Perspective of PGY2 at "top 10" program

[deleted573262]

Not sure where to put this, but this seems like an okay spot....

Family Medicine Doc Slays Over a Half-Million Dollar Debt | White Coat Investor

This family medicine physician knocked out over $510k in debt and has his sights now set on financial independence. Here's how he got it done.

www.whitecoatinvestor.com

"I have earned around $300,000 a year as a family doctor for the past 5 years on a fairly light clinical schedule. I currently work only Monday, Tuesday and Wednesday most weeks except for 10 weekends a year where I do day shift hospitalist work. With a part-time like schedule and a 4 day weekend most weeks, I don’t feel too much burnout."

hospital medicine is thriving. a friend signed a contract to see psych outpatients 32 hrs/week and take call once a month. he's making 400k first year out of psych residency. some joke that psych is the new derm and there's good reason.

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[deleted947887]

The level of greed among posters on this forum is astounding. Medicine is a calling. Physicians should be willing to go wherever for whatever. Just think of the poor chairs and how much work they are putting in for so little.
All for what you ask? To allow radiation oncology to enter into the house of medicine (once again).

You should all be ashamed of yourselves.

 

[thecarbonionangle]

hospital medicine is thriving. a friend signed a contract to see psych outpatients 32 hrs/week and take call once a month. he's making 400k first year out of psych residency. some joke that psych is the new derm and there's good reason.

psych has changed a lot over past few years, it is increasingly competitive and more lucrative

 

[radoncgrad2019]

Only way I would do Psych is if I matched rad onc at a place like Baylor!

 

[deleted774703]

Only way I would do Psych is if I matched rad onc at a place like Baylor!

I got a lot of heat for saying I wouldn’t go to Baylor and it’s mediocre program when making my program tiers

very interesting it keeps coming up now. Must be a dumpster fire lol

 

[RickyScott]

I dont care the program; prospect of being forced into unacceptable geography,
would make me pass on the field.

 

[PhotonBomb]

I got a lot of heat for saying I wouldn’t go to Baylor and it’s mediocre program when making my program tiers

very interesting it keeps coming up now. Must be a dumpster fire lol

Place is worse than you can imagine.

 

[PhotonBomb]

medgator and KHE are a dyad in the Force like Kylo and Rey. Place needs both.

 

[bluebubbles]

As much as I agree that residency programs ought to be held to higher standards, and that poorly performing or even just below average programs should be closed or contracted (a la Jack Welch's General Electric), I can't help thinking we're missing part of the picture.

To my knowledge, the hospital systems behind the "big 3" programs serve a predominantly wealthy or at least well-insured clientele. On the flip side, some programs with difficulty filling in the MATCH in recent years (USC, Miami, etc.) primarily serve the indigent and uninsured at a county hospital, as does Baylor. This is not coincidence. Well-capitalized hospital systems can perhaps provide residency programs with more resources for didactics & research, and for radiation oncology in particular, additional exposure to shiny objects (ahem, "capital-intensive technology") like protons. These things are good for residents, though they may come at a cost.

For example, for indigent patients, is it realistic that they receive their radiation oncology care at UCLA/Cedars or MDA? Perhaps. Certainly, there's a recent wave of interest in enrolling minorities onto clinical trials; however, for the trials that I'm personally aware of, the sponsor requires that patients bring their own insurance to cover standard of care. Further, for certain hospitals, the bottom line and staying in the black is of utmost importance, and as any trialist knows, patient selection is critical.

When programs go unfilled in 2020, including many that care for underserved patients, is that entirely a good thing if we look past our schadenfreude and job market woes? Just playing devil's advocate.

 

[baculum1]

As much as I agree that residency programs ought to be held to higher standards, and that poorly performing or even just below average programs should be closed or contracted (a la Jack Welch's General Electric), I can't help thinking we're missing part of the picture.

To my knowledge, the hospital systems behind the "big 3" programs serve a predominantly wealthy or at least well-insured clientele. On the flip side, some programs with difficulty filling in the MATCH in recent years (USC, Miami, etc.) primarily serve the indigent and uninsured at a county hospital, as does Baylor. This is not coincidence. Well-capitalized hospital systems can perhaps provide residency programs with more resources for didactics & research, and for radiation oncology in particular, additional exposure to shiny objects (ahem, "capital-intensive technology") like protons. These things are good for residents, though they may come at a cost.

For example, for indigent patients, is it realistic that they receive their radiation oncology care at UCLA/Cedars or MDA? Perhaps. Certainly, there's a recent wave of interest in enrolling minorities onto clinical trials; however, for the trials that I'm personally aware of, the sponsor requires that patients bring their own insurance to cover standard of care. Further, for certain hospitals, the bottom line and staying in the black is of utmost importance, and as any trialist knows, patient selection is critical.

When programs go unfilled in 2020, including many that care for underserved patients, is that entirely a good thing if we look past our schadenfreude and job market woes? Just playing devil's advocate.

Closing down a bad no good program because it fails to provide education and oppportunities for residents should be done regardless of where these residents write notes. The hospitals will continue to operate without the residents and if they fall apart it will tell you it was a highly abusive program to begin with. most of the programs you mentioned are at risk of not matching because they are bad not because people don’t want to treat the poor. The field should not be afraid to close or suspend bad programs until improvement happens in the current situation.

I see no reason anybody should rank a bad program unless one needs to be in that city for very strong personal family reasons. This is a buyer’s market. Please do not go to a bad program. Message any of us if you have doubts

 

[radoncgrad2019]

The EMPIRE never pays for IMRT. *****holes.

 

[deleted774703]

As much as I agree that residency programs ought to be held to higher standards, and that poorly performing or even just below average programs should be closed or contracted (a la Jack Welch's General Electric), I can't help thinking we're missing part of the picture.

To my knowledge, the hospital systems behind the "big 3" programs serve a predominantly wealthy or at least well-insured clientele. On the flip side, some programs with difficulty filling in the MATCH in recent years (USC, Miami, etc.) primarily serve the indigent and uninsured at a county hospital, as does Baylor. This is not coincidence. Well-capitalized hospital systems can perhaps provide residency programs with more resources for didactics & research, and for radiation oncology in particular, additional exposure to shiny objects (ahem, "capital-intensive technology") like protons. These things are good for residents, though they may come at a cost.

For example, for indigent patients, is it realistic that they receive their radiation oncology care at UCLA/Cedars or MDA? Perhaps. Certainly, there's a recent wave of interest in enrolling minorities onto clinical trials; however, for the trials that I'm personally aware of, the sponsor requires that patients bring their own insurance to cover standard of care. Further, for certain hospitals, the bottom line and staying in the black is of utmost importance, and as any trialist knows, patient selection is critical.

When programs go unfilled in 2020, including many that care for underserved patients, is that entirely a good thing if we look past our schadenfreude and job market woes? Just playing devil's advocate.

I STRONGLY DISAGREE with this argument

It is not a rad onc RESIDENTS duty to be the primary care taker of underserved patients

If that institution truly cares about that specific population then they should hire MORE ATTENDINGS

Too often residents are used as rationale for what is an instutitions and attendings job

 

[radoncgrad2019]

I see where BlueBubbles is coming from, but that's a slippery slope.

the same exact thing can be said about the job market - 'Well if we contract residency slots, there will be less people to go and serve rural areas' which btw is true.

 

[Mandelin Rain]

Ideally, not all future rad oncs are only comfortable treating rich white people with considerable personal resources in a completely optimized clinical milieu.

 

[RadOncDoc21]

medgator and KHE are a dyad in the Force like Kylo and Rey. Place needs both.

Agree.... def not the same without them. I’ll pour out some liquor for them!

 

[radoncgrad2019]

Ideally, not all future rad oncs are only comfortable treating rich white people with considerable personal resources in a completely optimized clinical milieu.

this is a bit of a stretch too lol.

 

[baculum1]

I STRONGLY DISAGREE with this argument

It is not a rad onc RESIDENTS duty to be the primary care taker of underserved patients

If that institution truly cares about that specific population then they should hire MORE ATTENDINGS

Too often residents are used as rationale for what is an instutitions and attendings job

Agree some people act like it is all on the residents. What exactly is the responsibility of some of these “attendings”. Sole purpose of a residency is to educate. If attendings cannot function on their own without residents these places don’t deserve to exist and i strongly doubt they are even providing the best patient care. Close all these places down and stop making excuses for bad programs which have consistently been bad

 

[metallica81788]

Ideally, not all future rad oncs are only comfortable treating rich white people with considerable personal resources in a completely optimized clinical milieu.

Those are my least favorite types of patients. IMO, residency should provide you with the experience to take care of all different types of patients - the rich, the poor, diverse, etc in any set of circumstances. This prepares you for any type of job with any type of clinical support. I wouldn't know, but I would imagine grads of some of the top programs don't know what it is like to not have everything available to them at their fingertips. The real world takes some improvisation and things that go beyond didactics and tumor boards.

 

[baculum1]

but I would imagine grads of some of the top programs don't know what it is like to not have everything available to them at their fingertips. The real world takes some improvisation and things that go beyond didactics and tumor boards.

i have heard this yeah but i would encourage applicants to seek out programs which provide good clinical training while providing a great education and good career opportunities for residents.Those two concepts are not mutually exclusive

 

[radoncgrad2019]

i have heard this yeah but i would encourage applicants to seek out programs which provide good clinical training while providing a great education and good career opportunities for residents.Those two concepts are not mutually exclusive

exactly. I think the idea that 'good' programs are elitist, serve the rich, and don't teach you how to think/be creative/treat all kinds of patients is silly AF.

be better, SDN.

 

[radoncgrad2019]

if anything, that's what the PD at a bad bad program would love to tell you. like a Michelle Ludwig type (BCM) or a Formenti type at Cornell

'We may not educate you, but we will work you to the bone and you will learn how to be a REAL DOCTOR! our 'clinical training' is second to none and by 'clinical training' we just mean you are going to see a ton of patients and contour a ton of cases with minimal guidance or input!' Education is for people who don't learn how to be REAL doctors like me and you'

 

[Mandelin Rain]

This prepares you for any type of job with any type of clinical support. I wouldn't know, but I would imagine grads of some of the top programs don't know what it is like to not have everything available to them at their fingertips. The real world takes some improvisation and things that go beyond didactics and tumor boards.

I have noticed this phenomenon. "What do you mean there isn't an Onc Psych/Onc Pain/Oral Surgeon/Nav Bronch/whatever service immediately available?"

 

[metallica81788]

if anything, that's what the PD at a bad bad program would love to tell you. like a Michelle Ludwig type (BCM) or a Formenti type at Cornell

'We may not educate you, but we will work you to the bone and you will learn how to be a REAL DOCTOR! our 'clinical training' is second to none and by 'clinical training' we just mean you are going to see a ton of patients and contour a ton of cases with minimal guidance or input!' Education is for people who don't learn how to be REAL doctors like me and you'

Oh it's definitely what PDs of bad programs that will overwork and undereducate you will say. I've heard it and experienced it. The concepts should not be mutually exclusive. If you think I'm trying to bash elite programs, you have misread me. I'm all for fewer residency programs with better education.

The fact is that elite programs and even non-elite programs have resources that many smaller or more rural hospital systems do not have when it comes to coordinating patient care. Learning how to navigate and problem-solve things like the below without hand-holding and when circumstances are not ideal is very useful in many real world jobs (like plenty of the few that will be available in the future). The residents at these programs will be okay in the end (or continue to work at places with all of these advantages) but it doesn't hurt to have practice.

"What do you mean there isn't an Onc Psych/Onc Pain/Oral Surgeon/Nav Bronch/whatever service immediately available?"/QUOTE]

 

[baculum1]

Oh it's definitely what PDs of bad programs that will overwork and undereducate you will say. I've heard it and experienced it. The concepts should not be mutually exclusive. If you think I'm trying to bash elite programs, you have misread me. I'm all for fewer residency programs with better education.

The fact is that elite programs and even non-elite programs have resources that many smaller or more rural hospital systems do not have when it comes to coordinating patient care. Learning how to navigate and problem-solve things like the below without hand-holding and when circumstances are not ideal is very useful in many real world jobs (like plenty of the few that will be available in the future). The residents at these programs will be okay in the end (or continue to work at places with all of these advantages) but it doesn't hurt to have practice.

Do you believe your former program which overworked you and undereducated you should be shut down?
I am glad people are mentioning programs which already do this. Heres to hoping more people step up and name more places

 

[baculum1]

Agree.... def not the same without them. I’ll pour out some liquor for them!

Please leave me some whiskey, i need it to drown my sorrows, the rest can go to khe and alligator

 

[deleted1002574]

Read it again
The stats she is quoting is from the report a few decades ago.

 

[RadOncMegatron]

Read it again
The stats she is quoting is from the report a few decades ago.

My bad you are correct. Post deleted.