city of hope or USC

[jamesq]

If you could only interview at one of the programs, which would it be. Unfortunately, I would love to interview at both, but they land on the same day. Any pros or cons of the programs would be appreciated. Thanks!

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[Gfunk6]

There are older posts (~ 2 years old) on all the Rad Onc programs in Southern CA located in the "Interview Impressions" thread here and here. I also found reviews from 2012 here and here.

City of Hope is a pretty new program that started a few years back. USC has been around for a while but had fallen pretty far until Eric Chang was hired as the new Chair. Most observers think this hire was a highly positive development.

 

[Jiantkwazi]

Kaiser.

 

[Gfunk6]

There are quite a few programs now in Southern California compared to only a few years ago: City of Hope, USC, UCLA, UCSD, Cedars, and Kaiser. IMHO, UCLA is probably the best overall department as things now stand.

 

[deleted4401]

Why in the world are there so many new programs popping up? The big markets are super saturated, and training people in LA is just going to lead to more saturation in CA and other big cities. Strange. It's going to be nearly 200 positions by the time the decade is over, at the current rate of growth. I'd say time to start shutting down positions.

 

[medgator]

Why in the world are there so many new programs popping up? The big markets are super saturated, and training people in LA is just going to lead to more saturation in CA and other big cities. Strange. It's going to be nearly 200 positions by the time the decade is over, at the current rate of growth. I'd say time to start shutting down positions.

Completely agree.

If anyone wants more proof, talk to current chiefs looking for jobs this year.

 

[Gfunk6]

I disagree somewhat. I trust the RRC to not add Rad Onc residency spots "willy nilly," but only after careful consideration. Considering the RRC has sharply reduced the # of positions in the past due to a perceived oversupply (which turned out to be wrong), I do think they have our specialty's best interests at heart.

Also, there has been a documented, published prediction of an impending "undersupply" of Rad Oncs. Like in every other field in medicine though, the shortages don't occur in saturated markets but rather in undeserved areas that many people would prefer not to live.

 

[stems]

I disagree somewhat. I trust the RRC to not add Rad Onc residency spots "willy nilly," but only after careful consideration. Considering the RRC has sharply reduced the # of positions in the past due to a perceived oversupply (which turned out to be wrong), I do think they have our specialty's best interests at heart.

Also, there has been a documented, published prediction of an impending "undersupply" of Rad Oncs. Like in every other field in medicine though, the shortages don't occur in saturated markets but rather in undeserved areas that many people would prefer not to live.

I disagree. Unfortunately the pgy-5s this year have had more difficulty in obtaining jobs as compared to before. I agree with the previous posters that the number of residency positions should be kept low. Otherwise we will end up like pathology where our graduates have difficulty obtaining positions. This would result in fewer great minds entering radonc.

 

[stems]

I have to respectfully disagree with you GFunk. Its my understanding that the RRC focuses primarily on the new institution being able to meet the residency requirements rather than doing a careful consideration of what the needs of our specialty is. The decrease in spots was noted after 1995 when the job market was not prepared for the number of graduates (Flynn et al IJORBP, 1999 I think) but it took a major oversupply to cause this. I think we are better off nipping this in the bud before we have a repeat of that situation.

In terms of the undersupply article, if you look at the predictions, the increase in number of spots far outpaces what the JCO article even predicted; further, projections that looked at the undersupply failed to account for reimbursment cuts which will let to docs seeing more patients rather than hiring and decreases in grant funding which will likely cut physician scientits opportunities. I think as a specialty we are far better off being undersupplied than oversupplied in terms of remaining an appealing specialty and one where trainees are able to easily get jobs and get compensated well for them. I have friends in other more saturated specialties that have to take 50% or more pay cuts to be in populated markets, I dont want that to happen to our specialty

Can ASTRO/ARRO take this topic up to prevent oversupply?

 

[medgator]

. I have friends in other more saturated specialties that have to take 50% or more pay cuts to be in populated markets, I dont want that to happen to our specialty

My understanding is that this is already happening in saturated markets now. Just not to that degree

 

[deleted4401]

The practice in Northern Virginia is now on a 5 year partnership track. We've moved to 4. The large practice in Chicago starts people at 50k below national average and has a 4 year track. So many people this year still looking, because they are looking for that perfect job in the suburb of a medium-to-large city, but those are further and far between.

I'm not one to purposely want to limit supply, but our shortage is not being solved by these increases. Just makes the big city situation worse. I also read the jco thing and it recommends more hypofx and that individual docs need to have more on treatment. In Florida and Texas, not uncommonly people have 12-15 on treatment. Nowhere near the amount of people that are suitable for hypofx (Canadian for breast, one and done for bone mets, and we treat every ultra low risk prostate case) are getting treated that way.

So, in summary, we can solve this without training many more of our future competitors!

S

 

[canadianoutlaw]

On the interview trail, almost every other program director claims they are applying to increase their number of residents. And many already have. So it's not just new programs popping up but established programs are actively expanding

 

[stems]

On the interview trail, almost every other program director claims they are applying to increase their number of residents. And many already have. So it's not just new programs popping up but established programs are actively expanding

Chairmen need to understand that by expanding their programs they're just hurting the future of the field. It's unfortunate that the main reason departments do this is because of the cheap/free labor residents provide.

 

[Gfunk6]

The practice in Northern Virginia is now on a 5 year partnership track. We've moved to 4. The large practice in Chicago starts people at 50k below national average and has a 4 year track. So many people this year still looking, because they are looking for that perfect job in the suburb of a medium-to-large city, but those are further and far between.

Anecdotal evidence is just that. My practice has a 3 year track (which has remained unchanged) and a couple of my buddies graduating in 2013 have signed with practices in ultra-competitive areas which are 2 years and 3 years for partnership track. I'd like some hard data to show what the median time to partnership is before making conclusions.

I know this thread has morphed a couple of times already from the better of two SoCal programs, to the best of all SoCal programs, to too many residents, to problems with the job market. I guess now it's on problems with excess time to partnership, so I guess I'll toss my two cents on the issue.

Time to partnership is a highly complex issue and cannot be uniformly applied across all practices and locations. If your group is "professional services only" then what exactly are you buying into? In these types of groups, only the partners receive revenue from professional services and the "partnership track" guys can be overloaded with work and are paid a straight salary. In these types of situations it would highly benefit the partners to keep you working as an employee for as long as possible.

If your group owns stuff (e.g. linacs, real estate) then a buy-in makes sense. Each buy in should be considered small capital infusion which the practice can keep in reserve for big-purchases, pay employees, etc. In these cases, it would actually make sense for you to become partner as fast as possible so that the risk is more equitably distributed among partners and so that they have more capital.

Caveat #1 = even the above is an over-simplification, but I was trying to make a point about the difference in partnership between different practices

Caveat #2 = remember that you NEED to have a presence in a community to generate referrals to generate revenue for yourself; in saturated markets this takes a minimum of 2-3 years of socializing with referring MDs; if they made you a partner right away, you'd have to pay the buy-in AND would make a lot less than the partners due to a weak referral base

 

[medgator]

Caveat #2 = remember that you NEED to have a presence in a community to generate referrals to generate revenue for yourself; in saturated markets this takes a minimum of 2-3 years of socializing with referring MDs; if they made you a partner right away, you'd have to pay the buy-in AND would make a lot less than the partners due to a weak referral base

Very good points in regards to community private-practice.