April 2002

Survivor: Residency

By Michael J. Katin, MD

As of 20 years ago the specialty of Radiation Oncology (then known as Therapeutic Radiology) had fully separated from Diagnostic Radiology (then known as Radiology) and residency positions were filled by eager, dedicated, aggressive physicians striving to make an impact on medical science. This is best reflected by comments received in a survey taken in 1982 as to why entering first-year residents wanted to make this their life's work:

  1. "There were no openings in Dermatology."
  2. "I can stay underground in the department all day and I don't have to come out until dark."
  3. "The voices told me to do it."
  4. "It was the only residency I could get this year that would let me stay in New York City."
  5. "You mean we don't read x-rays? What kind of a radiology residency is this?"

Recently, things have changed significantly as our specialty has come to be seen as highly desirable. While this could be construed as a form of mass hysteria, the fact is that the only way to get a Radiation Oncology residency now is to inherit one. No, that's probably an exaggeration. As long as an applicant had a stellar record in medical school, excellent recommendations from appropriate faculty members, and a PhD, there still is a chance to get a residency.

After all, having a strong research background is important in all fields of medicine, especially if an ongoing project might result in the ASTRO Resident Research Award and, ideally, the Nobel prize. Eventually it could turn out that absolutely no one has good enough credentials to be accepted, resulting in depopulation of our specialty, and, mercifully, extinction.

Before this happens, there might be one last chance to interrupt this trend. Obviously, the current system needs to be changed. Right now there's a "match" system in place which institutionalizes the procedure of having people officially assigned to the places that have already made an agreement with them. It's like going through a lot of rituals to have an arranged marriage between two people who have already been living together for five years and have two kids. It's time to make the process truly competitive and not to discourage physicians with fewer than two lead articles in "Science" from trying to get into our field.

It won't do any good to have exquisite treatment plans and meticulous outcome data and literature reviews when you're being evicted from your own department or when you're allowed to stay on at a salary that's less than the department administrator gets (not that there's anything wrong with that, if any of them are reading this).

We need at least 4 years of being restocked with people aggressive enough to deal with referring physicians, hospital CEOs, managed care despots, and the government, not just super scientists who will get run over by every special interest group in existence. The plan is that for the next 4 years the specialty can be revitalized using a new selection process.

This would be similar to the mating habits of the Uganda kob, which has guaranteed survival of these fine creatures over thousands of years. The only prerequisite would be to have a medical degree, one PGY-1 year, and the desire and ability to absorb and give out punishment.

I can't reveal the specifics, but sign up is in Tora Bora at 0500 hours on 20 April.

CMS and ASCO, get ready to rumble.

email: mkatin@radiotherapy.com