a modest proposal, for students

[Tigerstang]

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

It can be done. Easily.

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[OTN]

Setting up a solo radiation oncology practice coming out of residency is easy? You can't be serious. Not only is not "easy", it is impossible.

 

[Tigerstang]

Setting up a solo radiation oncology practice coming out of residency is easy? You can't be serious. Not only is not "easy", it is impossible.

Ok. If you say so. I did it, but I guess I did something impossible. And I'm not the only one who did it either.

 

[OTN]

Ok. If you say so. I did it, but I guess I did something impossible. And I'm not the only one who did it either.

How long ago?

Edit: I just want to emphasize for medical students/residents that graduating from a radiation oncology residency and expecting to be able to "hang a shingle", let alone doing it easily, is not realistic. There's a radonc residency graduate in my city who moved here 7 years ago with her husband, who is also a subspecialist. She has never worked as a radonc. Why didn't she just start her own practice if it's so easy?

 

[Tigerstang]

How long ago?

Edit: I just want to emphasize for medical students/residents that graduating from a radiation oncology residency and expecting to be able to "hang a shingle", let alone doing it easily, is not realistic. There's a radonc residency graduate in my city who moved here 7 years ago with her husband, who is also a subspecialist. She has never worked as a radonc. Why didn't she just start her own practice if it's so easy?

5 years ago. It's ok, you can be right, I can be wrong, if it makes you feel better.

 

[scarbrtj]

How long ago?

Edit: I just want to emphasize for medical students/residents that graduating from a radiation oncology residency and expecting to be able to "hang a shingle", let alone doing it easily, is not realistic. There's a radonc residency graduate in my city who moved here 7 years ago with her husband, who is also a subspecialist. She has never worked as a radonc. Why didn't she just start her own practice if it's so easy?

Another cautionary/worrisome data point? This is a (one of many possible of course) reason the ***average*** American rad onc sees only 100-120 new patients per year.

One thing is certain: starting a new freestanding practice solo is about unheard of, and truly about impossible in a CON state.

 

[OTN]

5 years ago. It's ok, you can be right, I can be wrong, if it makes you feel better.

How did you get the capital coming out of residency to build a clinic?

 

[Tigerstang]

How did you get the capital coming out of residency to build a clinic?

I started with a hospital contract. Worked as an independent contractor to a hospital, where I fought for referrals from an established group that also had a contract with the hospital (open network). Within a year I was doing well and applied for bank financing to develop a free standing center at one of that hospitals new satellite facilities that had not yet opened an RT facility. It was hard. I have a lot of debt. But it's what worked for me. I am not implying it is easy to do, but it is certainly not impossible.

 

[Tigerstang]

How long ago?

Edit: I just want to emphasize for medical students/residents that graduating from a radiation oncology residency and expecting to be able to "hang a shingle", let alone doing it easily, is not realistic. There's a radonc residency graduate in my city who moved here 7 years ago with her husband, who is also a subspecialist. She has never worked as a radonc. Why didn't she just start her own practice if it's so easy?

I should point out if it's been 7 years maybe she doesn't want to work? I'm not sure this anecdotal story has much meaning.

Don't get me wrong I absolutely believe our field is oversaturated and most of the posters on here are telling the truth. But let's avoid the hyperbole.

 

[OTN]

I started with a hospital contract. Worked as an independent contractor to a hospital, where I fought for referrals from an established group that also had a contract with the hospital (open network). Within a year I was doing well and applied for bank financing to develop a free standing center at one of that hospitals new satellite facilities that had not yet opened an RT facility. It was hard. I have a lot of debt. But it's what worked for me. I am not implying it is easy to do, but it is certainly not impossible.

It makes more sense, then, as your first job out of residency was not one you created yourself. I can't imagine a bank financing a new grad without a referral base like you had developed.

The anecdotal story has meaning if you're a resident with a subspecialist spouse.

 

[Tigerstang]

It makes more sense, then, as your first job out of residency was not one you created yourself. I can't imagine a bank financing a new grad without a referral base like you had developed.

The anecdotal story has meaning if you're a resident with a subspecialist spouse.

I had no referral base when I started. My first job out of residency was created entirely by myself. I walked into zero patients under beam. But you have a pathologic need to be right, so sure, you're right. Whatever champ.

 

[OTN]

I had no referral base when I started. My first job out of residency was created entirely by myself. I walked into zero patients under beam. But you have a pathologic need to be right, so sure, you're right. Whatever champ.

I'm not sure why you see the need to be so condescending. I'm merely trying to figure out how you were able to accomplish what is rather unique to our field.

You may have walked into zero patients under beam, but you also walked into a department which was already physically present and fully-staffed. To suggest that's the same as a new resident "hanging a shingle" themselves is disingenuous at best.

 

[w00tz]

I'm not sure why you see the need to be so condescending. I'm merely trying to figure out how you were able to accomplish what is rather unique to our field.

You may have walked into zero patients under beam, but you also walked into a department which was already physically present and fully-staffed. To suggest that's the same as a new resident "hanging a shingle" themselves is disingenuous at best.

He's clearly the Chuck Norris of rad oncs. There's no point in trying to understand.

 

[Pointless]

Ok. If you say so. I did it, but I guess I did something impossible. And I'm not the only one who did it either.

Don't worry, I've had the residents on this board also tell me that I, and many people I know, also don't exist. Only people who have negative experiences exist, it seems.

 

[Tigerstang]

I'm not sure why you see the need to be so condescending. I'm merely trying to figure out how you were able to accomplish what is rather unique to our field.

You may have walked into zero patients under beam, but you also walked into a department which was already physically present and fully-staffed. To suggest that's the same as a new resident "hanging a shingle" themselves is disingenuous at best.

" your first job out of residency was not one you created yourself. "

"You can't be serious. Not only is not "easy", it is impossible. "

Who's condescending?

 

[Reaganite]

I understand where tigershark is coming from. I routinely read certain things are "impossible" on this board, even though I've personally done them. That being said, OTN has always been a fair poster from my estimation, and I don't think he's questioning the legitimacy of building a practice from scratch. He's speaking more to the infrastructure. Even the best rad onc entrepreneurs among us started at an existing facility and learned the business, developed a referral base, etc. before they ventured out into building their own center(s).

 

[deleted18755]

I had no referral base when I started. My first job out of residency was created entirely by myself. I walked into zero patients under beam. But you have a pathologic need to be right, so sure, you're right. Whatever champ.

I don't care for or about the back and forth but your experiences are definitely unique and honestly quite impressive.

I suspect you want to keep some degree of anonymity, but can you please elaborate on your experiences, accomplishments, hurdles/failures, etc. Older guys like me would be interested in hearing about it and applauding your drive and everything, but I bet residents and maybe even younger graduates would benefit from hearing about your unique experiences and path!

 

[RickyScott]

I don't care for or about the back and forth but your experiences are definitely unique and honestly quite impressive.

I suspect you want to keep some degree of anonymity, but can you please elaborate on your experiences, accomplishments, hurdles/failures, etc. Older guys like me would be interested in hearing about it and applauding your drive and everything, but I bet residents and maybe even younger graduates would benefit from hearing about your unique experiences and path!

agree here. Certainly that is not something i could have done within a year of training. Attests to quality of people in this field in highly competitive job market.

 

[Tigerstang]

Don't get me wrong, I still agree with the general gestalt that the field is in rapid decline and the sky truly is falling. But to say with hard work and willingness to take big risks (and by big risks, I mean pour your life savings into your career and pray you don't go belly up) you can't succeed, it's simply not true. It's just that most people are not willing to take that kind of risk. They want to walk into a practice where partnership is handed to them after 2-3 years. They don't want the sleepless nights, endless meetings with admins and bankers and contractors, fear you might lose your house, months without a paycheck, and all the other stress that comes with establishing a practice. Where our field failed is we let others (hospitals, companies like 21C/McKesson, etc) take those risks while we sat back hoping for a large steady paycheck. In that approach, you will get a paycheck, but you shouldn't be surprised when it drops every year. You don't control the means of production, so you can't control the compensation. It's no different than any other profession.

 

[RickyScott]

Don't get me wrong, I still agree with the general gestalt that the field is in rapid decline and the sky truly is falling. But to say with hard work and willingness to take big risks (and by big risks, I mean pour your life savings into your career and pray you don't go belly up) you can't succeed, it's simply not true. It's just that most people are not willing to take that kind of risk. They want to walk into a practice where partnership is handed to them after 2-3 years. They don't want the sleepless nights, endless meetings with admins and bankers and contractors, fear you might lose your house, months without a paycheck, and all the other stress that comes with establishing a practice. Where our field failed is we let others (hospitals, companies like 21C/McKesson, etc) take those risks while we sat back hoping for a large steady paycheck. In that approach, you will get a paycheck, but you shouldn't be surprised when it drops every year. You don't control the means of production, so you can't control the compensation. It's no different than any other profession.

You can work your butt off, take risk etc, but in most established markets in 2020, this is about financially aligning referring docs (usually by forming multispecialty group) with radiation, not just a matter of providing good pt service/pt care.

 

[scarbrtj]

I had no referral base when I started. My first job out of residency was created entirely by myself. I walked into zero patients under beam.

Now the odds of this, or something similar, being a graduating rad onc resident's trajectory is <<<100/26000. But we all can dream.

 

[evilbooyaa]

I had no referral base when I started. My first job out of residency was created entirely by myself. I walked into zero patients under beam. But you have a pathologic need to be right, so sure, you're right. Whatever champ.

I think OTN's point is that you at least had access to a machine and clinic space afforded to you on day 1-365 (or however long you were acting as an independent contractor).

Regardless, you stepping out and financing your own facility one year into attendinghood is extremely risky and impressive at the same time and I'm glad it worked out for you. Congrats.