Private practice "rankings"

[medgator]

Hard to get a job as a medical director as a fresh grad lol. I'm not applying for those because who would take me seriously (unless it's a solo doc practice) as a fresh grad becoming the medical director?

I know someone who took one of those remote solo jobs out west. Definitely jarring as a new grad but they managed to pass orals and make a boatload of money. Prob not for everyone

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[seper]

"Medical director" descriptor at a solo place does not add any extra meaningful duties. In fact, it only adds to salary.

 

[scarbrtj]

Hard to get a job as a medical director as a fresh grad lol. I'm not applying for those because who would take me seriously (unless it's a solo doc practice) as a fresh grad becoming the medical director?

Fifteen or more years ago many practices would take fresh or one year old grads as medical directors because rad oncs were known, outside of radiation oncology, as being--and I quote--"rare as hens' teeth."

 

[nkmiami]

Not trying to take a "side," but I feel like xrthopeful and I are on a similar page and figured I'd respond to this. I've made similar statements as xrthopeful for reasons described previously, mainly that I feel like the job market this year was pretty good because the vast majority of big cities where I was looking had at least one job opportunity. I called it "good" relative to the previous few years where several of those cities didn't have jobs (to be fair, not as bad doesn't equal good). We would all probably agree that, if we were to simply state "these 10 cities had 15 jobs" or whatever so that makes it good, it would be disrespectful to the candidates not positioned well to get one of those jobs. Echoing my previous post, but I only pulled off my job by messaging (e.g. LinkedIn), emailing & calling many practices early in the process. Current PGY4s (rising PGY5s): if you haven't started yet, please please start reaching out to practices you may be interested in joining. I assure you that it's okay if you take a few hour break from studying to do this. I was very surprised when I spoke with several friends (PGY5s at the time) at ASTRO last year who hadn't really started the process yet. It very well may have worked out fine for them, but that's risky. Many of the elite groups decide early.

I can't imagine the stress of having failed radbio or physics or not having found a job yet and wish that on no one. It would certainly be easy for a practice to think "why didn't this person land a job last year or why did they fail physics/radbio? Something must be wrong," but as we've written a lot about, you can do everything pretty well and still not have it work out on time. So, in fairness to the individuals not fortunate enough to have found a job yet, I'd like to share something with those on here who have hiring power and are willing to consider this statement from me (a nobody to you): though you may have some innate concerns about competency or training, as long as we acknowledge a certain fundamentally-necessary work ethic and ability or baseline of training of the candidate, please remember that the minutiae of training/practicing the way you'd like them to practice can always come later, but you cannot retrain cultural fit. Cultural fit should far outweigh the details of "didn't find a job as a PGY5" or whatever when choosing a candidate. And on that note, if you're reading this in the future and feel like you work hard and are a genuinely good person (what I value in my team infinitely more than knowing the function of Wee1), please don't hesitate to PM me to ask if I know of any job.

Given what it would have taken any current pgy5 to match in this field, even in a lower tier program, it is very disheartening that there is a component of them who cant find jobs/experiencing great difficulties. When California Pacific, closed and posted online details, they were far better residency candidates than I was. It is simply not acceptable, if even one in 10 residents with 250+ board scores/AOA /research pubs has difficulty finding a job or a forced into an exploitative one.

I again want to state that in terms of a solution, networking early is not the answer as it does not increase the number of jobs. If you networked early and got a job, great for you, but this is a zero sum game, and obviously you just took a job that would have gone to someone else. In the end someone has to get screwed if there are not enough jobs.

 

[KHE88]

Given what it would have taken any current pgy5 to match in this field, even in a lower tier program, it is very disheartening that there is a component of them who cant find jobs/experiencing great difficulties.

There was also this thing that happened where the ABR failed 50% of these same previously top performing med students turned residents on a "minimal competence" board exam. And then published opinion articles stating that the reason for the 5 standard deviation abnormality was simply due to stupider or more complacent residents. And then bullied them into submission and patronized them face to face at the 2018 ASTRO meeting.

Again, this was a thing that actually happened. I think it bears repeating ad infinitum what Mr. Wallner and Miss Kachnic did at the helm of the ABR.

 

[nkmiami]

There was also this thing that happened where the ABR failed 50% of these same previously top performing med students turned residents on a "minimal competence" board exam. And then published opinion articles stating that the reason for the 5 standard deviation abnormality was simply due to stupider or more complacent residents.

Again, this was a thing that actually happened. I think it bears repeating ad infinitum what Mr. Wallner and Miss Kachnic did at the helm of the ABR.

Sure, but my issue is there still needs to be enough job openings for those 50%. Failing 50% should not significantly decrease the number of openings. In fact, I have spoken with several residents who passed their boards had great difficulties in the job search (you could argue in fact that it should have given them a significant competitive advantage, that those who passed should have an easy time finding a job)

 

[scarbrtj]

Given what it would have taken any current pgy5 to match in this field, even in a lower tier program, it is very disheartening that there is a component of them who cant find jobs/experiencing great difficulties. When California Pacific, closed and posted online details, they were far better residency candidates than I was. It is simply not acceptable, if one in 10 residents with 250+ board scores/AOA /research pubs has difficulty finding a job or a forced into an exploitative one.

I again want to state that in terms of a solution, networking early is not the answer as it does not increase the number of jobs. If you networked early and got a job, great for you, but this is a zero sum game, and obviously you just took a job that would have gone to someone else. In the end someone has to get screwed if there are not enough jobs.

You're not kidding.

 

[deleted947887]

You're not kidding.

#protecttheinnocent

#savemedicalstudents

#dontdieinthedessert

 

[BobbyHeenan]

...and still the worst part about that infographic is ASTRO gives an A-OK to treating with protons for prostate as long as it's on a (worthless) registry trial. Strong stance there, guys.

 

[scarbrtj]

...and still the worst part about that infographic is ASTRO gives an A-OK to treating with protons for prostate as long as it's on a (worthless) registry trial. Strong stance there, guys.

Eh, don't get me started. One of the most statistically significantly positive RT-centric trial results of all time, and the all-seeing, all-powerful ASTROians essentially say: the it-says-IMRT-in-the-article-title trials were not IMRT. Only instance in the history of medicine a specialty society came out in strong disfavor of a clinically positive trial AFAIK to the extent that the society had to redefine de novo/sans peer review the trial's arms. (No need to argue with me; I know I'm "wrong.")

 

[Gfunk6]

You're not kidding.

This is hilarious. However, I think it should be "don't routinely consider radiation oncology" to stick with the theme of what is presented.

 

[medgator]

Fifteen or more years ago many practices would take fresh or one year old grads as medical directors because rad oncs were known, outside of radiation oncology, as being--and I quote--"rare as hens' teeth."

Good thing our incompetent leadership "fixed" that problem

 

[deleted941485]

Hard to get a job as a medical director as a fresh grad lol. I'm not applying for those because who would take me seriously (unless it's a solo doc practice) as a fresh grad becoming the medical director?

Places like that can be picky. Even these out of the way places in the south are being snatched up like hot cakes.

I saw one in AL last week like actually within an hour from a city!! Next thing I know WHAM!! Gone! Job in KY? Sorry man we have a ton of applicants to interview already. Literally at this point if you want a job and they post the salary if you really want to work there tell them you’ll take a 20% pay cut for the contract.

 

[Krukenberg]

Depends on your subspecialty and whether you want to do private practice or academics. Without a more specific set of criteria, I can tell you the fastest growing markets are in the midwest and central US. On the coast, expect lots of competition, especially in academics, and as much as 100-200K less pay than if you go somewhere less "desirable." The major cities are saturated and if you practice something very specific (such as myself), those job openings may not be available. However, if you absolutely must live in a major city, be prepared to give up some of your wish list items -- I rejected a job offer that was in a major city but would not offer me opportunity for research, which was important to me.

Was randomly browsing SDN and came across an AMA from an ortho attending. Med student asked if jobs in desirable cities were available in ortho. Interesting answer. The grass isn’t always greener guys

 

[deleted941485]

Was randomly browsing SDN and came across an AMA from an ortho attending. Med student asked if jobs in desirable cities were available in ortho. Interesting answer. The grass isn’t always greener guys

You can get an attending position in a city which is a huge difference. You probably will be doing Hips and knees till you drop and taking trauma call every other week for 400K and no partnership but they are available. For RO it’s just, sorry man there’s nothing really here

 

[Krukenberg]

You can get an attending position in a city which is a huge difference. You probably will be doing Hips and knees till you drop and taking trauma call every other week for 400K and no partnership but they are available. For RO it’s just, sorry man there’s nothing really here

What good is living in a “desirable” city if you have a terrible job that pays poorly? It’s a recipe for unhappiness. She said it herself: all the growth in the ortho job market is in the Midwest.

 

[deleted941485]

What good is living in a “desirable” city if you have a terrible job that pays poorly? It’s a recipe for unhappiness. She said it herself: all the growth in the ortho job market is in the Midwest.

Very true. Which I why I marvel at people that take attending jobs in NYC for the cultural diversity cuisine and night life. Meanwhile they are making less and on call all the time and half their paycheck goes to that new luxury apartment in Manhattan they can barely afford. They end up living like residents.

BUT...at least that’s an option for them as crappy as it may be.

 

[Krukenberg]

Very true. Which I why I marvel at people that take attending jobs in NYC for the cultural diversity cuisine and night life. Meanwhile they are making less and on call all the time and half their paycheck goes to that new luxury apartment in Manhattan they can barely afford. They end up living like residents.

BUT...at least that’s an option for them as crappy as it may be.

Give me a job any day where I can come home happy, make enough to save for an early retirement, and fly to a desirable city for the weekend than a job in nyc where I’m miserable, making less money, and spending more money to suffer through all of it.

I’m right there with everyone that expansion makes NO sense and puts the field at risk, but hyperbole has overtaken this forum and may be more of a threat to the specialty if the quality of our applicant pool plummets. We need the brightest minds to innovate this field and create new indications.

The job market in desirable cities is pretty crappy across all specialties. If you want to live in a big city and make a great income then don’t go into medicine, period.

 

[medgator]

For RO it’s just, sorry man there’s nothing really here

Or here.....let's give you this non tenure-track "mentored faculty position" where we pay you a little more than a fellow....

 

[deleted947887]

Give me a job any day where I can come home happy, make enough to save for an early retirement, and fly to a desirable city for the weekend than a job in nyc where I’m miserable, making less money, and spending more money to suffer through all of it.

I’m right there with everyone that expansion makes NO sense and puts the field at risk, but hyperbole has overtaken this forum and may be more of a threat to the specialty if the quality of our applicant pool plummets. We need the brightest minds to innovate this field and create new indications.

The job market in desirable cities is pretty crappy across all specialties. If you want to live in a big city and make a great income then don’t go into medicine, period.

The quality of the application pool plummeting is a product of decisions made by those in academics. It is not fair to place this responsibility on the misanthropes of sdn. With twitter, it is easy to message Kavnough, Kacnic, Steinberger, and all the other academics responsible for the fall of the specialty. Why is the blame being directed here? If they dont care about the health of the specialty, why should we? This nonsense about the fall in the quality of residents is all a ruse to continue the pyrimad scheme.

 

[deleted941485]

The quality of the application pool plummeting is a product of decisions made by those in academics. It is not fair to place this responsibility on the misanthropes of sdn. With twitter, it is easy to message Kavnough, Kacnic, Steinberger, and all the other academics responsible for the fall of the specialty. Why is the blame being directed here? If they dont care about the health of the specialty, why should we? This nonsense about the fall in the quality of residents is all a ruse to continue the pyrimad scheme.

Correct me if I’m wrong but didn’t PW and kachnic retract a paper from PRO that basically says just that. They probably retracted it because it would reveal too much of their own agenda which is to fail people on the boards after they’d spent 3 years in the freaking specialty

 

[medgator]

hyperbole has overtaken this forum and may be more of a threat to the specialty if the quality of our applicant pool plummets.

You can thank the powers that be in academics for that. I certainly wouldn't blame SDN for being the Canary in the coal mine on this issue several years ago.

We literally have data from 2014 showing 1/3 of graduates not being able to obtain a job in their preferred geographic region when the job market arguably was much better.

 

[deleted947887]

Correct me if I’m wrong but didn’t PW and kachnic retract a paper from PRO that basically says just that. They probably retracted it because it would reveal too much of their own agenda which is to fail people on the boards after they’d spent 3 years in the freaking specialty

The fact that paper made it past the editorial board says a lot about the specialty's mantra of "eat your young."

In what other specialty would someone allow inflammatory garbage like that to be directed at another group of physicians, much less, a group of physicians in your own specialty??? It is idiotic, but great that the they allowed it to make it past the editor. It spelled things out for anyone who had any doubt. That, and the fact that there was a PD on here (a real "class act") posting about "keeping the animals out." No, the fall of the specialty is a result of greed, elitism, and incompetent academics.

 

[Krukenberg]

You can thank the powers that be in academics for that. I certainly wouldn't blame SDN for being the Canary in the coal mine on this issue several years ago.

We literally have data from 2014 showing 1/3 of graduates not being able to obtain a job in their preferred geographic region when the job market arguably was much better.

Totally agree about SDN leading the way on this critical issue. But I’ve seen the specialty described as “wretched,” “ruined,” and all sorts of negative terms here as if the job market has already collapsed. I’ve talked to med students second guessing their interest in rad onc not because of a concern about the job market but because the specialty is described as ruined on SDN. I think the rhetoric we should be using is that it’s fulfilling work that always has required geographic flexibility (look at the old FAQ), and there are major concerns about the expansion and how that will affect job markets in the future. However we don’t have evidence yet that grads are having to do fellowships en masse.

Give med students an honest appraisal of the current state without supercharged rhetoric and let them weigh the balance of pros and cons. I think there are so many downsides to med onc, and I’d hate for students who otherwise would have loved the work in rad onc to instead choose heme/onc.

We should continue to pressure Astro and others about the expansion. ARRO day at Astro will have a panel on residency expansion and job market. If there’s a Q & A portion we can express concerns at that too

 

[medgator]

Totally agree about SDN leading the way on this critical issue. But I’ve seen the specialty described as “wretched,” “ruined,” and all sorts of negative terms here as if the job market has already collapsed. I’ve talked to med students second guessing their interest in rad onc not because of a concern about the job market but because the specialty is described as ruined on SDN. I think the rhetoric we should be using is that it’s fulfilling work that always has required geographic flexibility (look at the old FAQ), and there are major concerns about the expansion and how that will affect job markets in the future. However we don’t have evidence yet that grads are having to do fellowships en masse.

Give med students an honest appraisal of the current state without supercharged rhetoric and let them weigh the balance of pros and cons. I think there are so many downsides to med onc, and I’d hate for students who otherwise would have loved the work in rad onc to instead choose heme/onc.

We should continue to pressure Astro and others about the expansion. ARRO day at Astro will have a panel on residency expansion and job market. If there’s a Q & A portion we can express concerns at that too

I think, like everything, SDN should be taken with a grain of salt. It's just been crazy to watch what has happened with the job market thanks in part to residency expansion coupled with hypofractionation taking off for much of bread and butter RO.

The mantra was pick 2/3 (job quality, big salary or location). Now it's down to 0 or 1 for many it seems. ASTRO and the powers at be were asleep at the wheel until the most recent match, while SDN had been on target about this for years...

 

[Chartreuse Wombat]

Correct me if I’m wrong but didn’t PW and kachnic retract a paper from PRO that basically says just that. They probably retracted it because it would reveal too much of their own agenda which is to fail people on the boards after they’d spent 3 years in the freaking specialty

This is not true. The paper was not retracted. It was taken down temporarily because some references were left out of the manuscript originally published. The paper is available online.

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology - PubMed

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology

www.ncbi.nlm.nih.gov

 

[medgator]

This is not true. The paper was not retracted. It was taken down temporarily because some references were left out of the manuscript originally published. The paper is available online.

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology - PubMed

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology

www.ncbi.nlm.nih.gov

Crazy. I wonder which PP physicians blessed that alphabet soup of radiobiology questions on the most recent exam.

I guess we will see how things go on the next exam, but unfortunately it seems like the bottom truly does need to fall out of the specialty before the ABR (and ASTRO) gets a clue...

 

[deleted947887]

This is not true. The paper was not retracted. It was taken down temporarily because some references were left out of the manuscript originally published. The paper is available online.

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology - PubMed

Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology

www.ncbi.nlm.nih.gov

What do you think is a lower point for the specialty:

1) having to cite wikipedia in published articles ?

2) worrying about an online social media network for medical students (so much so, that they have to publish articles about it)?

 

[medgator]

What do you think is a lower point for the specialty:

1) having to cite wikipedia in published articles ?

2) worrying about an online social media network for medical students (so much so, that they have to publish articles about it)?

To play devil's advocate, is it not possible that stats and quality of entering residents went down when the specialty collectively decided to increase spots annually, often by double digits? And wouldn't that also represent a low point for the specialty?

 

[deleted947887]

To play devil's advocate, is it not possible that stats and quality of entering residents went down when the specialty collectively decided to increase spots annually, often by double digits? And wouldn't that also represent a low point for the specialty?

You are right. I should add a number 3

3) when academics became unable to run their own clinic independently?

 

[GapCalc]

However we don’t have evidence yet that grads are having to do fellowships en masse.

I'm fairly certain you wrote this off-handedly, but "grads having to do fellowships en masse" is beyond a bad job market. That's a catastrophe. That's a year of lost income, another year of accumulating student loan interest, another move away from friends/family, all without a real value-add outside of a few specific areas like brachytherapy or peds. I would argue that there is a line that constitutes a "bad job market" and it comes much earlier than near-mandatory fellowships.

Are we there yet? I would argue yes, but reasonable people can disagree. However, to say that we aren't headed in a very, very troubling direction with increasing # docs per year and a decreasing # number of fractions/indications is intellectually dishonest. This may turn around on phase III oligomet data, but if I were a med student evaluating my career options, I wouldn't predicate my future on that supposition.

Give med students an honest appraisal of the current state without supercharged rhetoric and let them weigh the balance of pros and cons. I think there are so many downsides to med onc, and I’d hate for students who otherwise would have loved the work in rad onc to instead choose heme/onc.

Agreed. I don't think any med student interested in rad onc should automatically do IM and heme onc instead, I just think it's important to encourage med students to have a good idea what the other options are out there.

To play devil's advocate, is it not possible that stats and quality of entering residents went down when the specialty collectively decided to increase spots annually, often by double digits?

Thankfully, we have data in the form of "Charting Outcomes in the Match" to evaluate this. Here it is:

2007
# Matched: 134 (US + independent)
Mean/Median Step 1: 235/236
25-7th %ile: 223-248
AOA: 24$%
PhD 21%
Mean abstracts/presentations/pubs: 6.3

2009
# Matched: 142
Mean/Median Step 1: 238/241
25-7th %ile: not reported
AOA: 35%
PhD 22%
Mean abstracts/presentations/pubs: 9.7

2011
# matched: 164
Mean/Median Step 1: 240/244
25-7th %ile: not reported
AOA: 31%
PhD 22%
Mean abstracts/presentations/pubs: 8.3

2014 -- this group was PGY4s during 2018 rad bio/phys testing
# matched: 177
Mean/Median Step 1: 241/248
25-7th %ile: not reported
AOA: 23.6%
PhD 23%
Mean abstracts/presentations/pubs: 12.2

2016 -- reported differently from prior years; NRMP required applicants to 'opt in' to report data; may skew data
# matched: 149 (lower than NRMP reported # of 185 matches)
Mean/Median Step 1: 247/251
25-7th %ile: not reported
AOA: 27.5%
PhD 24.8%
Mean abstracts/presentations/pubs: 12.7

2018 -- like 2016, this was self-reported data and sample may be skewed
# matched: 165 (lower than NRMP reported # of 188 matches)
Mean/Median Step 1: 247/253
25-7th %ile: not reported
AOA: 35.2%
PhD 20.8%
Mean abstracts/presentations/pubs: 15.6

Additionally, someone asked Dr. Kachnic at the ARRO seminar at ASTRO 2018 how the 2018 examinees did on the 'recycled' questions. Apparently, these recycled questions comprise something like 30-60% of the test every year. These re-used questions can provide perspective and year-to-year comparisons. Apparently the 2018 examinees did, on average, better on those reused questions than did the examinees who answered the same questions in 2017.

Taken together with the match data, I have trouble believing that as of 2016, our applicants are the driving factor behind worse exam performance.

 

[deleted947887]

I'm fairly certain you wrote this off-handedly, but "grads having to do fellowships en masse" is beyond a bad job market. That's a catastrophe. That's a year of lost income, another year of accumulating student loan interest, another move away from friends/family, all without a real value-add outside of a few specific areas like brachytherapy or peds. I would argue that there is a line that constitutes a "bad job market" and it comes much earlier than near-mandatory fellowships.

Are we there yet? I would argue yes, but reasonable people can disagree. However, to say that we aren't headed in a very, very troubling direction with increasing # docs per year and a decreasing # number of fractions/indications is intellectually dishonest. This may turn around on phase III oligomet data, but if I were a med student evaluating my career options, I wouldn't predicate my future on that supposition.



Agreed. I don't think any med student interested in rad onc should automatically do IM and heme onc instead, I just think it's important to encourage med students to have a good idea what the other options are out there.



Thankfully, we have data in the form of "Charting Outcomes in the Match" to evaluate this. Here it is:

2007
# Matched: 134 (US + independent)
Mean/Median Step 1: 235/236
25-7th %ile: 223-248
AOA: 24$%
PhD 21%
Mean abstracts/presentations/pubs: 6.3

2009
# Matched: 142
Mean/Median Step 1: 238/241
25-7th %ile: not reported
AOA: 35%
PhD 22%
Mean abstracts/presentations/pubs: 9.7

2011
# matched: 164
Mean/Median Step 1: 240/244
25-7th %ile: not reported
AOA: 31%
PhD 22%
Mean abstracts/presentations/pubs: 8.3

2014 -- this group was PGY4s during 2018 rad bio/phys testing
# matched: 177
Mean/Median Step 1: 241/248
25-7th %ile: not reported
AOA: 23.6%
PhD 23%
Mean abstracts/presentations/pubs: 12.2

2016 -- reported differently from prior years; NRMP required applicants to 'opt in' to report data; may skew data
# matched: 149 (lower than NRMP reported # of 185 matches)
Mean/Median Step 1: 247/251
25-7th %ile: not reported
AOA: 27.5%
PhD 24.8%
Mean abstracts/presentations/pubs: 12.7

2018 -- like 2016, this was self-reported data and sample may be skewed
# matched: 165 (lower than NRMP reported # of 188 matches)
Mean/Median Step 1: 247/253
25-7th %ile: not reported
AOA: 35.2%
PhD 20.8%
Mean abstracts/presentations/pubs: 15.6

Additionally, someone asked Dr. Kachnic at the ARRO seminar at ASTRO 2018 how the 2018 examinees did on the 'recycled' questions. Apparently, these recycled questions comprise something like 30-60% of the test every year. These re-used questions can provide perspective and year-to-year comparisons. Apparently the 2018 examinees did, on average, better on those reused questions than did the examinees who answered the same questions in 2017.

Taken together with the match data, I have trouble believing that as of 2016, our applicants are the driving factor behind worse exam performance.

Residency should be extended to 6 years to allow time to pass the boards. This was suggested in the past but dismissed.

 

[scarbrtj]

Residency should be extended to 6 years to allow time to pass the boards. This was suggested in the past but dismissed.

I was board certified before I graduated residency. That'll never happen again. It should. It was pretty ideal.

 

[medgator]

Residency should be extended to 6 years to allow time to pass the boards. This was suggested in the past but dismissed.

Back in the 90s residency was extended from 3 to 4 years, supposedly, in part, to help the abysmal job market.

Dejavu....

 

[scarbrtj]

Back in the 90s residency was extended from 3 to 4 years, supposedly, in part, to help the abysmal job market.

Dejavu....

Deja vu all over again, what's old is new again, and so on. The guy to go to, for all who might want to see some of the sins of the past, is Dr. Flynn (whom we all know) in the Red Journal last century. He's never been afraid to light some a$$es on fire so to speak. In 1996:

Dr. Coleman’s article is to be applauded for shedding light on some of the most pressing issues facing our specialty. The average annual case load (number of new patients irradiated per FTE radiation oncologists) has clearly deteriorated after being stable for a 20-year period. The caseload will continue to deteriorate as the number of radiation oncologists continues to grow more rapidly than the number of patients suitable for radiation treatment.

Flynn was the guy who pointed out (that the other GME guys pointed out) that we need about one rad onc per 100000 people; in 1992, there were about 250 million Americans and about 2300 rad oncs were estimated needed. So the population is about 325 million now, which would mean about 3000 rad oncs needed. Of course, we've got like 60-70% more than that, about 5000 or so. Were estimates in the early 1990s so WILDLY off that we need 5000+, and ever growing, rad oncs now? Things have changed and all, indications-wise, but that's a rather chasmic discrepancy. Read some of his writings. More salient than ever I reckon.

 

[medgator]

Deja vu all over again, what's old is new again, and so on. The guy to go to, for all who might want to see some of the sins of the past, is Dr. Flynn (whom we all know) in the Red Journal last century. He's never been afraid to light some a$$es on fire so to speak. In 1996:

Dr. Coleman’s article is to be applauded for shedding light on some of the most pressing issues facing our specialty. The average annual case load (number of new patients irradiated per FTE radiation oncologists) has clearly deteriorated after being stable for a 20-year period. The caseload will continue to deteriorate as the number of radiation oncologists continues to grow more rapidly than the number of patients suitable for radiation treatment.

Flynn was the guy who pointed out (that the other GME guys pointed out) that we need about one rad onc per 100000 people; in 1992, there were about 250 million Americans and about 2300 rad oncs were estimated needed. So the population is about 325 million now, which would mean about 3000 rad oncs needed. Of course, we've got like 60-70% more than that, about 5000 or so. Were estimates in the early 1990s so WILDLY off that we need 5000+, and ever growing, rad oncs now? Things have changed and all, indications-wise, but that's a rather chasmic discrepancy. Read some of his writings. More salient than ever I reckon.

Your post should be stickied and put into the FAQ

 

[radoncgrad2019]

Regarding US grads and fellowships that was discussed upthread - would indeed be nice to have hard data on how many US grads are doing fellowships. Anectodatally, I think this is a vast minority. The one US grad I have heard of in the last 5 years doing a fellowship was a full-time research fellowship for someone that is now a physician scientist.

Also anectodotally - my (now former PD) at a 'top 15' type reputable program said that he has not had a US grad even apply to our fellowship in the last 5 or 6 years. We have a fellow every year and it is always someone from abroad looking to expand their knowledge before (usually) returning home.

I think the job market will have bottomed out when US grads are having to take fellowships because they can't find a job. What happened in Radiology for example. Luckily we are not there yet. Hopefully never will be, though we have to take some steps to prevent that of course.

 

[medgator]

Regarding US grads and fellowships that was discussed upthread - would indeed be nice to have hard data on how many US grads are doing fellowships. Anectodatally, I think this is a vast minority. The one US grad I have heard of in the last 5 years doing a fellowship was a full-time research fellowship for someone that is now a physician scientist.

Also anectodotally - my (now former PD) at a 'top 15' type reputable program said that he has not had a US grad even apply to our fellowship in the last 5 or 6 years. We have a fellow every year and it is always someone from abroad looking to expand their knowledge before (usually) returning home.

I think the job market will have bottomed out when US grads are having to take fellowships because they can't find a job. What happened in Radiology for example. Luckily we are not there yet. Hopefully never will be, though we have to take some steps to prevent that of course.

I know 2 us grads that took fellowships in the last few years to wait it out since there were no jobs in their preferred geographic region. There was a fellowship survey published in the red journal and I think it was mentioned on SDN recently showing that the number of us grads taking fellowships was not insignificant

 

[medgator]

I'm just dying to know why this portlandia job keeps getting posted again.... Radiation Oncologist - Compass Oncology Portland

 

[RollTideRadOnc]

I'm just dying to know why this portlandia job keeps getting posted again.... Radiation Oncologist - Compass Oncology Portland

Can't be good. Rumor has it that they had a new Harvard grad in that position. They made him medical director of RadOnc, but he lasted about two years before having to leave. I think any number of reasonable (and unreasonable) inferences can made.

 

[xrthopeful]

Where did he go?

 

[medgator]

Can't be good. Rumor has it that they had a new Harvard grad in that position. They made him medical director of RadOnc, but he lasted about two years before having to leave. I think any number of reasonable (and unreasonable) inferences can made.

Bawstun ain't Portlandia. They'll probably hire someone from the West coast next time, I bet

 

[6MVPhotons]

Current resident interested in private practice. I came across this thread and found it interesting, but potentially outdated, regarding top private practices in the country. From the discussion 4 years ago, private practices included:

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)
TOPA (TX)
Tennessee Oncology (TN)

Are these still considered "top" private practice groups? What sets these "top" places apart from other private practices (compensation, market share, reputation, etc)? Are there any others you would add to this list? What should residents consider important when looking into PP opportunities.

 

[BobbyHeenan]

Current resident interested in private practice. I came across this thread and found it interesting, but potentially outdated, regarding top private practices in the country. From the discussion 4 years ago, private practices included:

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)
TOPA (TX)
Tennessee Oncology (TN)

Are these still considered "top" private practice groups? What sets these "top" places apart from other private practices (compensation, market share, reputation, etc)? Are there any others you would add to this list? What should residents consider important when looking into PP opportunities.

Those are big practices with quality docs - at least of the few I'm familiar with in that list. ?Most/some? also own some share of equipment too. Whether that sort of a set up is something you want is hard to know.

All of those variables you mention set private practices a part - reputation, compensation, turn over (or lack there of), relationship with local hospital admin, competitors (or lack there of), "buy in." Are you cross-covering? Covering satellites?

Ask questions on the board, go to ARRO or ASTRO talks on jobs, etc. Talk to former residents out in the world. Those practices above are well know and presumably excellent, but lots of other ones are out there though the market for good private jobs in "good" locations is very competitive.

 

[Doctorer]

Current resident interested in private practice. I came across this thread and found it interesting, but potentially outdated, regarding top private practices in the country. From the discussion 4 years ago, private practices included:

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)
TOPA (TX)
Tennessee Oncology (TN)

Are these still considered "top" private practice groups? What sets these "top" places apart from other private practices (compensation, market share, reputation, etc)? Are there any others you would add to this list? What should residents consider important when looking into PP opportunities.

Yup, these are still considered "top" practices. My understanding is that the Princeton group's structure has changed a bit over the years, and it may not be as favorable as it once was, but that's only a rumor I've heard so I'd try to confirm for myself. Some of these practices (SERO, for example) have both partnership track as well as employed positions. Personally I wouldn't take an employed position.

 

[GapCalc]

Beware of PP groups of any size that offer different versions of 'partnership' based on when you join. I'm not sure if this applies to the list you provided, but some groups are known to have super duper partners who have technical ownership and a bigger role in decision-making for the practice, while newer 'partners' are essentially employees earning their professional income with no real consideration for true ownership.

Things that generally make a PP good: location, compensation, vacation, admin support, being physician-run/owned, having ROs on the board (if multi-specialty), a fare split of technical ownership (if machines are owned), camaraderie amongst current docs, solid track record of taking on partners, well-defined partnership track with timeline, dominant position in local markets.

 

[RickyScott]

Other than location, would not want to be a part of roa.

 

[Mandelin Rain]

Other than location, would not want to be a part of roa.

ROA New England, right?

I think the Inova group in Virginia is also ROA. And there's another in Wisconsin.

 

[elementaryschooleconomics]

I forgot about this thread, haha.

The theme of the past 15 years has just been insane consolidation in American medicine. Then the pandemic accelerated the process further.

When I look at this list:

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)
TOPA (TX)
Tennessee Oncology (TN)

My first thought, honestly, is not "these are the best" but "these are who's left".

In the past, part of the reputation of these groups stemmed from their size and infrastructure, which is also how they still survive. It's not worth ranking them, really. At least not to me. There's no point.

Unless the ranking is based on "who can continue to hold out the longest"?

 

[Fpg1245]

I forgot about this thread, haha.

The theme of the past 15 years has just been insane consolidation in American medicine. Then the pandemic accelerated the process further.

When I look at this list:

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)
TOPA (TX)
Tennessee Oncology (TN)

My first thought, honestly, is not "these are the best" but "these are who's left".

In the past, part of the reputation of these groups stemmed from their size and infrastructure, which is also how they still survive. It's not worth ranking them, really. At least not to me. There's no point.

Unless the ranking is based on "who can continue to hold out the longest"?

PROG is a shadow of itself and I believe is now part of a larger organization.