WomanWhoWouldCurie

[domestique]

@residentwhocuries_2019 assuming you have any geographic flexibility at all, it may be in your interest to allow direct messages to your profile.

---

Members don't see this ad.

 

[Mandelin Rain]

If you didn't see it coming you weren't using your imagination. (Like they say in psych: "always keep a dirty mind.") In today's day and age, and this is not just particular to medicine, you ALWAYS have to think worst case scenario. If you can imagine it, and it seems plausible, you have to think it's possible. (However, in medicine, you REALLY have to think worst case scenario.)

Yes. You had been beating the supervision drum for a long while. I have my own worst case scenarios that seem entirely plausible to me that center around other doctors being able to circle things in the body. Seems more plausible this week with us losing primacy over the linac. “A rad onc doesn’t need to be there? No one needs to be there? Why can’t I just use the machine for my patients?”

We’ll see.

 

[DoctwoB]

Am I missing something here or this a silly way to frame the job market issue? Yes, geographic flexibility is extremely limited in this field but that is the case for EVERYONE. Why are we acting like it's somehow more of an issue for women than it is for men?



This is what I don't understand. "All the gals I know chose to marry people with geographic limitations while the guys married people with more flexibility, so unfair!"

You made a decision to marry someone knowing full well they had a job that restricted where they could live. And then you made a decision to enter a field that has been known to be very geographically limiting, It's not like this issue came about all of the sudden. Sometimes you have to make sacrifices and, assuming you're not looking to replace your husband with a more geopraphically friendly one, that means you need to accept the reality that your job prospects will be limited because that's the path you chose.

I am a huge critic of this job market and how bad leadership has let things get, but it is equally limiting for everyone irrespective of gender.

That’s exactly the OPs point though! That if you want to help women in Rad Onc, fix the job market (I.e. make it better for everyone). Her point is stop talking about Microagressions and diversity and Fix the field, and in doing so you will also make it better for women’s and minorities.

 

[deleted1002574]

That’s exactly the OPs point though! That if you want to help women in Rad Onc, fix the job market (I.e. make it better for everyone). Her point is stop talking about Microagressions and diversity and Fix the field, and in doing so you will also make it better for women’s and minorities.

Here’s the issue. They have made it an overwhelming feature of current research and of radonc twitter. I agree that we should stop talking about that stuff, but when you do, those voices get louder. You have to “Saul Alinsky” then and use their words and their logic to actually get anywhere. Read up on your intersectionality “literature” and get into the muck!

 

[evilbooyaa]

My only criticism of this post (I whole-heartedly agree with the rest), is that is mid six figures = 500k or something near that? Is this resident turning down 500k at an academic satellite in a city that she would want to live in just because it's not a private practice? If so, that is insane to me. Adjust your expectations. 500k for a new grad in anything close to a desireable city is an absolute non-starter.

Anything over 300-350k for a new grad living in a desireable city is now an exceedingly good deal. OP will end up with a job, somewhere. She may be unhappy with the compensation, but she will get a job.

****, I'll go that desireable city in that academic satellite for 350k, who wants to hire me?

 

[OTN]

OP m

My only criticism of this post (I whole-heartedly agree with the rest), is that is mid six figures = 500k or something near that? Is this resident turning down 500k at an academic satellite in a city that she would want to live in just because it's not a private practice? If so, that is insane to me. Adjust your expectations. 500k for a new grad in anything close to a desireable city is an absolute non-starter.

Anything over 300-350k for a new grad living in a desireable city is now an exceedingly good deal. OP will end up with a job, somewhere. She may be unhappy with the compensation, but she will get a job.

****, I'll go that desireable city in that academic satellite for 350k, who wants to hire me?

OP might not necessarily end up with a job. There's an umemployed female radiation oncologist in our large city whose husband is a subspecialist. She's never worked after residency, as she couldn't find a good job where he could. It's now been 6ish years (I think) since she graduated. Going to be VERY tough to get back into the field at this point.

 

[evilbooyaa]

OP m


OP might not necessarily end up with a job. There's an umemployed female radiation oncologist in our large city whose husband is a subspecialist. She's never worked after residency, as she couldn't find a good job where he could. It's now been 6ish years (I think) since she graduated. Going to be VERY tough to get back into the field at this point.

I have heard of female radiation oncologists who don't end up working as attendings. N=2. Hope that is not what happens to OP. OP should run, not walk, back to that academic satellite job in the city that works for her husband and sign on the dotted line.

 

[scarbrtj]

Yes. You had been beating the supervision drum for a long while. I have my own worst case scenarios that seem entirely plausible to me that center around other doctors being able to circle things in the body. Seems more plausible this week with us losing primacy over the linac. “A rad onc doesn’t need to be there? No one needs to be there? Why can’t I just use the machine for my patients?”

We’ll see.

The one stop gap I have seen against this is that only doctors who’ve had extensive use/training w/ a linac can be authorized users on a linac. Not that it “has” to be a rad onc but in practice it’s only rad oncs who have this background. (Obviously if you're a BC rad onc you're "in" for AU re: almost anything you trained on in residency in theory.) In some states this AU thing is the case. However some states do not apply the authorized user concept to linacs. Also some private payors don't allow operating/billing outside one's BC specialty. (EDIT: also a hospital privileges thing, for now.)

But IMHO it would behoove ASTRO to start building a big, beautiful, metaphorical wall around radiation oncology to keep our “circle drawing” and radiation prescribing sacrosanct. We all begrudgingly admit, I hope, that endocrinologists can... and some do... prescribe radioactive iodine w/ proper training eg? We gotta be vigilant. Use our imagination!

If needing to be passively present during EBRT was our indispensable skill... well we see where that got us. And technically it could have been ANY MD. Not just a rad onc. Still can in freestanding. You say we "lost" our linac primacy...

What I have also been saying here for years is that we never had it to begin with.

 

[OTN]

The one stop gap I have seen against this is that only doctors who’ve had extensive use/training w/ a linac can be authorized users on a linac. Not that it “has” to be a rad onc but in practice it’s only rad oncs who have this background. In some states this AU thing is the case. However some states do not apply the authorized user concept to linacs. Also some private payors don't allow operating/billing outside one's BC specialty.

But IMHO it would behoove ASTRO to start building a big, beautiful, metaphorical wall around radiation oncology to keep our “circle drawing” and radiation prescribing sacrosanct. We all begrudgingly admit, I hope, that endocrinologists can... and some do... prescribe radioactive iodine w/ proper training eg? We gotta be vigilant. Use our imagination!

If needing to be passively present during EBRT was our indispensable skill... well we see where that got us. And technically it could have been ANY MD. Not just a rad onc. Still can in freestanding. You say we "lost" our linac primacy...

What I have also been saying here for years is that we never had it to begin with.

Growth of SBRT (Timmerman predicts it will be ~50% of radonc business in the next 10ish years) will function as a stop gap as well. No one going to do that without a radonc present. It's why- even if I wanted to- my center still has to be staffed every day.

 

[scarbrtj]

Growth of SBRT (Timmerman predicts it will be ~50% of radonc business in the next 10ish years) will function as a stop gap as well. No one going to do that without a radonc present. It's why- even if I wanted to- my center still has to be staffed every day.

This logic is assailable. Two reasons:

1) The HOPPS general supervision rule applies to ALL outpatient therapies. SBRT is one such outpatient therapy. There is nothing special per se about SBRT (on a linac using X-rays). Open to being proven wrong. However even in the freestanding setting a judge has ruled...
2) "[they] fail[ed] to direct the Court to any requirement in the LCDs that a radiation oncologist be present at the time of [SBRT] treatment."

 

[OTN]

This logic is assailable. Two reasons:

1) The HOPPS general supervision rule applies to ALL outpatient therapies. SBRT is one such outpatient therapy. There is nothing special per se about SBRT (on a linac using X-rays). Open to being proven wrong. However even in the freestanding setting a judge has ruled...
2) "[they] fail[ed] to direct the Court to any requirement in the LCDs that a radiation oncologist be present at the time of [SBRT] treatment."

Even if allowed by payers, it seems excessively risky to me from a medicolegal standpoint.

 

[scarbrtj]

Even if allowed by payers, it seems excessively risky to me from a medicolegal standpoint.

Totally. But I can conceptualize in my mind a way for the radiation oncologist to be 1000 miles away from the SBRT and provide a good & proper & medicolegally defensible means of providing SBRT care. Has anybody tried that? No. Might they in the future?

 

[deleted1002574]

Even if allowed by payers, it seems excessively risky to me from a medicolegal standpoint.

Based on?

 

[Krukenberg]

Based on?

seems like the lawsuit would sell itself. “Doctor you were treating with high doses of radiation without any physician even in the building?”

 

[deleted1002574]

seems like the lawsuit would sell itself. “Doctor you were treating with high doses of radiation without any physician even in the building?”

Skeptical that whatever "happened" in this hypothetical scenario (wrong dose, wrong location, wrong whatever) would have happened whether physician there or not. Was plan QA'd and passed? Was image guidance checked and approved (remotely)? What would be the difference with on site doc or not? I'm just asking, because if a dramatic error happened, I don't see how doc on site changes outcome. I could be wrong.

 

[Mandelin Rain]

Growth of SBRT (Timmerman predicts it will be ~50% of radonc business in the next 10ish years) will function as a stop gap as well. No one going to do that without a radonc present. It's why- even if I wanted to- my center still has to be staffed every day.

I honestly see the rise of SBRT as one of our greatest existential threats. Easy to contour. Dosimetrist/computer algorithm does all the “work”. Weekend class to teach you dose tolerances. Zap it.

need little in the way of oncologic training to see a spot and zap a spot. IR guys do it with microwaves, frozen needles, and chemo. Can they really not learn how to do it with XRays? Do radiologists not know about XRays? About radiation safety? About making money?

 

[scarbrtj]

seems like the lawsuit would sell itself. “Doctor you were treating with high doses of radiation without any physician even in the building?”

Actually this lawsuit WILL NOT sell itself IMHO. There will be literally hundreds of practices next year giving SBRT-ish 8 Gy doses to large volumes, thus ostensibly more dangerous than some SBRTs (in a 24 hr period at least), for palliation sans in-building rad oncs. Medicare has explicitly called this safe.

 

[scarbrtj]

Skeptical that whatever "happened" in this hypothetical scenario (wrong dose, wrong location, wrong whatever) would have happened whether physician there or not. Was plan QA'd and passed? Was image guidance checked and approved (remotely)? What would be the difference with on site doc or not? I'm just asking, because if a dramatic error happened, I don't see how doc on site changes outcome. I could be wrong.

Lawyers like to bring out stuff that “shocks the conscience” and no MD presence is one such thing that probably doesn’t affect care substantially ... but sounds sexy. Over time, it will be a lot less sexy for lawyers to bring up.

 

[BobbyHeenan]

I'll disagree about the concern over losing SBRT.

WE have the world's experts in lung cancer not even agreeing how to treat a proximal lung SBRT. We've got more SBRT adoption for prostate but varying doses/techniques.

Sure, a peripheral 1 cm lung tumor floating out away from everything isn't challenging...but I have cases I struggle with constantly and feel like a good knowledge of experience and literature is extremely important. Do we treat the tumor to full dose but risk structure X, do we skimp on coverage here or there, etc. We violated dose constraints all the time in training and made judgement calls that were explained well by my attending because my board study book/textbook/Emami table/RTOG dose constraint was about to be violated. Lots of tough calls that I think we need to be trained on in residency with continual practice re-evaluation.

 

[MegaVoltagePhoton]

It’s absolutely critical that, instead of downplaying the physician supervision aspect of sbrt, we play it up and make sure it remains absolutely in the domain of radiation oncology.

Frankly it seems very unproductive and, in fact, foolish to publicly question it. Many non radiation oncologists read sdn. Other specialists can and will read this stuff.

 

[w00tz]

If physician presence is required in Europe and Canada for SBRT then I think we should be worried anyways because there is already precedence. If not, then I agree it is foolish give birth to this idea.

 

[scarbrtj]

It’s absolutely critical that, instead of downplaying the physician supervision aspect of sbrt, we play it up and make sure it remains absolutely in the domain of radiation oncology.

Frankly it seems very unproductive and, in fact, foolish to publicly question it. Many non radiation oncologists read sdn. Other specialists can and will read this stuff.

MVP I hear you. But the horse is out of barn. Medicare (HOPPS 2020) and the courts (rulings) have already spoken. I’m not questioning it anymore than I’m questioning the existence of Santa Claus. We must deal with facts as they are not as we wish. If we want new facts, we will have to create them.

 

[McConaughey]

This field won’t be the same for a while. This is a teachable moment.

 

[Palex80]

Women do earn less than equally qualified men, they are offered less job opportunities and have less chances to get promotions. Women have been fighting to change all that in the past years, and I find it correct.

However, I have to state that arguments like:

Women are more likely than men to have geographically-restricted spouses. This is not controversial. I can see this in my own program: several of the male residents I've known were married to NPs or PAs, one stay-at-home mom, one to another doc. They could pretty much move anywhere they wanted and cast a job search net across the whole country. But ALL of the female residents I know (in radonc or elsewhere) are married either to other doctors (they are probably the most flexible) or to lawyers/consultants/financiers. These people, as does my husband, need to be in big cities to do their work. AS THE JOB MARKET TIGHTENS IT WILL CONTINUE TO DISPROPORTIONATELY AFFECT WOMEN.

and

Agree w poster on SDN that geographic determinabilility (term coined by @d_golden) disproportionately affects women given gender norms (women tend to marry men with at least equal education and slightly older, meaning they’re more likely to have geographic constraints).

are not helpful.

WHO you marry, is your choice. I do not think it's right to be critical on the job market, simply you made THE CHOICE to marry someone, who can't / won't move. You KNEW that. It's like choosing to buy a minivan than a sports car and then complaining when people are faster than you on the speedway. It happens because you bought a minivan. But don't worry, you will have less trouble getting the groceries in your can than the the person that bought the sports car.

Furthermore stereotypes like "men radonc doctors marry NPs or PAs" while "women radonc doctors marry lawyers/consultants/financiers" are not really helpful in the conversation. They are stereotypes.

 

[medgator]

This field won’t be the same for a while. This is a teachable moment.

I'm really hopeful we've found the nadir in this specialty, but realistic that it may not happen until March, or maybe next year

 

[scarbrtj]

OP m


OP might not necessarily end up with a job. There's an umemployed female radiation oncologist in our large city whose husband is a subspecialist. She's never worked after residency, as she couldn't find a good job where he could. It's now been 6ish years (I think) since she graduated. Going to be VERY tough to get back into the field at this point.

Maybe this is why on average female radiation oncologists earn a lot less than men.

 

[PhotonBomb]

Deval Patrick will save Rad Onc!

 

[Krukenberg]

I blame scarbtj who wouldn’t shut the **** about supervision rules being silly.

I forget who but someone around here kept telling him not to dig stuff up that didn’t need digging....

the anesthesia forum has a private forum where you have to show the moderator your society membership. Should we create one to discuss billing or anything else that could come back to bite us? It wouldn’t surprise me if insurance/medicare workers monitor SDN to see what practicing physicians are saying about their billing practices. Job market stuff can stay in public

 

[elementaryschooleconomics]

I am a PGY-5 female at a top 15 (per Doximity) program. I can't say more than that because - as you may have heard - there aren't that many of us, and I don't want to out myself.

I've avoided this board since I started residency because I found the negativity distracting. Since I had committed to this field, I felt like it was only bringing me down to spend time on here reading all the doom and gloom. But now I have something to confess: I would not choose radonc again. I know I'm preaching to the choir, but I think as many voices as possible need to be heard detailing the suffering that residency expansion has wrought on so many of us now and likely in years to come.

The last five years have been tough on my husband and me. Like most female doctors, I married someone similarly high-achieving who NEEDS to be in a major city to do his job. I was aware from the start that this might be difficult to guarantee in radiation oncology, but, like all of you, I love this field. I love the patients, the technology, and the work we do. I got into a very good residency and I was assured time and again (by other interviewees, upper level residents, attendings) that if I did well in our program I should not worry about finding a job. None of our residents ever had, they said. So I took a leap and committed five years of my life to this amazing field. I've done well in residency. I published on a variety of topics, and I'm well liked in our department, but there was always this specter of the job search haunting me.

I was optimistic when I started my job hunt earlier this year. I really just wanted to be in the same city as my husband without a huge commute for either of us. He was even willing to switch locations within his firm, if necessary, to accommodate my job (love him <3). But from the outset there was very little available in any city that would work for him.

I interviewed with a variety of academic places, and had a couple offers for low quality pseudo-academic satellite positions with private practice workload for academic pay. There were some opportunities with historically malignant churn-and-burn private practices. Then, a few weeks ago, one of the docs at our institution used one of his connections to help me find the kind of job I was looking for - the kind of job I went into medicine for. Nothing extravagant, but a mid-six figure salary that would allow me to pay off my loans and support our family. I had a phone interview and they seemed interested and invited me out for a site visit.

Yesterday, they called to cancel. The new general supervision change, they said, had caused them to hold off hiring this year. Maybe in the future. They were, of course, very sorry. And how can I blame them? They are doing what's best for themselves and their practice.

So here I am, in the winter of my PGY-5 year, without any job, and dwindling hope of finding one that isn't exploitative. My husband is, as always, super supportive, and fortunately makes enough that - at least temporarily - we can both survive on his salary. I know I still have six months left, but my stress level is through the roof. It feels like the walls are closing in and I really might end up unemployed. One of my co-residents had a offer pulled as well.

This is an employment crisis for me and for many others. But more importantly, it's a women's issue. And what I came on here to rant about is that NOT ONE SINGLE HIGH PROFILE RADONC WOMAN has said anything about this. Not Reshma Jagsi, Malika Siker, Fumiko Chino... none of the twitter celebs have touched this with a ten foot pole. When they have, they have largely supported getting more women and minorities into the field. REALLY?! MORE?! So they can end up jobless and desperate like me five years from now?!

So what I really came on here to say, in addition to sharing this story, is to say that the #womenwhocurie thing is a farce. THERE IS ONLY ONE "WOMEN'S ISSUE" IN THIS FIELD, and it is RESIDENCY EXPANSION. Women are more likely than men to have geographically-restricted spouses. This is not controversial. I can see this in my own program: several of the male residents I've known were married to NPs or PAs, one stay-at-home mom, one to another doc. They could pretty much move anywhere they wanted and cast a job search net across the whole country. But ALL of the female residents I know (in radonc or elsewhere) are married either to other doctors (they are probably the most flexible) or to lawyers/consultants/financiers. These people, as does my husband, need to be in big cities to do their work. AS THE JOB MARKET TIGHTENS IT WILL CONTINUE TO DISPROPORTIONATELY AFFECT WOMEN. And minorities too, because I don't know many POCs who want to go work in rural appalachia.

So here I am - a living embodiment of why radonc is a terrible field for many women (or men with geographically restricted spouses - I know there are plenty of you out there too ). But when I go to some of these women's meetings I don't hear a peep about it. All we talk about is things that don't matter. I've never met anyone in power in this field who was the least bit sexist to me, or who didn't go above and beyond to mentor me (male or female). People call me Dr. X - and when they don't, it doesn't harm me in the least, and I'm not at all offended by it. BUT I WANT A JOB. And the idea that all I need is a good pep talk and a hashtag is, to be frank, demeaning and a bit sexist.

When I almost decided not to enter this field, I didn't do it because of some implicit bias or whatever unprovable gobbledygook people are attributing it to these days, I did it because I am a rational human being making choices about what's best for me and my family. And now, five years, as an almost-equally rational human being, I would advise anyone reading this not to choose it. Please do not make the same mistake I did. Please listen. If you are a student applying, or a PGY-1 in a prelim-IM program (really if you are in any position to feasibly bail out of radiation oncology) I would advise that you do it. The sky really is falling.

I just want a job near my husband. I want to be able to have a family and a decent income and a fulfilling job helping cancer patients. I don't care about all the academic politics and power moves and heaping blame on men. These people went on and on expanding their residencies in a way that knew was unsustainable and now we will all pay the price for it. And instead of acknowledging this or trying to fix it, they are silent. I wish they would stand up and use their voices to help women in this field in the best way they can: cut residency spots, drastically and immediately. Frankly, if you want to show you are an advocate for women... #heforshe or #sheforshe.... this is the only meaningful thing you can do.

Wow, I do have to say OP - by tapping into the #womenwhocurie movement, ESPECIALLY the week it took place, you really blew up the job issue. It's been all over Twitter, and has even been discussed by people in my department who don't know what SDN is, and definitely don't have Twitter.

While your personal situation is unfortunate, telling your story will hopefully help the field out as a whole.

 

[OTN]

Women do earn less than equally qualified men, they are offered less job opportunities and have less chances to get promotions. Women have been fighting to change all that in the past years, and I find it correct.

However, I have to state that arguments like:



and



are not helpful.

WHO you marry, is your choice. I do not think it's right to be critical on the job market, simply you made THE CHOICE to marry someone, who can't / won't move. You KNEW that. It's like choosing to buy a minivan than a sports car and then complaining when people are faster than you on the speedway. It happens because you bought a minivan. But don't worry, you will have less trouble getting the groceries in your can than the the person that bought the sports car.

Furthermore stereotypes like "men radonc doctors marry NPs or PAs" while "women radonc doctors marry lawyers/consultants/financiers" are not really helpful in the conversation. They are stereotypes.

It was OP's choice, sure, but I doubt she was told "you will need to restrict what you look for in a spouse if you go into radonc", which is the truth in all this, male OR female.

 

[evilbooyaa]

the anesthesia forum has a private forum where you have to show the moderator your society membership. Should we create one to discuss billing or anything else that could come back to bite us? It wouldn’t surprise me if insurance/medicare workers monitor SDN to see what practicing physicians are saying about their billing practices. Job market stuff can stay in public

This is in process.

 

[Palex80]

It was OP's choice, sure, but I doubt she was told "you will need to restrict what you look for in a spouse if you go into radonc", which is the truth in all this, male OR female.

But is this radiation-oncology specific? Are not most highly-qualified jobs an issue anyway when it cones to flexibility and how couples can get jobs in certain areas? If my wife is an oil drilling specialist, I should presume that at some I may have to live in Texas or the Persian Gulf.

And why does anyone have to „tell“ you about it? I believe that people are responsible for the choices they make in life. She wasn‘t 10 when she decided to go into radonc.

When I was in medical school and considered Radonc more than 15 years ago I was told two things:

1. The job market looks terrible right now. There are way too many graduates for resident spots, you will have a hard time finding a spot in a desirable location / speciality. You will probably end up getting a very short contract (6 months-1 year) and may have to switch places every now and then according to hospitals‘ budgets till you finish residency.

2. RadIation Oncologists work mainly in hospitals in cities (there were very few departments in small clinics and private practices back then). If you decide to go into RadOnc you will probably have to live in a city.

Both of these statements didn‘t materialize. By the time I finished the job market looked a lot better and I got a 5 year contract at my first choice. And nowadays there are alot of small departments and practices all over the place.

Based in what I was told back then, I would have to limit my spouse-choice to people who live in cities, can switch workplaces swiftly and make some money, since I may be out of salary now or then... Perhaps a free-lancing photographer, certainly not a farmer...

 

[w00tz]

But is this radiation-oncology specific? Are not most highly-qualified jobs an issue anyway when it cones to flexibility and how couples can get jobs in certain areas? If my wife is an oil drilling specialist, I should presume that at some I may have to live in Texas or the Persian Gulf.

And why does anyone have to „tell“ you about it? I believe that peopke are responsible for the choices they make in life. She wasn‘t 10 when she decided to go into radonc.

Maybe I didn't pay enough attention when I was a medical student, but I failed to realized the extreme geographic restrictions in radiation oncology as well. I don't think I realized it until the end of my PGY2 year, when the seniors in my program where struggling to find jobs in their desired geographic preference. I partially blame myself for not asking these questions as a med student, but at the time, I was really just worried about matching in the first place. But I'm also going to pull the victim card and place partial blame on others, because after doing 3 rad onc rotations, a gap year, and going to plenty of people already in rad onc for advice, and even browsing SDN at the time - it never really came up! Maybe the residents at the top programs I rotated at didn't have this issue at the time? Maybe they knew, but withheld it from me? Maybe I was just blinded by #radoncrocks (didn't really exist then) to even think about the practicalities of finding a job after residency as a med student. Was it in this forum's FAQ? In any case, I found out as a resident and was shocked how bad it was and I have a feeling the OP and I are not the only ones that were blindsided by how bad the geographic restriction is. I think over-training and the change in job market in the past 5-6 years also has a lot to do with this problem as well.

To me, anyone that graduates medical school and does a residency has a "high-qualified job", but this problem isn't remotely as bad when you look at GI, Hem/onc, pulmonary, radiology, and probably 95% of residency trained doctors.

To OP, I had a geographic restriction when I was job hunting last year and I was able to make it work. The pay isn't amazing, but I'm making decent money (average per Terry Wall) and I'm happy overall. Also, I went from 0 offers in December to 2 in January, so things do pop up all the time. Although things do seem to be a bit different this year, but I did want to try and give you a little bit of hope that things may work out.

 

[Palex80]

To me, anyone that graduates medical school and does a residency has a "high-qualified job", but this problem isn't remotely as bad when you look at GI, Hem/onc, pulmonary, radiology, and probably 95% of residency trained doctors.

Perhaps not, indeed. However, I do have to say that, as a European, reading these endless threads on the job market situation in the US, geographic restrictions and salaries, I get the impression that 50% of all radonc graduates seem to think that they are ENTITLED to a job in NYC, Boston, San Francisco or San Diego, making >500k per year and working normal hours once they finish residency.

Well, this obviously cannot work... Not 50% of the US population lives in those areas. And of course there are cuts in the medical system.
The Germans have this saying: "Die fetten Jahre sind vorbei" whcih translates into "The fat years are over". I think one can certainly say that for the field of radiation oncology in the US.

"Desirable" location is not necessarily speciality-bound. The people of Garden City, Kansas are going to need both a gastroenterologist and a radiation oncologist at the end of the day and someone will have to take that spot.

 

[RadOncDoc21]

Perhaps not, indeed. However, I do have to say that, as a European, reading these endless threads on the job market situation in the US, geographic restrictions and salaries, I get the impression that 50% of all radonc graduates seem to think that they are ENTITLED to a job in NYC, Boston, San Francisco or San Diego, making >500k per year and working normal hours once they finish residency.

Well, this obviously cannot work... Not 50% of the US population lives in those areas. And of course there are cuts in the medical system.
The Germans have this saying: "Die fetten Jahre sind vorbei" whcih translates into "The fat years are over". I think one can certainly say that for the field of radiation oncology in the US.

"Desirable" location is not necessarily speciality-bound. The people of Garden City, Kansas are going to need both a gastroenterologist and a radiation oncologist at the end of the day and someone will have to take that spot.

I disagree, nobody had those expectations coming out of residency. I do expect residents to come out either thinking they will lose out on one or the other and now likely both (money, location). I also believe that residents graduating soon will lose out on all three (money, location, and job), unless they do a fellowship.

This is the state of our field right now.

 

[medgator]

Maybe I didn't pay enough attention when I was a medical student, but I failed to realized the extreme geographic restrictions in radiation oncology as well. I don't think I realized it until the end of my PGY2 year, when the seniors in my program where struggling to find jobs in their desired geographic preference. I partially blame myself for not asking these questions as a med student, but at the time, I was really just worried about matching in the first place. But I'm also going to pull the victim card and place partial blame on others, because after doing 3 rad onc rotations, a gap year, and going to plenty of people already in rad onc for advice, and even browsing SDN at the time - it never really came up! Maybe the residents at the top programs I rotated at didn't have this issue at the time? Maybe they knew, but withheld it from me? Maybe I was just blinded by #radoncrocks (didn't really exist then) to even think about the practicalities of finding a job after residency as a med student. Was it in this forum's FAQ? In any case, I found out as a resident and was shocked how bad it was and I have a feeling the OP and I are not the only ones that were blindsided by how bad the geographic restriction is. I think over-training and the change in job market in the past 5-6 years also has a lot to do with this problem as well.

Pick 2/3 (job type/quality, location, salary) was always the expectation in radonc, even when the job market was the best it had been in awhile, last decade. You might get that pp with technical buy in, but you'd be in the middle of nowhere to get it.

Or you might get that job in a desirable locale but you'd take the salary hit to get it, but maybe you wouldn't be working too hard.

Picking an exact city to practice in when graduating in any given year has always been a tough proposition nonetheless. That was always known to me, but even if you took a hit on getting into a desirable city, you'd be paid handsomely as a consolation prize. As I mentioned before, I know AMGs that took a fellowship this decade to wait out the job market a year to see if something opened up geographically.

Nowadays, 2/3 is a pipe dream. If a pgy5 gets 0-1/3 this year, sounds like they should be thrilled #ThxExpansion

 

[PhotonBomb]

I disagree, nobody had those expectations coming out of residency.

No, I disagree with you.

The person who posted this is expecting 500k in a big city, starting.

when they got likely 300-350k starting in the city of their choice that would work for their husband, they cried foul.

 

[Krukenberg]

I get the impression that 50% of all radonc graduates seem to think that they are ENTITLED to a job in NYC, Boston, San Francisco or San Diego, making >500k per year and working normal hours once they finish residency.

Well, this obviously cannot work... Not 50% of the US population lives in those areas.

you’d definitely think that reading this forum, but then I remember that of the most vocal job market posters only a few seem to be residents. The others already have attending jobs.

 

[RadOncDoc21]

No, I disagree with you.

The person who posted this is expecting 500k in a big city, starting.

when they got likely 300-350k starting in the city of their choice that would work for their husband, they cried foul.

If that is the case then I agree, the OP is unreasonable, but I’ll still say “most” residents don’t have those expectations coming out, especially now a days.

 

[thecarbonionangle]

Idk of anybody who was expecting to make 500k in a big city right out of bat. What people are frustrated with Is the lack of opportunity even in smaller cities. Many jobs in less desirable places ended up being quite competitive this year as people applied broadly due to market forces.

 

[medgator]

No, I disagree with you.

The person who posted this is expecting 500k in a big city, starting.

when they got likely 300-350k starting in the city of their choice that would work for their husband, they cried foul.

Really? Sounds like they at least wanted a track to that salary, unclear whether the op expected that upfront, I doubt it

Yesterday, they called to cancel. The new general supervision change, they said, had caused them to hold off hiring this year. Maybe in the future. They were, of course, very sorry. And how can I blame them? They are doing what's best for themselves and their practice.

So here I am, in the winter of my PGY-5 year, without any job, and dwindling hope of finding one that isn't exploitative.

 

[medgator]

Idk of anybody who was expecting to make 500k in a big city right out of bat. What people are frustrated with Is the lack of opportunity even in smaller cities. Many jobs in less desirable places ended up being quite competitive this year as people applied broadly due to market forces.

Correct. No track to mid six figures in semi desirable cities, smaller metros or at all it seems lately.

Academic satellites are probably never going to get you to that salary, while a hospital private group may have.

 

[PhotonBomb]

What most people want (and what causes alarm when you worry you won’t get it) is a fair shake - feeling like you’re not being exploited or are going to get kicked to the curb. That’s the concern with churn and burn type PP places. In contrast that’s the security of being employed in academics, even if it’s a DIRTY SATELLITE. There’s a comfort and security level knowing they’re not going to fire you or try to screw you over.

SURE if you look at the current 2019 Billings and and see how much your salary is, obviously the hospital is taking a cut. That’s the reality of being employed. One of my urology buddies was grumbling to me recently because his practice got bought out by the big hospital in town because the ‘gravy train was done’.

 

[PhotonBomb]

Correct. No track to mid six figures in semi desirable cities, smaller metros or at all it seems lately.

Academic satellites are probably never going to get you to that salary

There are definitely plenty of jobs still that are tracks to 500k. Even in big size cities. In 2019. In the future, yeah fair to question.

 

[medgator]

There are definitely plenty of jobs still that are tracks to 500k. Even in big size cities. In 2019. In the future, yeah fair to question.

You should let @DukeNukem know about even one. He'd jump on it and maybe PayPal you a finders fee after he starts?

Has anyone noticed how dead the ASTRO site has been post CMS bombshell?

 

[PhotonBomb]

You should let @DukeNukem know about even one. He'd jump on it.

Has anyone noticed how dead the ASTRO site has been post CMS bombshell?

I mean 11 jobs posted in the last week. Seems about average. You can quibble about quality of jobs but for the mid winter, post-ASTRO period, seems about average if not a little above average.

 

[PhotonBomb]

You should let @DukeNukem know about even one. He'd jump on it and maybe PayPal you a finders fee after he starts?

Has anyone noticed how dead the ASTRO site has been post CMS bombshell?

Idk what to tell Duke. People that are applying this year can vouch that there are certainly 500k jobs. I am not aware of duke’s limitations.

 

[medgator]

I mean 11 jobs posted in the last week. Seems about average. You can quibble about quality of jobs but for the mid winter, post-ASTRO period, seems about average if not a little above average.

Fair enough, most of them seem to be be in fairly small metros, minus the VA and HCA job, but it is what it is

 

[thecarbonionangle]

How many people are needed to be called a “midsized city”, >150k?

 

[medgator]

How many people are needed to be called a “midsized city”, >150k?

Per my expert Google search:

According to US sources "any city with a population of between 100,000 and 300,000 persons, located within a Metropolitan Statistical Area of 1 million persons or more, could qualify as a mid-sized city" (see here).