Salary specific info

My understanding is that both private practice and academic Radiation Oncologists have the same starting salaries (~$200,000). However, in private practice your maximum salary is generally much higher and once you hit partner you should be making roughly double or more of your starting salary (~$400,000). Towards the twilight of your career you can make more depending on many factors.

Academics Radiation Oncologists do get pay raises as they ascend the hierarchy of the tenure-track ladder however they are never paid as much as their private practice counterparts. I have seen Chairs make ~$400,000 but they are highly accomplished clinicians and researchers. It is far easier to make that kind of money in private practice.

Gfunk6 said:

My understanding is that both private practice and academic Radiation Oncologists have the same starting salaries (~$200,000). However, in private practice your maximum salary is generally much higher and once you hit partner you should be making roughly double or more of your starting salary (~$400,000). Towards the twilight of your career you can make more depending on many factors.

Academics Radiation Oncologists do get pay raises as they ascend the hierarchy of the tenure-track ladder however they are never paid as much as their private practice counterparts. I have seen Chairs make ~$400,000 but they are highly accomplished clinicians and researchers. It is far easier to make that kind of money in private practice.

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this is basically correct although the monies can be even higher if youre willing to practice in some areas. this is both for private and academic. ive seen places that had to cap their attendings (not chairs) at 500K in academics. ive also seen much lower in BOTH arenas.

stephew said:

this is basically correct although the monies can be even higher if youre willing to practice in some areas. this is both for private and academic. ive seen places that had to cap their attendings (not chairs) at 500K in academics. ive also seen much lower in BOTH arenas.

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How does it work that an Academic institution would cap phys. salaries?
I thought they all had fixed salaries and could not earn anything extra or on their own.
Can someone explain this to me. Please.

NunoBR said:

How does it work that an Academic institution would cap phys. salaries?
I thought they all had fixed salaries and could not earn anything extra or on their own.
Can someone explain this to me. Please.

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well a couple of things. Salaries can be distributed in many ways. As a flat salary to all, heirarchical, or tiered 2nd to things like productivity. However distrubtion aside, even iwth a fixed salary, things like yearly raises etc come into play. at some point they put on a cap and shunt monies into things like resaerch to support junior's resaerch in labs etc (as in this case). So while you may get a cost of living raise, other addititve monies after a certain point can be put on hold for instance.

Maybe this is a fair assessment of physicians across the board, it gives some perspective to other specialities:

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Money is important to support your family, etc. but let's also consider the fulfillment of patient care and oncology research.

http://www.studentdoc.com/internal-medicine-salary.html

http://www.physicianssearch.com/physician/salary2.html

http://www.docjobsonline.com/salary.htm

Ask any sleep-deprived, stressed-out resident about salary and sacrifice about the merits and pains of delayed gratification. In the end, the generic, fortune cookie advice of "DO WHAT MAKES YOU HAPPY; BE HAPPY WITH WHAT YOU DO" is not so far-fetched.

folks i dont know why every thread that mentions income turns into a moral treatise on the nobility of medicine versus greed. But all agree that the original poster has the purest of heart and stay on topic here.

Is it true that the more prestigous, big name universities (ie harvard/jh) often pay less than lower-tier places because they have no problem recruiting? I've heard that in the past, especially when you factor in living costs in many of those cities.

stephew said:

folks i dont know why every thread that mentions income turns into a moral treatise on the nobility of medicine versus greed. But all agree that the original poster has the purest of heart and stay on topic here.

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I dont believe many of the sites that you guys provided links for. They seem too low. I suppose the avg may be more accurate, but I have definitely seen many people get higher max salaries in many of the fields.

It says the max for FPs and IM is around 245k. I know some GPs making over 500k.

I m guessing this probably compiled all the salaries from job sites or similar things. I m guessing if you open your own private practice you could make much more in many of the fields.

;

Every year at ASTRO, ARRO presents a survey from prior graduating classes of residents. Prior graduates are asked questions about their job searches, research time (if they went into academics), insurance issues, restrictive covenants, salary, etc. Granted, it's somewhat unscientific but it gives you a rough notion of what people have been offered in the recent past. It might be worth asking some of the senior residents in your nearest rad onc dept if they have the results. Or, if you have the chance to go to ASTRO as a medical student, it is definitely worth attending the ARRO program. In last year's survey, I think the going starting salary was somewhere in the range of $200 - 220k with a lot of regional variation. Generally, if you're willing to go out into the middle of nowhere you will be offered more. Private practice starting salary was a little higher than academics, but not much (with the potential to grow much more quickly).

Also, if you are in academics, there can be a lot of variation in the way salaries are structured. Some universities will have a base salary from the university that is then supplemented by a separate salary from the radiation department (as a separate corporation). If you are research oriented, your salary may be partially paid by a grant. Or you may end up being a salaried hospital employee.

Also keep in mind that the job market ebbs and flows in this field. If you're a medical student now, there's no way to predict what the job market will be like when you graduate. Programs are adding residency spots left and right. This is good for you when you're applying into residency but may be bad for you when you graduate and have to compete with all these people for jobs. This isn't meant to be ominous, just another thought to consider.

Hope this is useful.

The 200-250K amount for a new attending is about right. My first few months as a new resident, I received a recruiting letter offering 700K+ to start for some places down in Texas. That letter probably went to every resident in the country. In general, the job market is tight on the coasts and less so in the middle. In some places, you can make partner in as little as 2-3yrs. The chair of my department (in New York) makes over a million a year, but he is older than dirt and has seniority.

mind you, salaries for 700K etc reflect where things are located. they dont give that sort of buckage because they're geniunely interested in your well being and happiness. also, there is a ALOT of reading between lines that needs to be done when you go into private practice. getting a lawyer to read your contract before you sign is agood thing.

Just out of curiosity, do you know what cities in Texas this apocryphal $700k position was in?

cdf95cro said:

Just out of curiosity, do you know what cities in Texas this apocryphal $700k position was in?

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The letter was vague (naturally) but implied that there were several major professional sports teams in the area, implying that Dallas was the city. One of my fellow residents from Texas tells me the state is making a big push to try to get more medical care in "the valley" i.e. near the Rio Grande/Mexican border, because there are a lot of poor people there and the area is greatly underserved, medically.

be very very careful with these things. Big bucks are not given typically to people in places where others want to live. at least certainly not off the bat.

XRTMM said:

The 200-250K amount for a new attending is about right. My first few months as a new resident, I received a recruiting letter offering 700K+ to start for some places down in Texas. That letter probably went to every resident in the country. In general, the job market is tight on the coasts and less so in the middle. In some places, you can make partner in as little as 2-3yrs. The chair of my department (in New York) makes over a million a year, but he is older than dirt and has seniority.

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I always hear people say how their chairs of their depts make a mill a year even upto 3 mill a year.

Is that difficult to do (become a chair of a dept)? What does being a chair entail? Research?

Thanks.

im going to go out on a limb here and say youre not going to be a chairman. there are relatively few academic centers and you have to be top of the pile in your career to even be considered. As a chairman you are the person who is ultimately responsible for the department, its vision, its execution and management. it s ver serious job. And tey rarely make a million. if you want those sort of big bucks, the easiest way is to ditch medicine now and take another career. you'll do fine as a radiation oncologist. Some do become rich beyond avarice but they're as much full time business men/women.

The Chairman at Roswell Park fits this description. He has an MBA and very few publications (26 on PubMed, and no 1st author pubs since 1997).


Anyway, side question - is there chairmen/women who were more business and/or leadership oriented (possibly MBAs or people involved in other business ventures) and whose CV may not include as much research as it does background in asset management, leadership at the university, etc.?

-S[/QUOTE]

radiaterMike said:

The Chairman at Roswell Park fits this description. He has an MBA and very few publications (26 on PubMed, and no 1st author pubs since 1997).

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True. From the business side of things, I'd say Roswell Park is one of the best run in the country for its size. A very pro-resident environment. And the chair DOES have a PhD as well.

Gfunk6 said:

True. From the business side of things, I'd say Roswell Park is one of the best run in the country for its size. A very pro-resident environment. And the chair DOES have a PhD as well.

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Emory apparently has a knack for the business side as well...

Re: Stephs comment on the fact that out of scale pay can be a red flag, I was curious about the listed position; I know a friend here in Texas leaving a 650K+ position due to working conditions/location. Essentially, a bunch of urologists got a MimiC and are sending EVERY pt for IMRT (which bills approx 2-3 times a rad prost). Sad.

yep. you'd be amazed at what goes on. Im my senior year, my colleague at JHH, who is a brilliant doc, was getting ready for private. We were talking about some treatment and he said "well the private practice answer is that drug x is always used since it reimburses more". Mind you, this isn't necessarily done in a cold calculated way. Human beings rationalize much to themselves all the time over many issues in life. but decisions are made through a financial filter. Even in academics though usualy less in terms of day to day treatment than in terms of program development.

hey guys!! What is the salary range for an average radiation oncologist?

One of my classmates found this link. I'm not sure how realistic it is though. http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

tha'ts fairly good. its obviously locale dependent.

kp99 said:

One of my classmates found this link. I'm not sure how realistic it is though. http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

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Are these academic or private practice numbers? Seem a little low for practice (taking location into account).

Thaiger75 said:

Are these academic or private practice numbers? Seem a little low for practice (taking location into account).

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These numbers are quite consistent with what folks from residency have been offered here in Texas and the Southwest for private practice.

all around including private practice.

stephew said:

yep. you'd be amazed at what goes on. Im my senior year, my colleague at JHH, who is a brilliant doc, was getting ready for private. We were talking about some treatment and he said "well the private practice answer is that drug x is always used since it reimburses more". Mind you, this isn't necessarily done in a cold calculated way. Human beings rationalize much to themselves all the time over many issues in life. but decisions are made through a financial filter. Even in academics though usualy less in terms of day to day treatment than in terms of program development.

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Along those lines, I attended a conference where the speaker was plugging microarray genetic analysis. When someone asked what it cost, the speaker said, "Well, it's covered by Medicare now." Notice, she didn't actually say what it cost, and that the fact that it was covered by Medicare was supposed to be code for "someone else is paying for it". Well, that someone else is you, the taxpayer. I've lost track of how many of these new "targeted therapies" have come out that offer at best an incremental improvement in survival but at a mega-increase in cost. For example, a single dose of Zevalin costs $25,000! Just shows what happens when the real cost is shielded from the consumer - all market incentives to control costs are thrown out the window.

Mistake.

Since many of our patients have relatively short life spans the malpractice premiums tend to be low.

Link: http://phius.com/medicine/medx/rates.htm

doctalaughs said:

Is it true that the more prestigous, big name universities (ie harvard/jh) often pay less than lower-tier places because they have no problem recruiting? I've heard that in the past, especially when you factor in living costs in many of those cities.

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bump

doctalaughs said:

Is it true that the more prestigous, big name universities (ie harvard/jh) often pay less than lower-tier places because they have no problem recruiting?

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Yes, they tend to have starting salaries that are lower than private practice and lower than other academic institutions. Prestige has something to do w/ it but another major factor is that many "name" places are in cities w/ a perceived high quality of living. I'm not speaking of Harvard/JH specifically just generally.

If you want to maximze your income go private in a place with perceived poor quality of living in the middle of nowhere.

You all undoubtedly know that this field pays better than most, and when you consider how hard one has to work to "do well" in rad onc, it wins hands down over the other lucrative specialties, most of whom still have to work pretty hard for their money. It's not that one doesn't have to work hard in rad onc, but a reasonably busy practice may require 40-45 hours per week, and very rare evenings and weekends. Obviously, the harder you work the more you make, but one doesn't have to kill one's self to generate a very comfortable income. What you earn in private practice is a function of: a)how many patients you treat, and b)the percent of revenue you generate that you get to keep. Location may play into both of these, but reimbursement varies relatively little from location to location within the US.

I know I shouldn't be doing this, but I'm going to let you in on a secret that most of us private guys want to keep secret from those of you that will be entering the work force and eventually working with/for us. Here it is: The formula for determining how much revenue is generated per patient on treatment. If you know this then you can negotiate your contract from a position of knowlege, and won't have to depend on the benevolence of your prospective employer.Does anyone want to guess what this figure is before I give it away? This is the number that, when multiplied by the average number of patients on treatment over the course of a year, will give you how much revenue one would normally expect to collect given an average case mix in a community setting. Go ahead and guess, and I'll post the answer in a few days.

I know its been posted before that an IMRT prostate treatment course is reimbursed by Medicare something on the order of 45k

Yes I've been told prostate IMRT bills close to $1000 per daily session whereas non IMRT treatments are closer to 100 per treatment.

A private attending, I would guess, can earn close to 20% of revenue generated?

now your'e getting to see how patients are inappropriately treated based on reimbursement. happens all the time and helped out by patients searching the net and learning about technologies that aren't necessary or even good for them, but that they then demand. And im not talking the "we dont have proof that parachutes save lives" cases either. Dr Emmanuel did a great talk at astro this year that touched on this aspect.

Okay, due to popular demand, I will now reveal, with a few caveats, the formula for getting a rough idea of what revenues a practice will generate based on the average number of patients on-treatment. Multiply the average number of on-treatment patients by $24,000. For example, if a practice maintains an average of 50 pts on treatment, one would expect that practice to generate annual revenues of around $1.2 million. Now this assumes an "average" caseload, whatever that is, and around 5% uninsured patients. This does NOT take into account practice expenses, but for most hospital-based practices the overhead is minimal. In my nearly 20 years of hospital-based private practice, the typical yearly expenses would include malpractice insurance at around $15,000 per physician (less during the first few years of practice), health insurance at around $12,000 per physician/family, billing at 8-10% of collections, and miscellaneous expenses at around $12-15,000. So let's go back to the hypothetical 50 patient, two physician practice; after expenses, the net revenue available for physician compensation would be around $1.0 million. Currently you can have up to $45,000 per year of pre-tax money put into a retirement plan ($50,000 for those over age 50). So if both docs do that, the expected bottom-line payout to each doc should be around $450K per year.

The caveats: this will vary some by region; if you are doing alot of SRS/brachy/Gammaknife it could be higher; if there is high HMO penetration it could be less; these numbers will likely go down ALOT over the next few years, although I've been hearing that since I began practicing, and although there has been slow incremental decrease in reimbursement, somehow we, as a specialty, have been spared the deep cuts suffered by most other previously-lucrative specialties over the years. The American College of Radiology (ACR) has worked hard to keep it that way, but you never know when it will end. Final caveat: this is completely off the record and for your personal use only. Use this as a guideline, but don't take out a mortgage based on it.

Bottom line: to the med students considering this specialty, do it if you think you'll enjoy it, not for the money. The lifestyle will almost certainly remain a good one compared to most of our peers, but the money may not, so you should be in it because it's what you want to do. It's a great field to be in right now; I certainly have absolutely no regrets about it, and feel incredibly fortunate to have found it. Good luck.

am duly impressed someone around long enough for 20 years of practice will have a screen name called "pimpmyrad".

What can I say? It's having teenage children that keeps me on my toes. I even know what "the shocker" is, although it's not something I really wanted to learn, at least not from my daughter.

lets keep it clean folks.

50 pts on treatment sounds a bit too busy for a 2-physician practice.

qwert said:

50 pts on treatment sounds a bit too busy for a 2-physician practice.

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oh ho hardly in private practice.

qwert said:

50 pts on treatment sounds a bit too busy for a 2-physician practice.

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Agree w/ Steph. From those I've spoken with, 25-30 is a median patient load, with really busy private docs as high as 50-60. The other prevailing sentiment from the private docs is that the overall workload for 30 patients on treatment is roughly equivalent to a patient load of 15-20 at an academic center. Obviously, this is highly dependent on the population each doc treats; those with special interest in head&neck, esophageal and other routinely toxic treatment sites may have a different outlook on the workload.

As someone who has been in a community practice for a while, my memory of the average workload per attending (and resident) where I did my residency is a bit hazy, but I don't recall any of them having more than 15-20 pts on treatment at any given time. Most residents coming out of training have a bit of an adjustment to make when entering private practice in terms of the workload, but usually adjust to the increased pace within a year or so, at least in my experience based on those I've hired over the years. You do learn to become more efficient with time, and spend time on the things that are most important. There are practices out there with 40-50 pts per MD, but that is just too busy for me, and you really don't have time to spend with your patients if you're that busy. I know one guy in such a practice, and he hired a PA (physicians assistant) to see his on-treatment patients so he could spend all his time contouring and treatment-planning in dosimetry. He'd see the pt for the inital eval, and then not again until they finished. That wouldn't work for me, but it takes all types, I guess.

I see. Thanks!