Future of Radiation Oncology in Canada

[rice]

I recently went through  the rad onc section of Student Doctor Network, and there's a lot of doom and gloom over there. People there are very worried about the future of this specialty in the USA with regard to their declining job market, income, lifestyle, and respect by other specialties. Apparently there has been a huge oversupply of residents since 2000 and it's made the situation get quite bad. There are a few threads there that specifically tell medical students to not pick this specialty.

As a potential applicant to rad onc in Canada, this makes me a bit nervous...do residents in Canada have the same outlook as in the US? Are there any residents here that manage to get good jobs in the US? Do residents here still recommend that I go into this field if I am interested or should I maybe switch to diagnostic rads?

Any advice on this would be really appreciated.

[ChemPetE]

Taking short break from board prep to attempt to succinctly answer your question with a few points:

 

- separate job markets completely. My personal take is US is filling up, Canada is getting better.

- canadian RO job market has shown continuous slow improvement since I’ve been in med school and during residency

- if i recall correctly, 90% of canadian grads will have full time employment by 2 yrs out of training, but much fewer grads are seeking work in US in the past few years, consistent with more jobs opening up

- there is significant anticipated growth in the canadian market due to demographics, significant retirements due to elderly workforce, and increased indications for RT with oligometastatic dz

- biggest factor affecting employment in canada is in fact is not # graduating but rather utilization rates. It’s expected that the number of RO residents entering will be increased to meet expected future demand in the coming years

- job market is still tightish, and these of course are projections, and residency is a long ways away, and the same thing has been said in the past (oh things will be better when you graduate). That being said, the employment data that exists for Canadian ROs I would say is fairly robust and granular and suitable for some of these models as it is a small specialty relatively speaking, so there *may* be less “assumptions” in these models, but there are still some.

- you can do a quick pubmed search to find canadian rad onc job market survey data that discusses some of this. Alternatively, reach out to your local program director and residents and hear what they have to say

- i had no personal qualms of advising entry to RO for this batch of medical students that approached me. This year, carms did fill RO 100% in first round as opposed to many years prior.

RO and diagnostic rads are entirely different specialties with different lifestyles and practice differences. I would evaluate each of them critically and decide which one is a better fit for you. 

Others please feel free to chime in with your own thoughts and anecdotes and data as you see fit of course, I value others opinions.

[blah1234]

43 minutes ago, ChemPetE said:

Taking short break from board prep to attempt to succinctly answer your question with a few points:

 

- separate job markets completely. My personal take is US is filling up, Canada is getting better.

- canadian RO job market has shown continuous slow improvement since I’ve been in med school and during residency

- if i recall correctly, 90% of canadian grads will have full time employment by 2 yrs out of training, but much fewer grads are seeking work in US in the past few years, consistent with more jobs opening up

- there is significant anticipated growth in the canadian market due to demographics, significant retirements due to elderly workforce, and increased indications for RT with oligometastatic dz

- biggest factor affecting employment in canada is in fact is not # graduating but rather utilization rates. It’s expected that the number of RO residents entering will be increased to meet expected future demand in the coming years

- job market is still tightish, and these of course are projections, and residency is a long ways away, and the same thing has been said in the past (oh things will be better when you graduate). That being said, the employment data that exists for Canadian ROs I would say is fairly robust and granular and suitable for some of these models as it is a small specialty relatively speaking, so there *may* be less “assumptions” in these models, but there are still some.

- you can do a quick pubmed search to find canadian rad onc job market survey data that discusses some of this. Alternatively, reach out to your local program director and residents and hear what they have to say

- i had no personal qualms of advising entry to RO for this batch of medical students that approached me. This year, carms did fill RO 100% in first round as opposed to many years prior.

RO and diagnostic rads are entirely different specialties with different lifestyles and practice differences. I would evaluate each of them critically and decide which one is a better fit for you. 

Others please feel free to chime in with your own thoughts and anecdotes and data as you see fit of course, I value others opinions.

Interesting to hear that things have gotten better over time. I still remember the warnings and horror stories I heard during medical school.

Are US Rad Oncs able to easily get licensure in Canada? Do you foresee any bleed over effect as their market worsens?

Will healthcare funding allow or keep pace with Rad Onc jobs? I ask because I can only think about an analogue with surgical resource limitations. Huge demand for joint replacements and we easily produce enough Orthos to help service that demand but the bottleneck is limited OR time and limited provincial funding. 

[ChemPetE]

 

Re: US: who knows on the bleed over effect. That’s an unknown for sure. I think red tape is minimal/achievable to motivated parties, but less likely to see from lack of interest. If anything, more likely to see return of expats than US nationals here. However, people there for longer periods of time are less likely to feel effects of the shrinking US market, and are probably less apt to leave. So my personal thoughts are it will be a minimum effect more than anything, but it’s anybody’s guess

Re: Funding: Probably there will be a lag for funding following need of services, but in general the public getes uppity in general if waiting times for cancer consults get big. Heathcare economics of oncology are complex, but despite the capital and operating costs of radiation services, drug therapy is expected to be the huge cash sink. Again, US data but you get a sense of perspective here: https://forums.studentdoctor.net/threads/perspective-in-oncology.1366940/ . Immunotherapy costs the gov’t $$$, and indications for that is exploding. More likely we’ll see a resistance to pay for latest and greatest targeted/immunotherapies without OS benefits in robust phase III trials, with the standard for formulary approval increased. But again, who knows. Certainly oncology costs (and by extension, drug costs) for provincial gov’ts are set to continually increase as a result of new indications, better understanding of immunotreatments, maturation of ongoing trials, and increased incidence and prevalence. SBRT is cheap in comparison. This is much a bigger picture of the healthcare system question than RO specific, I think.

[rice]

Amazing, thank you for taking the time to write this in depth response. I just needed some reassurance. I think I would enjoy diagnostic rads too but would really miss the direct patient contact. Glad to know that the job market should be brighter by the time I’m coming out of fellowship.

[ChemPetE]

Should be. Of note, this year Canada filled all of its RO spots. US had 26 left this time before SOAP, first time in millenia. Yup, US is going to be in for a rough ride. Not every US RO is on board with that interpretation, but I think they’re going to go through what Canada went through with its oversupply.

[thestar10]

On 3/8/2019 at 4:08 PM, blah1234 said:

Interesting to hear that things have gotten better over time. I still remember the warnings and horror stories I heard during medical school.
Are US Rad Oncs able to easily get licensure in Canada? Do you foresee any bleed over effect as their market worsens?

There is one center that preferentially hires internationally trained people but for the most part there is little crossover. 

Will healthcare funding allow or keep pace with Rad Onc jobs? I ask because I can only think about an analogue with surgical resource limitations. Huge demand for joint replacements and we easily produce enough Orthos to help service that demand but the bottleneck is limited OR time and limited provincial funding.   

It wont kill people to wait for joint replacements (directly at least). We are at the governments mercy for our number of spots but they would not be able to let it get as bad as ortho. That being said, unlike ortho you can pile the existing workload onto existing rad oncs.

9

 

[thestar10]

That being said, I think radiation oncology is a great career. The one thing is you have to be okay settling down permanently in other areas away from family and friends. Think long and hard about that.

[blah1234]

On 3/11/2019 at 11:18 PM, thestar10 said:

That being said, I think radiation oncology is a great career. The one thing is you have to be okay settling down permanently in other areas away from family and friends. Think long and hard about that.

Are openings primarily in small communities these days? Or do you mean that it's the lottery of "whatever city is hiring that year"? 

[thestar10]

56 minutes ago, blah1234 said:

Are openings primarily in small communities these days? Or do you mean that it's the lottery of "whatever city is hiring that year"? 

The latter.  A job in your ideal city may not have an opening for 5+ years sometimes.

[blah1234]

1 hour ago, thestar10 said:

The latter.  A job in your ideal city may not have an opening for 5+ years sometimes.

The biggest con in my opinion. My subspecialist friends complain mostly about the lack of friends and family if they have a poor job market. I think priorities change so much over the course of training that it is not enough just to love the job itself in my opinion

[rmorelan]

1 hour ago, blah1234 said:

The biggest con in my opinion. My subspecialist friends complain mostly about the lack of friends and family if they have a poor job market. I think priorities change so much over the course of training that it is not enough just to love the job itself in my opinion

this is a problem - I wouldn't say so much as its a con but rather something that just talked about enough. All the information is out there, and has been for a long time but most sources of information for premeds don't really discuss it. 

In a 3 hours how to get into medical school I usually spend about 45 minutes just talking about pros and cons - more the cons actually as the pros most people already kind of know. People wonder why but it is important I think to go into this eyes open. You are not going to be able to quite often say exactly where you will work, or even if you will work in a "big city", and you may have to fight for a bit to get where you want to go even if you do eventually end up there.