Would you guys recommend going into rad onc?

[coryjpettit]

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[seper]

Good question... is there going to be a drastic job market correction? Maybe, but it'll take more like 15 years to come back full circle to RadOnc shortage.

 

[evilbooyaa]

Has been asked ad nauseum on this forum before.

Don't go into it for the money at this point.

Still the most rewarding experience in all of medicine for me.

 

[medgator]

Has been asked ad nauseum on this forum before.

Don't go into it for the money at this point.

Still the most rewarding experience in all of medicine for me.

I'd wager the money will still be better than a lot of specialties and the work will be a lot more interesting.

The real issue is geographic/job location imo

 

[thecarbonionangle]

Do the middle of nowhere jobs pay more?

 

[deleted127837]

I'd wager the money will still be better than a lot of specialties and the work will be a lot more interesting.

The real issue is geographic/job location imo

Going by the rhetoric here, getting a job fresh out of residency, that isn't in the middle of nowhere, in the 5-7 years OP is probably looking at, sounds like the problem. If existing salaries don't drop, reimbursements decrease, investment in new tech remains a constant, and nobody retires, it's going to be hard for entry-level salaries to remain steady.

And if de facto PGY-6 positions, like the Stanford "instructor" and the various fellowships continue to expand, while more people each year wrap up residency without jobs, that timeframe seems rougher and rougher.

 

[medgator]

Do the middle of nowhere jobs pay more?

As a rule, Yes. Probably true for many specialties.

 

[Neuronix]

Do the middle of nowhere jobs pay more?

In most specialties and how it used to be in rad onc is "1-2 hours out of major metro area" or "beautiful suburb" or "college town" or whatever.

Now you're talking about legit middle of nowhere to go get the highest paying jobs where they'll actually try to make your life pleasant to keep you around.

 

[Fpg1245]

Honestly, it was probably a decent job with decent prospects up to a few years ago but who cares about that. The future Is what you should care about. I'd be pretty careful before committing to this and would examine other specialties and seriously look at them before coming to this. While the work is interesting, they're are also many drawbacks (job opportunities, compensation, ability to advance, overall relevance in oncology). In my opinion, simply what interests you as a medical student is a poor way of picking a specialty. That was a luxury which has disappeared. Long term viability and tolerability of the job should also be on your radar. Personally I picked rad onc because I really didn't care much for other fields I was exposed to during my 3rd yr rotations but then again I really got limited exposure. In my short time in the field, I honestly haven't felt anything other than regret.

 

[medgator]

In my short time in the field, I honestly haven't felt anything other than regret.

Is that specialty specific or because of your job/location/salary?

 

[DebtRising]

It's been discussed heavily, hesitate to post.

Question is easy to understand if you consider 'structural' unemployment.

In 3 years field went from a 10% 'undersupply' to a 4% 'oversupply'. Residency spots increased dramatically for the former - and academic programs continued to expand even after the latter was published. Weigh the merits of that approach, or your desire to be in a field with 'superiors' who treat your livelihood with such regard.

Reimbursements are down. Continue to go down. Indications for radiation are down. Payer driver to avoid referral to a costly treatment is strong. Referring physicians have disincentive to refer direct (onc home model) or indirect (rad versus third line drug x). Referring physician salary is down. Older physicians not retiring. Job market projections making assumptions about age of retirement that do not correlate with this fact. Job market saturated - definition of desirable creep to 'very undesirable'. And let's be clear - those 'very undesirable' areas are not of bad people, places, activities, religions, scenery. To harbor ultra-competitive, technology driven people who have certain tastes and expectations of lifestyle for working hard and sacrificing so much and say 'you will not be in a big city... you may not be in a medium or small city...' is dishonest. Not a single program I can tell for ASTRO or SCAROP to match 'underserved' ares with persons who enjoy those areas.

So in short, setup is for 'structural' under or unemployment in Rad onc - no matter how well you do, number of structural forces outside your control are working against the chances of finding a job that is enjoyable to you. None of this will get better in 5 or 10 years. There are numerous people who have posted here, unhappy with their choice and changing fate of their career, who will hold on for what they have tightly and will make it more difficult for new grads indirectly. Many people assume that a labor market cycles like a business cycle. False in structural unemployment.

Is rad onc worth it?
Which rad onc - the one the previous generation practiced in, or the one you will be practicing in? Setup for multiple years of numerous forces working against you, while academic programs seem content to expand to generate their own captive labor.

 

[agnes5]

I'm an MS3 who has struggled to decide between rad onc and peds for a while. I thought I was going to do rad onc for a little bit, but I just couldn't get over the issues with the job market. In talking with my advisors, I feel as though it's not worth the risk for me to go into a field that sounds so uncertain in regards to jobs and all these random unboarded fellowships popping up. On top of it, I have an nontraditional family and am grounded to the coasts. So in the end, I decided against rad onc. I love the field, but I just couldn't do it.

 

[Reaganite]

Lots of truth bombs in DebtRising's post. Although I have to give a shout all to all the insurance companies that continue to refuse to work with the hospital machine. Believe it or not, many of the HMOs we bash are what keep private practice Rad Onc around. The feds would love nothing more than to consolidate all the cancer care under the umbrella of the d-bags in academia.

 

[fiji128]

So I have been talking around to some folks about open positions over the last few months (finished residency June 2016). It amazes me that over the last two years, U of West Virginia, U of Tennessee, U of Arkansas have opened programs and that also private hospital systems in rural eastern Pennsylvania and Louisiana are also looking into starting residency programs. This while many of the jobs that are available are in way out of the way places, many of which lack on site physics and or dosimetery support or even things like a dedicated CT simulator. Compared to other specialties the job market is simply terrible and looks to only be getting worse. Consider entering the specialty with great caution and with realistic expectations in regards to how an oversupply of MDs effects the job market and employment opportunities for everyone.

 

[Sheldor]

OP, there is a lot of doom and gloom on this board that I just don't see echoed in my real world conversations. Some of it is, but not all of it. I've been a part of SDN for a decade+, and you just always have to remember that these online forums tend to distill truth to the point that its so concentrated it can be tough to swallow. I think that radiation oncology is an incredible field and I think that a good career can still be had in it. I think that no matter what changes come some things will remain constant about our field that I think make it worth considering such as the subject, the patient population, the work hours (M-F), and our role as a specialist. That said, for me, the one down side is the inability to roll in to any small town in america and set up shop or get a job. You may have to be a few hour drive from your ideal location, is that okay with you?

Over the last 10 years I've come here to learn from this great community and then when I head out into the real world I always see shades of SDN in my reality, but real life is complex, and I think its not quite as bad as it tends to sound here.

 

[thecarbonionangle]

Whats the general feeling from the seniors this year who secured a job in your department? how many people do you know of that cannot find a job or will be under-employed next year (locums only while they continue to look)?

With fellowships becoming a real possibility in the future for many, would you guys recommend looking into a general fellowship or doing something like a "proton fellowship" or pediatrics to become more appealing for jobs?

I'm hearing more and more reports of people having a tougher time to find jobs in places that aren't even that "desirable".

 

[metview]

This is depresing hearing this as an MS3 set on rad onc. For all those who regret it, what other specialties would you have gone in to? What other fields are like rad onc in terms of hours and reimbursement?

 

[medgator]

This is depresing hearing this as an MS3 set on rad onc. For all those who regret it, what other specialties would you have gone in to? What other fields are like rad onc in terms of hours and reimbursement?

Hours and reimbursement aren't really the main drivers for why many of us went into rad onc.... but if you want to go down that line of thinking, probably derm. The work is totally different though and I'd probably be bored to tears, personally

 

[metview]

Forget my last part about the hours/reimbursement. For those who regret it, what other field would you have chosen?

 

[Cooluser123]

With fellowships becoming a real possibility in the future for many, would you guys recommend looking into a general fellowship or doing something like a "proton fellowship" or pediatrics to become more appealing for jobs?

I'm hearing more and more reports of people having a tougher time to find jobs in places that aren't even that "desirable".

I think this has been discussed ad nauseam. If you were at ARRO day at ASTRO this year, there was a fellow panel answering questions from the audience. One question directly asked, did you take the fellowship because there were no jobs? Every one of them looked flabbergasted by this possibility.

I'm not sure how much of the koolaid they drank beforehand/just acting the part vs fellows truly pursuing unique training and very particular interests. I know the latter is the case at least some of the time by looking at publications from recent fellows or jobs landed after their fellowship. After the session, I did believe that they earnestly sought the training not for a dearth of jobs, for whatever my anecdote and opinion are worth.

 

[Krukenberg]

http://www.redjournal.org/#/article/S0360-3016(17)30010-X/fulltext
Authors suggest limiting expansion to underserved regions and de-emphasizing research among Med student applicants could ease the oversupply and maldistribution. Good to see a former PD as one of the authors.


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[Neuronix]

Changing the type and location of rad onc residents without changing the number of rad onc residents can not fix the oversupply problem.

 

[redoitall]

To the OP.

I learned that I had matched this Monday, will find out where tomorrow. As a student who strongly considered Radonc, I decided to go into Radiology. I could state many reasons as to why I didn't do Radonc. I considered many variables , from getting along with the residents in the specialty to the uncertain future. I talked to some PGY-5 residents at my institution and learned several took on a fellowship job due to geographical constraints (to be with their SO or around families). But in truth, I just found that I didn't like it enough to risk it. It seems that I enjoyed Radiology more (and many will say that the job market is worse). In the end, I would simply say that if there is nothing else you would rather do, then go for it knowing that there is some uncertainty in the job market (but these are cyclical, so no matter what specialty you pick, at some point, the job market will suck, except perhaps for the few specialties that understood that adding residents to enjoy the benefit of cheap labor is not the way to a sustainable and attractive career prospect).
As for me, I will be extremely happy as a radiologist. I just clicked with it and enjoyed the nature of the job. It seems I am not into patient contact...
Another big thing was research in the field, but not as in clinical trial, more as technology development. I believe that as a radiologist I will have access to this type of research as well. So it seems that I end up keeping the best of it and not having to deal with the worst of it.

In the end you really need to find out if this is truly what you love, I mean with passion. If not, then find what you love and go for that. Try to get exposure to Radonc as early as possible, but do not discard other specialties. Be inquisitive, remain open and follow your heart. Good luck.

 

[OTN]

http://www.redjournal.org/#/article/S0360-3016(17)30010-X/fulltext
Authors suggest limiting expansion to underserved regions and de-emphasizing research among Med student applicants could ease the oversupply and maldistribution. Good to see a former PD as one of the authors.


Sent from my iPhone using SDN mobile app

I was very, very disappointed to see them dismiss residency contraction very easily, in a single line, by citing a paper in the Red Journal. If it's unlawful to restrict residency positions due to market conditions, how can so many other specialties do it? Pediatric surgery does it ALL THE TIME and out in the open. Simply ridiculous our "leaders" won't do it. Medical students aren't idiots- at least those going into radonc for the time being aren't. If they realize you have to burnish your "community practice" credentials to get a residency position, all of the sudden they're going to remember how they sure really would love to live near Aunt Judy in Nebraska and take care of patients.

As far as OP goes, I love radiation oncology, love my job, love the location, practice, etc. Someone mentioned "decreased importance of radiation in oncology" as one of their reasons for avoiding the specialty, but I strongly disagree. We're just as important for cancer care as we always have been, and I see no reason that will be changing in my lifetime. However, I graduated 8 years ago, before the current academic "leaders" decided to not care about their trainees. All of this stuff is cyclical, but unfortunately right now we're in a really tough spot as far as employment prospects after graduation. It may change, but with academic departments sticking their heads in the sand and refusing to make the tough choices, it's hard to know if and when.

 

[CaptainEngineer]

I guess I'm curious to how people define quality location.

I'm an engineer for one of the big three automotive, and that's going to medical school next year specifically because I'd much rather be in a community practice (there's something to be said about 9-5s being miserable if you're in the wrong field). Rad onc catches my attention as an electrical engineer simply because the tech seems right up my alley. Obviously I have a long list of things to do before ever considering residency; just curious to learn what current people think.

To me, the west coast of Michigan actually sounds awesome. Traverse City is a nice suburb, would keep me right next to family - and it's on the beach. Would that be what an outsider considers "rural"? Or would even Detroit be "undesirable" due to the rep (it's actually pretty awesome now that the hipsters rebuilt Midtown)?


Edit:
Also please forgive the obnoxious handle name, I created that when I was 21

 

[OTN]

I guess I'm curious to how people define quality location.

I'm an engineer for one of the big three automotive, and that's going to medical school next year specifically because I'd much rather be in a community practice (there's something to be said about 9-5s being miserable if you're in the wrong field). Rad onc catches my attention as an electrical engineer simply because the tech seems right up my alley. Obviously I have a long list of things to do before ever considering residency; just curious to learn what current people think.

To me, the west coast of Michigan actually sounds awesome. Traverse City is a nice suburb, would keep me right next to family - and it's on the beach. Would that be what an outsider considers "rural"? Or would even Detroit be "undesirable" due to the rep (it's actually pretty awesome now that the hipsters rebuilt Midtown)?


Edit:
Also please forgive the obnoxious handle name, I created that when I was 21

Most of Michigan would be considered rural to most people. I'm from the Midwest myself, so I don't find it as much of a problem as others. However, jobs even in suburbs of big cities are becoming more and more difficult to come by. When people say "rural" now, there's a good chance they actually mean more rural than Traverse City.

 

[BobbyHeenan]

I was very, very disappointed to see them dismiss residency contraction very easily, in a single line, by citing a paper in the Red Journal. If it's unlawful to restrict residency positions due to market conditions, how can so many other specialties do it? Pediatric surgery does it ALL THE TIME and out in the open. Simply ridiculous our "leaders" won't do it. Medical students aren't idiots- at least those going into radonc for the time being aren't. If they realize you have to burnish your "community practice" credentials to get a residency position, all of the sudden they're going to remember how they sure really would love to live near Aunt Judy in Nebraska and take care of patients.

As far as OP goes, I love radiation oncology, love my job, love the location, practice, etc. Someone mentioned "decreased importance of radiation in oncology" as one of their reasons for avoiding the specialty, but I strongly disagree. We're just as important for cancer care as we always have been, and I see no reason that will be changing in my lifetime. However, I graduated 8 years ago, before the current academic "leaders" decided to not care about their trainees. All of this stuff is cyclical, but unfortunately right now we're in a really tough spot as far as employment prospects after graduation. It may change, but with academic departments sticking their heads in the sand and refusing to make the tough choices, it's hard to know if and when.

I agree with this. The whole hiding behind anti-trust lawsuits thing is a fallacy in my opinion. If they really wanted to fight expansion they could take an alternate position. In fact, was work force not cut before? The citation they use is from their own opinion paper.

Can someone cite one single successful law suit where dermatology or pediatric surgery or *insert other competitive field* candidates won a suit regarding perceived lack of residency expansion?

 

[medgator]

Most of Michigan would be considered rural to most people. I'm from the Midwest myself, so I don't find it as much of a problem as others. However, jobs even in suburbs of big cities are becoming more and more difficult to come by. When people say "rural" now, there's a good chance they actually mean more rural than Traverse City.

I know the market is bad but i can't imagine people are fighting for jobs in towns with 15K people far in a Midwestern state far from a major city....

 

[CaptainEngineer]

I know the market is bad but i can't imagine people are fighting for jobs in towns with 15K people far in a Midwestern state far from a major city....

Is that even viable? My (rather naive) understanding is that the cost of linear accelerators drives most rad onc physicians towards large cancer centers. While clearly the US doesn't force people to operate in this model, like Canada does, is it realistic to think that such a cancer center would exist truly in the middle of no where?

I guess again it all depends on your definition of "good" location. One of my favorite cities is actually Louisville, Kentucky because of the combination of nice people, good food, and beautiful scenery. I'd wager that 98% of my engineering classmates would have never considered that a nice place to live (I know I certainly didn't until I worked there lol).

 

[OTN]

I went to an ASTRO talk about jobs about 10 years ago where a presentation using a back-of-the-envelope calculation (cancer incidence, need for RT, etc) suggested a population of ~60k would be necessary to support a radonc. That might be a bit high, but I think it's closer to being accurate than 15k.

 

[medgator]

I went to an ASTRO talk about jobs about 10 years ago where a presentation using a back-of-the-envelope calculation (cancer incidence, need for RT, etc) suggested a population of ~60k would be necessary to support a radonc. That might be a bit high, but I think it's closer to being accurate than 15k.

Population is part of it but so is demographics. A younger, non smoking population is going to feed a linac less than an older group of smokers. I know Utah can be tough to find a job in for that exact reason lol.

That being said, I've heard of 50k being the average to support a linac, but then we see linacs in remote parts of AK, WI, MN etc where that may not be the case

 

[DebtRising]

Argument that they are unable to cut or regulate slots is ridiculous / unfounded. Embodiment of problem.

Training residents takes resources. Time. Money. Man power from different field. Money may be from tax payers.
ASTRO accepted the parameters of employment model. They posted prominently on website about 'undersupply' when model predicted such. Them hiding from the oversupply now is hypocritical, at best.

If you accept the validity of the model and that training resident has cost (which is evident - cost to society either financial or drawing a physician away from other field whose services are in demand, to resident who may have a large debt and 8+ years post college in need of job), then as stewards of the field leadership has a moral and ethical imperative to realize this balance and regulate slots.
To claim anti trust is ridiculous - there is no role for leadership of RO in context of larger field of medicine, where resources are being constrained in big picture, to help utilize global resources correctly? Bull.

It should be illegal to allow expansion of trainees into a field where the labor market model, that the field's leaders accepted and used as rationale to increase trainee slots previously, now predicts oversupply for the next decade. If not illegal it is certainly immoral to abdicate this responsibility as 'anti trust'. Anti-trust from who? Your data informs that already too much of a global, limited resource is being allocated without need

Instead - "fellowship" expansion. Cyclical? How will this be cyclical without changes?

 

[bluebubbles]

.

 

[CaptainEngineer]

It differs for every person, but the other fields I'd consider would be fast-track internal medicine / medical oncology, or going into software engineering.

That's not a joke...I don't find a lot of other fields of medicine appealing. Even if they're great fields (e.g. cardiology), either the training period is too long or they have their own job market issues.

I don't know why people think software engineers have it so great to be honest.

For one, it's an EXTREMELY cyclical field. I know a lot of people who made bank in the early 2000s only to end up literally working as IT (think tech support) for the next decade because no one was hiring. Sure, the cream of the crop do end up in Amazon or Google - but those have their own problems. Palo Alto has a borderline housing crisis right now; my friends in the bay area almost exclusively share small apartments despite what is theoretically a solid salary. It's also a misnomer that engineering is actually a true 9-5. You may start around 40 hour weeks, but by the time you actually have a few projects the reality for most people is closer to 55. The higher paying jobs out west end up also having very frequent weekends (the joke at Apple is if you don't show up Sunday, don't return Monday). Management = mandatory weekends + evenings as well. Trust me, there's more than a few burned out/miserable coders out there.

TL;DR
You can theoretically make good money in CS, but you have to be exceptional to get the high paying jobs which entail staring at computer screen 60-70 hours a week. Same rule as medicine applies: only go into it if you actually like it.

PM me if you want more details.

 

[Neuronix]

I was in IT/software engineering before I went into medicine. I used to code several languages and got bored in my computer science degree before I switched to pre-med knowing absolutely nothing about biology, chemistry, physics, etc.

Zero regrets on the change. Some of my old friends are now quite rich. Most are in the 100-200k/year ballpark, though they started earning that long before I did. Higher salaries often require a move to very high cost of living areas, but then again the starting pay for rad onc in those areas (silicon valley/NYC) for rad oncs tends to be on the order of 250k.

That said, for me personally this was the right decision by far. I work hard, but find this much more personally fulfilling. YMMV.



I just think that anyone going into rad onc nowadays has to accept that they will have little to no control over their location in their career. The old physician mantra of pick two of location, lifestyle, and salary is probably down to one in rad onc. That is: pick one of location, lifestyle, OR salary.

There's a lot of justification in this thread "Oh I like x place and most people wouldn't consider it." or "The city needs to be y size before it can support a rad onc." Yes, the jobs I'm talking about where I know people are still getting good salaries are in the midwest or rural south. Places like west Texas, north Minnesota/Wisconsin, and other plains towns you've probably never heard of. If that appeals to you, good for you. I can't guarantee this will continue, and it's entirely possible that even if those jobs still exist in 5-10 years that they'll not pay as well as they do now.

If you are very interested in going back to a particular area, there's no guarantee there will be a job opportunity out there for you. There might be a job in Louisville the year you graduate. There might not. Then what? There might be a job in the entire rocky mountain states when you graduate. There might not. Even if there are, you might not get picked for that job. You need to be ready with a contingency. Spouse can only be in one metro area for their career? You need to seriously consider whether you can be separated from your spouse or unemployed or underemployed at least temporarily, if not permanently. I don't want to hear the rationalization that it's like this in all medical specialties. General FP or IM docs can get decent jobs anywhere. I'm not making this stuff up. I see it with my own eyes. There are a lot of rad oncs out there working locums, part-time, just doing insurance auths (vomit), or other scenarios because they're stuck in a given location and locked out by a non-compete or the job market.

You may get stuck doing a fellowship, though even a 6 year training pathway for a specialist isn't so bad (radiology pretty much requires a 1-2 year fellowship, for example).

 

[eteshoe]

I don't know why people think software engineers have it so great to be honest.

For one, it's an EXTREMELY cyclical field. I know a lot of people who made bank in the early 2000s only to end up literally working as IT (think tech support) for the next decade because no one was hiring. Sure, the cream of the crop do end up in Amazon or Google - but those have their own problems. Palo Alto has a borderline housing crisis right now; my friends in the bay area almost exclusively share small apartments despite what is theoretically a solid salary. It's also a misnomer that engineering is actually a true 9-5. You may start around 40 hour weeks, but by the time you actually have a few projects the reality for most people is closer to 55. The higher paying jobs out west end up also having very frequent weekends (the joke at Apple is if you don't show up Sunday, don't return Monday). Management = mandatory weekends + evenings as well. Trust me, there's more than a few burned out/miserable coders out there.

TL;DR
You can theoretically make good money in CS, but you have to be exceptional to get the high paying jobs which entail staring at computer screen 60-70 hours a week. Same rule as medicine applies: only go into it if you actually like it.

PM me if you want more details.

Definitely agree w/ your assessment of the engineering industry (was a ChemE in industry before switching into medicine). From my friends who work at Amazon/Google/Microsoft, they tend to stick around for a few yrs (pay off college loans) and then move on to smaller companies since those companies work their employees like dogs for their 110k salaries.