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I matched to Rad Onc this cycle! Many programs shared their alumni lists with us while interviewing, and most recent graduates were able to find employment (staff or locum) after 1 fellowship. There were also outliers who found employment straight away or who did 2 fellowships. Overall, it looks like things are slowly improving!

I think it was less popular this year, at least partially, because people didn’t get enough exposure through visiting electives. Anecdotally I can think of a few people in my class who were considering it but weren't able to secure a home school elective. It's also a smaller specialty, so small fluctuations (ie 5 less people applying) could have a big impact on the match. 

Overall, It’s a very rewarding specialty and such a hidden gem in medicine that not a lot of people get exposure to or know about. If you enjoy:

- emotionally satisfying patient encounters and relationships from treating cancer or relieving painful end of life symptoms (including long-term continuity of care in the form of post-treatment surveillance)

- cutting edge technology - probably the most advanced technology used in modern medicine (See this, this, or this)

- procedural work (radiation treatment planning, brachytherapy)

- creativity and creating personalized treatment plans based on anatomy and clinical/patient factors

- Multi-disciplinary, teamwork-based so you get to make lots of friends from other specialities and allied health professions

- Lots of exciting advances to look forward to in the future such as cardiac radiosurgery, treating oligo-metastatic disease with SABR, FLASH, and radio-pharmaceuticals 

I can go on all day but I honestly think when it comes to the day-to-day work of rad onc, no other specialty comes close to how sweet this career is! The downsides are the geographic limitations - it's a resource-heavy specialty so you need to be at a hospital/cancer centre (can't just set up in a plaza somewhere and practice RO). 

I think it's an amazing option if you're looking to match in the 2nd round- both Ottawa and Queen's were pretty high up on my rank list actually. Hit me up if you have any questions :)

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Rad onc jr staff here. Lot of misinformation out there about rad onc, and a lot of what hits the usual medical students I would qualify as outdated or misunderstood.

Some data: http://www.caro-acro.ca/wp-content/uploads/2020/07/CARO-Human-Resources-Report-2019.pdf

COVID was the curveball, where we saw a lot of places put hiring freezes on. But that has long since ended for most places. 

When I was a sr med student, there was what, like 3 postings nationally on the job board for the year? Now, I think BC has hired something like almost a dozen ROs in the past year, and that is one province alone. It is quickly turning about, I think primarily due to shift in demographics with *some* retirements, but we have not yet hit the big retirement wave, so to speak. Back in 2019 probably 2 years for most people to have secured full time employment in canada (with maybe just over half by one year of fellowship). This year I have been keeping less track of as I know less of the class, but I suspect that most if not all have jobs already lined up for July after their one year fellowhip, and I would anticipate this trend to continue.

You can't compare US and Canadian markets - they are vastly different. At present US is still better than Canada for finding work right out of residency, but their ability to continually absorb 200+ residents a year is almost nil now, and I expect underemployment for them to accumulate quite quickly in the next handful of years. The US is vastly over training, where as Canadian residency spots have been cut for the past 10 years where it's now starting to show the difference. In addition, there are a lot of regulatory and practice pattern changes in the US that do not apply up North, which grossly cuts the amount of practicing rad oncs needed in the US. Things like supervision requirements now do not require a rad onc MD in the US to supervise radiation treatments, so that a NP could supervise a linac (important for smaller towns if the doc wants to go on vacation, would previously require a locum, no longer does, and allows for cross-coverage of sites, so rad oncs can be more 'efficient'). Reimbursement changes are happening quickly in the US, where previously would be heavily FFS and fee per treatment, are now transitioning to bundled payments (eg per diagnosis), so you see a lot of 30+ treatment regimes transitioning to 5 fraction hypofractionated courses, which require fewer rad oncs in the US. In Canada we have more practical use of hypofractionation in part due to resource constraints, and this really doesn't apply and/or impact to such a dramatic degree as the US. I would readily counsel anyone to think about practicing US rad onc to run away and never look back - I think their job market is scorched for at least 15 years and they will see a huge exodus from practice there, especially where their specialty leadership is only now starting to 'look' at the problem, and not make any practical or rectifying changes yet. This is in stark comparison to Canada, where there has been more proper stewardship of the specialty, and I think still would allow for a well compensated, rewarding and fulfilling career. There are some trade offs of course, as with anything in medicine, but I am in my dream position and wouldn't change it for anything (please do read this last sentence and import a huge amount of survivorship bias and make your own conclusions from multi-sourced data). I continue to counsel incoming medical students and junior residents that I expect their employment opportunities to continue to improve over the coming years, and if medical students are interested, to pursue the specialty, as it really is a unique gem.

With regards to open positions - it really is a weird thing. It's every other year it seems there are open spots. Historically there are similar positions/medical students as internal medicine, and I used that as a comparison. It may not have held up this year. But as Sauna said, with low numbers, with small individual choice fluctuations can make a large impact for if it fully fills or if there are a few open spots. I know from our program we had about half the applications we typically have, and that number has held constant more or less since I applied myself. Most were from out of province, and we weren't sure if we were going to match (although we did - very excited for our incoming cohort, they sound like they will be a tremendous). My personal opinion is to chalk this up to COVID and elective time/exposure more than anything. 

I fully expect the Ottawa and Queens spot to fill in second round, and with talented candidates.



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On 4/22/2021 at 6:55 PM, MasterDoc said:

no jobs

Rad Onc PGY5. Gonna disagree with you. Jobs situation is way better than previous. Average is still 1 year fellowship but most have a job out of residency or after 1 year. Ottawa is a good program and suprised it went unmatched over others . I think having everything virtual hurt the smaller specialties as impossible to get a feel for the program without visiting.

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1 hour ago, thestar10 said:

Rad Onc PGY5. Gonna disagree with you. Jobs situation is way better than previous. Average is still 1 year fellowship but most have a job out of residency or after 1 year. Ottawa is a good program and suprised it went unmatched over others . I think having everything virtual hurt the smaller specialties as impossible to get a feel for the program without visiting.

You gotta update your signature then :P 

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