Rad onc with biggest decrease in applications of any specialty

[MegaVoltagePhoton]

But the most recent published data DOES state there is an impending oversupply of radiation oncologists. Like, published in red journal. Many who are most vocal (at least on SDN, without fear of obvious retaliation) about limiting residency expansion are CURRENT or recently graduated residents.

Don't misunderstand me. I also agree that unchecked residency expansion is a problem. I agree that ASTRO leadership could and should have done more to stop it (but, mainly, SCAROP/ADROP should have done more). I just don't buy that many of the vocal anti-expansion voices on this board are wholly doing so out of pure goodness towards the next generation of med students, nor do I believe academia is to bear the sole blame for the real issues rad onc is dealing with. The sanctimonious anti-academic echo chamber has gotten out of hand and at this point is outdraining the many positives of this field, which still do exist.

And come on...do you really believe the anti-expansion rhetoric on this forum is new? It's been around for years. People have been complaining about expansion since what, 2013? Even earlier?

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[MegaVoltagePhoton]

I am probably the number one alarmist, "hater," fearmonger here.

1) Residency slots have more than doubled (90 to 200 and growing) since the early 2000's so how can that not impact the job market. Oldgreyradonc, who has an opposing view, even admits that it was not a cakewalk to get a job back then, before the expansion. In what world do you live in that this has no bearing on a job market already faced with hypofractionation and hospital consolidations and shouldnt lead to concern?

2) Notion of private practice: Most radoncs are like myself, employed by a community hospital, according to surveys, and salaried. I am "private practice" because I dont work for a university is nonsensical. I have never seen a penny of technical fees. I have always received a salary and RVU production bonus that has no incentive for IMRT treatments, which is by far the most common form of employment. Presently, I know of one or 2 docs in desirable metropolitan areas that get any kind of technical component. And if I was truly in private practice and greedy, I would be totally in favor of more residents to exploit.

3) How would I benefit from lower quality applicants in terms of jobs five years from now? Residency slots are unchanged. There would still be the same number of docs coming out with MSKCC Harvard and MDACC, etc on their resumes, very desirable to my administrators? Lower quality docs ultimately just deligitimize the entire field and lead to less innovation, which is not in my interest.

4)fees: if the same hospital procedures are on average 70% more expensive in Northern california vs Southern, isnt it completely reasonable that there are much larger differentials between MSKCC and 21 C in yonkers/wescherster? Our own reimbursement for stereo for bone is about 4-5x less what the Mayo clinic says they charge on mednet.

5) Yes, 10-15 years ago imrt was exploited by private practice- Beams and Schemes is a seminal article, but now it is the academic centers who are expanding with satellites. At the heart of the issue, however, is the fixed cost nature of radiation economics (so price increases are tremedous windfall) but now, the landscape tremendously favors the large hospital systems with tremendous negotiating clout due to presence or reputation. And when they acquire relative pricing advantages, it only financially makes sense for them to acquire rivals, set up satellites. There is so much academic and lay literature on prices in these systems (not utilization) as the single biggest issue in health care. It makes front page of NY times/wash post/la times several times a year as well as JAMA, etc-

6) if a medstudent wants to investigate the job market, rotate, speak with residents and junior attendings. Find out why locums rates havent changed in 20 years and are lower than daily salaries with benefits, see if there is mobility with junior faculty etc, Has there been a growth in "fellowships" in recent years.

Much of what you say is not incorrect. But I think you've answered your own question. Everyone knows the hemming and hawing on SDN won't accomplish anything in terms of freezing residency applications (and it hasn't in at least five years). So, the effect has only been to scare away med students, thereby diluting the pool of good applicants by opening the gates to DO and FMG, while leaving the same total (and rising) number of residents. The perception of these docs is well known -- it's not a question of hiring a grade from MSKCC vs a grad from a mid-tier US program, it's a question of hiring a grad from a mid-tier US program versus someone who is considered subpar (rightly or wrongly). This absolutely creates a scenario wherein already employed and established individuals have a much larger claim to holding onto their jobs.

BTW, the party line on SDN has always been that private practice doesn't care about MSKCC or MDACC on the resume, only academia does. Has that changed now?

As for the comments about IMRT, I just find it laughable because, since we love political analogies, it is like what happened with the filibuster and the nuclear option. Yes, private practice abused IMRT so much that our entire specialty got called out in the NEJM and we went from no one knowing who the **** we were to having a giant bullseye on our back...yet now the same crew ******s and moans about a hospital system buying them up?

 

[medgator]

Everyone knows the hemming and hawing on SDN won't accomplish anything in terms of freezing residency applications (and it hasn't in at least five years). So, the effect has only been to scare away med students, thereby diluting the pool of good applicants by opening the gates to DO and FMG, while leaving the same total (and rising) number of residents. The perception of these docs is well known -- it's not a question of hiring a grade from MSKCC vs a grad from a mid-tier US program, it's a question of hiring a grad from a mid-tier US program versus someone who is considered subpar (rightly or wrongly). This absolutely creates a scenario wherein already employed and established individuals have a much larger claim to holding onto their jobs.

Wow......

 

[MegaVoltagePhoton]

Wow......

Who was affected by the path market tanking? By IR expansion leading to a fellowship glut?

The applicants? Or those already in practice?

 

[MegaVoltagePhoton]

Yes I'm sure none of the recent resident job survey numbers published in the red journal corroborating what was on this forum had anything to do with it....

And you still can't rebut the fact that there was a 50% increase in residency spots this decade with trends towards decreased demand in multiple disease sites as we move to observation and hypofx in some patients.

More grads are actually better for entrenched private practices, lower salaries, more supply etc. Not a difficult thing to figure out. Do you think everything is a conspiracy theory?

Why would I need to rebut the fact that a 50% increase in residency spots was a bad idea? Show me when I've ever said that was a good idea?

The number of grads isn't going to drop. We are all aware of this. There are many instances of people on this forum posting exactly that. The very fact that the number of grads won't drop, but the specialty will fill up with FMGs and there will be no "market correction". So how exactly is what I'm saying incorrect?

Also, are you really going to argue that there isn't a stereotype against FMGs and DOs? I mean how can one in one breath state that the field is going to decline, but then pretend there isn't a stereotype?

I don't believe there's a "conspiracy", in that, I don't think private practice are to blame for residency expansion. I do think, however, that those specifically crying doom and gloom about this specialty and telling people not to apply were not simply being Mother Theresa-like in their generosity.

 

[medgator]

Why would I need to rebut the fact that a 50% increase in residency spots was a bad idea? Show me when I've ever said that was a good idea?

The number of grads isn't going to drop. We are all aware of this. There are many instances of people on this forum posting exactly that. The very fact that the number of grads won't drop, but the specialty will fill up with FMGs and there will be no "market correction". So how exactly is what I'm saying incorrect?

Also, are you really going to argue that there isn't a stereotype against FMGs and DOs? I mean how can one in one breath state that the field is going to decline, but then pretend there isn't a stereotype?

I don't believe there's a "conspiracy", in that, I don't think private practice are to blame for residency expansion.

You implied opinions on SDN from existing practitioners caused applications to drop, rather than the published data in ijrobp showing a tougher market. Pretty specious, if you ask me.

I do think, however, that those specifically crying doom and gloom about this specialty and telling people not to apply were not simply being Mother Theresa-like in their generosity.

This is a forum where med students come for advice. Pretty twisted that you think we have nothing better to do than screw future med students with accurate advice about what is going on in the job market currently.

As others have posted, in this thread, entrenched practices benefit in this environment. Why would we want "less desirable" (as you imply) fmg/DO labor in scenario. Personally, if I'm trying to get the best hire for $250k in perpetuity, and "screw them out of partnership", I want someone with a good personality and English skills who can interact well with patients and referrings and bring in more business. I would want a big supply of said labor so there is always someone ready to replace the last person I fired.

Perhaps you should spend less time sh*****ng on your perceived motives of your pp colleagues on this forum and more time understanding using a little common sense. Personality and communication skills matter as much, if not more, in PP, esp in a competitive market.

Btw, there is precedent for RO trying to improve the job market...happened in the early to mid 90s when several programs were shut down and training was extended by a year. I'm not holding my breath, but at some point the leadership may realize how badly they've screwed things up and try to make RO a competitive and desirable field again. That will only happen when the field hits rock bottom, like it seems to be doing now, with more applicants than positions.

I got my RO residency slot last decade after not matching with double digit interview numbers. I eventually ended up with a great job in a decent location and feel sad that the powers at be have basically tried to destroy that for those going forward. I tried to read on everything as much as I could when trying to choose a specialty, and part of that was going to more senior folks at sdn at the time. I appreciated the information I got from sdn at the time and this is my chance to give back now with honest advice from the PP perspective.

 

[medgator]

Who was affected by the path market tanking? By IR expansion leading to a fellowship glut?

The applicants? Or those already in practice?

Pretty sure those applicants who matched and completed training were affected by the bad market eventually...

 

[RickyScott]

[QUOTE. I do think, however, that those specifically crying doom and gloom about this specialty and telling people not to apply were not simply being Mother Theresa-like in their generosity.[/QUOTE]

It is not so much altruism as annoyance, but my interests are probably aligned with the medstudents, so I am going to call it like is. I have a great job and hospital administration presently, but I have seen that turn on a dime early in my career, and heard similar experiences from others both, in and outside of universities. Administrators and chairmen change, and hospitals merge etc. If something goes sour, I would likely not be able to get a decent job in my region where there have been almost no jobs for past 4 years. Lateral movement among junior faculty is now non-existent and it is probably very difficult to get raises when you cant interview and get job offers. It is not just about graduating residents.

 

[OTN]

I find it pretty damn offensive to assume my motivations are only borne of greed. As I mentioned in another thread, our very large private practice has a set pathway to partner which is the same for everyone. Increased numbers of radiation oncologists will not affect what we offer to everyone and always have. It will not affect our bottom line in any way, as (unfortunately for graduating residents) the amount of capital expenditure needed to start a radiation oncology program prevents newly minted radoncs from "hanging their shingle" and competing with us in any of our markets.

As a result, I want- very badly- our field to be filled with only the best medical students. I want to be respected at tumor boards. I want to be respected in academic institutions, and I want our field to be pushed forward with good, thought-provoking, innovative research. You need good medical students to become radiation oncologists for this to happen. Residency expansion has affected the job market and will continue to do so, and it is explicitly not the fault of those of us in private practice- it lies at the feet of only the academics. Vilifying those of us who feel it is right to raise our concerns about the field, trying to shame us into silence by questioning our motivations, and trying to pull the wool over the eyes of interested medical students is flat-out wrong to do.

 

[evilbooyaa]

This is a long view of the situation, but perhaps seeing USMD interest in the field dwindling and having more spots filled with IMGs/FMGs/DOs will cause leadership to re-evaluate what they want for this field and create changes that makes USMDs want to start applying to the field again. Maybe leadership feels really good right now because Rad Onc has been, at least for the past 5-10 years, insanely competitive. Maybe once it becomes a shoe-in to match (probably not a one year thing) or people use rad onc as a back-up specialty, or there's some percentage of IMGs/FMGs matching into the field they'll re-evaluate, kind of like what happened in the 90s.

This is nothing against DOs, personally- I know a few of them in the field and they all either had amazing scores or really busted their ass up and above what a USMD had to do just to get a shot at a RO residency. However, the perception of competitiveness is driven by this. I have no doubts that recent DOs in residency were some of the smartest people from their schools. Are we going to be able to say the same thing now that there are more spots than applicants?

Fully agree with OTN that, as a field, we should strive to have the best medical students, because as a end of the line referral-dependent specialty, other specialties will generalize our field in a negative light if we don't know, if not more than, at least equal about oncology when compared to the med-oncs and the surgeons.

 

[Mandelin Rain]

Much of what you say is not incorrect. But I think you've answered your own question. Everyone knows the hemming and hawing on SDN won't accomplish anything in terms of freezing residency applications (and it hasn't in at least five years). So, the effect has only been to scare away med students, thereby diluting the pool of good applicants by opening the gates to DO and FMG, while leaving the same total (and rising) number of residents. The perception of these docs is well known -- it's not a question of hiring a grade from MSKCC vs a grad from a mid-tier US program, it's a question of hiring a grad from a mid-tier US program versus someone who is considered subpar (rightly or wrongly). This absolutely creates a scenario wherein already employed and established individuals have a much larger claim to holding onto their jobs.

This is borderline magical thinking.

Started complaining about expansion and concerns about the future job market 5 years ago, so that in 5 years time med students may take heed and avoid the specialty, so that in 5 years time the graduating residents are of perceived "worse" quality, so that once they have the requisite 5 years of experience they don't come and take our current job.

It's an impressive 15-year long game we're all playing.

 

[deleted950463]

So, the effect has only been to scare away med students, thereby diluting the pool of good applicants by opening the gates to DO and FMG, while leaving the same total (and rising) number of residents.

Does being a DO automatically mean a poor applicant? If that DO applicant has a 270 step 1 and NEJM level pubs?

 

[evilbooyaa]

Does being a DO automatically mean a poor applicant? If that DO applicant has a 270 step 1 and NEJM level pubs?

Having a DO means that your application gets scrutinized more, in general, in Rad Onc. I imagine a DO that had those stats would be able to match, but probably not at MDA or MSKCC (which is where a MD with the same stats would be competitive for)

 

[MegaVoltagePhoton]

My comments were out of line and I apologize.

However, as someone who's been in academia for a while post residency, I also think some of the anti-academia rhetoric is misplaced and overblown and the future of the specialty is not cut and dry.

 

[MegaVoltagePhoton]

Does being a DO automatically mean a poor applicant? If that DO applicant has a 270 step 1 and NEJM level pubs?

I don't understand meaningless hypothetical questions like this. That person is highly unlikely to exist. If they did, it would be in a one-off situation.

So, yes, there is a stigma against DOs. That is real.