a modest proposal, for students

[deleted956486]

Great. I'm excited to start the job search.

These jobs must've been buried between all the exciting and innovative fellowship opportunities.

Hospitalist Physician job in

Hospitalist Physician job in

www.practicelink.com

---

Members don't see this ad.

 

[deleted956486]

No matter what evidence is presented, the job market will always be great. I mean, even if we look at pathology, their professional association is still trying to spin that narrative.

CAP responds to SDN Pathology

The State of the Job Market for Pathologists - Evidence From the College of American Pathologists Practice Leader Survey David J. Gross, PhD; W. Stephen Black-Schaffer, MD; Robert D. Hoffman, MD, PhD; Donald S. Karcher, MD; Edith Lopez Estrada, BA; Stanley J. Robboy, MD; Michael B. Cohen, MD...

forums.studentdoctor.net

The truth of the matter is that if the job market was great, people would ignore the people complaining about it (how come we dont see these types of posts in the Urology forum, Ophtho, Ortho?).

 

[Neuronix]

I'm not going to put up with personal attacks. If you have a fantastic job to offer, please let me know. Until then, I'm done with this discussion. You can post whatever you like, but personal attacks against users will not be tolerated.

 

[Pointless]

I'm not going to put up with personal attacks. If you have a fantastic job to offer, please let me know. Until then, I'm done with this discussion. You can post whatever you like, but personal attacks against users will not be tolerated.

I wasn't... huh? Never said anything personal in the least. Did I miss something?

 

[Neuronix]

I wasn't... huh? Never said anything personal in the least. Did I miss something?

Sorry for the confusion. That was in response to another poster whose posts I have deleted. I didn't want to call anyone out in particular.

 

[Pointless]

Sorry for the confusion. That was in response to another poster whose posts I have deleted. I didn't want to call anyone out in particular.

Gotcha, no worries.

Anyway, I think we've covered the topic to everyone's satisfaction (and completely derailed this thread to boot).

My offer stands to anyone who wants to hear more about a more or less typical hospital employed situation, feel free to PM me.

 

[scarbrtj]

Right, I understand that I guess, but if you DID want to go into rad onc, you're not competing against all 26000 people. 25800 are going for another specialty. As has been pointed out ad nauseum on this forum, rad onc has never been easier to match into. So, realistically, this is nothing close to the NFL analogy. You will be likely have little difficulty matching rad onc, then you will be competing against the 180-200 others graduating with you.

You’ll be competing against a great many other than ~200. Don’t know if hyperbole or not but I recall a person here saying they just applied for a PP job that had “hundreds” of applicants. And there will be competitions part deux and trois within 5 years of graduating for many. Plus we are adding new competitors er teammates all the time. The competitiveness, like a traffic gridlock wave, has shifted from the residency application process into the job market.

So, is it your supposition that the survey numbers are fabricated? I don't know what kind of jobs you have interviewed for but I guess I should have clarified "not academic". I am happy to discuss this with you at greater length via PM if you want.

Anyway, literally the first job post on ASTRO is a private practice track that I bet would get you over $500k after the 2 year partnership.

'therapy OR associates OR evansville OR in OR STATECODE:"IN"' Jobs | ASTRO Radiation Oncology Career Center

3,404 'therapy OR associates OR evansville OR in OR STATECODE:

careers.astro.org

This would be a great job. Very good MDs and practice.

Re: MGMA, my only problem with it in the past is the sample size has been very small. I remember one year when the N was about 50 rad oncs nationwide or so. I think they are doing better nowadays (in regards to sample size). FWIW, I have never reported my salary to any official body ever because I have never been polled or queried or whatever you wanna call it. I would gladly do so.

WARNING: some math coming. As far as I have been able to discern, rad onc costs the entire U.S. society--all insurance and Medicare--about $7 billion a year. (My totally WAG 95% C.I. here is $5.5-8 billion.) Now from here, pick your poison. Do rad oncs get ~20% of that? If so, that'll average about ~$260K per rad onc in the U.S. Some people might choose 30%, which I think overall would be too generous. But if that's the case, that's about $410K per rad onc in the U.S. So the idea that the median is ~$450K... well, it doesn't readily compute. It's *possible*. But like they say in psychiatry: keep a dirty mind. I'll fall back to our old saw that we are over-supplied. And if so, salary is... for all U.S. rad oncs... a more or less zero sum game.

 

[Pointless]

Re: MGMA, my only problem with it in the past is the sample size has been very small. I remember one year when the N was about 50 rad oncs nationwide or so. I think they are doing better nowadays (in regards to sample size). FWIW, I have never reported my salary to any official body ever because I have never been polled or queried or whatever you wanna call it. I would gladly do so.

Fair enough point re: the limited sample size, but MGMA has been pretty consistent every year. And, FWIW, the numbers they report jive very well with my personal experience.

Out of curiosity, do you find the numbers being reported as wildly inaccurate? I'm dying for some of the private practice/employed types to chime in here.

WARNING: some math coming. As far as I have been able to discern, rad onc costs the entire U.S. society--all insurance and Medicare--about $7 billion a year. (My totally WAG 95% C.I. here is $5.5-8 billion.) Now from here, pick your poison. Do rad oncs get ~20% of that? If so, that'll average about ~$260K per rad onc in the U.S. Some people might choose 30%, which I think overall would be too generous. But if that's the case, that's about $410K per rad onc in the U.S. So the idea that the median is ~$450K... well, it doesn't readily compute. It's *possible*. But like they say in psychiatry: keep a dirty mind. I'll fall back to our old saw that we are over-supplied. And if so, salary is... for all U.S. rad oncs... a more or less zero sum game.

To this point, I should say that these are specifically NON-ACADEMIC salaries on MGMA. I would agree with you otherwise, but I think what happens is that you have a ton of academics slaving away for somewhere between $200-400k and everyone else making 500k+. But at least the big academic programs get paid 10x what my hospital does to Choose Wisely.....

 

[RadOncG]

I really don't know why you or others get worked up about fellowship postings when it's often the same ones being posted again and again through the year because people aren't taking them

the real jobs are being taken, both the ones that post and the ones that don't post.

are you graduating next year? You'll be fine. work hard and hustle.

Not worked up. It's just interesting that the only opportunities in moderate sized cities are felllowships.

Work hard and hustle and I will get an average rad onc salary in Evansville, Indiana. I agree with both of you that this is true. It is just not my ideal scenario. I did not know this is would be the reality when I applied.

If you want to let medical students know that if they work really hard for 5 years they will get an average rad onc salary job in Evansville then go for it. This will ensure nobody applies in the future.

 

[FrostyHammer]

Let's say a medical student wished to minimize the number of future compromises they have to make. They have worked hard in their life and already made many sacrifices. They are now 30+ maybe with a family to support etc. Would you recommend this specialty for this hypothetical medical student?

Here's my answer to your question: why would it ever be my place to "recommend" anything to this student? Have him/her know the pros and cons, and let them make their life's decision. Simple as that.

 

[RadOncG]

Here's my answer to your question: why would it ever be my place to "recommend" anything to this student? Have him/her know the pros and cons, and let them make their life's decision. Simple as that.

Fair. Also convenient.

What would you say are the cons? Particularly in relation to compromises that may be necessary in the future.

 

[radiation]

One thing about steering med students into medical oncology at this juncture is that even though salaries for med onc appear to be peaking now, there is an even longer latency period for that route (6 years) for the whole economic and job market landscape to shift. Trying to optimize on market conditions in 2020 rather than which specialty will likely give you greater intrinsic job satisfaction is another risk that must be weighed.

6 years from now, we know there will be new president staring down exponentially rising healthcare costs. Current oncology drug prices are unsustainable and are clearly outpacing the costs of radiation. If you are a medical student that is trying to avoid a specialty where you want more autonomy in location/pay/etc and want to avoid being affected by capricious economic policy, I don't know if medical oncology is obviously the better choice (not going to down the rabbit hole of politics further than that).

 

[Brim]

Odds of a college footballer making it into the NFL: ~1.6%.
Odds of a med school grad making it into a choice rad onc job: (~100/26000) = 0.4%
So med school grads, choose the NFL instead of rad onc. Your odds are better

“If your lucky enough” ‍♂️

 

[deleted573262]

“If your lucky enough” ‍♂

it's YOUR college education

 

[FrostyHammer]

Fair. Also convenient.

What would you say are the cons? Particularly in relation to compromises that may be necessary in the future.

I think those have been discussed as libitum in this forum, understatedly beaten to death...

 

[20181121]

There is a lot of misinformation in this thread.

If you don't believe MGMA, take a look at AMGA. Or AAMC. Or Terry Wall's data.

I am also surprised at the focus on job postings. Job postings are not how people get jobs in this field, let alone other highly compensated fields within and outside of medicine (ask your friends at Skadden Arps or McKinsey how many of them applied online!). Jobs are often posted after an offer has been made and accepted, and HR just has to go through the motions.

My read of the arguments on this thread and others boils down to this:
- There is a handful of 5-10 people, writing multiple posts throughout the day (where does this free time come from?), who are actively trying to dissuade medical students from applying for radiation oncology. If you look back at their prior posts, you will get a sense of their agendas.
- Pessimistic predictions are being made - which is fine - but blatant falsehoods and inaccurate data are also being shared - which is not acceptable.

I would urge students to do their own research based on real data, talk to their own and other residents, attendings, and private practice radiation oncologists, and think of Student Doctor Network as one data point that represents the views of, say, 20 individuals (since I am an SDN poster, I count myself among those 20!).

 

[RadOncG]

I think those have been discussed as libitum in this forum, understatedly beaten to death...

True. So sounds like you recognize these issues as cons.

This should all be discussed with medical students. The people that think SDN is an echo chamber should listen to what the academics tell medical students.

It is a foregone conclusion that people just woke up one day and decided to trash the specialty online. They have no legitimate concerns and clearly a lot of free time because they are just out to destroy the specialty. There is no critical appraisal of the concerns discussed.

At least here we can get different opinions and have these discussions.

 

[scarbrtj]

So, is it your supposition that the survey numbers are fabricated? I don't know what kind of jobs you have interviewed for but I guess I should have clarified "not academic".

Fair enough point re: the limited sample size, but MGMA has been pretty consistent every year. And, FWIW, the numbers they report jive very well with my personal experience. Out of curiosity, do you find the numbers being reported as wildly inaccurate? I'm dying for some of the private practice/employed types to chime in here. To this point, I should say that these are specifically NON-ACADEMIC salaries on MGMA. I would agree with you otherwise, but I think what happens is that you have a ton of academics slaving away for somewhere between $200-400k and everyone else making 500k+. But at least the big academic programs get paid 10x what my hospital does to Choose Wisely.....

I suppose I am saying there is a possibility that MGMA is inaccurate. And this goes to my point re: rad onc has now become a zero sum game. And it somewhat calls into question your incredulity that anyone could compare a HS or NCAA football player striving to turn pro and a college or med student eyeing rad onc. Because you tacitly imply there's now a bimodal distribution of possible career outcomes: "slavers" (salary $200-400K a year) and the lucky ($500K+ a year salaries). That right there lowers the probability that someone with rad onc aspirations will wind up fulfilled either individually or in comparison to a peer. (Plus, most rad onc graduates must now look forward to academic jobs instead of PP jobs anayway.) And that also makes one a bit suspicious of MGMA metrics, or at least suspicious in how to understand them.

The MGMA presents salaries as if they were normally distributed, certainly not bimodally. That's why they report all the way from 10th to 90th percentiles. The last data I saw from MGMA was a mean rad onc salary of about $550K a year for 2019. Now let's assume there are 5000 rad oncs in the U.S; 5000 x $550,000 = $2.75 billion. To put that in perspective, the most Medicare has ever reported spending in a year on rad onc is ~$2.2 billion (~5y ago). Right now they report around $1.5-1.6 billion a year. By scrounging for hard to come by informational scraps, I believe a reasonably high estimate for total rad onc spending (yes, professional and technical) in the U.S. per year is $7 billion. Probably $6 billion is more reasonable, but lets say $7 billion. Now can we actually believe in our heart of hearts that rad oncs get ($2.75 billion/$7 billion = 0.4) 40% of the total professional and technical reimbursement???? I can not. And I won't ever. Now if we had 3000 rad oncs in America, I could better believe that math...

3000 x $550,000 = $1.65 billion; ($1.65 billion/$7 billion = 0.23), ie rad oncs get ~23% of prof/tech...

But we have 5000+ rad oncs in America. Not 3000. So the mean salary of ~$550K quoted for rad oncs does not make 100% believable financial or economic sense. A *mean* salary quoted that's half that WOULD make sense. Every rad onc we add to the labor market is not doing undone or hitherto unclaimed work. The ~$7 billion (or more likely ~$6 billion) pie is not growing.

 

[RadOncG]

I would urge students to do their own research based on real data, talk to their own and other residents, attendings, and private practice radiation oncologists, and think of Student Doctor Network as one data point that represents the views of, say, 20 individuals (since I am an SDN poster, I count myself among those 20!).

I'm sure they will. They're smart people.

What they will find in real life is that sentiment is rapidly turning to agreeing with the general consensus of this message board. It is happening because the job search is not going well for some currently.

ARRO invited Simul Parikh to speak for a reason. He says on twitter under his own name what we say here anonymously.

 

[elementaryschooleconomics]

My read of the arguments on this thread and others boils down to this:
- There is a handful of 5-10 people, writing multiple posts throughout the day (where does this free time come from?), who are actively trying to dissuade medical students from applying for radiation oncology. If you look back at their prior posts, you will get a sense of their agendas.

It was a Sunday afternoon, and we're Radiation Oncologists...?

 

[Neuronix]

If you don't believe MGMA, take a look at AMGA. Or AAMC. Or Terry Wall's data.

We're discussing all that and more in detail in the private forum. PM if you'd like access. I do need to verify that you're a rad onc resident or attending first.

Posting from my bathroom break at the sweatshop

 

[RickyScott]

One thing about steering med students into medical oncology at this juncture is that even though salaries for med onc appear to be peaking now, there is an even longer latency period for that route (6 years) for the whole economic and job market landscape to shift. Trying to optimize on market conditions in 2020 rather than which specialty will likely give you greater intrinsic job satisfaction is another risk that must be weighed.

6 years from now, we know there will be new president staring down exponentially rising healthcare costs. Current oncology drug prices are unsustainable and are clearly outpacing the costs of radiation. If you are a medical student that is trying to avoid a specialty where you want more autonomy in location/pay/etc and want to avoid being affected by capricious economic policy, I don't know if medical oncology is obviously the better choice (not going to down the rabbit hole of politics further than that).

salaries are set by supply and demand largely, not price of drugs. If drugs cost half as much, you will still need to pay what free market requires if your hospital wants to treat cancer (and there is a shortage right now and as cancer becomes more of a chronic disease, or treatments expand to older and sicker pts with targeted/biological therapies, this trend may worsen). They bill strictly on e&m codes and only average around 5-6 thousand rvus.

 

[radiation]

salaries are set by supply and demand largely, not price of drugs. If drugs cost half as much, you will still need to pay what free market requires if your hospital wants to treat cancer (and there is a shortage right now and as cancer becomes more of a chronic disease, or treatments expand to older and sicker pts with targeted/biological therapies, this trend may worsen). They bill strictly on e&m codes and only average around 5-6 thousand rvus.

Supply and demand are not independent of price of drugs. Medicare reimburses average sales price+ 6%. Are you arguing the price of drug reimbursement does not have an effect of salaries? If drugs cost half as much, heme/onc salaries would certainly take a hit.

http://www.medpac.gov/docs/default-source/reports/chapter-5-medicare-part-b-drug-and-oncology-payment-policy-issues-june-2016-report-.pdf?sfvrsn=0

 

[OTN]

Supply and demand are not independent of price of drugs. Medicare reimburses average sales price+ 6%. Are you arguing the price of drug reimbursement does not have an effect of salaries? If drugs cost half as much, heme/onc salaries would certainly take a hit.

http://www.medpac.gov/docs/default-source/reports/chapter-5-medicare-part-b-drug-and-oncology-payment-policy-issues-june-2016-report-.pdf?sfvrsn=0

In the private practice world they would.

In academia/hospital-based practices, they always have and always will hire for as little as they possibly can. Supply and demand.

 

[RickyScott]

Supply and demand are not independent of price of drugs. Medicare reimburses average sales price+ 6%. Are you arguing the price of drug reimbursement does not have an effect of salaries? If drugs cost half as much, heme/onc salaries would certainly take a hit.

http://www.medpac.gov/docs/default-source/reports/chapter-5-medicare-part-b-drug-and-oncology-payment-policy-issues-june-2016-report-.pdf?sfvrsn=0

I am arguing that.
Btw- hospitals/clinics in medonc make most of profit from supportive drugs like Neulasta etc

 

[radiation]

I am arguing that.
Btw- hospitals/clinics in medonc make most of profit from supportive drugs like Neulasta etc

I am not actually sure what we are arguing at this point, but I am not following what your are saying. I am saying heme/onc supply and demand is at least in part driven by reimbursement and is subject to change in the next 6 years. This is very clear from the aftermath of the 340B drug pricing program. As soon as hospitals were able to exploit this loophole and charge list prices for heme/onc drugs for which they received a discount, they created a demand for heme/onc doctors in these hospitals (up 230% increase in staffing), likely due to increased margins from oncology drugs. This is not dissimilar to the consolidation to hospital-based practices in radiation oncology, with the closing down of many physician owned heme/onc clinics not eligible for 340B

https://www.nejm.org/doi/full/10.1056/NEJMsa1706475

As a note, the heme/onc forum has discussed the the concern on the effect of reimbursement on salaries as well

De-Compensation

Hello everyone, Any reasoning behind the downtrend of Oncology compensations? I have been hearing/reading that future for compensation for Oncology will be lower than that of a hospitalist in not too long. It is strange that with all the growth of this specialty it's being financially...

forums.studentdoctor.net

It is difficult for me to imagine a scenario where drug pricing/reimbursement does not affect heme/onc salaries. That would be akin to saying reimbursement for hypofractionation doesn't affect rad onc salaries. I agree with you that heme/onc bills comparatively less rvus than rad onc. In 2020, the CMS conversion factor for heme/onc is $36.0896.

https://www.hematology.org/Advocacy/ASH-Testimony/2019/10066.aspx

So if average wRVU is ~5k and conversion of ~$36, thats 180k. Given the numbers for heme/onc salaries being thrown around here, where is the rest of the salary coming from? My argument is that is related to drug reimbursement to the hospital variably baked into heme/onc salaries, for which 340B hospitals have huge margins on. Who knows how long this loophole lasts? Their issues are not so dissimilar ours, with the big difference being we are a much smaller specialty more easily affected by things like workforce oversupply

 

[PhotonBomb]

What’s the CMS conversion factor for rad onc?

 

[RickyScott]

I am not actually sure what we are arguing at this point, but I am not following what your are saying. I am saying heme/onc supply and demand is at least in part driven by reimbursement and is subject to change in the next 6 years. This is very clear from the aftermath of the 340B drug pricing program. As soon as hospitals were able to exploit this loophole and charge list prices for heme/onc drugs for which they received a discount, they created a demand for heme/onc doctors in these hospitals (up 230% increase in staffing), likely due to increased margins from oncology drugs. This is not dissimilar to the consolidation to hospital-based practices in radiation oncology, with the closing down of many physician owned heme/onc clinics not eligible for 340B

https://www.nejm.org/doi/full/10.1056/NEJMsa1706475

As a note, the heme/onc forum has discussed the the concern on the effect of reimbursement on salaries as well

De-Compensation

Hello everyone, Any reasoning behind the downtrend of Oncology compensations? I have been hearing/reading that future for compensation for Oncology will be lower than that of a hospitalist in not too long. It is strange that with all the growth of this specialty it's being financially...

forums.studentdoctor.net

It is difficult for me to imagine a scenario where drug pricing/reimbursement does not affect heme/onc salaries. That would be akin to saying reimbursement for hypofractionation doesn't affect rad onc salaries. I agree with you that heme/onc bills comparatively less rvus than rad onc. In 2020, the CMS conversion factor for heme/onc is $36.0896.

https://www.hematology.org/Advocacy/ASH-Testimony/2019/10066.aspx

So if average wRVU is ~5k and conversion of ~$36, thats 180k. Given the numbers for heme/onc salaries being thrown around here, where is the rest of the salary coming from? My argument is that is related to drug reimbursement to the hospital variably baked into heme/onc salaries, for which 340B hospitals have huge margins on. Who knows how long this loophole lasts? Their issues are not so dissimilar ours, with the big difference being we are a much smaller specialty more easily affected by things like workforce oversupply

salary per rvu is 80-90$ (because there is a shortage!) in most hospitals. Hospitals have been jacking up $ per rvu for them. Likely wouldn’t change if the hospital lost money every time it gave out drugs, because again there is a shortage. Guess who can charge a ton of technical fees- pathologists! But there is no shortage so they don’t get paid much. Psychiatrists shortage? Yes so they are getting paid, but no technical for most and inpt psych for the homeless not a money maker.
why do diamonds cost a lot? And guess what would happen If the supply doubled?

btw 340 b ended last year unless you are an nci center.

 

[FrostyHammer]

True. So sounds like you recognize these issues as cons.

This should all be discussed with medical students. The people that think SDN is an echo chamber should listen to what the academics tell medical students.

It is a foregone conclusion that people just woke up one day and decided to trash the specialty online. They have no legitimate concerns and clearly a lot of free time because they are just out to destroy the specialty. There is no critical appraisal of the concerns discussed.

At least here we can get different opinions and have these discussions.

I never said I didn't recognize these as cons. What I don't appreciate is forcing one sided opinions onto a population that is clearly smart enough to make their own decisions. This is a basic form of bigotry, in some senses. I agree that it should be discussed, but not without a balance of the pros. Discussing the cons without the pros (like what happens daily on SDN) is IMHO just as utterly worthless as discussing the pros without the cons (like what happens daily on Twitter). Both very opposite but equally useless.

 

[FrostyHammer]

I am not actually sure what we are arguing at this point, but I am not following what your are saying. I am saying heme/onc supply and demand is at least in part driven by reimbursement and is subject to change in the next 6 years. This is very clear from the aftermath of the 340B drug pricing program. As soon as hospitals were able to exploit this loophole and charge list prices for heme/onc drugs for which they received a discount, they created a demand for heme/onc doctors in these hospitals (up 230% increase in staffing), likely due to increased margins from oncology drugs. This is not dissimilar to the consolidation to hospital-based practices in radiation oncology, with the closing down of many physician owned heme/onc clinics not eligible for 340B

https://www.nejm.org/doi/full/10.1056/NEJMsa1706475

As a note, the heme/onc forum has discussed the the concern on the effect of reimbursement on salaries as well

De-Compensation

Hello everyone, Any reasoning behind the downtrend of Oncology compensations? I have been hearing/reading that future for compensation for Oncology will be lower than that of a hospitalist in not too long. It is strange that with all the growth of this specialty it's being financially...

forums.studentdoctor.net

It is difficult for me to imagine a scenario where drug pricing/reimbursement does not affect heme/onc salaries. That would be akin to saying reimbursement for hypofractionation doesn't affect rad onc salaries. I agree with you that heme/onc bills comparatively less rvus than rad onc. In 2020, the CMS conversion factor for heme/onc is $36.0896.

https://www.hematology.org/Advocacy/ASH-Testimony/2019/10066.aspx

So if average wRVU is ~5k and conversion of ~$36, thats 180k. Given the numbers for heme/onc salaries being thrown around here, where is the rest of the salary coming from? My argument is that is related to drug reimbursement to the hospital variably baked into heme/onc salaries, for which 340B hospitals have huge margins on. Who knows how long this loophole lasts? Their issues are not so dissimilar ours, with the big difference being we are a much smaller specialty more easily affected by things like workforce oversupply

THANK YOU. This may have been the first post I've seen in a while that says something negative about med onc. Everyone else makes it seem like med onc has exactly zero disadvantages. Perhaps we should all migrate over to the med onc SDN forum and actually have a balanced discussion...

 

[radiation]

What’s the CMS conversion factor for rad onc?

All specialties have the same MPFS conversion factor. There is also a separate geographic practice cost index multiplier. It gets quite complicated. Colloquially people will lump them all in as a single "conversion factor" to make it easier to discuss. Here's a couple links to better explain

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedcrePhysFeeSchedfctsht.pdf

career growth Archives

blog.supercoder.com

 

[RickyScott]

Trust me, ask a medonc or fellow what average dollar per rvu most hospitals paying. Whatever metric you are citing is not how they are being paid.

 

[RadOncG]

I never said I didn't recognize these as cons. What I don't appreciate is forcing one sided opinions onto a population that is clearly smart enough to make their own decisions. This is a basic form of bigotry, in some senses. I agree that it should be discussed, but not without a balance of the pros. Discussing the cons without the pros (like what happens daily on SDN) is IMHO just as utterly worthless as discussing the pros without the cons (like what happens daily on Twitter). Both very opposite but equally useless.

Great. I think we are all on the same page.

Hope to see you over on twitter telling them to stop being so one sided as well.

 

[PhotonBomb]

Trust me, ask a medonc or fellow what average dollar per rvu most hospitals paying. Whatever metric you are citing is not how they are being paid.

Dude you’re so out of touch lmao

 

[FrostyHammer]

Great. I think we are all on the same page.

Hope to see you over on twitter telling them to stop being so one sided as well.

I neither have Twitter nor want to even go anywhere close to those biased dumpster-fire-like discussions they have there...

 

[RadOncG]

I neither have Twitter nor want to even go anywhere close to those biased dumpster-fire-like discussions they have there...

Me either. We're glad to have your opinion here though.

I think here you find many individuals that love this specialty and are concerned about the future. Levels of fear and tactics for change may vary obviously.

 

[Mandelin Rain]

But... case logs.

 

[Mandelin Rain]

I think here you find many individuals that love this specialty and are concerned about the future. Levels of fear and tactics for change may vary obviously.

I think you're correct here.

I'll readily admit this. I'm about 10ish years out. I love my work. I love my patients. I love my clinic. I like my pay (inflation adjusted it was better before, but fine). My location is great for me but YMMV. I also realize that I have 15-20 more years left to practice. I don't want a collapse of this specialty. Much of that is self interest, sure. But once you start practicing, we all share similar self interests. You don't want the market flooded with docs willing to accept bare minimum salaries. You don't want to work harder/longer for the same or less pay. You want some flexibility to change jobs if circumstance dictates you must.

Some posters here (yes, they are all doctors) have taken an analytic approach, some have simply shared their experience/opinion/concerns, and some have adopted a repetitive shock and awe approach. The latter have done this because they are impassioned, were talking about it 7 years ago in more civil terms and got no results, and now there is a handful of bot posters here screaming "all is well" equally repetitively.

 

[DoctwoB]

Guys, guys, you’re both right. Salaries come from a combination of supply and demand of a given specialty. The revenue generated by said specialty is a big part of the demand equation, but far from the only part. For example PCPs often lose money purely on RVUs but make it up for the system through steering patients to imaging, labs, specialists, etc. within the system. Likewise hospitals probably take a bath on hemeonc salaries in terms of the RVUs they generate because they drive a lot of high $ services to the hospital including drugs, surgery, and imaging. The MBAs in the hospital know that hiring a med onc drives X number of dollars to their system, and will be willing to pay up to that number (or even more sometimes to allow for a new service line) to hire one. The supply of heme oncs is the other big factor, If they doubled their numbers tomorrow, hospitals would have to compete much less on salary to get one and salaries would go down.

 

[Mandelin Rain]

Likewise hospitals probably take a bath on hemeonc salaries in terms of the RVUs they generate because they drive a lot of high $ services to the hospital including drugs, surgery, and imaging.

Don't forget: Radiation Oncology. Can make up the bath you're taking on the med onc by screwing the rad onc.

 

[scarbrtj]

Guys, guys, you’re both right. Salaries come from a combination of supply and demand of a given specialty. The revenue generated by said specialty is a big part of the demand equation, but far from the only part. For example PCPs often lose money purely on RVUs but make it up for the system through steering patients to imaging, labs, specialists, etc. within the system. Likewise hospitals probably take a bath on hemeonc salaries in terms of the RVUs they generate because they drive a lot of high $ services to the hospital including drugs, surgery, and imaging. The MBAs in the hospital know that hiring a med onc drives X number of dollars to their system, and will be willing to pay up to that number (or even more sometimes to allow for a new service line) to hire one. The supply of heme oncs is the other big factor, If they doubled their numbers tomorrow, hospitals would have to compete much less on salary to get one and salaries would go down.

Relatively speaking rad oncs see so few patients in terms of "true" patient visits this is probably least applicable to rad onc vs any other specialty of which I know. (And the weekly OTV doesn't count folks; e.g. there are about twice as many derms as rad oncs but all of derm averages about 50 million patient visits/year... there's only somewhere in neighborhood of 600K *new* rad onc patients per year in the U.S.). You know the little question mark bricks you hit in Super Mario that spit out the gold coins? Rad oncs: not really broad-based brick hitters (again, relatively speaking). Not a dis. Just nature of our particular beast. Our brick is the linac. An insular brick. Or maybe everyone else is Mario and we are the brick!

 

[RickyScott]

I think you're correct here.

I'll readily admit this. I'm about 10ish years out. I love my work. I love my patients. I love my clinic. I like my pay (inflation adjusted it was better before, but fine). My location is great for me but YMMV. I also realize that I have 15-20 more years left to practice. I don't want a collapse of this specialty. Much of that is self interest, sure. But once you start practicing, we all share similar self interests. You don't want the market flooded with docs willing to accept bare minimum salaries. You don't want to work harder/longer for the same or less pay. You want some flexibility to change jobs if circumstance dictates you must.

Some posters here (yes, they are all doctors) have taken an analytic approach, some have simply shared their experience/opinion/concerns, and some have adopted a repetitive shock and awe approach. The latter have done this because they are impassioned, were talking about it 7 years ago in more civil terms and got no results, and now there is a handful of bot posters here screaming "all is well" equally repetitively.

Well said. Describes me as well. I have adopted repetitive shock and awe approach, but I truly believe we can’t absorb 1000 new grads in next 5 years (and it’s not like their positions were created by an intelligent plan)

when you train with some of the leadership (and twitter dbags) and realize some of them are not the brightest (despite being well spoken) and also very self interested guys, you come at this from a different perspective than a medstudent full of reverence for academics who are presumably “looking out for the field”

 

[RickyScott]

No matter what evidence is presented, the job market will always be great. I mean, even if we look at pathology, their professional association is still trying to spin that narrative.

CAP responds to SDN Pathology

The State of the Job Market for Pathologists - Evidence From the College of American Pathologists Practice Leader Survey David J. Gross, PhD; W. Stephen Black-Schaffer, MD; Robert D. Hoffman, MD, PhD; Donald S. Karcher, MD; Edith Lopez Estrada, BA; Stanley J. Robboy, MD; Michael B. Cohen, MD...

forums.studentdoctor.net

The truth of the matter is that if the job market was great, people would ignore the people complaining about it (how come we dont see these types of posts in the Urology forum, Ophtho, Ortho?).

Just Read the CAP editorial. When technical specialties tank this hard, -and we will soon be in same boat-, should they just dispense with the MD requirement and open up residencies to np/pas? just tarnishes the whole field of medicine when 20% of applicant pool are us mds.

 

[scarbrtj]

Just Read the CAP editorial. When technical specialties tank this hard, -and we will soon be in same boat-, should they just dispense with the MD requirement and open up residencies to np/pas? just tarnishes the whole field of medicine when 20% of applicant pool are us mds.

had no idea that only about 200 U.S. seniors apply for 600 pathology positions annually. They fill by non-US grads; wound up filling about 569 out of 601 slots last year total, but again only about 33% were American grads. Would add: this 33% fill metric by U.S. grads should be obvious evidence that the people in pathology power should contract spots. Looks like to that they say: nah.

 

[RickyScott]

had no idea that only about 200 U.S. seniors apply for 600 pathology positions annually. They fill by non-US grads; wound up filling about 569 out of 601 slots last year total, but again only about 33% were American grads. Would add: this 33% fill metric by U.S. grads should be obvious evidence that the people in pathology power should contract spots. Looks like to that they say: nah.

1)Some traditional highly intellectual specialties like path and psych will always attract some grads no matter what the circumstances. Us,not so much. Those who are really interested in cancer, could just become oncologists.
2) also goes to show, no matter how obvious the numbers/math, and outrage on SDN and freaking JAMA, those who benefit financially from a system dont care and will misuse CMS dollars for their own benefit.

 

[deleted941485]

So, is it your supposition that the survey numbers are fabricated? I don't know what kind of jobs you have interviewed for but I guess I should have clarified "not academic". I am happy to discuss this with you at greater length via PM if you want.

Anyway, literally the first job post on ASTRO is a private practice track that I bet would get you over $500k after the 2 year partnership.

'therapy OR associates OR evansville OR in OR STATECODE:"IN"' Jobs | ASTRO Radiation Oncology Career Center

3,404 'therapy OR associates OR evansville OR in OR STATECODE:

careers.astro.org

Evansville has been looking for quite sometime and is emblematic of the larger problem if you ask me.

Also, I wouldn’t get hung up on PP offerings especially as a new grad. None of these partner salaries will exist in a few years anyway because of forces that I’m sure you are already aware of. In fact, the notion of a “partner” in the current climate should be stricken from new grads vocabulary

 

[OTN]

Evansville has been looking for quite sometime and is emblematic of the larger problem if you ask me.

Also, I wouldn’t get hung up on PP offerings especially as a new grad. None of these partner salaries will exist in a few years anyway because of forces that I’m sure you are already aware of. In fact, the notion of a “partner” in the current climate should be stricken from new grads vocabulary

Our practice still offers traditional partnerships to new hires, and we will not change this practice moving forward. Still some good ones out there, but harder and harder to get those jobs, unfortunately.

 

[deleted941485]

Our practice still offers traditional partnerships to new hires, and we will not change this practice moving forward. Still some good ones out there, but harder and harder to get those jobs, unfortunately.

For all intents and purposes, these jobs don’t exist because they aren’t in places where most people live or want to live. And even if I had he privilege of getting a job like that...of what use is partnership? What does it mean anymore? Unfortunately I know more people that get screwed by this arrangement than not.

The bigger question is Why should I let anyone else other than me be in charge of my own professional fees? What does an RO group offer other than skimming off the newly hired?

 

[yesmaster]

There is a lot of misinformation in this thread.

- There is a handful of 5-10 people, writing multiple posts throughout the day (where does this free time come from?), who are actively trying to dissuade medical students from applying for radiation oncology. If you look back at their prior posts, you will get a sense of their agendas.
- Pessimistic predictions are being made - which is fine - but blatant falsehoods and inaccurate data are also being shared - which is not acceptable.

I would urge students to do their own research based on real data, talk to their own and other residents, attendings, and private practice radiation oncologists, and think of Student Doctor Network as one data point that represents the views of, say, 20 individuals (since I am an SDN poster, I count myself among those 20!).

There is a lot of misdirection on this forum.

- There is a handful of 5-10 people, writing multiple posts throughout the day (with much free time thanks to cheap midlevels and even cheaper residents), who are actively trying to lure medical students into applying to radiation oncology. If you look back at their prior posts, you will get a sense of their agendas.
- Irrationally exuberant anachronisms defend the status quo - which is unfortunate but expected - but blatant falsehoods and inaccurate data are also being shared - which is not acceptable.

I would urge students to do their own research based on real data, talk to their own and other residents, attendings, and private practice radiation oncologists, and think of Student Doctor Network as one data point that represents the views of, say, 20 individuals (since I am an SDN poster, I count myself among those 20!).

 

[OTN]

For all intents and purposes, these jobs don’t exist because they aren’t in places where most people live or want to live. And even if I had he privilege of getting a job like that...of what use is partnership? What does it mean anymore? Unfortunately I know more people that get screwed by this arrangement than not.

The bigger question is Why should I let anyone else other than me be in charge of my own professional fees? What does an RO group offer other than skimming off the newly hired?

Good luck staying profitable while negotiating with payers and equipment suppliers (both hardware and software) as a solo radonc.