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Residencies in Medical Physics difficult to obtain

  1. Mar 7, 2013 #1
    Hey all,

    I've read a lot of perspectives on Medical Physics job market and residency market and I thought I had a moral obligation to contribute to the conversation as I have first-hand experience. I just went through the residency application process.

    I am a graduating Medical Physics Masters student who just got a residency. My graduate program is pretty good in my opinion and has been CAMPEP-accredited for longer than most (More than five years). We have some top researchers and big names in the field. If you want to get into this field, you need to go to a CAMPEP-accredited graduate program BTW. I liked all my advisors and professors. I think they are good people who did right by me.

    I am a pretty competitive student (4.0 grad school GPA, rec. letters from big names in the field, research awards). I applied to 25 radiation oncology physics residencies. I had five in-person interviews. I ended up getting 2 offers. The offer I took is with an institution that regularly hires most of their residents after they complete their residency, so things are looking pretty good for me. I'm telling you this so you know I'm not just some bitter unemployed low-quality candidate who is ranting and projecting my personal failures. I am a top-notch student who is getting offers even in a very competitive market. I can't be any more specific about my credentials though for fear of retribution.

    But the market for residencies is just that, competitive. It’s very tough out there. It may be a bottleneck year because people have to jump on the residency train for the new requirements that take place in 2014. The requirements are going to make it mandatory to do a residency if you want to get certified by the ABR to be a practicing medical physicist. Programs haven't expanded their residencies enough, but still, it was REALLY competitive and I don't know if it will be easier next year. Additionally, there are plenty of people who haven't got residencies yet and thus re-applied, meaning there is an excess group of candidates who are still trying to get their foot in the door. Considering how competitive it was this year (I know people who didn’t get anything), I expect more of this next application season. This isn't even considering the job market post-residency, which may not be much better.

    Every single residency program I applied to probably had at least 100 applicants. Note that a residency program usually has 1 slot available, sometimes two, rarely more. The following is a list of programs, slots available, and number of applicants. This information is from personal experience and from talking to fellow students. This is for the 2013 application season (i.e. for residencies that start July 1st, 2013).

    Northwest Medical Physics near Seattle - 1 slot - 160 applicants
    Ohio State - 1 slot - over 100 applicants - interviewed 13
    Thomas Jefferson - 3 slots - over a 150 applicants – interviewed more than 20
    NYU Langone - 1 slot - over a 100 applicants -said they'd interview 10
    Emory - 1 slot - over 100 applicants
    UCLA - 1 slot - over 140 applicants
    Henry Ford Health System - 1 slot - over a 100 applicants - interviewed 11

    Additionally, my friend interviewed at University of Wisconsin's residency program and said they interviewed 7 total for 1 slot, but I don't know how many applied. I don't have the rest of the numbers, but you'd be hard pressed to find a residency program that didn't have a least 90 applicants to it. Granted, people are probably applying to every program they can, so a lot of these applicants are also applicants at other places, but its still pretty bad. Google "campep accredited residencies" and look at how many programs there are yourself. Almost none of these places paid for travel or lodging expenses during the interview process.

    I'd say most Masters graduates (50% +) did NOT get a residency this application season. It’s a lot better for Ph.D., but I really wouldn't want to get a Ph.D. job just to do clinical work, as you definitely don't need a Ph.D. to do that type of work. And unfortunately, the vast majority of these master students paid for their own education, unlike Ph.D.s who get their education paid for and get a living stipend.

    The issue here is that most of the graduate programs have their Master students pay their own way. I.e. they have to pay for their own tuition and living expenses. Some graduate programs have accepted Master students without even interviewing them (Duke, Wayne State, UPenn). To me that says they aren't really that invested in those students and their futures, but they’ll still take their money. Heads of graduate programs never really talk about this when you interview though, for reasons you can probably guess. I don’t know how the finances of Medical Physics graduate programs work, but I think there is a monetary incentive to take on students even if you can’t place them in jobs/residencies. Therefore, it’s not that big of a deal to them if the market gets saturated with talent. Hell, that's probably good for them, more choices for who you employ and you don't have to treat them as well. That’s pretty unethical in my opinion. Then again, this happens for graduate schools in general. Why turn down money (Master students) or cheap labor (Ph.D. students)? The President of the American Association for Physicists in Medicine (AAPM) has said similar things.

    “Further, it is unethical to require students to commit themselves to years of hard work and financial stress in the hope of finding work in an already saturated market place. Funding graduate students through research naturally regulates growth and serves our mission; the current environment calls for limiting graduate program enrollment.” -Dr. John Bayouth, President-AAPM
    http://online.medphys.org/resource/1/mphya6/v38/i8/pii_s1?view=fulltext&login&bypassSSO=1


    Additionally, for the Master students that DO get residencies, they don't usually get the better ones, and they don't usually get the locations they want. The better residencies usually prefer Ph.Ds. They again, practically every residency program prefers Ph.D.s over Master students.

    In short, Medical Physics is a pretty neat field. I like the material. I’ve had a really positive experience so far. I'm personally glad I'm in this field as I like the work and I love helping people. But I worked really hard, graduated from a great Masters program, and was still really lucky to get a residency. Please be careful before you enter this field. Be wary about paying for your masters and do your research. You don't want to go further into debt to get a degree that is so specialized it can't be used anywhere else, but still not have a residency/job.

    Ask the students at these programs what the outlook is like, ask the people who didn’t get any offers what it’s like. Don’t assume heads of graduate programs are telling you the whole story. Some graduate programs have attached residency programs that give their students first priority. Those are advisable in my opinion, but they are rare. If you get a Ph.D. from a pretty good CAMPEP-accredited medical physics program, this probably won’t be much of an issue. But that’s a much bigger commitment than a Masters degree.

    Hope this helps you make an informed decision.
     
    Last edited: Mar 8, 2013
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  3. Mar 8, 2013 #2

    PBD

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    Thanks for your insight. I'm just starting out on my med physics career, am a junior right now. I will be working in a med physicist's lab this summer. In a way I'm afraid of kind of falling in love with the field and then finding no jobs at the end of the rainbow. How are job prospects if you finish your residency? Do you think part of the reason residencies are now required is to keep the number of board-certified med physicists down (and the job prospects up- for those who do get through)?
     
  4. Mar 8, 2013 #3
    I think the job prospects post residency are better than the prospects of getting a residency, but I don't know for sure, as I haven't looked for a job yet, just a residency. I have no idea what the job market will be like in a couple years, and no one can say for sure. This I do know though, there is an ample supply of students for residencies.

    There is an issue though that a lot of people want ABR certified physicists when they post job ads, which means you have passed Part 2 and Part 3. Part 2 you can take immediately after your residency, but you'll need some more job experience and mentoring to pass Part 3. Therefore, that may end up being another bottleneck. You can finish your residency, but if people only want ABR certified physicists (i.e. Parts 1 through 3 passed), you are out of luck.

    Residencies are required because lots of programs don't give students enough clinical training to go out into the field and do the job. Didactic training is not enough, you need hands on clinical training. Requiring residencies are a quality check for physicists to ensure patients get the quality of treatments they deserve and no one gets hurts. It is absolutely a good idea, and I don't think its a labor market trick to limit the number certified physicists.

    If you get a Ph.D. in a CAMPEP Medical Physics program, I think you'll be okay. But even then, Academic Medical Physics positions and research funding are hard to get according to my advisors. They say there are more Ph.D.s than there are Professorships and Academic Medical Physics positions (which are different). Again, my advisors are well known in the field, so I trust their input. So you can probably get a clinical job if you get a Ph.D., but its kinda idiotic to get a Ph.D. just to get a clinical job. I feel like you don't need to get a Ph.D. just to do a clinical job. If you aren't willing to get a Ph.D. in Medical Physics to get a clinical job, you should be careful. Its all or nothing. You go all the way to get a job or you just wasted years of your life, and possibly a lot of money, for nothing. Its all complicated by the fact that the directors of graduate programs aren't telling the whole story, and don't necessarily have any reason to.
     
  5. Mar 8, 2013 #4

    PBD

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    Ok, I see where a residency is really necessary. That does makes sense to me now. But I don't understand is on the one hand you say getting a PhD in order to do clinical work is idiotic, but on the other hand you say residencies strongly prefer PhDs. And residencies are now required to work as a clinician.

    Which means getting a PhD is idiotic, but yet is a good idea if you want to eventually become a clinical medical physicist. I will admit I am confused!
     
  6. Mar 8, 2013 #5
    Well, the labor market is saturated for residencies. So programs are looking at lots of good candidates, plenty of which have Ph.D.s. All things considered, Ph.D.s do add to the appeal of a candidate. Some of that appeal is legitimate. But I don't think it is necessary. But as competition goes up, you may have to do something like get a Ph.D. to get the added edge over others to get a residency. The fact that more Ph.Ds are getting residencies is reflective of the over-saturation of the market, not of a strong need for clinicians to actually have Ph.Ds.

    If you want to work in the clinic, I think the best things to do to get qualified for that work is to... work in the clinic. 5 years from now I'll be more qualified to work in the clinic because I'll have 5 years of clinical experience than if I where to get a Ph.D. (probably 3 more years) and have 2 years of clinical experience. Having a Ph.D. certainly does add some value, but I don't think its necessary. Its more for people who actually wanna do research for a living, not do solely clinical work. A lot of Ph.Ds who end up doing mostly clinical work are certainly qualified, but they probably wanted to do more research and settled for the job they could get. Then again, the people who make decisions about who gets residencies are, surprise surprise, people with Ph.Ds. They clearly have a different bias than me.
     
  7. Mar 8, 2013 #6

    atyy

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    There's a counterpoint in that interesting article by Jay W.Burmeister:

    "Finally, I believe that a student’s choice to enter this field of study is generally a result of the desire to apply science to medicine, not the expectation of a guaranteed job or residency upon graduation."

    !

    At least he agrees "Graduate programs must be honest and forthright with prospective students about the realities of the job market, and there is clearly a real and ethical problem if this information is withheld. Understanding the risk involved in pursuing a career and achieving a desired outcome, however, is the responsibility of the student."
     
    Last edited: Mar 8, 2013
  8. Mar 8, 2013 #7
    Well, sure, but without a job or residency how are they going to continue to apply science to medicine? Seems somewhat incoherent.
     
  9. Mar 8, 2013 #8
    "Finally, I believe that a student’s choice to enter this field of study is generally a result of the desire to apply science to medicine, not the expectation of a guaranteed job or residency upon graduation."

    Most students are assuming "desire to apply science to medicine" = a job/residency. Unless he's insinuating students like getting (and sometimes paying for) degrees even if they don't get jobs/residencies, which is ridiculous.

    Also, Jay Burmeister is a director of one of those programs whose Masters students pay their own way. In the past, this program has also accepted people without even interviewing them, and still may be doing that today.
    http://radiationoncology.med.wayne.edu/medphys/graduate-program/ [Broken]
    So draw your own conclusions there.

    Guaranteed? Of course not. Nothing should be guaranteed. But a reasonable chance of actually getting a residency if you bust your ***? I think that's fair. And I don't think that's what students are getting.

    "Understanding the risk involved in pursuing a career and achieving a desired outcome, however, is the responsibility of the student."

    I agree, which is why I'm trying to give students necessary information to make an informed decision. Because directors of graduate programs aren't gonna do it.
     
    Last edited by a moderator: May 6, 2017
  10. Mar 8, 2013 #9

    Choppy

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    I'll preface my opinions by stating that my experience is in the Canadian system, but there are a number of issues that I feel need to be addressed in this thread.

    (1) On the issue of departments somehow getting money for the number of students they bring in.

    This is complete rubbish, at least for any program that I've been involved with. Students COST money (not to mention time, effort, and resources). This cost is only partially offset by tuition.

    I would also caution against paying for it though. There are still programs out there that provide full support, or at least come with options for well-paying QA jobs.

    (2) On the numbers of applicants posted...
    They strike as a little high, but not unreasonable for some of the larger centres in the USA. However I would point out those are TOTAL numbers of applicants. When you have an opportunity to look over the applications that come in, one thing you'll find is that the number of QUALIFIED applicants is substantially lower. A lot of people want to get into a medical physics residency and will fire off their CV wasting everyone's time despite not having credentials listed as requirements. Further if you look at all of those applications, you're likely to find that most are from the same pool of applicants.

    That's not to say the numbers aren't still very competative. I agree completely that they are and my arguments don't cut them down by two orders of magnitude. I just felt it necessary to point out some of the mitigating factors.

    Also on this issue, I believe CAMPEP is soon going to require its programs to publish data on their graduates. I don't know the exact details, but likely it will be how many students go on into accredited residencies, how many residents go on to work in th field, etc. The numbers are concern that's been heard loud and clear by the power that be at AAPM/CAMPEP.

    (3) On the issue of a PhD for clinical work.
    I agree it's not necessary. But if you go back to point (1), it's similar for residents. It costs money and time to train someone. One of the reasons that PhDs are favoured is that because they have more research experience they can function as post-docs and move research programs forward as they are trained.

    Another factor that comes into play is the model of job function (/protection) for what medical physicists do. One thing you'll see in radiation oncology departments is that radiation therapists are becoming more professionalised (if that's a word). To be an RT is used to be a 1 or 2 year program. Now it's a full degree, often covering very similar to physics programs. Some places are even offering master's programs. So the basic "clinical" functions that a medical physicist performs are likely to be encroached on by RTs. So I suspect there is heavy favouritism towards PhDs because they allow us to more solidly mark our territory as a profession.

    All of that said, there are places that seem to prefer MSc graduates. One of the disadvantages of having a PhD is that just as it can be "assumed" that you don't want to do research if you have an MSc, it can be assumed that you want to do research if you have a PhD. In a busy clinical environment, a department may not want someone who's going to disappear every afternoon to run some Monte Carlo simulations.
     
  11. Mar 8, 2013 #10
    "This is complete rubbish, at least for any program that I've been involved with. Students COST money (not to mention time, effort, and resources). This cost is only partially offset by tuition."

    Like I said, I don't know for sure how graduate school finances work. But if that's true, why are programs taking on Master students?
     
  12. Mar 8, 2013 #11

    Andy Resnick

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    Because that's our function- to provide an educational experience for the student. We limit our enrollment in Medical Physics to the number of available slots for the practicum portion, and that number is set by our partner hospital. And yes, it is a small number (4 per year).

    I can also attest that graduate students cost our institution (both institutions, if you include clinical rotations) money. Education is a money-losing enterprise.
     
  13. Mar 8, 2013 #12
    That doesnt add up though. If you are losing money teaching then you need to make that up somehow otherwise you would go bust. Is somebody teaching for free, a kind of pro-bono service? Or is the govt. subsidizing the students?

    Standard undergrad and grad education sure isnt a money losing enterprise. Maybe it is for the government and student, but not for the school. School employees make money from educating, rather than having to pay or volunteer.
     
  14. Mar 8, 2013 #13

    atyy

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    That at least seems different from what the OP is warning about, since your students do get residencies - or is that different from the practicum portion you mention?
     
  15. Mar 8, 2013 #14

    Choppy

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    Education is heavily subsidized by the government. So the difference comes out of the pockets of taxpayers. My understanding is that in the USA the ratios are different, more comes out of the student's pocket, but there is still overall a fairly heavy government subsidy.

    I certainly don't get paid any extra for teaching, it's just part of the job. In fact, even if I add up every penny of tuition paid by all our students per year it doesn't cover the pay even for single a resident (well maybe it would in someplaces). But you can't make the argument that's its creating jobs.

    And like Andy mentioned there are very practical limitations to how many students we can accept in a given year (equipment, office space, computing resources, etc.)

    So why even bother? That's a good question. I can think of a few reasons:

    (1) Recruitment. When you have a graduate program you will often have your pick of the graduates for residencies or permanent positions at your institution. (As I've mention in other threads a student's job interview starts on his or her first day of grad school.) There is always a bit of a random element to hiring externally. When someone comes through your program you know what that person's strengths and weaknesses are.

    (2) Professional development. If your staff have teaching duties it forces them to keep current in their field. Possibly as a 2b, there are some people who actually enjoy teaching, so you have more highly motivated employees.

    (3) Research. In a field where the technology changes very rapidly, you keep on top of it by leading the way. This also enables you to offer a better service to your patients.

    (4) Altruistic. It is generally believed there's a boom in cancer care coming and we want to make sure we have well-trained professionals to deal with that.
     
  16. Mar 9, 2013 #15

    atyy

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    But if you get paid for the job, then you don't you get paid for teaching? I don't understand the point about getting paid versus getting paid extra.
     
  17. Mar 9, 2013 #16
    lol, aww comon man. If its part of the job then you do get paid for it. I dont get paid any extra for sweeping floors at the end of the night, its just part of my job. That doesnt mean I'm losing money by sweeping floors.
     
  18. Mar 9, 2013 #17

    Choppy

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    I didn't say I don't get paid for teaching. I said I don't get paid EXTRA for teaching... in the context of debunking this idea that bringing in more students into medical physics graduate programs is some kind of a cash grab.

    To carry on ModusPwnd's analogy, from my point of view there are other people in the profession who simply don't sweep the floor. And while it's tempting to argue that the others perhaps wash the dishes or clear the overn instead, my opinion is that it doesn't balance out. But even if it did, carrying the analogy further, I'm trying to say that neither I nor my department benefits by finding more floors for me to sweep.

    All of that said, maybe I'm taking this stuff a little too personally. I have experience with two programs directly - the one I was trained through and the one I instruct in - although I talk frequently with colleagues associated with other programs.

    Maybe there are programs that are set up to somehow cash in on tuition. I don't personally see how it would work and there are far better ways to make money in this field, but doesn't mean the scenario is impossible.

    If the point of the original poster is essentially "buyer beware" - I whole heartedly agree.
     
  19. Mar 9, 2013 #18

    atyy

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    I suppose the mystery then is who benefits if there are indeed programmes which accept paying students who have a very low chance of getting residencies, as presumably neither the students nor patients benefit - in fact, as you, the OP and Dr Bayouth seem to agree, the students may be getting a bad deal. Naively, I would think that the programs accepting these students benefit. But if the benefit is not financial profit, is it something else such as government funding for research or facilities? Or did the programs also miscalculate and end up worse off (seems unlikely given that you agree that the buyer should be alert).
     
  20. Mar 10, 2013 #19
    In the context of what you are saying it should be quite the opposite then right? Restaurants do actively try to minimize their floor area to avoid costly maintenance. Your department, by analogy, should be actively trying to minimize the amount of students. But cant you minimize it to zero? If what you say is true, the departments with zero students would be doing the best. Why ever take any student at all if they only cost money? It just doesnt add up. I suspect that somebody else (probably the government) is giving you money and with that there is a mandate to teach and thus teaching is bringing in that money. But you are saying this is not the case which leaves me very confused... Why does any dept take on students?
     
  21. Mar 10, 2013 #20

    StatGuy2000

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    As I understand it, colleges/universities in general receive funding from a number of different sources:

    (1) Funding from governments or government agencies (both directly to the schools and also through specific research grants).

    (2) Tuition from students.

    (3) Other sources of funding (through spin-off companies, business investments, endowments, alumni contributions, partnerships with the private sector, etc.).

    The precise percentage of funding will vary to a certain extent. But I would suspect that contingent upon source (1) (and possibly from source (3) as well) is that the college/university accept students and teach the said students.

    Now what are the costs associated with teaching students in colleges/universities? These would include the following:

    (1) Salaries for lecturers/instructors/professors.

    (2) Maintenance costs of the buildings (both in the buildings where courses are taught and in the residences for students who live on-campus).

    (3) Maintenance costs or purchases of computers, lab equipment, books in libraries, microfiche, etc.

    (4) Financial aid to students (including scholarships, grants, etc.)

    (5) Any other costs that haven't been outlined above.

    While you can argue that taking on more students will add value through tuition, it alone may not be sufficient to offset any increases in the costs to teaching those students outlined in my list of costs above. So I would suspect that taking on more students won't necessarily lead to a cash grab for schools. After all, why is it that so many schools have limited enrolment for its schools?
     
  22. Mar 10, 2013 #21
    Because they have a limited carrying capacity of their overhead and faculty. Its an optimization curve. If they dont accept any students, they will lose money. They lose tuition dollars, they lose their building in the university, they lose their cheap workers for their grants. In "regular" university, both undergrad and grad, students are the life blood of departments. All the money comes in because of the students. Tuition dollars, grant dollars, state subsidizes, all of it is based on students. And they are always looking for higher enrollment numbers too, because with more students comes more money - not the other way around.

    I dont quite see what makes medical physics different from this. Are the extra dollars needed for education and not covered by tuition being subsidized by patients from attached hospitals? If not then its being subsidized by the govt. with an attached mandate to take on students. Or no?
     
  23. Mar 10, 2013 #22
    Then I have a question- how does the program stay solvent? Is the loss off-set by state/federal grant money?
     
  24. Mar 10, 2013 #23

    Choppy

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    As I mentioned there are several reasons why a department would want a graduate program. But I can't really see how any of them apply in a beneficial way to a "diploma mill" type scenario, where large numbers of students are turned over with minimal research contributions. You get a lot more research out of a student who stays for a PhD and then a residency. Conversely, if you have lax standards and allow in anyone who meets minimal criteria and can pay tuition you run the risk of allowing "lemons" into your program - students who are not productive, fail out, waste a lot of time, damage equipment, etc.

    A miscalculation isn't outside of the realm of possibility. Quants don't have the greatest track record on predicting the economy, so I'm not sure why medical physicists would be expected to be any better. We understand that there is expected to be substantial growth in the field of cancer care over the coming decade, and the programs are set up to meet that demand - in fact, a few years ago people believed that we were headed for a catastrophe with not having nearly enough programs in place to meet this demand.

    Then the economy did what it did.

    I think the larger reason for the state of the medical physics residency job market goes back to the ABR admission criteria (CCPM is following suit). Several years ago it was announced that an accredited residency was going to be required for certification - as of 2014. There were a number of very good reasons for this. But at the time there were only ~ 20 accredited programs in north america. Since then the number has grown, but the number of new medical physicists needed per year was also estimated to be ~ 200 (in the US) and the number of available residencies hasn't grown that much. So there is a race right now to accredit residencies to both meet the needs of the profession, and to avoid stonewalling those students who are working their butts off to get into the profession. At the same time, they can't move too fast. If you race through an accreditation process, you may miss something and if this happens too frequently it makes the whole accreditation itself rather pointless.
     
  25. Mar 10, 2013 #24

    Choppy

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    But "doing the best" in what respect? If no one was training new medical physicists, that wouldn't be a stable state for the profession. Someone has to train them, and train them well.

    I gave a number of examples of why departments would take on students. Clearly, there are advantages to having students in your department, but as I also said these seem to fall apart in a "diploma mill" scenario.
     
  26. Mar 10, 2013 #25

    Choppy

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    From what I've seen the feedback is not all that efficient, if it's present at all. A medical physics department (in Canada anyway) is given both a mandate and a budget to accomplish that mandate. A medical physics director can't simply go to his or her superiors and say, "Hey, I admitted five more students this year, boost my funding."

    He or she could attempt to increase the educational program's capacity and then have to provide an argument to a board who will divert funding from other programs. But that argument goes back to "reasons why a medical physics department would need to take on more students." And it simply won't fly to say "so I can get more money coming into the department." Instead the argument would have to fit with the board's mandate - and be better than whatever it is currently doing.
     
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