UNLESS YOU CAN MATCH INTO A TOP 3 PROGRAM.



I will share my experience of job finding so that prospective applicants and medical students have a clear understanding of “job opportunities” in radiation oncology when you graduate from a mediocre/nobody program. I graduated from a small program with no name recognition. It was essentially a private practice group with a university name backing it up, that had somehow tricked the ACGME into giving them a program. They had little to no connection to potential work places, and on top of that, showed no interest in helping you find a job (which actually is more common across the nation than you may suspect despite their warm smiles during residency interview days. They got what they wanted of you- what happens afterwards is of no concern to them). In a 4 year period of graduating residents, not one person got a job in a reasonable metropolitan area. In fact, one of the people graduating after me couldn’t even find a job in a largely homogenous, unexciting, culturally devoid area of American society, which is even sadder because you would think it shouldn’t be so hard to find a job there. She didn’t even get interviews in the area and she wasn’t dumb or awkward, and she was chief! She had to go to another unexciting area, one farther away from her family. Two others quit their first jobs suddenly because it was so bad.



I applied to over 50 jobs in every part of the country. I got 3 interviews. I interviewed in one place in a remote town on the east coast. The town was very small but the landscape was beautiful, so I figured I could live with a small town as long as I could walk among the beautiful landscape. I did not get that job.



My second interview was in a larger metropolitan area in the Midwest (not Chicago), but the group was kind enough to make it clear that my work hours would be 6:30-7 am (tumor boards) to 7pm-8 pm, with multiple inpatient consults per week, and covering multiple facilities, and a starting salary of 220k. I don’t actually care about only 220k but I went into radiation oncology because I do care about my personal life. Most importantly, I know that I get tired after 8-9 hrs of work, and 12 hrs would lead to burnout fast. While the city was larger, it was definitely not my ideal location. I could not imagine being a pleasant doctor to my patients feeling burnt out so early on in my career. While it may be easy for some to poo poo those of us who care about our schedule, I would assume that the majority of radiation oncology applicants apply to rad onc because of both the actual job and the promised work schedule. There were multiple other specialties I would have liked but this one won out because I liked the combination of content and lifestyle (including potentially living in AWESOME locations!)



I was offered an interview at a place (4 hrs from Minneapolis, 3 hrs from an airport) where the recruiter on the phone literally told me that my salary was guaranteed for 2 years, after which I would have to come up with a “creative” solution to supporting my salary. Was I going to sell cupcakes?



The last place (and current job) I interviewed at, I ONLY got the interview because of a connection (not through residency). The recruiter told me he got hundreds of applications (many from new grads) and the only reason he interviewed me was because he recognized the name of the person/connection. I actually love my job and co-workers. What I don’t love, and can be extremely depressing is the location. It has one of the highest rates of poverty and violence for a town of its size (it’s not big). The strip malls are becoming empty and closing down. There are many small depressing gambling places with slot machines and strip bars with neon signs with red legs that criss cross (they’re not even a sleek strip bars). There are parks where people flash you (yes, they pull their pants down) as you are taking a stroll, enjoying the flowers, and you hear conversations in the distance consisting of “Don’t do it, don’t do it” and the response “But I don’t want to live anymore.” It’s not funny. It’s sad. The school system is atrocious. The same bank got robbed 3 times in 6 months by a guy on foot (no getaway car) and a knife (no gun). Property taxes are high because the town has no economy. Buying property is a sure way to lose money and good luck trying to sell it a few years later. The closest reasonable city is 90-120 min away. The only reason people live here is because they are too poor to move. It is one of those towns that the New Yorker does a story on because of how depressed it is- the anguish of non-urban middle of nowhere America.



While I actually like my job, if I die in 5-10 years and I have spent every day of the last 5-10 years of my life in this town, I may on my death bed wonder why didn’t I die before radiation oncology residency, or even before medical school? I gave up so much of my life trying to build a dream that is not remotely attainable, and it wasn’t something absurd like “I want to be a rock star, or actor and live in a penthouse in Tokyo.” Medicine is supposed to be dependable and open up opportunities not limit your life drastically. That is why we make such a huge sacrifice with regards to our time and money. I not only wanted one job opportunity in a great location with good hours but RATHER (gasp! Oh my!) I wanted multiple options from which I could choose. That is every intelligent hardworking person’s expectation. That is why we work hard. That after years and years of studying and accumulating debt you have multiple opportunities, not worsening limitations. I got an MD and went into radiation oncology. I did not get a PhD in medieval art history.



Even if you don’t live in an impoverished area, you probably will end up in a mediocre area at best where the most exciting store is a Barnes and Noble. The majority of 21 year olds who take on medical school debt, and the majority of 25 years graduating with 120K (probably more like 200k) of debt never say, "I want to live in a place where Barnes and Noble is the hot spot in town." The once a month coupon I get for a free latte for being a B&N member doesn’t cut it for me. That was not my dream. It is still not my dream. I still look out for jobs in reasonable locations (like suburbs of a large metropolis, I would accept a 220k salary, but I can’t work 12-13 hr days).



You know what I dream of? I dream of living in a community where people read and have intellectual discussions and are cultivated and interested in things beyond sports and hunting. I dream of school systems that produce educated children. I dream of neighborhoods that are actually lovely. I dream of parks where I won’t be flashed. I dream of a town where the best restaurant is not Paneras and the most interesting store is not Micheals. I dream of banks that get robbed by men (or women) with guns and getaway cars. I truly with all of my heart when I applied to residency did not think this was a wild dream- apparently it is a wild farfetched dream.



Those of you who are guaranteed entry into MSK, MD Anderson and Harvard- by all means, apply! Because you probably will get your (esp non-academic) dream job. You can get a job in Hawaii, in California, in New York City, in Boston, in the DC area and in Sedona. These programs do have amazing opportunities. BUT MOST OF YOU ARE NOT GOING TO GO THERE FOR RESIDENCY. For the rest of you, especially ones who are going to match in middle of the road to unheard of programs (the vast majority despite the empty promises at interview time), you will not capture the life you have imagined.



I remember when I was an intern and like a dumba**, thought to myself, I am so much better than these people going into internal medicine. Those people live in San Francisco, New York, and the DC area with good schedules and decent salaries (not 500k, but above 200). They have awesome personal lives! They are laughing at me. Actually, they are not thinking of me because they have better things to do, such as take part in the liveliness of their communities. I could never find a job that pays over 200k with a decent schedule in those areas- absolutely NEVER. Can Harvard grads? Yes. But not me nor my kind.



I actually considered aerospace medicine but I didn’t apply (not sure I would’ve gotten in) because the job opportunities were limited to maybe 3 cities. I couldn’t commit to that. I feel like I ended up with worse.



The friends I know, none of whom went to top 3 programs, all have mediocre jobs at best- by no means a dream job. Either the location is terrible or the work load is insane, often coupled with an internist salary (like 250k max).



I don’t understand the legal details of why we are in this situation. The reasons why it’s happening is not at ALL remotely important to those of you who are applying to rad onc residency right now. What is important is that this is the reality, and that it is extremely unlikely to change soon as no one is working on a solution. And you deserve to know (as I severely wish I had known) before you throw away the rest of your life.



This is my day: I wake up, I go to work, arriving at 7:45 to 8 am, and I leave around 5 pm. I read, watch tv, and/or do some “hobby” to pass the time. I have no friends outside of work. There are no restaurants that are exciting. There are no cultural events. There is zero reason to leave my apartment other than to put gas in my car or go to the grocery store. The closest Whole Foods and Trader Joes are more than an hour away. Sometimes I play the lottery to throw excitement into my life. I don’t win. My most interesting thoughts this winter have been 1.) in response to seeing rabbit tracks in the snow, “Oh my. A bunny has passed this way.” And 2.) in response to the light pattern cast by the sun through the cheap plastic blinds on my beige apartment wall, “Well, isn’t the morning light lovely today.” These thoughts are only truly exciting if you are Beatrix Potter or a 17th century Dutch master painter who specializes in light and shadow.



My bank account is growing and growing but it does not make me happy because I have nothing to spend it on. Seriously, the money is not even exciting because I have nothing to spend it on. Married physicians leave town within 2-3 years because the spouses get depressed or the children need to actually go to decent schools.



My only goal (because doubtful in 7 – 10 years, I’m going to find a good job because contrary to popular belief the market will not fix itself) is to save aggressively and “retire” in 10 years (and live frugally), and say good bye to radiation oncology (not even because I hate it- I don’t hate the job itself, but because I simply can’t find a job in a good enough location, and money is not the end all of my life). Do I want to retire early? No, I wanted to have a long fulfilling career which includes a cultivated personal life. I can’t get that, and so therefore, I’m just going to “transition” out. I will be the unemployed physician, the physician no longer using their MD.



No matter how kind and wonderful of a human being you are, no matter how much you love radiation oncology (and it is interesting but so are other specialties, and so are other non-medical fields), it is extremely difficult to live in a depressing town. That is why depressing towns have lower life expectancies- it takes its toll on you.



My other option is to do locums- but that’s not a great way to start your career and obviously not stable. Perhaps I could do a “fellowship?” Absolutely not. Fellowships are jokes and in my opinion delays your growth as a physician because you just continue to be the baby doctor. And I’m not even sure it would have helped.



Please be wise. Looking back on it, after not having matched in a top program, I wish I had dropped out of radiation oncology all together and done some other field with much better living opportunities. Just rank the programs whose alumni do have amazing jobs. Don’t be fooled by promises at interviews from smaller institutions. If they tell you people have great jobs, they are lying to you. Alumni who graduated even 4 years ago don’t count. Be wise, prudent and suspicious; be wary that some people say they are part of a larger system in a big city but in reality work in the middle of nowhere at a satellite facility, making half of what the main institution makes. Only accepting residency in a top tier program is sort of like the people who apply to law school, but will ONLY go to law school if it’s a top 5-10 program esp when the economy was bad- those people were brilliant. They didn’t want to graduate from a medicore law school and end up in the middle of nowhere just so they could have a job and pay off their debt and catch up on retirement saving. Our problem is not even related to the S&P 500 index.



The moral obligation falls on the residency programs. I don’t know the details of anti-trust laws but do know Congress often grants lobbyists from various industries exemptions. Are the people who benefit from residency expansions going to spend time lobbying Congress to stop it? Of course not. Not to mention it is usual that a group of supposedly intelligent human beings are approaching a problem in such an uninspiring manner- basically saying there is no solution. There is alway a solution- you just have to work on it. Even if it is basically impossible to fix this situation, the exact reasons why we can’t fix the problem are not at all important for the prospective applicant. The only thing that is important is that a deplorable job market is the reality, and going into radiation oncology limits your life opportunities, rather than expanding it. It is sad and hard to say this but it is true. Radiation oncology for me has been more of a prison rather than an expansion of my life.



The problem is that people want you to be grateful for an opportunity that you never wanted. We are all intelligent- we never had to go into this field, but they want us to be relieved just to get a job, no matter where it is. We are not unskilled laborers- our prospects should not be poor. As intelligent human beings with aspirations, we SHOULD expect jobs in nice areas as we DO deserve it. If that is not available, then the FUTURE applicants should clearly know this. We should not present them with false hope. That’s immoral.



I wanted to live in a real metropolitan area- that was a basic need for me. The FUTURE should look for other opportunities when they don’t match somewhere that will provide them with hopeful opportunities, and the very basics for their life goals.



Seriously, PROSPECTIVE APPLICANTS, if you don’t match into a top program, don’t bother doing it. It is NOT worth it. There are ways to have back-up specialties. Someone from my med school applied to both plastic surgery and family medicine- she was a great applicant- nobody had an issue with it. Another applied to both orthopedics and derm- no one had an issue with him either. It is POSSIBLE and REASONABLE and INTELLIGENT to have multiple interests and end up with the residency program that gives you the BEST opportunity to live the life you want, including your personal life. That is how I would have done it on retrospect. Or just apply to rad onc and if you don’t match to an awesome program, re-apply to a different specialty the next year.



I'm not just disgruntled. I’m massively disappointed in myself that I did not have a better understanding of what I accepted several years ago. I feel tricked, but mostly I feel stupid. How could I have been so foolish? I was an adult yet so blind to my future. I feel ashamed for not being able to project myself far enough into the future to understand how little control I would have over my occupation (including the where) and how much it would affect my daily life. I’m ashamed that I allowed my debt to accumulate and my retirement goals to be ignored for this career that is essentially a prison, that now I have no choice but to stay in this job for another 10 years just to catch up on repaying debt and saving for retirement. I can’t just walk away now because I have no other skills. Dr. Zeitman has hope for the future because he does not have to feel the pain of the present, nor do his residents. I wish the best for Dr. Zeitman but far more importantly, I wish the best for our current young future, who should not make the same mistake I made or many others of us have made. We should not lie to them about their future. Going to a top 3 institution may still get you an amazing job in an ideal location (esp non-academic); going to a nobody institution gets you misery.



I know that a lot of people convince themselves by trite sayings, “but still we are aren’t in internal medicine, “ “hey, there’s still nothing else better out there,” but, yes, there are better things out there and they do provide a better tomorrow. Many people just do not want to admit to themselves that they made a mistake. It is extremely hard to tell yourself you made a mistake by choosing this field. It makes you feel like your entire essence is a failure, that all your hard work and rationality was a mistake and a failure, but I did make a mistake and I want you, the future applicant to know this. For those of who us who did not go to Harvard/MSK/MDAnderson, we don’t want to call ourselves stupid and makes ourselves feel bad compared to them, so we pep talk ourselves in all sorts of ways so that we can keep on with our lives…whatever, future applicant, don’t make the same mistake we did.



I may love radiation oncology, I may enjoy my actual job, but every time I drive home and pass the neon criss-crossing legs, I do recognize I made a massive mistake and it will affect the remainder of my future. If you all are okay with living 2 hrs outside of Saint Louis, 90 min outside of Kansas City, 2hrs outside of Cincinatti, 2 hours outside of Indianopolis, somewhere in Nebraska or Abilene, TX, by all means become a radiation oncologist! (And I’m not EVEN sure I saw jobs in these locations). Otherwise, do not be lured by the money. It’s not worth it.



Best wishes to all of you. With all of my heart, I hope everyone ends up with a well rounded wonderful life. May your local bank robberies not be successful with just a knife and shoes. (By the way, there are plenty of guns here, but not everyone can afford them).



I will now return to convincing myself that bunny tracks in the snow are mind blowing.