Radonc or not? Having doubts

[ifeelgood47]

Hey folks, want to anonymously ask. I know this specialty isn't popular for most, but lately i've kinda been into it on my rotations. I feel like I can't talk to the trainees/faculty in my home program openly so I just wanted to ask here.
I'm originally from Toronto and would love to go back, and tbh I want a good specialty with decent income expectations and QoL. I've heard from one of the program directors 1/4 of radoncs in Canada are IMGs, so that to me sounds pretty scary.

Are there any staff or senior residents out there who can comment on the latest job situation? I don't want to be fighting against IMGs for spots and would like to be in Toronto long term. Sorry it's my first post I hope it's ok to be open about this.

[b9k]

Not a senior resident nor staff in radiation oncology, but I can share some of my thoughts. 

3 hours ago, ifeelgood47 said:

Are there any staff or senior residents out there who can comment on the latest job situation? I don't want to be fighting against IMGs for spots and would like to be in Toronto long term. Sorry it's my first post I hope it's ok to be open about this.

There are some data that indicate improvements in the employment market for Canadian rad onc trainees. See this recent publication. Anecdotally recent graduates at my training program obtained staff positions, either directly after residency, or after completing a fellowship. 

3 hours ago, ifeelgood47 said:

I'm originally from Toronto and would love to go back, and tbh I want a good specialty with decent income expectations and QoL.

Radiation oncology is a fantastic field for many reasons, for example, the interdisciplinary nature of the specialty or having the privilege to care for oncology patients. However, it may not be the best specialty for income expectations and quality of life. See the CMA Radiation Oncology physician specialty profile for more information.

[anonymouspls]

The CMA specialty profile posted above doesn't have any data for rad onc income. It's reporting average income for all medical specialties, probably because they don't have enough data for rad onc. 

I gunned for radiology for first 3 years of medical school and changed to rad onc in 4th year, matched rad onc this year. So I'm pretty biased but I'll let you know what I've learned from asking around and from mentors. Job market is pretty good. A lot of residents are getting jobs right out of residency now days without fellowships. You can be decently geographically flexible within 2-3 years out of fellowship if you really want a specific location (I say fellowship because if you say really want to be in Toronto, you would probably ask around and see what people are hiring and tailor your fellowship towards that - like doing CNS at sunnybrook because they're hiring etc). Income ranges are pretty broad in Canada but if you're practicing in Ontario, I would say conservatively that 400K and up (and much higher) is not unreasonable to say. There is official data that I read sometime during CARMS which reported the average income in Ontario at right above 500K. I would say rad onc is one of the best 9-5 specialties out there. Lifestyle is excellent compared to other specialties, very chill call load and your day to day is a dream compared to surgeons and other specialties. It's also one of the chiller residencies out there along with Nuc med, path and maybe psychiatry. 

Here is a survey of 31,000 physicians from the US with reported incomes, with their average salaries. You can see rad onc is at #7 at 547K USD, and is the highest non-surgical specialty listed.

https://www.beckershospitalreview.com/compensation-issues/20-highest-lowest-paid-physician-specialties-doximity.html

 

Please message me if you have any other questions. There are some rad onc staff on this website so hopefully they can chime in as well. 

[ChemPetE]

On 4/15/2023 at 2:07 PM, ifeelgood47 said:

Hey folks, want to anonymously ask. I know this specialty isn't popular for most, but lately i've kinda been into it on my rotations. I feel like I can't talk to the trainees/faculty in my home program openly so I just wanted to ask here.
I'm originally from Toronto and would love to go back, and tbh I want a good specialty with decent income expectations and QoL. I've heard from one of the program directors 1/4 of radoncs in Canada are IMGs, so that to me sounds pretty scary.

Are there any staff or senior residents out there who can comment on the latest job situation? I don't want to be fighting against IMGs for spots and would like to be in Toronto long term. Sorry it's my first post I hope it's ok to be open about this.

Expect many jobs. IMGs are probably from the era where there last was a shortage and training was critically ramped up, before the over supply. Our home program pgy-5s have had multiple job offers direct out of residency this year, as opposed to pursuing fellowships. Still ‘busy’ in terms of QoL but I enjoy my job, very little call in group practice, and enjoy weekends. The jobs that are available I think are likely still to be competitive for site/location/etc, but there will be many retirements and opportunites so that you can go direct into practice.

I’ll send you a DM with my email in case you wish to discuss further

[daniorerio]

Just wanted to share my own experience as I considered radonc in med school and invested in it quite a bit, but ultimately decided against it after my experiences and talking to several people in the Toronto program. I'm grateful for the honesty of the senior residents regarding the job situation in Toronto, though I can't speak for other parts of Canada where things might be improving somewhat.

1. Location: Many Toronto residents told me they chose the program to be near family but later regretted it. They mentioned that being in Toronto doesn't guarantee a job there, and pursuing a less demanding residency program while building a strong CV is a better strategy. They also noted that Toronto hires many international fellows and staff from the USA, leading to fierce competition and a prevalence of politics and nepotism.

2. Culture. This was the main deterrent for me. The residents said the Toronto program is the most demanding in Canada, requiring long hours and research commitments. They advised against joining the program, recommending London or other friendlier programs instead. The staff in Toronto can be difficult, treating residents poorly and often favoring those with better connections or nepotism. I can definitely see that from what I experienced. The residents felt they couldn't voice their concerns due to the close-knit nature of the department. One of the residents on the selection committee confidently told me Toronto generally doesn't get their top choices on the CaRMS list, and even went empty once.

3. Money. Academic salaries in Toronto aren't particularly high compared to community jobs. Residents suggested considering community positions for a more relaxed lifestyle, better work hours, and decent pay.

4. Quality of life. I was warned that my quality of life would suffer in the Toronto program, and that I should look elsewhere for a more balanced experience.

5. Job market. The residents were honest about the possibility of having to leave Toronto or even Ontario due to tough competition. They mentioned that Ontario is expected to supply radoncs to other provinces without residency programs, which was a red flag for me. Recent news about Ontario making it easier for USA/UK/Ireland grads to practice there only adds to the concern. It seems the Toronto job market might be struggling, but other locations could be better.

The choice is yours and it certainly looks like there are people here who made it work. But it became clear to me that radonc wasn't the right fit for my goals of staying in Toronto, avoiding research obligations, and maintaining a good quality of life with decent pay. I ultimately chose a different specialty and am very happy with my decision and a good job market and reasonably high salary.

 

 

 

[deeman101]

I know this is a bit old but I'll throw in a couple more cents into the mix. As someone who has recently interviewed for jobs and probably more in touch with the current state of affairs. The salaries are definitely increasing in this specialty. Led by Ontario but even the bottom denominator is seeing big pay increases. There is currently an under-supply which is growing and at least in some provinces that has led to negotiating leverage. Also great as a candidate graduating out. Its going to be a buyer's market for the next 5 years easily. Most residency programs are great.

As for Toronto's residency program and staying in Toronto, there is a mismatch of expectations I've observed. Every Toronto resident I've met says they like research, want to do research, see themselves as academic, etc. and somehow going from the Toronto residency to a "lesser" place is unacceptable. But its very clear most of them just wanted to be close to home and probably more than happy just seeing patients and punching a 9-to-5 card. To those that are super passionate about research its very easy to spot when someone is just saying words vs actually really into research. For the two academic radonc centers, they are really feeling a need to dramatically accelerate their research programs and raise their international profile, so those goals just don't jive with the goals of some of their residents. If you identify as a type A and top 10th percentile for research, leadership and being a game changer for the field then Toronto as a resident or staff is a good fit.  10% of their residents do thrive because this is who they are. Otherwise, its better to pick another Ontario residency program and then take a job in a community center in the GTA. There are plenty available. But also keep in mind Canada is much bigger than Toronto and there are many awesome places. I grew up in Toronto but its been many years since I left and enjoyed living in many other places in Canada.

[anonymouspls]

1 hour ago, deeman101 said:

I know this is a bit old but I'll throw in a couple more cents into the mix. As someone who has recently interviewed for jobs and probably more in touch with the current state of affairs. The salaries are definitely increasing in this specialty. Led by Ontario but even the bottom denominator is seeing big pay increases. There is currently an under-supply which is growing and at least in some provinces that has led to negotiating leverage. Also great as a candidate graduating out. Its going to be a buyer's market for the next 5 years easily. Most residency programs are great.

As for Toronto's residency program and staying in Toronto, there is a mismatch of expectations I've observed. Every Toronto resident I've met says they like research, want to do research, see themselves as academic, etc. and somehow going from the Toronto residency to a "lesser" place is unacceptable. But its very clear most of them just wanted to be close to home and probably more than happy just seeing patients and punching a 9-to-5 card. To those that are super passionate about research its very easy to spot when someone is just saying words vs actually really into research. For the two academic radonc centers, they are really feeling a need to dramatically accelerate their research programs and raise their international profile, so those goals just don't jive with the goals of some of their residents. If you identify as a type A and top 10th percentile for research, leadership and being a game changer for the field then Toronto as a resident or staff is a good fit.  10% of their residents do thrive because this is who they are. Otherwise, its better to pick another Ontario residency program and then take a job in a community center in the GTA. There are plenty available. But also keep in mind Canada is much bigger than Toronto and there are many awesome places. I grew up in Toronto but its been many years since I left and enjoyed living in many other places in Canada.

Hey, as someone who just matched to rad onc, could you speak a little more about what the job hunt has been like? What sort of geographic flexibility are you looking at, and what salary ranges youre seeing? Idk if you mentioned but have you done a fellowship, as I suspect that would change things too! You can pm me if uncomfortable with posting publicly. Highly appreciated!

[rmorelan]

ha a bit off topic as well but the number of academic physicians I know that are actually doing academic research is quite the minority overall - this was something that originally was quite the surprise to me. It is clearly not the primary reasons most people seek out academic practise - the majority of it does seem to be actually driven by location, and then of course the work itself. I suppose this isn't super surprising - if people really were interested in research they would be well researchers and gone down that route rather than clinical medicine. 

[shikimate]

21 minutes ago, rmorelan said:

ha a bit off topic as well but the number of academic physicians I know that are actually doing academic research is quite the minority overall - this was something that originally was quite the surprise to me. It is clearly not the primary reasons most people seek out academic practise - the majority of it does seem to be actually driven by location, and then of course the work itself. I suppose this isn't super surprising - if people really were interested in research they would be well researchers and gone down that route rather than clinical medicine. 

If they pay me 500K a year to do research I'd gladly give up clinical practice for it lol. Want me to do it from 6-9pm and during my fishing days? They can shove that **** up their ***.

[deeman101]

14 hours ago, shikimate said:

If they pay me 500K a year to do research I'd gladly give up clinical practice for it lol. Want me to do it from 6-9pm and during my fishing days? They can shove that **** up their ***.

Haha, then you're right to not focus on research. The days of doing research only during business hours is long gone. Even for radoncs with 80% "protected" research time. Most of my research production happens between 11pm and 3am. My collaborators have their kids go to bed earlier though so it's earlier in the night for them. 

 

15 hours ago, anonymouspls said:

Hey, as someone who just matched to rad onc, could you speak a little more about what the job hunt has been like? What sort of geographic flexibility are you looking at, and what salary ranges youre seeing? Idk if you mentioned but have you done a fellowship, as I suspect that would change things too! You can pm me if uncomfortable with posting publicly. Highly appreciated!

Compensation stuff you'll have to DM me. I'm not going to say more than it's good and getting better publicly. Fellowships are not necessary but some more academic program chairs still would prefer it. Don't do it unless it's what you want personally I'd say. For geographic flexibility, there are many places now in Canada that are hiring. But if you have just one place in mind and have your heart set on it then it can be difficult if the stars don't align. In general, where you will choose to work is a balance of location, lifestyle, and type of practice.

 

 

15 hours ago, rmorelan said:

ha a bit off topic as well but the number of academic physicians I know that are actually doing academic research is quite the minority overall - this was something that originally was quite the surprise to me. It is clearly not the primary reasons most people seek out academic practise - the majority of it does seem to be actually driven by location, and then of course the work itself. I suppose this isn't super surprising - if people really were interested in research they would be well researchers and gone down that route rather than clinical medicine. 

In general it's true, but a bit less so in radonc. Radonc and medonc are both so academic that it selects for similar people. It's just that the level of academia is sometimes mismatched between the candidate and institution. But I'd say even the majority of community centers participate in some type of research willingly and without real incentivization.