Updated Rankings - Top 10 for clinical training / finding a job

[RadOncDoc2k19]

The job outlook for future rad onc residency graduates is grim in the upcoming years according to the various discussions on SDN. It has been quite some time since program rankings were discussed. For those still choosing to go into this field despite all of the unknowns, where would you feel comfortable matching at the current time? What are people's "top 10" when taking into account important factors such as clinical training, emphasis of resident education, job prospects, etc.

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[elementaryschooleconomics]

I HATE these threads.

That being said, and acknowledging that I'm disappointing myself by engaging here, I think that an increasingly important metric would be "age of department and size of graduate network".

In other industries, certain schools are important/more competitive because of (in part) their alumni network (Ivy Leagues, Notre Dame, several California schools, etc).

If, with APM and general supervision, we are truly entering a The Job Crunch Era, networking will become increasingly important. Therefore, the programs that have an advantage are the older and larger ones. This would obviously include The Big 3 and other commonly discussed places like Duke, Yale, Mayo, Michigan, Chicago, etc etc. You know the names.

But I would posit this could also include less discussed programs like VCU (or, going old school, the Medical College of Virginia). That department has been around for decades, and you can find people with ties to VCU all over the country.

Actually learning Radiation Oncology is largely dependent on the individual, and becoming a "minimally competent" RadOnc can be accomplished at most programs in America. The rest is on the individual and how much effort they're willing to put in. Beyond the alumni network, it would behoove each applicant to look for a department which fits their particular personality and learning style.

...and then start networking as a PGY-2.

 

[Church of Radiontology]

Each applicant's top 10 will be substantially different depending upon what sort of post-residency job is desired. I recommend that applicants take the following approach.

1. Articulate what job is sought (e.g., clinical academic, lab-research, hospital PP, group PP, etc.)

2. Use the friendly current residents to discern whether graduates have reached similar positions in the past few years. (N.B., if there are no friendly residents, don't waste your time ranking the program. You don't want to go where people are fundamentally, collectively dissatisfied.) If the program hasn't been placing residents in your job category of choice, it's not likely associated with either the training or the networking that you'd need to do so.

3. Realize that your professional goals could change dramatically during the next 5.5 years. It's easy to be gung-ho about research/academics when you're a medical student who has only encountered medicine in an academic milieu. Never forget that most physicians involved in education seek to mold the next generation of physicians after their own image, but the reality is that most physicians will not and should not be academics. Furthermore, academics only implies an association with a university; it does not confer moral or intellectual superiority vis-a-vis private practitioners. Don't prematurely circumscribe your options. Compound this with expected or unforeseen personal issues (marriage, children, extended family, geography) and income (Yes, you may love research, but how much of a pay cut are you willing to accept to pursue it? Would your spouse (or future spouse) agree?), and a senior medical student really only has an inclination as to his preferred job after residency. And, no one knows what the job market will be in 5+ years.

While we all could agree on the criteria and population of weak programs, among the top 25% or so, it all comes down to personal preferences, priorities, taste, culture, and fit. There is no such thing as a uniformly agreed upon top 10 and to compile one would require us to subsume our own individual considerations to those of the group.

 

[OTN]

Each applicant's top 10 will be substantially different depending upon what sort of post-residency job is desired. I recommend that applicants take the following approach.

1. Articulate what job is sought (e.g., clinical academic, lab-research, hospital PP, group PP, etc.)

2. Use the friendly current residents to discern whether graduates have reached similar positions in the past few years. (N.B., if there are no friendly residents, don't waste your time ranking the program. You don't want to go where people are fundamentally, collectively dissatisfied.) If the program hasn't been placing residents in your job category of choice, it's not likely associated with either the training or the networking that you'd need to do so.

3. Realize that your professional goals could change dramatically during the next 5.5 years. It's easy to be gung-ho about research/academics when you're a medical student who has only encountered medicine in an academic milieu. Never forget that most physicians involved in education seek to mold the next generation of physicians after their own image, but the reality is that most physicians will not and should not be academics. Furthermore, academics only implies an association with a university; it does not confer moral or intellectual superiority vis-a-vis private practitioners. Don't prematurely circumscribe your options. Compound this with expected or unforeseen personal issues (marriage, children, extended family, geography) and income (Yes, you may love research, but how much of a pay cut are you willing to accept to pursue it? Would your spouse (or future spouse) agree?), and a senior medical student really only has an inclination as to his preferred job after residency. And, no one knows what the job market will be in 5+ years.

While we all could agree on the criteria and population of weak programs, among the top 25% or so, it all comes down to personal preferences, priorities, taste, culture, and fit. There is no such thing as a uniformly agreed upon top 10 and to compile one would require us to subsume our own individual considerations to that of the group.

Re: #1, I would still play the game. If you really think a particular program would be best for you, and that program dislikes pp applicants, don't tip your hand. We already see PDs talking about "service" and "volunteerism" rather than hard metrics, so I would check those boxes too, like I did while in medical school.

One could argue that getting into a top program is even more important now than it was 10-15 years ago. Then, graduating from a lower-tiered program (those would all be middle-tiered programs now) meant you wouldn't necessarily get your first choice of an academic job, and might not have the networking set up to get a perfect pp job. Now, it may mean unemployment.

 

[Church of Radiontology]

I absolutely agree about keeping one's true intentions and expectations tacit while voicing all the enthusiasm for becoming an academic that one plausibly can muster. There is nothing so offensive to an interviewer as an applicant who has the temerity to have a different set of priorities for his own career. (Yes, this is petty, but it's real. There is no logical connection between "I expect to provide excellent clinical care to the public in a private practice." and "I think your academic career is worthless.", but that's how it would be received.)

I don't know if it still happens, but some programs have been known to go so far as to require interviewees to sign a statement committing to an academic career--5.5 years in the future. Of course this is impossible to know and to enforce, but it attests to the mindset of some academicians. My only encounter with this was years ago and programs are probably too clever to coerce this in writing now, but the attitude remains in some places I'm sure. My attitude was "How the heck do I know what job I'll take when I'm in my 30s? But if I have to sign the paper to proceed with the interviews today, sure. So far as that goes, I intend to go into academics, but you've already offended me with your self-congratulatory prejudice."

What's wrong with training good doctors to go do good work? Statistically, that's more important than creating more academics. Apart from the sheer numbers of academic vs. non-academic physicians, placing one good rad onc in private practice, especially in a smaller town or rural area, can have a greater impact on the practice of radiation oncology than does the addition of one more junior attending at a large academic center.

 

[seper]

Doubt anyone has actually extracted a written statement like that from an applicant, but this tension between "academics" and future private practitioners use to be real.

 

[medgator]

, but this tension between "academics" and future private practitioners use to be real.

Still is. Probably worse now

 

[evilbooyaa]

I imagine two of the most important things to ease the job search are 1) proximity to where you would like to end up as an attending, and 2) how big of an alumni network there is to use for connections and networking.

'Name-value' of a program is still very important as well. Research is well and good but major academic institutions are not going to hire graduating residents from lower-tier programs regardless of the amount of research produced.

 

[metview]

There are so many ways to rank programs (ie. research, clinical training, reputation/name, location) and a comprehensive ranking takes into account all of those factors. For example, some programs have great reputation/name while other programs have great research but are lesser known. If I had to take a stab taking into account research, clinical traning, and reputation/name:

1. Harvard
2. MDA
3. MSK
4. Stanford
5. Penn
6. UCSF
7. WashU
8. Hopkins
9. Duke
10. UMichigan
11. Mayo

As always, every attempt is imperfect but I think this is reasonably accurate and programs outside of big 3 and can be re-ordered.

 

[PhotonBomb]

I honestly don't think the whole thing of programs only wanting to train academicians is much of a thing anymore, as it was more strongly felt 5-10 years ago.

all the top programs send more people into PP than academics routinely. It's understood, and PDs these days are more expecting it.

of course no need to be the guy/gal who tells someone in an interview 'I don't care about research and only know I want to be in PP' but that's more because it would make someone (including me) question your sense and your poise when it's easy not to say something like that in an interview, not that I care that you feel like you want to do PP. would also make me think you don't really know as much as you think, because I have seen so many people set on PP do academics and people who were initially set on academics do PP.

the 'normal person' thing to do is to take the best job available that checks the most boxes, regardless of 'academics' or 'PP' which are increasingly more similar than in a past era.

 

[Krukenberg]

I imagine two of the most important things to ease the job search are 1) proximity to where you would like to end up as an attending, and 2) how big of an alumni network there is to use for connections and networking.

'Name-value' of a program is still very important as well. Research is well and good but major academic institutions are not going to hire graduating residents from lower-tier programs regardless of the amount of research produced.

If you have a compelling connection to a geographic area, going to a top ten program and just getting in touch with PP in your desired area early would be just as good or better as going to an inferior program closer by. Going to the better program leaves your options more open if your preference changes

 

[PhotonBomb]

If you have a compelling connection to a geographic area, going to a top ten program and just getting in touch with PP in your desired area early would be just as good or better as going to an inferior program closer by. Going to the better program leaves your options more open if your preference changes

Absolutely agree. I really think name matters for many people/places.

Look at the recent Seattle area ‘true PP’ job posting on ASTRO from few days ago. They straight up say looking for someone from a top program.

And everyone knows that the big groups like SERO, ROC, etc al favor recruits from ‘name’ places, for better or worse

 

[Mandelin Rain]

Everyone, everywhere, for every specialty wants a Harvard doctor.

MDACC and MSK carry very strong name recognition in some regions, and absolutely none in others.

Literally everyone in the first world knows Harvard.

 

[medgator]

Absolutely agree. I really think name matters for many people/places.

Look at the recent Seattle area ‘true PP’ job posting on ASTRO from few days ago. They straight up say looking for someone from a top program.

And everyone knows that the big groups like SERO, ROC, etc al favor recruits from ‘name’ places, for better or worse

Practice dependent obviously. Seems to matter less in the Sunbelt imo compared to NE or west coast

 

[deleted1002574]

Harvard or Yale (even not a top program) or Stanford will get you cred pretty much everywhere, especially in the non academic hospital setting and a lot of private practices. They are the most famous. Probably can throw Hopkins and Duke and Mayo in there. Sloan / Mdacc very regional and also more known by the upper SES / elites.

 

[PhotonBomb]

okay, everyone hold on.

I buy that some practices care about pedigree more than others when hiring.

But the idea that Sloan/Mdacc names are 'regional' are more known by 'elites' is hilarious.

Every single radiation oncologist knows what Sloan and MDACC are and the weight of those names.

Stop.

 

[elementaryschooleconomics]

okay, everyone hold on.

I buy that some practices care about pedigree more than others when hiring.

But the idea that Sloan/Mdacc names are 'regional' are more known by 'elites' is hilarious.

Every single radiation oncologist knows what Sloan and MDACC are and the weight of those names.

Stop.

RadOncs? Of course.

Patients or some random referring community PCP in Idaho? No way.

 

[PhotonBomb]

RadOncs? Of course.

Patients or some random referring community PCP in Idaho? No way.

yeah but we are talking about rad oncs.

and i would give more credit to a 'random' PCP, but besides the point.

 

[elementaryschooleconomics]

yeah but we are talking about rad oncs.

and i would give more credit to a 'random' PCP, but besides the point.

Yeah sorry, didn't mean to imply I was disparaging a "random PCP". I would bet a lot of money that someone born and raised in the midwest, with little to no exposure to Oncology, going to med school and residency also outside of the coasts, practicing in a community in Idaho, is not going to view MSKCC the same way we do.

Similarly, if I was building a practice in Wyoming, what would be easier to sell to my patients and referring docs? A cadre of RadOncs from "name-brand" places recognized worldwide because of their use in pop culture? Or relatively niche names like MSKCC?

To be clear, I am IN NO WAY implying any sort of inferiority to MSKCC or debating their place in The Big Three, at all.

I am from a poor and rural community.

Everyone knows about Stanford, Hopkins, Yale, Harvard, etc.

No one knows what a Memorial Sloan Kettering is, except people who have seen Step Brothers a lot:

 

[deleted1002574]

okay, everyone hold on.

I buy that some practices care about pedigree more than others when hiring.

But the idea that Sloan/Mdacc names are 'regional' are more known by 'elites' is hilarious.

Every single radiation oncologist knows what Sloan and MDACC are and the weight of those names.

Stop.

Yes, radoncs do.

No one else does. Trust me

 

[PhotonBomb]

Yes, radoncs do.

No one else does. Trust me

I don’t trust you.

Ignoring med onc for a second, MDACC obviously also has strong subspecialty training in all the surgery fields.

 

[elementaryschooleconomics]

I don’t trust you.

Ignoring med onc for a second, MDACC obviously also has strong subspecialty training in all the surgery fields.

This is why these "Top 10" or whatever threads annoy me so much.

There's a difference between objective reality, and the narrative reality which we create.

In terms of objective reality, for all I know, some of these expansion programs SDN loves to bring up might actually produce the best Radiation Oncologists in the modern era. Perhaps City of Hope, out of all the programs, makes the "best" RadOncs, however that's defined. But how do I know? I didn't train there. And even if I did - how would I know that it was the best? I only trained at that one program. I only interact with a small number of doctors (compared to all the doctors in America). They could all tell me I'm the best, but how do they know? They haven't interacted with all the RadOncs in all of America.

So then it comes down to opinion. We all can only train in one program in one snapshot of time. Perhaps you train at a place that's AMAZING right now, but in a few years the chair changes, the PD changes, some financial decisions are made - maybe it's marginally less amazing. But you wouldn't know that. For you, in that time, it was amazing, and that's all you're going to tell people till the end of your career, because it was true for you.

Looking at it from a showmanship point of view, from a business point of view - there's huge value in name recognition. While it's true that some "name-brand" places might not have the best training, and ride the reputation of other aspects of an institution - what does that matter in narrative reality?

This is actually what has made me the most disappointed in science and medicine. I came into this profession looking for objectivity. Turns out, I'm looking in the wrong place.

 

[PhotonBomb]

i agree that reputation is objective for sure and it's hard to know what to believe in these threads.

that's why I think looking for objective things in the programs, like Evilbooya alluded to, matter.

You NEED to be at a program with organized eduation, attendings who give morning conferences and talks, attendings that are at times uncovered.

those three HAVE to be met.

 

[medgator]

Yes, radoncs do.

No one else does. Trust me

I've had pts walk in and tell me they are going to get a second opinion at "MD Anderson" at the time of initial consult fwiw. I have to them it's an affiliate unless they are flying to Houston.

Hospitals pay a pretty penny for that affiliation btw.* It isn't anywhere close to free and I imagine there has to be a compelling ROI for them to want to do it.









*- knowledge garnered from knowing a health system that had the affiliation and purposely got rid of it, one of the reasons being the expense: benefit ratio.

 

[Mandelin Rain]

I guarantee that 99% of my patients and PCPs have never heard of either MDACC or MSK. These are regional names.

Once you get out of onc world, they just don’t hold any cache in much of the country.

 

[PhotonBomb]

I guarantee that 99% of my patients and PCPs have never heard of either MDACC or MSK. These are regional names.

Once you get out of onc world, they just don’t hold any cache in much of the country.

lmao

 

[elementaryschooleconomics]

lmao

@PhotonBomb, what about this is so hard to believe?

 

[PhotonBomb]

@PhotonBomb, what about this is so hard to believe?

‘99 percent’

Like medgator suggested, if only one percent of people knew the name MDACC, they wouldn’t have hospitals paying money for the name in every corner of this Trump Nation.

 

[Mandelin Rain]

lmao

You’re simply wrong. Wherever you live or whatever you’re doing, it seems incomprehensible that someone wouldn’t know cancer centers in nyc or houston. But many just don’t.

 

[Mandelin Rain]

‘99 percent’

Like medgator suggested, if only one percent of people knew the name MDACC, they wouldn’t have hospitals paying money for the name in every corner of this Trump Nation.

A local hospital did this. They gave it up after a single year. Why? Nobody had ever heard of the “name” on the door nor cared.

 

[PhotonBomb]

A local hospital did this. They gave it up after a single year. Why? Nobody had ever heard of the “name” on the door nor cared.

okay, then maybe in your neck of the woods, your 99 percent statement may come close to the truth

 

[PhotonBomb]

and moot point anyways because the entire POINT was that rad oncs knew the name MDACC

 

[Mandelin Rain]

and moot point anyways because the entire POINT was that rad oncs knew the name MDACC

Of course. But that’s the point you’re making.
no one is arguing that.

 

[PhotonBomb]

Of course. But that’s the point you’re making.
no one is arguing that.

Please see ROFallingDown post:


Harvard or Yale (even not a top program) or Stanford will get you cred pretty much everywhere, especially in the non academic hospital setting and a lot of private practices. They are the most famous. Probably can throw Hopkins and Duke and Mayo in there. Sloan / Mdacc very regional and also more known by the upper SES / elites.

 

[Mandelin Rain]

If I’m hiring someone because I want our patients and docs to look at his credentials and think, “Yup, that kid must be good”, I 100% agree with his list. It would be applicable nationwide too.

 

[deleted1002574]

If I’m hiring someone because I want our patients and docs to look at his credentials and think, “Yup, that kid must be good”, I 100% agree with his list. It would be applicable nationwide too.

100% still agree with myself . How long have you been in practice, out of curiosity? Having lived and practiced in two regions of the country, I’m just really curious about what in the world you’re talking about.

 

[PhotonBomb]

100% still agree with myself . How long have you been in practice, out of curiosity? Having lived and practiced in two regions of the country, I’m just really curious about what in the world you’re talking about.

okay you’re right, practices don’t give a **** about grads from MDACC. They have trouble getting jobs.

Med students, don’t rank MDACC!

 

[Mandelin Rain]

100% still agree with myself . How long have you been in practice, out of curiosity? Having lived and practiced in two regions of the country, I’m just really curious about what in the world you’re talking about.

I was agreeing with you.

 

[deleted1002574]

I was agreeing with you.

I know !!! Quoted wrong guy. Meant Bomberman

 

[deleted1002574]

Holy histrionics, Bomberman.

Just meant it’s not household name to hospital admins and a lot of private practices (not radoncs).

 

[RickyScott]

I imagine two of the most important things to ease the job search are 1) proximity to where you would like to end up as an attending, and 2) how big of an alumni network there is to use for connections and networking.

'Name-value' of a program is still very important as well. Research is well and good but major academic institutions are not going to hire graduating residents from lower-tier programs regardless of the amount of research produced.

I think there is diminishing return of name value among top programs. Going to mskcc ove

I guarantee that 99% of my patients and PCPs have never heard of either MDACC or MSK. These are regional names.

Once you get out of onc world, they just don’t hold any cache in much of the country.

when did rotation at msk in medschool near turn of century, none of my classmates knew about it. However, much less marketing back then

 

[Reaganite]

Practice dependent obviously. Seems to matter less in the Sunbelt imo compared to NE or west coast

Its practice and geography-dependent like you said. I'm hiring, and no SDN top 10 nerd will sniff my practice . Can I put out an ad that says that??

 

[Krukenberg]

Its practice and geography-dependent like you said. I'm hiring, and no SDN top 10 nerd will sniff my practice . Can I put out an ad that says that??

so if a top 10 grad who grew up near you and reached
out early to you, that would hold no sway?

 

[medgator]

so if a top 10 grad who grew up near you and reached
out early to you, that would hold no sway?

I'd take mid tier with connections over top without, personally

 

[PhotonBomb]

I'd take mid tier with connections over top without, personally

right but krukenberg is asking about a well-trained person WITH connections.

 

[Chartreuse Wombat]

As payors continue to narrow networks all of this name recognition will become moot. The elites will continue to do well for a few more years but in the long-term relying on the FFS model will doom them. The platform is burning.

 

[PhotonBomb]

As payors continue to narrow networks all of this name recognition will become moot. The elites will continue to do well for a few more years but in the long-term relying on the FFS model will doom them. The platform is burning.

I disagree. Marketing matters and helps
Drive medical care in the modern era of corporate medicine. Some Patients will always be driven to go to the ‘big names’ or ‘shiny buildings’ and that will drive volume. regardless of the payment structure, you need patients to walk in the door.

Many patients don’t know or don’t care, but definitely many do. Hospitals advertise for a reason.

 

[SneakyBooger]

I disagree. Marketing matters and helps

Did someone say Cancer Treatment Centers of America?

 

[Reaganite]

so if a top 10 grad who grew up near you and reached
out early to you, that would hold no sway?

I made the comment somewhat in jest to highlight the point pedigree doesn't matter to everyone. Yes, I would be much more impressed by someone from any residency program who reached out to me early, offered to do locums, impressed my staff and patients, etc. I find on-the-job interviews much more valuable than a CV. I have received several CV's from residents at top 10s that stress their research history and all the fancy equipment they work with. That's all well and good, but I'm much more interested in someone with a baseline level of competence who my patients will love and rave about to the referring docs and insurance company.