Programs that could be candidates for contracting/closing

[fiji128]

In the long term programs will not go unmatched. The standards for incoming PGY-2's will just be lowered and FMGs will be recruited to make sure all available spots are filled. This happens in every other specialty where there are more residency spots then interest from US med school grads. Absolutely no reason why rad onc would be any different. Everyone knows probably 25 to 40% of the programs currently out there are substandard and could be closed for the betterment of the specialty but no one institution will be willing to admit this about their program and be willing to take the hit. The place I trained could easily be closed down and has many "red flags" including more residents then attendings and 95% of didactics being resident lead. But I suspect there is almost no chance that it will ever close down.

The RRC had a opportunity to raise the minimum standard for programs but basically chose to just increase the upper limit of cases that residents are allowed to see/manage (could have mandated a minimum of 8 clinical faculty and 4 linacs onsite and enough brachy cases for residents to actually be clinically competent at graduation just to name a few). Instead no existing program will likely have much difficulty meeting the new requirements. It's like the RRC knew it had to do something but could only raise standards in such a way that all current programs would agree on.

---

Members don't see this ad.

 

[radoncgrad2019]

In regards to BCM, let me say that this is not a dig at the residents from the program. I’m sure that people who thrive in that environment come out of fine through a high amount of self-learning. I have been around for a while and unfortunately I am very familiar with the program. I also know multiple former recent and distant alumni, personally. The program has been an absolute dumper fire for a long time, even though it is an older program, but let’s focus on the most recent issues. They recently lost a majority of their faculty including their chair and their PD, and the majority of their physics staff. They have three faculty at their primary site and those faculty also staff the other hospital (2nd site), and the VA is all adjunct faculty that you mostly cover and they are not truly part of the department, has been a less ideal learning environment for quite sometime now. In total they have 8 residents for three sites with only 3 faculty, excluding adjunct. Look at their website, this is public as well. There may be more faculty coming, but that is besides the point. Anybody who knows the details of this program knows it has been a constant revolving door due to some serious issues. The didactics are mostly residents teaching each-other with minimal faculty involvement for the CLINICAL didactics component. I know for a fact they have had multiple board failures over the past 10 years. They have been on probation in the past (also public record). They are a very clinical program with high volume, with minimal teaching and faculty involvement.

When I post about this, I am not intending to harm current residents or alumni, I am simply highlighting that this is absolutely a bottom of the barrel program in terms of residency experience and it is not a good place to train, if you can avoid it. In the current environment, this is very important to highlight. If one thrives at a program like this, it means that person is pretty self-driven and able to navigate it, but I simply cannot recommend this program to anybody out there for training purposes. You will very likely be unhappy, even if you likely/absolutely come out of it clinically competent.

 

[deleted941485]

Honestly it’s a joke because all of them are literally candidates for contraction or closure

The small upstarts that opened in the last 10 years should probably be closed

Large programs have added to their rolls as well and probably are even more culpable.

 

[RickyScott]

In regards to BCM, let me say that this is not a dig at the residents from the program. I’m sure that people who thrive in that environment come out of fine through a high amount of self-learning. I have been around for a while and unfortunately I am very familiar with the program. I also know multiple former recent and distant alumni, personally. The program has been an absolute dumper fire for a long time, even though it is an older program, but let’s focus on the most recent issues. They recently lost a majority of their faculty including their chair and their PD, and the majority of their physics staff. They have three faculty at their primary site and those faculty also staff the other hospital (2nd site), and the VA is all adjunct faculty that you mostly cover and they are not truly part of the department, has been a less ideal learning environment for quite sometime now. In total they have 8 residents for three sites with only 3 faculty, excluding adjunct. Look at their website, this is public as well. There may be more faculty coming, but that is besides the point. Anybody who knows the details of this program knows it has been a constant revolving door due to some serious issues. The didactics are mostly residents teaching each-other with minimal faculty involvement for the CLINICAL didactics component. I know for a fact they have had multiple board failures over the past 10 years. They have been on probation in the past (also public record). They are a very clinical program with high volume, with minimal teaching and faculty involvement.

When I post about this, I am not intending to harm current residents or alumni, I am simply highlighting that this is absolutely a bottom of the barrel program in terms of residency experience and it is not a good place to train, if you can avoid it. In the current environment, this is very important to highlight. If one thrives at a program like this, it means that person is pretty self-driven and able to navigate it, but I simply cannot recommend this program to anybody out there for training purposes. You will very likely be unhappy, even if you likely/absolutely come out of it clinically competent.

Sounds like they should close. Btw I believe Baylor/Methodist may have been first site to deliver imrt the us! Think they had Nomos peacock ssystem back in the early 90s

 

[DebtRising]

Targeting specific programs is counter productive. Have a system whereby some government body or administration says - society needs this many of you, we will clear this many, if you want more you can pay into medicare an excess of dollars to match the projected increased spending that comes with excess physician capacity (a principle often proven in health care economic studies). If it projects society needs 100 slots, then have a lottery of where the excess capacity gets decreased from, truly random, minus the programs who voluntarily pay extra for the 'privelege' of education. In other words - make the residency landscape match actual needs rather than piggy bank for programs big and small to exploit cheap labor for positions that no employment projection suggests exists, particularly in a environment where CMS is actively cutting the need for positions and reimbursement.

My negativity comes from the fact that I see no future for us in 10 years, maybe 5, otherwise. Think of the 'demand' for rad onc this year with ABM, CMS changes in supervision, and the lag in decrease from corona virus related delays, relative to a field like internal medicine.

 

[medgator]

My negativity comes from the fact that I see no future for us in 10 years, maybe 5, otherwise. Think of the 'demand' for rad onc this year with ABM, CMS changes in supervision,

We will have a future. Some of us always will

 

[RickyScott]

We will have a future. Some of us always will

Like with the corona virus in jan, we know that many of this years graduating medical students who match will not have a future in the field.

 

[RickyScott]

Steve Hahn’s judgement in denying approval of testing in late feb despite lack of alternatives should really cast doubt on Astro leadership competency.
Astro presidents that have followed him like Brian K and Paul H have flat out lied to medstudents on Twitter. These guys are eloquent and somewhat charismatic but 100% dead wrong.

 

[medgator]

Steve Hahn’s judgement in denying approval of testing in late feb despite lack of alternatives should really cast doubt on Astro leadership competency.
Astro presidents that have followed him like Brian K and Paul H have flat out lied to medstudents on Twitter. These guys are eloquent and somewhat charismatic but 100% dead wrong.

Much easier to do what is status quo than what is right. Hahn wasn't going to want to rock the boat in an election year

 

[medgator]

Cornell nixed as of summer 2021

 

[evilbooyaa]

Cornell nixed as of summer 2021

Interesting - their website still lists them as looking for ERAS candidates for 2021: Radiation Oncology Residency Training Program | Radiation Oncology

Wonder what the story behind this is.

 

[thecarbonionangle]

Cornell nixed as of summer 2021

this was and had been truly an aweful program. I heard things were even further south once Formenti took over. Columbia is not far behind, AND last but not least, NY METHODIST, most definitely a bottomless hell pit. They are the three headed monster of aweful NYP affiliated “residencies” which should be closed down. Hopefully the residents can find spots. Wish them the best.

while this appears to be good news, there is much work to be done. Too many very bad programs out there, and the ACGME appears to know, openly admitted by THE PW in an editorial. This is the true sin, folks!

 

[medgator]

this was and had been truly an aweful program. I heard things were even further south once Formenti took over. Columbia is not far behind, AND last but not least, NY METHODIST, most definitely a bottomless hell pit. They are the three headed monster of aweful NYP affiliated “residencies” which should be closed down. Hopefully the residents can find spots. Wish them the best.

while this appears to be good news, there is much work to be done. Too many very bad programs out there, and the ACGME appears to know, openly admitted by THE PW in an editorial. This is the true sin, folks!

Downstate was pretty dumpy when i interviewed there years ago... Didn't hear great things about it either

 

[StIGMA]

Not involved in their program but knew some of their people and the impetus for this is almost certainly persistently poor ACGME surveys from multiple resident classes year after year.

 

[Radonc90]

Interesting bc I thought Formenti is a decent/nice person.
Maybe (*maybe*) the attendings in that dept were hopeless (treating residents like ****)...just a theory...

Maybe ACGME made this decision based on a complex equation: "toxic" program + bad job market...

 

[Chartreuse Wombat]

Cornell nixed as of summer 2021

Neha and the RRC is doing the right thing

 

[thecarbonionangle]

Neha and the RRC is doing the right thing

we’re all counting on you Neha. Praying for your success!

 

[RickyScott]

Interesting bc I thought Formenti is a decent/nice person.
Maybe (*maybe*) the attendings in that dept were hopeless (treating residents like ****)...just a theory...

Maybe ACGME made this decision based on a complex equation: "toxic" program + bad job market...

Formenti is an excellent scientist, but heard she is quite toxic to faculty. Not sure about how she is with the residents.

West Virginia should be next.

 

[fiji128]

I interviewed at Cornell, prior to Formenti moving there from NYU, for residency. At the time I could tell the program was a little iffy but it was peak rad onc and I would've given just about anything to match there.

 

[thecarbonionangle]

I interviewed at Cornell, prior to Formenti moving there from NYU, for residency. At the time I could tell the program was a little iffy but it was peak rad onc and I would've given just about anything to match there.

well its a good thing you got to keep your left nut. Things turned out for the best.

 

[Radonc90]

I am going over the list (ARRO list), and these are my thoughts.
Feel free to comment as you wish...

- CPMC in CA: this program has been an issue since day 1. Glad it is gone.
- Cedars-Sinai: should never be opened in the first place. Unless you believe in nepotism.
- City of Hope: OK, will cut them some slack. Back in the good old days, they were famous for Bone Marrow Transplant.
Maybe they should close soon.
- Kaiser in CA: I have never been a big fan of Kaiser: the way they practice medicine.
However, in the modern days of hypofx, they have a point for yrs that the rest of country did not buy into.
- UCLA: used to be OK. The current chair is not an academic person. He was chosen bc of politics.

- Georgetown and its Medstar fiasco. Idk how they are still alive.
- Augusta GA, should never be open in the first place.

- U of Kansas: has been a troubled place for yrs and yrs, since the day of Kumar. Chen was a bit better.
- Louisville: will cut them some slack bc of their fiasco with C.H.I. (KentuckyOne fiasco). But big corporations have damaged tons of academic med centers.

- Wayne State in Detroit. Idk how they are still alive. DMC has been in trouble for yrs. This place is probably "in the ICU", Idk when they will pull the plug.

- MS: Vijay is a nice person. But this program should not be opened, given the job market.
- Nebraska: This program should not be opened at all.

- Flushing, NY: what can I say?
- Brooklyn, NY: ditto.

- Northwell NY: OK bc it is a big health system and they have the volume.
- Syracuse, NY: are they doing OK? ICU or on the floor lol?
- Rochester NY: great during Phil Rubin's time. I don't have any info now.

- Drexel, Temple...gone or combined with other PH programs.
- Baylor: This program has been so so for a long time.
- Temple, TX: why was this allowed to open?

 

[scarbrtj]

I am going over the list (ARRO list),a nd these are my thoughts.
Feel free to comment as you wish...

- CPMC in CA: this program has been an issue since day 1. Glad it is gone.
- Cedars-Sinai: should never opened in the first place. Unless you believe in nepotism.
- City of Hope: OK, will cut them some slack. Back in the good old days, they were famous for Bone Marrow Transplant.
Maybe they should close soon.
- Kaiser in CA: I have never been a big fan of Kaiser: the way they practice medicine.
However, in the modern days of hypofx, they have a point for yrs that the rest of country did not buy into.
- UCLA: used to be OK. The current chair is not an academic person. He was chosen bc of politics.

- Georgetown and its Medstar fiasco. Idk how they are still alive.
- Augusta GA, should never be open in the first place.

- U of Kansas: has been a troubled place for yrs and yrs, since the day of Kumar. Chen was a bit better.
- Louisville: will cut them some slack bc of their fiasco with C.H.I. (KentuckyOne fiasco). But big corporations have damaged tons of academic med centers.

- Wayne State in Detroit. Idk how they are still alive. DMC has been in trouble for yrs. This place is probably "in the ICU", Idk when they will pull the plug.

- MS: Vijay is a nice person. But this program should not be opened, given the job market.
- Nebraska: This program should not be opened at all.

- Flushing, NY: what can I say?
- Brooklyn, NY: ditto.

- Northwell NY: OK bc it is a big health system and they have the volume.
- Syracuse, NY: are they doing OK? ICU or on the floor lol?
- Rochester NY: great during Phil Rubin's time. I don't have any info now.

- Drexel, Temple...gone or combined with other PH programs.
- Baylor: This program has been so so for a long time.
- Temple, TX: why was this allowed to opened?

I thought Augusta had closed. No?

 

[medgator]

I am going over the list (ARRO list),a nd these are my thoughts.
Feel free to comment as you wish...

- CPMC in CA: this program has been an issue since day 1. Glad it is gone.
- Cedars-Sinai: should never opened in the first place. Unless you believe in nepotism.
- City of Hope: OK, will cut them some slack. Back in the good old days, they were famous for Bone Marrow Transplant.
Maybe they should close soon.
- Kaiser in CA: I have never been a big fan of Kaiser: the way they practice medicine.
However, in the modern days of hypofx, they have a point for yrs that the rest of country did not buy into.
- UCLA: used to be OK. The current chair is not an academic person. He was chosen bc of politics.

- Georgetown and its Medstar fiasco. Idk how they are still alive.
- Augusta GA, should never be open in the first place.

- U of Kansas: has been a troubled place for yrs and yrs, since the day of Kumar. Chen was a bit better.
- Louisville: will cut them some slack bc of their fiasco with C.H.I. (KentuckyOne fiasco). But big corporations have damaged tons of academic med centers.

- Wayne State in Detroit. Idk how they are still alive. DMC has been in trouble for yrs. This place is probably "in the ICU", Idk when they will pull the plug.

- MS: Vijay is a nice person. But this program should not be opened, given the job market.
- Nebraska: This program should not be opened at all.

- Flushing, NY: what can I say?
- Brooklyn, NY: ditto.

- Northwell NY: OK bc it is a big health system and they have the volume.
- Syracuse, NY: are they doing OK? ICU or on the floor lol?
- Rochester NY: great during Phil Rubin's time. I don't have any info now.

- Drexel, Temple...gone or combined with other PH programs.
- Baylor: This program has been so so for a long time.
- Temple, TX: why was this allowed to opened?

What about iowa, Arizona, musc, downstate/Brooklyn, NY Methodist, Columbia. Haven't checked in on them in awhile but they were as bad if not worse than whatever was on your list.

In fact the upstate programs were OK, in terms of case breadth and volume vs NYC seeming to have too many crap programs next to NYU and Sloane

 

[ramsesthenice]

What about iowa, Arizona, musc, downstate/Brooklyn, NY Methodist, Columbia. Haven't checked in on them in awhile but they were as bad if not worse than whatever was on your list.

In fact the upstate programs were OK, in terms of case breadth and volume vs NYC seeming to have too many crap programs next to NYU and Sloane

I agree, I thought the upstate programs were good.

I’m in the Midwest and I would say Iowa has come a long way. Faculty has grown in the last few years, patient volume is high, they have good technology. They only have 6 (maybe 7?) residents. Apparently (before I left the east coast) it use to be a PP with residents but that doesn’t seem to be the case anymore.

 

[medgator]

From the rad onc Twitter thread, sounds like oklahoma and downstate are on probation. No reason they both shouldn't be shut down. People were taking jobs in OK before that program ever opened

 

[bergonieandtribondeau]

I really feel for the residents at those programs pending closure. As in, not only did they have to actively endure that malignant and ill-conducive culture during training, but they now face the prospect of complete and total uncertainty about their future. Where do they go from here? Who takes them? Certainly not an enviable position to be in. The sad fact is that these programs who cannot keep up their end of the bargain do not deserve to exist in the first place, but its the residents who bear the burden and get hurt in the end.

 

[thecarbonionangle]

The acceptance of the culture of “residents should teach themselves” and just write notes and do contours is widespread. Lots of apologists for a bad education and training. Some just don’t know any better but some definitely facilitate it for opportunistic reasons (free labour, sycophants). Now with multiple programs rumoured to be opening soon and with many bad places newly opened and already established, makes the situation very hard to fix. I dont see how we fix this, folks

 

[elementaryschooleconomics]

The acceptance of the culture of “residents should teach themselves” and just write notes and do contours is widespread. Lots of apologists for a bad education and training. Some just don’t know any better but some definitely facilitate it for opportunistic reasons (free labour, sycophants). Now with multiple programs rumoured to be opening soon and with many bad places newly opened and already established, makes the situation very hard to fix. I dont see how we fix this, folks

Amen. I did a traditional Internal Medicine intern year. The contrast between the intentional education/training I received then and the incidental education/training I received in a RadOnc residency is striking.

 

[ramsesthenice]

From the rad onc Twitter thread, sounds like oklahoma and downstate are on probation. No reason they both shouldn't be shut down. People were taking jobs in OK before that program ever opened

I want to be careful how this gets worded because I think we should be careful passing judgement but I can’t tell you anything about Oklahoma. Literally nothing. And that troubles me a bit. They are the only program in my geographic region that is truly a black box to me and that seems like a bad sign. Anyone have first hand information or experience?

 

[medgator]

The acceptance of the culture of “residents should teach themselves” and just write notes and do contours is widespread. Lots of apologists for a bad education and training. Some just don’t know any better but some definitely facilitate it for opportunistic reasons (free labour, sycophants). Now with multiple programs rumoured to be opening soon and with many bad places newly opened and already established, makes the situation very hard to fix. I dont see how we fix this, folks

Spread the good (or bad, depending on your perspective) word....

 

[thecarbonionangle]

I want to be careful how this gets worded because I think we should be careful passing judgement but I can’t tell you anything about Oklahoma. Literally nothing. And that troubles me a bit. They are the only program in my geographic region that is truly a black box to me and that seems like a bad sign. Anyone have first hand information or experience?

not a good place. Relatively new program, very clinical, recent chair was a med onc/RO who practiced both, have mevion protons, nice cancer center from oil money donations. They have had board failures. Poor didactics and teaching historically. Some new inbred blood in charge trying to improve things

 

[ramsesthenice]

FWIW, I don’t think we have focused enough on the top in this thread. Of course programs that have <1:1 fac/res ratio etc should go but let’s not forget In a field our size there just is not a good reason to me why any program should be taking 5+ residents a year. I don’t care how big or renowned they are. Heck, I don’t think most places should be taking more than 2 per year. Nothing good happens to a field (any field) when a sizable proportion of their trainees is concentrated to a few training programs.

 

[medgator]

FWIW, I don’t think we have focused enough on the top in this thread. Of course programs that have <1:1 fac/res ratio etc should go but let’s not forget In a field our size there just is not a good reason to me why any program should be taking 5+ residents a year. I don’t care how big or renowned they are. Heck, I don’t think most places should be taking more than 2 per year. Nothing good happens to a field (any field) when a sizable proportion of their trainees is concentrated to a few training programs.

They're all guilty. Still remember when Mayo Rochester and CCF matched 2/year after the turn of the century. They have both been at 3 for some time

 

[thecarbonionangle]

They're all guilty. Still remember when Mayo Rochester and CCF matched 2/year after the turn of the century. They have both been at 3 for some time

the problem is that program size became equated with prestige, so all these places expanded. Some “well known” cancer centre can take 5+ a year for no clear reason and it is justified by their prestige, etc. i don’t fully remember but other places have expanded like UTSW and Emory over the years. It is not just a couple of places. People were always looking to grow places and it slowly happened over the past ten years.

 

[seper]

not a good place. Relatively new program, very clinical, recent chair was a med onc/RO who practiced both, have mevion protons, nice cancer center from oil money donations. They have had board failures. Poor didactics and teaching historically. Some new inbred blood in charge trying to improve things

I think it’s a good program, in my experience in dealing with their grads

 

[thecarbonionangle]

I think it’s a good program, in my experience in dealing with their grads

Smart people find a way to succeed. This is more a testament of last ten years of recruitment vs. a sign of a great program that someone is a competent rad onc. Very few places are putting out incompetent people. I am saying the standard should be higher than “yeah i talked to them and they seemed to know to to treat a prostate”

 

[seper]

Smart people find a way to succeed. This is more a testament of last ten years of recruitment vs. a sign of a great program that someone is a competent rad onc. Very few places are putting out incompetent people. I am saying the standard should be higher than “yeah i talked to them and they seemed to know to to treat a prostate”

To get into any Radonc in 2010-15 you had to be a bona fide genius. I barely squeeked in 2005 and these people can run circles around me all day long

 

[RadRadRad]

I thought Augusta had closed. No?

mcg/Augusta closed

How about
-Tennessee - private practice forced into academics
-Arkansas-don’t know much about them but just opened

 

[thecarbonionangle]

mcg/Augusta closed

How about
-Tennessee - private practice forced into academics
-Arkansas-don’t know much about them but just opened

both struggling no good places.

 

[Music Man Stan]

mcg/Augusta closed

How about
-Tennessee - private practice forced into academics
-Arkansas-don’t know much about them but just opened

My understand is that Arkansas is sadly struggling because they’re not even the big-dog in town - that’s CARTI. The last I heard is that U Arkansas was trying to save their reputation by becoming an NCI cancer center but it hasn’t actually happened. They have a tough time attracting good talent to Little Rock and when CARTI next door makes considerably more money, it’s a recipe for disaster.

 

[medgator]

My understand is that Arkansas is sadly struggling because they’re not even the big-dog in town - that’s CARTI. The last I heard is that U Arkansas was trying to save their reputation by becoming an NCI cancer center but it hasn’t actually happened. They have a tough time attracting good talent to Little Rock and when CARTI next door makes considerably more money, it’s a recipe for disaster.

Sounds like another program that should be shut down

 

[Radonc90]

- Forgot about WV program, should be closed.

 

[PRAD_ONC]

Everyone knows Rutgers has the best biryani. That's a top tier program.

what biriyani spot you recommend? ... just curious. More interesting conversation than the delusional 'kill list' this thread has spawned.

 

[deleted941485]

You know you’re in high demand when the difference between shortage and surplus is on the order of 10 lol. God so pathetic

 

[deleted941485]

If Neha wants to fly across the country with a flame thrower and burn down programs I’ll fly her first class anywhere in the US.

 

[medgator]

what biriyani spot you recommend? ... just curious. More interesting conversation than the delusional 'kill list' this thread has spawned.

Sounds like someone is a grumpy PD worried about filling this year....

 

[thecarbonionangle]

what biriyani spot you recommend? ... just curious. More interesting conversation than the delusional 'kill list' this thread has spawned.

it’s ok you’ll still get a warm body, pulse optional. Relax buddy, you will be alright

 

[PRAD_ONC]

Sounds like someone is a grumpy PD worried about filling this year....

it’s ok you’ll still get a warm body, pulse optional. Relax buddy, you will be alright

I'm a semi-recent grad and just as pissed about the job market as most posters here. I fortunately found a PP job I'm happy with but not in the location I want. I definitely could've had both as a med onc ... which was the other field I was considering. I too feel cheated and felt trapped towards the end of my residency.

When you're essentially creating a hit list for entire programs based on nothing but rumors, you're not really helping foster a legitimate solution. Singling out individual programs (wether deserved or not) is not a complete solution to the problem. It doesn't addresses the programs that have expanded over the years or the terrible training at most.

Much better than singling out individual programs (and making their current residents feel even more trapped). Why not create criteria to decrease the overall resident volume?

i.e.

1. Increase require cases to 900
2. Make weekly attending lectures mandatory (not the BS resident led 'teaching' that's so common)
3. >2 attending to resident ratio at the primary site
4. min 8 attendings at the primary site

 

[Radonc90]

...
1. Increase require cases to 900
2. Make weekly attending lectures mandatory (not the BS resident led 'teaching' that's so common)
3. >2 attending to resident ratio at the primary site
4. min 8 attendings at the primary site

Interesting idea. I like it.
If true, then > 40% the radonc programs are gone bc my guess is that about 40% of them don't even have 601 cases/yr.

 

[Ray D. Ayshun]

I'm a semi-recent grad and just as pissed about the job market as most posters here. I fortunately found a PP job I'm happy with but not in the location I want. I definitely could've had both as a med onc ... which was the other field I was considering. I too feel cheated and felt trapped towards the end of my residency.

When you're essentially creating a hit list for entire programs based on nothing but rumors, you're not really helping foster a legitimate solution. Singling out individual programs (wether deserved or not) is not a complete solution to the problem. It doesn't addresses the programs that have expanded over the years or the terrible training at most.

Much better than singling out individual programs (and making their current residents feel even more trapped). Why not create criteria to decrease the overall resident volume?

i.e.

1. Increase require cases to 900
2. Make weekly attending lectures mandatory (not the BS resident led 'teaching' that's so common)
3. >2 attending to resident ratio at the primary site
4. min 8 attendings at the primary site

Even better, don't match anyone for a year, then make the case requirement 750 for the return to the 3 year residency.