fail to SOAP can still fill those positions outside the match. They can also put a foreign trained fellow on a path to board certification totally outside the match, but that essentially fills a resident position. The only way to find out the number of these positions filled outside the match is to contact the programs directly, though I doubt they're talking. At some point we should be able to see the number of positions filled through the match and cross reference that to current number of residents.

I'm very concerned that many of the 35-40 non-filled positions will still SOAP or fill outside the match. Thus, we will still end up with 170-180 residents this year, and possibly more, which does nothing to address the oversupply problem. As long as there are jobs anywhere at any rate people will still take these positions. There are a lot of desperate medical students out there from within the US or from other countries (e.g. US Caribbean grads) with hundreds of thousands in debt to pay who will take a chance at anything.

I'm a bit of a fatalist like KO. Nobody will agree to fix this problem, and there is no will to fix this from leadership. I am an academic, and I have met with numerous academics over Zoom/Teams over the past year who refuse to contract but put it in diplomatic terms like "We won't SOAP but we won't contract and deny a position from someone who wants to train with us" or "we're holding a spot back from this year's match" with no guarantee that they won't just open up another spot next year. There's plenty of talk about how applicants now are more diverse, care more about cancer patients, etc nowadays.

Good luck everyone. I'll be up here rearranging deck chairs with you all. At least current med students can't say that we didn't warn them.

This is why I went through the trouble of recording and posting all the official resident positions for each program for 2019 and 2021. Plenty of places saying they won't soap but how many are actually willing to permanently decrease resident compliment? Apparently only the programs that are actually fully closed. That's the true reality at the end of day. In no universe dose rad onc need to be churning out 170 or 180 residents per year but every chair thinks like Randall and that their program is awesome and is not part of the problem.

 

[domestique]

It means we are going to SOAP. Otherwise, the institution will flag us as an incomplete residency program, Chair will be questioned and some resources may be pulled from us

your chair should maybe grow the **** up and give the dean or whomever he/she answers to some ******* context.

 

[seper]

your chair should maybe grow the **** up and give the dean or whomever he/she answers to some ******* context.

Right. But then the institution will wind down the residency program. Chair will go down a tier in the hierarchy. There are probably financial ramifications for Chair. Also, our program director will lose 20% of his pay which is his "residency stipend".

 

[medgator]

Right. But then the institution will wind down the residency program. Chair will go down a tier in the hierarchy. There are probably financial ramifications for Chair. Also, our program director will lose 20% of his pay which is his "residency stipend".

An anonymous name and shame would go a long way here

 

[thecarbonionangle]

Right. But then the institution will wind down the residency program. Chair will go down a tier in the hierarchy. There are probably financial ramifications for Chair. Also, our program director will lose 20% of his pay which is his "residency stipend".

BINGO. These are the incentives of why they look the other way in hellpit places. Some will take pay cuts and loss of standing. If you are there to “teach” even if many never bother at hellpit places, and there is nobody there to be “taught” then maybe you shouldn’t be employed is what some worry about

 

[ramsesthenice]

Right. But then the institution will wind down the residency program. Chair will go down a tier in the hierarchy. There are probably financial ramifications for Chair. Also, our program director will lose 20% of his pay which is his "residency stipend".

This is the unfortunate reality. Medical education is not and never has been an altruistic endeavor. As long as there are 180 GME approved spots, there will be near that many residents. There may be a few programs that are able to hold out but even at places like UNC, which I believe are sincere, you think the dean would let them go 50% unfilled next year too without question? Or the year after that?

 

[seper]

This is the unfortunate reality. Medical education is not and never has been an altruistic endeavor. As long as there are 180 GME approved spots, there will be near that many residents. There may be a few programs that are able to hold out but even at places like UNC, which I believe are sincere, you think the dean would let them go 50% unfilled next year too without question? Or the year after that?

I teach for free and residents indeed "slow me down". However, you are 100% right that eductaion of RadOnc residents is a business.

 

[medgator]

I teach for free and residents indeed "slow me down". However, you are 100% right that eductaion of RadOnc residents is a business.

They're about to slow you down a lot more...

 

[FrostyHammer]

I'm curious how many of the positions will truly go unfilled. We will have some sense of this after SOAP.

Programs that don't use SOAP or fail to SOAP can still fill those positions outside the match. They can also put a foreign trained fellow on a path to board certification totally outside the match, but that essentially fills a resident position. The only way to find out the number of these positions filled outside the match is to contact the programs directly, though I doubt they're talking. At some point we should be able to see the number of positions filled through the match and cross reference that to current number of residents.

I'm very concerned that many of the 35-40 non-filled positions will still SOAP or fill outside the match. Thus, we will still end up with 170-180 residents this year, and possibly more, which does nothing to address the oversupply problem. As long as there are jobs anywhere at any rate people will still take these positions. There are a lot of desperate medical students out there from within the US or from other countries (e.g. US Caribbean grads) with hundreds of thousands in debt to pay who will take a chance at anything.

I'm a bit of a fatalist like KO. Nobody will agree to fix this problem, and there is no will to fix this from leadership. I am an academic, and I have met with numerous academics over Zoom/Teams over the past year who refuse to contract but put it in diplomatic terms like "We won't SOAP but we won't contract and deny a position from someone who wants to train with us" or "we're holding a spot back from this year's match" with no guarantee that they won't just open up another spot next year. There's plenty of talk about how applicants now are more diverse, care more about cancer patients, etc nowadays.

Good luck everyone. I'll be up here rearranging deck chairs with you all. At least current med students can't say that we didn't warn them.

This is why we need to have a singular organization fixing/setting the number of radonc residency slots, not greedy chairs applying for expansion anytime it tickles their fancy. Problem is that ASTRO has shown itself to not care about radoncs or the field, and this type of experiment has failed a million times with the US government being able to negotiate drug prices. People like KHE88 call that type of thought "socialist", and yet here we are at the very unique point of $200 billion a year in cancer care costs (and rapidly rising)...

 

[2021Doctor]

2019: 183 residents filled in match +15 residents added in SOAP + X residents added postmatch = 198+ residents
2020: 156 residents filled in match + 27 residents added in SOAP + X residents added postmatch = 183+ residents
2021: X residents filled in match + Y residents added in SOAP + Z residents added postmatch = + residents

Residency Data & Reports

The latest Match results and data for the Main Residency Match.

www.nrmp.org

Total Number of Radiation Oncology Residents
2001-2002: 468
2002-2003: 507
2003-2004: 518
2004-2005: 534
2005-2006: 540
2006-2007: 565
2007-2008: 589
2008-2009: 595
2009-2010: 615
2010-2011: 612
2011-2012: 666
2012-2013: 676
2013-2014: 705
2014-2015: 721
2015-2016: 733
2016-2017: 749
2017-2018: 767
2018-2019: 774
2019-2020: 771
2020-2021: 783
ACGME - Accreditation Data System (ADS)

 

[Chartreuse Wombat]

2019: 183 residents filled in match +15 residents added in SOAP + X residents added postmatch = 198+ residents
2020: 156 residents filled in match + 27 residents added in SOAP + X residents added postmatch = 183+ residents
2021: 153 residents filled in match + X residents added in SOAP + Y residents added postmatch = 153+ residents

Residency Data & Reports

The latest Match results and data for the Main Residency Match.

www.nrmp.org

Total Number of Radiation Oncology Residents
2001-2002: 468
2002-2003: 507
2003-2004: 518
2004-2005: 534
2005-2006: 540
2006-2007: 565
2007-2008: 589
2008-2009: 595
2009-2010: 615
2010-2011: 612
2011-2012: 666
2012-2013: 676
2013-2014: 705
2014-2015: 721
2015-2016: 733
2016-2017: 749
2017-2018: 767
2018-2019: 774
2019-2020: 771
2020-2021: 783
ACGME - Accreditation Data System (ADS)

Employers and membership organizations are excited by this growth. Low salaries and lots of dues in the future...

 

[RickyScott]

As long as people think this is a good idea

View attachment 332607

we will match. There are plenty of people with highly questionable judgement.

What is that?

 

[thecarbonionangle]

it is a sad day in our specialty when good programs are going unmatched and doing the right thing and not filling while hellpits soap or “filled” with any warm body they found. this cannot be good for our field. If you thought we got little respect as a field, wait until we are perceived as lowest of the lowest tier applicants.

the devil’s advocate counterargument is that all these md phds, pedigree, high step people did nothing for the field but give us less radiation, hypofractionation, lowest hanging fruit stuff and also got us nowhere!

where to go now? Nobody seems to know! What we do know for certain is breadlines are coming. I am aggressively preparing for this.

 

[ramsesthenice]

What is that?

That my friend, is an unfortunate product called a Perfect Brownie Pan which allows you to bake a batch of brownies without any middle pieces. Why would anyone ever want to do that? I personally hope the FBI and homeland security compiled a list of people who actually bought one because they are clearly not right in the head.

 

[DireMoose]

it is a sad day in our specialty when good programs are going unmatched and doing the right thing and not filling while hellpits soap or “filled” with any warm body they found. this cannot be good for our field. If you thought we got little respect as a field, wait until we are perceived as lowest of the lowest tier applicants.

Does this lead to even more polarization of residency programs' perceived quality? Those that held to their standards vs those who clearly took warm bodies. Agree that breadlines are coming for all, but for the few positions available down the line, might make an easier time for employers to set the floor at "UNC/Emory/Vandy" (if they truly don't SOAP or add outside the match). At least you are selecting from an already decent pool of (many dozens) of applicants for your (one) open job.

 

[thecarbonionangle]

I think for like competitive years graduates, even if hell pit you are going to be getting a good medical student, likely 240+, etc etc. once BC it will not matter. However, moving forward when quality is clearly dropping, it will be difficult for all, regardless.

 

[2021Doctor]

Does this lead to even more polarization of residency programs' perceived quality? Those that held to their standards vs those who clearly took warm bodies. Agree that breadlines are coming for all, but for the few positions available down the line, might make an easier time for employers to set the floor at "UNC/Emory/Vandy" (if they truly don't SOAP or add outside the match). At least you are selecting from an already decent pool of (many dozens) of applicants for your (one) open job.

Employers will likely base their decisions on who will work for less money, not on quality of program. The proliferation of NPs and PAs in hospitals and emergency rooms across the country is due to $$$$ considerations.

 

[thecarbonionangle]

It is a race to the bottom because of oversupply, unfortunately. If people are desperate enough they will take a major metro salary for a job in “middle of nowhere”.

 

[metallica81788]

I foresee many 2 day per week jobs making ~150k for machine coverage, if that's even a thing anymore. At least to oversee our high dose all 5fx regimens.

Real question is will the hospitals prefer that to one RadOnc that could reasonably handle all that alone? Guess whatever is cheaper.

 

[RickyScott]

It is a race to the bottom because of oversupply, unfortunately. If people are desperate enough they will take a major metro salary for a job in “middle of nowhere”.

Jobs with the worst of all worlds: major metro salaries in middle of nowhere fill last and have the highest turnover. This prompts the likes of “subatomic doc”on twitter to declare that radonc has a maldistribution problem!

 

[ramsesthenice]

Does this lead to even more polarization of residency programs' perceived quality? Those that held to their standards vs those who clearly took warm bodies. Agree that breadlines are coming for all, but for the few positions available down the line, might make an easier time for employers to set the floor at "UNC/Emory/Vandy" (if they truly don't SOAP or add outside the match). At least you are selecting from an already decent pool of (many dozens) of applicants for your (one) open job.

What you are saying makes sense but honestly I doubt it. Over supply is already here and I don't see anything happening with the match really changing many peoples perceptions of specific programs. I see the global "competence is assumed" being eroded more than anything.

 

[RadsRocks!]

I foresee many 2 day per week jobs making ~150k for machine coverage, if that's even a thing anymore. At least to oversee our high dose all 5fx regimens.

Real question is will the hospitals prefer that to one RadOnc that could reasonably handle all that alone? Guess whatever is cheaper.

150k for 2 days of workdays sounds kind of tempting... You could be upper middle class and always have a mini vacation every week if the days are consecutive.

 

[elementaryschooleconomics]

150k for 2 days of workdays sounds kind of tempting... You could be upper middle class and always have a mini vacation every week if the days are consecutive.

5 years of residency after 4 years of med school and several hundred thousand dollars in debt for a 2 day a week/$150k job? Hard pass, that ain't gonna cover loan payments and a mortgage son.

 

[ramsesthenice]

5 years of residency after 4 years of med school and several hundred thousand dollars in debt for a 2 day a week/$150k job? Hard pass, that ain't gonna cover loan payments and a mortgage son.

No, but once you get all that paid off and get some monies put away it can be a bit more tempting. You know, when you have one of those days and you feel like going full Half-Baked on your boss?

 

[elementaryschooleconomics]

No, but once you get all that paid off and get some monies put away it can be a bit more tempting. You know, when you have one of those days and you feel like going full Half-Baked on your boss?

Oh yeah, definitely, 150k/2 days a week sounds good EVENTUALLY, but not if it's a geographically constrained option for a new grad.

Unless their family is wealthy, or their spouse has a great income, or they want to live in a studio apartment in Nebraska.

 

[RadsRocks!]

Sounds perfect for someone with young kids or who wants to work part time.

 

[hal9k]

It is a race to the bottom because of oversupply, unfortunately. If people are desperate enough they will take a major metro salary for a job in “middle of nowhere”.

doubt so..would rather just do some small business medically related to be honest. can always work for large pharm companies/consulting companies

 

[hal9k]

Sounds perfect for someone with young kids or who wants to work part time.

the thing is..that kind of job is not gonna be in desirable locations..spouse may not be willing to relocate with you

 

[radonc17]

150k for 2 days of workdays sounds kind of tempting... You could be upper middle class and always have a mini vacation every week if the days are consecutive.

Do you think vacations are free?

With that many off days, you will spend more money

If earning less money to begin with, then what....


Okay lets account for child care

Excellent child-care in chicago for 1 child is ~2,200 per month x 12 months = 26,400

You could work for 5 days and make 300,000++


In short, taking this job would be a financial disaster

 

[thecarbonionangle]

doubt so..would rather just do some small business medically related to be honest. can always work for large pharm companies/consulting companies

Ok “small business”. Sounds good. Which one? With what capital? Unless you come from a wealthy family. A loan you say? What if you got no job?

there are posters here who have posted their experiences with consulting and industry and Most people don’t make that much money.

if a “middle of nowhere job” offers you 250-300 and that is what everyone is making, what RW calls “good living” or Dennis Hallahan’s wet dream, then most people are going to have a hard time matching that with “consulting”

 

[hal9k]

Ok “small business”. Sounds good. Which one? With what capital? Unless you come from a wealthy family. A loan you say? What if you got no job?

there are posters here who have posted their experiences with consulting and industry and Most people don’t make that much money.

if a “middle of nowhere job” offers you 250-300 and that is what everyone is making, what RW calls “good living” or Dennis Hallahan’s wet dream, then most people are going to have a hard time matching that with “consulting”

can always switch to other specialties like derm (3 more years) or rad (4 more)? I am just trying to brainstorm what can rad onc grads do if job market continues to worsen

 

[RadOncDoc21]

can always switch to other specialties like derm (3 more years) or rad (4 more)? I am just trying to brainstorm what can rad onc grads do if job market continues to worsen

Too bad those specialties remained competitive. They prob look at rad oncs like how we would a nuc med residency.

 

[thecarbonionangle]

can always switch to other specialties like derm (3 more years) or rad (4 more)? I am just trying to brainstorm what can rad onc grads do if job market continues to worsen

Ya that is doable if your SO has a decent job or is ok with the significant paycut to do more training. Female docs already delay kids more and more. Males also delay starting a family. It is doable but hard, especially once you got kids, a house with a morgage, etc.

ABR palliative care would be less time, could open up a clinic to supplement income. Some rad oncs have already tapped into medical MJ market

 

[hal9k]

Too bad those specialties remained competitive. They prob look at rad oncs like how we would a nuc med residency.

but most rad onc residents had 250+ step 1, multiple pubs and AOA?

 

[radonc17]

can always switch to other specialties like derm (3 more years) or rad (4 more)? I am just trying to brainstorm what can rad onc grads do if job market continues to worsen

Please correct me if I’m wrong, but I believe you have a finite amount of govt funding associated with residency spot

So if I match into a Govt funded RO spot, then I’m given 5 years

after that no salary associated OR have to find self funded spot

 

[hal9k]

Please correct me if I’m wrong, but I believe you have a finite amount of govt funding associated with residency spot

So if I match into a Govt funded RO spot, then I’m given 5 years

after that no salary associated OR have to find self funded spot

dont know how this works but I saw at least 2 residents from other specialties re-matched to rad onc after completing their initial residency and got paid..I am actually seriously thinking about switching...after all, my resume is still competitive

 

[radOresident]

Do you think vacations are free?

With that many off days, you will spend more money

If earning less money to begin with, then what....


Okay lets account for child care

Excellent child-care in chicago for 1 child is ~2,200 per month x 12 months = 26,400

You could work for 5 days and make 300,000++


In short, taking this job would be a financial disaster

i mean you do realize there are a lot of families that make <$150k a year with two full time working parents... not saying that I'd want to do this hypothetical job, but come on. $150k ain't in the poor house

 

[Gfunk6]

You guys are all overlooking an easy solution to the resident oversupply problem. MDACC, MSKCC, et. al. keep expanding and buying out community practices all around the country. We all get to bill 10x more for the exact same services and everyone makes $500k+ as faculty.

Win, win!

 

[RadOncDoc21]

Well anybody with a competitive application that can match into derm or radiology who chooses rad onc today I’ll tell them this: