CMS changes supervision rule. Rad Oncs no longer needed for daily operation of clinics. Med Students. Please read. You deserve to know implications.

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thecarbonionangle said:
the sad reality is many people in field just want a warm FMG body with a pulse , rather than contract so we will continue to sink. I can’t remember the last time understood what half of what a path fellow was saying at tumor board, pretty much our future, in a field where communication is so important
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As I wrote before, the situation is salvageable. Residents just need to step up instead of merely grumbling on SDN.

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radsisrad said:
To paraphrase the left-wing quip from 2008-2016, "thanks, Trump!"

This decision might be the final straw for Rad Onc, but Trump didn't create the mess. The oversupply created by greedy administrators/chairs/PDs is obviously what's to blame here. Rad Onc is not alone here; just ahead of the curve. EM grads will likely discover nasty surprises in a few years, but the chief difference is that EM applicants won't have to live with the same opportunity cost (many Rad Onc applicants, at least as of a few years ago, could easily have pursued Derm, Ortho, etc... not to mention the relative length of training).

The situation is not lost, however. What needs to happen is a draconian downsizing in residency spots. If I were a Rad Onc resident, I'd be meeting with all my co-residents right now and organizing a unanimously-signed letter demanding that starting either this cycle (unsure whether this is possible) or the next, there be a one- or two-year break from matching in NRMP.
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Instead, some programs like Case Western are actually adding positions?
 
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medgator said:
And others like Penn State are trying to start up a residency between Pitt and Philly
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It's MORE THAN CLEAR we have far too many residents, but I've heard about new programs opening, programs expanding, etc. Aside from a few PDs recognizing the problem on Twitter, precisely nothing has been done, programs are not changing their behavior, etc.

I'm not surprised, though, to be honest. Each program acts in its own best interest and will continue to do so. For all the lip service PDs and chairs play to the specialty as a whole, unless they're reigned in by some overarching body, they will not change their behavior, no matter the cost to their trainees.
 
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Who else is actively trying to open a new program at this point other then Penn State in Hershey Pa?
 
thecarbonionangle said:
I agree except for last part. If i turned in a signed letter with my co-residents to my greedy chair with sticky fingers, person would laugh at my face and maybe even ruin my career. This is a field filled with very vindictive petty people. This would only have any effect if a large majority (not just like 51%) of all current residents penned a letter demanding collective action. Even then, we would probably be ignored.....
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Having thought about this some more, let me offer an alternative perspective: a resident who led this kind of revolt and became known in the world of Rad Onc for it would instantly become a hero - not only to every single resident now in training, but also to "fellows", young attendings, and probably a good number of middle-aged and even older attendings. Sure, the market-flooding is highly beneficial for academics and a small minority of PPs. But my understanding is that everyone else in the field would be deeply relieved by a drastic reduction in trainees. I'd expect a resident who publicly led the charge for fewer training positions to be welcomed by dozens of PPs across the country. This is not dissimilar to the idea of politicizing marketing - sure, there will be some pissed-off consumers who will boycott your product, but the attention and exposure gained (as well as the subsequently-hardened customer base) often heavily outweigh the costs.
 
radsisrad said:
Having thought about this some more, let me offer an alternative perspective: a resident who led this kind of revolt and became known in the world of Rad Onc for it would instantly become a hero - not only to every single resident now in training, but also to "fellows", young attendings, and probably a good number of middle-aged and even older attendings. Sure, the market-flooding is highly beneficial for academics and a small minority of PPs. But my understanding is that everyone else in the field would be deeply relieved by a drastic reduction in trainees. I'd expect a resident who publicly led the charge for fewer training positions to be welcomed by dozens of PPs across the country. This is not dissimilar to the idea of politicizing marketing - sure, there will be some pissed-off consumers who will boycott your product, but the attention and exposure gained (as well as the subsequently-hardened customer base) often heavily outweigh the costs.
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What's a resident going to do to "lead" a revolt, though? They have zero leverage and zero power.
 
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"Revolt" talk is dumb. Are we talking Occupy RadOnc, Bolshevik, or Helter Skelter? Come on guys. Get real.
 
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Mandelin Rain said:
"Revolt" talk is dumb. Are we talking Occupy RadOnc, Bolshevik, or Helter Skelter? Come on guys. Get real.
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Rad Onc leadership is ruthlessly destroying the job market for current residents. Based on what I've read here, residents don't have time for half-measures. It's not overly dramatic to refer to unanimous demands for class-size reduction as a "revolt" against the direction your field's leadership has chosen. Understand, though, that the pot might need to be sweetened (e.g., with residents volunteering to increase their call frequency/burden).
 
So, say every resident signs a petition requesting a reduction in residency spots. What's the "Or else..." in this scenario.
 
Mandelin Rain said:
So, say every resident signs a petition requesting a reduction in residency spots. What's the "Or else..." in this scenario.
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The "or else" in this scenario is that a failure to respond with significant spot reductions would produce some the worst optics you can imagine.

Again, this isn't even the only way to tackle the issue. But if residents haven't unanimously brought their anger and concerns to their PDs and chairs, they've neglected a necessary step. Simply posting DO NOT APPLY RAD ONC threads on SDN won't prevent a few hundred applicants from matching into the field every year.
 
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radsisrad said:
The "or else" in this scenario is that a failure to respond with significant spot reductions would produce some the worst optics you can imagine.

Again, this isn't even the only way to tackle the issue. But if residents haven't unanimously brought their anger and concerns to their PDs and chairs, they've neglected a necessary step. Simply posting DO NOT APPLY RAD ONC threads on SDN won't prevent a few hundred applicants from matching into the field every year.
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just want to state for the record that the vast majority of discontent in SDN is posted by attendings.
 
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Krukenberg said:
just want to state for the record that the vast majority of discontent in SDN is posted by attendings.
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And somehow that makes it less valid? (Hint: we probably know our region's job market better than you do).

I'm guessing you think that ARRO survey was full of hot air as well?
 
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radsisrad said:
The "or else" in this scenario is that a failure to respond with significant spot reductions would produce some the worst optics you can imagine.

Again, this isn't even the only way to tackle the issue. But if residents haven't unanimously brought their anger and concerns to their PDs and chairs, they've neglected a necessary step. Simply posting DO NOT APPLY RAD ONC threads on SDN won't prevent a few hundred applicants from matching into the field every year.
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As a senior resident who has expressed my deep concern to my PD and Chair...they think everything is fine.
 
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Krukenberg said:
just want to state for the record that the vast majority of discontent in SDN is posted by attendings.
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The attending discontent is barely a kerfuffle, and oft times not even personal. The discontent posted by actual residents here, or newly minted rad oncs, or med students looking at rad onc, has been truly powerful IMHO. We attendings are watching events unfold as if viewing on the news and reporting our shock; some residents come here as if they were phoning from United flight 93.
 
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Krukenberg said:
just want to state for the record that the vast majority of discontent in SDN is posted by attendings.
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no matter what anyone says or thinks about this statement, this is an absolute factual statement, that cannot be argued.

Most of the posts are from about the same 4-5 posters, some like medgator or scarb who don't talk to any rad oncs in real life that aren't in their immediate sphere. I think scarb is a solo guy, medgator in a group practice.
 
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radoncgrad2019 said:
no matter what anyone says or thinks about this statement, this is an absolute factual statement, that cannot be argued.

Most of the posts are from about the same 4-5 posters, some like medgator or scarb who don't talk to any rad oncs in real life that aren't in their immediate sphere. I think scarb is a solo guy, medgator in a group practice.
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Again, addressing the posters rather the argument. And lying on top of it.

Classic rad onc Twitterati move. Are you an academic attending?
 
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medgator said:
Again, addressing the posters rather the argument.

Classic rad onc Twitterati move. Are you an academic attending?
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Dude, you literally just addressed the 'poster' (me) rather than the argument lmao.

you can't script this stuff.
 
addressing what argument? I literally said no matter what Krukenberg is right about that one fact. Done.
 
radoncgrad2019 said:
Dude, you literally just addressed the 'poster' (me) rather than the argument lmao.

you can't script this stuff.
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Fine, for sake of argument, grant you that most of postings are work of several discontents. Does that change anything?
Would that somehow diminish from the fact that residents have doubled during an era of hypofract and regulatory changes. Have medstudents had tge wool pulled over their eyes and tricked out of a field with a future of exploding job markets? What matters is validity of what is being posted.
 
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RickyScott said:
Fine, for sake of argument, grant you that most of postings are work of several discontents. Does that change anything?
Would that somehow diminish from the fact that residents have doubled during an era of hypofract and regulatory changes. What matters is validity of what is being posted.
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I never said there was a lack of validity. Did you read my post?
 
Plenty of residents on here posting their experiences, have people not read any of the threads filled with resident accounts? Some people really are BLIND
 
radoncgrad2019 said:
no matter what anyone says or thinks about this statement, this is an absolute factual statement, that cannot be argued.

Most of the posts are from about the same 4-5 posters, some like medgator or scarb who don't talk to any rad oncs in real life that aren't in their immediate sphere. I think scarb is a solo guy, medgator in a group practice.
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While there is variability in activity of users, I don't think anything in regards to the bolded is accurate.

Additionally, I won't pretend to know who medgator or scarb talk to IRL, and I recommend you probably not try to do that either.

Krukenberg said:
just want to state for the record that the vast majority of discontent in SDN is posted by attendings.
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Yes, there are more attendings on this website than there are residents. As with others, I'm not sure what your point is with this statement. I think there are MORE than enough resident experiences (both positive and negative) across the various threads in this forum to suggest that no residents post here.
 
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Mandelin Rain said:
"Revolt" talk is dumb. Are we talking Occupy RadOnc, Bolshevik, or Helter Skelter? Come on guys. Get real.
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It’s a tough balance. On the one hand a group of people will argue that we shouldn’t over react with hyperbolic statements about the situation. On the other hand if we don’t the field can and will become like pathology and radiology were in the past and that will have tremendous consequence for everyone involved. There very little way to measure the situation and so it’s a lot of ether where one side says nothing is wrong and the other side screams bloody murder. Decide where you want to go with it but keeping a calm head about it seriously risks underdoing it and a then little later it’s too late. SDN is a new paradigm to combat overexpansion ills, who knows where it will go but I’m certain that those that fell victim to path and radiology overexpansion wish they had this medium to call for a revolt to save their specialty
 
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Not that it helps any of you, but the very same concerns and arguments are made in dermatology -- only directed at private equity infiltration and mid level independence. The entire house of medicine is burning.
 
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MOHS_01 said:
Not that it helps any of you, but the very same concerns and arguments are made in dermatology -- only directed at private equity infiltration and mid level independence. The entire house of medicine is burning.
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Kind of doubt the entire house is burning. Good to read the book factfulness to understand why we have a tendency to such a bias
 
MOHS_01 said:
Not that it helps any of you, but the very same concerns and arguments are made in dermatology -- only directed at private equity infiltration and mid level independence. The entire house of medicine is burning.
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Market is still way more open in derm, geographically and you guys don't need a $2-3 million linac to hang a shingle.

That being said, I am surprised at the number of derm PAs and ARNPs I see in my neck of the woods. Seems like the docs rotate around just to do procedures/mohs
 
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medgator said:
Market is still way more open in derm, geographically and you guys don't need a $2-3 million linac to hang a shingle
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I think it's easy to say this, but we don't actually know. You have a derm MD coming to this forum and telling you this, and if you go read the derm forum ever, geography constantly comes up in terms of the job market and finding a 'good' job.
 
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PhotonBomb said:
I think it's easy to say this, but we don't actually know. You have a derm MD coming to this forum and telling you this, and if you go read the derm forum ever, geography constantly comes up in terms of the job market and finding a 'good' job.
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Perhaps, but I know a few derms in my region who started practices where zero rad onc jobs have been available for 3-4 years. Also with informally speaking to them, they do have a more open market as opposed to rad onc where a job may or may not be available in a given location in a given year.

N=1 of course
 
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there was this short period in the mid-2000s when Allergy/Immunology was considered 'hot'

i never hear about them anymore, wonder if their market/reimbursement tanked
 
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medgator said:
Market is still way more open in derm, geographically and you guys don't need a $2-3 million linac to hang a shingle.

That being said, I am surprised at the number of derm PAs and ARNPs I see in my neck of the woods. Seems like the docs rotate around just to do procedures/mohs
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There is nothing quite like FL derm; it’s a running joke (just not a funny one).

Yes, derm (and ortho and optho and urology, etc) have enjoyed fundamental market advantages over naturally consolidated specialties like path or rad onc, but the change in the environment has been striking in both its scope and speed over the past decade. Derm sub specialities have been grossly over trained which led to imbalances and the turn to midlevels to feed the beast; autonomous practice pushes turned the midlevels into competitors, and the highly fragmented and scalable derm market made it ripe for consolidation and PE infiltration.

Here’s the real kick in the teeth about it all: from a global, societal perspective, many of these changes are evolutionary advantaged, offering efficiencies that were always there and available — it’s just that we have traditionally been more interested in protecting our guilded fiefdoms than realizing efficiencies (for a variety of reasons, not all purely self serving). As healthcare grew into an increasingly outsized portion of the overall economy, the vultures and hyenas in suits were inevitably going to invade.
 
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MOHS_01 said:
There is nothing quite like FL derm; it’s a running joke (just not a funny one).

Yes, derm (and ortho and optho and urology, etc) have enjoyed fundamental market advantages over naturally consolidated specialties like path or rad onc, but the change in the environment has been striking in both its scope and speed over the past decade. Derm sub specialities have been grossly over trained which led to imbalances and the turn to midlevels to feed the beast; autonomous practice pushes turned the midlevels into competitors, and the highly fragmented and scalable derm market made it ripe for consolidation and PE infiltration.

Here’s the real kick in the teeth about it all: from a global, societal perspective, many of these changes are evolutionary advantaged, offering efficiencies that were always there and available — it’s just that we have traditionally been more interested in protecting our guilded fiefdoms than realizing efficiencies (for a variety of reasons, not all purely self serving). As healthcare grew into an increasingly outsized portion of the overall economy, the vultures and hyenas in suits were inevitably going to invade.
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Plenty of vultures and hyenas in our field. The hyenas are particularly the worst, they laugh at us as they circle us before they finish us. The snakes circle us too, field abound with them. No bigger viper pit in medicine than RO, filled with toxic vindictive inferiority complex petty people.
 
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PhotonBomb said:
I think it's easy to say this, but we don't actually know. You have a derm MD coming to this forum and telling you this, and if you go read the derm forum ever, geography constantly comes up in terms of the job market and finding a 'good' job.
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Oh it’s definitely easier to open a new general dermatology office than many specialty practices, no doubt. You can do it on a 500k line of credit and people can self refer themselves to you... and the demand is not nearly as restricted as it is for, say, rad onc services. The same cannot be said as easily for the Mohs or path guys, but probably still better than it is for many specialties. My point is the rapidity and degree of change over time, though; 15 years ago, in derm, you could easily have set up an office in practically anywhere, America and have a full schedule before opening the doors. Since that time the market has been flooded with providers (residency slots have doubled since my graduation), folks are working longer, midlevels exploded, and, most precipitously perhaps, insurer consolidation and MC Advantage expansion have narrowed panels and decimated reimbursements.

It’s a very toxic environment for small, subspecialty private practice right now. I think that is about the most ubiquitous thing in all of it.
 
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thecarbonionangle said:
Plenty of vultures and hyenas in our field. The hyenas as particularly the worst, they laugh at us as they circle us before they finish us. The snakes circle us too, field abound with them. No bigger viper pit in medicine than RO, filled with toxic vindictive inferiority complex petty people.
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You say literally the same thing in every post
 
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Haybrant said:
Kind of doubt the entire house is burning. Good to read the book factfulness to understand why we have a tendency to such a bias
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Perhaps, not familiar with the book.

....maybe I should start with the chapter focusing on normalcy bias - you know, the one most prevalent in academia?
 
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MOHS_01 said:
we have traditionally been more interested in protecting our guilded fiefdoms than realizing efficiencies (for a variety of reasons, not all purely self serving). As healthcare grew into an increasingly outsized portion of the overall economy, the vultures and hyenas in suits were inevitably going to invade.
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PhotonBomb said:
You say literally the same thing in every post
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The gilded fiefdoms still exist in healthcare and are maybe more gilded than ever. But the lords are the hyenas/vultures, and the MDs have become the serfs. Now they're not literally hyenas/vultures of course... but you can make a pretty good argument that they're literally lords, MDs the serfs.
 
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MOHS_01 said:
Oh it’s definitely easier to open a new general dermatology office than many specialty practices, no doubt. You can do it on a 500k line of credit and people can self refer themselves to you... and the demand is not nearly as restricted as it is for, say, rad onc services. The same cannot be said as easily for the Mohs or path guys, but probably still better than it is for many specialties. My point is the rapidity and degree of change over time, though; 15 years ago, in derm, you could easily have set up an office in practically anywhere, America and have a full schedule before opening the doors. Since that time the market has been flooded with providers (residency slots have doubled since my graduation), folks are working longer, midlevels exploded, and, most precipitously perhaps, insurer consolidation and MC Advantage expansion have narrowed panels and decimated reimbursements.

It’s a very toxic environment for small, subspecialty private practice right now. I think that is about the most ubiquitous thing in all of it.
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thank you for taking the time to post here. Very interesting/concerning to hear about the job challenges in other fields
 
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Krukenberg said:
thank you for taking the time to post here. Very interesting/concerning to hear about the job challenges in other fields
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Derm is totally different. Lot of cash paying and cosmetic procedures.
 
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nkmiami said:
Derm is totally different. Lot of cash paying and cosmetic procedures.
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And while there are maybe less than twice as many derms as rad oncs, there are likely 10 times as many job opportunities for derm vs rad onc at any given time. Couple that with the rad onc glut, really no comparison for job outlook either. Just from a sheer maths perspective using these links, and assuming 500 derms/200 rad oncs produced per year, and a job availability factor (equals number of MD search jobs divided by new, active job seekers):
Derm job availability factor = 791/500 = 1.58
Rad onc job availability factor = 65/200 = 0.33

IWurm8f.png
 
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