Canadian patients coming to US for RT

[IonsAreOurFuture]

My center includes protons so I'm used to patients traveling out of their home country to get care, but this headline surprised me:

Sending BC cancer patients to US won't fix overstretched system, says doctor

The situation in Vancouver, BC area is so bad that THOUSANDS of patients are now being sent to the US for XRT, all expenses paid. And it's not complicated patients, mostly prostate and breast patients.

It sounds like a 2 to 3 month wait to start treatment is not uncommon, and only 77% of patients start RT "within 28 days" - from consult or sim I'm guessing. 31 linacs in the province is not enough, 16 more are on order.

If the job market in the US sucks, they need you in Vancouver yesterday and it sounds like $480k to start (Canadian dollars).

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[wysdoc]

The two Canadian provinces which are now welcoming US licensed physicians are Ontario and Nova Scotia.
So maybe not Vancouver just yet but Toronto!
Two Canadian Provinces Lift Licensing Barriers for US Docs.

 

[IonsAreOurFuture]

Trying to get faster than usual care, by having concierge access to your doctor, is potentially against the law:

Telus Health's services under review after allegations of two-tiered medical care

Medical Services Commission to review practices to confirm Telus is not allowing queue jumping for patients who pay a fee.

vancouversun.com

Now that's just un-American! Seriously though, I wonder how long their PM Justin Trudeau would be waiting if he had prostate cancer.

 

[deleted1111261]

he has a different set of rules than other Canadians

 

[IonsAreOurFuture]

All animals are equal, but some are more equal than others...

 

[communitydoc13]

I wonder how long their PM Justin Trudeau would be waiting if he had prostate cancer.

Anyone who has prostate cancer can wait 6 months. An unpopular truth. Any life threatening prostate cancer managed with XRT is also going to get ADT. Despite that recent paper, no convincing data that starting XRT early relative to ADT really beneficial.

Probably also true for most ER+ breast cancer. If they are sending patients across the boarder, hopefully H&N, lung and CNS.

 

[taserlaser]

The focus is on the 5 fraction ones - most convenient for patients. 5 fr breast, some prostate (not sure if prostate SBRT or they are considering more protracted regimens). Last I heard was that the BC ROs and dosimetry were doing the planning and it was just the delivery that was contracted out, but I am not privy to the full details.

 

[Chartreuse Wombat]

My center includes protons so I'm used to patients traveling out of their home country to get care, but this headline surprised me:

Sending BC cancer patients to US won't fix overstretched system, says doctor

The situation in Vancouver, BC area is so bad that THOUSANDS of patients are now being sent to the US for XRT, all expenses paid. And it's not complicated patients, mostly prostate and breast patients.

It sounds like a 2 to 3 month wait to start treatment is not uncommon, and only 77% of patients start RT "within 28 days" - from consult or sim I'm guessing. 31 linacs in the province is not enough, 16 more are on order.

If the job market in the US sucks, they need you in Vancouver yesterday and it sounds like $480k to start (Canadian dollars).

Housing is absurdly expensive in Vancouver. CAN$480k probably can't buy a house within an hour of downtown..well maybe near the open air drug market

 

[Fpg1245]

Sending BC cancer patients to US won't fix overstretched system, says doctor

If the job market in the US sucks, they need you in Vancouver yesterday and it sounds like $480k to start (Canadian dollars).

I don’t think anything they do short of executing their elderly citizens will fix that shortage. So what’s their solution?

480K is a joke in a province and city that has actively refused to fix its housing shortage. I’m sure they can’t wait to rent a 2bed 2****ter in the bad part of town. Who knows maybe the BC cancer agency will offer a housing stipend lol!

 

[seper]

In Vancouver the average household income before taxes is 100K, so this definitely is not a joke

 

[evilbooyaa]

In Vancouver the average household income before taxes is 100K, so this definitely is not a joke

100k CAD or 100k real USD? If the former, ths 74k USD. Not nothing... but.

480k, if CAD, is 355k USD.

A few folks transferring from US centers to Canada though (as opposed to the much more common historical method of Canadian --> US) - Kirsch from Duke, Jillian Tsai from MSKCC, may be a few others.

 

[communitydoc13]

A few folks transferring from US centers to Canada though (as opposed to the much more common historical method of Canadian --> US) - Kirsch from Duke, Jillian Tsai from MSKCC, may be a few others.

Canada has a lot of upside. A doc is likely to be poorer, safer and with a better QOL in many ways. Canada now almost 18% Asian nationally and much more than that in the clean, cosmopolitan metros of Vancouver and Toronto, which both have tremendous nature near by. Their university system more sane than the US in terms of cost and quality and your kid can still apply to Princeton if they want to.

But, beer is expensive.

 

[sirspamalot]

Yeah.. no thanks.

Orca Islands, Victoria and Vancouver are cool to visit though.

 

[deleted1111261]

If money is the only thing that matters, then certain places and situations are just not going to work.

When 500k is “a joke” even in a big city, it tells your perspective. Docs making 500k in Vancouver or TDot are fine. Generally no/limited loans, don’t need to save much for college and food is relatively cheap. I just went this weekend. Ate like a king. Housing is tough, but if you’re from there, you figure it out.

It’s different there. Seems like just colder America, but it’s not. Most people - including docs - have a different relationship with money than we do. It’s a pretty great place to live if you’re of a different ethnicity/sexuality and that’s important to you (the big cities - I don’t know about the Letterkennys and other small towns)

 

[Neuronix]

Does this shortage of medical care have anything to do with a shortage of docs?

I was told by a recent Canadian grad that a few years ago not a single Canadian rad onc graduate finished with full-time rad onc attending level employment in Canada.

I applied for a physician-scientist position up there and was eventually told "no Americans need apply" due to oversupply of Canadian graduates. A friend of mine from Canada who came to the US for undergraduate through residency was basically told the same.

When 500k is “a joke” even in a big city, it tells your perspective.

Different discussion, but where I live houses in a decent school district with a decent commute start at $1000 sq/ft. At 7% mortgage rates, even at 500k/year it's tough to buy a two million dollar house for your family.

 

[taserlaser]

A few years ago that might be true, but right now I would say Canada is more on the undersupplied side of rad oncs. BC has hired over a national graduating class’s worth in the past 1-2 years, and basically alone as reset the market here. I think they’re the first ones to actively recruit for the upcoming demographic shift and we will see in time something similar across the rest of the country, although some of those hires were to fill people who left due to poor pay and high cost of living as there was /is some retention problems.

There are high wait times due to radiation capacity issues in general. There is a shortage of ROs in BC and I’m sure it plays a role here but not sure how direct.

Re job market, when I graduated there was a few grads that walked right into employment. Now it is the exception that would choose to upskill in brachy, peds etc but I think most are not choosing to do a fellowship now just given the direct employment opportunities available. The market is the best here it’s been in over 15 years in Canada at the moment. Our graduating residents each had multiple job offers, and we ourselves at my site are having trouble recruiting people to our centre at the moment. Multiple people have declined our offers to interview or offers of employment, and we have multiple unfilled spots we are trying to fill. Crazy how fast things can change.

One of the ROs I know that’s involved with our national Human Resources committee thinks we have less practicing ROs in Canada now than pre COVID. Aka we have already hit ‘peak Rad Onc’ right before we really need to expand and grow services due to population shift.

 

[taserlaser]

Does this shortage of medical care have anything to do with a shortage of docs?

I was told by a recent Canadian grad that a few years ago not a single Canadian rad onc graduate finished with full-time rad onc attending level employment in Canada.

I applied for a physician-scientist position up there and was eventually told "no Americans need apply" due to oversupply of Canadian graduates. A friend of mine from Canada who came to the US for undergraduate through residency was basically told the same.



Different discussion, but where I live houses in a decent school district with a decent commute start at $1000 sq/ft. At 7% mortgage rates, even at 500k/year it's tough to buy a two million dollar house for your family.

I will also add, since I have another friend who is looking for a clinician scientist position at the moment - true opportunities for those are still few and far between it seems, on both sides of the border. They’ve had very little luck with trying to negotiate something palatable so far. Our centre was a no go for something like that from the start. Really Toronto was the only place that would come close from what I heard.

 

[medgator]

A few years ago that might be true, but right now I would say Canada is more on the undersupplied side of rad oncs. BC has hired over a national graduating class’s worth in the past 1-2 years, and basically alone as reset the market here. I think they’re the first ones to actively recruit for the upcoming demographic shift and we will see in time something similar across the rest of the country, although some of those hires were to fill people who left due to poor pay and high cost of living as there was /is some retention problems.

There are high wait times due to radiation capacity issues in general. There is a shortage of ROs in BC and I’m sure it plays a role here but not sure how direct.

Re job market, when I graduated there was a few grads that walked right into employment. Now it is the exception that would choose to upskill in brachy, peds etc but I think most are not choosing to do a fellowship now just given the direct employment opportunities available. The market is the best here it’s been in over 15 years in Canada at the moment. Our graduating residents each had multiple job offers, and we ourselves at my site are having trouble recruiting people to our centre at the moment. Multiple people have declined our offers to interview or offers of employment, and we have multiple unfilled spots we are trying to fill. Crazy how fast things can change.

One of the ROs I know that’s involved with our national Human Resources committee thinks we have less practicing ROs in Canada now than pre COVID. Aka we have already hit ‘peak Rad Onc’ right before we really need to expand and grow services due to population shift.

Interesting. They have never taken US grads right, unlike the reverse, historically right?

 

[taserlaser]

Interesting. They have never taken US grads right, unlike the reverse, historically right?

Historically US grads have never wanted to come to Canada as US income was bonkers compared to us. Publicly funded institutions (ie basically every Canadian radiotherapy centre) must prioritize eligible Canadian citizens and permanent residents first before considering internationals. That is probably the bigger barrier. If someone much less qualified though still eligible applies, it puts the centre in a tough spot to select someone from the US. Not to say it hasn't happened though. Those factors in conjunction I think limit most people from applying. Licensing with ABR credentials I don't see as a big issue, though probably is some more paperwork from the provincial colleges.

Example - see this contemporaneous posting for Western, near the end - https://caro-acro.wildapricot.org/r...023/AD.Schulich_Radiation Oncologist_2023.pdf

"In accordance with Canadian immigration requirements, priority will be given to Canadian citizens and permanent residents."

 

[deleted1111261]

The salaries are coming closer (in Canadian dollars), right?

The difference was staggering before, but I heard some things have changed with regards to limitations on number of consults that can be seen.

So Taser, I’m a Canadian citizen but US greencard. I’d get preference ?

 

[taserlaser]

Re salaries - maybe? But we have also had a lot of attrition due to inflationary loss over the past decade+ too so hard to say. Cost of living in many Canadian cities have skyrocketed too, so ymmv

Re limitations on consults - I do not know/understand what you’re speaking of here. Probably just a limitation of where I practice. Each province has a different contract and organization in terms of remuneration. Some provinces are pure salary, some are mixed per diem + per patient/treatment, etc.

Re Canadian citizen - would put you in the ’not unhirable’ catagory at a minimum. Hard to say how a chair would view things as a whole but worthwhile opening up a dialogue with a centre if you were looking to move for sure. Probably more positive than not I think

 

[sirspamalot]

Imagine you live in a major metro area. Your 1M home you put down 30% because you can. Your two kids need to go to private school because public schools suck, at least until high school (50k a year) and of course you need a couple cars. You'll want to take a nice vacation a couple times, and the kids activities aren't free. You need stuff for the home, clothes and occasionally easting out. Dogs aren't cheap either. Don't forget to save for retirement.

500k on a W2 won't get you there comfortably.

 

[Fpg1245]

Imagine you live in a major metro area. Your 1M home you put down 30% because you can. Your two kids need to go to private school because public schools suck, at least until high school (50k a year) and of course you need a couple cars. You'll want to take a nice vacation a couple times, and the kids activities aren't free. You need stuff for the home, clothes and occasionally easting out. Dogs aren't cheap either. Don't forget to save for retirement.

500k on a W2 won't get you there comfortably.

500K is really not a lot of money in major metro. In Cali you’re basically middle class and any east coast cities. Moving to BC or Ontario sounds like the problem is even worse.

Factor in that you’re W2 and basically footing the bill for any new social programs these cities have in mind without any way of hiding the income.

 

[sirspamalot]

hiding the income

Uh, you mean legal deductions?

"Yeah, thats the ticket" -1990's

#

 

[deleted1111261]

Imagine you live in a major metro area. Your 1M home you put down 30% because you can. Your two kids need to go to private school because public schools suck, at least until high school (50k a year) and of course you need a couple cars. You'll want to take a nice vacation a couple times, and the kids activities aren't free. You need stuff for the home, clothes and occasionally easting out. Dogs aren't cheap either. Don't forget to save for retirement.

500k on a W2 won't get you there comfortably.

We have different world views

We are not paying for private school. 50k a year? I guess that’s a $100k raise for me. But seriously, the absolute best school in Detroit suburbs is $40k (Cranbrook) and the Parikhs are humbly accepting of “not best” for most things in life. If we had to, would consider the local Catholic school for my son who needs to get his knuckles rapped, which is <$14k

1 mil house? After 10 years+ out as a RO, I really hope one can afford this comfortably. We don’t pay that much for houses, but have more than one. I’ve never made spam money in my life. Never hit 7 digits, never scratched the surface.

I barely make over that number and I can’t imagine needing more. I certainly want more, but not really willing to do much to get it, so here we are.

I’m pretty cheap. Used 2018 Camry, no watches, no ski chalet, no country club, stay in 3-4 star instead of 5 star, wife DIYs a ton of ****.

 

[Fpg1245]

Uh, you mean legal deductions?

"Yeah, thats the ticket" -1980's

If you don’t own your own business, it simply doesn’t work. My neighbor drives an Aston Martin and a Ferrari and works 5 hours a day. Runs a small niche business. We live in a similar size homes. You think he’s paying taxes? **** no!

 

[sirspamalot]

#1099orGTFO - There is no other way. Not at our level.

I have worked for 1 full year as a W2 since leaving academia mid 2000's. But alas, many big institutions will never let you do this. So, you must geographically arbitrage to a smaller locale that is willing to play ball (and fight with the mothership) to allow 1099, to keep a high quality doc from leaving.

 

[communitydoc13]

the Parikhs are humbly accepting of “not best” for most things in life

Wow, baller Simul with a healthy take on dough. Kudos!

Canada not crazy at all. Have a good friend that moved there. He is less wealthy than he could be here, but much more security and more importantly, he is much more comfortable with the culture there.

US docs (specialists at least) tend to be aspirational regarding money.

 

[IonsAreOurFuture]

We have different world views

We are not paying for private school. 50k a year? I guess that’s a $100k raise for me. But seriously, the absolute best school in Detroit suburbs is $40k (Cranbrook) and the Parikhs are humbly accepting of “not best” for most things in life. If we had to, would consider the local Catholic school for my son who needs to get his knuckles rapped, which is
1 mil house? After 10 years+ out as a RO, I really hope one can afford this comfortably. We don’t pay that much for houses, but have more than one. I’ve never made spam money in my life. Never hit 7 digits, never scratched the surface.

I barely make over that number and I can’t imagine needing more. I certainly want more, but not really willing to do much to get it, so here we are.

I’m pretty cheap. Used 2018 Camry, no watches, no ski chalet, no country club, stay in 3-4 star instead of 5 star, wife DIYs a ton of ****.

I think it also has a little to do with how you grew up and your expectations for success, in terms of wealth.

For some people, $500k a year is a disaster, for others it feels like living the dream.

 

[seper]

#1099orGTFO - There is no other way. Not at our level.

I have worked for 1 full year as a W2 since leaving academia mid 2000's. But alas, many big institutions will never let you do this. So, you must geographically arbitrage to a smaller locale that is willing to play ball (and fight with the mothership) to allow 1099, to keep a high quality doc from leaving.

for most motherships, there is no such thing as a quality doc

 

[sirspamalot]

for most motherships, there is no such thing as a quality doc

 

[RickyScott]

I think it also has a little to do with how you grew up and your expectations for success, in terms of wealth.

For some people, $500k a year is a disaster, for others it feels like living the dream.

It really depends on your debt and where you live. 2 cars and a house in a very desirable location- SoCal, nyc, boston, sf could be difficult given taxes and cost of housing.

 

[medgator]

It really depends on your debt and where you live. 2 cars and a house in a very desirable location- SoCal, nyc, boston, sf could be difficult given taxes and cost of housing.

Forget about home ownership. Renting at $300-500k household imo in those markets

 

[sirspamalot]

Take home pay after taxes etc on 300k a year might be 180k. That is simply unsustainable, and pretty sad compensation really for such a highly specialized expert.

Interestingly, in 2006, I learned that the yacht I was on ("Lady Linda") cost 250,000 to refuel.

So here we are.

 

[RickyScott]

Take home pay after taxes etc on 300k a year might be 180k. That is simply unsustainable, and pretty sad compensation really for such a highly specialized expert.

Interestingly, in 2006, I learned that the yacht I was on ("Lady Linda") cost 250,000 to refuel.

So here we are.

That’s what Mikey Steinberg starts you off at.

 

[sirspamalot]

 

[deleted1111261]

If you want to live in the best city, have the best house, send your kids to the best schools, etc., even $2m a year may not cut it.

If you can figure out that best is a mindset, well.. you can work in a town like Port Huron and feel like a king.

 

[RickyScott]

If you want to live in the best city, have the best house, send your kids to the best schools, etc., even $2m a year may not cut it.

If you can figure out that best is a mindset, well.. you can work in a town like Port Huron and feel like a king.

A lot of grew up middle class in places like SoCal, nyc Boston suburbs w/ families still there.

 

[deleted1111261]

Have to learn to manage expectations.

Physicians used to be the richest family on a given block. Now, a $500k salary doesn’t crack the top 1%ile in Los Angeles.

 

[OTN]

Have to learn to manage expectations.

Physicians used to be the richest family on a given block. Now, a $500k salary doesn’t crack the top 1%ile in Los Angeles.

For those who were curious like I was, it takes $805,000 to be in the top 1% of income across the state of California:

Are you in California’s top 1%? New income analysis explains

Depending on where you live, it may not take as much income as you’d think to be in the top 1% of earners.

ktla.com

 

[sirspamalot]

Where does that put me if you earn about that but in a flyover state (lol)

 

[OTN]

$500k gets you into the top 1% in Ohio

Are you in Ohio’s top 1%? New income analysis explains

Depending on where you live, it may not take as much income as you’d think to be in the top 1% of earners.

www.nbc4i.com

 

[seper]

these are individual incomes? for a physician, household incomes are more informative IMO

 

[radoncftw]

That’s what Mikey Steinberg starts you off at.

and his service is 100% covered

 

[NotMattSpraker]

and his service is 100% covered

LOL pulling two separate residents because the service cant go uncovered for even a day...

 

[deleted1111261]

these are individual incomes? for a physician, household incomes are more informative IMO

Why for physician ? Is there some association with double incomes in physician households vs other ?

 

[sloh]

If you want to live in the best city, have the best house, send your kids to the best schools, etc., even $2m a year may not cut it.

If you can figure out that best is a mindset, well.. you can work in a town like Port Huron and feel like a king.

I live in SoCal. 1.5-2 million household income would cut it.

 

[seper]

Why for physician ? Is there some association with double incomes in physician households vs other ?

Well, traditionally the physician is a busy, in-person worker.
Thus doctors need a partner to stay home more and earn less.
In order to attain 1% percent living standard, doctor would need to earn essentially double.

This is of course very simplified

 

[communitydoc13]

you can work in a town like Port Huron and feel like a king.

I like to think of this incarnation of Simul as the "Joe Pera" version. Not quite UP and not quite a music teacher, but close. Of course, the world needs more Joe Peras.

 

[deleted1111261]

Well, traditionally the physician is a busy, in-person worker.
Thus doctors need a partner to stay home more and earn less.
In order to attain 1% percent living standard, doctor would need to earn essentially double.

This is of course very simplified

Wow. Is this for male physicians, female physicians or both ?

In an economic sense, we can use the Law of Comparative Advantage to sort this out.

It means a very fast typing lawyer should still hire a secretary. Or, a high earning physician outsources cleaning the house and lawn care.

Currently, I’m working full time and my wife doesn’t work outside the house. She is far busier than me.