Rad onc rankings

[DrProtonX]

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We’re very close, if not already, at the point that if you don’t have a job lined up for you after finishing residency, going into rad onc is a big gamble. Are you willing to gamble after 10+ years of hard work and $300k+ debt?

 

[Neuronix]

A lot of fear mongering here lately.

I do remember rad oncs being unemployed and underemployed back in the late 2010s.

Are we getting back to that?

 

[medgator]

A lot of fear mongering here lately.

I do remember rad oncs being unemployed and underemployed back in the late 2010s.

Are we getting back to that?

Really? Thought that was the 90s. 2010s and after were as good as they could be I thought. Decent mix of private and employed opportunities

 

[TheWallnerus]

I will say I am seeing $2500/day rad onc locums opportunities come across more routinely (as opposed to 2000 or less)

 

[medgator]

I will say I am seeing $2500/day rad onc locums opportunities come across more routinely (as opposed to 2000 or less)

Definitely more geographic availability now than say during or before covid but all pretty much employed with no negotiating and strict restrictive covenants

 

[Neuronix]

Really? Thought that was the 90s. 2010s and after were as good as they could be I thought. Decent mix of private and employed opportunities

In the late 2010s I had several friends who worked part-time (not by choice/underemployed) or stopped working as a clinical rad onc entirely due to need to be in one specific metro that was not hiring. I also knew several others who graduated into locums while looking for a partnership track position or took their first job in an undesired rural location and immediately started looking for a new position since they had no other option for full-time employment.

The job market was entirely different comparing 2010 and 2019 in my opinion. It was in the mid-2010s that the job market really saturated and the residency competitiveness took a huge hit as a result. I think things opened up a bit post-COVID, and I'm curious to see what happens moving forward.

I will say I am seeing $2500/day rad onc locums opportunities come across more routinely (as opposed to 2000 or less)

This is highly state dependent. Supply and demand rules everything.

 

[DrProtonX]

A lot of fear mongering here lately.

I do remember rad oncs being unemployed and underemployed back in the late 2010s.

Are we getting back to that?

Is it really fear mongering if it’s true?
These are some of the jobs posts on Astro website and practicelink:
Rhinebeck/Poughkeepsie NY $450k
Totowa NJ $383k
Olean NY $600k
Turlock CA $455k
Rochester NY $450k
Billings MT $570k
Albany NY $390k
Sacramento CA $510k
Madisonville KY $550k
Plattsburgh NY $441k
Corning NY $458k
Portsmouth OH $715k
Johsnson City NY $494k
Moses Lake WA $585k

Most of these are in towns middle of nowhere that should be paying high 6-figure if not 7 figure. Yet most are under $500k. Can you imagine an ortho, neurosurg, CTS even GI or Med onc working in these locations for anything less than $1M+?

 

[Neuronix]

Is it really fear mongering if it’s true?
These are some of the jobs posts on Astro website and practicelink:
Rhinebeck/Poughkeepsie NY $450k
Totowa NJ $383k
Olean NY $600k
Turlock CA $455k
Rochester NY $450k
Billings MT $570k
Albany NY $390k
Sacramento CA $510k
Madisonville KY $550k
Plattsburgh NY $441k
Corning NY $458k
Portsmouth OH $715k
Johsnson City NY $494k
Moses Lake WA $585k

Most of these are in towns middle of nowhere that should be paying high 6-figure if not 7 figure. Yet most are under $500k. Can you imagine an ortho, neurosurg, CTS even GI or Med onc working in these locations for anything less than $1M+?

Fearmonging vs. truth is the point of my post.

These undesirable location jobs at less than MGMA 75th percentile not being filled is a good sign that there are better jobs available.

 

[Doctorer]

Fearmonging vs. truth is the point of my post.

These undesirable location jobs at less than MGMA 75th percentile not being filled is a good sign that there are better jobs available.

Agreed. I see these as "sucker" ads. These places are looking for a sucker to take these jobs. Hopefully no one is taking these jobs.

 

[medgator]

In the late 2010s I had several friends who worked part-time (not by choice/underemployed) or stopped working as a clinical rad onc entirely due to need to be in one specific metro that was not hiring. I also knew several others who graduated into locums while looking for a partnership track position or took their first job in an undesired rural location and immediately started looking for a new position since they had no other option for full-time employment.

The job market was entirely different comparing 2010 and 2019 in my opinion. It was in the mid-2010s that the job market really saturated and the residency competitiveness took a huge hit as a result. I think things opened up a bit post-COVID, and I'm curious to see what happens moving forward.



This is highly state dependent. Supply and demand rules everything.

Is it really fear mongering if it’s true?
These are some of the jobs posts on Astro website and practicelink:
Rhinebeck/Poughkeepsie NY $450k
Totowa NJ $383k
Olean NY $600k
Turlock CA $455k
Rochester NY $450k
Billings MT $570k
Albany NY $390k
Sacramento CA $510k
Madisonville KY $550k
Plattsburgh NY $441k
Corning NY $458k
Portsmouth OH $715k
Johsnson City NY $494k
Moses Lake WA $585k

Most of these are in towns middle of nowhere that should be paying high 6-figure if not 7 figure. Yet most are under $500k. Can you imagine an ortho, neurosurg, CTS even GI or Med onc working in these locations for anything less than $1M+?

I get what @Neuronix is saying. At the same time, I'm with @DrProtonX that even if the geography has opened up which I think it has, salaries have taken a hit

 

[TheWallnerus]

I guess what @Neuronix is saying. At the same time, I'm with @DrProtonX that even if the geography has opened up which I think it has, salaries have taken a hit

Major downward pressures on salaries had to manifest SOMETIME… it’s elementary school economics

 

[winstonfoot5]

I will say I am seeing $2500/day rad onc locums opportunities come across more routinely (as opposed to 2000 or less)

What rates would you consider a "bad" , "good", and "excellent" ?

 

[Doctorer]

What rates would you consider a "bad" , "good", and "excellent" ?

Nice try Weatherby.

 

[allseasons]

I guess what @Neuronix is saying. At the same time, I'm with @DrProtonX that even if the geography has opened up which I think it has, salaries have taken a hit

it's honestly worth noting expectations have changed amongst applicants. When I saw those salaries my first thought was "huh, if this is the worst then not too bad".

Even with these cuts, rad onc remains one of the highest reimbursement per hour worked.

 

[radoncftw]

Major downward pressures on salaries had to manifest SOMETIME… it’s elementary school economics

where is ESE

 

[TheWallnerus]

What rates would you consider a "bad" , "good", and "excellent" ?

Bad 2000 or less
Good 2500
Excellent 2800 or more per day

 

[drowsy12]

Bad 2000 or less
Good 2500
Excellent 2800 or more per day

I’ve also been routinely seeing 2500-3000

 

[Neuronix]

I’ve also been routinely seeing 2500-3000

It’s all very location based. I moved from one state where the ceiling was 1500 and recruiters stopped calling me to another where I’ve been offered 4000 and I have to tell the recruiters to **** off and stop calling me.

 

[ivybme]

it's honestly worth noting expectations have changed amongst applicants. When I saw those salaries my first thought was "huh, if this is the worst then not too bad".

Even with these cuts, rad onc remains one of the highest reimbursement per hour worked.

I think there's a "bell curve" of dissatisfication among rad oncs:

The 2010-2019 era, people are most dissatisfied because rad onc job market worsened yet some of the most competitive med students went into rad onc for various reasons, and it was among the most competitive matches at the time

Pre 2010 rad onc started to get hot and the rug was not pulled beneath them yet, and now many of them are in leadership positions

Post 2020 rad onc expectations have changed and thus people are comparing it to less competitive specialties, for which it still beats out in terms of compensation and lifestyle, to an extent.

The other dissatisfaction lies in PP vs academic. Those that want a PP job will be increasingly dissatisfied in the era of consolidation, whereas for academic-focused rad oncs there are arguably more positions and more opportunities available. This is not always true but I have noticed this trend somewhat.

 

[Neuronix]

whereas for academic-focused rad oncs there are arguably more positions and more opportunities available. This is not always true but I have noticed this trend somewhat.

I agree with your post except I disagree with this statement. Most academic positions are basically equivalent to employed rad onc positions often with similar pay and lifestyle. Academics like to sell itself on “academic opportunities” that usually are not real or realistically obtainable.

People need to understand that the increase of academics in our specialty does not translate to an increased emphasis on research and teaching.

 

[medgator]

I agree with your post except I disagree with this statement. Most academic positions are basically equivalent to employed rad onc positions often with similar pay and lifestyle. Academics like to sell itself on “academic opportunities” that usually are not real or realistically obtainable.

People need to understand that the increase of academics in our specialty does not translate to an increased emphasis on research and teaching.

Yep, essentially buyouts/consolidation of previous indepdent/non-academic hospital systems. Cleveland Clinic has been doing this in FL, Mayo in FL and AZ etc.

 

[RadOncDoc21]

Yep, essentially buyouts/consolidation of previous indepdent/non-academic hospital systems. Cleveland Clinic has been doing this in FL, Mayo in FL and AZ etc.

Right, there is nothing academic about a rad onc clinic in the boonies with "insert big name academic logo" on the front.

 

[Radonky]

I agree with your post except I disagree with this statement. Most academic positions are basically equivalent to employed rad onc positions often with similar pay and lifestyle. Academics like to sell itself on “academic opportunities” that usually are not real or realistically obtainable.

People need to understand that the increase of academics in our specialty does not translate to an increased emphasis on research and teaching.

Only nuance I would have added, is that in academics you have increased clinic requirements compared to the past, and academic expectations have not changed, so you do 1.5x work. True at my shop, maybe other academic places you get a more relaxed lifestyle.

 

[CurbYourExpectations]

I would not be surprised if many academics are the busiest RadOncs in the US. More opportunity to be busy. With consolidation and fewer opportunities for legitimate private practice there are now and will be a growing amount of "academics" that have the clinical mentality of solo and private docs and will be or already are seeing more patients than many smaller private/community hospitals as a whole. People that would have thrived in a private system back in the day, but can now see tons of patients in an academic setting (howbeit with less incentive). When all roads lead to Rome (technology, referral patterns, consolidation, specialization, propaganda), you will see this happen more and more.

 

[CurbYourExpectations]

Only nuance I would have added, is that in academics you have increased clinic requirements compared to the past, and academic expectations have not changed, so you do 1.5x work. True at my shop, maybe other academic places you get a more relaxed lifestyle.

Like that OR older academics hanging out while younger academics do 2-3x the work. Few flavors, pick your poison.

 

[TheWallnerus]

I would not be surprised if many academics are the busiest RadOncs in the US. More opportunity to be busy. With consolidation and fewer opportunities for legitimate private practice there are now and will be a growing amount of "academics" that have the clinical mentality of solo and private docs and will be or already are seeing more patients than many smaller private/community hospitals as a whole. People that would have thrived in a private system back in the day, but can now see tons of patients in an academic setting (howbeit with less incentive). When all roads lead to Rome (technology, referral patterns, consolidation, specialization, propaganda), you will see this happen more and more.

I would be surprised if “many academics are the busiest RadOncs in the US.” Academic rad onc departments are very busy, but there are so many gosh darn rad oncs per department their individual ability to be busy gets diluted.

 

[CurbYourExpectations]

I would be surprised if “many academics are the busiest RadOncs in the US.” Academic rad onc departments are very busy, but there are so many gosh darn rad oncs per department their individual ability to be busy gets diluted.

Didn't wanna put you on the spot, but figured you'd know. If you could (and time allows), could you give a percentage by medicare data that are at the highest billers, academic vs private vs hospital employed? (this is not the most accurate representation).

 

[TheWallnerus]

Didn't wanna put you on the spot, but figured you'd know. If you could (and time allows), could you give a percentage by medicare data that are at the highest billers, academic vs private vs hospital employed? (this is not the most accurate representation).

Last time I checked the top 100 Medicare billers were almost exclusively non academic. The median Medicare reimbursement per rad onc is something like $150k per year (first time you see that you think wow that’s ridiculously low); that lower 50%ile is very heavy with academics.

 

[CurbYourExpectations]

Thanks for the info.

Second and third time I read I'm like wow, that's really low

There is some question to what the percentage of cancer patient treated with medicare is.

 

[drowsy12]

The median RVU numbers are available via AAMC and MGMA. The average reported RVU numbers are higher in AAMC academics as compared to MGMA non academic

 

[CurbYourExpectations]

I would be surprised if “many academics are the busiest RadOncs in the US.” Academic rad onc departments are very busy, but there are so many gosh darn rad oncs per department their individual ability to be busy gets diluted.

You would be surprised. At least I think. What do you think would be 90th percentile in new patients per radonc?

 

[TheWallnerus]

You would be surprised. At least I think. What do you think would be 90th percentile in new patients per radonc?

There are 1.2 million people a year that get irradiated in the US. Assume there are 5000 practicing rad oncs; that means the average is necessarily 240 new pts per rad onc per year. On top of that, we know that the Pareto distribution and “20 percent of the people do 80 percent of the work” is ubiquitous especially when considering things like “busy-ness.” So a 1.25-1.5x average is probably a safe upper limit for 90%ile. In other words 10% or less of rad oncs see 300-360 or more new patients a year. (The average is always much greater than the 50%ile in Pareto.)

 

[ramsesthenice]

Only nuance I would have added, is that in academics you have increased clinic requirements compared to the past, and academic expectations have not changed, so you do 1.5x work. True at my shop, maybe other academic places you get a more relaxed lifestyle.

At my old academic job, I averaged about 250 new starts per year with a 40% clinical FTE. That was on top of having a lab, writing grants, and doing trials. It got to be too much over time. Most of my colleagues there had similar or higher numbers (but had 70-80% cFTEs). I personally like being busy, but there is an undeniable issue in that context: residency training. Residents got a lot of hands on learning, but time for us to prepare didactics etc. was lacking. To your point, there are some very bust academic departments.

But in my experience, this was the outlier. Where I trained, I believe only 2/9 of the faculty averaged anything close to 200-250 new starts per year. Now I’m somewhere with about 60% of my previous volume. It’s much more manageable. I do a ton of interstitial implants and MR guided pancreatic SBRT, so I stay pretty busy. But I have more dedicated time for teaching, committee work, etc.

 

[TheWallnerus]

the Pareto distribution and “20 percent of the people do 80 percent of the work” is ubiquitous

Where I trained, I believe only 2/9 of the faculty averaged anything close to 200-250 new starts per year

 

[TheWallnerus]

Now I’m somewhere with about 60% of my previous volume. It’s much more manageable. I do a ton of interstitial implants and MR guided pancreatic SBRT, so I stay pretty busy. But I have more dedicated time for teaching, committee work, etc.

I have a theory that relative to other specialties in the institution radiation oncologists can generate more revenue with less clinical work (mostly because therapists, and the nature of our specialty’s workflow)… therefore making teaching, committee work, etc, more doable with minimal to no pushback on its time/effort ratio versus the clinical effort. (I also think this gives rad oncs an inflated to false perception they’re more bookish or academic versus their peers; another discussion.)

Allow the new coding changes to happen and let’s hear how things are in that regard after a couple of years for the dust to settle. It should be fine, but if there’s more struggle to do the non-clinical to some extent it was predictable.

 

[ramsesthenice]

I have a theory that relative to other specialties in the institution radiation oncologists can generate more revenue with less clinical work (mostly because therapists, and the nature of our specialty’s workflow)… therefore making teaching, committee work, etc, more doable with minimal to no pushback on its time/effort ratio versus the clinical effort. (I also think this gives rad oncs an inflated to false perception they’re more bookish or academic versus their peers; another discussion.)

Allow the new coding changes to happen and let’s hear how things are in that regard after a couple of years for the dust to settle. It should be fine, but if there’s more struggle to do the non-clinical to some extent it was predictable.

The problem I’ve seen is admin deciding we can do more with less. My last job didn’t start that way, but someone left and “we can absorb it.” Volume increased when a competitor left the region, we absorbed it without hiring. They bought a clinic without hiring a new faculty first and we covered it for over a year (50 miles away no less). I left in July and the plan was to hold off up to a year before filling my spot because of all the uncertainties in the air right now. That’s an average of 35-40 more new starts each If divided evenly among the remaining faculty (which it obviously won’t be).

It’s manageable and I’m not going to say any individual call was bad from a buisness perspective. But it makes devoting time to the non-clinical parts of the job very hard.

To be clear, I still loved that job. I loved the people and even though there were organization level challenges that got annoying some times, there was nothing so bad I was ready to go on account of me. It was family situation stuff the got me looking. I just got lucky and found a place specifically looking for someone experienced in MRI guided pancreatic treatment and interstitial Brachy in our target area. That’s very specific and happened to be my exact skill set. Things do work out sometimes.

 

[yesmaster]

There’s little to no incentive to be especially busy clinically so I doubt the busiest rad onc’s are in academics

In a pseudo-academic or satellite arrangement in an undesirable location with the right incentives, some of these docs can be busy

If I was in academics I would not stress about my clinical RVU’s, and I’d try to climb the admin ladder or IP/industry collaboration/startup spinoffs ladder. Admin ladder is a lot easier and financial payoffs more obvious.

 

[ramsesthenice]

There’s little to no incentive to be especially busy clinically so I doubt the busiest rad onc’s are in academics

In a pseudo-academic or satellite arrangement in an undesirable location with the right incentives, some of these docs can be busy

If I was in academics I would not stress about my clinical RVU’s, and I’d try to climb the admin ladder or IP/industry collaboration/startup spinoffs ladder. Admin ladder is a lot easier and financial payoffs more obvious.

It depends on the arrangement. There are plenty of academic centers that still heavily incentivize clinical productivity. I trained at very well respected mid tier program. The folks who greatly exceeded RVU targets could easily see bonuses of 100K+. The difference in pay between assistant and associate was only 25K. And there was essentially no admin ladder for clinicians to climb. Like many academic centers, most of the admin roles (directorships etc) were more honorary than financially rewarded. The highest paid positions were rarely held by MDs.

Not so at all where I am now. You have to meet the FTE adjusted median RVU target to receive a bonus but there is minimal incentive to exceed it. There is an extra bonus for exceeding 75th percentile but it’s only around 10K. Directorships of things like Brachy or Theranostics can snag you 40-50K per year. However, the broader admin ladder offers much less incentive for a rad onc than an internist with our pay structure. The base pay for a rad onc works out to around 70K per 0.1 cFTE (compared to about 30K for a general internist). Unless you make it to the very top, most of the pay incentives that come with promotions will be largely offset by reductions in clinical pay when they adjust your cFTE. Being vice dean might earn you an extra $250K, but if it required you to drop from 0.8 to 0.5 cFTE, you would only net about $40K.

This is something very tricky about academics for new grads. The pay structures and opportunities for personal advancement beyond standard promotion are often quite opaque and it’s hard to know what to ask when you don’t even know the potential variables. I think the two broadest buckets are higher base pay with smaller incentive bonuses vs lower base pay with higher incentive potential. Both can work out well, people just need to know what the better fit is for them.

 

[CaesarRO]

There’s little to no incentive to be especially busy clinically so I doubt the busiest rad onc’s are in academics

In a pseudo-academic or satellite arrangement in an undesirable location with the right incentives, some of these docs can be busy

If I was in academics I would not stress about my clinical RVU’s, and I’d try to climb the admin ladder or IP/industry collaboration/startup spinoffs ladder. Admin ladder is a lot easier and financial payoffs more obvious.

I've debated trying to shift into the admin world but I think the payoff is less certain and lifespan much shorter. I see admin roles turnover like crazy. It seems like you have 3-5 years to try to maneuver to get into a top executive position with a bonus.

There's a lot of survivorship bias seeing the admins leave or retire with multimillion dollar bonuses/golden parachutes.

The long runway and reliability of clinical income seems like a surer thing

 

[ramsesthenice]

I've debated trying to shift into the admin world but I think the payoff is less certain and lifespan much shorter. I see admin roles turnover like crazy. It seems like you have 3-5 years to try to maneuver to get into a top executive position with a bonus.

There's a lot of survivorship bias seeing the admins leave or retire with multimillion dollar bonuses/golden parachutes.

The long runway and reliability of clinical income seems like a surer thing

100% agree. The other thing is how prepared are you to move your family? The exec roles are usually not internal hires and often require more than 1 move to land. The fraction of admin roles most clinicians are likely to land that ends up paying substantially more than a reasonably compensated rad onc is relatively small.

I do know folks who have made substantial income promoting specific products like Barigel, Viewray, Unity, etc. If that kind of thing interests anyone, it’s definitely important to understand your contract and bylaws to know what is allowed.

 

[Doctorer]

This is something very tricky about academics for new grads. The pay structures and opportunities for personal advancement beyond standard promotion are often quite opaque and it’s hard to know what to ask when you don’t even know the potential variables. I think the two broadest buckets are higher base pay with smaller incentive bonuses vs lower base pay with higher incentive potential. Both can work out well, people just need to know what the better fit is for them.

This is an excellent point, and quite possibly the most important thing for people to understand. The difficult part is that these details are often very opaque and truly understood by very few (including the faculty). My guess is that this is by design, and it's not something that will easily become clear at an interview or even from talking to people. My approach to this is to simply look at turnover. If people are happy (and being fairly compensated plays in to that), they tend not to leave (really, the only thing that matters).

 

[yesmaster]

There are plenty of academic centers that still heavily incentivize clinical productivity. The folks who greatly exceeded RVU targets could easily see bonuses of 100K+.

I would not call this a hefty incentive. The difference between greatly exceeding and median RVU’s equates to multiple millions of dollars for academic centers, maybe more with their insurance rates. Generous of them to share low single digit % with their physician serfs.

Like many academic centers, most of the admin roles (directorships etc) were more honorary than financially rewarded.

Most of academics

The highest paid positions were rarely held by MDs.

Some specialties do well in academics. The dermatologist or specialist surgeon can stay in their city and move to a PP or community hospital. Rad onc’s mediocre comp in academics and lack of variability reflects the lack of optionality or job mobility for rad onc’s, and also the overemphasis on technology over physicians. Just my guess.

Academic rad onc’s should support legislation that strengthens private practice like site neutrality, an emaciated PP environment is bad for academic rad onc’s too. The people, not the institution.

Not so at all where I am now. There is an extra bonus for exceeding 75th percentile but it’s only around 10K.

It’s gotten worse. How surprising

This is something very tricky about academics for new grads. The pay structures and opportunities for personal advancement beyond standard promotion are often quite opaque

I don’t know what it’s like to be junior faculty, but I can say as a med student and resident, some chair or PD types gave mostly self serving advice, and my personal advancement was much better served by listening to senior peers. If it was up to chairs or more accurately academic system CEO’s, we’d all be interchangeable widgets or replaced by AI

 

[yesmaster]

My approach to this is to simply look at turnover.

It’s funny in retrospect when interviewing as a med student how academic dept’s with a lot of turnover would spin it as having “new blood”

 

[Radonky]

At my old academic job, I averaged about 250 new starts per year with a 40% clinical FTE. That was on top of having a lab, writing grants, and doing trials. It got to be too much over time. Most of my colleagues there had similar or higher numbers (but had 70-80% cFTEs). I personally like being busy, but there is an undeniable issue in that context: residency training. Residents got a lot of hands on learning, but time for us to prepare didactics etc. was lacking. To your point, there are some very bust academic departments.

But in my experience, this was the outlier. Where I trained, I believe only 2/9 of the faculty averaged anything close to 200-250 new starts per year. Now I’m somewhere with about 60% of my previous volume. It’s much more manageable. I do a ton of interstitial implants and MR guided pancreatic SBRT, so I stay pretty busy. But I have more dedicated time for teaching, committee work, etc.

props, that's a difficult service to carry.

 

[allseasons]

It’s all very location based. I moved from one state where the ceiling was 1500 and recruiters stopped calling me to another where I’ve been offered 4000 and I have to tell the recruiters to **** off and stop calling me.

Where were you offered 4000??

 

[Neuronix]

Where were you offered 4000??

My friend who negotiated this has asked me not to comment.

Keep in mind that far flung clinics will pay locums agencies up to 4000/day to fill these positions, and the agency keeps as much as 50%.

 

[Ray D. Ayshun]

My friend who negotiated this has asked me not to comment.

Keep in mind that far flung clinics will pay locums agencies up to 4000/day to fill these positions, and the agency keeps as much as 50%.

My place is probably paying around that after travel and call add-ons. I think 18-20K for every week I take off. Doc prob getting 2-2.5K daily, which isn't bad for doing literally nothing.

 

[A_DeMichele]

locum agency takes about 1/3. I've seen daily take-home rates $2600 for 2026

 

[PharMed2016]

Curious on how malpractice insurance works with locums. They must provide occurrence based insurance? Or is it the hospital or clinic that is being covered who provides this?

 

[TheWallnerus]

Curious on how malpractice insurance works with locums. They must provide occurrence based insurance? Or is it the hospital or clinic that is being covered who provides this?

My malpractice covers my locum