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The AB sunshine list definitely does not contain all the rad oncs and med oncs. I don't know why or how, but some of the top paid guys are not listed. Apparently theres a way to ask for exemption.

 

Proton therapy has been heralded as the second coming since the 90s. It hasn't really "come" yet. There are technical advantages to it (that are the wet dreams of any medical physicists), but clinically speaking those advantages are realized in specific settings. And even when the advantages are potentially significant, there has been few studies (maybe cause those studies need a $100+million facility) to show actual clinical benefit. The TRIUMF center is research only. They have treated patients on there experimentally in the past, but they no longer do. Intra-ocular melanoma is now treatable in cheaper and easier methods of radiation. There is a new micro cyclotron/synchrotron technology apparently coming out that should make proton therapy much cheaper and easier to access, but at the same time the precision of current radiation machines are also improving at a rapid rate. So we will see if proton therapy can meet the cost/benefit equation compared to photon radiators to be widely used one day.

 

That 5 year mark has been a carrot on the stick for the last 10 years at least. Everything always looks better "in 5 years". But for the first time since I have been aware of the field (2012) there is actually more jobs being posted and people actually being hired. My thought is this is mostly because community radonc centers are taking off, mostly in southern Ontario. There are still academic centers also hiring, but my feeling is the real relief is coming from the smaller centers. There are still the doomsday people, especially if you talk to radonc staff, but at this point refuting that the job market is not improving in radonc is like refuting climate change. We'll see how it goes with health care over-expenditure measures being negotiated in Ontario and other provinces.

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It's been a long time since this has been updated. Happy to answer questions. Still happy with my residency choice. Love what I do, most places have a great work/life balance, and you get to make a big difference in peoples lives. Lots of opportunities for research and education interests, and since it is a small field, there are lots of opportunities for developing 'in demand' technical competencies during a fellowship. MR Linacs are likely going to be the Proton's of the 90's... would love to be proven wrong. The job market hasn't panned out quite like I was sold on when I started residency, and I do believe there are too many rad onc residents compared to available jobs (particularly in Ontario), but most people end up with a job after 1 year of a fellowship in a location they are happy with.

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10 hours ago, mavrik13 said:

It's been a long time since this has been updated. Happy to answer questions. Still happy with my residency choice. Love what I do, most places have a great work/life balance, and you get to make a big difference in peoples lives. Lots of opportunities for research and education interests, and since it is a small field, there are lots of opportunities for developing 'in demand' technical competencies during a fellowship. MR Linacs are likely going to be the Proton's of the 90's... would love to be proven wrong. The job market hasn't panned out quite like I was sold on when I started residency, and I do believe there are too many rad onc residents compared to available jobs (particularly in Ontario), but most people end up with a job after 1 year of a fellowship in a location they are happy with.

Hi mavrik13, thank you for offering to answer some questions. I am a current M2 with some exposure to rad onc through shadowing and am interested in the field, but I have some questions I hope you can address. 

1. On the Student Doctor Network, there is an alarmingly pessimistic attitude towards rad onc primarily directed towards the job outlook in the US context. As it is on SDN I want to take it with a grain of salt, but the concerns relate to the over training of the number of rad onc residents (and to some extent with profit-driven healthcare and radiation oncologists being the down stream receiver of referrals). Some posts even suggest that they'd need to shut down all residencies for five years for their job market to recover. My questions for this is -> will the Canadian rad onc job market be protected from a potential over supply in the US (e.g., hiring practices of community vs. academic centres and preference for CDN vs USA training)? This is important as the Canadian market still doesn't seem fantastic despite what was sold to you and I wonder if rad onc will go the way of pathology, with IMGs making up an increasing number of the specialty. In addition, how is the job market for those who don't want to work in the major, major centres like Toronto and Vancouver (and maybe even have a preference for community)?

2. As the field of rad onc evolves in the future, I know that is it unlikely for rad onc to become obsolete in my lifetime. With that being said, there seems to be a general push for hypo fractionated treatment regimens, SBRT, SRS, etc. These are fascinating technologies that look really cool to use and learn with the potential for great patient outcomes. A potential side effect I wonder though is there are less on treatment checkups, and potentially less ownership or shared decision making with the patient. If you are not seeing the patient as often, I see it as becoming more difficult to build the relationships that rad onc is known for/make that difference in their life through managing cancer and treatment related side effects. My questions here essentially boils down to, in the future with new technologies how will the rad onc role change, and will it become more technical/"procedural" (or one-off? maybe more similar to interventional radiology)? What will define a rad onc as a physician oncologist vs. a technician who uses radiation? As targeted therapies become more prevalent and have fewer toxicities as compared to chemotherapies that med oncs use, will rad oncs in Canada become more involved in their prescribing?   

3. Earlier in this thread it was mentioned that rad onc evolved out of radiology rather than IM. While IM is a gruelling residency, at my naive point in training, I see IM as containing much potentially useful knowledge and experiences. Do you ever feel your medical knowledge is "lacking" or wish you had more of that general IM training when seeing patients (or if you are in a rad onc residency that sees inpatients?). Will this present problems related to my question 2 in the future and prevent rad oncs from being the MRP. With that being said, obviously rad onc is its own specialty for a reason and needs the time to develop expertise within its own competencies. 

I appreciate your time providing feedback on any of these questions! I'm sure if I'm thinking of these questions, that there are at least a few others also thinking some variation of them!

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On 8/10/2020 at 9:26 AM, CGreens said:

Hi mavrik13, thank you for offering to answer some questions. I am a current M2 with some exposure to rad onc through shadowing and am interested in the field, but I have some questions I hope you can address. 

1. On the Student Doctor Network, there is an alarmingly pessimistic attitude towards rad onc primarily directed towards the job outlook in the US context. As it is on SDN I want to take it with a grain of salt, but the concerns relate to the over training of the number of rad onc residents (and to some extent with profit-driven healthcare and radiation oncologists being the down stream receiver of referrals). Some posts even suggest that they'd need to shut down all residencies for five years for their job market to recover. My questions for this is -> will the Canadian rad onc job market be protected from a potential over supply in the US (e.g., hiring practices of community vs. academic centres and preference for CDN vs USA training)? This is important as the Canadian market still doesn't seem fantastic despite what was sold to you and I wonder if rad onc will go the way of pathology, with IMGs making up an increasing number of the specialty. In addition, how is the job market for those who don't want to work in the major, major centres like Toronto and Vancouver (and maybe even have a preference for community)?

Americans are experiencing what Canada experienced 15 years ago except on a much larger scale. Plan to do a fellowship in Canada (or 2+). Most Canadian centres will preferentially hire Canadians/PRs except some major academic centres where they hire international trained people to be primary researchers. Its tight everywhere. Community centres are smaller so they may not even hire anyone for a span of 5 years once you finish residency depending on their needs. It is very much a crapshoot. Not comparable to pathology, as Canada pathology programs cant attract enough Canadians for their needs, hence IMGs to fill the gaps. 

2. As the field of rad onc evolves in the future, I know that is it unlikely for rad onc to become obsolete in my lifetime. With that being said, there seems to be a general push for hypo fractionated treatment regimens, SBRT, SRS, etc. These are fascinating technologies that look really cool to use and learn with the potential for great patient outcomes. A potential side effect I wonder though is there are less on treatment checkups, and potentially less ownership or shared decision making with the patient. If you are not seeing the patient as often, I see it as becoming more difficult to build the relationships that rad onc is known for/make that difference in their life through managing cancer and treatment related side effects. My questions here essentially boils down to, in the future with new technologies how will the rad onc role change, and will it become more technical/"procedural" (or one-off? maybe more similar to interventional radiology)? What will define a rad onc as a physician oncologist vs. a technician who uses radiation? As targeted therapies become more prevalent and have fewer toxicities as compared to chemotherapies that med oncs use, will rad oncs in Canada become more involved in their prescribing?   

less on review visits isn't going to impact relationships. we still follow them. patients are happier that they happy less visits. I doubt it will become like IR. there are some sites like breast where we aren't really involved to heavily which I am fine with but most we play a central role. If we could pass off followups to surgeons, med oncs tbh most rad oncs would be happier. I doubt rad oncs will Rx targeted/immune  unless forced too. It adds too much patient volume and those patients are sicker. 

3. Earlier in this thread it was mentioned that rad onc evolved out of radiology rather than IM. While IM is a gruelling residency, at my naive point in training, I see IM as containing much potentially useful knowledge and experiences. Do you ever feel your medical knowledge is "lacking" or wish you had more of that general IM training when seeing patients (or if you are in a rad onc residency that sees inpatients?). Will this present problems related to my question 2 in the future and prevent rad oncs from being the MRP. With that being said, obviously rad onc is its own specialty for a reason and needs the time to develop expertise within its own competencies. 

Most rad oncs despise inpatient work (it sucks, doesn't pay well, sick patients, keeps you up at night etc). Some centres Rad Oncs aren't MRP and some are. I don't want to be an MRP for inpatients but at my centres we are. the vast majority of rad onc work is outpatient and when ever you dont do anything a lot your skills decay. I would say that most med oncs aren't all that comfortable/uptodate with their GIM skills after 10-15 years and they do IM training. 

I appreciate your time providing feedback on any of these questions! I'm sure if I'm thinking of these questions, that there are at least a few others also thinking some variation of them!

 

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