Is ID in worse shape than RO?

[Chartreuse Wombat]

Why No one Wants to Match into Infectious Diseases

An East Coast Academic Infectious Disease doctor & Professor tells the truth no one will say

vinayprasadmdmph.substack.com

---

Members don't see this ad.

 

[RadOncDoc21]

Why No one Wants to Match into Infectious Diseases

An East Coast Academic Infectious Disease doctor & Professor tells the truth no one will say

vinayprasadmdmph.substack.com

Definitely seems like he has an unbiased, non-political position.

 

[medgator]

Big story on NPR last night too

Newest doctors shun infectious diseases specialty

The pandemic put infectious diseases doctors in the spotlight. The 'Fauci Effect' raised the number of fellowship applicants in 2020, but this year almost half of the training programs went unfilled.

www.npr.org

Pay is pretty ****ty compared to cards, gi, heme/onc etc precisely because they aren't procedural or prescribing expensive drugs all the time from their pharmacy

 

[metallica81788]

ID can always go back and be a hospitalist, urgent care, etc, if wheels fall off or they hate it

We can't do jack s*** else

 

[Fpg1245]

Big story on NPR last night too

Newest doctors shun infectious diseases specialty

The pandemic put infectious diseases doctors in the spotlight. The 'Fauci Effect' raised the number of fellowship applicants in 2020, but this year almost half of the training programs went unfilled.

www.npr.org

Pay is pretty ****ty compared to cards, gi, heme/onc etc precisely because they aren't procedural or prescribing expensive drugs all the time from their pharmacy

It has worse comp than IM. But ID certainly has better long and short term job prospects. It’s very existence as a field isn’t on the line.

I def don’t cry for ID even if NPR does

 

[NotMattSpraker]

Big story on NPR last night too

Newest doctors shun infectious diseases specialty

The pandemic put infectious diseases doctors in the spotlight. The 'Fauci Effect' raised the number of fellowship applicants in 2020, but this year almost half of the training programs went unfilled.

www.npr.org

Pay is pretty ****ty compared to cards, gi, heme/onc etc precisely because they aren't procedural or prescribing expensive drugs all the time from their pharmacy

Is there a shortage or are we just lamenting that no on thinks ID is cool?

I don't understand why doctors take it personally when their field doesn't fill.

"I'm bummed out," says Dr. Carlos Del Rio, a professor at the Emory School of Medicine and president of the Infectious Diseases Society of America. "I love my field, I love what I do. And it's upsetting to know that my field may not be as attractive to trainees as I would like it to be."

This is a highly accomplished adult, full professor, and president of a society. As long as there are enough ID docs, he has earned the privilege to give no f#$%! what some med student thinks about ID.

All that said, maybe ASTRO can hire him as an insecurity consultant and boost up the med student propaganda section of their website.

 

[deleted1116990]

Why No one Wants to Match into Infectious Diseases

An East Coast Academic Infectious Disease doctor & Professor tells the truth no one will say

vinayprasadmdmph.substack.com

Let me address the obvious question as to why I am writing this piece anonymously. I am an ID faculty member at an academic center on the East coast but am somewhat early career and cannot risk the personal and professional backlash that might ensue if people knew I harbor these views.

That pretty much sums it up (and also why I don't think I could work for an academic or even large system again). Lots of people think infection control policies/dogma/mandates are ridiculous but are bludgeoned into compliance with direct threats to their employment and indirect threats to their reputation.

No, I wouldn't go into a field that has become entangled in stupid political arguments day-to-day even if it did pay well, which it doesn't. Sadly, that will probably just get worse as it will self-select for the handful who actually want to be involved in exactly that and become more of an echo chamber detached from the realities of life thereby resulting in even more boneheaded policy recommendations/demands.

$750orGTFO? More like $750andGTFOassoonasyoucan. I have serious doubts about both the profitability and viability of working in health care 10+ years from now, in any field, I have my doubts if this will still be viewed as a desirable career path for anybody. The AI chatbots has got me wondering if diagnostic rads, the best field to match into right now, will even exist then. Everyone else will just be tools of the government.

 

[NotMattSpraker]

No, I wouldn't go into a field that has become entangled in stupid political arguments day-to-day even if it did pay well, which it doesn't.

Wait, aren't you a radiation oncologist?

 

[communitydoc13]

As long as there are enough ID docs, he has earned the privilege to give no f#$%! what some med student thinks about ID.

Couldn't agree more.

Now med school deans and AAMC should have advocated for more docs decades ago. I will never understand how we let ourselves get into the position where even remotely adequately staffing community hospitals is contingent on a large influx of foreign medical school graduates. A situation that is itself vulnerable to political whimsy.

We need more medoncs and PCPs now. We may not need them in 20 years.

Regarding ID, it is as antithetical to radonc as any field in medicine: largely not procedural, significantly responsible for setting public health policy and poorly paid. It has it's perks and has always been a self selecting field.

An ID doc friend of mine once said to me, "you literally have a machine that prints money". I had to laugh. I made a lot more than him for probably the same amount of work, but he was on the faculty at a nice place in my home town, traveled the world to train folks in ID care and prevention, and was influential in medical school education. In many ways, I view his job as cooler.

Will there be enough ID docs for community care needs? I'm guessing probably so. Often a 200 bed hospital will get by with 1+ ID docs. You don't need an ID doc to treat every patient with COVID, you need hospitalists and intensivists and respiratory therapists and nurses. It is useful to have an in house ID expert.. In my experience, it is the ID docs expertise more than their presence or physical intervention that provides value.

Do we need more ID docs for the public health apparatus? I'm guessing probably not.

Again, it is likely that the medstuds are just smart.

 

[Fpg1245]

Couldn't agree more.

Now med school deans and AAMC should have advocated for more docs decades ago. I will never understand how we let ourselves get into the position where even remotely adequately staffing community hospitals is contingent on a large influx of foreign medical school graduates. A situation that is itself vulnerable to political whimsy.

We need more medoncs and PCPs now. We may not need them in 20 years.

Regarding ID, it is as antithetical to radonc as any field in medicine: largely not procedural, significantly responsible for setting public health policy and poorly paid. It has it's perks and has always been a self selecting field.

An ID doc friend of mine once said to me, "you literally have a machine that prints money". I had to laugh. I made a lot more than him for probably the same amount of work, but he was on the faculty at a nice place in my home town, traveled the world to train folks in ID care and prevention, and was influential in medical school education. In many ways, I view his job as cooler.

Will there be enough ID docs for community care needs? I'm guessing probably so. Often a 200 bed hospital will get by with 1+ ID docs. You don't need an ID doc to treat every patient with COVID, you need hospitalists and intensivists and respiratory therapists and nurses. It is useful to have an in house ID expert.. In my experience, it is the ID docs expertise more than their presence or physical intervention that provides value.

Do we need more ID docs for the public health apparatus? I'm guessing probably not.

Again, it is likely that the medstuds are just smart.

AAMC just wants to sell more and deans need to keep their school enrollment filled and expanding. The question of whether or not we need more docs is largely philosophical. Too many vested interests in getting a real answer to this question.

 

[medgator]

AAMC just wants to sell more and deans need to keep their school enrollment filled and expanding. The question of whether or not we need more docs is largely philosophical. Too many vested interests in getting a real answer to this question.

Huge explosion of DO schools from what I've seen lately, many with much larger tuition bills than what would be seen at in state MD schools. Many of these DO schools are for profit/PE-associated from what I've been reading.

Burrell is one I've seen advertising a lot lately in our area but apparently there's a plethora of them now. No difference imo with them vs ITT tech or Corinthian colleges. Or the likes of HCA trying to expand EM residency programs. Societal need isn't aligning with investor need.

For-Profit Medical Schools, Once Banished, Are Sneaking Back

In Idaho’s 2016 State of the State address, then-governor Butch Otter announced that he was directing the state’s Board of Education to work with the

tcf.org

Once Banned, For-Profit Medical Schools Are On The Rise Again In The U.S.

Montana is one of only four states without a medical school, and two groups with different financial models hope to remedy that. One plans a for-profit school, but critics say students may suffer.

www.npr.org

 

[Lamount]

Let me address the obvious question as to why I am writing this piece anonymously. I am an ID faculty member at an academic center on the East coast but am somewhat early career and cannot risk the personal and professional backlash that might ensue if people knew I harbor these views.

That pretty much sums it up (and also why I don't think I could work for an academic or even large system again). Lots of people think infection control policies/dogma/mandates are ridiculous but are bludgeoned into compliance with direct threats to their employment and indirect threats to their reputation.

No, I wouldn't go into a field that has become entangled in stupid political arguments day-to-day even if it did pay well, which it doesn't. Sadly, that will probably just get worse as it will self-select for the handful who actually want to be involved in exactly that and become more of an echo chamber detached from the realities of life thereby resulting in even more boneheaded policy recommendations/demands.

$750orGTFO? More like $750andGTFOassoonasyoucan. I have serious doubts about both the profitability and viability of working in health care 10+ years from now, in any field, I have my doubts if this will still be viewed as a desirable career path for anybody. The AI chatbots has got me wondering if diagnostic rads, the best field to match into right now, will even exist then. Everyone else will just be tools of the government.

Agree. At the risk of holding an unpopular view, I would argue DR has more to fear in the long run than we do.

If we accept that AI will become (or already is) better at reading scans than a DR… it will be much easier to prove AI superiority in a clinical trial than it will be to prove AI is better than a RO -not because we are any more competent, it’s just experimentally much more difficult.

 

[radoncftw]

Anecdotal evidence - but where I did intern year, probably like 10% of the the hospitalists were ID docs. Fellowship trained. They worked full time as hospitalists because it was more lucrative. It was nice because we never had to consult ID when they were attending for our IM team. But I found it kind of weird to train for 2-3 years and then do a job that you could have done without the additional training.

 

[radoncftw]

Agree. At the risk of holding an unpopular view, I would argue DR has more to fear in the long run than we do.

If we accept that AI will become (or already is) better at reading scans than a DR… it will be much easier to prove AI superiority in a clinical trial than it will be to prove AI is better than a RO -not because we are any more competent, it’s just experimentally much more difficult.

my DR colleagues get twice as much vacation as I do...

 

[medgator]

Agree. At the risk of holding an unpopular view, I would argue DR has more to fear in the long run than we do.

If we accept that AI will become (or already is) better at reading scans than a DR… it will be much easier to prove AI superiority in a clinical trial than it will be to prove AI is better than a RO -not because we are any more competent, it’s just experimentally much more difficult.

Not at all. Too much of a growth in studies volume, ai may help them keep their workload more manageable but in our area, DR demand still >>> RO demand. AI might be the one thing that makes their daily grind more palatable

 

[NotMattSpraker]

Not at all. Too much of a growth in studies volume, ai may help them keep their workload more manageable but in our area, DR demand still >>> RO demand. AI might be the one thing that makes their daily grind more palatable

Totally agree. In fact, Radiology is a nice case study to see how "market forces" can shape a job in good and bad ways. They talk and write openly about it a lot. AI, private equity, scope of practice of mid-levels. It's been going on since I was a med student.

As a Radiation Oncologist, my biggest concern is stewardship of our field... so I guess other Radiation Oncologists.

 

[Lamount]

my DR colleagues get twice as much vacation as I do...

I don't know about vacation... but in my academia microcosm, RO makes more than MO, DR, and about the same as IR

@NotMattSpraker Those who know me know that I am a hopeless optimist... that is to say, take this with a grain of salt. Regarding stewardship, I am encouraged by the quality of mid-career academicians -the GenXers who trained Xennials like me. I think the old guard is retiring and the new guard are impressive and bright folks.

 

[NotMattSpraker]

I don't know about vacation... but in my academia microcosm, RO makes more than MO, DR, and about the same as IR

@NotMattSpraker Those who know me know that I am a hopeless optimist... that is to say, take this with a grain of salt. Regarding stewardship, I am encouraged by the quality of mid-career academicians -the GenXers who trained Xennials like me. I think the old guard is retiring and the new guard are impressive and bright folks.

I do agree. For the first time, Im letting my ASTRO membership expire, but Ill keep watching. If the board turns over and their behavior changes, happy to jump back in to support the good ones. Im also an optimist and hope they succeed.

 

[metallica81788]

I think the old guard is retiring and the new guard are impressive and bright folks.

They can be impressive and bright but if they are focusing their efforts on decreasing indications or other useless things, our field won't improve

 

[sirspamalot]

Impressively stupid to destroy the field by simultaneously promoting hypofrac while pushing protons you mean. Meanwhile, I gave up my ASTRO membership as well. Its like 800$ for a subscription to a couple journals that I can get the articles eventually via scihub. Its not the journal that I need to support, its the organization. Until the org starts giving even one about the solo private practitioner then after 20 years.. I'm just done.

ps. the insult of not showing the job details without membership, nor allowing pp to become fellows (practically speaking) is the cherry on top. No one called to ask me why I quit after 20 years.. just a couple canned emails. #representorGTFO

 

[medgator]

, nor allowing pp to become fellows is the cherry on top.

Not like i cared to become an Astro fellow but didn't know this was true. Terrible if it is

 

[NotMattSpraker]

Impressively stupid to destroy the field by simultaneously promoting hypofrac while pushing protons you mean. Meanwhile, I gave up my ASTRO membership as well. Its like 800$ for a subscription to a couple journals that I can get the articles eventually via scihub. Its not the journal that I need to support, its the organization. Until the org starts giving even one about the solo private practitioner then after 20 years.. I'm just done.

ps. the insult of not showing the job details without membership, nor allowing pp to become fellows is the cherry on top. No one called to ask me why I quit after 20 years.. just a couple canned emails. #representorGTFO

I dont think that is true, there are private practice fellows and there have even rarely been private practice presidents. That said, I totally agree that they are a society run by academics for academics, and their refusal to acknowledge that they don't work for all of RO is one of the most frustrating things.

Honestly, if they did even the bare minimum of supporting trainees and junior doctors, Id probably join again. People don't seem to realize how hostile they are compared to other societies, even in Rad Onc. Don't look at what ASCO is doing for their general rank and file, non-US folks, and juniors... you'll get really mad.

 

[TheWallnerus]

I dont think that is true, there are private practice fellows and there have even rarely been private practice presidents. That said, I totally agree that they are a society run by academics for academics, and their refusal to acknowledge that they don't work for all of RO is one of the most frustrating things.

Honestly, if they did even the bare minimum of supporting trainees and junior doctors, Id probably join again. People don't seem to realize how hostile they are compared to other societies, even in Rad Onc. Don't look at what ASCO is doing for their general rank and file, non-US folks, and juniors... you'll get really mad.

Like Kanye West once said to the total discomfort of Mike Myers, “ASTRO hates private practice people.”

 

[RickyScott]

I dont think that is true, there are private practice fellows and there have even rarely been private practice presidents. That said, I totally agree that they are a society run by academics for academics, and their refusal to acknowledge that they don't work for all of RO is one of the most frustrating things.

Honestly, if they did even the bare minimum of supporting trainees and junior doctors, Id probably join again. People don't seem to realize how hostile they are compared to other societies, even in Rad Onc. Don't look at what ASCO is doing for their general rank and file, non-US folks, and juniors... you'll get really mad.

ASTRO works against the interests of junior/midlevel academics as well. Terrible organization. They really only represent the interests of chairs of large academic centers.

 

[NotMattSpraker]

ASTRO works against the interests of junior/midlevel academics as well. Terrible organization. They really only represent the interests of chairs of large academic centers.

Sure do. Reminder that they financially support chairs in collecting salary data then keeping secret. They have now blocked multiple members from obtaining this report. I still have no idea how that is legal. But you better believe I am no longer funding this out of my own pocket.

There are so many things, but this was "the straw" for me that broke it. Also, learning that they now charge trainees even more money to submit to their conference. Insanity.

 

[Tigerstang]

Not like i cared to become an Astro fellow but didn't know this was true. Terrible if it is

this is not true

 

[bobjonesbob]

my DR colleagues get twice as much vacation as I do...

They also likely cover a lot more very busy weekend and/or evening shifts than you do.

 

[medgator]

They also likely cover a lot more very busy weekend and/or evening shifts than you do.

They also have more flexibility in where to live and move to

 

[sirspamalot]

750ORGTFO Should be on the front of every red journal issue if they really cared about us.

In the end its always the same in the pyramid scheme.. #FyouGotMineBiyatch

 

[Lamount]

750ORGTFO Should be on the front of every red journal issue if they really cared about us.

Should it? I mean, i get that we used to be valued more… but I really don’t think there is a graceful way to whine about making 500k vs 750k

 

[Fpg1245]

Should it? I mean, i get that we used to be valued more… but I really don’t think there is a graceful way to whine about making 500k vs 750k

Yeah there is…an effective lobbying campaign and reduction in residency slots

 

[Lamount]

Yeah there is…an effective lobbying campaign and reduction in residency slots

Graceful?

It's the sort of argument that one shouldn't make loudly (or ? at all), lest someone ask why we are asking to be compensated >3x what an ID doc makes.

 

[medgator]

Graceful?

It's the sort of argument that one shouldn't make loudly (or ? at all), lest someone ask why we are asking to be compensated >3x what an ID doc makes.

Sounds like the id docs should be fighting harder for their own interests. No reason to **** on ours though, Ralph W

 

[RickyScott]

Graceful?

It's the sort of argument that one shouldn't make loudly (or ? at all), lest someone ask why we are asking to be compensated >3x what an ID doc makes.

I agree that it could be perceived as bad optics. The real issue is that salary is inextricably linked to geographic flexibity and lateral mobility in our case.

 

[sirspamalot]

Yes, how dare we advocate for our financial health. We takes what massah gives us and we likes it.

This is ridiculous. If you don't value yourself at 300/hr or more, why the hell should the money grubbing bean counters in the lavish offices treat you any differently than a hospitalist shift worker - you're replaceable, there's more coming every year, and frankly, "i don't give a damn" about your work/life balance or any other personal matters.

If we don't stand together and advocate, who do you think will? Lol. Get real. #750orGTFO

 

[RickyScott]

Sounds like the id docs should be fighting harder for their own interests. No reason to **** on ours though, Ralph W

Without knowing anything about ID, they almost certainly are over supplied. Psych and medonc earn more than double id despite also relying solely on e and m codes for salary.
The real issue is that today in many major cities, a doc w/student loans can’t afford a modest house on 300k a year. Very different than 1 vs 2 million. I grew up in one of the most desirable locals in the USA and teachers and policemen could afford homes there at the time. Advocating for a salary that would allow home ownership in newton, ma or the valley in LA for a doc should not be met with disdain.

ID sounds likes it is best for someone with a lot of family wealth if you plan on living in most major cities. Of course, then they will complain abt DEI.

 

[RadOncDoc21]

Without knowing anything about ID, they almost certainly are over supplied. Psych and medonc earn more than double id despite also relying solely on e and m codes for salary.
The real issue is that today in many major cities, a doc w/student loans can’t afford a modest house on 300k a year. Very different than 1 vs 2 million. I grew up in one of the most desirable locals and teachers and policemen could afford homes at the time. Advocating for a salary that would allow home ownership in newton, ma or the valley in LA for a doc should not be met with disdain.

Too bad nobody will feel sorry for you. Trust me as a doc, I wish I knew more as to what I was going into. The cost of education, the years lost just to come out of it at the highest tax bracket, working a lot with cuts in compensation with a ceiling and little respect, def would have done something else. Unfortunately, society has been trained to think that we are the rising cost of health care and that any “provider” can do what we do.

 

[metallica81788]

Should it? I mean, i get that we used to be valued more… but I really don’t think there is a graceful way to whine about making 500k vs 750k

Another issue with #750orgtfo is there are plenty of Radoncs that have no business making near 750, whether it be how busy they are or just that they suck

I know a rising tide lifts all boats but what % of Radoncs in the country are busy enough with quality work to deserve (ooooh that word) 750k

 

[sirspamalot]

What %? 100.0 of the smart ones who understand how to play this stupid game. And it has nothing to do with "quality" ; its about either the volume of work (#75wRVUorGTFOforW2) -or- you are in a place where replacing you with a locums will cost at least that or more (geographic arbitrage) -or- you have won at the pyramid game in pp/academia right place right #service years. Quality is assumed to be the satisfactory minimum. CMS nor private payors don't pay a premium for quality, so what are you smoking bro?

There is no "deserve" when it comes to money. This is something that is usually understood by everyone once they hit about age 25. You get what you earn (or steal, if you're a criminal e.g. Madoff, SBF, Hucksters/Shillers/Grifters, Market Big Dogs doing pseudo-legal manipulation etc).

Unfortunately, for some people..

 

[metallica81788]

Don't know if you've noticed, but the largest employers of Radoncs have hired so many of us that nobody can get the requisite volumes even at 75/wRVU - that is what I'm saying

Most just aren't that busy anymore and volume is capped even if you want more

 

[sirspamalot]

Then you are in the wrong job and perhaps its time to re-evaluate "where will I be in 5 years."

I do feel bad for my homies that are geographically trapped. There is only one way to escape this, and it ain't easy. But almost everyone with a will to grow wings can.. geographic arbitrage is for reals.

 

[communitydoc13]

Graceful?

It's the sort of argument that one shouldn't make loudly (or ? at all), lest someone ask why we are asking to be compensated >3x what an ID doc makes.

I agree.

You also just can't advocate for your own compensation with impunity without a cost (not saying don't do it at all). Having more recently been on the other side of contract requests from docs who are very aware of market forces, I can say that while you may temporarily get what you want if the market supports your position, those negotiations will not be forgotten. You will have to justify your worth going forward as market dynamics change.

There is a vague thing called the social contract. It means different things in different places and certainly means different things for an academic doc vs a community employed doc vs a member of a physician group with technical ownership. But, its there. There are reasons that high performing professional athletes can negotiate like they do: 1. they are not replaceable (no other Aaron Judge out there) and 2. their real worth in terms of merchandising, commercial revenue and ticket sales is still almost always markedly greater than their negotiated salary). While our real worth (revenue generated) may exceed our salary, it is very hard to demonstrate that your value is much more than the average practitioner in the field. In our field, there is always an at least average doc waiting to take your place.

Why does Louis Potters make what he does? I don't know him at all, but I am confident in the answer and it is not just revenue brought in. It is the relationships that he has with the people in power at Northwell Health. There are almost certainly board members who believe (falsely) that he is worth every penny. He has tapped into the power of networking.

For the vast majority of us who value the jobs that we have, #750orgtfo would only harm our relationships, be viewed as a breach of the social contract and in this market get us replaced.

Good for @sirspamalot, with their private aviation and parking lot scuffling, being able to engage in geographic arbitrage (great term BTW). But this the equivalent of the freelance bush pilot. It only makes sense when your value is not tied to an institution, and most of us are just not capable of it (me included).

Edit: as an aside, I have no respect for the docs who are attempting "geographic arbitrage" with my organization.

 

[deleted1116990]

Should it? I mean, i get that we used to be valued more… but I really don’t think there is a graceful way to whine about making 500k vs 750k

Yes, it absolutely should. It seems a lot more common to hear of specialties that we historically didn't think of as highly compensated like FM, psych, PM&R, less competitive IM subspecialties, etc making 400k. 10 years ago when I went to med school these specialities were more like mid 200s while rad oncs were in the 700+ range even back then.

Rad oncs have been gaslit/indoctrinated to not be able to differentiate between "paid" and "reimbursed"
A full time rad onc, anywhere, treating a full time load (25 patients) should be making ~750k total comp (value ~30k per average OTV). That's what's being reimbursed for that effort on the pro side, and if you're not taking it home, someone else is. They aren't giving a discount to the patient or the payer. Professional reimbursement should be yours and yours alone. Then there is the matter of technical and ancillary generated revenue, which we all know is extremely valuable, and the added value the radiation oncologist brings that way, and the matter of how much that the doctor should be entitled to (more than zero in most cases, but that's what virtually all of us get).

It seems more and more common to meet more liberal/social justice minded young doctors who have this "400k, 500k, whatever is plenty of money, wanting more than this is ethically wrong and I should be thankful someone else is giving me a chance to practice" attitude. If you're working hard, then you've been swindled and someone else is profiting off of you. People who truly believe this should probably be at a place like the VA because you will get paid for what you actually do, and probably even more.

 

[deleted1116990]

Another issue with #750orgtfo is there are plenty of Radoncs that have no business making near 750, whether it be how busy they are or just that they suck

I know a rising tide lifts all boats but what % of Radoncs in the country are busy enough with quality work to deserve (ooooh that word) 750k

Very true. The oversaturation in some academic systems is insane. If you're getting 400k at an academic system that has double the number of rad oncs it really needs and keeping about 12 on treat, that's different than if you're at that level stuck at a satellite somewhere on your own cranking through 40 7-to-7 with nobody to cover for you (which we all know happens). The former is basically a VA job, probably eating into technical to meet your base or otherwise subsidized.

The trick of making part time work full time is really just masking the overtraining problem. If you're treating 12 patients, that's a 2 day a week job and 400k is good pay for that. I'm sorry you have to waste your time being on site 5 days a week for that.

 

[sirspamalot]

Good for @sirspamalot, with their private aviation and parking lot scuffling

Not sure what you are implying by parking lot scuffling..lol. Come on now, we're not in high school. This is vectoring into some personal animosity it seems, lets unpack that shall we..

It only makes sense when your value is not tied to an institution, and most of us are just not capable of it (me included)

Way to throw everyone under the bus. "You will be assimilated" (into the institution). No, and hell no.

Do you accept the fact you can't/won't move and won't learn how to stand up and change things? Ok, do you. And you'll keep getting what you get and you'll learn to convince yourself that your chicken shyte is chicken salad.

I implore my peers to not go into the Matrix. There is an alternative way and while it ain't easy... it is real.

 

[sirspamalot]

Very true. The oversaturation in some academic systems is insane. If you're getting 400k at an academic system that has double the number of rad oncs it really needs and keeping about 12 on treat, that's different than if you're at that level stuck at a satellite somewhere on your own cranking through 40 7-to-7 with nobody to cover for you (which we all know happens). The former is basically a VA job, probably eating into technical to meet your base or otherwise subsidized.

The trick of making part time work full time is really just masking the overtraining problem. If you're treating 12 patients, that's a 2 day a week job and 400k is good pay for that. I'm sorry you have to waste your time being on site 5 days a week for that.

THIS.

 

[Lamount]

Yes, it absolutely should. It seems a lot more common to hear of specialties that we historically didn't think of as highly compensated like FM, psych, PM&R, less competitive IM subspecialties, etc making 400k. 10 years ago when I went to med school these specialities were more like mid 200s while rad oncs were in the 700+ range even back then.

Rad oncs have been gaslit/indoctrinated to not be able to differentiate between "paid" and "reimbursed"
A full time rad onc, anywhere, treating a full time load (25 patients) should be making ~750k total comp (value ~30k per average OTV). That's what's being reimbursed for that effort on the pro side, and if you're not taking it home, someone else is. They aren't giving a discount to the patient or the payer. Professional reimbursement should be yours and yours alone. Then there is the matter of technical and ancillary generated revenue, which we all know is extremely valuable, and the added value the radiation oncologist brings that way, and the matter of how much that the doctor should be entitled to (more than zero in most cases, but that's what virtually all of us get).

It seems more and more common to meet more liberal/social justice minded young doctors who have this "400k, 500k, whatever is plenty of money, wanting more than this is ethically wrong and I should be thankful someone else is giving me a chance to practice" attitude. If you're working hard, then you've been swindled and someone else is profiting off of you. People who truly believe this should probably be at a place like the VA because you will get paid for what you actually do, and probably even more.

FM making >400k? I honestly cannot imagine how that is true (except for a rare special circumstance). They make about 210k. Psych is similar. PM&R is likely variable depending upon the practice (? working with a sports team).

Fact: Median US physician salary is <250k (my PCP makes significantly less than this -I know, because our salaries are searchable) We had a long thread going through all of the data a few months ago... too lazy to find it, but I am sure someone can link it below.

Either you believe in market economics or you don't. If you do, you will accept whatever pay the market affords you, accept that market values those admins higher than it does you, and be confident that everything is as it should be. If you don't believe in market economics, you have to me why you are worth > 3x that of the average family doc.

I am not a social justice warrior -just a fan of intellectual consistency

 

[metallica81788]

Then you are in the wrong job and perhaps its time to re-evaluate "where will I be in 5 years."

I do feel bad for my homies that are geographically trapped. There is only one way to escape this, and it ain't easy. But almost everyone with a will to grow wings can.. geographic arbitrage is for reals.

In fact, that is the exact reason why I am making a career change.

My job started off as one of the lower volume lower pay range situations but then changed as I became solo. Admin wants to hire another doctor for not nearly enough work, so I'm out to where I will continue to be busy and fairly compensated for my work.

 

[sirspamalot]

you have to me why you are worth > 3x that of the average family doc.

I'll tell you why. Because replacing me will cost you at least that much or more. And if that isn't enough, what about the millions (2? 3?) I earn in pure profit for the org?

So yeah, I'll go with intellectual analysis. Survey says? Pay for the economic value I generate at a minimum and if I can negotiate it, pay for the difficulty in replacing me, and yes.. the quality of the work (building referrals, participation in leadership, etc).

Time to choose: red or blue pill ?

 

[RickyScott]

In fact, that is the exact reason why I am making a career change.

My job started off as one of the lower volume lower pay range situations but then changed as I became solo. Admin wants to hire another doctor for not nearly enough work, so I'm out to where I will continue to be busy and fairly compensated for my work.

In a large system such as upenn, keeping docs “hungry” /low volume is financially advantageous. If they unnecessarily treat two favorable risk prostates a year w/protons to generate some work, it will pay their entire salary.