I was recently looking into typical salaries of various physician specialties and found radiation oncologists (and dermatologists and radiologists) often earn more than twice as much as primary care physicians. I had heard this is a well paid field, but never realized to what extent. Does anyone know why this is? I can understand why surgeons and other physicians that have to make significant lifestyle sacrifices in their careers should be compensated for these sacrifices, but what about the fields that are more benign?
Salaries in Radiation Oncology
- Thread starter RadGoat
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You seem to have misunderstood the basis of physician reimbursement. $$$ that each specialty gets cannot be used as a proxy for their relative worth nor the clinical importance of the work they perform. Rather, reimbursement for each specialty is based on an arcane combination of the specialty's political clout in Washington, interests of pharmaceutical/medical device companies, and most importantly representation on Medicare CMS committees which essentially set reimbursement for various procedures/medical interventions.
Anesthesiology, for instance, offers excellent compensation. This is not due to the inherent worth of anesthesiologists, but rather their disproportionate representation (via PACs) in Washington relative to their numbers.
One benefit that Rad Onc has is our relatively small numbers. For instance, an often quoted fact is that reimbursement for the drug EPO is more than the combined billing for Rad Onc annually.
Ultimately, you cannot rely on reimbursement to remain stable over the years. For instance, many groups are pushing for higher reimbursement for primary care and lower for specialists. Thus, reimbursement should not be a major reason that you choose one specialty over another.
Anesthesiology, for instance, offers excellent compensation. This is not due to the inherent worth of anesthesiologists, but rather their disproportionate representation (via PACs) in Washington relative to their numbers.
One benefit that Rad Onc has is our relatively small numbers. For instance, an often quoted fact is that reimbursement for the drug EPO is more than the combined billing for Rad Onc annually.
Ultimately, you cannot rely on reimbursement to remain stable over the years. For instance, many groups are pushing for higher reimbursement for primary care and lower for specialists. Thus, reimbursement should not be a major reason that you choose one specialty over another.
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I totally agree with you, I have very little understanding of how reimbursement works. I don't recall a single lecture in college, med school, or internship addressing this, and it generally seems like a taboo topic.
Does it really boil down to political clout in Washington? I had heard rumors that that was the case, but I was not cynical enough to believe them.
Does it really boil down to political clout in Washington? I had heard rumors that that was the case, but I was not cynical enough to believe them.
Agreed, but still reimbursement is relatively stable and I know it plays an important if not central role in specialty selection.
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Political clout, while a major factor in reimbursement, is not the be all end all. The reality that we all have to deal with is that all physicians are putting their hands in a single cookie jar. If primary care reimbursement increases then specialty reimbursement must necessarily drop.
Some areas like cosmetic dermatology, aesthetic surgery, and concierge internal medicine that remain cash only will likely remain insulated from these reimbursement variations.
Some areas like cosmetic dermatology, aesthetic surgery, and concierge internal medicine that remain cash only will likely remain insulated from these reimbursement variations.
D
deleted4401
The other thing to keep in mind is that the relative volume of specialists is quite low compared to the number of primary care physicians. I.e., if they were going to make a direct exchange - higher PCP salaries and lower rad onc salaries - it would effect the specialists a lot. To increase the salary of all PCPs by 2-3% would probably lead to a decrease in rad onc salaries by 10% or more, because there are so many of them and so few of us.
It's a zero sum game, and what worries me is when PCPs complain about specialist salaries. They have to know what happens is first their slice gets bigger and ours get smaller (which is okay), then the next step is to make the entire pie smaller (which is not okay). We all have to be in lockstep rather than pitting against each other. Physician reimbursement is higher here than any other western country, but it isn't the reason we are heading towards system failure.
I think at most points in recent history, salaries are stable (anomalies exist, like the big hit medoncs took, or the big bump anesthesia got) but at this time all bets are off.
-S
It's a zero sum game, and what worries me is when PCPs complain about specialist salaries. They have to know what happens is first their slice gets bigger and ours get smaller (which is okay), then the next step is to make the entire pie smaller (which is not okay). We all have to be in lockstep rather than pitting against each other. Physician reimbursement is higher here than any other western country, but it isn't the reason we are heading towards system failure.
I think at most points in recent history, salaries are stable (anomalies exist, like the big hit medoncs took, or the big bump anesthesia got) but at this time all bets are off.
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This assumes that all of the cookies in the cookie jar are always spoken for.
do you think Rad Onc could someday go the way of CT surg now? by that i mean the treatment modality is no longer in as much demand and there ends up being way too many people trained for it ith not enough jobs?
or could it go the way of nuclear medicine, similar in that it is not really popular now and there aren't many jobs in it?
i never get a serious answer about what people really think the future of xrt is? people in other specialties think radiation will be looked at like blood-letting some day in that its brutal and a primitive treatment for how cancer will some day (maybe in the next 20 yrs) be treated. blood letting is obv an extreme example but you get the picture. its discouraging because I really like the idea of a career taking care of cancer patients with radiation technology but i can't help but wonder about the future
or could it go the way of nuclear medicine, similar in that it is not really popular now and there aren't many jobs in it?
i never get a serious answer about what people really think the future of xrt is? people in other specialties think radiation will be looked at like blood-letting some day in that its brutal and a primitive treatment for how cancer will some day (maybe in the next 20 yrs) be treated. blood letting is obv an extreme example but you get the picture. its discouraging because I really like the idea of a career taking care of cancer patients with radiation technology but i can't help but wonder about the future
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First, I would strongly suggest you read the FAQ as most of your questions are answered there.
No. As a matter of fact I think Rad Onc will force other specialities to go the way of CT surgery. For instance (again, as stated in the FAQ), stereotactic body radiosurgery (SBRT) has been shown to be equivalent to surgery in terms of local control for early stage lung cancer and (probably) superior in terms of side effects. There are numerous other examples of this in our field.
As to the second part of your question, the # of radiation oncologists in our field is conservatively and aggressively regulated by the powers that be. A few years ago, there was a predicted excess of practicing radiation oncologist so residency slots were cut significantly. This prediction turned out to be false so they beefed up slots subsequently.
One of the main problems with nuclear medicine is that much of their training is included in the course of a diagnostic radiology residency. Thus, it makes more sense to hire a radiologist as they can do a lot more than a nuc med physician.
You cannot draw a similar analogy to our field as no other speciality subsumes the training that we receive.
That's because nobody can seriously predict the future. Especially when there are so many variables involved.
Some "people" also beleive that the Holocaust never happened, that the Earth is flat, and the the government is hiding alien corpses in Roswell. So what?
Again read the FAQ.
Let me say NO OTHER SPECIALITY has any idea what the hell we do. Maybe it's easier to think that we just "push the button." Our field is incredibly complex and sophisticated. Surgeons may think they can do SBRT and it's all fun and games until a patient winds up with a spinal cord transection or goes blind.
Perhaps I can explain things this way. The unit of radiation is the Gray (Gy). If people get a whole body exposure of ~ 4 Gy, 50% of them will die within several weeks. We routinely adminsiter more than TWENTY TIMES this dose to various parts of the body including the head and neck and prostate to treat cancer. There is a reason our residency is four years.
No. As a matter of fact I think Rad Onc will force other specialities to go the way of CT surgery. For instance (again, as stated in the FAQ), stereotactic body radiosurgery (SBRT) has been shown to be equivalent to surgery in terms of local control for early stage lung cancer and (probably) superior in terms of side effects. There are numerous other examples of this in our field.
As to the second part of your question, the # of radiation oncologists in our field is conservatively and aggressively regulated by the powers that be. A few years ago, there was a predicted excess of practicing radiation oncologist so residency slots were cut significantly. This prediction turned out to be false so they beefed up slots subsequently.
One of the main problems with nuclear medicine is that much of their training is included in the course of a diagnostic radiology residency. Thus, it makes more sense to hire a radiologist as they can do a lot more than a nuc med physician.
You cannot draw a similar analogy to our field as no other speciality subsumes the training that we receive.
That's because nobody can seriously predict the future. Especially when there are so many variables involved.
Some "people" also beleive that the Holocaust never happened, that the Earth is flat, and the the government is hiding alien corpses in Roswell. So what?
Again read the FAQ.
Let me say NO OTHER SPECIALITY has any idea what the hell we do. Maybe it's easier to think that we just "push the button." Our field is incredibly complex and sophisticated. Surgeons may think they can do SBRT and it's all fun and games until a patient winds up with a spinal cord transection or goes blind.
Perhaps I can explain things this way. The unit of radiation is the Gray (Gy). If people get a whole body exposure of ~ 4 Gy, 50% of them will die within several weeks. We routinely adminsiter more than TWENTY TIMES this dose to various parts of the body including the head and neck and prostate to treat cancer. There is a reason our residency is four years.
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Can something like radiation oncology become irrelevant one day? Of course. Every medical specialty is heavily dependent on advent of new technology, which is more or less exactly how CT surgery went out of business. The difference with something like CT surgery and radiation oncology, as opposed to something like neurology or pediatrics is that the entire specialty is based on a certain mode of treatment - as opposed to a broader classification like a demographic or a body system.
Will radiation oncology become irrelevant soon? Probably not... no one knows. It's entirely possible that radiation and/or surgery will no longer be the best and only options to treat certain types of cancer. It might happen, or it may never happen, but I don't think it should affect anyone's choice of specialties, given the likelihood is so small.
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Gfunk, this is a bit narrow-minded. I have consulted Sylvia Brown on this issue (other notable works by her: http://www.youtube.com/watch?v=hRc4LkBRjIc) and she guaranteed me that radiation oncology will be in demand for years to come.
nice!
D
deleted4401
Wow, what a remarkably uneducated, unintelligent posting. You'd think in a field like medicine people would actually use science or evidence or judgement before commenting inanely/asking leading questions. Or, they might even use wikipedia or the search button or read a FAQ posting).
One would think that there would be a better way to treat a brain metastasis other than cutting the skull open and taking away a fair amount of normal brain. Oh wait, there already is.
One would think you could cure an early stage lung cancer without taking out an entire lobe of lung. Oh wait, you can do that.
One might conjecture that you could spare somebody a high risk of incontinence and impotence, while still curing their prostate cancer. Oh my gosh, there is something that allows for that. In fact there is more than one way!
A person may hypothesize that there has to be a better way than a mastectomy to treat breast cancer, while still achieving high local control rates. By golly, multiple international groups have figured out that this is possible!
Someone might think that instead of cutting out the voicebox, there has got to be a way to treat throat cancer without leaving a patient without a voice. Oh man, if I had just googled it, I would have learned that it is possible. Hallelujah!
If (and I can tell with the way the questions is posed - 'people in other specialties think radiation will be looked at like blood-letting some day in that its brutal and a primitive treatment for how cancer will some day) you already believe that radiation oncology is primitive and going to go the wayside, I'm not sure what anonymous people on this board can tell you that will change your mind. Read a book or a journal, read the FAQ, use the search function or google, spend a month in some oncology clinics.
Drowsy12, what you have just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.
-S
One would think that there would be a better way to treat a brain metastasis other than cutting the skull open and taking away a fair amount of normal brain. Oh wait, there already is.
One would think you could cure an early stage lung cancer without taking out an entire lobe of lung. Oh wait, you can do that.
One might conjecture that you could spare somebody a high risk of incontinence and impotence, while still curing their prostate cancer. Oh my gosh, there is something that allows for that. In fact there is more than one way!
A person may hypothesize that there has to be a better way than a mastectomy to treat breast cancer, while still achieving high local control rates. By golly, multiple international groups have figured out that this is possible!
Someone might think that instead of cutting out the voicebox, there has got to be a way to treat throat cancer without leaving a patient without a voice. Oh man, if I had just googled it, I would have learned that it is possible. Hallelujah!
If (and I can tell with the way the questions is posed - 'people in other specialties think radiation will be looked at like blood-letting some day in that its brutal and a primitive treatment for how cancer will some day) you already believe that radiation oncology is primitive and going to go the wayside, I'm not sure what anonymous people on this board can tell you that will change your mind. Read a book or a journal, read the FAQ, use the search function or google, spend a month in some oncology clinics.
Drowsy12, what you have just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.
-S
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Great thread! I was wondering if anyone had access to this article and could possibly send it to me? Thanks!
http://www.semradonc.com/article/S1053-4296(08)00021-0/abstract
http://www.semradonc.com/article/S1053-4296(08)00021-0/abstract
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Personally I see cutting people open or pumping their bodies full of toxic chemicals as far more "brutal and primitive" than precisely administering a beam of radiation with minimal healthy tissue damage or side effects.
D
deleted126335
I am an anesthesiologist. Your statement is inaccurate. Yes, Anesthesiologists on average enjoy an above average salary/benefit package. The reason is not disproportionate representation. It is based on the fact that the OR and the OB suite are the major cash cows of hospitals. They cannot function without anesthesia. Anesthesia services are also frequently needed on extremely short notice. Thus hospitals have historically been willing to pay up for excess capacity in order to attract surgeons and OBs from taking their business elsewhere.
Anesthesia is an incredibly low respect and low prestige specialty. We are the bitch*s of the hospital on call for intubations, central lines, spinal taps, screaming teenagers needing an epidural @ 3am all of course needed "STAT". Hospital administrators HATE the fact that they frequently have to subsidize us. If a specialty is low respect and low prestige the only way to get med students to choose it is by being well paid.
The PAC activity of Anesthesiologists is primarily related to the encroachment of CRNAs.
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Very interesting and relevant point. Given the relatively high pay and lifestyle friendliness, anesthesia is still far from being a competitive specialty a la radiology or any of the surgical subspecialties.
D
deleted126335
low prestige, low respect, low security, frequent night call- ORs and
OB are always open. More than most docs we are viewed as a commodity or institutional service. When the commodity is in short supply-boom times. When there is an excess of supply-look out below. Check out the match data for the period from about 1995-2000. The quality and numbers of med students choosing the field dropped like a rock during this period. Reason-there were no decent jobs outside of cowtown.
D
deleted4401
So strange... I always thought highly of anesthesia. Never thought of it as low prestige. Not when they make that sort of money. And I thought it was reasonably competitive.
-S
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agreed. Even the CRNAs pull in well over 6 figures.
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Low respect compared to whom? I love these mindless generalization. You are accorded the respect that you deserve. If you're a ****ty anesthesiologist then that's what you get. While the competitiveness of the specialty is revelant, anesthesia is not PM&R or pathology or family medicine or peds. The pay is commiserated with the skills. Why are you paid highly? Because you can slide that damn endo-tracheal tube in at 3am in a burned patient with a quickly edematous airway. Because you can manage an ICU ventilator better than those useless pulmononary ICU people and manage pressors like it's no one's business. Because you can render a shoulder completely insensate via a skillfully placed interscalene block for surgery. Because you can diagnose lumbar radiculopathy and do a transforaminal epidural steroid injection under fluoroscopy. Because if there is a code on the floor and the patient needs resuscitation, who but you can do it best?
Why are you short changing our profession? You disgust me. It's your low regard for your own specialty that emboldens mid-level practitioner to think that they are as capable as a physician. If there's blame, you should look at yourself in the mirror.
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Super. Thanks for listing off all the job requirements of an anesthiologist. What's the point, again? Can you not do the same thing for every single specialty? How can any inter-specialty comparison ever be made via this method? Yes, no one puts an endo-tracheal tube in better than an anesthesiologist. But, who can manage neurological pathologies better than a neurologist? Or a psychological disease better than a psychiatrist? From where and how do you come up with their respective pay? Do both those fields deserve equal pay to anesthesiologists or radiologists?
The truth of the matter, as stated before, is that reimbursement rates in the American health care system is largely decoupled from the intrinsic medical value a procedure/diagnosis/surgery adds. It's simply set by how much Medicare and private insurers are paying for a service at a certain time. And this, of course, changes with time and the advent of new technologies.
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GFunk, can we move this thread to the anesthesiology forum? 
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Oh, I see. So you are to lecture to me how reimbursement works? Pray tell wise one, when was the last time you submitted a billing?
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GFunk, can we move this thread to the anesthesiology forum?
You'll get no complaints here. I was simply alerted by someone in the know that there happens to be a rogue anesthesiologist in your forum. I thought I'd chime in with a thought or two to balance the situation. Some of my best friends are rad oncs.
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Oh, I see. So you are to lecture to me how reimbursement works? Pray tell wise one, when was the last time you submitted a billing?
Huh? How was I lecturing you on the actual process of billing? I was simply pointing out your terrible reasoning for why you think specialties are paid what they're paid.
D
deleted126335
I got out in the mid 90s during the job crunch. Name brand all ivy credentials. Because of the nature of exclusive contracting I had to work for an FMG yoyo who did 2 years of residency in a community residency 20 years earlier. He never took call and made triple my salary. No ability to build a practice, no hope of parity, the fact that I could do the sickest patients slicker than anyone meant nothing because this jerk was golfing buddies with the big surgeons. I left to a solid practice when the market turned a few years later.
Nothing could further prove my point than yesterday another state opted out of Medicare supervision requirements for CRNAs. Colorado actually became the sixteenth state to opt out and the THIRD state whose state board of medicine actually supported the opt out.
Open your eyes.
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Sadly, this thread has mutated far beyond its original purpose. Closing . . .
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