ASTRO panel session on US rad onc labor market

[deltamed]

Agree, would be interesting to hear more about how other specialties have successfully regulated this and achieved an optimal balance. Can anyone speak to this?

Fyi dermatology is not immune from the same problems and many do think the academic leaders are overtraining. It's not as bad as path, radiology (or radonc) but there actually is no "smart" leader in derm restricting the supply. The market is actually fairly saturated in large areas.

Rather I think that the demand for services is more elastic in patient-facing specialties. Also, ability to have cash pay patients and rely on referrals less helps.

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[xrthopeful]

Rather I think that the demand for services is more elastic in patient-facing specialties.

Radiation Oncology.

The field that TEN YEAR poster could think isn't patient facing.

This could be a thread all on its own, but why are people so dumb?

 

[deltamed]

Radiation Oncology.

The field that TEN YEAR poster could think isn't patient facing.

This could be a thread all on its own, but why are people so dumb?

Sorry perhaps my post was mis-worded. What I meant by patient-facing is the tendency for patients to pick their own doctor.

Clearly this is almost zero for specialties like path, rads or anesthesia. I would argue its also fairly low for rad-onc (even though you guys spend most of your time seeing patients) and other specialties where patients come for a specific issue based on referral for a fairly defined time-period. Less so for primary care and specialties like derm where many patients shop around for their doctor and end up "patients for life."

 

[medgator]

Sorry perhaps my post was mis-worded. What I meant by patient-facing is the tendency for patients to pick their own doctor.

Clearly this is almost zero for specialties like path, rads or anesthesia. I would argue its also fairly low for rad-onc (even though you guys spend most of your time seeing patients) and other specialties where patients come for a specific issue based on referral for a fairly defined time-period. Less so for primary care and specialties like derm where many patients shop around for their doctor and end up "patients for life."

In competitive markets, patients & referring MDs can "choose" their rad onc/cancer center

 

[RadOncDoc21]

In competitive markets, patients & referring MDs can "choose" their rad onc/cancer center

Yea, but how many patients really know what they're looking for in a rad onc. There is so much marketing now, it's really hard for doctors, much less patients to understand the difference between a "cyberknife vs. "trubeam" or "protons vs. "targeted-therapy."

Everything these days is "personalized" medicine and latest technology with stupid ads and fancy machines. It's hard to tell BS from fluff.

 

[medgator]

Yea, but how many patients really know what they're looking for in a rad onc. There is so much marketing now, it's really hard for doctors, much less patients to understand the difference between a "cyberknife vs. "trubeam" or "protons vs. "targeted-therapy."

Everything these days is "personalized" medicine and latest technology with stupid ads and fancy machines. It's hard to tell BS from fluff.

Hence why successful practices market to a degree. The biggest source and impact on your consult numbers though will generally be referring MDs, both primary care and specialists.

 

[subatomicdoc]

If you want to hear more about the job market, we will be discussing a Canadian perspective with Shaun Loewen on Twitter February 21st.

The article: Delayed Workforce Entry and High Emigrations Rates for Recent Canadian Radiation Oncology Graduates
The hashtag to tune in: #radonc

It's a global chat starting Sunday morning and Dr. Loewen will join for live discussion 8-9 PM CST. The focus is on the article but has implications for the U.S. experience.
Ping me on Twitter if you have any questions.

 

[mpdoc2]

If you want to hear more about the job market, we will be discussing a Canadian perspective with Shaun Loewen on Twitter February 21st.

The article: Delayed Workforce Entry and High Emigrations Rates for Recent Canadian Radiation Oncology Graduates
The hashtag to tune in: #radonc

It's a global chat starting Sunday morning and Dr. Loewen will join for live discussion 8-9 PM CST. The focus is on the article but has implications for the U.S. experience.
Ping me on Twitter if you have any questions.

Anyone else think we shouldn't allow Canadian grads to practice in the US without completing a residency program here? This is the case for all other countries, why should Canada be any different than other countries? With the tight job market they're taking jobs away from American grads.

 

[medgator]

Anyone else think we shouldn't allow Canadian grads to practice in the US without completing a residency program here? This is the case for all other countries, why should Canada be any different than other countries? With the tight job market they're taking jobs away from American grads.

Doesn't it work both ways? Fwiw, I hear the rad onc market is tight there too. Btw, there are jobs here if you look away from the coasts

 

[thecarbonionangle]

It's not just Canadian grads. I've seen people from other countries who did a fellowship and then took the boards and got an attending job in the US. Rad onc is one of the few specialties to have this loophole.

 

[medgator]

It's not just Canadian grads. I've seen people from other countries who did a fellowship and then took the boards and got an attending job in the US. Rad onc is one of the few specialties to have this loophole.

I've seen that in diagnostic rads, but not rad onc.

 

[subatomicdoc]

Anyone else think we shouldn't allow Canadian grads to practice in the US without completing a residency program here? This is the case for all other countries, why should Canada be any different than other countries? With the tight job market they're taking jobs away from American grads.

There are barriers making it more difficult for Canadian physicians to get a permanent job in the U.S. so there is a competitive 'moat' for U.S. trained radiation oncologists. However, as an employer I want someone who may have the right training and be a good fit for my practice. Why should I be limited in who I can hire?

That is why the discussion should be interesting. In Canada, there are some controls are the number of residency spots. In the U.S., there aren't but that may be why radiation oncology has become less competitive recently. I'll be interested to see what Dr. Loewen has to say about his research.

 

[mpdoc2]

There are barriers making it more difficult for Canadian physicians to get a permanent job in the U.S. so there is a competitive 'moat' for U.S. trained radiation oncologists. However, as an employer I want someone who may have the right training and be a good fit for my practice. Why should I be limited in who I can hire?

That is why the discussion should be interesting. In Canada, there are some controls are the number of residency spots. In the U.S., there aren't but that may be why radiation oncology has become less competitive recently. I'll be interested to see what Dr. Loewen has to say about his research.

I don't care about you as an employer. I care about the graduating residents.

 

[mavrik13]

Anyone else think we shouldn't allow Canadian grads to practice in the US without completing a residency program here? This is the case for all other countries, why should Canada be any different than other countries? With the tight job market they're taking jobs away from American grads.

For the record, the discussion has also been had in Canada about not allowing US trained Rad Onc's to take jobs in Canada (and I support it from both sides of the border). There have been cases of rad oncs hired in Canada who did their residency elsewhere (from the US to India to beyond) within the last 3-4 years (although with Canadian fellowships, usually) despite the severe lack of jobs for new graduates.

While I don't know the specific state of the US job market, from reading this site it seems like there are always jobs available, just in less desirable areas. That is in stark contrast to Canada, where we are limited by public funding for cancer centres. The job market is loosening up a little bit here, but few (last year, ~10%) attain a job straight out of residency.

 

[mpdoc2]

For the record, the discussion has also been had in Canada about not allowing US trained Rad Onc's to take jobs in Canada (and I support it from both sides of the border). There have been cases of rad oncs hired in Canada who did their residency elsewhere (from the US to India to beyond) within the last 3-4 years (although with Canadian fellowships, usually) despite the severe lack of jobs for new graduates.

While I don't know the specific state of the US job market, from reading this site it seems like there are always jobs available, just in less desirable areas. That is in stark contrast to Canada, where we are limited by public funding for cancer centres. The job market is loosening up a little bit here, but few (last year, ~10%) attain a job straight out of residency.

I'm sure it'll be like that in the US soon.

 

[medgator]

I'm sure it'll be like that in the US soon.

You're wrong. Get away from the coasts and you'll find jobs.

 

[subatomicdoc]

I don't care about you as an employer. I care about the graduating residents.

My point is you can't control who can apply for U.S. jobs. If you care about graduating residents, then tell SCAROP, ADROP, ACGME and other bodies to limit the number of trainees and lessen supply.

 

[mpdoc2]

My point is you can't control who can apply for U.S. jobs. If you care about graduating residents, then tell SCAROP, ADROP, ACGME and other bodies to limit the number of trainees and lessen supply.

Of course you can control who applies for US jobs. A guy trained in Radiation Oncology in Thailand can't apply for an attending position here, neither should one from Canada. That would limit supply as would ACGME caps on resident positions. Honestly who are primary failing us in this field are the chairmen and program directors who are being selfish by continually expanding their programs despite their residents having an obviously difficult time finding jobs.

 

[Chartreuse Wombat]

My point is you can't control who can apply for U.S. jobs. If you care about graduating residents, then tell SCAROP, ADROP, ACGME and other bodies to limit the number of trainees and lessen supply.

The only association that can reduce the number of trainees is SCAROP. ADROP, ABR and ACGME have no jurisdiction in this regard.

 

[subatomicdoc]

The only association that can reduce the number of trainees is SCAROP. ADROP, ABR and ACGME have no jurisdiction in this regard.

I agree that SCAROP is the best place to start. BTW, I'm inviting Chirag Shah, CARO and ASTRO to join in the discussion on Twitter.

 

[Gfunk6]

Color me stupid, but how do you have a "discussion" on Twitter? I thought you needed a thread based format like Reddit.

 

[subatomicdoc]

Color me stupid, but how do you have a "discussion" on Twitter? I thought you needed a thread based format like Reddit.

It's not intuitive, but a hashtag is like a radio station. Tune in and you get a stream of live tweets around that topic or tag. Many different medical interests including cancer-specific tags curate health information. Example in JAMA Oncology: http://bit.ly/CTO2016

Example journal club topic: we discussed the NEJM shave margin trial with lead author Anees Chagpar from Yale. Here are the transcript[ http://bit.ly/RadOncJC11t ] and analytics [ http://bit.ly/RadoncJC11f ]. It's not for everyone but if you're willing to share in a public forum, Twitter has a broader impact on public sentiment and offers the chance to interact with other radiation oncologists globally. It takes some getting used to, but almost every author joining the #radonc JC is new to the platform and likes the experience.

 

[Taurus]

But I thought the rad onc thought leaders wanted to cross train rad oncs and IR? Once rad oncs had some procedural skills, then won't that open doors?

 

[thecarbonionangle]

Rad oncs already do procedures like brachy but I do think the possibility of some cross training in onc IR would be very interesting, but I am not aware of any programs which offer that opportunity.

 

[medgator]

Definitely a contrast from the jco study a few years ago looking at the oncology job market as a whole and more in line with what we see in the field

http://www.redjournal.org/article/S0360-3016(16)00233-9/abstract

 

[Damn_Daniel]

Man, you love posting stuff that's already been posted. You repost your own articles (hilarious). And then you post something I posted two weeks ago. Well done, bro.

 

[medgator]

Man, you love posting stuff that's already been posted. You repost your own articles (hilarious). And then you post something I posted two weeks ago. Well done, bro.

No one is going to find out in between your paragraphs of drivel in the wrong thread as a hyperlink.

Think about that next time, bro.

 

[Gfunk6]

In my view, if there ever was an article that deserves to be posted multiple times in multiple threads, it's that one.

 

[Damn_Daniel]

True say!

Let's just re post constantly! Great idea. Let's not have original thoughts or new information. I at least deserve some attribution, "Lyin' Ted"

Drivel? Someone has to be the one that fights against the heavy fractionaters and people that use unsound science to defend their high billings ways.

Go Trump!

 

[redoitall]

Definitely a contrast from the jco study a few years ago looking at the oncology job market as a whole and more in line with what we see in the field

http://www.redjournal.org/article/S0360-3016(16)00233-9/abstract

As an MS3 contemplating RadOnc, it is a bit scary. I don't want to live on the coasts or even any big city in particular. I am fairly flexible so hopefully that will help. But I find it quite sad that I have to worry about job prospects even before starting residency. I was interested in Rads and RadOnc and think that radonc is better. Yet when I read this article and all the job reports, how can we go from a shortage (by all prediction) to now a possible excess. Honestly, I don't see myself doing anything else. Still this stuff is disheartening.

 

[medgator]

As an MS3 contemplating RadOnc, it is a bit scary. I don't want to live on the coasts or even any big city in particular. I am fairly flexible so hopefully that will help. But I find it quite sad that I have to worry about job prospects even before starting residency. I was interested in Rads and RadOnc and think that radonc is better. Yet when I read this article and all the job reports, how can we go from a shortage (by all prediction) to now a possible excess. Honestly, I don't see myself doing anything else. Still this stuff is disheartening.

If you don't mind places like Salina KS, Rhinelander WI or somewhere near the great lakes, you'll be fine, even 5-10 years from now

 

[medicinewoman101]

Definitely a contrast from the jco study a few years ago looking at the oncology job market as a whole and more in line with what we see in the field

http://www.redjournal.org/article/S0360-3016(16)00233-9/abstract

Thanks for posting. Hadn't seen it. This is entirely in line with what we all knew to be the case the past few years. The most important thing that needs to be said is that the old terrible rad oncs will not retire. Many of them think what they learned in residency is enough and never update their skills simply collecting paychecks well beyond their worth. We needs studies to demonstrate how bad and useless these physicians are. We need them gone or graduating residents will continue to feel extreme pain in finding jobs at all even though they are a 10 times better than these obstructionist physicians. If you're contemplating a career in rad onc I would seriously encourage you to reconsider.

 

[Fpg1245]

Thanks for posting. Hadn't seen it. This is entirely in line with what we all knew to be the case the past few years. The most important thing that needs to be said is that the old terrible rad oncs will not retire. Many of them think what they learned in residency is enough and never update their skills simply collecting paychecks well beyond their worth. We needs studies to demonstrate how bad and useless these physicians are. We need them gone or graduating residents will continue to feel extreme pain in finding jobs at all even though they are a 10 times better than these obstructionist physicians. If you're contemplating a career in rad onc I would seriously encourage you to reconsider.

So who are these evil rad onc relics? What exactly makes them so useless? If we purged the field of every rad onc you deemed unfit for practice, we would still be faced with the same issue of training programs putting out too many graduates. Your little witch hunt would under the best of circumstances only temporarily relieve our troubles. At worst, it's a waste of time and effort that could have been spent strengthening the argument through studies like the one referenced above that the demand for radiation services simply is not as robust to justify the current number of grads.

 

[Damn_Daniel]

Well, I'm not in support of this "witch hunt". By the way, that's sort of sexist ... majority of these older doctors are not female, no reason to continue this war on women. Maybe Zombie Hunt? Sounds too apocalyptic. I'll have to think about that.

But, you gotta admit, the grandfathering in of the physicians that were older was a real jerk move. One, it was unfair to the rest of us. Two, the very people that should have been re-examined were being allowed to practice having their knowledge and skills assessed. It's one of the first reasons I started hating ASTRO and the ABR.

It's not that they are useless or relics. But, I would guarantee you that if someone studied average fractions delivered for a bone met by someone who is over 55 vs doctors that are underr 55, you would see a staggering difference. You're not going to see reliance on RTOG atlases for contouring, b/c these people were grandfathered in and don't have to study "the right way" to do something. It's not just because you're old that you're useless or a relic, but if you're older, in your 70s, and you aren't forced to continue to learn, there is good chance you won't be as "evidence based" or clinically sound. It's just the truth. Not picking on older docs. Some are good. Many are not. You have to be honest - some fresh grad that passed our battery of harrassment (i.e. the ABR's written and oral boards) is probably far more suited to treat patients than some 70 year old that's been grandfathered in. Say what you want about our field, but the people that have graduated in the last 15 years are among the brightest and best, and getting through the boards have made them pretty knowledgeable doctors. I hassle people about fractionation, but we all agree on the overall treatment of the vast majority of cancer patients. Not many fields have not sort of consensus. A second opinion radiation consultation generally just confirms what the first gal said. A second opinion to a surgeon can led to a drastically different management plan.

Not gonna get a job in a good city easily. Going to get paid less and less. I'd estimate $300k salary in a nice city mid career, and $400k in a rural area mid career. Still not bad money for a great job.

 

[OTN]

Well, I'm not in support of this "witch hunt". By the way, that's sort of sexist ... majority of these older doctors are not female, no reason to continue this war on women. Maybe Zombie Hunt? Sounds too apocalyptic. I'll have to think about that.

But, you gotta admit, the grandfathering in of the physicians that were older was a real jerk move. One, it was unfair to the rest of us. Two, the very people that should have been re-examined were being allowed to practice having their knowledge and skills assessed. It's one of the first reasons I started hating ASTRO and the ABR.

It's not that they are useless or relics. But, I would guarantee you that if someone studied average fractions delivered for a bone met by someone who is over 55 vs doctors that are underr 55, you would see a staggering difference. You're not going to see reliance on RTOG atlases for contouring, b/c these people were grandfathered in and don't have to study "the right way" to do something. It's not just because you're old that you're useless or a relic, but if you're older, in your 70s, and you aren't forced to continue to learn, there is good chance you won't be as "evidence based" or clinically sound. It's just the truth. Not picking on older docs. Some are good. Many are not. You have to be honest - some fresh grad that passed our battery of harrassment (i.e. the ABR's written and oral boards) is probably far more suited to treat patients than some 70 year old that's been grandfathered in. Say what you want about our field, but the people that have graduated in the last 15 years are among the brightest and best, and getting through the boards have made them pretty knowledgeable doctors. I hassle people about fractionation, but we all agree on the overall treatment of the vast majority of cancer patients. Not many fields have not sort of consensus. A second opinion radiation consultation generally just confirms what the first gal said. A second opinion to a surgeon can led to a drastically different management plan.

Not gonna get a job in a good city easily. Going to get paid less and less. I'd estimate $300k salary in a nice city mid career, and $400k in a rural area mid career. Still not bad money for a great job.

My understanding is that the certification of older radoncs done before the current MOC mess represented a "contract" between the ABR and the physician, so it grandfathering in HAD to be done. Forcing those docs to undergo recertification, while making perfect sense, would have violated the original contract. That's what the ABIM faced as well.

 

[XRT_doc]

Well, I'm not in support of this "witch hunt". By the way, that's sort of sexist ... majority of these older doctors are not female, no reason to continue this war on women. Maybe Zombie Hunt? Sounds too apocalyptic. I'll have to think about that.

But, you gotta admit, the grandfathering in of the physicians that were older was a real jerk move. One, it was unfair to the rest of us. Two, the very people that should have been re-examined were being allowed to practice having their knowledge and skills assessed. It's one of the first reasons I started hating ASTRO and the ABR.

It's not that they are useless or relics. But, I would guarantee you that if someone studied average fractions delivered for a bone met by someone who is over 55 vs doctors that are underr 55, you would see a staggering difference. You're not going to see reliance on RTOG atlases for contouring, b/c these people were grandfathered in and don't have to study "the right way" to do something. It's not just because you're old that you're useless or a relic, but if you're older, in your 70s, and you aren't forced to continue to learn, there is good chance you won't be as "evidence based" or clinically sound. It's just the truth. Not picking on older docs. Some are good. Many are not. You have to be honest - some fresh grad that passed our battery of harrassment (i.e. the ABR's written and oral boards) is probably far more suited to treat patients than some 70 year old that's been grandfathered in. Say what you want about our field, but the people that have graduated in the last 15 years are among the brightest and best, and getting through the boards have made them pretty knowledgeable doctors. I hassle people about fractionation, but we all agree on the overall treatment of the vast majority of cancer patients. Not many fields have not sort of consensus. A second opinion radiation consultation generally just confirms what the first gal said. A second opinion to a surgeon can led to a drastically different management plan.

Not gonna get a job in a good city easily. Going to get paid less and less. I'd estimate $300k salary in a nice city mid career, and $400k in a rural area mid career. Still not bad money for a great job.

LOL Zombie Hunt.

 

[RadOncDoc21]

I'm not trying to add to the witch hunt but my retiring partner did IMRT on everyone, full fractionation course, never did any type of complex contours, would treat anything that looks suspicious and did not believe in having a setup margin.

Not saying they're all like that but come on man!

 

[redoitall]

If you don't mind places like Salina KS, Rhinelander WI or somewhere near the great lakes, you'll be fine, even 5-10 years from now

It's that bad hey? I could make do, not sure about the weather though... But at least it is good to know that I may have a way to pay back those damn loans.

 

[mpdoc2]

As an MS3 contemplating RadOnc, it is a bit scary. I don't want to live on the coasts or even any big city in particular. I am fairly flexible so hopefully that will help. But I find it quite sad that I have to worry about job prospects even before starting residency. I was interested in Rads and RadOnc and think that radonc is better. Yet when I read this article and all the job reports, how can we go from a shortage (by all prediction) to now a possible excess. Honestly, I don't see myself doing anything else. Still this stuff is disheartening.

Benjamin Smith was off by an order of magnitude and now you still have chairmen and program directors still pointing to his paper as an excuse for expanding their program when in reality they just wanted cheap labor. Some graduates are resorting to fellowships which unlike radiology doesn't really help the resident find a job. I guess that's even more cheap labor for the chairmen to hire!

 

[redoitall]

Benjamin Smith was off by an order of magnitude and now you still have chairmen and program directors still pointing to his paper as an excuse for expanding their program when in reality they just wanted cheap labor. Some graduates are resorting to fellowships which unlike radiology doesn't really help the resident find a job. I guess that's even more cheap labor for the chairmen to hire!

Well in Rads, a fellowship has become a requirement (almost) to get a job. RadOnc is not that (at least yet). What amazes me is why do we keep pumping out 170 new Radiation Oncologists per year if the job market can't absorb them. Granted that cheap labor might be one of the reasons. But at term, the field will become less attractive...

 

[Damn_Daniel]

I've seen people contour uterus as the bladder for intact uterine cancer cases, the whole neck (muscles and all) for head and neck IMRT cases, and completely omit the mesorectum for rectal cases. People don't get trained for more conformal treatment planning unless they have to or want to. You can lead a horse to water, but you can't make him open a book.

 

[mpdoc2]

Well in Rads, a fellowship has become a requirement (almost) to get a job. RadOnc is not that (at least yet). What amazes me is why do we keep pumping out 170 new Radiation Oncologists per year if the job market can't absorb them. Granted that cheap labor might be one of the reasons. But at term, the field will become less attractive...

You'd be surprised how dumb and short-sighted chairmen in radonc are. They're usually from the old-guard when any idiot could get into the field. I know a couple of them who wouldn't even get into the field if they applied today.

 

[Reaganite]

I've seen people contour uterus as the bladder for intact uterine cancer cases, the whole neck (muscles and all) for head and neck IMRT cases, and completely omit the mesorectum for rectal cases. People don't get trained for more conformal treatment planning unless they have to or want to. You can lead a horse to water, but you can't make him open a book.

View attachment 201948

I briefly experimented with hiring older docs because they are cheaper, but I will never make that mistake again. Don't know what it is about contouring neck muscles and completely missing the actual lymph nodes, but I'd see that on almost every patient. The worst part is I would direct them to textbooks, RTOG contouring atlases, etc. and I would always get "I don't believe that stuff." Plus, these guys have no concept of GTV, CTV, PTV. I recently signed a contract to review rad onc treatment practices for a county hospital, and I couldn't believe the contours I was seeing. The clinical outcomes were ever scarier. Essentially, every head and neck patient recurred...many almost immediately after completing chemo-RT since so much of the neck was missed in the target volumes. Scary stuff going on, but these dinosaurs still control many of the private practices.

 

[RadOncDoc21]

Unfortunately, these are the ones who milked the use of IMRT in the early 2000's and made a killing while reimbursements are going down faster then a Kardashian... Hello!

 

[Damn_Daniel]

Yup, and these very people don't have to take the tests. Thanks, ASTRO. Another great move, guys. Sell out young docs? Check. Sell out freestanding centers? Check. Stand silently while residencies double in size? Check. People think that my old buddy Randy Paul was a crank for creating a parallel licensure system for opthalmology, but honestly, it makes a lot of sense. The current one for initial certification is very strong, but the MOC/recertification is a complete and utter joke. It's offensive. I wish I could create a Damn Daniel Certification. When you pass, you get a "Back it at again with that specialty licensure!" commemorative letter and white Vans. Honestly, though, we don't have very good representation. Really lame.

I briefly experimented with hiring older docs because they are cheaper, but I will never make that mistake again. Don't know what it is about contouring neck muscles and completely missing the actual lymph nodes, but I'd see that on almost every patient. The worst part is I would direct them to textbooks, RTOG contouring atlases, etc. and I would always get "I don't believe that stuff." Plus, these guys have no concept of GTV, CTV, PTV. I recently signed a contract to review rad onc treatment practices for a county hospital, and I couldn't believe the contours I was seeing. The clinical outcomes were ever scarier. Essentially, every head and neck patient recurred...many almost immediately after completing chemo-RT since so much of the neck was missed in the target volumes. Scary stuff going on, but these dinosaurs still control many of the private practices.

 

[redoitall]

You'd be surprised how dumb and short-sighted chairmen in radonc are. They're usually from the old-guard when any idiot could get into the field. I know a couple of them who wouldn't even get into the field if they applied today.

mpdoc2, my biggest concern is that I can't see myself do anything else, given my interests and background, as well as the entire paradigm of the practice of medicine. There are so many things I dislike about that paradigm (details beside the point), and I think RadOnc is relatively free of many of these issues (although I do not know everything about RadOnc practice I must admit).
Now, I am just curious, but as an attending, how difficult is it to start one's own RadOnc practice, I mean with the equipment needed and market, how realistic is it to think about that. As a disclaimer, my goal is academic medicine, and running a business is not an endeavor I contemplate at all...

 

[mpdoc2]

mpdoc2, my biggest concern is that I can't see myself do anything else, given my interests and background, as well as the entire paradigm of the practice of medicine. There are so many things I dislike about that paradigm (details beside the point), and I think RadOnc is relatively free of many of these issues (although I do not know everything about RadOnc practice I must admit).
Now, I am just curious, but as an attending, how difficult is it to start one's own RadOnc practice, I mean with the equipment needed and market, how realistic is it to think about that. As a disclaimer, my goal is academic medicine, and running a business is not an endeavor I contemplate at all...

It's not realistic. The capital costs are too high to start fresh and the markets are over-saturated with radiation facilities. So it would be difficult to get patients in the door when you have expenses costing millions/yr. So unless you have a group of surgeons and medoncs who are your family or are your best-friends to send you patients, you probably won't be able to open up a practice. This is especially the case now since the Hospitals have realized radiation can make them money and have pretty much employed all the medoncs.

 

[medicinewoman101]

It's not just the 70 year olds, it's like 45+. Total obstructionist physicians. We really shouldn't beafraid to speak out against our elders. Esp the ones that are out in practice not contributing anything to the field, trying to pump profits like it's their job with no understanding or willingness to learn modern techniques. Quote studies or guidelines or atlases and they are above it. "No no, I've never seen this toxicity develop, Its not possible for someone to achieve a cure like this etc..." They must be Holden to a different creator bc they know more than randomized trials. Stop being afraid to speak out against them, they are everywhere. Yes they are the chairmen who over enrolled our field for cheap labor residents while pulling salaries so they can have their summer home in croatia. The reply to the IJROBP letter (the so called bloodbath) is one of the most shameful things I've ever seen published and we just went along with it.

 

[medgator]

It's not realistic. The capital costs are too high to start fresh and the markets are over-saturated with radiation facilities. So it would be difficult to get patients in the door when you have expenses costing millions/yr. So unless you have a group of surgeons and medoncs who are your family or are your best-friends to send you patients, you probably won't be able to open up a practice. This is especially the case now since the Hospitals have realized radiation can make them money and have pretty much employed all the medoncs.

That's a bit too simplistic. Freestanding centers may be down, but they are not out. As hospitals open and consolidate centers, payors are looking for the less expensive option. Many insurance companies preferentially contract with freestanding centers because they deliver care for less $$$. That being said, starting a center in the current environment would be very tough. Freestanding centers these days go with gently used while hospitals are shelling out $$$$ for truebeam and protons. They may hire MAs or LPNs while RNs staff hospital sites. That is how they survive (lower cost structure).

The future may not be as kind to hospital-based radiation oncology as it has been the last decade. Things like bundled payments and payment parity legislation (equalizing pay between freestanding and hospital-based centers) may swing the pendulum back towards freestanding radiation oncology.

The reply to the IJROBP letter (the so called bloodbath) is one of the most shameful things I've ever seen published and we just went along with it.

I don't think any of us "went along with it" Just check out that thread http://forums.studentdoctor.net/threads/bloodbath-in-red-journal.1014614/

 

[Damn_Daniel]

Nobody went along with it. Everyone is pissed. We sacrificed a new hire, not because we didn't need her, but we needed to make sure that everyone understood that the #struggleisreal. Everywhere you go, you see a radonc. My uber driver was a PGY5 in Louisville, had no idea what he was going to do next. Was like, "well, we need a PA". Even academic centers do incentive pay via RVUs. You think I want some dum dum taking the patients I can easily treat myself?

Wifi at my uncles funeral is a f-cking joke. This took forever to get through.