More and more programs using SOAP to fill

[RadsRocks!]

Since WVU has been mentioned, interesting that no WVU student matched in radiation oncology.

If you have the President-Elect of ASTRO as the department chair and no student this year selected the specialty that is .... interesting.

2021 | School of Medicine | West Virginia University

Just needs more exposure!!!

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Members don't see this ad.

 

[RadsRocks!]

Interesting...

I am almost sure most of the 35 unfilled spots will eventually be filled anyway.

There are ___ US grads per yr, and there are a finite ____ residency slots (everything from IntMed to Pathology to GenSurg etc.), people who don't match in their chosen specialty may end up in radonc.
I feel bad for these M4s who don't match and have to SOAP. Let's say an M4 is not matched to let's say Derm and decided to SOAP into radonc, we should not blame the student, he/she needs a job, we should blame the programs that SOAP.

NRMP Match in one photo:
- RED = Rad Onc.
- GREEN = I didn't know there are only 2 programs offering Nuc Med in this country. Learning something everyday.

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I mentioned yesterday that the number of nuclear medicine programs has dropped from ~80 to 4 and someone could write an article about how they were able to close as time went on instead of matching/soaping suckers

 

[medgator]

Since WVU has been mentioned, interesting that no WVU student matched in radiation oncology.

If you have the President-Elect of ASTRO as the department chair and no student this year selected the specialty that is .... interesting.

2021 | School of Medicine | West Virginia University

You sure about that?

 

[Radonc90]

Would be a shocker if this is true. How did Florida, Vandy, UVA, MCW not match but apparently the trashiest trash (LIJ, NY Methodist, Alleghany, and Baylor) did?

I think it is "comfort level"...

Let's say an M4 is average or just above-average, he/she is afraid of matching to top programs (more demanding, more work, cannot keep up with the "genius residents" and "scary" in terms of intellectual level), that M4 will rank those "trashy" programs high on the list bc of comfort level and ignores the top programs when it comes to ranking...

 

[CurbYourExpectations]

The field generally agrees that we have too many residency spots. The solution will need to be to equitably reduce spots. No program, big or small, will like this.

I by no means have "THE" solution, but people must agree on a few basic points to move forward:
1. What defines an optimal training environment? Given there are 30+ programs with protons and growing throughout the world, and fewer and fewer programs have robust brachy programs, and more and more having adaptive (ethos) and MR Linac, should residency programs have standards of what they can offer?
2. Is there educational benefit to having more than 1 resident per year?
3. Is there educational benefit to having more than 3 residents per year (this may vary for some programs that functionally are multiple hospitals like HROP vs MSKCC)?

If we have ~180 slots per year, and the market supports <130 per year, some equitable standards need to be made. This again has nothing to do with SOAP as many who match now are less qualified than SOAP candidates. It has to do with providing excellent training that allows people to get jobs and contribute meaningfully to our field and help patients.

Perhaps in remote areas of the country the standards should be different than large urban areas. I dont know, but you must start somewhere.

Best,
Dan

Hey Dan,
There are almost as many programs as there are likely needed RadOncs/year in the future. This would mean the average program would fall between 1-2 residents per year even if residencies close down.
Curious, do Chairs and other Leaders in the field often talk about these issues behind closed doors and discuss how to try to fix things? Or are the problems still avoided or denied for the most part? It is hard to believe that everyone seems to know there is an issue except for the people at the top. Transparency and knowing that there are more people in leadership positions who have the power to change things and are working towards changing things would do wonders for the morale of the field. We need more people in power that are speaking up and trying to take action, and I appreciate you for being transparent with your thoughts on this and hope others follow.

 

[seper]

The best force is to have a whistleblower complaint to CMS that these programs, such as WVU, are committing Medicare fraud by using residency slots for a field with no demand from the population, and adequate staffing for decades. But not all slots are Medicare funded.

Another is to bring to attention the lax requirements of our residency completion by the ACGME and make them a party to a medical malpractice lawsuit. But these are hard to find and personal, and would likely involve judgement.

Otherwise, WVU’s gonna WVU and you can see how much support we get from ASTRO. The amount of programs that SOAP this year and last year shows the “leaders” would rather have people with no draw to cancer care or inability to get in other specialities as up to 25% of our graduating class. And no individual should be made to feel shame here or singled out - but some gal/guy who woke up and was like “man I didn’t get OB, maybe FM or rad onc” should be supported? What was the value of our work? What was the value of screening to see who would be good in cancer care? Or research / physics driven?

This is not far fetched as it sounds... The sole purpose of a residency is to provide a path for employment.
What happened with for-profit colleges a few years back?
I sat through some of the GME meetings this year and RadOnc leadership is not worried about liability yet.
Most RadOnc programs are not using CMS funds (discussed on this board)

 

[Radonc90]

@CurbYourExpectations and @seper...

- Yes, the oversupply issues were discussed at SCAROP level.
At the end of the day, the "mine operators" only care how many coal workers they have in the mine, if
I can mention the canary...
Some programs truly have interests in their residents' future, and the field's future.
Some don't, who knows.
Human nature is selfish...

- ASTRO cannot force individual chairs to contract (this is what they told the world about anti-trust bs), but each chair can do it on his/her own (by choice). If they can increase the size, they can decrease the size. Just like we gain some weight, we can lose weight to become healthy again...

- I think most radonc resident spots are funded by Medicare Part A. A few are funded by grants and other sources of money, if necessary.

 

[medgator]

...

- I think most radonc resident spots are funded by Medicare Part A. A few are funded by grants and other sources of money, if necessary.

CMS froze funding in 1997...

 

[ElectronGammaShower]

CMS froze funding in 1997...

AAMC just endorsed a newly introduced bill to increase GME funded positions by 1000. Does this bill have any chance getting approved?

https://www.aamc.org/news-insights/press-releases/aamc-endorses-resident-physician-shortage-reduction-act-2021-0

 

[radonc17]

AAMC just endorsed a newly introduced bill to increase GME funded positions by 1000. Does this bill have any chance getting approved?

AAMC Endorses Resident Physician Shortage Reduction Act of 2021

Newly reintroduced bill would increase federal support for physicians’ graduate medical education programs to increase access to care for patients nationwide

www.aamc.org

I heard there is a stipulation that 500 of the spots over next 4 years have to be radonc.....

JK

 

[blue.jay]

 

[SubserviantToABR]

I decided to take a peek at the Google doc spreadsheet and saw this gem in there. This is awesome, and while this week is dedicated for celebration, our new colleagues should think long and hard about what is to come for them. There is always a chance to get out in the next 15 months. Take that time and delve within your soul. I'm too all-in (I finished residency within the past couple of years) to make a career change, but it is not late for them. Remember, you think you love the job but just wait until you find out that it does not love you back.

 

[Krukenberg]

View attachment 333054
I decided to take a peek at the Google doc spreadsheet and saw this gem in there. This is awesome, and while this week is dedicated for celebration, our new colleagues should think long and hard about what is to come for them. There is always a chance to get out in the next 15 months. Take that time and delve within your soul. I'm too all-in (I finished residency within the past couple of years) to make a career change, but it is not late for them. Remember, you think you love the job but just wait until you find out that it does not love you back.

It’s weird to me though that they switched from rad onc into a field with such a bad job market that pretty much all grads have to do a fellowship. also with structural issues of its own like telerads competition and private equity take overs

 

[medgator]

It’s weird to me though that they switched from rad onc into a field with such a bad job market that pretty much all grads have to do a fellowship. also with structural issues of its own like telerads competition and private equity take overs

Incorrect. They're job market has gotten better as ours has gotten worse over the last several years.

I don't see us bottoming out like they did unfortunately with the existential threat of ongoing hypofx and apm/bundles coming

 

[Krukenberg]

Incorrect. They're job market has gotten better as ours has gotten worse over the last several years.

I don't see us bottoming out like they did unfortunately with the existential threat of ongoing hypofx and apm/bundles coming

I still see rads grads from good programs all taking fellowships. Until that reverses I remain unconvinced that the job market is “good”

 

[medgator]

I still see rads grads from good programs all taking fellowships. Until that reverses I remain unconvinced that the job market is “good”

Uhhh those are all ACGME accredited... So probably necessary for subspecialty practice, even then, rads grads are definitely getting jobs in my area without a fellowship while the rad onc market has remained tight the last few years.

Very different the the proliferation of unaccredited trash fellowships in our specialty the last decade as a place for grads to hang out for a year to wait out a bad (and worsening) job market.

 

[CurbYourExpectations]

I still see rads grads from good programs all taking fellowships. Until that reverses I remain unconvinced that the job market is “good”

Of the radiology residents I know and have talked to about this they now do the fellowships to help deepen their understanding prior to finding a job even though most can now get a job straight out of residency.

 

[radsisrad]

It’s weird to me though that they switched from rad onc into a field with such a bad job market that pretty much all grads have to do a fellowship. also with structural issues of its own like telerads competition and private equity take overs

Lol.

Telerads with the right company/group could give me >600k for WFH, and that's with day shifts. The fellowships aren't *quite* "optional", in that most groups are looking to shunt their MSK studies to someone MSK-trained, neuro studies to neuro-trained, etc. But I could have gotten >700k in good locations without fellowship.

 

[medgator]

Lol.

Telerads with the right company/group could give me >600k for WFH, and that's with day shifts. The fellowships aren't *quite* "optional", in that most groups are looking to shunt their MSK studies to someone MSK-trained, neuro studies to neuro-trained, etc. But I could have gotten >700k in good locations without fellowship.

Maybe you can let @Krukenberg know how much things have improved after bottoming out several years ago

 

[RickyScott]

Maybe you can let @Krukenberg know how much things have improved after bottoming out several years ago

Big difference is that utilization of radiology is not going down.

 

[medgator]

Big difference is that utilization of radiology is not going down.

Quite the opposite actually... Low dose CT (recently expanded indications), increased pet ct usage with new radiotracers etc

 

[RickyScott]

Quite the opposite actually... Low dose CT (recently expanded indications), increased pet ct usage with new radiotracers etc

Don’t hear too many radiologists campaigning to get rid of or space out screenings tests.

 

[RickyScott]

And on a personal note, here is to radiology making progress on virtual colonoscopies ASAP.

 

[radonc17]

Don’t hear too many radiologists campaigning to get rid of or space out screenings tests.

yup it’s a positive movement no matter how much Vinay Prasad writes about it

Why cancer screening has never been shown to “save lives”—and what we can do about it

The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad and colleagues argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening Despite growing appreciation of the harms...

www.bmj.com

 

[IRattending2021]

I still see rads grads from good programs all taking fellowships. Until that reverses I remain unconvinced that the job market is “good”

I was able to find a job in NYC getting paid pretty decently prior to the current covid exodus after residency in a pretty middle of the road program. Now 5 hospitals in NYC hiring IRs.

can you say the same for radonc?

 

[radonc17]

I was able to find a job in NYC getting paid pretty decently prior to the current covid exodus after residency in a pretty middle of the road program. Now 5 hospitals in NYC hiring IRs.

can you say the same for radonc?

Hey @IRattending2021 - Don’t need to make the 99% of us who believe the radonc market is crappy, of which it is not of our creation, just to respond to 1 non believer

 

[medgator]

Hey @IRattending2021 - Don’t need to make the 99% of us who believe the radonc market is crappy, of which it is not of our creation, just to respond to 1 non believer

I think @Krukenberg and a few others really need to hear it from outside our specialty to get the point, since clearly everything we've said has been falling on deaf ears.

Not sure how anyone can equate s "fellowship" in rads vs rad Onc to mean the same thing

 

[RickyScott]

I think @Krukenberg and a few others really need to hear it from outside our specialty to get the point, since clearly everything we've said has been falling on deaf ears.

Not sure how anyone can equate s "fellowship" in rads vs rad Onc to mean the same thing

Certainly some in our specialty prone to North Korean style propaganda- that job market is bad in all specialties, and in fact we have it quite good in comparison.

 

[medgator]

Interesting to see this and wonder how the RadOnc numbers would look overlayed on this graph since 2015 or so



The ascent of competitiveness in psych has seemed to mirror the decline of our own specialty in the eyes of US M.D. students

 

[deleted1098629]

Interesting to see this and wonder how the RadOnc numbers would look overlayed on this graph since 2015 or so



The ascent of competitiveness in psych has seemed to mirror the decline of our own specialty in the eyes of US M.D. students

Surely this is a good thing for the folks in psychiatry and their patients ?

We need those smart enlightened minds advancing mental health care.

God knows I might need a good geriatric psychiatrist in a decade or two

 

[IRattending2021]

Psych is the new derm. Actually I think the uptick in psych reflect USMD’s desire for options, options to practice medicine the way they want.

medicine is now heavily corporatized and commoditized. Most specialist can no longer practice in private practice, or if so, is heavily skimmed by older partners.

enter psychiatry, where you can still hang a shingle and be choosy about your insurance panel.

 

[seper]

Glad to see psych doing well despite pandemic

 

[w00tz]

Glad to see psych doing well despite pandemic

I wonder how psych residency programs are increasing their "exposure" to attract applicants