Yeah that’s inevitable esp with 5fx Sbrt coming around the corner. Perfecting your Sbrt skills for 2 years is gonna be a must even. It’s gonna be like radiology fellowships except more useless than that. More like path fellowships
We fixate on new grads getting jobs but honestly I worry even more about those that are out practicing now with families and mortgages keeping the jobs they have at the salary they aren’t at.
Most of them are employed but eventually admin looks at the numbers and there’s is a reckoning a bad one. They aren’t gonna put up with your 5fx if they aren’t making money on it.
The near-constant low-level anxiety of being a practicing radonc in today's day and age isn't something I was expecting. No matter what your situation, it's a time that should make one nervous. Successful private practice? Well, a hospital system could buy out your referring practices, and you're done for. A huge, very well-monetized academic center could open up a satellite center across the street and use their state-derived marketing dollars to end you.
Employed hospital physician? Increasing numbers of new grads means your current salary and benefits -whatever that may be- is under very real threat. Academic physician? At a satellite? Same issue as with the employed hospital position, except your salary will already be low, as the academic administrators know all about the new grad glut. They created it after all. Not going to be getting that protected research/teaching time they all preach is so important after all, and the quality of your future residents may suffer.
What the ivory tower folks
don't seem to understand is that with radonc, if you lose your job/position due to factors out of your control, in today's day and age, that's an absolute disaster in terms of your entire life. As we all know, you cannot simply "hang a shingle" with radonc like you can with many other specialties, including primary care, family medicine, Ob/Gyn (though that's tough, but can be done with Ob hospitalists), neurosurgery (all you need is an office and an MA), many types of ortho (hand especially), general surgery (depending on how you want to practice), plastics, ENT, dermatology, and several IM subspecialties.
In those specialties, physicians are less sensitive to job market issues, as they can go out and practice themselves without many millions of dollars of capital and an established referral base. As it's simply not possible in radonc, due to the capital involved, unemployment problems are orders of magnitude more impactful. Additionally, with the relatively small size of our specialty, not only can you not set up your own practice, you won't be able to choose where you end up. At all. Location is a bigger deal once you have a family, they have a life established, etc. As a result, although I have a tremendous practice and am very, very happy overall, there's always a low-level fear that forces outside of my control will take it all away from me and I'll be separated from my family.
That's not an idle fear. Happened to a radonc in my neck of the woods. Came into town to try to join a group and compete with us a few years ago. Didn't work out, and he was fired before making partner. His family now lives in this state as he travels the US doing locums and asking me every month or two if I know of any jobs in the state. I do not. Living and working apart from your family is a terrible place to find yourself. Is there another specialty where, after losing a job in one of the most populous states in the nation, you couldn't find another? Hell, this is in one of the top 15 metro areas in the country. I'm willing to bet that, non-competes aside, you'd be able to find a job in this exact same city in nearly every other specialty, barring a few outliers.
There aren't many other specialties in medicine that have the same issues we do with respect to jobs, and as a result we are- and always have been- extremely sensitive to job market concerns. Tenured academicians are the last people in the world I would expect to understand that, but they're the very ones who need convincing.
