The market for radiation oncologists

 Dr. Wes Talcott at Yale points me to some contemporary discussion of the labor force in radiation oncology.  As with a number of other medical specialties, there's a tension between the number of staff needed to prep a patient for treatment and the number of new board certified specialists needed to supervise such treatment. Residents fill the first kind of position, and time and training transforms them into the second.

The contemporary discussion seems to focus on proposals that individual residency programs should reduce the number of residency positions they need to fill, in a decentralized manner, either by offering fewer positions in the Match, or declining to fill positions that aren't filled in the main Match. There is a concern that a coordinated reduction in positions would invite antitrust scrutiny, although other specialties (such as gastroenterology*) have managed that.

Here's an article from the International Journal of Radiation Oncology*Biology*Physics:

Chicken Little or Goose-is-Cooked? The State of the US Radiation Oncology Workforce: Workforce Concerns in US Radiation Oncology by Chirag Shah, MD and Trevor J. Royce, MD, MS, MPH, Published:March 11, 2021 DOI: https://doi.org/10.1016/j.ijrobp.2020.11.056  

"oversupply worries have reached a fever pitch among trainees, with the job market being the primary concern and 52% perceiving an increasingly competitive market10; these concerns have manifested in a precipitous decline in student interest, with 14% of RO residency positions unmatched in the 2020 Match (compared with previous rates of near 0%) and worse numbers expected for the 2021 match."

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Here's a reply, suggesting that the current situation presents an opportunity for the RO profession to remake itself in various ways:

When in a Hole, Stop Digging: In Reply, Workforce Concerns in US Radiation Oncology  Louis Potters, MD, FASTRO, FACR,  Published:March 11, 2021, International Journal of Radiation Oncology*Biology*Physics, DOI: https://doi.org/10.1016/j.ijrobp.2020.12.024

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A different kind of reply is that fewer U.S. medical graduates are applying for RO residency positions in the Match:

No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties  by Chelain R.GoodmanM.D., Ph.D.aAustinSimM.D., J.D.hElizabeth B.JeansM.Ed, M.D.dJustin D.AndersonM.D.bSarahDooleyM.D.cAnkitAgarwalM.D., M.B.A.gKarenTyeM.D., M.S.eAshleyAlbertM.D.fErin F.GillespieM.D.iRahul D.TendulkarM.D.kClifton D.FullerM.D., Ph.D.aBrian D.KavanaghM.D.jShauna R.CampbellD.O. Available online 11 March 2021,In Press, Journal Pre-proof International Journal of Radiation Oncology*Biology*Physics https://doi.org/10.1016/j.ijrobp.2021.03.006

"In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from 2010-2019 (Median [Interquartile Range],187 [170-192], p<0.001). Across all specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010-2019 in both the number of ERAS applicants from the US and Canada (-31%) as well as the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 65% (n=122) were filled by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, a significant decrease from 2010-2019 (Median=92% [IQR, 88-94%], p=0.002). The percentage of radiation oncology programs and positions unfilled prior to the SOAP was significantly increased in 2020 compared to 2010-2019 (Programs: 29% versus 8% [5-8%], p<0.001; Positions: 19% versus 4% [2-4%], p<0.001). Despite >99% (n=127 of 128) of US senior applicants successfully matching in the 2020 NRMP, 16 of 24 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top utilizer of the 2020 SOAP, filling 15% of total positions versus a median of 0.9% [0.3-2.3%] across all specialties (p<0.001).

Conclusions

Supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole."

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*The reduction in gastroenterology residency positions was combined with an increase of a year in required training, and this combination contributed to the unraveling of the gastro Match, which has since been restored. See the background discussion in

McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.

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Update: here's a discussion of the RadOnc situation by the Rad Onc Virtual Visiting Professor Network

Interviews in the Medical Physics residency match (too many, and what to do about it..)

Medical physics has a residency match, and like other residency matches it is suffering from (apparently) too many interviews.

Here's a signed editorial in the Journal of Applied Clinical Medical Physics (one correlate of it being an editorial rather than a paper is this:
"Received: 4 September 2019 | Accepted: 5 September 2019")

Some considerations in optimizing the Medical Physics Match
by Richard V. Butler1, John H. Huston1, George Starkschall2
1Department of Economics, Trinity University, San Antonio, TX,
2Department of Radiation Physics, The University of Texas MDAnderson Cancer Center, Houston, TX

"In 2018, 79% of graduates of CAMPEP‐accredited graduate programs were accepted into residency programs.4 Consequently, to ensure a match, candidates interview at many programs. There is also a harmful feedback mechanism here. As applicants apply to more programs, the acceptance rate at each program declines. Consequently, applicants may apply to even more programs to increase their perceived probability of acceptance into a program. This is costly for the candidates in terms of travel expenses, and costly for the interviewing faculty in terms of time away from research, clinic, and teaching.
...
"Because the problem of optimal applications is an economics problem, there has been a search for solutions and a developing literature on the subject. Balter et al.5 show that limiting the number of applications candidates can submit is superior to limiting the number of applications a program can evaluate. Entering an application limit into the Gale/Shapley algorithm that underlies the matching process, the authors conclude that "the optimal limit in the number of applications balances the tradeoff between being unmatched and gaining a better match in the aggregate, and the benefit can be considerable if the graduates'preferences over the positions are not very correlated.
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"Another approach to a solution is "signaling." A program would be permitted to notify a small number (somewhere between three and five) of applicants prior to interviews that it is seriously interested in them. This gives the applicant useful information about his/her chances at that particular program and so makes the benefit function a bit less fuzzy. Because the problem in medical physics seems to be more at the interview stage than the initial application stage, some form of signaling by institutions offering residencies might help reduce uncertainty so that at least some applicants could focus on the places where they have good chance and pass on visits to some of their more marginal options."
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Here are earlier posts on the medical physics residency match.

Why aren't clearinghouses used in college admissions?

I recently had an email from  Professor Deepak Hegde, at NYU's Stern School who asked me a question that led to the following exchange (edited for brevity and reproduced with his permission):

"Why are admission decisions in a broader set of settings (e.g., Phd applicants-programs, MBA applicants-to-business schools and so on)  not cleared through matching programs as is done with medical schools and residency applicants (or in some cases public schools matching)?   Are there a general set of conditions that one could develop to understand the contexts in which the matching algorithm that have helped advance could be implemented effectively?"

I replied as follows:

"I certainly don’t have a complete answer, but one obvious piece is that setting up a centralized clearinghouse for a whole market involves getting a lot of parties to coordinate and cooperate.  So I would guess that MBA admissions have a better chance of getting organized than, say Ph.D. admissions, since MBA programs are more alike one another than are Ph.D. programs (e.g. in Physics and Philosophy, or Chemistry and Chinese).

"And since wide scale cooperation is hard, I think it mostly happens in market in which people are very dis-satisfied with the existing system, and not just somewhat irritated.

"Is it your sense that MBA admissions is in a crisis of some sort?"

His reply: "In my assessment ... MBA admissions is not facing such a crisis, yet."

So...I think the MBA Match isn't something we'll hear about in the near future.

The Medical Physics Residency Match

Ethical violations and discriminatory behavior in the MedPhys Match

Kristi R. G. Hendrickson, Titania Juang, Anna Rodrigues, Jay W. Burmeister

Journal of Applied Clinical Medical Physics

First published: 20 August 2017 DOI: 10.1002/acm2.12135   

"Thirteen percent of 2015 respondents and 20% of 2016 respondents were asked by at least one program how highly they planned to rank them or which program they would rank first. Thirty-seven percent of 2015 and 40% of 2016 program directors indicated that candidates communicated to the program their rank intent, with 22.0% in 2015 and 12.5% in 2016 being told that their program would be ranked first. Twenty-three percent of 2015 respondents indicated being asked by at least one program during the interview about children or plans to have children; including 19% of males and 33% of females. In 2016, these values were 28% overall, 22% male, and 36% female. Fifty-seven percent of 2015 respondents who were asked this question indicated being uncomfortable or very uncomfortable answering, including 27.3% of males and 88.9% of females. In 2016, 42.9% of all respondents indicated being uncomfortable or very uncomfortable answering, including 10.0% of males and 80.0% of females.

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See also the editorial in the same journal: The Dark Side of the MedPhys Match
by John A. Antolak PhD, Timothy D. Solberg PhD

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Here are earlier posts on the medphysics fellowship match, and radiation oncology.

It's costly to interview for residency programs

Here's a debate about how to reduce the time and money cost of interviewing faced by many applicants for medical residencies and fellowships.

Medical physics has a fairly recent match, here's a debate in the Journal of Applied Clinical Medical Physics that focuses primarily on replacing on-site interviews with either electronic interviews (skype or equivalent), or with interviews at a conference, i.e. all in one place.

Maximizing the cost benefit of physics residency interview
Justus Adamson and/vs Sonja Dieterich

Maladaptive interviewing culture in some residency matches

Here's a paper that describes the high-pressure interviewing that goes on before the resident match for Radiation Oncology (and proposes that residency directors should behave better):

Taking “the Game” Out of The Match: A Simple Proposal
by Abraham J. Wu MD, Neha Vapiwala MD, Steven J. Chmura MD, PhD, Prajnan Das MD, MS, MPH, Roy H. Decker MD, PhD, Stephanie A. Terezakis MD and Anthony L. Zietman MD
in the International Journal of Radiation Oncology, Biology, Physics, 2015-12-01, Volume 93, Issue 5, Pages 945-948

"Holliday et al  (3)  conducted an anonymous survey in which medical students applying in Radiation Oncology reported experiencing “behaviors that conflict with written NRMP policies, either during or after interviews”  (3)  . Of those who responded, alarmingly high percentages perceived that the system can be “gamed” through actions ranging from a wink and a nod, embellished thank you notes and advocacy phone calls, all the way to overt promises and declarations of interest (the potentially disingenuous nature of which is disturbing in itself). Radiation Oncology is fortunate to attract über-competitive “top-seed” candidates with credentials that confer prestige and promise to our specialty's future  (4)  , but, it being such a competitive field, most candidates are applying to dozens of programs. Both programs and candidates have sought a way through the morass by essentially “prearranging” matches ahead of the Match deadline. Programs seek affirmation that the applicant will rank them first, and applicants, with the stress of an overwhelming process, are tying themselves into knots trying to let all the programs at which they interview feel that they will be ranking them number one. Many candidates have complicated decisions to make about their lives and genuinely do not know their program ranking until the last minute, but the pressure is on to “show their hand”  (5)  . First-year residents, when asked what it was that they found most stressful about the process, describe the subtle pressure that programs put them under “to declare” them as top of the list. The anxiety when applicants are obligated to “play the game” is immense, even cruel. An implicit requirement to declare a first-choice program may have significant practical consequences: an excellent applicant who declared a “first choice,” yet narrowly failed to match at that program, may have plummeted down the rank list of other programs unwilling to “waste” a high slot on him or her. Applicants may not be truthful in their post-interview communications (for example, telling multiple programs they are the first choice)—behavior that can never be condoned, but which the new norms incentivize. The report by Holliday et al confirms what we knew in our hearts: that the pendulum has indeed, insidiously, swung in this direction and that these behaviors are now regarded as the new normal rather than in any way deviant.
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"From the perspective of the applicants, Jena et al  (10)  surveyed senior medical students at 7 US medical schools regarding post-interview communications with programs and uncovered that more than 85% of respondents reported communicating with programs, with nearly 60% notifying more than one program that they would rank it highly. Furthermore, students reported that programs indicated that they would be “ranked to match,” “ranked highly” (52.8%), or other similar suggestive euphemisms. Most worrisome is that nearly a quarter of applicants admitted that they altered their rank order list on the basis of these programmatic communications, and 1 in 5 who ranked programs according to these promises did not match at that program, despite ranking it first. 

New match for medical physics residency positions

Since you ask (Should there be a residency match for medical physics?), the answer is yes. Here's the announcement: 2015 Medical Physics Matching Program. It's organized by National Matching Services, and will use the Roth-Peranson algorithm.

HT: Jonah Peranson of NMS

Should there be a residency match for medical physics?

The Journal of Medical Physics has published a debate on the resolution: Medical physics residents should be placed using a matching program

Stephen Sapareto, X. Ronald Zhu and Colin G. Orton, Moderator
Med. Phys. 41, 060601 (2014); http://dx.doi.org/10.1118/1.4871039

Arguing for the Proposition is Stephen Sapareto, Ph.D., arguing against the Proposition is X. Ronald Zhu, Ph.D.

Medical physicists get Board certification following a residency, but they are Ph.D.s and not M.D.'s, so they finish their degree only after writing a dissertation.

Briefly, the position in favor of a match is that graduates are facing a chaotic unraveled market that resembles the one for medical residents prior to the institution of a match.  And the position against a match rests on the observation that medical physicists don't all finish at the same time of year, and that the present rules on timing would be sufficient if only they could be enforced...

Here's an explanation of what medical physicists do, from the American Association of Physicists in Medicine.