Off-Topic Continuation about Drexel's Program Closure

[deleted947887]

Should be a lesson to the wise. Unless you get into a top 20 program you may not even graduate. Top 10 to get a job.

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[medgator]

I was very confused about how positive some med students seemed about that program on the interview trail in the past few years.

Probably the same ones that are certain they will get their desired RO job in their desired locale when all is said and done

 

[medgator]

Should be a lesson to the wise. Unless you get into a top 20 program you may not even graduate. Top 10 to get a job.

More FUD from Sphinx. Shocking

Plenty of stable programs in the top 50

 

[deleted947887]

More FUD from Sphinx. Shocking

Plenty of stable programs in the top 50

I'm sorry that was a typo. You are correct. I meant top 50. 50 stable programs. The other 60 or so are not. As medgator so aptly corrected me.


Mods, can we make the following three lines a sticky?

Top 50 to graduate
Top 30 to pass your boards
Top 20 to get your desired job.

 

[baculum1]

I think programs are setting themselves up for buyer's remorse during interview cycles. "We have daily didactics, a dedicated rad bio course" sounds great and you have visions of an energetic attending relaying the intricacies of their site to you daily, with a radiobiologist going through the mysterious biology surrounding this technology.

Then you're finishing PGY2. You haven't seen an attending show up, much less participate in morning lecture in 2 months. The rad bio course is just thumbing through Hall and saying "uh, any questions?". You feel lied to.

Take heart though: save for what seems like 2 or 3 institutions (if even that!), EVERYWHERE is like that. Our field talks a big game about being super-academic-oriented but don't really seem to care much about educating residents. Or dedicating resources for research. Or actually doing hypothesis-directed research. We pride ourselves on memorizing lots of stuff for a few tests, but then don't really do much with that knowledge.

pretty much sums up my residency experience. Giant dissapointment. There are places out there, however, with legit educational programs, and i really don't think it is as few as you say.

 

[baculum1]

I was very confused about how positive some med students seemed about that program on the interview trail in the past few years.

To be fair, the Christiana facility was great and all the attendings there trained in great programs and were all really nice. The program had a good history due to Luther Brady. I can see how people may fall for the okie dokie. However, I knew back then to stay far away due to recently been shut down, which made me rank them low due to the risk involved. What this shows me, is that no matter the risk, lack of name, people will take a rad onc spot any day, and programs just care about a warm body, someone to write notes, push buttons, do scut. Our field will continue to fill, no matter what, no matter how "bad" things get....

 

[baculum1]

I'm sorry that was a typo. You are correct. I meant top 50. 50 stable programs. The other 60 or so are not. As medgator so aptly corrected me.


Mods, can we make the following three lines a sticky?

Top 50 to graduate
Top 30 to pass your boards
Top 20 to get your desired job.

50% of rad onc residents passed both tests, unaware of data correlating program prestige to board pass rates. PW/LK tell us "small programs" do worst. Little evidence given. As everything in life, the better programs will always have benefits. Rad onc is a small field and most cannot go to these programs so majority of people graduate from "non-top" places. I would say don't do rad onc if you have geographical limitations. If you have a geographical preference, try to do residency nearby. There is a lot of regional bias in our field, and often good jobs in areas and surrounding states are filled before they are even posted, people want someone who is going to stay, not someone who comes from a completely different part of the country with no connections with lower odds of staying. If you end up having to have a geographical preference due to life changing, SO, etc, then you may have to take a job in an area which may not be your top preference. Go there and give people good care, value the opportunity for growth and learning. If after a few years, you still want to look for a job in that area, you will be more valued now as a BC rad onc with experience and hopefully good references and track record. Keep an open mind, your first job is usually not your last.

 

[TDDro]

FWIW I heard all the Drexel rad oncs are taken care of. I think they all transferred to programs within PA. Of course, IIRC from this past match there were 4 unmatched PA spots so it looks like it evened out.

Can't believe this news came out weeks before the start of a bunch of PGY1s...can you imagine how f#&cked some people are feeling? Day 1 you show up knowing you're out of a job in 2 months. And you can't just find another job in that field...you have to scrape for somewhere that has an open spot or reapply through the match to get yourself a job 12 months from now.

About the only thing you can do to keep your career options open is drive for Uber...that is just wild.

Edit: oh, and not releasing the GME funds should be criminal. You sign someone up for indentured servitude, then cancel the job but hold onto the funds for said job? FOH....

 

[Pointless]

FWIW I heard all the Drexel rad oncs are taken care of. I think they all transferred to programs within PA. Of course, IIRC from this past match there were 4 unmatched PA spots so it looks like it evened out.

Can't believe this news came out weeks before the start of a bunch of PGY1s...can you imagine how f#&cked some people are feeling? Day 1 you show up knowing you're out of a job in 2 months. And you can't just find another job in that field...you have to scrape for somewhere that has an open spot or reapply through the match to get yourself a job 12 months from now.

About the only thing you can do to keep your career options open is drive for Uber...that is just wild.

Is that what is actually happening to the incoming PGY1's?? Seems improbable, but highly unfortunate if that is the case.

Tangentially, I will agree with some of what is being said here about the disconnect between what is promised and what is delivered when it comes to residency education. Somehow, I don't think radiation oncology is alone in this. We have some issues to deal with in our field, chiefly with overtraining and lack of innovation to sustain us going forward, but I continue to find the doom and gloom on these threads to be hyperbolic and fairly inaccurate. As a field RIGHT NOW, radiation oncology is fantastic and I commonly find myself chuckling and shaking my head at what other specialties have to put up with compared to us. As to the future, Yogi Berra said it best: "It's tough to make predictions, especially about the future".

 

[xrthopeful]

but I continue to find the doom and gloom on these threads to be hyperbolic and fairly inaccurate. As a field RIGHT NOW, radiation oncology is fantastic and I commonly find myself chuckling and shaking my head at what other specialties have to put up with compared to us. As to the future, Yogi Berra said it best: "It's tough to make predictions, especially about the future".

yes.

 

[Ray D. Ayshun]

Is that what is actually happening to the incoming PGY1's?? Seems improbable, but highly unfortunate if that is the case.

Tangentially, I will agree with some of what is being said here about the disconnect between what is promised and what is delivered when it comes to residency education. Somehow, I don't think radiation oncology is alone in this. We have some issues to deal with in our field, chiefly with overtraining and lack of innovation to sustain us going forward, but I continue to find the doom and gloom on these threads to be hyperbolic and fairly inaccurate. As a field RIGHT NOW, radiation oncology is fantastic and I commonly find myself chuckling and shaking my head at what other specialties have to put up with compared to us. As to the future, Yogi Berra said it best: "It's tough to make predictions, especially about the future".

Tough to make predictions? Any case in which you can apply Newton's first law is one in which making a prediction is pretty simple.

 

[Pointless]

Newton's first law? Something about an object in motion staying in motion? Not sure how that applies to us as a field, but sure. If I'm playing devil's advocate, however, what if there is some fundamental shift that increases the need for RT? What if the abscopal effect becomes a solidified thing and we are called on to SBRT a lesion in every stage IV patient at diagnosis? Can you definitively say that this is impossible? Then you can't predict the future. And if you can, I'd like some stock tips please

 

[Ray D. Ayshun]

Newton's first law? Something about an object in motion staying in motion? Not sure how that applies to us as a field, but sure. If I'm playing devil's advocate, however, what if there is some fundamental shift that increases the need for RT? What if the abscopal effect becomes a solidified thing and we are called on to SBRT a lesion in every stage IV patient at diagnosis? Can you definitively say that this is impossible? Then you can't predict the future. And if you can, I'd like some stock tips please

Buy an index fund.

If the ball's rolling down hill, it'll keep rolling downhill unless an external force acts upon it. The health of the field appears to be going downhill, and those with the power to alter the course are saying things will get better because they always do, and doing nothing of substance to alter the direction of things. Rad onc beats a lot of things, that doesn't mean we should make decisions based on hope. When your patients ask about prognosis, I doubt you quote Yogi. What's our prognosis?

 

[thecarbonionangle]

Buy an index fund.

If the ball's rolling down hill, it'll keep rolling downhill unless an external force acts upon it. The health of the field appears to be going downhill, and those with the power to alter the course are saying things will get better because they always do, and doing nothing of substance to alter the direction of things. Rad onc beats a lot of things, that doesn't mean we should make decisions based on hope. When your patients ask about prognosis, I doubt you quote Yogi. What's our prognosis?

Yeah.I think some people are frustrated by being told everything will work out, when we do not know that, nobody knows that, but also see little to none is being done to prevent a decline in our field. Also the also often thrown out line about, if there is a problem, we can't do anything about it because we have our hands tied behind our backs. The likely decline in the quality of applicants which will follow, increasing representation of residents who would otherwise not have matched, may affect our field negatively, maybe not.

Fact is nobody knows what will happen. Objective data is definitely not good about some directions/trends in the field. I would want to see our "leaders" take a more decisive approach to addressing these problems. ABR debacle and lack of leadership regarding these issues really soured the belief that we have the leadership we need to address our future issues.

 

[medgator]

Is that what is actually happening to . As a field RIGHT NOW, radiation oncology is fantastic and I commonly find myself chuckling and shaking my head at what other specialties have to put up with compared to us. As to the future, Yogi Berra said it best: "It's tough to make predictions, especially about the future".

Absolutely. If you can find the job you want in the geography you are looking for, that is.

Of course, it doesn't matter how "fantastic" your residency experience is if you can't find a job that meets at least some of your checklist at the end of it.

Just spoke to an IR today telling me how open the radiology market is locally and nationally for jobs compared to a few years ago. Seems like a complete 180 for us during that time

 

[KHE88]

Yeah.I think some people are frustrated by being told everything will work out, when we do not know that, nobody knows that, but also see little to none is being done to prevent a decline in our field. Also the also often thrown out line about, if there is a problem, we can't do anything about it because we have our hands tied behind our backs. The likely decline in the quality of applicants which will follow, increasing representation of residents who would otherwise not have matched, may affect our field negatively, maybe not.

Fact is nobody knows what will happen. Objective data is definitely not good about some directions/trends in the field. I would want to see our "leaders" take a more decisive approach to addressing these problems. ABR debacle and lack of leadership regarding these issues really soured the belief that we have the leadership we need to address our future issues.

Rad onc is a sinking ship, but there is a floor.

Supply and demand has previously been in our favor with less favorable demand curves in the big cities, but still overall favorable in aggregate. What's going to happen without an external force regulating the supply is that salaries will be pushed down across the board and the Laredo type jobs will fill all be filled at reduced salaries. Ultimately most people will not retrain in other fields and will be forced to compete for previously uncompetitive jobs.

So it may end up we're making 250k in the big cities and 400k in rural areas, all as easily replaceable employees and naturally no bargaining power, but hey still with weekends off and no call. We won't be starving, but the rates billed to payors won't change, and all the oversupply will do is divert more dollars that the physician bill for to the hospital system before the MD's check gets cut.

If I were an average med student looking at this (to whom rad onc is now WIDE open), I'd wonder... why not go into emergency medicine, psych, or even family med where you can make comparable salaries but have way, way better geographic flexibility and job security? And if I were a circa 2012-competitiveness level applicant, I'd be wondering why not try for derm, rads, or optho first?

Hey, you wanna know what happens when you increase residency spots by two thirds (literally) in 10 years???

Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018 - PubMed

We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.

www.ncbi.nlm.nih.gov

Case log numbers go down, especially definitive cases. Who would have thought??!

Nothing to see here guys!! The ABR knows the big threat to our field's safety is residents not knowing their molecular bio signalling pathways at TAQMAN assays.

 

[thecarbonionangle]

Rad onc is a sinking ship, but there is a floor.

Supply and demand has previously been in our favor with less favorable demand curves in the big cities, but still overall favorable in aggregate. What's going to happen without an external force regulating the supply is that salaries will be pushed down across the board and the Laredo type jobs will fill all be filled at reduced salaries. Ultimately most people will not retrain in other fields and will be forced to compete for previously uncompetitive jobs.

So it may end up we're making 250k in the big cities and 400k in rural areas, all as easily replaceable employees and naturally no bargaining power, but hey still with weekends off and no call. We won't be starving, but the rates billed to payors won't change, and all the oversupply will do is divert more dollars that the physician bill for to the hospital system before the MD's check gets cut.

If I were an average med student looking at this (to whom rad onc is now WIDE open), I'd wonder... why not go into emergency medicine, psych, or even family med where you can make comparable salaries but have way, way better geographic flexibility and job security? And if I were a circa 2012-competitiveness level applicant, I'd be wondering why not try for derm, rads, or optho first?

Hey, you wanna know what happens when you increase residency spots by two thirds (literally) in 10 years???

Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018 - PubMed

We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.

www.ncbi.nlm.nih.gov

Case log numbers go down, especially definitive cases. Who would have thought??!

Nothing to see here guys!! The ABR knows the big threat to our field's safety is residents not knowing their molecular bio signalling pathways at TAQMAN assays.

you better know your Cdc25, Wee1, Chk1/2 COLD. Do not forget Taqman and delta method. Otherwise you be SOL!
Don't worry guys, LK who is moving on to once again another institution (poor Columbia, surely will help), PW from 21C, now leads one of the most corrupt organizations in our specialty's history, who has been around for decades have the field's future interests in mind. Ain't nothing to see here folks.

 

[Krukenberg]

If I were an average med student looking at this (to whom rad onc is now WIDE open), I'd wonder... why not go into emergency medicine, psych, or even family med where you can make comparable salaries but have way, way better geographic flexibility and job security? And if I were a circa 2012-competitiveness level applicant, I'd be wondering why not try for derm, rads, or optho first?

I don’t get why it’s tossed around so casually here that med students should pick their specialty just on geographic flexibility. I’d bet most residents in rad onc hate the specialties you listed. Why spend your career in a “desirable” area and be miserable 12-15 hours per day 5-6 days per week.

 

[KHE88]

you better know your Cdc25, Wee1, Chk1/2 COLD. Do not forget Taqman and delta method. Otherwise you be SOL!
Don't worry guys, LK who is moving on to once again another institution (poor Columbia, surely will help), PW from 21C, now leads one of the most corrupt organizations in our specialty's history, who has been around for decades have the field's future interests in mind. Ain't nothing to see here folks.

Don't forget how to use CtIP and BRCA1 to force homoglogus repair. Super frickin important. I forget my CtIP and accidentally treated a patient with NHEJ the other day. ABR has to protect the public from hacks like me. Truly dangerous if you don't know your CtIP and forget to mutate to Glu instead of Ala and just go around trying to do super lame dna repairs in G1.

 

[KHE88]

I don’t get why it’s tossed around so casually here that med students should pick their specialty just on geographic flexibility. I’d bet most residents in rad onc hate the specialties you listed. Why spend your career in a “desirable” area and be miserable 12-15 hours per day 5-6 days per week.

You're preaching to the choir. It's tossed around because so many people prioritize geographic location over everything else when it comes to picking a specialty. I truly have no geographic restrictions and would go to northern Canada to practice rad onc for the right price. We need more people like that. Not the NYC/SF/DC or bust crowd.

Why do you think these coastal universities can advertise these exploitative intrusctor positions? Because someone wants to be there so bad they will take it at virtually any cost!

Unfortunately from about 2005-2015 program directors and chairs were more interested in ranking candidates debating between derm and rad onc and taking people with 250+ step scores who were clearly dual applying derm vs. somebody with a below average step 1 obsessed with rad onc trying to do everything in the world to get into the field and grateful to have a shot anywhere.

 

[medgator]

Unfortunately from about 2005-2015 program directors and chairs were more interested in ranking candidates debating between derm and rad onc and taking people with 250+ step scores who were clearly dual applying derm vs. somebody with a below average step 1 obsessed with rad onc trying to do everything in the world to get into the field and grateful to have a shot anywhere.

Patently false. Research was a huge component to matching back then, and given someone with a worse score, as long as they met the cutoff, research and letters (along with the interview) mattered way more than grades/score, unlike say Ortho or derm.

Nowadays it's pretty much going to be anyone with a pulse, unfortunately

 

[medgator]

I don’t get why it’s tossed around so casually here that med students should pick their specialty just on geographic flexibility. I’d bet most residents in rad onc hate the specialties you listed. Why spend your career in a “desirable” area and be miserable 12-15 hours per day 5-6 days per week.

Geographic flexibility imo means being able to find something with a given state or region. 1/3 of folks in 2014 couldn't swing that. I would imagine geographic flexibility is important to most in medicine.

The dogma in rad onc used to be you could sacrifice 1-2/3 to get what you needed, now there are some locations that flat out have saturated in the last few years and won't have opportunities available for awhile, regardless of salary

 

[KHE88]

Patently false. Research was a huge component to matching back then, and given someone with a worse score, as long as they met the cutoff, research and letters (along with the interview) mattered way more than grades/score, unlike say Ortho or derm.

Nowadays it's pretty much going to be anyone with a pulse, unfortunately

That's not what I said. But even still that's a pretty definitive claim. I know of a handful of people (can count on one hand, but not zero) that got into rad onc with with a 260+ and zero publications and a couple last minute rad onc rotations, and even more with weak research but very good step scores and AOA. It's not hard to get your name on a couple pubs with minimal effort if you have a rad onc department.

My point is that during the ultra competitive years there were many programs that were focusing mostly on step scores. Yeah, you're not going to get to the top of the rank list with a 265 and no research, but you'll at least get interviews and on some rank lists with a high score. In 2012 or so, I would have much rather been somebody who last minute declared rad onc with a 265 step 1 and no rad onc research vs. somebody with a 215 step 1 and 3-4 first author rad onc pubs. These days the former applicant would not be applying to rad onc at all, whereas the latter applicant likely would be matching at a decent mid tier program.

Step 1 as a screening tool for interviewing and ranking applicants in rad onc always made no sense to me, especially with absurdly high cutoffs of 240+ to even be considered (is there really that much a difference between someone with a 250 and a 235 given the trivialities of what's tested on step 1 and how it's basically become a memorization contest?). Rad onc is so far removed from other fields and what's tested on step 1, we honestly would be better off with our own custom entrance exam and study guides focusing on specific med school level things like anatomy, oncology-related molecular bio, biostats, and even some basic radiation physics. Of course the competitiveness of the specialty wouldn't allow for such a luxury now. Nobody would study for and take an extra test to go into this field anymore (although proving your ability to take a bunch of extra stupid tests surely would be useful in this brave new post-ABR-scandal world).

I've heard people are talking about making step 1 pass/fail now too, so maybe I'm not the only one who thinks its importance/relevance/predictive use is overhyped.

 

[KHE88]

Geographic flexibility imo means being able to find something with a given state or region. 1/3 of folks in 2014 couldn't swing that. I would imagine geographic flexibility is important to most in medicine.

The dogma in rad onc used to be you could sacrifice 1-2/3 to get what you needed, now there are some locations that flat out have saturated in the last few years and won't have opportunities available for awhile, regardless of salary

This totally depends on what you mean by "region"

If this means getting your pick between the West, Midwest, Southwest, Southeast, or Northeast, then yeah, you'll get your "pick" as Elko, NV (RIP), and Seattle are technically in the same region.

If your region means being within 2 hours driving distance of a certain location, yeah good luck.

Virtually everybody, when referring to preferred "region" means something closer to the latter rather than the former.

 

[DukeNukem]

I don’t get why it’s tossed around so casually here that med students should pick their specialty just on geographic flexibility. I’d bet most residents in rad onc hate the specialties you listed. Why spend your career in a “desirable” area and be miserable 12-15 hours per day 5-6 days per week.

Residents in rad onc would "hate" these other specialties? Please. How many people came into medical school knowing that they wanted to do rad onc? I don't know any except the ones whose parents got them nice partnership jobs after graduation that don't exist for the rest of us.

No, I was thinking surgery or radiology before rad onc. I probably would have done radiology too had I not found out about rad onc, which I'm sure is very common. I don't know any radiologists working "12-15 hours a day 5-6 days a week". Same for derm. Though if they did, they'd be making a heck of a lot more than me.

What bothers me about being a radiation oncologist isn't being a radiation oncologist. I like the work and the patients. What I hated was having no choice of where to do residency (apply everywhere) followed by repeating the same thing for an attending job. I basically had no options upon graduation despite a ton of "networking", landed in a very malignant department in a random part of the country, and now several years later I can't get out because the job market is just as tight as when I graduated and I still have no options to leave.

I don't know any radiologists who are up all weekend worried about salary cuts and losing their jobs over academic department malignancy, and having no idea where they're going to go if they lose their job. I don't know any radiologists or dermatologists being told by their chair to shut up and do what they're told and get paid less than other places or else they're going to be replaced with one of the hundreds of new grads applying for their job.

All of the rad oncs where I work just talk about the FIRE movement. "The only way out is early retirement." At least in radiology I could bail out of this hell hole to a new job. Most docs in medicine switch jobs their first few years. That should have been me--but in rad onc there are no jobs left to switch to. Sure there are always trade offs in medicine--location, lifestyle, pay... Rad onc is, take whatever job you're given when you graduate (if you can even find one) and STFU. Oh, you couldn't do any better? That's your fault for not being connected enough. Please. Such a cop out. There's some job in nowheresville Midwest that doesn't really exist or is also being picky about who they hire. Ok cool. Thanks for the tip.

Being a rad onc is such a privilege that being a slave for an "academic" hospital system who knows they've got their claws in you is no big deal. Get real. Doing any specialty with a job market this bad is an absolute mistake. It's a setup for exploitation. I'd rather work a decent job in another specialty than be taken advantage of in rad onc. If only I knew 10 years ago what I know now. Hopefully someone reading now will make the right choice and do rads or derm or med onc or whatever else instead, and still feel like a physician with some value and some control over their professional life.

 

[thecarbonionangle]

At the end of the day medicine is just a JOB. If you think of it as any more than that you are setting yourself up for unhappiness. You will not find the fulfillment, life meaning, “calling” you heard about as a young cockroach. Now you got your wings. Reality knocking on door. the world has no problem squishing you and your dreams. You got dreams? F your “dreams”. You want to get home, have a life outside of work and be happy at the end. There are many fields in medicine where people find that to an extent. There is no perfect field as it is just a job. rad onc has pluses and negatives but idea that a good amount of people would not be able to stand other things is ridiculous. Its a job. I always thought it was cool in ER that they just sign off and hand their patients after their shift. they recognize its a job, time to go! sure ER has negatives too but also positives just like us.

 

[thecarbonionangle]

So far its been interesting regarding jobs. I already have interviews starting soon, cities, not “desirable” but legit midsize. Combination of posted/nonposted. Applying everywhere (deja vu to residency applications all over again, no idea where i will end up once again, hate the uncertainty), even middle of nowhwere. Some of these places will not even respond to me or call me back lol, very strange, and we talking middle of nowhere!!! Complete crapshoot.

 

[medgator]

. I always thought it was cool in ER that they just sign off and hand their patients after their shift. they recognize its a job, time to go! sure ER has negatives too but also positives just like us.

Continuity of care makes it hard to take long vacations in RO, medical oncology etc unless you've got really good partners who can step up to the plate.

I am usually getting calls/emails/texts late into my first week and during my second week of vacation about new consults that have to get in ASAP.

Rads, gas, hospitalists, ER etc have it much better in that regard.

 

[seper]

Now that's a depressing post. Medicine is a job, but a fulfilling one. You can't be in it for just the money, it's a setup for disappointment.

At the end of the day medicine is just a JOB. If you think of it as any more than that you are setting yourself up for unhappiness. You will not find the fulfillment, life meaning, “calling” you heard about as a young cockroach. Now you got your wings. Reality knocking on door. the world has no problem squishing you and your dreams. You got dreams? F your “dreams”. You want to get home, have a life outside of work and be happy at the end. There are many fields in medicine where people find that to an extent. There is no perfect field as it is just a job. rad onc has pluses and negatives but idea that a good amount of people would not be able to stand other things is ridiculous. Its a job. I always thought it was cool in ER that they just sign off and hand their patients after their shift. they recognize its a job, time to go! sure ER has negatives too but also positives just like us.

 

[medgator]

Now that's a depressing post. Medicine is a job, but a fulfilling one. You can't be in it for just the money, it's a setup for disappointment.

Sure, but you can't be treated like an expendable commodity either. The issues go beyond just pay

Beyond burnout: The real problem facing doctors is moral injury

The patients’ needs cannot always win—and often don’t.

www.medicaleconomics.com

 

[thecarbonionangle]

Now that's a depressing post. Medicine is a job, but a fulfilling one. You can't be in it for just the money, it's a setup for disappointment.

When did i say money? Money ain’t it. I have never had it and do not care for it. I care about my happiness. You totally read that into my post and missed my point. Sorry to bust your bubble. I do not recommend people to look for “fulfillment” in any career. Definite mistake. I can like what i do, helping people but i will not let it comsume me and destroy my personal life. Thats how you end up DEAD. Not ready to check out yet, you read?

 

[seper]

Sorry, if it's not the money, what is it then? Health insurance? Respect from friends at the bar? An excuse to get out of the house 9 am - 4 pm?

When did i say money? Money ain’t it. You totally read that into my post and missed my point. Sorry to bust your bubble. I do not recommend people to look for “fulfillment” in any career. Definite mistake. I can like what i do, helping people but i will not let it comsume me and destroy my personal life. Thats how you end up DEAD. Not ready to check out yet, you read?

 

[thecarbonionangle]

Sorry, if it's not the money, what is it then? Health insurance? Respect from friends at the bar? An excuse to get out of the house 9 am - 4 pm?

Yo that sounds pretty good. Draw up that contract!

 

[Krukenberg]

At the end of the day medicine is just a JOB. If you think of it as any more than that you are setting yourself up for unhappiness. You will not find the fulfillment, life meaning, “calling” you heard about as a young cockroach. Now you got your wings. Reality knocking on door. the world has no problem squishing you and your dreams. You got dreams? F your “dreams”. You want to get home, have a life outside of work and be happy at the end. There are many fields in medicine where people find that to an extent. There is no perfect field as it is just a job. rad onc has pluses and negatives but idea that a good amount of people would not be able to stand other things is ridiculous. Its a job. I always thought it was cool in ER that they just sign off and hand their patients after their shift. they recognize its a job, time to go! sure ER has negatives too but also positives just like us.

It’s a job but I guarantee I would hate spending 60 hours per week in family medicine clinic or the shift work of EM. Most specialties of medicine that I tried included routine things that I didn’t like, except rad onc. Picking a specialty solely because of geographic flexibility is absurd

 

[medgator]

Picking a specialty solely because of geographic flexibility is absurd

As absurd as ignoring it altogether.

 

[thecarbonionangle]

It’s a job but I guarantee I would hate spending 60 hours per week in family medicine clinic or the shift work of EM. Most specialties of medicine that I tried included routine things that I didn’t like, except rad onc. Picking a specialty solely because of geographic flexibility is absurd

that's fine good for you. There's definitely some people who believe they would be miserable doing anything but rad onc, but I get the sense there's people who would have also been happy in other fields, and this likely represents a good chunk of people. I don't believe in extremes, "absolute fit", "soul-mates", whatever you want to call it. The fact is, I think most human beings would probably be ok with multiple situations and multiple people. Some of these things are just timing, chance, etc. The world is a complex casino.

Sure picking a specialty only due to geographic flexibility is absurd. Picking one and ignoring factors that clearly matter to people is equally absurd. Believing that the specialty is a complete free fall where people will make 100k and work with only FMGs is absurd but to ignore the legitimate issues we are facing, and telling people it will all work out, is equally absurd (something i perceive a good amount of "leaders" are doing, and i've even read it thinly veiled or openly in some of the posters here).

Right now, we are all in situations where we may be approached to discuss our field. I choose to highlight positives, negatives, etc and let people make their decision. I do find that some are completely ignoring the negatives or not even discussing them with applicants. We set ourselves up for bad things without transparency. I believe people are open minded and appreciate a field where issues are being addressed and taken seriously. Important things to watch, though not holding breath is, the ABR exams this year, what will come of the Amdur/Lee discussions about our boards (will we actually do the right thing), how we will address our significant challenges going forward of oversupply, hypofrac, underutilization, etc etc. If as an applicant, I objectively feel that these things are truly not being addressed, is it smart to go into rad onc?

 

[thecarbonionangle]

This is what shocked and disheartened me the most as I transitioned from student to resident to attending. Not the problems themselves, not even the fact that they weren’t being addressed, but the fact that there was a clear taboo even to talk about them. This is broader than just the oversupply problem: residencies suppress inconvenient truths about their own programs; the field as a whole suppresses inconvenient truths about the job market. Residents are scared because they need jobs; junior attendings are scared because they need promotions; chairs are willfully oblivious because they surround themselves with sycophants...

Problems do not get solved by being ignored. Like an occult malignancy, they deepen and worsen. Our biggest problems could easily be solved with forthright discussion and some very mild corrective measures. Most estimates of oversupply are 10-15% which means cutting 20-40 spots nationally. Blah blah blah antitrust. All the brilliant minds we match into this field can’t figure out a way to cut a few dozen spots?

Absolutely, even if some may agree we probably should cut some spots, then they're like well of course, not my spots, we need them or why not cut them from this terrible place which should not even exist, I mean do they even do any research?. They have fooled themselves into thinking they need them, they have hired attendings that cannot function without residents or created a culture that enables such set up. I do believe that some departments would really suffer with less residents, but is this really our problem or their problem due to their bad culture? I have seen attendings literally be unable to function without a resident, even young ones.

"leaders" could literally begin by saying, ok my program takes 4+ a year and we are going to take 1-2 less moving forward because we want to LEAD, plus put pressure on other influencial people to also follow suit. Keep dreaming!

Just look at the petty intransigence of the whole ABR debacle. Its another example of our field's issues.

 

[Pointless]

At the end of the day medicine is just a JOB. If you think of it as any more than that you are setting yourself up for unhappiness. You will not find the fulfillment, life meaning, “calling” you heard about as a young cockroach. Now you got your wings. Reality knocking on door. the world has no problem squishing you and your dreams. You got dreams? F your “dreams”. You want to get home, have a life outside of work and be happy at the end. There are many fields in medicine where people find that to an extent. There is no perfect field as it is just a job. rad onc has pluses and negatives but idea that a good amount of people would not be able to stand other things is ridiculous. Its a job. I always thought it was cool in ER that they just sign off and hand their patients after their shift. they recognize its a job, time to go! sure ER has negatives too but also positives just like us.

I am genuinely sorry for whatever happened to you to make you this jaded before you have even graduated residency. I love going to work every day and I don't think I've stumbled across any type of special unicorn job; I think there are plenty like it, though I would think they are becoming increasingly rare in academia. Good luck, hope it works out for you.

 

[thecarbonionangle]

I am genuinely sorry for whatever happened to you to make you this jaded before you have even graduated residency. I love going to work every day and I don't think I've stumbled across any type of special unicorn job; I think there are plenty like it, though I would think they are becoming increasingly rare in academia. Good luck, hope it works out for you.

this is not a situation of "who hurt you". People have had different life experiences. It's a good thing to surround yourself with people from all sort of backgrounds, as this makes you more open minded. Not everybody's past, present, future is a kumbaya moment. Glad it is for you but recognize that is not the case for everyone and people will see things differently from you. Also you're kinda making my point. My point is precisely that there is no "unicorn job" out there, and rad onc is not one. Everything has pros and cons.

 

[Pointless]

this is not a situation of "who hurt you". People have had different life experiences. It's a good thing to surround yourself with people from all sort of backgrounds, as this makes you more open minded. Not everybody's past, present, future is a kumbaya moment. Glad it is for you but recognize that is not the case for everyone and people will see things differently from you. Also you're kinda making my point. My point is precisely that there is no "unicorn job" out there, and rad onc is not one. Everything has pros and cons.

I understand that, it's just unfortunate that you are about to finally escape all of the crap of medical school and residency and your prospects don't have you feeling excited. At this point, its a little late to lament your decision to go into this field, so might as well find the best job you can and hopefully enjoy it. My job is not perfect by any means, but I enjoy it and it seems pretty comparable to other rad oncs that I know and talk with on a regular basis. Whatever is happening in academia/residency doesn't seem to have pervaded into private practice/hospital employment yet. Despite the constant vitriol here on SDN, rad onc right now is a pretty nice gig for most people.

 

[thecarbonionangle]

I understand that, it's just unfortunate that you are about to finally escape all of the crap of medical school and residency and your prospects don't have you feeling excited. At this point, its a little late to lament your decision to go into this field, so might as well find the best job you can and hopefully enjoy it. My job is not perfect by any means, but I enjoy it and it seems pretty comparable to other rad oncs that I know and talk with on a regular basis. Whatever is happening in academia/residency doesn't seem to have pervaded into private practice/hospital employment yet. Despite the constant vitriol here on SDN, rad onc right now is a pretty nice gig for most people.

it is a mix of all the things, not just excitement (frustration, anxiety, the soup of emotions)!, but sure since you want me to talk about excitement. I AM EXCITED!

 

[Krukenberg]

Everything has pros and cons.

I think that is the truth regarding rad onc as a specialty choice for med students right now, however you and others use hyperbole to inflate the cons. SDN did a great job raising the alarm about expansion but is discrediting itself with the rhetoric going around.

 

[medgator]

I think that is the truth regarding rad onc as a specialty choice for med students right now, however you and others use hyperbole to inflate the cons. SDN did a great job raising the alarm about expansion but is discrediting itself with the rhetoric going around.

What rhetoric? Are you implying the stories posted on here by real individuals struggling to find a job that meets at least some of their needs are somehow false?

Or that the published red journal data from 2014 showing 1/3 not being able to find a job in their preferred geographic region is false?

There absolutely has been a tightening in the job market as a result of expansion. Those of us who have graduated a decade+ ago have seen those changes before our very eyes, something likely not appreciated by those of you in training now, or recently graduated.

 

[deleted947887]

I think that is the truth regarding rad onc as a specialty choice for med students right now, however you and others use hyperbole to inflate the cons. SDN did a great job raising the alarm about expansion but is discrediting itself with the rhetoric going around.

You're either a chair or program director looking for fresh meat. My $.02

 

[thecarbonionangle]

I think that is the truth regarding rad onc as a specialty choice for med students right now, however you and others use hyperbole to inflate the cons. SDN did a great job raising the alarm about expansion but is discrediting itself with the rhetoric going around.

I've said before that I know people who had a fantastic time in residency and that there are programs that have a good educational system; I get the sense that you're quite happy and that's awesome!. I have also stated that this has not been my experience (others have as well and this includes residents an attendings, PW actually agrees!). "hyperbole" is all about perspective. There is clear ok im pretty sure that's very exagerated vs. I have never seen that, but it could actually happen (and it does to some people, just because you have not experienced it). Also none of us know eachother (or maybe we do, which would be hilarious), but there's more to people than what it may seem online, so we should all try to not make generalizations about people based on a few posts. Humor is hard to convey sometimes as well as sarcasm, etc.

 

[evilbooyaa]

Almost nobody in Rad Onc complains about the patients, the oncological care we provide, or the technology. Those are the pros. Those will never change. Think about Hospitalists, EM docs, Vascular Surgeons, etc. who complain about the patients. To them, some fraction of the patients are cons.

All that being said, doesn't mean we can't discuss the VERY real cons of going into rad onc. To simply say 'it's pros and cons' in an attempt to dismiss the entire argument is unfortunate, IMO.

 

[thecarbonionangle]

Almost nobody in Rad Onc complains about the patients, the oncological care we provide, or the technology. Those are the pros. Those will never change. Think about Hospitalists, EM docs, Vascular Surgeons, etc. who complain about the patients. To them, some fraction of the patients are cons.

All that being said, doesn't mean we can't discuss the VERY real cons of going into rad onc. To simply say 'it's pros and cons' in an attempt to dismiss the entire argument is unfortunate, IMO.

there's a certain instinct and some people need it more than others that whenever a topic is highlighting too many negatives,people want some "positivity" sprinkled in otherwise they feel it does not affect reality. We already agree on the positive things. Its just making us feel better.

 

[RSAOaky]

I think that is the truth regarding rad onc as a specialty choice for med students right now, however you and others use hyperbole to inflate the cons. SDN did a great job raising the alarm about expansion but is discrediting itself with the rhetoric going around.

SDN did a great job of raising the alarm about expansion. Then nothing was done about expansion. Then a once competitive field went SIGNIFICANTLY unmatched. Then SDN was blamed as the problem and very little was done about expansion.

While I agree that there is some degree of hyperbole about the cons, it is borne out of the complete unwillingness of the powers at be to accept responsibility for or to do anything about them. The people who are against residency expansion are at odds with those who have willingly let it run rampant and, at the same time, have all the control over it and every interest in letting it continue.

All we've heard for the last 3 years that this has been brought up as a problem is "we can't control residency expansion that's illegal." The truth is that we can both reduce the quantity of residents and improve the quality of residents simply by making the residency program requirements more specific and more stringent. Changes that have been proposed to pay lip service, but will not go far enough to make any appreciable difference.

Unfortunately the powers at be have job security, a vested interest in the status quo, and absolutely no desire to break up the old boys club and anger their colleagues so they do just enough to say they're doing something, but not enough to actually make a difference.

 

[bluebubbles]

Estimates of oversupply are 10-15% which means cutting 20-40 spots nationally

On a national basis, cutting 10% of spots might be easy, but it is more challenging for an individual department. IMHO, there are a few types of attendings:

A) Those that can function without a resident and maintain patient volume
B) Those that can function without a resident but with decreased patient volume
C) Those that can't function without a resident due to seniority/tenure, legitimate non-clinical responsibilities, or apathy/laziness
D) Those that can't function without a resident due to competency issues

My guess is: A = 15%, B = 55%, C = 15%, D = 15%. I'm actually very sympathetic towards A & B; in particular, for B, there may be pressure from higher powers to maximize or maintain patient volume. C is tough, because no matter what happens on that attending's service, they are untouchable for one reason or another, and any mistakes fall on the resident's shoulders. D is the worst. Their incompetence might've been ignored because of nepotism (daddy's a bigwig in rad onc), because their former PD/chair was afraid to discipline them, because their former residency program was a poor training environment, etc. I am hesitant to join the voices of those calling for "easier" board exams because if anything, clinical written & oral boards should be more difficult. (radbio & physics are, like, whatever). IMO, fellowships should be reserved for those that are subpar clinically, instead of those that failed to network aggressively. In any case, as much as I hate working with C or D, I would never want C or D to be uncovered, and that's what would happen if residencies started cutting spots.

There may be a component of old white men swigging expensive alcohol while conspiring to expand residencies, but the cause for workforce oversupply was and is likely more systemic/decentralized.

With the Affordable Care Act (2008-2016), there was a push towards ACO's or consolidated care delivery systems, so academic hospitals started buying up private practices. By my estimate, with 15 rad onc's per department x 100 departments, there are 1500 academic attendings nationally (including satellite/VA), and 2500 private practice attendings. Whatever the specific numbers are, the % of academics is way too high, and these academics push up the demand & reliance on residency labor because of A-D above. The culture of academics is not one of self-sufficiency; to be fair, there's a legitimate role for resident/NP/PA coverage for true clinician-educators, clinician-scientists, clinical leadership, etc. However, my guess is that compared to private practice, a 100% clinical "academic" isn't expected to run his or her clinic without a resident/NP/PA for at least part of the year. How many academic hospitals are rich and/or disciplined enough to get NP/PA's instead of residents?

One potential fix for workforce oversupply is to undo the consolidation of private practices into academic systems (which, let's be honest, are less & less academic and more & more revenue machines). It's popular for residents to clamor for attendings to be uncovered but this is a subpar solution. Robbing Peter to pay Paul. It'd be better if the pseudo-academic, 100% clinical jobs were just replaced by legit, independent private practice jobs.

In any case, it's hard for me to be upset or point fingers; workforce oversupply is just an unfortunate situation. If it sounds like it's out of my hands, that's because it is. I'm just a resident.

Speculative monologue-of-the-day over.

 

[bluebubbles]

Leadership (e.g. chairs) might seem like big fish, but there are bigger fish (hospital CEO's), and bigger fish still (legislators, insurers, healthcare reimbursement environment). Even if they wanted to act unilaterally, I'm not sure they could. Shrugs.