More and more programs using SOAP to fill

[hal9k]

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

LOL...not today I agree but what about those who matched during peak years? 3 more years is probably worth it if the job market continues to worsen

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Members don't see this ad.

 

[radonc17]

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

i didn’t say it’s a poor hosue

I said financially it’s a disaster

it’s a disaster because you are giving up $150,000 potential income based on average starting salaries in Chicago

for relative savings of 24,000 childcare from staying at home

 

[medgator]

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

Govt/CMS froze residency funding in 1997 iirc, most if not all of these "expansion" spots were likely dept or hospital funded i am guessing

 

[radonc17]

Govt/CMS froze residency funding in 1997 iirc, most if not all of these "expansion" spots were likely dept or hospital funded i am guessing

the problem is we don’t know when we match

Can hospital transfer funding between programs?

for example if a funded IM spot is cut then could they give funding to radonc?

I believe This was one of the issues for some residents when they were looking for spots after their program shut down

 

[Radonc90]

Re program contracting in size...

The answer is yes, they can do it.
All they have to do is look back what they had in 1990s and retrace their steps.
Everyone still has a job in the dept.
Program contraction does not mean it is bad.

Let's say a program had 6 spots in 1990s and expanded to the current quota = 8.
They can always go back to 6.
The sponsoring institution just re-allocates the 2 positions to other specialties such as IntMed (there are plenty of them) etc.

The job of the Chairs and PDs is to advise the GME office what is proper for the specialty on the long run.
Many specialties went through this in the past: Anesth, Pathology etc.
All the Chairs need to do is to be honest with GME Dean with the current data...

Another approach is do nothing and let the medstudents decide, which is happening as we speak.
You watch my words after this Friday, a lot of these places will say one thing but will do another thing:
- Fill with SOAP
- Fill outside of SOAP

This is academic and rural hosp CEOs' dream: plenty of cheap talents (highly trained)...

 

[hal9k]

Re program contracting in size...

The answer is yes, they can do it.
All they have to do is look back what they had in 1990s and retrace their steps.
Everyone still has a job in the dept.
Program contraction does not mean it is bad.

Let's say a program had 6 spots in 1990s and expanded to the current quota = 8.
They can always go back to 6.
The sponsoring institution just re-allocates the 2 positions to other specialties such as IntMed (there are plenty of them) etc.

The job of the Chairs and PDs is to advise the GME office what is proper for the specialty on the long run.
Many specialties went through this in the past: Anesth, Pathology etc.
All the Chairs need to do is to be honest with GME Dean with the current data...

Another approach is do nothing and let the medstudents decide, which is happening as we speak.
You watch my words after this Friday, a lot of these places will say one thing but will do another thing:
- Fill with SOAP
- Fill outside of SOAP

This is academic and rural hosp CEOs' dream: plenty of cheap talents (highly trained)...

after a while, it wont be talents...ppl will self select..no capable person will sign up for unemployment after 5 years' training..also TBH, rural hospitals don't have that many openings due to small population

 

[Med Director New England]

Rad Onc is joining Path at the bottom of the medical specialty hierarchy. All chairs think their program is great and nothing will change except the quality of applicants they can attract.

Mid career pathologist here

I have interest in this thread and similar ones b/c I think the same thing is happening in path. Overtraining relative to demand for pathologists.

funny the academics in path say the exact same things you guys are saying here. The job market concern is a myth, Complaining on SDN is the reason US grads have lost interest etc. Path grads now do on average 2 fellowships when 1 was the norm 15 years ago and no fellowships was typical 30 yrs ago

I think your field is so much smaller than path that overtraining will become painfully obvious very soon.

keep speaking up - and good luck.

 

[thecarbonionangle]

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!

And every one of your breast tangents is “approved” by Ben Smith. Win win!

 

[elementaryschooleconomics]

And every one of your breast tangents is “approved” by Ben Smith. Win win!

"Dr @thecarbonionangle, I noted that you only had 1.9cm of flash on your latest case. This is unacceptable and dangerous. We are sending you back to PGY5 for remediation. Please acknowledge this email." - dystopian Ben Smith email, circa 2033

 

[medgator]

And every one of your breast tangents is “approved” by Ben Smith. Win win!

Just follow the cook book!

 

[thecarbonionangle]

If you fail the ben smith “review” you will be notified that your patient is being moved to a “center of excellence” closer to mothership. Sorry you ain’t safe to treat breast cancer. Needs to go somewhere where people can intelligently decide between 15 and 16 fx

 

[Gfunk6]

And every one of your breast tangents is “approved” by Ben Smith. Win win!

What an absurd statement. Treating breast cancer with tangents is so 1970. All such patients would go back to the MDACC mothership for intensity-modulated proton therapy. As we know, all community doctors (including those trained by MDACC) are utterly incapable of sub-specialty radiation treatments.

 

[Radonc90]

Someone is getting serious...
What to do when the Chair is breathing down the PD's neck?

---

 

[ramsesthenice]

What an absurd statement. Treating breast cancer with tangents is so 1970. All such patients would go back to the MDACC mothership for intensity-modulated proton therapy. As we know, all community doctors (including those trained by MDACC) are utterly incapable of sub-specialty radiation treatments.

Don’t exaggerate G funk. At least 20-30 of them will be needed as controls for a randomized phase 2 at some point.

 

[Radonc90]

I am thinking about starting a Biryani fellowship...
(non-accredited fellowship...)

---

 

[GapCalc]

Someone is getting serious...
What to do when the Chair is breathing down the PD's neck?

---

What about their poorly considered prior legal arguments about antiturst???
Was that all nonsense?
Have we been bamboozled by our 'leadership'?!?

 

[thecarbonionangle]

What an absurd statement. Treating breast cancer with tangents is so 1970. All such patients would go back to the MDACC mothership for intensity-modulated proton therapy. As we know, all community doctors (including those trained by MDACC) are utterly incapable of sub-specialty radiation treatments.

“I only treat left breast APBI with MFO IMPT. Consider a carbon ion boost angle. Anything else is a sin”

 

[TheWallnerus]

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!

This is the ONLY way oversupply, and falling RO demand, haven't combined to explode violently in rad onc's face. (And it's been the way that rad onc keeps "packin' em in"/avoiding total employment collapse... >50% of all rad oncs now in "academics"). Thanks to this, it's been much more of a slow, smoldering burn.

What about their poorly considered prior legal arguments about antiturst???
Was that all nonsense?
Have we been bamboozled by our 'leadership'?!?

Nah, don't go crazy. Still no "legal" method to dial back spots. (Everyone who is, is just breaking the law?)

Just follow the cook book!

@Gfunk6

 

[Mandelin Rain]

If rad onc pre-2019 was a bubble, are all the people matching after 2019 bag holders?

Feels like it.

 

[Mandelin Rain]

Where are we?

 

[Mandelin Rain]

Bubble? Just this summer KO was on a panel (with that tool from SERMO) where they said that radonc has a wonderful future and no one should worry about jobs.

The cat changes his mind like the weather. Whichever way the prevailing Twitter wind is blowing is what KO thinks.

 

[thecarbonionangle]

If rad onc pre-2019 was a bubble, are all the people matching after 2019 bag holders?

Feels like it.

In the end, someone is always left holding the bags. It is our turn now.

 

[evilbooyaa]

the problem is we don’t know when we match

Can hospital transfer funding between programs?

for example if a funded IM spot is cut then could they give funding to radonc?

I believe This was one of the issues for some residents when they were looking for spots after their program shut down

This is something that programs consider and a question a prospective applicant could ask. The issue is not that none of the money comes, but it ends up being about 50% of what a resident would have normally received (I forget if it's DME or IME that is cut-off for somebody pursuing re-training).

I think if you were competitive otherwise, this would put you at a slight advantage compared ot other applicants, all things else being equal, but this on it's own likely isn't enough to make a re-training applicant go unmatched. At least I think. Places that self-fund spots this is a non-issue, and larger places that can subsidize the resident salary, this is also a non-issue. Would be more of an issue for smaller places that have medicare funded spots.

 

[fiji128]

View attachment 332722
Where are we?

Somewhere between the Denial and maybe Fear stages. Definitely haven't hit Capitulation yet.

 

[Mandelin Rain]

Somewhere between the Denial and maybe Fear stages. Definitely haven't hit Capitulation yet.

Yeah. I was thinking "bull trap", as in, "We've chased out all the paper handed high-achievers. This is definitely the new bottom because this group of students are more invested and will fix our glaring math problem with umm.... [checks card]... diversity. They're all-in on $70k jobs. Future is bright."

 

[GreySwan]

Probably this have been mentioned before. Can someone explain the "not legal" part for contraction?

I honestly think leadership is just passing the bucket from their role to the individual programs. AKA, my program is better than yours, I should SOAP you should not (or contract).

Unrelated: Applicant here who decided to take the risk based on my personal risk/benefit assumptions, and matched to the field. Let me just thank you for at least helping us be informed and going in without our heads being in the sand.

 

[metallica81788]

Since nobody applies to RadOnc anymore and everyone who was actually interested in the field matched, who are these SOAP applicants? Purely foreign grads? Surely derm and neurosurgery rejects would be better off in medicine or general surgery?

One would think anybody trying to SOAP RadOnc is crazy or just absolutely 100% desperate for anything.

 

[Neuronix]

Probably this have been mentioned before. Can someone explain the "not legal" part for contraction?

The argument that ASTRO and a number of other stakeholders make is that it is not legal for them to dictate the overall number of trainees in radiation oncology. They argue that such actions are anti-trust because they would dictate to individual programs the size of their programs, and claim that they would be immediately sued and lose if they tried to do this. They state that no stakeholder has the authority to set the number of trainees in the specialty. Therefore, it is left to individual programs to decide the size of their programs, and medical students to decide whether they want to join. The only relevant regulatory body that can control program size is the RRC of the ACGME for programs looking to start a new program, maintain their program, or expand their program. They are not allowed to use job market concerns in their decisions about residency programs, only quality of training concerns to make those decisions. Unfortunately, the RRC has set a pretty low bar for opening programs, maintaining them, and expanding them in my opinion, and there is no significant effort to raise that low bar.

 

[evilbooyaa]

The argument that ASTRO and a number of other stakeholders make is that it is not legal for them to dictate the overall number of trainees in radiation oncology. They argue that such actions are anti-trust because they would dictate to individual programs the size of their programs, and claim that they would be immediately sued and lose if they tried to do this. They state that no stakeholder has the authority to set the number of trainees in the specialty. Therefore, it is left to individual programs to decide the size of their programs, and medical students to decide whether they want to join. The only relevant regulatory body that can control program size is the RRC of the ACGME for programs looking to start a new program, maintain their program, or expand their program. They are not allowed to use job market concerns in their decisions about residency programs, only quality of training concerns to make those decisions. Unfortunately, the RRC has set a pretty low bar for opening programs, maintaining them, and expanding them in my opinion, and there is no significant effort to raise that low bar.

Not if you listen to KO - didn't you see that 7 interstitials is necessary, and now residents actually HAVE to do 5-10 tandem based procedures?! what a raising of the bar!!!111

However, some are whispering that there may be some additional steps in changing RRC requirements in the pipeline. Maybe that's what Simul is referencing. I am not in the know on this.

 

[deleted969641]

Since nobody applies to RadOnc anymore and everyone who was actually interested in the field matched, who are these SOAP applicants? Purely foreign grads? Surely derm and neurosurgery rejects would be better off in medicine or general surgery?

One would think anybody trying to SOAP RadOnc is crazy or just absolutely 100% desperate for anything.

Programs are taking people who failed to match in Ob/gyn and psych. Seriously.

I remember when I was a med student who would do anything to get into rad onc. I didn't think I had a shot but applied anyway despite the PD telling me I needed to change my expectations about matching into something so competitive with average board scores. I showed dedication to the field and got in somewhere far away and upended my life to go there and train far away from my family. Now programs are taking anyone with a pulse and the programs in my home state are repeatedly in the SOAP. What a farce. We've gone from almost requiring people with PhDs and multiple primary author publications in the field to accepting applicants who have never done a rad onc rotation and didn't even know what the field really was before it showed up on the SOAP list the day before. I'm not saying these people can't be trained, but in the old days, at least PGY-2s showed up on day 1 knowing what a linac was, and many of them already knew studies and basics of planning. It will take 5-10 years for the effects of this (board failures) to eventually get programs shut down. In the process lives will get ruined as residents are terminated for incompetence or not graduated (people who should never have been there to begin with). But hey, notes will get written.

 

[fiji128]

The argument that ASTRO and a number of other stakeholders make is that it is not legal for them to dictate the overall number of trainees in radiation oncology. They argue that such actions are anti-trust because they would dictate to individual programs the size of their programs, and claim that they would be immediately sued and lose if they tried to do this. They state that no stakeholder has the authority to set the number of trainees in the specialty. Therefore, it is left to individual programs to decide the size of their programs, and medical students to decide whether they want to join. The only relevant regulatory body that can control program size is the RRC of the ACGME for programs looking to start a new program, maintain their program, or expand their program. They are not allowed to use job market concerns in their decisions about residency programs, only quality of training concerns to make those decisions. Unfortunately, the RRC has set a pretty low bar for opening programs, maintaining them, and expanding them in my opinion, and there is no significant effort to raise that low bar.

As we know there are a ton of issues here (I'm not saying the OP is supporting what astro has previously said about this). Astro has no power to dictate anything to anybody but they can study the issue and present findings. Really a no brainer. Just speaks volumes about the people running the show there.

It was about two years or so ago that a big announcement was made by the RRC about revising programing standards in an effort to raise the bar just a tad. After everyone gave their input the end result was the RRC would allow residents to log more cases I believe. Basically nothing of substance.

ASTRO leadership and those running the RRC are basically from the same group of "academic" "leaders" which is why nothing will change except for the quality of applicants this specialty can attract.

 

[RickyScott]

As we know there are a ton of issues here (I'm not saying the OP is supporting what astro has previously said about this). Astro has no power to dictate anything to anybody but they can study the issue and present findings. Really a no brainer. Just speaks volumes about the people running the show there.

It was about two years or so ago that a big announcement was made by the RRC about revising programing standards in an effort to raise the bar just a tad. After everyone gave their input the end result was the RRC would allow residents to log more cases I believe. Basically nothing of substance.

ASTRO leadership and those running the RRC are basically from the same group of "academic" "leaders" which is why nothing will change except for the quality of applicants this specialty can attract.

Yip. Astro is really about protecting the economic interests of large academic departments and the insane prices they are able to bill at. When price transparency is widespread, the greed will be laid bare.

 

[TheWallnerus]

Since nobody applies to RadOnc anymore and everyone who was actually interested in the field matched, who are these SOAP applicants? Purely foreign grads? Surely derm and neurosurgery rejects would be better off in medicine or general surgery?

One would think anybody trying to SOAP RadOnc is crazy or just absolutely 100% desperate for anything.

As a piece of co-information, those that aren’t SOAPing, namely the US grads, still appear to be of as equally high caliber as the past (ARRO data I think). Still seeing many MD/PhDs on the Twitter celebrating a rad onc match. As the guy on Princess Bride says, “Inconceivable!”

 

[elementaryschooleconomics]

As a piece of co-information, those that aren’t SOAPing, namely the US grads, still appear to be of as equally high caliber as the past (ARRO data I think). Still seeing many MD/PhDs on the Twitter celebrating a rad onc match. As the guy on Princess Bride says, “Inconceivable!”

I have personally been told by several students across several institutions that they were still being "advised" by their IRL faculty mentors that the RadOnc job market is fine, the noise on the internet isn't real.

Things really seem to be blowing up this week though so...let's see what students are told next year...

 

[RickyScott]

As a piece of co-information, those that aren’t SOAPing, namely the US grads, still appear to be of as equally high caliber as the past (ARRO data I think). Still seeing many MD/PhDs on the Twitter celebrating a rad onc match. As the guy on Princess Bride says, “Inconceivable!”

Some people are more believing/reverent of academics than others.

 

[medgator]

Programs are taking people who failed to match in Ob/gyn and psych. Seriously.

Il

Psych is pretty sought after now... Almost mirror images of what it was a decade or two ago vs rad Onc

 

[TheWallnerus]

Psych is pretty sought after now... Almost mirror images of what it was a decade or two ago vs rad Onc

If you had any aptitude whatsoever in psych in med school right now you’d sense the schizoid, schizotypal, schizoaffective, schizophreniform, organic brain disease, Korsakoffian disorders in rad onc in an attosecond and run far, far away.

 

[RickyScott]

Some people are more believing/reverent of academics than others.

Could lead to demographic changes ie are certain groups/genders more likely to buy their nonsense.

 

[Ray D. Ayshun]

Where'd scarb go?

 

[Mandelin Rain]

Where'd scarb go?

🚀🚀🚀🌙🌙🌙

 

[TheWallnerus]

Where'd scarb go?

He was raptured. Because clearly the End Times are near.

 

[elementaryschooleconomics]

He was raptured. Because clearly the End Times are near.

 

[fiji128]

The argument that ASTRO and a number of other stakeholders make is that it is not legal for them to dictate the overall number of trainees in radiation oncology. They argue that such actions are anti-trust because they would dictate to individual programs the size of their programs, and claim that they would be immediately sued and lose if they tried to do this. They state that no stakeholder has the authority to set the number of trainees in the specialty. Therefore, it is left to individual programs to decide the size of their programs, and medical students to decide whether they want to join. The only relevant regulatory body that can control program size is the RRC of the ACGME for programs looking to start a new program, maintain their program, or expand their program. They are not allowed to use job market concerns in their decisions about residency programs, only quality of training concerns to make those decisions. Unfortunately, the RRC has set a pretty low bar for opening programs, maintaining them, and expanding them in my opinion, and there is no significant effort to raise that low bar.

Looks like they are having the same problem with the RRC over in the ER world.

"I think we need to increase the minimum procedure requirements and hospital requirements to accredit and re-accredit residencies. 35 ETT, 20 CVLs, 6 pacing, 30% simulated? Not nearly enough. Also, simulating any of your common procedures like ETTs, CVLs, resuscitations, etc. should not be allowed and the peds should not be simulated either. If you can't secure good peds training sites, you shouldn't be a residency. STEMI center should be a requirement.

I also think there should be 10,000 patients per year per resident per class. 75,000 patients per year = no more than 7 residents per year so they can see enough pathology and have access to enough procedures/resuscitations to be not just mediocre, but highly skilled like the specialists we should be. This limitation also needs to include concurrent PA/NP residencies so if you want 4 PAs in a residency along side 10 EM residents per year, you better see 140,000 pts/year. (In no world will those midlevels be as productive and would not be worth it vs more residents). How can you be prepared to see it all when I don't get the chance to see it all in residency. By our 3rd year every resident needs to be seeing >2pts per hour if only to see the diversity of patients, never mind the training on being thorough while also efficient.

Finally, faculty time also needs to be protected and mandated so these CMGs can't just use their current docs as "faculty" and the lecture logs need to be audited during accreditation reviews.

Until we raise the bar to reflect the training we should have, the RRC can't do much."

 

[Mandelin Rain]

Looks like they are having the same problem with the RRC over in the ER world.

"I think we need to increase the minimum procedure requirements and hospital requirements to accredit and re-accredit residencies. 35 ETT, 20 CVLs, 6 pacing, 30% simulated? Not nearly enough. Also, simulating any of your common procedures like ETTs, CVLs, resuscitations, etc. should not be allowed and the peds should not be simulated either. If you can't secure good peds training sites, you shouldn't be a residency. STEMI center should be a requirement.

I also think there should be 10,000 patients per year per resident per class. 75,000 patients per year = no more than 7 residents per year so they can see enough pathology and have access to enough procedures/resuscitations to be not just mediocre, but highly skilled like the specialists we should be. This limitation also needs to include concurrent PA/NP residencies so if you want 4 PAs in a residency along side 10 EM residents per year, you better see 140,000 pts/year. (In no world will those midlevels be as productive and would not be worth it vs more residents). How can you be prepared to see it all when I don't get the chance to see it all in residency. By our 3rd year every resident needs to be seeing >2pts per hour if only to see the diversity of patients, never mind the training on being thorough while also efficient.

Finally, faculty time also needs to be protected and mandated so these CMGs can't just use their current docs as "faculty" and the lecture logs need to be audited during accreditation reviews.

Until we raise the bar to reflect the training we should have, the RRC can't do much."

Faculty give and/or attend resident lectures in ER? Y'all lucky.

 

[dieABRdie]

Since nobody applies to RadOnc anymore and everyone who was actually interested in the field matched, who are these SOAP applicants? Purely foreign grads? Surely derm and neurosurgery rejects would be better off in medicine or general surgery?

One would think anybody trying to SOAP RadOnc is crazy or just absolutely 100% desperate for anything.

See post #7 from this thread in the psych forum last year:

Confused and devastated without a match | Student Doctor Network

 

[RadOncDoc21]

See post #7 from this thread in the psych forum last year:

Confused and devastated without a match | Student Doctor Network

 

[RadOncMegatron]

When is Match this year? Also, when do we find out match % and SOAP numbers?

 

[brushbeamscanning]

Match is Friday, I think official numbers come out late April historically?

 

[thecarbonionangle]

This friday is matchday. Many programs patting themselves in match that they “filled” and avoided soap. Bring out the bottles of André, Franzia “chillable red” and plastic red cups. Yay!

 

[Conn Seannery]