Why is rad onc not more competitive?

[UndecidedMS2]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

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[Neuronix]

 

[Gfunk6]

View attachment 384537

/thread

 

[UndecidedMS2]

View attachment 384537

Look at gen surg. They had 14% saying they job market is very strong comparing to 18% rad onc but its competitiveness gets more and more each year. Also look at Ortho, on the lower end of this but it’s one of the most competitive specialties (it might actually be THE most). This graph actually proves my point, while the concerns about job market is true, I don’t think it’s the only reason for the massive drop in rad onc competitiveness.

 

[TheWallnerus]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

If that job in Arkansas doesn’t work out, get ready to move to Arizona immediately! This shows a good proportion of the better job offers right now, not a tiny fraction thereof.

 

[Neuronix]

Look at gen surg. They had 14% saying they job market is very strong comparing to 18% rad onc but its competitiveness gets more and more each year. Also look at Ortho, on the lower end of this but it’s one of the most competitive specialties (it might actually be THE most). This graph actually proves my point, while the concerns about job market is true, I don’t think it’s the only reason for the massive drop in rad onc competitiveness.

It might also have something to do with the American Board of Radiology randomly failing half of a residency class a few years back on their boards and nobody ever being held accountable for it.

There are many reasons. A doubling in the size of the residency programs is the primary contributor to the job market issues. The potential of radiation oncology to grow is frequently questioned, and certainly by the measures we have utilization looks pretty flat compared to competing specialties like med onc and radiology.

But at the end of the day, the specialty was one of the most competitive 10 years ago and is now one of the least. Educating medical students about our existence has not changed and has nothing to do with the changes in competitiveness in my opinion.

 

[communitydoc13]

It's OK that it is not competitive. In fact, it's better.

If you want to do radonc, you will have more opportunities. You also will not be doing it in part for the social cachet associated with a highly competitive field (many of us were influenced by this to some degree).

Radonc is a good field day to day, but I do not feel that it's in the greatest service to country to attract the best and brightest at this point. (Also, IMGs are almost universally the best and brightest among their cohort).

I need a surgical oncologist, another urologist, another ENT and psych where I am. (Forget NS and gyn-onc). It took lots of effort to get adequate medonc staffing.

Also...despite what leadership wants to tell you, in no other field are you universally doing a national job search, unless you are looking for high end academics.

 

[Ray D. Ayshun]

also get ready to move after year 2 when pay becomes production based.

 

[Mandelin Rain]

also get ready to move after year 2 when pay becomes production based.

 

[fiji128]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

Just a heads up, the Portsmouth OH, Elmira NY, Jonesboro AK positions have been variably posted off and mostly on for about 10 years. Citing these places as an indication of a job market that isn't terrible is bunk.

 

[TheWallnerus]

Just a heads up, the Portsmouth OH, Elmira NY, Jonesboro AK positions have been variably posted off and mostly on for about 10 years. Citing these places as an indication of a job market that isn't terrible is bunk.

To paraphrase our car’s side view mirror for the undecided med student: the job market in rad onc may be crappier than it appears.

Right now our professional society is saying if you take one of these small practice solo rad onc job offers, no matter if you’re sick or dying, or if your kid is sick or dying, you’ve got to be in the clinic no matter what. Even if all your treated patients have zero side effects and are getting small daily fraction sizes. So the “great lifestyle” you mentioned may work out to be a “the great lifestyle may be crappier than it appears” thing too. We will see.

 

[elementaryschooleconomics]

rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students.

Please, tell me more about this "great lifestyle".

That's highly subjective, and the myth is mostly based on comparing residency structure.

Yes, almost without question, the RadOnc residency is less demanding in terms of time physically in a hospital than something like Neurosurgery.

Conversely, we have garbage educational resources and four distinct board exams focusing on esoterica that continue until we're at least a year out of residency. People spend literally hundreds of hours studying for just radbio/physics alone, and don't even get me started on orals.

But all of that doesn't matter, in a sense. Residency (and boards) are just a brief period of time in a long career. What about after?

If you think 7:15AM OR times are the 7th circle of hell, or being the "attending of record" for hospital inpatients is something out of a horror film...OK, sure. I think there are people out there who feel that way.

But I personally know (and work with) surgeons (and multiple other doctors) who structure their group with a two weeks on/two weeks off schedule. I literally have to base some of my referrals/meetings around "who is not in Europe right now".

Also, I personally know a surgeon who...parted ways with a hospital under less-than-idyllic circumstances. Even though this is in a rural area, that surgeon immediately started work at a different hospital still within reasonable commuting distance from home.

That is not possible in RadOnc.

I've come to realize that many of the general opinions/stereotypes of workloads for each specialty is formed when we're medical students, and is driven by observing (and then living) the residency programs we're exposed to.

But the "real world", the career that happens after residency - that's the ABSOLUTE WILD WEST. There's no reason to assume a mid-career Neurosurgeon has a "worse" lifestyle than a mid-career RadOnc, based solely on the subjectivity of "lifestyle" alone, but beyond that...on how much agency a Neurosurgeon commands.

Now to be clear, I enjoy being a Radiation Oncologist. While I do know some of us with relatively "easy" jobs...it ain't me. But I also know RadOncs with even more demanding jobs, or who have taken on much higher levels of risk, etc.

This is all subjective.

 

[RickyScott]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

As pointed out, you won’t be making these salaries after a year or two which is why they keep getting posted. A typical job in a rural location, 1000 miles from your home may pay 400- 500k, but so do many other specialties such as psych in these locations. job mobility is horrendous and there are significant future facing risks.

 

[MidwestRadOnc]

Please, tell me more about this "great lifestyle".

That's highly subjective, and the myth is mostly based on comparing residency structure.

Yes, almost without question, the RadOnc residency is less demanding in terms of time physically in a hospital than something like Neurosurgery.

Conversely, we have garbage educational resources and four distinct board exams focusing on esoterica that continue until we're at least a year out of residency. People spend literally hundreds of hours studying for just radbio/physics alone, and don't even get me started on orals.

But all of that doesn't matter, in a sense. Residency (and boards) are just a brief period of time in a long career. What about after?

If you think 7:15AM OR times are the 7th circle of hell, or being the "attending of record" for hospital inpatients is something out of a horror film...OK, sure. I think there are people out there who feel that way.

But I personally know (and work with) surgeons (and multiple other doctors) who structure their group with a two weeks on/two weeks off schedule. I literally have to base some of my referrals/meetings around "who is not in Europe right now".

Also, I personally know a surgeon who...parted ways with a hospital under less-than-idyllic circumstances. Even though this is in a rural area, that surgeon immediately started work at a different hospital still within reasonable commuting distance from home.

That is not possible in RadOnc.

I've come to realize that many of the general opinions/stereotypes of workloads for each specialty is formed when we're medical students, and is driven by observing (and then living) the residency programs we're exposed to.

But the "real world", the career that happens after residency - that's the ABSOLUTE WILD WEST. There's no reason to assume a mid-career Neurosurgeon has a "worse" lifestyle than a mid-career RadOnc, based solely on the subjectivity of "lifestyle" alone, but beyond that...on how much agency a Neurosurgeon commands.

Now to be clear, I enjoy being a Radiation Oncologist. While I do know some of us with relatively "easy" jobs...it ain't me. But I also know RadOncs with even more demanding jobs, or who have taken on much higher levels of risk, etc.

This is all subjective.

I know a cardiothoracic surgeon in a rural area who would operate then immediately disappear to Vegas for a week or more dumping the post op care on those grossly unqualified. It literally took years to get rid of him and he was ultimately replaced with someone even worse. These guys all pulled down over 1M w2 pay.

 

[NotMattSpraker]

rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students.

How many do you want?

 

[UndecidedMS2]

I know a cardiothoracic surgeon in a rural area who would operate then immediately disappear to Vegas for a week or more dumping the post op care on those grossly unqualified. It literally took years to get rid of him and he was ultimately replaced with someone even worse. These guys all pulled down over 1M w2 pay.

I can’t comment on this specific surgeon and how he ran his practice. CT surgery is known for many things but being a lifestyle specialty is not one of them. Also comparing that to Rad Onc is not fair. Rad onc is a 5 year residency with one year being research year and working 50-55hr a week on average. While CT surgery is minimum of 8 years with residents working 80-120hrs a week. Then it’s the matter of actual work. Doing heart surgery is far far more stressful than planning radiation treatment. I’d much much prefer to do rad onc and get paid $400-500k than do ct surgery for $1M

 

[UndecidedMS2]

How many do you want?

idk, but having more spots than US grad applicants is definitely not ideal!

 

[elementaryschooleconomics]

idk, but having more spots than US grad applicants is definitely not ideal!

Can you elaborate?

 

[UndecidedMS2]

Can you elaborate?

this cycle 175 spots were available with 148 US grad applicants (127MD 21DO).

 

[NotMattSpraker]

this cycle 175 spots were available with 148 US grad applicants (127MD 21DO).

Why should the number of US grads match the number of spots?

For all intents, the field fills, the demographics just changed to now include more non US MD grads.

I’m not seeing anyone discussing how the demographics change might or might not affect “workforce outcomes”, broadly (unpredictably) defined.

I’m not trying to be difficult, just trying to honestly understand the blanket goal of recruiting more applicants today (US or otherwise)

 

[elementaryschooleconomics]

this cycle 175 spots were available with 148 US grad applicants (127MD 21DO).

Right - all spots will get filled as they always have.

Why precisely does it matter how many spots are US MD grads vs other?

 

[seper]

Right - all spots will get filled as they always have.

Why precisely does it matter how many spots are US MD grads vs other?

When Radonc was in demand, all match spots went to US grads

 

[radiation]

When Radonc was in demand, all match spots went to US grads

Did the fact that Rad onc was once an ultra competitive specialty with MD/PhDs, high board scorers, AOA and all US grads help the field at all? Does the make up of a field dictate how well it will do for jobs or health of the field? Half of med oncs are DO/IMGs (in 2024, which is probably peak)

 

[evilbooyaa]

idk, but having more spots than US grad applicants is definitely not ideal!

this cycle 175 spots were available with 148 US grad applicants (127MD 21DO).

Why should only US grads get to go into Rad Onc? Because we were a competitive specialty for a 10-15 year period (butnot for the rest of our 50+ year lifetime)?

You see a mismatch and want more US med students to apply.

I see a mismatch and think "the canaries have come-a-calling" that US med students say "no thanks"

Best way to get the mismatch to match better would be to decrease residency spots nationwide.

 

[thecarbonionangle]

Did the fact that Rad onc was once an ultra competitive specialty with MD/PhDs, high board scorers, AOA and all US grads help the field at all? Does the make up of a field dictate how well it will do for jobs or health of the field? Half of med oncs are DO/IMGs (in 2024, which is probably peak)

View attachment 384576

Of course it did not help the field at all. MD PhDs mostly ended up in PP. Many of the ones who are actually in academics, do non-radiation related research, use their time to come up with ways to reduce the need for radiation. All of this “talent” brought the field absolutely nothing.

 

[NotMattSpraker]

Did the fact that Rad onc was once an ultra competitive specialty with MD/PhDs, high board scorers, AOA and all US grads help the field at all?

It helped people like Jeff Michalski feel proud of themselves.

It helped private practices with a huge supply of very smart, resilient, and hard working physicians, so that the culture of your practice doesn't really matter. Abuse away.

It likely helped academic practices get more grants (pedigree + hard working/resilient is the best set up to get grants).

It helped ****ty leaders say things like "look at this magazine article, you make so much money, stop complaining".

Seems like a huge win for everyone that will retire in the next 10-20 years.

 

[communitydoc13]

Seems like a huge win for everyone that will retire in the next 10-20 years.

The ultra competitiveness just hurt a lot of careers. At some point meritocracy becomes a negative.

SERO has a couple PP docs with early career CVs that would make any academic blush. They are not doing world class research at SERO.

Fair number of hungry, aspiring academics couldn't get their foot in the door because their pedigree wasn't quite up to snuff in that era.

It certainly helped the chairs from that era; some proportion of whom managed to graduate from radonc to head major hospitals, cancer institutes and the FDA.

Things are now as they should be.

A US med school grad has a competitive advantage for jobs in a field with a lot of IMGs. Enjoy that advantage. It is not necessarily earned, but it is real.

 

[IonsAreOurFuture]

Of course it did not help the field at all. MD PhDs mostly ended up in PP. Many of the ones who are actually in academics, do non-radiation related research, use their time to come up with ways to reduce the need for radiation. All of this “talent” brought the field absolutely nothing.

I do feel badly for all the people who were expecting high powered research careers in the city of their choice close to family and friends, yet ended up at one point in a small town satellite that nobody has heard of. I've been there and done that.

And yet, I think there is a silver lining in having such hard working and talented people in our workforce. For example, there is an entirely new crop of complicated technology coming down the pipeline that we weren't trained on but will need to learn the fundamental physics and biology of to use successfully.

Things like:

FLASH - we don't even know the exact mechanisms of normal tissue sparing, but that isn't stopping it from coming to a city near you - the first US human trial completed and the 2nd has begun, and multiple going on in Europe

GRID/lattice/ SFRT - how do you get improved tumor control by only boosting a third of it? Or maybe you don't, but how will we prove or disprove it?

MRI guidance - yes we need a billing code, but it opens up a whole frontier of SBRT and dose escalation to the liver, pancreas and other organs I was told in medical school not to touch

PET guidance - it's like an old West shootout, for patients with stage IV disease - what is the practical limit of volumes we can treat with that thing, and why? Is it going to be lymphopenia and marrow toxicity or something else

Proton therapy - yes we need more data, and it's actually starting to arrive in trickles in the NCCN - anyone of the big trials if positive could create an overnight demand that we are unable to fulfill - we still need good research into the physics and RBE for optimal use, and no shortage of research opportunities there

Carbon ions - are they going to be worth it? Not just economically, but in terms of physics, RBE, cell kill and sparing - the basics of radbio and that physics textbook we all read

Vtach, Afib, arthritis, alzheimer's, Parkinson's and other CNS diseases - there is no shortage of incurable "benign" diseases where a small area of high dose or large area of small dose might deflect the course of a chronic illness for the better - why aren't we palliating those?

Because we need the best and brightest that we've recruited to our field (i.e. All of us) to change it for the better and show what we can do, rather than what we can't

 

[medgator]

Because we need the best and brightest that we've recruited to our field to change it for the better and show what we can do, rather than what we can't

Getting the exact opposite of that now thanks to the leadership in our specialty, many of whom have no interest in changing the status quo.

Not like we haven't read this story before though

 

[thecarbonionangle]

I do feel badly for all the people who were expecting high powered research careers in the city of their choice close to family and friends, yet ended up at one point in a small town satellite that nobody has heard of. I've been there and done that.

And yet, I think there is a silver lining in having such hard working and talented people in our workforce. For example, there is an entirely new crop of complicated technology coming down the pipeline that we weren't trained on but will need to learn the fundamental physics and biology of to use successfully.

Things like:

FLASH - we don't even know the exact mechanisms of normal tissue sparing, but that isn't stopping it from coming to a city near you - the first US human trial completed and the 2nd has begun, and multiple going on in Europe

GRID/lattice/ SFRT - how do you get improved tumor control by only boosting a third of it? Or maybe you don't, but how will we prove or disprove it?

MRI guidance - yes we need a billing code, but it opens up a whole frontier of SBRT and dose escalation to the liver, pancreas and other organs I was told in medical school not to touch

PET guidance - it's like an old West shootout, for patients with stage IV disease - what is the practical limit of volumes we can treat with that thing, and why? Is it going to be lymphopenia and marrow toxicity or something else

Proton therapy - yes we need more data, and it's actually starting to arrive in trickles in the NCCN - anyone of the big trials if positive could create an overnight demand that we are unable to fulfill - we still need good research into the physics and RBE for optimal use, and no shortage of research opportunities there

Carbon ions - are they going to be worth it? No just economically, but in terms of physics, RBE, cell kill and sparing - the basics of radbio and that physics textbook we all read

Vtach, Afib, arthritis, alzheimer's, Parkinson's and other CNS diseases - there is no shortage of incurable "benign" diseases where a small area of high dose or large area of small dose might deflect the course of a chronic illness for the better - why aren't we palliating those?

Because we need the best and brightest that we've recruited to our field (i.e. All of us) to change it for the better and show what we can do, rather than what we can't

I like your optimism. I really hope you are right. i do think there is often a contradiction in what people say. People want data, but when data is given it is dismissed as not good enough or not significant. Recent examples I have seen in this board:

1) people demand data for esophagus but dismiss phase 2 as too confusing to understand. Same people state protons are not needed
2) proton CSI in LMD, not needed can do VMAT
3) proton liver data, same thing, you can dose escalate safely with photons.
Etc

They are NOT wrong. So what if proton prostate or head and neck proton is “positive”? you really think it will create a sudden immediate need for more protons?. I doubt it. People will say the exact same.

I wont even go into BGRT and MRL, i have even more doubts on that!

The people who thought they would all be doing practice changing research in NYC were lied by their “mentors” and “leaders”. Or they did not understand the realities of our field. Plain and simple.

I do what i can on my end. I interact with rotating students often and i tell them the unequivocal truth.

 

[RickyScott]

FYI flash is the next abscopal.

 

[thecarbonionangle]

FYI flash is the next abscopal.

Maybe MDACC will TM it as “FLA$H” like they did “radscopal”

 

[Mandelin Rain]

Maybe MDACC will TM it as “FLA$H” like they did “radscopal”

CANCER

 

[elementaryschooleconomics]

FYI flash is the next abscopal.

I think it's more accurate to say FLASH is the next hyperthermia, but that might just be because I was in a RadOnc lab in the decade after the hyperthermia hype had died.

A rose, by any other name.

 

[thecarbonionangle]

What is more exciting to me is radiopharm. big pharma agrees. You now have Pfizer, AstraZeneca, Eli spending billions on it. This will be good for our field. I hope to see us put significant capital into this and boost reimbursement rather than trying to fight old fights of supervision. Man how refreshing would this be!?

 

[Clean7795]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

Lack of exposure means very little. There's no mandatory derm, opthal, or plastics rotation in most schools (and are generally underrepresented in the medical school curriculum).

Medical student interest is driven by 4 main factors:
1. Interest (e.g. medical vs surgical vs diagnostic)
2. Earning potential
3. Lifestyle (including ability to choose where to live)
4. Prestige (aside from the above factors, the main driver of prestige is specialty competitiveness in and of itself)

The earning potential hasn't changed that much in 5 years.

But it has become more well-known that the job market is terrible location wise, and the previous prestige of being competitive is no longer there. Also, arguably interest may have dwindled as the modern era of oncology is driven by pharmaco/immunotherapy from medoncs.

 

[medgator]

Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.

Just a heads up, the Portsmouth OH, Elmira NY, Jonesboro AK positions have been variably posted off and mostly on for about 10 years. Citing these places as an indication of a job market that isn't terrible is bunk.

Elmira NY and Waterloo IA. Look at where the closest big cities are.

Not exactly geographic hotspots for where you can find good biryani (surrogate on this forum for good geographic locations).

@UndecidedMS2 are those cities where you envisioned practicing?

 

[OTN]

Lack of exposure means very little. There's no mandatory derm, opthal, or plastics rotation in most schools (and are generally underrepresented in the medical school curriculum).

Medical student interest is driven by 4 main factors:
1. Interest (e.g. medical vs surgical vs diagnostic)
2. Earning potential
3. Lifestyle (including ability to choose where to live)
4. Prestige (aside from the above factors, the main driver of prestige is specialty competitiveness in and of itself)

The earning potential hasn't changed that much in 5 years.

But it has become more well-known that the job market is terrible location wise, and the previous prestige of being competitive is no longer there. Also, arguably interest may have dwindled as the modern era of oncology is driven by pharmaco/immunotherapy from medoncs.

Earning potential has decreased over the last 5 years compared to other specialties. Radonc compared to itself? No, but that's not the comparison that matters.

 

[UndecidedMS2]

Elmira NY and Waterloo IA. Look at where the closest big cities are.

Not exactly geographic hotspots for where you can find good biryani (surrogate on this forum for good geographic locations).

@UndecidedMS2 is there where you envisioned practicing?

My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.

 

[RickyScott]

My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.

You definitely want to date accordingly. Consider ruling out most women with a career (law, mba, engineering, science) on match. Also good to make sure your parents are healthy and won’t be needing any help.

 

[elementaryschooleconomics]

My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.

You definitely want to date accordingly. Consider ruling out most women with a career (law, mba, engineering, science) on match. Also good to make sure your parents are healthy and won’t be needing any help.

Ah. My favorite path of logic.

@RickyScott is correct.

To flesh it out a bit: @UndecidedMS2, do you plan to stay single forever? No matter your answer to that question, are you certain you'll feel the same way in 5 years? 10 years?

If you find a long-term partner/spouse, you're either hoping they're going to be OK with going to the "middle of nowhere" for half a decade, OR, you plan on finding this person "in the middle of nowhere" and then taking them out of that place to be where YOU really want to be. What if that person is really tied to that location?

What about kids? And, as @RickyScott pointed out, how are your parents? Do you have a family you're close to?

I can't tell you how many times I've heard the "I'll just go live in the middle of nowhere and make a ton of money, then leave".

I'll tell you right now, you can make more money just straight up leaving medicine, then. Got any friends at McKinsey?

 

[Ray D. Ayshun]

Ah. My favorite path of logic.

@RickyScott is correct.

To flesh it out a bit: @UndecidedMS2, do you plan to stay single forever? No matter your answer to that question, are you certain you'll feel the same way in 5 years? 10 years?

If you find a long-term partner/spouse, you're either hoping they're going to be OK with going to the "middle of nowhere" for half a decade, OR, you plan on finding this person "in the middle of nowhere" and then taking them out of that place to be where YOU really want to be. What if that person is really tied to that location?

What about kids? And, as @RickyScott pointed out, how are your parents? Do you have a family you're close to?

I can't tell you how many times I've heard the "I'll just go live in the middle of nowhere and make a ton of money, then leave".

I'll tell you right now, you can make more money just straight up leaving medicine, then. Got any friends at McKinsey?

I think what he's looking for in women is road rash. So he should be okay.

 

[thecarbonionangle]

My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.

A quote about a plan from Mike Tyson comes to mind

 

[NotMattSpraker]

1) people demand data for esophagus but dismiss phase 2 as too confusing to understand. Same people state protons are not needed
2) proton CSI in LMD, not needed can do VMAT
3) proton liver data, same thing, you can dose escalate safely with photons.

Ok hold on lol, this is unfair. These examples are really more an investigator problem than the field accepting data. The proton people are so ridiculous these days, twisting themselves in knots to justify their biased actions.

Esophagus I really dont see the problem. As a community generalist, I am not sending my patients out of state based on a single institution phase II trial showing benefit on a complicated analysis. I believe in the analysis, my problem is will it apply to my patient who will be operated on here? Not sure. The phase III is a well designed trial. I loved to put people on that when I had protons. This seems like the ideal strategy, I wish all disease sites were going this way with regard to protons. RIGHT HEAD & NECK FOLKS?!

Also, its hard to really characterize the benefit for patients; the phase III will help a lot. What if they are not operable? Then no protons at all? What if they are 80? Remember I need to send my patients out of state on their own dime. I need to be able to give them an idea of what they get back for that money and effort. No phase III does this perfectly, but there are a lot of limitations to the phase II (which is a very nice study IMO).

Ill just repeat what Ive said before. The biggest barrier to GI-006 enrollment I experienced was the ability for patients to get protons off trial. The lack of data is a self imposed problem, it's not a referrals problem.

CSI LMD... dont blame gen pop, blame the investigators. I think this is a gamed trial, it makes NO sense. I dont understand how everyone from the PI to the trial review committee could ignore the copious VMAT CSI data. We have done it in my clinic. I have asked this question and no one will answer. At the institutional level, it is reasonable to say "WE aren't comfortable", but the world is comfortable with VMAT CSI. No one seems interested in trialing protons versus VMAT. This should have been the phase III. We all know why it's not. Therefore I revert back to first principles. Im OFFERING my 40 year old but not 80 year old with LMD for protons. Without clear benefit, many 40 year olds may not want to go.

Protons for Liver is loma linda, so therefore its loma linda data haha, you get what you get. Its a great trial with the usual caveats from that center. Don't be silly. We all know that many patients can have excellent safe SBRT that will be the same as protons in this setting. It's all better than TACE and thats the point. If you want to send out all your patients, do it. I am not, unless they are CP B or C and I think liver volumes are an issue.

My question is why people are still getting TACE today. We should be way more pissed about that.

 

[medgator]

.

My question is why people are still getting TACE today. We should be way more pissed about that.

Hard to break referral patterns I'm guessing. Should change with time I bet. Tace has had a stronger indication I think for the IR guys than rfa ever did in lung cancer.

I bet they are doing less tace now than 5-10 years ago, I definitely feel like my liver sbrt volume is up during that time

 

[UndecidedMS2]

Ah. My favorite path of logic.

@RickyScott is correct.

To flesh it out a bit: @UndecidedMS2, do you plan to stay single forever? No matter your answer to that question, are you certain you'll feel the same way in 5 years? 10 years?

If you find a long-term partner/spouse, you're either hoping they're going to be OK with going to the "middle of nowhere" for half a decade, OR, you plan on finding this person "in the middle of nowhere" and then taking them out of that place to be where YOU really want to be. What if that person is really tied to that location?

What about kids? And, as @RickyScott pointed out, how are your parents? Do you have a family you're close to?

I can't tell you how many times I've heard the "I'll just go live in the middle of nowhere and make a ton of money, then leave".

I'll tell you right now, you can make more money just straight up leaving medicine, then. Got any friends at McKinsey?

Everyone wants to live in desirable area so the lower salaries is because of high demand and it’s the same for every other specialty (some more than others, I agree) but it’s definitely not unique to Rad Onc. Obviously I don’t wanna stay single forever, but what I would want in the next 5-10 years… who knows, 5-10 years ago I thought i wanted to do CT surg or surg onc but here I am now. Everyone here acting like you’re gonna hate your life in rad onc and “warning” med students to not get into this field while making $400k+ with a great lifestyle (minimal call, no weekend, not many emergencies etc). Why? Just because you might not find a job in NYC that pays $500k! Who cares? Get one in Poughkeepsie. Much lower COL, less traffic, less headache and you can enjoy NYC on weekends.

 

[elementaryschooleconomics]

Everyone wants to live in desirable area so the lower salaries is because of high demand and it’s the same for every other specialty (some more than others, I agree) but it’s definitely not unique to Rad Onc. Obviously I don’t wanna stay single forever, but what I would want in the next 5-10 years… who knows, 5-10 years ago I thought i wanted to do CT surg or surg onc but here I am now. Everyone here acting like you’re gonna hate your life in rad onc and “warning” med students to not get into this field while making $400k+ with a great lifestyle (minimal call, no weekend, not many emergencies etc). Why? Just because you might not find a job in NYC that pays $500k! Who cares? Get one in Poughkeepsie. Much lower COL, less traffic, less headache and you can enjoy NYC on weekends.

If you think you ain't working weekends in RadOnc

You're gonna have a bad time

 

[UndecidedMS2]

If you think you ain't working weekends in RadOnc

You're gonna have a bad time

Doing couple hours of contouring is not the same as being on call and doing bunch of surgeries

 

[drowsy12]

If you think you ain't working weekends in RadOnc

You're gonna have a bad time

You’re very busy. I work weekends sometimes too. MANY don’t.

I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?

 

[elementaryschooleconomics]

You’re very busy. I work weekends sometimes too. MANY don’t.

I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?

Sure -

How long have you been in independent practice?