RadOnc Is Still The Best Field in Medicine

[GreyingRadOnc]

Agree with this 100%. As a field we are docile and obedient. This should be no different.

How has pitchforks and torches helped?

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[smith2009]

How has pitchforks and torches helped?

Exactly! Bend over and take it like they do in prison.

/s (see request below)

 

[evilbooyaa]

It's called sarcasm.

Fair enough. Hard to read sarcasm on the internet especially given the views that have been (seriously) expressed on this forum. Carry on. I encourage use of /s to avoid backlash in the future.

 

[evilbooyaa]

How has pitchforks and torches helped?

The initial pitchforks and torches is what lead to ABR even releasing the pass rates officially in the first place.
The second pitchforks and torches when those were confirmed is what lead to Kachnic having the meeting with ARRO and ADROP in regards to the statistics.

Ongoing and future pitchforks and torches may lead to: 1) discussion about % correct compared between old and new questions, 2) stratification of results by institutions who do or do not have a member on the committee responsible for writing the test, 3) an earlier time for re-tests to take radbio/physics (if not mid year, then more than 1 day before clinical writtens), 4) development of better study guides for both new and repeat test takers so as to make this problem a one-year issue rather than a perpetuating one, and 5) pressure on ABR to fix the pass rates for next year (regardless of how they do it)

 

[GreyingRadOnc]

Exactly! Bend over and take it like they do in prison.

So, what's the chances that this 30% that failed pass the exam next round? Of that crew, what's the chances they go on to complete the ABR process and are board certified before the 7 year limit (or whatever it is). Very close to 100%, right?

Then, what's the chances that they find a job....a job. Based on the work force survey > 94% had jobs. See above for the starting salaries that Rad Oncs are paid. Lets just say 400k. Are you working on Passover/Christmas/July 4th/weekends? Did you make your child's 5th birthday party for emergency surgery? Do you get called all night for the sniffling baby with a rash? The drug seeking backpain brick layer? That is prison?? I think many people would sign up for that prison. I feel SO lucky every time I talk to a friend in primary care that is on the front lines. My dad sold door to door for years, weekends, winter....for a fraction of that. Peek at the people selling you fancy cosmetics, working 2 jobs. I had a woman sell me a sub at subway this year....she was early 60's and looked really sad....so I asked her how she was. She works 2 jobs, 1 in telemarketing during the day and the other working at a downtown subway where she got beat up last month. Sure...they made different choices in life that lead them in a different direction, but YOU ARE NOT IN PRISON.

I get the feeling there's an element on this board that is actively trying to dissuade med students from choosing rad onc. Maybe that is even working based on application numbers over the past year. Let's play that out. The field doesn't fill and the quality of the applicant pool continues to fall off. That adversely affect you very quickly and for many years. These subsequent trainees will be your partners. They will be the ones that have to compete with encroaching specialties at tumor boards/reimbursement committees/etc. How will that wind up a win for you? ASTRO just fought back a big reduction in billing. Would that have hurt your practice if it had gone in place and don't you want the best/brightest arguing for you?

Meanwhile the lament is not based on any financial or professional reality. The field is sound in terms of the current job market and reimbursement is solid. We don't face AI or telemedicine competition. There's continued technological improvements and innovation. If you consider time at work, compensation, burn out, QOL what specialty has is better? You are holding a loaded gun with this forum and you're insisting on shooting yourself, and everyone else, in the foot.

 

[GreyingRadOnc]

The initial pitchforks and torches is what lead to ABR even releasing the pass rates officially in the first place.
The second pitchforks and torches when those were confirmed is what lead to Kachnic having the meeting with ARRO and ADROP in regards to the statistics.

Ongoing and future pitchforks and torches may lead to: 1) discussion about % correct compared between old and new questions, 2) stratification of results by institutions who do or do not have a member on the committee responsible for writing the test, 3) an earlier time for re-tests to take radbio/physics (if not mid year, then more than 1 day before clinical writtens), 4) development of better study guides for both new and repeat test takers so as to make this problem a one-year issue rather than a perpetuating one, and 5) pressure on ABR to fix the pass rates for next year (regardless of how they do it)

All of those things happened from thoughtful exchanges between the professional groups, not least of those ARRO. One fault the groups made is not communicating well what they were all working on to improve the problem behind the scenes. That started happening, based on the ADROP letter to PDs, within a few days of the results being posted to residents.

 

[evilbooyaa]

"Rad Onc isn't so bad right now because at least you're not in prison"

^ do you hear what you sound like?

People are upset that their salaries are going down. People are upset that leadership is not protecting the future of our field. People are upset that residencies started expanding like mad when the data came out that there was going to be an undersupply. People are MORE upset that despite more recently published data showing that the previous analysis was flawed and that we're already on the path to oversupply, but programs continued to keep expanding residency positions and drive salaries down even further. People are upset that rather than trying to improve the minimum standards or in anyway protect our field, leadership just throws their hands up and goes "not my problem", like there's no way around any of these issues. That was all happening over the past few years. The Radbio/physics fail bomb was unexpected, but I don't really think that it influenced applications (for this year). The best and brightest medical students who had competing interests in medical school are likely now leaning away from rad-onc given the job market concerns.

Explosion of satellites means that graduating residents are frequently limited to jobs where they're working essentially a private practice job for academic salary. These are all negative things for new attendings that were less common 10 years ago. 10 years ago residents going to a satellite was like "damn, that sucks, hope you transition to a PP job soon!" but now is going to be the pinnacle of many a new rad onc's career. There are likely going to be 'satellite lifers' going forward now, which would've been unheard of 10 years ago.

But we're supposed to deal with it, because it could be worse, at least we're not in prison?

 

[smith2009]

OK, lets do this again.

So, what's the chances that this 30% that failed pass the exam next round?

Fail rate was not 30%. More likely 40% and closer to 50%. Until the ABR releases the cumulative pass rate (does it not baffle anyone that this wasn't released already?) it's 50%.

Then, what's the chances that they find a job....a job. Based on the work force survey > 94% had jobs. See above for the starting salaries that Rad Oncs are paid. Lets just say 400k. Are you working on Passover/Christmas/July 4th/weekends? Did you make your child's 5th birthday party for emergency surgery? Do you get called all night for the sniffling baby with a rash? The drug seeking backpain brick layer? That is prison?? I think many people would sign up for that prison. I feel SO lucky every time I talk to a friend in primary care that is on the front lines. My dad sold door to door for years, weekends, winter....for a fraction of that. Peek at the people selling you fancy cosmetics, working 2 jobs. I had a woman sell me a sub at subway this year....she was early 60's and looked really sad....so I asked her how she was. She works 2 jobs, 1 in telemarketing during the day and the other working at a downtown subway where she got beat up last month. Sure...they made different choices in life that lead them in a different direction, but YOU ARE NOT IN PRISON.

I hope you all got that folks. WE ARE NOT IN PRISON! That is the standard for comparison-PRISON. Calling all medical students! I was waiting for some special "Greying rad onc" to give me some story about how I should be grateful because of such and such...My friend, this generation of rad oncs was the crème de la crème. We beat out our medical school colleagues in so many ways. Life experiences are one of them. I don't need to share mine on a public message board. My colleagues and I don't want pity, we don't brag about our hardships. We do our jobs and move on. I've worked more than 3 jobs at one point. I've been beaten up multiple times. But that's not the point of this discussion. What does any of that have to do with radiation oncology? Are you trying to make me feel guilty for the POOR DECISIONS MADE BY OUR LEADERS? Sorry. Been there. Done all of that.

I get the feeling there's an element on this board that is actively trying to dissuade med students from choosing rad onc. Maybe that is even working based on application numbers over the past year. Let's play that out. The field doesn't fill and the quality of the applicant pool continues to fall off. That adversely affect you very quickly and for many years. These subsequent trainees will be your partners. They will be the ones that have to compete with encroaching specialties at tumor boards/reimbursement committees/etc. How will that wind up a win for you? ASTRO just fought back a big reduction in billing. Would that have hurt your practice if it had gone in place and don't you want the best/brightest arguing for you?.

Yeah, I'm really gonna tell medical students to come to a field where the board pass rate is 50% and the argument about the current job market uses prison as a standard for comparison...listen to yourself. YOU ARE IN DENIAL. Don't invite someone to your house if its dirty or unsafe. Before you ask medical students to come to radiation oncology, make sure it is safe. As it stands now, it is far from it. "Quality of the applicant pool?" GET OVER YOURSELF. What does that even mean? You're so infatuated with this. Why does it matter? The "quality" will be as good as when LK and PW got in-if not better. Things are great. Things will be great.

Meanwhile the lament is not based on any financial or professional reality. The field is sound in terms of the current job market and reimbursement is solid. We don't face AI or telemedicine competition. There's continued technological improvements and innovation. If you consider time at work, compensation, burn out, QOL what specialty has is better? You are holding a loaded gun with this forum and you're insisting on shooting yourself, and everyone else, in the foot.

What specialty has it better? Medical Oncology, IM, Nursing, Engineering, Computer Science...

 

[GreyingRadOnc]

What specialty has it better? Medical Oncology, IM, Nursing, Engineering, Computer Science...

[/QUOTE]

If you believe that then I think you trained in the wrong field. In 20+ years I never wanted the life of my friends in IM or Med Onc, but that's because I like my job. Some days, when everyone is doing badly in my clinic, I wish I would have done ophtho....but then I rally.

You can retrain you know. I get the feeling you're a resident. You have 30+ years of misery ahead if this field doesn't match well with you. Get out and try something else.

 

[GreyingRadOnc]

"Rad Onc isn't so bad right now because at least you're not in prison"
People are upset that their salaries are going down. People are upset that leadership is not protecting the future of our field. People are upset that residencies started expanding like mad when the data came out that there was going to be an undersupply. People are MORE upset that despite more recently published data showing that the previous analysis was flawed and that we're already on the path to oversupply, but programs continued to keep expanding residency positions and drive salaries down even further.

But you know it's the ACGME that is doing that with more spots. It's got nothing to do with ASTRO, ABR (who might tend to agree), or any other entity.

Also....you didn't quote me correctly btw. I was replying to Smith's comment earlier (which was in very poor taste I might add). I never said what you quoted and you missed the point.

 

[evilbooyaa]

But you know it's the ACGME that is doing that with more spots. It's got nothing to do with ASTRO, ABR (who might tend to agree), or any other entity.

Also....you didn't quote me correctly btw. I was replying to Smith's comment earlier (which was in very poor taste I might add). I never said what you quoted and you missed the point.

Sure, fine, but ASTRO/ADROP could up the laughably low requirements for graduation, right? But they have no motivation to. Residents can graduate without doing a single T&O for definitive cervix and simply doing vaginal cylinders x 20 or whatever the number is. No requirements for any definitive radiation - just crank out your 350 palliative cases and you're ready to practice! That's our leadership thinking that residents are trained adequately for the field. But then we have brachytherapy (and other) fellowships to fill, right?

 

[RickyScott]

But you know it's the ACGME that is doing that with more spots. It's got nothing to do with ASTRO, ABR (who might tend to agree), or any other entity.

Also....you didn't quote me correctly btw. I was replying to Smith's comment earlier (which was in very poor taste I might add). I never said what you quoted and you missed the point.

1) The academic chairmen/senior docs increase the spots and they basically are ASTRO leadership
2) Residency spots have doubled in 10 years. This is not "sound," and medstudents should legitimately be concerned about future job markets. Even if the market was 100% ok today- which it is not- they should be concerned with that kind of expansion and what it means in 5-10 years.
3) large academic facilities with their sattelites are basically the Quest/ameripath/labcore for our field (as reimbursement strongly favors these facilities and their expansion)

 

[thecarbonionangle]

ADROP will not help us

 

[RickyScott]

ADROP will not help us

Just started reading the path boards and similar program director on there named "Wiener" telling medstudents that there is no job problem despite the fact that residents are averaging 2+ fellowships etc.

 

[thecarbonionangle]

Yeah i think there is a lot of denial about this issue

 

[imhopeful432]

1) The academic chairmen/senior docs increase the spots and they basically are ASTRO leadership
2) Residency spots have doubled in 10 years. This is not "sound," and medstudents should legitimately be concerned about future job markets. Even if the market was 100% ok today- which it is not- they should be concerned with that kind of expansion and what it means in 5-10 years.
3) large academic facilities with their sattelites are basically the Quest/ameripath/labcore for our field (as reimbursement strongly favors these facilities and their expansion)

The number of residency positions grew until 2015-2016 because the best data/ASTRO 2012 workforce study suggested there was a shortage of rad oncs in training. That was appropriate.

It has been clear since then we are now in an oversupply situation. Guess what? The number of residency positions has been stable at just about 190 since 2015/2016. Are there a few bad actors (read: program in northern California) who exploit the situation, further expand, and create clinical instructorships? Yes. But its ridiculous to suggest ASTRO leadership/the ABR are in some vast conspiracy to screw the next generation.

Also the use of satellites has been growing in every field (and also thankfully slowed down since legislation limiting hospitals charging hospital outpatient charges for newly acquired facilities a couple years ago). Not unique to radiation oncology.

For anyone that wants to be part of the solution, run to serve for in a leadership position in ASTRO/ACRO, join the government relations council, serve on payer relations committee, work to integrate radio-pharmaceuticals and other modalities in your practice to better serve patients and "grow the pie" for radiation oncology.

 

[KHE88]

That is prison?? I think many people would sign up for that prison. I feel SO lucky every time I talk to a friend in primary care that is on the front lines. My dad sold door to door for years, weekends, winter....for a fraction of that. Peek at the people selling you fancy cosmetics, working 2 jobs. I had a woman sell me a sub at subway this year....she was early 60's and looked really sad....so I asked her how she was. She works 2 jobs, 1 in telemarketing during the day and the other working at a downtown subway where she got beat up last month. Sure...they made different choices in life that lead them in a different direction, but YOU ARE NOT IN PRISON.

Wow, what a coincidence! We just had our med student specialty fair today. We hung a banner over our station to advertise our specialty and chose to go with "Rad Onc: It's better than prison." We originally were going to go with "Rad Onc: It's better than cancer," but a few people thought this was in bad taste.

What are the odds??!

 

[Cyberrad]

The field is competitive. I review applications. It's competitive. The amount of insane applications is down, but that means less people finding out on match day they didn't match....and I don't feel badly about that tbh. I saw some great students go unmatched last year and it was immensely sad. Furthermore, you don't need to train at a top 3 place to get a job. I'm not at a "top 3 place" and all my residents found jobs they were very excited about and had multiple offers. If you're not a resident in the last year of training or a PD, you're basing it on personal bias.

50% didn't fail. It's tragic what happened this year, but it's not the routine in Rad Onc. As ARRO rightly pointed out, it was > 5 SD from the mean pass rate. 30% failed Rad Bio and 30% failed Physics....if you know a combined number that's 50% I'd be interested to see it. It wasn't presented at ASTRO as such.

Lisa Kachnic is a really hard working, intelligent person who cares about residency training. Full stop. At the PD meeting she shared that she conditioned her boards. She expressed an openness to finding solutions and solving the problem. She has faced a barrage of personal attacks related to the boards this year and she's an unpaid volunteer. That's not professional IMO. ARRO made a much bigger impact while pursuing it in a professional manner.

Meanwhile, the PDs are working on solutions and have been since the problem was known. Those are all academics and are volunteering their time to improve the lives of residents. If you doubt that ask the ARRO reps who were very forceful with the PDs and ABR what they thought of it.

Perfectly stated. I echo your sentiments. Lisa is a class act. Those that attach her personally no nothing of her. They are angry - and the mob attitude is to attack the leader. She has helped to lead many good changes at the ABR. You will thank her in many years for MOC being a better process.

 

[Cyberrad]

It's much much worse. Some insurers won't cover your care if you didn't certify at the first go around. I know this because I had a colleague condition 1 section and he faced immense pressure from his employer since there were insurers that didn't pay for his care. This was 5-6 years back. I doubt it has changed. Insurers favorite word is no. I think your SO was very lucky or practicing in a center that could disguise that.

If you fail the clinical written exams you can't sit for the oral exam on cycle. They face similar problems. It's also embarrassing to have to explain the issue to your new employer.

Both are much worse than having to take 2 exams over a short time frame. Back when (early 2k's) we took all 3 with number 2 pencils over 2 days. That's a little "up hill both ways", but it's doable and doesn't mess with your overall schedule.

My point is that it's okay to be upset, mad, hurt, disappointed, etc., but it's not okay to be unprofessional. I get that you feel the ABR was unprofessional with their early response, but what does that have to do with you? No one on this board has influence with the ABR, and there is no ABR alternative (the alt boards all require initial ABR certification). Suing the ABR is well and good...but you will find no one outside the field has sympathy about it. Please see the broader discussions in the public domain when people have complained about boarding in the past. We are considered rich and smart. Patients expect us to keep up our credentials and would not be pleased if we said "hey, we just decided to alter the pass rate to make more people pass." The nuance of how the exam was done and prior pass rates will be lost on them....ie I don't think a jury would side with the plaintiffs.

Your last paragraph is spot on.

You can behave on this board how you chose - but the realities are some of the comments here are incredibly unprofessional and you should be embarrassed about what you write. When you have a real job this behavior will get you terminated from most positions and make it hard to find a new job. I would urge you to take a step back. The ABR is well run. You might not like the results but their mission is to the greater good if the public. There is no conspiracy here. Hundreds of people are involved in writing and evaluating the exam. Anomalies happen. It happened this year. But being unprofessional makes me question if you should look in mirror and rethink if medicine is really what you want to do, where professionalism is part of every day life.

 

[medgator]

Your last paragraph is spot on.

You can behave on this board how you chose - but the realities are some of the comments here are incredibly unprofessional and you should be embarrassed about what you write. When you have a real job this behavior will get you terminated from most positions and make it hard to find a new job. I would urge you to take a step back. The ABR is well run. You might not like the results but their mission is to the greater good if the public. There is no conspiracy here. Hundreds of people are involved in writing and evaluating the exam. Anomalies happen. It happened this year. But being unprofessional makes me question if you should look in mirror and rethink if medicine is really what you want to do, where professionalism is part of every day life.

Your comments are completely divorced from reality. The abr has only further hurt the field with these recent events coupled with the shameless expansion of residency slots the last decade

Objectively, the abr has handled this debacle equally unprofessional, including kachnics comments and wallners email responses.

 

[Neuronix]

The State of this Forum: Rules to Live By

No personal attacks please. Discuss ideas, not the the people posting them.

PS: I deleted the blatantly offending post.

 

[Cyberrad]

Your comments are completely divorced from reality. The abr has only further hurt the field with these recent events coupled with the shameless expansion of residency slots the last decade

Objectively, the abr has handled this debacle equally unprofessional, including kachnics comments and wallners email responses.

Unfortunately you should realize the ABR is ni time in expanding residency slots. That is a decision made solely by the ACGME. The ABR has no responsibility on that.

As for the exam, the realities is that the ABR has never deviated in its scoring methodology used over the decades or by the other boards. They didn’t need to provide a response. Yes some of the comments may have sounded inapproproaye but you should re read the posts made about Wallner and Kachnic who have been personally attacked in an unprofessional manner.

 

[smith2009]

I agree with Cyberrad.
Kachnic and Wallner are class acts.
The ABR is a well oiled machine that is run professionally and honestly.
It is most certainly not run like the mafia.
No one should speak negatively about the ABR or its leadership.
The posters on this forum are unprofessional and should not be doctors.
The ABR should charge residents 2000$ a year as a right-to-speak fee.
Donald Trump is a scholar and a gentleman.
The world is flat...

Sorry, I tried. It's just too bleak and sad.

But seriously. You acknowledge this year was an anomaly. Why shouldn't the ABR be held accountable to give residents back their fees and offer them a retake? It's not the residents' faults the ABR, Kachnic and Wallner screwed up. Why should the residents be punished unfairly? I mean, this is a professional organization? Why did they take so long to respond and do it deceptively? Kachnic is the PRESIDENT, she happens to be a rad onc. She's not the president of the radonc division. The ABR is her responsiblity. And more importantly than that, she wrote an inflammatory article insulting these residents that ended up with the anomalous exam. That's not a coincidence, and if it is, she should apologize and fix this appropriately.

Your last paragraph is spot on.

You can behave on this board how you chose - but the realities are some of the comments here are incredibly unprofessional and you should be embarrassed about what you write. When you have a real job this behavior will get you terminated from most positions and make it hard to find a new job. I would urge you to take a step back. The ABR is well run. You might not like the results but their mission is to the greater good if the public. There is no conspiracy here. Hundreds of people are involved in writing and evaluating the exam. Anomalies happen. It happened this year. But being unprofessional makes me question if you should look in mirror and rethink if medicine is really what you want to do, where professionalism is part of every day life.

 

[smith2009]

The fact that some posters are trying to stifle dissent and criticism using "professionalism" shows how pathetic the field has become. Let's be honest. You're angry that this is an anonymous forum. You can't hurt these people and that angers you. While that is fun to watch, it is more important to note that this mentality is a reflection of the sort of organized mob the field has become. Sorry this doesn't fit with the current culture of rad onc, but the mission of sdn is to provide unbiased information to medical students:

Physician co-founder and volunteer director, Lee Burnett, summarizes our vision, “We founded the site to provide free, independent, and unbiased information to students. When SDN was created, there was no such thing as social media – no Facebook, no Twitter. Applying to schools, residencies or fellowships was essentially a solo effort and you simply hoped for the best. Not all colleges offer pre-health advisors and even they did, they were limited in their ability to gather and share information. SDN was created to fill that need.

 

[thecarbonionangle]

The eye of Sauron ivory tower is watching.

 

[Gfunk6]

The positions that many posters are taking here are hyper-polarized. I think there is a happy medium where one side can admit that the ABR is not the devil incarnate and the other side can admit that the ivory tower may be out of touch with some of the realities on the ground.

 

[RadOncDoc21]

Wrong on both sides! Fake News! Witchunt!

Election day is upon the field of rad onc!

 

[Cyberrad]

I agree with Cyberrad.
Kachnic and Wallner are class acts.
The ABR is a well oiled machine that is run professionally and honestly.
It is most certainly not run like the mafia.
No one should speak negatively about the ABR or its leadership.
The posters on this forum are unprofessional and should not be doctors.
The ABR should charge residents 2000$ a year as a right-to-speak fee.
Donald Trump is a scholar and a gentleman.
The world is flat...

Sorry, I tried. It's just too bleak and sad.

But seriously. You acknowledge this year was an anomaly. Why shouldn't the ABR be held accountable to give residents back their fees and offer them a retake? It's not the residents' faults the ABR, Kachnic and Wallner screwed up. Why should the residents be punished unfairly? I mean, this is a professional organization? Why did they take so long to respond and do it deceptively? Kachnic is the PRESIDENT, she happens to be a rad onc. She's not the president of the radonc division. The ABR is her responsiblity. And more importantly than that, she wrote an inflammatory article insulting these residents that ended up with the anomalous exam. That's not a coincidence, and if it is, she should apologize and fix this appropriately.

Just because there was an anomaly doesn’t mean t was wrong. You first need to understand that the ABR does not grade on a curve. They have a criterion reference standard that is a well established testing protocol. They have spent time looking at the data. There is no clear smoking gun. Perhaps it was the program directors who thought too highly of their residents - that is how they develop the reference standard. The ABR is full of volunteers who graciously give their time. Professionalism is a big item - you may not believe it - but the attack’s on Kachnic who is a very decent person were uncalled for. She has no power to impact the exam results. She has been an ardent supporter of residents. She is just a trustee - recently the head of the board. Valerie Jackson is the head of ABR. Maybe write to her.

Finally - the ABR doesn’t owe anyone anything. It’s unfortunate that some have to retest. Hopefully they will keep costs low. But the ABR has a greater responsibility to the general public. Without them, you’d be under a lot more government regulation which you don’t want.

 

[pbrocks15]

What are the consequences of failing the board? Is it only given once a year? Does it make you less competitive for jobs?

 

[Gfunk6]

What are the consequences of failing the board? Is it only given once a year? Does it make you less competitive for jobs?

There are four board exams. Physics/Radbio are typically taking at the end of your PGY-4, Clinical Oncology at end of PGY-5, and Oral Exam one year after graduation.

You remain "board eligible" for five years after graduation. That means that you have until that time to pass all of the exams and become "board certified." If you fail one exam you still remain "board eligible." Most hospitals say you have to be BE/BC in order to practice. If you are supposed to be BC and you fail an exam, you may need to justify to your hospital in writing why this happened (e.g. I failed the exam but I will study hard and re-take it).

Clearly if you become "board ineligible" you can be terminated and ineligible for most jobs. However, I've not personally heard of the same happening for someone who failed/conditioned an exam and remained "board eligible."

 

[pbrocks15]

There are four board exams. Physics/Radbio are typically taking at the end of your PGY-4, Clinical Oncology at end of PGY-5, and Oral Exam one year after graduation.

You remain "board eligible" for five years after graduation. That means that you have until that time to pass all of the exams and become "board certified." If you fail one exam you still remain "board eligible." Most hospitals say you have to be BE/BC in order to practice. If you are supposed to be BC and you fail an exam, you may need to justify to your hospital in writing why this happened (e.g. I failed the exam but I will study hard and re-take it).

Clearly if you become "board ineligible" you can be terminated and ineligible for most jobs. However, I've not personally heard of the same happening for someone who failed/conditioned an exam and remained "board eligible."

Thanks! Are the Physics and Radbio board exams difficult? I do worry a little that I have no recall of any physics and it does not exactly come naturally to me. I heard that the physics boards don't delve THAT deep into physics, is that true as well?

 

[smith2009]

That makes sense. The program directors thought too highly of their residents and this resulted in the one year drop in scores we saw. Totally makes sense now. Anomalies don't suggest errors. Presidents have no power. And it's better to be regulated by an unchecked organization with competing interests than the government. It all makes sense now. Maybe we can write this as a response to ARRO? If ARRO is reading, take notes. This guy is spot on.

Just because there was an anomaly doesn’t mean t was wrong. You first need to understand that the ABR does not grade on a curve. They have a criterion reference standard that is a well established testing protocol. They have spent time looking at the data. There is no clear smoking gun. Perhaps it was the program directors who thought too highly of their residents - that is how they develop the reference standard. The ABR is full of volunteers who graciously give their time. Professionalism is a big item - you may not believe it - but the attack’s on Kachnic who is a very decent person were uncalled for. She has no power to impact the exam results. She has been an ardent supporter of residents. She is just a trustee - recently the head of the board. Valerie Jackson is the head of ABR. Maybe write to her.

Finally - the ABR doesn’t owe anyone anything. It’s unfortunate that some have to retest. Hopefully they will keep costs low. But the ABR has a greater responsibility to the general public. Without them, you’d be under a lot more government regulation which you don’t want.

 

[smith2009]

Thanks! Are the Physics and Radbio board exams difficult? I do worry a little that I have no recall of any physics and it does not exactly come naturally to me. I heard that the physics boards don't delve THAT deep into physics, is that true as well?

50% (around that range- we dont know for certain because the people in charge of the exam won't provide the details) failed physics or radiation biology. Don't worry this year's class is an anomoly (that big word means outlier) because they're not as smart as other years. Their Step 1 average was around 245 but the results this year are an anomoly and do not reflect the difficulty of the exam.

 

[pbrocks15]

50% (around that range- we dont know for certain because the people in charge of the exam won't provide the details) failed physics or radiation biology. Don't worry this year's class is an anomoly (that big word means outlier) because they're not as smart as other years. Their Step 1 average was around 245 but the results this year are an anomoly and do not reflect the difficulty of the exam.

Can't they just retake the exam?

 

[smith2009]

Can't they just retake the exam?

You were born for this field kiddo ;-)

 

[pbrocks15]

You were born for this field kiddo ;-)

Seriously though, cant they just retake the exam? I'm sure it's an inconvenience but is it going to negatively impact them otherwise?

 

[smith2009]

Seriously though, cant they just retake the exam? I'm sure it's an inconvenience but is it going to negatively impact them otherwise?

Yes they can. But they don't know what to study because the exam has no study guide. It also costs money and takes time. More importantly than that, the people that are charged with writing the exam, came out with an editorial that was insulting to residents before the exam was administered so some people (I'm not naming names, but Im sure you can guess who!) are of the view that they screwed the residents over on purpose. All of that plus our job market is terrible.

(As you can see we have issues, but what family doesn't?) /s

 

[evilbooyaa]

Seriously though, cant they just retake the exam? I'm sure it's an inconvenience but is it going to negatively impact them otherwise?

Yes, they can re-take the exam next year. The exam is given one day prior to when they would have to do the clinical written exam. So now people who failed will have to do 2 or 3 exams instead of 1 in a 2-day period.

People start interviewing for jobs as a PGY-5 and with a more competitive job market, I wonder how many places care about rad bio/physics failure when they're interviewing PGY-5s for job openings.... certainly enough openings that competitive jobs could be picky about stuff like that.

Otherwise agree with above that "we still don't have any idea of what to study"

 

[pbrocks15]

Yes they can. But they don't know what to study because the exam has no study guide. It also costs money and takes time. More importantly than that, the people that are charged with writing the exam, came out with an editorial that was insulting to residents before the exam was administered so some people (I'm not naming names, but Im sure you can guess who!) are of the view that they screwed the residents over on purpose. All of that plus our job market is terrible.

(As you can see we have issues, but what family doesn't?) /s

Yes, they can re-take the exam next year. The exam is given one day prior to when they would have to do the clinical written exam. So now people who failed will have to do 2 or 3 exams instead of 1 in a 2-day period.

People start interviewing for jobs as a PGY-5 and with a more competitive job market, I wonder how many places care about rad bio/physics failure when they're interviewing PGY-5s for job openings.... certainly enough openings that competitive jobs could be picky about stuff like that.

Otherwise agree with above that "we still don't have any idea of what to study"

Interesting to be hearing all this. Thanks for the input.

Yeah this isnt comforting to an interested third year student....

 

[scarbrtj]

Feeling very "Animal Farm" 'round here. Who are the pigs and who are the sheep though? To paraphrase Orwell, I'm going to start protesting really loudly once I find the right arguments to make.

So now people who failed will have to do 2 or 3 exams instead of 1 in a 2-day period

In my day, that's how we did it AND WE LOVED IT

 

[pbrocks15]

Feeling very "Animal Farm" 'round here. Who are the pigs and who are the sheep though? To paraphrase Orwell, I'm going to start protesting really loudly once I find the right arguments to make.

In my day, that's how we did it AND WE LOVED IT

What are your two cents on the job market and compensation?

 

[Cyberrad]

That makes sense. The program directors thought too highly of their residents and this resulted in the one year drop in scores we saw. Totally makes sense now. Anomalies don't suggest errors. Presidents have no power. And it's better to be regulated by an unchecked organization with competing interests than the government. It all makes sense now. Maybe we can write this as a response to ARRO? If ARRO is reading, take notes. This guy is spot on.

Well....you are again wrong. The ABR is not unchecked. They have a diverse board of trustees that guid the organization. The ABR's mission is to the public - what competing interests are you referring to. There is no industry money, no other organizations funding it. We are self regulating our profession. I know it's hard to be on the examinee side. But trust me, having the government regulate this would never be better - just look at healthcare. You have no idea what programs from the government for quality look like - ie MACRA/MIPS where we jump through un-necessary hurdles. Or child abuse training on an annual basis - ie a one size fits all policy that has virtually no impact on what we actually do every day.
It's easy to call the ABR the enemy as a resident. But you'll have more insight once you have actually passed. Board certification is a necessary evil - every doctor in this country does it. Your not the first.
Finally, the ABR under Kachnic has been incredibly responsive. They can't change a standard for a particular scenario, but they have done tons to reduce the burden of MOC. Remember to thank Dr. Kachnic for helping to eliminate the cognitive exam (you would be taking every 10 years) for the OLA (online assessment) which will make life much easier.

 

[Cyberrad]

50% (around that range- we dont know for certain because the people in charge of the exam won't provide the details) failed physics or radiation biology. Don't worry this year's class is an anomoly (that big word means outlier) because they're not as smart as other years. Their Step 1 average was around 245 but the results this year are an anomoly and do not reflect the difficulty of the exam.

You are so wrong smithy.....it was over 70% pass for physics and bio. You can't add the 30% fail from both as many who failed one failed both. That is unlikely 50%. And not sure where you are getting the step 1 average. ABR does not have that data - you are just guessing. I know many programs have residents with step 1 <230

 

[Cyberrad]

Yes, they can re-take the exam next year. The exam is given one day prior to when they would have to do the clinical written exam. So now people who failed will have to do 2 or 3 exams instead of 1 in a 2-day period.

People start interviewing for jobs as a PGY-5 and with a more competitive job market, I wonder how many places care about rad bio/physics failure when they're interviewing PGY-5s for job openings.... certainly enough openings that competitive jobs could be picky about stuff like that.

Otherwise agree with above that "we still don't have any idea of what to study"

Let's take a quick step back in history. Prior to 2005, residents took all 3 exams (240 questions per section) over 1 1/2 days. This change of taking physics/rad bio started in 2005. And physics and biology are now half the length. You get no pity complaining. Incidentally, those same examinees all took much longer step 1 and 2 exams - 2 full days for each step. It's clearly very possible to not only take all 3 sections of rad onc boards at once, but to also pass them. I did, as did every board certified rad onc prior to 2005.

 

[smith2009]

American Board of Radiology Foundation receives grant from Varian Medical Systems for national brachytherapy registry | Varian Medical Systems

The ABR's mission is to the public - what competing interests are you referring to. There is no industry money, no other organizations funding it.

 

[Cyberrad]

"Rad Onc isn't so bad right now because at least you're not in prison"
but programs continued to keep expanding residency positions and drive salaries down even further.

Explosion of satellites means that graduating residents are frequently limited to jobs where they're working essentially a private practice job for academic salary.

There seems to be some disconnect in your logic. For private practices, how does an increase in candidates drive salaries down. A private practice hires what it needs. They don't overstaff. Just because there might be a market oversupply, doesn't mean I have to hire. And it's unlikely someone will come in a plop down a center in 2018 next to an existing one if you don't have the referral base which we have built through hands on personal relationships and high quality care.
Our reimbursement and hence salary are controlled by two things - Medicare and commercial payors. Medicare we have no control over, but there is no clear indication of a fiscal cliff, though it will tend down based on how the medicare pot works. Commercial payors we negotiate with and have dialogues.

As for satellites, you should be aware, that ever since the ACA passed, many are going into hospital employed models. Pretty analogous to satellites (which actually do pay more than their academic counterparts in many scenarios, or have 3-4 day work weeks). This is a trend in all of medicine currently, and most prevalent in desirable regions of the country - ie california, Northeast, major cities.

 

[Neuronix]

For private practices, how does an increase in candidates drive salaries down.

You're assuming that practices treat their new hires equitably and fairly. Sure, some do. But there are plenty that are happy to take advantage of desperate new grads, paying them less than they could and pocketing the difference.

And it's unlikely someone will come in a plop down a center in 2018 next to an existing one if you don't have the referral base which we have built through hands on personal relationships and high quality care.

I have heard exactly these words used to justify why they pay someone so much less than what they make with no opportunity to ever grow into it.

As for satellites, you should be aware, that ever since the ACA passed, many are going into hospital employed models. Pretty analogous to satellites (which actually do pay more than their academic counterparts in many scenarios, or have 3-4 day work weeks).

Satellites are where the vast majority of the jobs are. Personally, I haven't seen them pay better or have 3-4 day work weeks.

 

[medgator]

For private practices, how does an increase in candidates drive salaries down. A private practice hires what it needs. They don't overstaff. Just because there might be a market oversupply, doesn't mean I have to hire. .

When you do finally need to though, what do you think excess supply will do to your employment offer? Or locums rates?

Think logically here. And if that logic is too complicated for you, pose your question in the pathology subforum which has been dealing with excess residency supply and decreased demand for years now.

 

[RickyScott]

There seems to be some disconnect in your logic. For private practices, how does an increase in candidates drive salaries down. .

Dont want to be insulting, but this is like asking why the world is round. It is easily the silliest statement I have read on these boards. This is really, really basic and taught to my six grader. Supply and Demand/scarcity. Because when you have a lot of candidates for the job, you can chose who will take it for the least amount of pay/accept the worst conditions to the point where fellowships fill in desirable locations even though they offer very little "training:" palliative care in Boston or NY, lung stereo- Stanford.

Why do you think rural jobs in our field pay many times more than jobs in Manhattan? Why is a diamond expensive and water cheap. Like gravity, these concepts were formalized hundreds of years ago.

I am going to doxx you as academic chair you probably are.

 

[Cyberrad]

Well, I am not assuming. I hire for my practice. Most practices are pretty fair....yes there are bad apples.....most do not take advantage of new grads. I have many friends in some of the major private groups across the country, and none of us try to take advantage of anyone. Why would they do that when they expect them to become full partners and colleagues. Why would you treat someone poorly just to score a few bucks when the bigger picture is the lifetime relationship as a colleague.

I was initially offered a position by one of the top 3 academic centers satellites years ago. The job was a 4 day week, with 1 day of 'academics' that most in the office took as a day off. Salary was 20% higher than the main in town site.