Programs I SHOULD apply to

[deleted1111261]

If it’s Indy PD, I hear underrated and happy residents. Seem to get pretty good jobs. Kudos

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[RSAOaky]

So read the post about radiation oncology “hellpits” and found it quite informative. But now, I ask the opposite question: which programs should a US MD actually apply/aim for?

This thread:

Rad onc rankings

I would remove Hopkins from the A list and Duke from the B list. Those are reasonable suggestions. While Duke doesn't always get a lot of love on here, several chairs I talked to were pretty high on the place and their academic placement seems solid. Hopkins got a lot of buzz on the interview...

forums.studentdoctor.net

Was last updated like…ages ago. But from what I gather, some of the top programs appear to be: Harvard. MSK, MD Anderson, Penn, John’s Hopkins, U Wash, U Mich, Stanford, UCSF, Yale, Duke, U Chicago, UCSD, Mayo, UF, Cleveland…

Are these the programs students in this upcoming match cycle should be aiming for? Are there any programs that I’m missing?

And for the record, yes we know the job market is in the toilet. But I figure it’ll be helpful to at least know which programs have the reputation/support to help their graduates out when it comes time to enter the fire

If you are hellbent on applying, then I would set reasonable expectations for yourself first and foremost. Next I would very seriously consider the following.

1) Academic vs. private - do you absolutely love research and are committed to it? If so you should go to the strongest academic department and seriously focus your efforts on research. I don’t mean just passively doing it, get involved and do everything you can to make you a good academic candidate. This will put you in the strongest position to get the job you want. You will find a job in a tolerable location. If you kind of want to do academics but location is the most important factor to the point that you would give up academics to be in a specific location, then see next slide.

2) location - decide how important location is. If academics is your passion, would you be willing to work somewhere like Rochester (Mayo) if it meant you could do awesome radonc research? If so, go to the best academic department you can. However, if location trumps all else, you really need to do residency at the biggest and best program you can in that location. Penn if you want to be in Philly, MSK if you want to be in NY, UCSF if you want to be in Cali, you get the drift. The reason for this is that your best chance of getting a job out of residency is if you are a known quantity, and the best way of being a known quantity in your desired location is by doing residency there. If your residency is a large health system, they will have more potential openings. Also, if you have a lot of attendings that are well known and well liked, and you are well known and well liked, there will be a lot more opportunities for you. I’m serious. There’s a number of jobs in my region this year. One health system needs to fill a spot for a new grad and asks about the graduating residents that want to stay in the area. They have 3-4 strong candidates without even putting an ad out. That job will fill before anyone knows they’re looking. The rest of the jobs will post ads but they already know their candidates unless someone absolutely wows them. Don’t expect to be that exception, you probably won’t be. I can’t stress enough that the location you train in will have the greatest impact on where you wind up practicing. The person that has the inside track on the two best job opportunities in my region is graduating from a hellpit…in my region. I repeat. If you want to be in a specific location, it’s probably better to be at a hellpit in that location than a prestigious program somewhere else. (edit: the last statement is all within reason of course. There are some hellpits that are ****ty residencies but offer good training with well connected attendings).

3) Salary - have the expectation you will make 300-350 starting and 400-450 mid career in any place you want to be. Don’t expect to make 500+. That doesn’t mean it won’t happen, just don’t expect to. For you to make that money you will need to get lucky or work in the middle of nowhere. Please don’t go into this field expecting to get lucky. You are not the exception. If you plan to take a job in the middle of nowhere making 500+ and are happy with that life plan, then it really doesn’t matter where you do residency.

 

[Radonky]

Will also add - you have to hustle

PGY-3 I was emailing PP groups in my area. PGY4 I did external rotations with other institutions. They all turned into interviews. Friends at top programs didn't have interviews, when I asked how many cold calls/emails they sent out - 0. ASTRO board alone doesn't cut it.

 

[medgator]

Will also add - you have to hustle

PGY-3 I was emailing PP groups in my area. PGY4 I did external rotations with other institutions. They all turned into interviews. Friends at top programs didn't have interviews, when I asked how many cold calls/emails they sent out - 0. ASTRO board alone doesn't cut it.

"The best jobs never make it to the ASTRO career center."

 

[RickyScott]

If Rad Onc is where your passion is, you should pursue it - period
Smaller programs can provide excellent clinical training AND offer research opportunities AND treat their residents like professional learners (no scut work).
Smaller programs can assist residents with networking and jobs, too. Faculty who graduated elsewhere and/or have professional connections are just as willing to advocate for residents as program alumni.
Be careful with labeling places "the best". Sometimes they won't be the best fit for you. Sometimes they don't deserve their reputation, or their residents aren't really happy, but won't say it because they don't want to mare the reputation of the program that follows them forever.
Keep your options open and look at all programs before crossing them off your list due to one arbitrary filter or another. Programs are continually reminded to take a wholistic view of candidates. I encourage candidates to do the same with programs.

Good luck.

Those of you looking for jobs: in any field (medicine and otherwise), if you get 2/3: location, salary, job description/responsibilities. consider it a valid option. Hitting all 3 with your first at-bat is unlikely. And like another poster said, your first job is called your "first job" because it's highly likely a "second" one will follow.

"The best jobs never make it to the ASTRO career center."

I would caution most jobs are now associated with a large hospital system that are required to post. There is not a huge secret job bank. The fact that you have to really hustle to find a job is a poor reflection on the field. Residents in other fields recieve tens of unsolicited job offers. And so did I when graduated 10+ years ago -from a well known hellpit.

 

[deleted1111261]

I would caution most jobs are now associated with a large hospital system that are required to post. There is not a huge secret job bank. The fact that you have to really hustle to find a job is a poor reflection on the field. Residents in other fields recieve tens of unsolicited job offers. And so did I when graduated 10+ years ago -from a well known hellpit.

Wonder what year you graduated

My job search year was 2009 and almost nothing unsolicited. Got offers from good places, tho, like SERO, but I had to work for it

 

[fiji128]

You guys all beat me to it. After years of specialized training, when you hear things like you need to reach out years in advance of graduation, know and be in with the right people, best jobs are unlisted, places want a known quantity, ect... These are all signs that the specialties' job market is still terrible when compared to almost all other medical specialties. Just saying. This type of stuff should not be normalized.

 

[metallica81788]

You guys all beat me to it. After years of specialized training, when you hear things like you need to reach out years in advance of graduation, know and be in with the right people, best jobs are unlisted, places want a known quantity, ect... These are all signs that the specialties' job market is still terrible when compared to almost all other medical specialties. Just saying. This type of stuff should not be normalized.

I can't even have relevant conversations with anyone in another specialty re: jobs. They're all in demand. Can move whenever wherever they want and keep ascending up the salary ladder. We might as well be speaking different languages.

 

[fiji128]

I can't even have relevant conversations with anyone in another specialty re: jobs. They're all in demand. Can move whenever wherever they want and keep ascending up the salary ladder. We might as well be speaking different languages.

100%.

 

[communitydoc13]

I can't even have relevant conversations with anyone in another specialty re: jobs. They're all in demand. Can move whenever wherever they want and keep ascending up the salary ladder. We might as well be speaking different languages.

In my community hospital, which is not urban but not in a bad location either, we are the only specialty that it is easy to recruit for. This dramatically impacts the dynamics of physician expectations and interactions with administration.

 

[OTN]

When I graduated in 2009, I had several pp good offers in several desirable locations, as location was paramount for me. However, these didn't materialize without me actively trying to find them. I cold called/emailed more than 100 radoncs across the country, hit up all my prior residency grads for contacts/info, and scoured the ASTRO job board over and over. I started early in my PGY-4 year and was relentless.

The difference was, back then you could get an "All 3" job (job type/location/salary) with that kind of effort. Needle-in-haystack now. Even back then, however, if location was important, going to residency near where you wanted to end up was critical.

 

[RickyScott]

Wonder what year you graduated

My job search year was 2009 and almost nothing unsolicited. Got offers from good places, tho, like SERO, but I had to work for it

Couple years before that. 5 practices called the program director. Not sero or the Princeton group, but by todays standards would be considered desirable jobs.
talk of “hustle” and “initiative” shifts the blame from the over expansion to the candidate. It assumes that if all candidates only were willing to hustle, jobs will be created out of thin air by performative hustling. Anyone spouting this garbage is a conman.

Edit reminds me of glengarry Glenn Ross. If a real estate agent is not making a sale it is because they aren’t hustling, not because there is a huge oversupply of realestate agents and only 5% can make a living selling houses.

 

[deleted1111261]

Yeah this is all real and what I’ve seen, too

Meaning it’s not breadlines but it is not jobs falling into our arms.

You have to work for it - perhaps more than any specialty.

I had dinner with colorectal surgeons the other night. They did what we did and the future looks terrible. I think more than double positions in ten years time. Surgical oncology similar. They were talking about how a position would get 2-3 candidates. Now, they get more than a dozen and when they whittle it down, the 2-3 left are (vomit) “rockstars”.

 

[NotMattSpraker]

If you are hellbent on applying, then I would set reasonable expectations for yourself first and foremost. Next I would very seriously consider the following.

1) Academic vs. private - do you absolutely love research and are committed to it? If so you should go to the strongest academic department and seriously focus your efforts on research. I don’t mean just passively doing it, get involved and do everything you can to make you a good academic candidate. This will put you in the strongest position to get the job you want. You will find a job in a tolerable location. If you kind of want to do academics but location is the most important factor to the point that you would give up academics to be in a specific location, then see next slide.

2) location - decide how important location is. If academics is your passion, would you be willing to work somewhere like Rochester (Mayo) if it meant you could do awesome radonc research? If so, go to the best academic department you can. However, if location trumps all else, you really need to do residency at the biggest and best program you can in that location. Penn if you want to be in Philly, MSK if you want to be in NY, UCSF if you want to be in Cali, you get the drift. The reason for this is that your best chance of getting a job out of residency is if you are a known quantity, and the best way of being a known quantity in your desired location is by doing residency there. If your residency is a large health system, they will have more potential openings. Also, if you have a lot of attendings that are well known and well liked, and you are well known and well liked, there will be a lot more opportunities for you. I’m serious. There’s a number of jobs in my region this year. One health system needs to fill a spot for a new grad and asks about the graduating residents that want to stay in the area. They have 3-4 strong candidates without even putting an ad out. That job will fill before anyone knows they’re looking. The rest of the jobs will post ads but they already know their candidates unless someone absolutely wows them. Don’t expect to be that exception, you probably won’t be. I can’t stress enough that the location you train in will have the greatest impact on where you wind up practicing. The person that has the inside track on the two best job opportunities in my region is graduating from a hellpit…in my region. I repeat. If you want to be in a specific location, it’s probably better to be at a hellpit in that location than a prestigious program somewhere else. (edit: the last statement is all within reason of course. There are some hellpits that are ****ty residencies but offer good training with well connected attendings).

3) Salary - have the expectation you will make 300-350 starting and 400-450 mid career in any place you want to be. Don’t expect to make 500+. That doesn’t mean it won’t happen, just don’t expect to. For you to make that money you will need to get lucky or work in the middle of nowhere. Please don’t go into this field expecting to get lucky. You are not the exception. If you plan to take a job in the middle of nowhere making 500+ and are happy with that life plan, then it really doesn’t matter where you do residency.

Such great advice. I'd add that people should think early and hard (and with an open mind) about what will make them happy because they will eventually need to make some decisions. It's not a job market where people will get everything they want, and there are a lot of judgmental people in our field who love to tell you during training what you should be doing with your life.

I speak with a lot of trainees and it is surprising how many struggle to answer the basic question of "what do you want you life to look like in 5 years?". It is a "leadership" problem and not the trainees fault, but so many clearly just want A job.

 

[theradiator]

Such great advice. I'd add that people should think early and hard (and with an open mind) about what will make them happy because they will eventually need to make some decisions. It's not a job market where people will get everything they want, and there are a lot of judgmental people in our field who love to tell you during training what you should be doing with your life.

I speak with a lot of trainees and it is surprising how many struggle to answer the basic question of "what do you want you life to look like in 5 years?". It is a "leadership" problem and not the trainees fault, but so many clearly just want A job.

Don't catch a falling knife

 

[deleted1116990]

I am presently considering a hospital employed position I found out about through a recruiter's cold call to me. Salary above 75th percentile. It happens, but it's only because I have stuck myself in a region most people don't want to be in by nature of where I did my residency, which is nowhere near where I'm from. Jobs in that area are off limits to me!

I have a med onc friend who just did a locums gig paying $5200/day. Seriously.

The weird thing is that rad onc still outearns med onc in hospitals based on salaries, but med onc absolutely crushes it when it comes to locums rates. Same with other specialties. Huge numbers doing locums now because they can earn double over a salaried job that way. You can make 7 figures in anesthesia doing locums full time right now based on what I've read in their forum. This can't go on forever.

 

[communitydoc13]

This can't go on forever.

Reaching criticality regarding medonc. The docs are smart. With these numbers, locum at 50% full time and make the same. QOL probably goes up. Full time community medonc can be a grind with lots of accountability and in hospital stuff that comes up. Many hospitals cobbling together medonc services with locums. (a terrible investment on the hospital's part)

I expect employed medonc salaries to soar in the near future. They should.

 

[deleted1116990]

Reaching criticality regarding medonc. The docs are smart. With these numbers, locum at 50% full time and make the same. QOL probably goes up. Full time community medonc can be a grind with lots of accountability and in hospital stuff that comes up. Many hospitals cobbling together medonc services with locums. (a terrible investment on the hospital's part)

I expect employed medonc salaries to soar in the near future. They should.

My friend was offered 770k in a large metro area. Present comp is high 5s I think. 770k is slightly higher than what I was able to negotiate, so yes, maybe they are passing us as we speak. Of course you would expect that if a desperate hospital will pay 5200/day for med onc locums, and the best I have ever seen in an ultradesperate situation for rad onc was a hair above half of that.

 

[metallica81788]

My community hospital (part of large system) medoncs are now in the 800s and it still doesn't prevent them cycling for other opportunities

The community hospital medonc game will be supported by expensive locums for the near future and care will (and already has) suffer(ed)
Why work 48 weeks a year when you could work 20-26 and not be accountable for long term continuity and system problems?

 

[deleted1116990]

Many community hospitals don't get it. If we think they don't get it with rad onc, then they really don't get it with med onc.

They squeeze the (very profitable) department as much as they can to make up for losses from cost centers in the hospital which means severely overburdening and underpaying employed physicians. In community PP midlevels carry much of the load. It baffles me why med oncs continue to do this and just get beat on by small rural hospitals for median salary. Yes, in PP you are covering more sites/volume and have more inpatient responsibilities, but income potential is up to triple what you can make employed well into 7 figure range (1.5ish where I am) and you are not wasting your time doing stuff that can be done by midlevels. If netting a million dollars a year post tax doesn't seem worth it to you, then you can work half the year as a locums and make the same amount as a 1.0 FTE employed med onc and be owned by no one. If I had that option as a rad onc, I would seriously consider it. Take a 25% paycut but have half the year free to do what I want? Can I do another residency during that time? Sign me up.

Will be interesting to see how this plays out when employed med oncs finally throw in the towel and quit and the hospitals' oncology programs implode. Will not be good for the solo employed rad onc at these places. Not to mention the patients. Maybe opportunities for freestanding PP to make a comeback?

 

[RadsRocks!]

I would caution most jobs are now associated with a large hospital system that are required to post. There is not a huge secret job bank. The fact that you have to really hustle to find a job is a poor reflection on the field. Residents in other fields recieve tens of unsolicited job offers. And so did I when graduated 10+ years ago -from a well known hellpit.

Ya I am a first year radiology resident and already get job offers. My seniors have signed offers in residency/fellowship and get stipends while still in training.

 

[metallica81788]

Will be interesting to see how this plays out when employed med oncs finally throw in the towel and quit and the hospitals' oncology programs implode. Will not be good for the solo employed rad onc at these places. Not to mention the patients. Maybe opportunities for freestanding PP to make a comeback?

My place might be there in a year or two I'll keep you posted

 

[deleted1116990]

My place might be there in a year or two I'll keep you posted

Would anyone take a rad onc job at a hospital that doesn't have a med onc and is trying to hire? Seems like they would get tired of paying you a rad onc salary to manage the handful of in house surgical referrals and palliative patients that trickle down from the inpatient side?

 

[Mandelin Rain]

Would anyone take a rad onc job at a hospital that doesn't have a med onc and is trying to hire? Seems like they would get tired of paying you a rad onc salary to manage the handful of in house surgical referrals and palliative patients that trickle down from the inpatient side?

Alternate thought: if the referring docs like and trust you, you may actually end up treating more patients as the person directing the care.

 

[communitydoc13]

Alternate thought: if the referring docs like and trust you, you may actually end up treating more patients as the person directing the care.

If you are struggling with medonc staffing, recommend encouraging radonc as first referral for locoregional H&N and lung (more efficient anyway). Also, see your follow-ups. Medonc will often hold onto H&N, GYN and rectal/anal f/ups even when they don't often review imaging personally or do intimate exams. Unless refractory renal insufficiency or bad cytopenias (rare) also not efficient use of clinic, although radoncs often eager to defer f/u medicine to others.

Also, would be nice if there was an age adjusted standard for blood counts. Community heme just killed with benign heme consultations.

 

[Reaganite]

Heard from a friend physics locums gigs are now 2k+! Have heard therapy locums rates close to physicians locums even.

 

[deleted1116990]

As long as there are many hundreds of boomers out there competing for scraps in rural Pensatucky or Missoklansas we will never get decent locums rates. So never.

One of the best things about our field also bites us in this way. 75 year olds aren't going to sign up for grueling weeklong hospitalist, med onc, ICU gigs. They have no problem spending a week here and there babysitting a linac and seeing a few OTVs for $1500/day.

Pulm locums aren't hired to babysit the ICU and watch Netflix. You can't just show up with a pulse and do nothing and get paid.

 

[RickyScott]

Just a thought. With Russian mobilization, programs may very well salivate over desperate cheap labor? Bring docs/ radoncs over as cheap “fellows” and maybe offer them residency after a couple years. Will Dan Golden soon be recruiting in Moscow?

 

[TheWallnerus]

Pulm locums aren't hired to babysit the ICU and watch Netflix. You can't just show up with a pulse and do nothing and get paid

PULM:

 

[Doctorer]

Would anyone take a rad onc job at a hospital that doesn't have a med onc and is trying to hire? Seems like they would get tired of paying you a rad onc salary to manage the handful of in house surgical referrals and palliative patients that trickle down from the inpatient side?

No. That sounds like a great way to atrophy your skills and become undesirable to hire after a while. On top of the issues you mention.

 

[tomballunger]

The programs you should apply to are diagnostic radiology programs instead. current R4s who are only a few months in are signing on jobs, the most picky fellow still has tons of offers but wants time to interview for the groups in his desired city, and just take a look at the job board on merritt hawkins, those give a ballpark of what to expect; radiology being the number 3 most recruited specialty last year behind NPs and fam med. Sure you might miss the patient interaction, but can always do mammo or even IR fellowship. And while radiology residency is rough in a sense where you learn a new modality/organ system for the first time every month as a junior/plow through soul crushing plain films/feels like a sweatshop at times, at the end of the tunnel is a very high paying job in demand and it might be actually interesting as a diagnostic rads catching and diagnosing things no other clinician would know how to do. Maybe the secret is out now though, diagnostic radiology seems much more competitive now. so many away rotators, and even the home med students are staying for more than a couple hours and doing multiple radiology rotations/research. Job market might change for radiology in a few years though but its a way safer choice than radonc

 

[RickyScott]

The programs you should apply to are diagnostic radiology programs instead. current R4s who are only a few months in are signing on jobs, the most picky fellow still has tons of offers but wants time to interview for the groups in his desired city, and just take a look at the job board on merritt hawkins, those give a ballpark of what to expect; radiology being the number 3 most recruited specialty last year behind NPs and fam med. Sure you might miss the patient interaction, but can always do mammo or even IR fellowship. And while radiology residency is rough in a sense where you learn a new modality/organ system for the first time every month as a junior/plow through soul crushing plain films/feels like a sweatshop at times, at the end of the tunnel is a very high paying job in demand and it might be actually interesting as a diagnostic rads catching and diagnosing things no other clinician would know how to do. Maybe the secret is out now though, diagnostic radiology seems much more competitive now. so many away rotators, and even the home med students are staying for more than a couple hours and doing multiple radiology rotations/research. Job market might change for radiology in a few years though but its a way safer choice than radonc

And radiology studies will only increase over time. Rads aren’t looking to eliminate their modality.

 

[tomballunger]

agreed. the list is never ending and radiologists complain and push for hiring more radiologists to manage it, but they aren't going to do large trials on eliminating things.

 

[communitydoc13]

agreed. the list is never ending and radiologists complain and push for hiring more radiologists to manage it, but they aren't going to do large trials on eliminating things.

Large trials on eliminating imaging would undoubtedly show that you could eliminate most of it. Think about what standards of non-inferiority could be used here.

There is no interest (or very little, some screening groups are definitely in the “this much mammo etc. is stoopid camp”) in doing this however. Diagnostic rads has become a de facto extension of the physical exam and well over utilized in a culture of defensive medicine. Therapeutic rads has become something to be avoided as personalized medicine and systemic therapeutics improve.

 

[TheWallnerus]

agreed. the list is never ending and radiologists complain and push for hiring more radiologists to manage it, but they aren't going to do large trials on eliminating things.

Radiologists are too busy to run trials anyways

 

[DireMoose]

The programs you should apply to are diagnostic radiology programs instead. current R4s who are only a few months in are signing on jobs, the most picky fellow still has tons of offers but wants time to interview for the groups in his desired city, and just take a look at the job board on merritt hawkins, those give a ballpark of what to expect; radiology being the number 3 most recruited specialty last year behind NPs and fam med. Sure you might miss the patient interaction, but can always do mammo or even IR fellowship. And while radiology residency is rough in a sense where you learn a new modality/organ system for the first time every month as a junior/plow through soul crushing plain films/feels like a sweatshop at times, at the end of the tunnel is a very high paying job in demand and it might be actually interesting as a diagnostic rads catching and diagnosing things no other clinician would know how to do. Maybe the secret is out now though, diagnostic radiology seems much more competitive now. so many away rotators, and even the home med students are staying for more than a couple hours and doing multiple radiology rotations/research. Job market might change for radiology in a few years though but its a way safer choice than radonc

Second these thoughts as far as the hot Radiology market. They are going in the exact opposite direction as RadOnc in terms of fellowships. Talked to Rads residents and they are getting offers for jobs that they used to have to do fellowships for.
Definitely an “up year” for RadOnc job market per senior residents, but pay close attention to the overall trend.

 

[Palex80]

Large trials on eliminating imaging would undoubtedly show that you could eliminate most of it. Think about what standards of non-inferiority could be used here.

There is no interest (or very little, some screening groups are definitely in the “this much mammo etc. is stoopid camp”) in doing this however. Diagnostic rads has become a de facto extension of the physical exam and well over utilized in a culture of defensive medicine. Therapeutic rads has become something to be avoided as personalized medicine and systemic therapeutics improve.

This is not entirely correct.
There are two large trials currently running that are looking at reduction of routine mammography for patients without risk factors for breast cancer and intensification of imaging for those at high risk.

The US trial:

The WISDOM Study - Join The Movement

The WISDOM Study is working to find the safest and most effective way to detect breast cancer for every woman. Join the movement today.

www.thewisdomstudy.org

The European trial:

The project - MyPeBS

www.mypebs.eu

 

[communitydoc13]

This is not entirely correct

You're right. I was aware of pushback on mammo and controversies regarding frequency.

Also some initiatives in Emergency medicine that I am aware of regarding algorithmic medicine to reduce reflexive imaging studies.

Curbing Unnecessary and Wasted Diagnostic Imaging - PubMed

Curbing Unnecessary and Wasted Diagnostic Imaging

pubmed.ncbi.nlm.nih.gov

Pretty prominent opinion piece. Not a radiologist among the authors. Trends still pretty remarkable regarding rads studies.

 

[medgator]

This is not entirely correct.
There are two large trials currently running that are looking at reduction of routine mammography for patients without risk factors for breast cancer and intensification of imaging for those at high risk.

The US trial:

The WISDOM Study - Join The Movement

The WISDOM Study is working to find the safest and most effective way to detect breast cancer for every woman. Join the movement today.

www.thewisdomstudy.org

The European trial:

The project - MyPeBS

www.mypebs.eu

Good luck getting that past the breast cancer lobby in the states

 

[deleted1111261]

I think what frustrates “outsiders” is the thread is about someone figuring out what programs to apply to.

By a few days, it’s about applying to radiology, radiology comp, mammography.

Only thing missing is masks, politics and biryani!

Those that have chosen RO have chosen it, that decision point is complete. Now what .. there are some decent programs, there are ways to make yourself marketable and some people will get decent jobs.

May the odds be forever in your favor!

 

[TheWallnerus]

This is not entirely correct.
There are two large trials currently running that are looking at reduction of routine mammography for patients without risk factors for breast cancer and intensification of imaging for those at high risk.

The US trial:

The WISDOM Study - Join The Movement

The WISDOM Study is working to find the safest and most effective way to detect breast cancer for every woman. Join the movement today.

www.thewisdomstudy.org

The European trial:

The project - MyPeBS

www.mypebs.eu

Leaders of WISDOM are pathologist and surgeon I think.

I want to see a US "mammogramist" advocating and launching trials for less mammographic screening. I'll wait.

One interesting thing about WISDOM... if you're a male, but identify as female (sorry I can't write this sentence less clumsily), you can enroll on WISDOM.

 

[Mandelin Rain]

You're right. I was aware of pushback on mammo and controversies regarding frequency.

Also some initiatives in Emergency medicine that I am aware of regarding algorithmic medicine to reduce reflexive imaging studies.

Curbing Unnecessary and Wasted Diagnostic Imaging - PubMed

Curbing Unnecessary and Wasted Diagnostic Imaging

pubmed.ncbi.nlm.nih.gov

Pretty prominent opinion piece. Not a radiologist among the authors. Trends still pretty remarkable regarding rads studies.

Academic Rad oncs would be tripping over the themselves to get on a similar piece regarding eliminating rad onc.

 

[elementaryschooleconomics]

I think what frustrates “outsiders” is the thread is about someone figuring out what programs to apply to.

By a few days, it’s about applying to radiology, radiology comp, mammography.

Only thing missing is masks, politics and biryani!

Those that have chosen RO have chosen it, that decision point is complete. Now what .. there are some decent programs, there are ways to make yourself marketable and some people will get decent jobs.

May the odds be forever in your favor!

Ah, the internet: the sharpest of double-edged swords.

To reorient ourselves, because I know we get "drive-by posts" with SDN users from other specialties - how much does faculty turnover/churn matter for your residency programs?

It's a silly question, to a point, because OBVIOUSLY the culture/experience of any department can be changed if you replace...everyone. But where's the line? How much turnover needs to take place, as a function of size, before culture changes? I went to one of the largest residency programs in the country. Looking at that post on Page #1 of this thread, ranking programs by number of residents, it was definitely top 15.

Even in such a "large" program, over the last ~12 years, there were at least four distinct "eras" of experience at my program. While there were some organizational changes which influenced things (surprise: academic health network mergers), it had much more to do with faculty. Literally having a couple PD changes and a key faculty member leave drastically changed the resident experience.

I haven't been gone all that long and talking to current residents...the place sounds absolutely unrecognizable. Personally, I know I feel like the opinion I have from my own experience is no longer applicable to the residents who would start in a year or two.

I think this is probably the way most places operate. If you have some really strong-willed, long-term people who are heavily involved (micromanage) from top positions (Chair, Vice Chair), then perhaps there's more of an enduring culture.

But...yeah. My advice remains: go to the program the general public thinks is the most prestigious and be prepared to teach yourself all of Radiation Oncology. The first thing people learn about me is all the shiny doo-dads on my CV, whether or not I know what I'm talking about isn't factored in until much later (...if ever).

 

[RickyScott]

Ah, the internet: the sharpest of double-edged swords.

To reorient ourselves, because I know we get "drive-by posts" with SDN users from other specialties - how much does faculty turnover/churn matter for your residency programs?

It's a silly question, to a point, because OBVIOUSLY the culture/experience of any department can be changed if you replace...everyone. But where's the line? How much turnover needs to take place, as a function of size, before culture changes? I went to one of the largest residency programs in the country. Looking at that post on Page #1 of this thread, ranking programs by number of residents, it was definitely top 15.

Even in such a "large" program, over the last ~12 years, there were at least four distinct "eras" of experience at my program. While there were some organizational changes which influenced things (surprise: academic health network mergers), it had much more to do with faculty. Literally having a couple PD changes and a key faculty member leave drastically changed the resident experience.

I haven't been gone all that long and talking to current residents...the place sounds absolutely unrecognizable. Personally, I know I feel like the opinion I have from my own experience is no longer applicable to the residents who would start in a year or two.

I think this is probably the way most places operate. If you have some really strong-willed, long-term people who are heavily involved (micromanage) from top positions (Chair, Vice Chair), then perhaps there's more of an enduring culture.

But...yeah. My advice remains: go to the program the general public thinks is the most prestigious and be prepared to teach yourself all of Radiation Oncology. The first thing people learn about me is all the shiny doo-dads on my CV, whether or not I know what I'm talking about isn't factored in until much later (...if ever).

Corey would do well to close down his own program. While decent, it is still not the Cleveland clinic, whose chairman is always begging for applicants. Chirag can handle all the breast in Cleveland.

 

[CurbYourExpectations]

That's not going to happen, still going to be ~90 programs in match this year.
Won't be surprised if there are 200 spots again this year.

 

[RickyScott]

That's not going to happen, still going to be ~90 programs in match this year.
Won't be surprised if there are 200 spots again this year.

Of course not. No one is going to disagree with the part about giving treatment to only those who need it. The sick part about expanding more than every other field is the flat out extreme deviancy that needs to be condemned by mainstream accademics.

 

[DebtRising]

So painful to read these posts thinking of my current situation and what I could have done. Good luck, you really want to do this just make sure you network. More important than program unless program is big enough to do that for you.

 

[Palex80]

One interesting thing about WISDOM... if you're a male, but identify as female (sorry I can't write this sentence less clumsily), you can enroll on WISDOM.

There is rational behind that, although the investigators could have restricted this only to those males that identify as females and take hormones?
(I think i surpassed your clumsiliness)

 

[Lamount]

Everyone needs to take deep breath and remember that we all have fun jobs that pay more than most docs and require less time than many… and acknowledge that some others may want to go into rad onc. Much of the frustration that we all feel is things aren’t as easy for us as was promised when we were applying. I don’t think this is the case anymore. Folks are going into this field with their eyes open. If they want advice, let’s give it to them.

OP and others who are asking for guidance e… would say that outright rankings are not terribly helpful. Would be easier to help for specific regions/professional interests

 

[ivybme]

The advice I was primarily given was to choose the best programs in your general region, except that the Big 3 programs can be equal to or better than the best programs in your desired region.

From my experience and personal opinions on the interview trail, this is what I thought were the top programs by region:

Big 3: MDACC, MSKCC, HROP
East: Penn, Johns Hopkins
Midwest: Mayo, WashU, Michigan
West: UCSF, Stanford, UCSD
South: Duke, UNC, Florida

Next tier below:
East: Yale, Maryland
Midwest: Cleveland Clinic, Chicago, Wisconsin
West: UCLA, Colorado, OHSU
South: UTSW, Emory

Some other rankings of desired locations:
NYC: MSKCC >>> NYU = Sinai > Montefiore > Columbia >>> NYP = Downstate = Stony Brook
California: UCSF >= Stanford > UCSD >> UCLA >> USC > Kaiser = Cedars Sinai > UC Davis, City of Hope, UCI, Loma Linda

I may ruffle some feathers but this is just my 2c.