Radiation Oncology Job Market - ACR Webinar

[deleted941485]

I think SERO distributes talking points like a political party. I had an unrelated conversation with another member of the practice recently and we talked about the state of Radiation Oncology - this person had very similar views (and phrasing) as Butler.

However, if I had a stranglehold on a large geographic area with dominance assured for years to come...I would also be very bullish.

They certain are large enough to mimic their larger and more corporate health system which spew out canned statements about whatever hot topic is floating around

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[deleted941485]

Last week, I recently heard of a BC rad onc who has decades of experience who cannot find a job. Applying very broadly, no luck.

Also heard places like Carlsbad decided not to hire someone due to changes in supervision rules. They pulled offers. It is happening already folks

Honestly, I knew rad oncs with 15 years worth of experience that spent as much time looking for a new job that I did my first time looking for a job. Pretty disheartening.

 

[fiji128]

It's been well over a year since I last saw a posting about that Salina KS job. A google search shows there are now 2 rad oncs at that hospital. So that's no longer a last ditch fall back. I guess the same goes for the previously always available Carlsbad NM job. But its probably fine as a bunch of careerist academics with no skin in the game and currently not looking for positions seem to think there is nothing to worry about.

 

[thecarbonionangle]

I feel like they want “concrete” evidence the job market is bad and breadline unemployment is here. By then it will be too late. Nothing you can do can fix anything for the foreseeable future.

i think upcoming 2021 class will be a tough job market. Take and sign the first decent job offer you get and never look back. If you delay by a year (fellowship) nobody can guarantee things will improve. It is anybody’s guess.

 

[fiji128]

I feel like they want “concrete” evidence the job market is bad and breadline unemployment is here. By then it will be too late. Nothing you can do can fix anything for the foreseeable future.

i think upcoming 2021 class will be a tough job market. Take and sign the first decent job offer you get and never look back. If you delay by a year (fellowship) nobody can guarantee things will improve. It is anybody’s guess.

Ya its ridiculous that a cabal of academic elites just made up a bunch on numbers and projections and it gets published it in JCO saying were going to have a shortage. Reason enough to double the supply of rad oncs because they kinda had a hunch and just as importantly a good pedigree.

However, on the other hand, there is no hard evidence of an oversupply so we can't do anything. I kinda feel like some of these rad oncs wouldn't believe that their house was on fire until they see a peer reviewed article published 9 months later stating that indeed their house had been on fire and is now a pile of ashes.

 

[RickyScott]

Ya its ridiculous that a cabal of academic elites just made up a bunch on numbers and projections and it gets published it in JCO saying were going to have a shortage. Reason enough to double the supply of rad oncs because they kinda had a hunch and just as importantly a good pedigree.

However, on the other hand, there is no hard evidence of an oversupply so we can't do anything. I kinda feel like some of these rad oncs wouldn't believe that their house was on fire until they see a peer reviewed article published 9 months later stating that indeed there house had been on fire and is now a pile of ashes.

Yes, the evidence based idiots! Climate change deniers.

 

[OTN]

Ya its ridiculous that a cabal of academic elites just made up a bunch on numbers and projections and it gets published it in JCO saying were going to have a shortage. Reason enough to double the supply of rad oncs because they kinda had a hunch and just as importantly a good pedigree.

However, on the other hand, there is no hard evidence of an oversupply so we can't do anything. I kinda feel like some of these rad oncs wouldn't believe that their house was on fire until they see a peer reviewed article published 9 months later stating that indeed there house had been on fire and is now a pile of ashes.

Same thing with the "this would be a good paper/editorial" reply to the breastfeeding problem. WHY can academics not communicate/work in any other setting other than a journal? We really have to go through the write---> submit ----> correct ---> approval ----> publishing circus just to talk about how the ABR are inflexible jerks?

 

[Mandelin Rain]

Same thing with the "this would be a good paper/editorial" reply to the breastfeeding problem. WHY can academics not communicate/work in any other setting other than a journal? We really have to go through the write---> submit ----> correct ---> approval ----> publishing circus just to talk about how the ABR are inflexible jerks?

Journal offers some shelter. It's a "proper" channel, peer reviewed, edited, etc... You're not at risk of putting your unrefined, diesel strength opinion out there. That would be miscreant.

However, the airing of laundry in journals is incredibly passive aggressive. So pretty perfect for rad onc.

 

[scarbrtj]

Same thing with the "this would be a good paper/editorial" reply to the breastfeeding problem. WHY can academics not communicate/work in any other setting other than a journal? We really have to go through the write---> submit ----> correct ---> approval ----> publishing circus just to talk about how the ABR are inflexible jerks?

In rad onc, discrimination isn't really discrimination until it's peer-reviewed discrimination.

 

[evilbooyaa]

Ya its ridiculous that a cabal of academic elites just made up a bunch on numbers and projections and it gets published it in JCO saying were going to have a shortage. Reason enough to double the supply of rad oncs because they kinda had a hunch and just as importantly a good pedigree.

However, on the other hand, there is no hard evidence of an oversupply so we can't do anything. I kinda feel like some of these rad oncs wouldn't believe that their house was on fire until they see a peer reviewed article published 9 months later stating that indeed there house had been on fire and is now a pile of ashes.

No, no, no, completely wrong.

If it affects them and it is advantageous to do so, they will move quickly. See how quickly residencies expanded after the Ben Smith 'shortage of rad onc' paper got published, and the inertia to reverse that after the 'oops lol jk we're going to have an oversupply' publication has been?

If YOUR house was burning down they would want a peer reviewed article published after your house was already ashes.

 

[Mandelin Rain]

No, no, no, completely wrong.

If it affects them and it is advantageous to do so, they will move quickly. See how quickly residencies expanded after the Ben Smith 'shortage of rad onc' paper got published, and the inertia to reverse that after the 'oops lol jk we're going to have an oversupply' publication has been?

If YOUR house was burning down they would want a peer reviewed article published after your house was already ashes.

I read and re-read this post trying to figure it out.

I think what you are saying is; "LET YOUR JOURNAL ARTICLES BE THE KINDLING FROM WHICH YOUR HOUSE BURNS!!!!!!!!" Followed by maniacal laughter.

Correct me if I'm wrong though.

 

[FreeRT]

Posted by Chris Pope MD on RoHUB--

Original Message:
Sent: 03-21-2019 05:57 PM
From: Christopher Hays Pope
Subject: Are we over training the number of Radiation Oncologists?

I have found this a very interesting discussion and would like to provide my perspective on the Issue at hand. Here are my Bullet points.

• I entered my residency in 1994 and was taken aside by the two senior residents at the time and told that I should abandon Radiation Oncology. Their rational was that there was a glut of applicants and good jobs where proving very difficult to find for them. They thought the future of the field was dim and encouraged me to consider changing my specialty. I have been practicing now for over 20 years and I am glad I did not listen to this advice.
• During the time I was in residency the "word" of the downfall of RadOnc apparently hit the medical schools and there was a year where our program at the University of Louisville had a very poor applicant pool and had to cast a broad net just to find any good applicants. It literally went from you must be AOA to have a chance to unfilled slots and a decreased "quality" of applicant. That is if you define quality strictly by academic accomplishments.
• The key factor that changed this was the implementation of the 5th year of training. Most programs did not implement this until it was absolutely required and the effect of that was to have a year when the pipeline of residents dried up. This resulted in lots of good job opportunities for the next several years.
• The field is dynamic and changing. Over my career I have seen a shrinkage in the indications for radiation treatment. For example when I trained it was not uncommon to treat Lymphoma and I was involved in treating Mantles and inverted Y fields all the time. Now that is mostly a thing of the past and many lymphoma patients are treated with chemotherapy alone. I think that over time this pattern will continue. We are going to find better ways to treat cancer that will reduce or eliminate indications for XRT.
• As far as Hypofractionation for breast cases my Institution was an early adopter. I think it is a positive for the patients and it has become the standard for most of our breast patients now. We have been doing this for years as the data is there and it is the right thing to do. However that being said the reality is that I end need to see a lot more patients total per year to keep the daily census up. The demographics of the Baby boom have helped make it possible to maintain my treatment numbers at a level that allows us to continue operations but what will happen when that generation passes from the earth. If/when payments are given by diagnosis and not the number of treatments the Hypofractionation bandwagon will really start rolling and each radiation oncologist will be theoretically able of treating a greater number of patients as the thru-put of your individual center increases with shrinking length of therapy.
• Regarding Brachytherapy. In Kentucky when I trained we had no shortage of GYN and Prostate Brachytherapy. The University of Louisville often had residents come from other programs for a month to get their required number of cases which I believe at the time was 10. You could easily get 10 cases in a month on the GYN service at U of L with Dr Bill Spanos in the mid 1990's. I would not be shocked it I had close to 100 under by belt by the time I graduated. That being said I have never done a single GYN or prostate implant since I graduated. You simply do not need a HDR machine in every practice. This is both because most single site centers do not have the volume to make the thing economically feasible. More significantly if you are going to maintain your competence you need a significant volume of cases per year. In my group we have five sites with 6 liniacs total. We have one HDR machine and one partner who performs the HDR.
  • Perhaps one thing that should be considered is to have highly specialized portions of what we do become fellowship only. Things like Peds, Brachytherapy, Proton, etc could be broken off and if you want to pursue that specialization you would be required to complete a fellowship.
    • Advantages
      • Remove these topics from the general boards and have options to sit for specialty boards and be certified as a sub specialization.
      • Those people who complete a fellowship would be more marketable for academic and non academic positions where their skill set is needed.
      • Create a better level of competency in those people who are inclined to pursue a more esoteric path.
      • Allow a pathway for those who are going to be a private practice "generalist" to excel in that endeavor as well without the crazy hurdles of cramming for board topics you have never seen or managed in your training and will likely never see again.
• In general I think that the forces of the current Market outlined above result in a present and future in witch each Radiation oncologist will be able to provide service more overall patients per year due to Hyperfractionation. In effect the slice of the pie that I can serve via my single liniac center becomes bigger as fractions decrease provided the patients show up at my door. I think the only reason this is currently working is the demographic wave we are currently riding and once that peaks I foresee a lot of low volume centers having to close their doors unless something dramatically changes. In short all of us are going to be able to eat a bigger slice of the ever shrinking pie. This is not a good setting to be producing a oversupply of residents in radiation oncology.

------------------------------
Christopher Hays Pope
CARTI
Little Rock AR
501 (501) 280-0983

 

[scarbrtj]

Posted by Chris Pope MD on RoHUB--

Original Message:
Sent: 03-21-2019 05:57 PM
From: Christopher Hays Pope
Subject: Are we over training the number of Radiation Oncologists?

I have found this a very interesting discussion and would like to provide my perspective on the Issue at hand. Here are my Bullet points.

• I entered my residency in 1994 and was taken aside by the two senior residents at the time and told that I should abandon Radiation Oncology. Their rational was that there was a glut of applicants and good jobs where proving very difficult to find for them. They thought the future of the field was dim and encouraged me to consider changing my specialty. I have been practicing now for over 20 years and I am glad I did not listen to this advice.
• During the time I was in residency the "word" of the downfall of RadOnc apparently hit the medical schools and there was a year where our program at the University of Louisville had a very poor applicant pool and had to cast a broad net just to find any good applicants. It literally went from you must be AOA to have a chance to unfilled slots and a decreased "quality" of applicant. That is if you define quality strictly by academic accomplishments.
• The key factor that changed this was the implementation of the 5th year of training. Most programs did not implement this until it was absolutely required and the effect of that was to have a year when the pipeline of residents dried up. This resulted in lots of good job opportunities for the next several years.
• The field is dynamic and changing. Over my career I have seen a shrinkage in the indications for radiation treatment. For example when I trained it was not uncommon to treat Lymphoma and I was involved in treating Mantles and inverted Y fields all the time. Now that is mostly a thing of the past and many lymphoma patients are treated with chemotherapy alone. I think that over time this pattern will continue. We are going to find better ways to treat cancer that will reduce or eliminate indications for XRT.
• As far as Hypofractionation for breast cases my Institution was an early adopter. I think it is a positive for the patients and it has become the standard for most of our breast patients now. We have been doing this for years as the data is there and it is the right thing to do. However that being said the reality is that I end need to see a lot more patients total per year to keep the daily census up. The demographics of the Baby boom have helped make it possible to maintain my treatment numbers at a level that allows us to continue operations but what will happen when that generation passes from the earth. If/when payments are given by diagnosis and not the number of treatments the Hypofractionation bandwagon will really start rolling and each radiation oncologist will be theoretically able of treating a greater number of patients as the thru-put of your individual center increases with shrinking length of therapy.
• Regarding Brachytherapy. In Kentucky when I trained we had no shortage of GYN and Prostate Brachytherapy. The University of Louisville often had residents come from other programs for a month to get their required number of cases which I believe at the time was 10. You could easily get 10 cases in a month on the GYN service at U of L with Dr Bill Spanos in the mid 1990's. I would not be shocked it I had close to 100 under by belt by the time I graduated. That being said I have never done a single GYN or prostate implant since I graduated. You simply do not need a HDR machine in every practice. This is both because most single site centers do not have the volume to make the thing economically feasible. More significantly if you are going to maintain your competence you need a significant volume of cases per year. In my group we have five sites with 6 liniacs total. We have one HDR machine and one partner who performs the HDR.
  • Perhaps one thing that should be considered is to have highly specialized portions of what we do become fellowship only. Things like Peds, Brachytherapy, Proton, etc could be broken off and if you want to pursue that specialization you would be required to complete a fellowship.
    • Advantages
      • Remove these topics from the general boards and have options to sit for specialty boards and be certified as a sub specialization.
      • Those people who complete a fellowship would be more marketable for academic and non academic positions where their skill set is needed.
      • Create a better level of competency in those people who are inclined to pursue a more esoteric path.
      • Allow a pathway for those who are going to be a private practice "generalist" to excel in that endeavor as well without the crazy hurdles of cramming for board topics you have never seen or managed in your training and will likely never see again.
• In general I think that the forces of the current Market outlined above result in a present and future in witch each Radiation oncologist will be able to provide service more overall patients per year due to Hyperfractionation. In effect the slice of the pie that I can serve via my single liniac center becomes bigger as fractions decrease provided the patients show up at my door. I think the only reason this is currently working is the demographic wave we are currently riding and once that peaks I foresee a lot of low volume centers having to close their doors unless something dramatically changes. In short all of us are going to be able to eat a bigger slice of the ever shrinking pie. This is not a good setting to be producing a oversupply of residents in radiation oncology.

------------------------------
Christopher Hays Pope
CARTI
Little Rock AR
501 (501) 280-0983

Reasonable rad oncs exist? Wild and crazy stuff.

 

[thecarbonionangle]

Reasonable rad oncs exist? Wild and crazy stuff.

let me know where they at when ya find ‘em!