Advice appreciated

[DrProtonX]

I’m interested in doing pp after my training however i’m not in one of the “top-10” programs. Unfortunately it seems like there’s a notion that residents at smaller programs, especially those who matched after rad onc competitiveness tanked, are of lower quality. While I absolutely disagree with that, I can’t change people’s mind when it’s already set (rightfully or not, based on personal experience or what not but that’s beside the point).
So I’d like to know what can I do throughout the residency that could help my application stand out when applying for jobs in future?

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[medgator]

I’m interested in doing pp after my training however i’m not in one of the “top-10” programs. Unfortunately it seems like there’s a notion that residents at smaller programs, especially those who matched after rad onc competitiveness tanked, are of lower quality. While I absolutely disagree with that, I can’t change people’s mind when it’s already set (rightfully or not, based on personal experience or what not but that’s beside the point).
So I’d like to know what can I do throughout the residency that could help my application stand out when applying for jobs in future?

Do you have a specific area in mind? Never hurts to reach out early enough. Maybe look at some locums your senior year at these places etc

 

[DrProtonX]

Do you have a specific area in mind? Never hurts to reach out early enough. Maybe look at some locums your senior year at these places etc

Preferrably northeast or midwest

 

[medgator]

Preferrably northeast or midwest

Probably need to start researching those areas now and finding out the lay of the land. In this field, unfortunately it is never too early to start

 

[thecarbonionangle]

Your first job is not your last. Pick a region and take the closer good job you find. Go there do a good job and continue to look closer to where you want. It might take you longer, maybe less. If you talk to people in elite programs, they think the job market is great, and people are getting jobs exactly where they want. Lower tier to hellpits have a mixed experience.

 

[NotMattSpraker]

I’m interested in doing pp after my training however i’m not in one of the “top-10” programs. Unfortunately it seems like there’s a notion that residents at smaller programs, especially those who matched after rad onc competitiveness tanked, are of lower quality. While I absolutely disagree with that, I can’t change people’s mind when it’s already set (rightfully or not, based on personal experience or what not but that’s beside the point).
So I’d like to know what can I do throughout the residency that could help my application stand out when applying for jobs in future?

Network, lol. I used to be so annoyed when people would say this advice because it’s so impractical.

Practically, convert Midwest or northeast to real life cities that have radiation oncologists. The Midwest is huge and has both Chicago and “rural”.

Find out who works in those cities and talk to them early.

Talk to all rad oncs in the city because “private practice” is not a real life type of job that has a fixed definition.

The more people that know you as a person, the less chance you are “filtered out” of consideration by your program tier.

Also, don’t ignore people outside those areas if you happen to meet them while networking, for example at ASTRO. Just make sure they know you are a trainee that wants this type of job in these regions.

You want to maximize the number of chances some person connects you with a hiring person at the right time. More people know you in general, know your goals, like you as a person… all leads to more chances.

Finally, use common sense and don’t treat people like a means to an end. The people you are networking with have to like you for these connections to help you. If you are pushy or rude or entitled, it will backfire.

I feel like this needs to be said based on some past experiences, unfortunately.

 

[drowsy12]

Your first job is not your last. Pick a region and take the closer good job you find. Go there do a good job and continue to look closer to where you want. It might take you longer, maybe less.

Agree

If you talk to people in elite programs, they think the job market is great, and people are getting jobs exactly where they want.

Honestly disagree, I don’t think I know anyone that has ever called the rad onc job market like that, even when I was looking to apply to the field 15 years ago. This has never been the case for rad onc and anyone would be lying to say you can get whatever location you want when you want, now or in 2005.

 

[fiji128]

Network, lol. I used to be so annoyed when people would say this advice because it’s so impractical.

Practically, convert Midwest or northeast to real life cities that have radiation oncologists. The Midwest is huge and has both Chicago and “rural”.

Find out who works in those cities and talk to them early.

Talk to all rad oncs in the city because “private practice” is not a real life type of job that has a fixed definition.

The more people that know you as a person, the less chance you are “filtered out” of consideration by your program tier.

Also, don’t ignore people outside those areas if you happen to meet them while networking, for example at ASTRO. Just make sure they know you are a trainee that wants this type of job in these regions.

You want to maximize the number of chances some person connects you with a hiring person at the right time. More people know you in general, know your goals, like you as a person… all leads to more chances.

Finally, use common sense and don’t treat people like a means to an end. The people you are networking with have to like you for these connections to help you. If you are pushy or rude or entitled, it will backfire.

I feel like this needs to be said based on some past experiences, unfortunately.

Just a reminder, Rad Onc is probably the only specialty out there that requires this level of "effort" to get a decent position for a US trained MD. If you train in just about anything else employers are falling over themselves to hire competent physicians.

 

[RickyScott]

Agree


Honestly disagree, I don’t think I know anyone that has ever called the rad onc job market like that, even when I was looking to apply to the field 15 years ago. This has never been the case for rad onc and anyone would be lying to say you can get whatever location you want when you want, now or in 2005.

That’s why it was such a good idea to double resident numbers.
re OP: are there any decent “private practice” left in the northeast. Everyone I know works for a large system.

 

[madchemist89]

You should cold call/email rad oncs in the area you wish to practice in. Most will ignore you, but one or two may be thinking about retiring or need extra help. There may be an upcoming vacancy that needs to be filled. These opportunities will never hit the open job market.

 

[Mandelin Rain]

That’s why it was such a good idea to double resident numbers.
re OP: are there any decent “private practice” left in the northeast. Everyone I know works for a large system.

ROA New England?

 

[NotMattSpraker]

Just a reminder, Rad Onc is probably the only specialty out there that requires this level of "effort" to get a decent position for a US trained MD. If you train in just about anything else employers are falling over themselves to hire competent physicians.

If one knows how to look, its very easy to see the consequences of consolidation and labor oversupply in a lot of markets.

Rad Onc is really the only specialty Ive seen that works so hard to quash discussion of either of those topics.

 

[OTN]

You should cold call/email rad oncs in the area you wish to practice in. Most will ignore you, but one or two may be thinking about retiring or need extra help. There may be an upcoming vacancy that needs to be filled. These opportunities will never hit the open job market.

I did this 15 years ago- cold called/emailed more than 100 radoncs across the US. It led to a few leads. Interestingly, one of the radoncs I emailed in the city in which I was hired and still work to this day told me the city was full and to not come here. Oops looks like he was precisely wrong.

 

[RickyScott]

ROA New England?

heard a lot of negatives about that group

 

[DrProtonX]

That’s why it was such a good idea to double resident numbers.
re OP: are there any decent “private practice” left in the northeast. Everyone I know works for a large system.

I hope so. While I see the appeal of being hospital employed, making $400-500k with less headache, it’s such a shame we’re giving up the possible 7-figure ceiling

 

[xrt123]

People in private practice generally care bout are you going to be a reliable, affable, and hard working partner. We generally do not what top "top 10 program" you were at. These "top 10 programs" are a chair change, PD change and a bad match from being a malignant program with a bad rep.

 

[Tigerstang]

What is private practice?

 

[DrProtonX]

What is private practice?

Collecting pro fee and ideally percent of technical fee

 

[madchemist89]

You’re very unlikely to see any technical fee unfortunately.

 

[DrProtonX]

You’re very unlikely to see any technical fee unfortunately.

Who gets the technical fee then?

 

[thecarbonionangle]

Who gets the technical fee then?

Maybe “senior partners” who will never let you in or string you along, or the hospital which maybe uses it to keep your department staffed and pockets the rest. I know of very few people who have this (technical).

 

[thecarbonionangle]

Network, lol. I used to be so annoyed when people would say this advice because it’s so impractical.

Practically, convert Midwest or northeast to real life cities that have radiation oncologists. The Midwest is huge and has both Chicago and “rural”.

Find out who works in those cities and talk to them early.

Talk to all rad oncs in the city because “private practice” is not a real life type of job that has a fixed definition.

The more people that know you as a person, the less chance you are “filtered out” of consideration by your program tier.

Also, don’t ignore people outside those areas if you happen to meet them while networking, for example at ASTRO. Just make sure they know you are a trainee that wants this type of job in these regions.

You want to maximize the number of chances some person connects you with a hiring person at the right time. More people know you in general, know your goals, like you as a person… all leads to more chances.

Finally, use common sense and don’t treat people like a means to an end. The people you are networking with have to like you for these connections to help you. If you are pushy or rude or entitled, it will backfire.

I feel like this needs to be said based on some past experiences, unfortunately.

Networking is good and we should all do it. It is good advice but it is just vague and can be hard to actually implement. ASTRO for example, I have never made a meaninful connection, has always felt like a very clickish vibe. ACRO I have been to multiple times and there were more opportunities to meet people and most were cool and friendly. However it is still hard to translate a friendly small talk conversation to a job. It takes time and some luck and good timing.

 

[DrProtonX]

Maybe “senior partners” who will never let you in or string you along, or the hospital which maybe uses it to keep your department staffed and pockets the rest. I know of very few people who have this (technical).

If you’re hospital employed, it makes sense that hospital collect the technical fee since they own the machines. But what’s the point of pp partnership if you don’t get a part of technical fee?

 

[TheWallnerus]

If you’re hospital employed, it makes sense that hospital collect the technical fee since they own the machines. But what’s the point of pp partnership if you don’t get a part of technical fee?

Almost all freestanding private practice bill global (no prof or tech CPT modifier). The technical is still there of course, it’s just subsumed within that global charge. If you make MGMA median and have an average patient load, you’re getting 0% of technical and not getting 100% of professional (this is true for any rad onc). If you have an average patient load and make a really, really nice salary in private practice, you’re getting a portion of the technical (even though that may not be spelled out in a contract per se). You could argue that an academic chairman who has 10 or less patients under beam and is making 1 million a year is getting a portion of the technical.

 

[NotMattSpraker]

Networking is good and we should all do it. It is good advice but it is just vague and can be hard to actually implement. ASTRO for example, I have never made a meaninful connection, has always felt like a very clickish vibe. ACRO I have been to multiple times and there were more opportunities to meet people and most were cool and friendly. However it is still hard to translate a friendly small talk conversation to a job. It takes time and some luck and good timing.

This is exactly right, which is why my advice is to never leave "networking" in the hands of anyone else other than you. Don't miss the events, but also dont expect ASTRO or ACRO's little events to get you a job.

If you have a goal in mind where there is just a low N for jobs, and you are reaching out for the first time even in March of PGY4 year, you're probably too late.

I always remember how a person reached out in a polite way multiple times over years from early in training. By the time they come for their formal interview, all I am thinking about is their clear dedicated commitment to my practice/region. I dont even remember where they trained (nor do I care that much).

In fact, if I dont have a job when they graduate, Im even more likely to help them find one in town... simply because I like them. Ive had a few friends where that happened.

 

[DrProtonX]

Almost all freestanding private practice bill global (no prof or tech CPT modifier). The technical is still there of course, it’s just subsumed within that global charge. If you make MGMA median and have an average patient load, you’re getting 0% of technical and not getting 100% of professional (this is true for any rad onc). If you have an average patient load and make a really, really nice salary in private practice, you’re getting a portion of the technical (even though that may not be spelled out in a contract per se). You could argue that an academic chairman who has 10 or less patients under beam and is making 1 million a year is getting a portion of the technical.

Thanks, this was very helpful

 

[DrProtonX]

This is exactly right, which is why my advice is to never leave "networking" in the hands of anyone else other than you. Don't miss the events, but also dont expect ASTRO or ACRO's little events to get you a job.

If you have a goal in mind where there is just a low N for jobs, and you are reaching out for the first time even in March of PGY4 year, you're probably too late.

I always remember how a person reached out in a polite way multiple times over years from early in training. By the time they come for their formal interview, all I am thinking about is their clear dedicated commitment to my practice/region. I dont even remember where they trained (nor do I care that much).

In fact, if I dont have a job when they graduate, Im even more likely to help them find one in town... simply because I like them. Ive had a few friends where that happened.

I’ve already contacted a place in a location i’m interested in multiple times but didn’t get any response, I guess I shouldn’t get a cold feet and keep trying. It’s very humbling when comparing to my friend who was a pgy5 rad last year and was getting bombarded by recruiters with $40-60k a month offers

 

[Tigerstang]

Collecting pro fee and ideally percent of technical fee

It was a joke. These types of jobs don't exist anymore. 80% of doctors are employed.

 

[BobbyHeenan]

It was a joke. These types of jobs don't exist anymore. 80% of doctors are employed.

I agree....the only sort-of-getting-technical-fees thing that happens out there is at some (typically rural/lower volume) places the hospital or owner of the linac (presuming not freestanding) will pay the doc a "clinical director" stipend or fee that is on top of professional collections.

Obviously if they are employed then many places negotiate a $/RVU...and at the end of the day, that $ may be coming from technical if the pro fee side isn't producing enough to cover that contract rate.

So some "private practices" that bill separate from hospital pro fees will get money from the hospital on top of their pro fees. In my experience though this is in uncompetitive markets and has been in situations where physician recruitment/retention has been an issue and the admins actually care about keeping competent docs.

*edit - i'm basically saying the same thing @TheWallnerus is after re-reading this thread.

 

[randomname2018]

1. Ask your PD for an alum spreadsheet or list. See who landed where and if you have potential friends in an area. If your PD doesn't have this, then its on you to make it. Contact former grads first if it aligns with your geographic requirements.

2. Expand your search and build a spreadsheet of where you want to go. Find the practices you like that might be a reasonable fit. Use the ASTRO directory for contact information.

3. Reach out prior to ASTRO. In a brief email, indicate who you are and your interest in their practice. Attach CV. Ask to meet at ASTRO. Keep a log of who you contacted, when, and the status.

4. For those that respond, ask about practice needs now and in the coming years. Set out to build those skills. Rinse and repeat.

Overall, be an honest, reasonable person. Don't bull**** these people. This is a small field and people talk.

 

[communitydoc13]

If you make MGMA median and have an average patient load, you’re getting 0% of technical and not getting 100% of professional (this is true for any rad onc).

Not true any more. Payor mix and practice habits matter a lot.

If you are seeing 80% Medicare with some Medicaid and no premium plan patients (fair number of locations like this), pro fees alone and 6 consults a week (where you are appropriately not treating them all) may not get you to MGMA median.

I recommend PSA with a hospital as ideal middle ground (obviously owning the machines makes docs rich, but this is now uncommon). It will protect you from downward pressures regarding annual Medicare adjustments, decreased fractionation and decreased indications. (It also makes it easier to practice judiciously). The technical comp is much, much higher than physician pro-fees. The hospital will still do fine.

 

[OTN]

I agree....the only sort-of-getting-technical-fees thing that happens out there is at some (typically rural/lower volume) places the hospital or owner of the linac (presuming not freestanding) will pay the doc a "clinical director" stipend or fee that is on top of professional collections.

Obviously if they are employed then many places negotiate a $/RVU...and at the end of the day, that $ may be coming from technical if the pro fee side isn't producing enough to cover that contract rate.

So some "private practices" that bill separate from hospital pro fees will get money from the hospital on top of their pro fees. In my experience though this is in uncompetitive markets and has been in situations where physician recruitment/retention has been an issue and the admins actually care about keeping competent docs.

*edit - i'm basically saying the same thing @TheWallnerus is after re-reading this thread.

There are some private practices that exist in desirable areas which own their own equipment, and as a result the radoncs are able to collect some of the technical revenue. They're becoming a smaller and smaller slice of the pie overall, however, and I'm not sure I see how that trend is going to reverse. It would be better for patients and providers if it did, but I'm not holding my breath.

 

[TheWallnerus]

If you are seeing 80% Medicare with some Medicaid and no premium plan patients (fair number of locations like this), pro fees alone and 6 consults a week (where you are appropriately not treating them all) may not get you to MGMA median.

Didn’t want to disillusion the padawan so early in the Jedi training.

 

[medgator]

Almost all freestanding private practice bill global (no prof or tech CPT modifier). The technical is still there of course, it’s just subsumed within that global charge. If you make MGMA median and have an average patient load, you’re getting 0% of technical and not getting 100% of professional (this is true for any rad onc). If you have an average patient load and make a really, really nice salary in private practice, you’re getting a portion of the technical (even though that may not be spelled out in a contract per se). You could argue that an academic chairman who has 10 or less patients under beam and is making 1 million a year is getting a portion of the technical

Pro only setups are weak sauce in 2020+. Unfortunately you are often better off hospital employed esp in a low volume situation vs PSA arrangement and doing your own billing.

Such is how the game has changed

 

[RickyScott]

Didn’t want to disillusion the padawan so early in the Jedi training.

Pro only setups are weak sauce in 2020+. Unfortunately you are often better off hospital employed esp in a low volume situation vs PSA arrangement and doing your own billing.

Such is how the game has changed

Ultimately proff fees are becoming a farce as all the reimbursement is concentrated in the technical. Probably should just do away with them.

 

[Fpg1245]

Ultimately proff fees are becoming a farce as all the reimbursement is concentrated in the technical. Probably should just do away with them.

You can’t run a practice and even get paid anywhere near MGMA with pro fees only. The problem is employers like the play games with the RVUs because it just means they have to dip more into the sweet tech rev to pay you.

 

[NotMattSpraker]

I’ve already contacted a place in a location i’m interested in multiple times but didn’t get any response, I guess I shouldn’t get a cold feet and keep trying. It’s very humbling when comparing to my friend who was a pgy5 rad last year and was getting bombarded by recruiters with $40-60k a month offers

The hit rate is very low. Its worth acknowledging this is not an easy thing to do for regular well adjusted people haha. It sucks cold calling anyone. You really have to keep at it as a new grad unless you come from those rare programs where faculty do this for you. I did not.

Id just add that it seems like so many are not super thoughtful about what they want and/or wont compromise or get creative.

At some point, hopefully, you will be comparing a few real life options that all have some compromise. The ol' pick 1 or 2 location, money, job type... you wont get all 3. Hopefully all are small compromises and its still pretty exciting to consider your future out of residency (it always is).

I think my initial job search would have been improved if I would have done that prospectively with a more open mind. I applied narrowly based on false assumptions.

Don't give up on that center, but are there other centers that get you close to your "PP x interesting location" solution?

Geographically close with a commute, far away but similar type of location, same location but academic clinical track satellite instead of "PP". All of these might make you happy or at least be sustainable for a couple years and therefore would increase your opportunities.

PS, I view a true PP ownership job in 2024 as pretty risky? I am risk averse, but like... read the room. There is so much pressure to consolidate, I would have like constant anxiety as a new grad pre-partner. Maybe you stay PP, but ownership changes, and that could happen multiple times over a few years. I know someone that was purchased by an academic center and got a pay cut. I even know of someone that lost their job in a bankruptcy and they do not yet have another. Clear black swan, but it happened.

 

[Mandelin Rain]

You can’t run a practice and even get paid anywhere near MGMA with pro fees only. The problem is employers like the play games with the RVUs because it just means they have to dip more into the sweet tech rev to pay you.

Lol. News to me, I guess. Maybe I should give back a whole bunch of money.

 

[radoncftw]

Lol. News to me, I guess. Maybe I should give back a whole bunch of money.

totally depends on payor mix, treatment mix, and volume; also overhead. it is definitely possible, but I don't think the delta between academics/hospital employed vs. PP is as great as it used to be for most people.

 

[fiji128]

totally depends on payor mix, treatment mix, and volume; also overhead. it is definitely possible, but I don't think the delta between academics/hospital employed vs. PP is as great as it used to be for most people.

The real delta now is in the level of control over the practice more then anything else.

 

[radoncftw]

The real delta now is in the level of control over the practice more then anything else.

that too. Nice to not having your salary cut/renegotiated because of an RN, MBA (no offense) hospital admin.

 

[Mandelin Rain]

totally depends on payor mix, treatment mix, and volume; also overhead. it is definitely possible, but I don't think the delta between academics/hospital employed vs. PP is as great as it used to be for most people.

Of course. If you're treating 5-10 Medicaid patients, you're not going to make much. PSA wouldn't make sense there. I do agree that the trend hasn't been great for pro fees. Still, you got 20-25 private pay patients? You're probably making MUCH more than employed.

The real delta now is in the level of control over the practice more then anything else.

THIS. Though it is indeed still very possible to make (a bit) more on less work than in an employed setting.

 

[Fpg1245]

Lol. News to me, I guess. Maybe I should give back a whole bunch of money.

Lol I guess you’re one of the haves

taking care of CEOs with Gleason 7 prostates or bored housewives with early stage Bc all day with commercial insurance? Sounds awesome

The rest of us are stuck in prior auth managed Medicaid evicore with an employer that screws you out of money.

But congrats on the job buddy

 

[Mandelin Rain]

Lol I guess you’re one of the haves

taking care of CEOs with Gleason 7 prostates or bored housewives with early stage Bc all day with commercial insurance? Sounds awesome

The rest of us are stuck in prior auth managed Medicaid evicore with an employer that screws you out of money.

But congrats on the job buddy

Totes. Or you could've just been wrong. Not sure what seems more likely.

Always good to double down on stupidity though. Just in case.

 

[communitydoc13]

The real delta now is in the level of control over the practice more then anything else.

Exactly, with PSA you can work out schedule among yourselves, structure contracts for new hires based on physician needs, hire your own biller.

These things can make a big difference for flexibility. If you have good docs, who act in good faith and are willing to do some service for the hospital, the hospital may be happy to just leave you alone. (The ideal situation short of collecting technical revenue for yourself).

PSA does not strictly mean pro collections only. It can be structured in many ways. It does mean that you are not technically an employee of the hospital. Even the freedom to structure your practice within an LLC has benefits in terms of tax liability. (Of course an outstanding employer may make up the difference with a good benefits package...there is no one right answer).

As is clear from posts above...pro collections can vary widely (per patient...not just due to volume). It is worth knowing what collections are in a given practice (although I don't recommend going down this line of questioning as a prospective hire right out of residency).

 

[Fpg1245]

Totes. Or you could've just been wrong. Not sure what seems more likely.

Always good to double down on stupidity though. Just in case.

what is so special about your corner of the world? It still sounds like total BS.

Ouch! Too close to home? 😂

 

[medgator]

what is so special about your corner of the world? It still sounds like total BS.

Ouch! Too close to home? 😂

No need to be a putz about it. Many different experiences on this forum

 

[Fpg1245]

No need to be a putz about it. Many different experiences on this forum

Why defend them?

You're right some arrangements are more out of touch than others and increasingly irrelevant.

 

[Mandelin Rain]

what is so special about your corner of the world? It still sounds like total BS.

Ouch! Too close to home? 😂

Why defend them?

You're right some arrangements are more out of touch than others and increasingly irrelevant.

Cool story. Much accurate. Bigly in touch.

Sorry you've been triggered. I get you've had a bad experience. That sucks. That's not everyone. Us docs treating only CEOs are still hanging in there.

 

[Mandelin Rain]

Note: I'm open to being corrected on any of this, and perhaps should be moved to private forum, but I don't want new grads seeing only disinformation.

The ROCR Pro Fees payment table is up on their website. It's roughly based on average CMS collections for services by disease sites across America right now, today. [actually: "Those rates were based on radiation oncology payment data under the Hospital Outpatient Prospective Payment System (HOPPS) between 2017-2019 and trended forward to 2024"]. Some sites are less than 3k, some are more than 3k. Prostate is more than 4k. Let's assume about 3k per patient right now to keep the numbers easy. That's Medicare. Let's say your private payor contracts are about 100-150% Medicare. This is definitely not true in all markets, but they are nice round and reasonable numbers to start with between straight Medicare and what the hospitals get. To again keep it easy, let's assume that only 50% of your patients have private insurance and the rest on straight Medicare or state.

Let's say you have 24 patients (busy-ish, but easily doable practice) on treatment consistently and your average treatment course is about 4 weeks. That's 6 new patients per week or about 300 new starts per year. Half public, half private payor.

3k for public x 150 = 450k
4.5k (3k x 150%) for good contracts private x 150 = 670k
3k (3k x 100%) for not so good contract private x 150 = 450k
Total Range: 900k - 1.12mil

To my knowledge, this does not include E/M charges like consults or follow ups [edit: "All evaluation and management (E/M) codes associated with the initial consult would continue to be paid FFS."] or med director stipends or whatever else outside of the bundled treatment specific pro fees. So you'd likely get a bit more (about 10% for E/M per my experience).

Obviously, a ton of assumptions and rounding being made here. Does not apply to everyone, etc.... And you certainly don't get to keep all those collections. You have to pay billers, and other administrative overhead, and med mal, and your own health/disability insurance, and your own retirement funding. However, I don't think it's a wholly unreasonable model either. and even if it's 2x more generous that it should be, and you cut that total collection in half.... you still arrive at about.... MGMA median salary.

Saying that "You can’t run a practice and even get paid anywhere near MGMA with pro fees only." just feels erroneous prima facie. You need a reasonable volume and a decent mix of cases/payors. But that's true anywhere. Ain't no hospitals paying you 800k to treat 4 patients in the middle of nowhere anymore.

EDIT: I'd place unity for an average employed vs average PSA salary at somewhere between 15-20 patients on beam in an average clinical scenario/geography. Less than that and you almost assuredly would be better off employed. More than that, and you almost assuredly would do better on a PSA. Because most clinics operate at about those volumes, the pay between private PSA groups and employed docs have become fairly similar which is why I full heartedly agreed with this statement, "The real delta now is in the level of control over the practice more then anything else." I think that's right and important.