Article: Why did Radonc Become competitive in last 5 years.

[fettucine]

Just skimming through astro journal, found interesting article on why the field became more competitive in the last 10 years or so. Apparently the bottom line was that in the 80's they projected oversupply of radiation oncologists, which is what happened in the the late 80's. The programs cut positions, and the field became less lucrative by med students because of a soft job market. However those who graduated late 80's early 90's, at least 1/3 of them went into academics "temporarily" mainly because of the soft job market, and to wait until better and more lucrative private practices roll around. It just so happened that ACGME increased the training requirement to 4 years from three around 1995. This suddenly caused less graduates coming out in the subsequent years. So basically the bottom dropped out because of less amount of people going in the field, low number of spots, combined with less people coming out.

This all resulted in better wages for the graduates and people in the field, and those academicians who were waiting around for better job offers also took the newly offered private practice jobs for better salary than what they were making. This compounded even more to the increased demand in academics which couldn't increase the number of spots, and was failing to recruit more med students.

That is why for those of us who had been interested in radonc since getting into med-school.. you must have noticed a progressive early increase in the competitiveness of radonc.

Just a simplified version of the article. I will attempt to attach a word document for full version. Below is the table that they posted on the Academic salary of Rad-onc.

Table 3.

Median salaries for academic radiation oncologists Position Academic year Increase (%)
1999–2000 2001–2002 % Increase
Instructor $134,000 $187,000 39.5
Assistant Professor $185,000 $213,000 15.0
Associate Professor $231,000 $253,000 9.5
Professor $260,000 $271,000 4.0


Data from Association of American Medical Colleges academic annual salary surveys.


-f8
Comments and alt. interp?
Hopefully the file uploads otherewise the source:
International Journal of Radiation Oncology*Biology*Physics
Volume 62, Issue 2 , 1 June 2005, Pages 519-525
Title: Radiation oncology career decision variables for graduating trainees seeking positions in 2003–2004
Authors:Lynn D. Wilson M.D., M.P.H., , , Daniel F. Flynn M.D.† and Bruce G. Haffty M.D.

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[qwert]

Thanks for the interesting info.
My inference from this is that competitiveness of the field is transient. All you folks who's going into RadOnc for money may regret some day

 

[RadOncMan]

Must agree - with the number of residency positions going up by over 33% in the last few years (an astounding number!), salaries and job oportunities will inevitably plummet. This is NOT the field to go into for the money. Go into Plastics, Derm, GI if you really want the money as the number of their residency positions have remained stable despite the increase in demand.

 

[stephew]

well i sort of disagree (but its only my view based on soft info, no tables involved.). the reason is this: first the prediction was in the early 1990's - i remember during my interview process in 1998 the residents were asking me what i heard- they were scared they couldnt get a job becuase it was glutted. Needless to say they al leasily did. But speaces were cut right about the year i started in 2000. What happened? Not enough docs graduating. opps! Reexpand. It was acknowledged where i trained that the estimation was a horrible mistake and at a metting with some chairmen this was discussed.

But the thing is lots of people started looking into radonc at the time there was a fear of shrinking sports post residency.

Also, the good money good hours is the same as it ever was and in fact, reimbursement was relatively better in the past; radoncs in the 1990's were making a ton relatively to other fields and aft erh "Managed care" scare, things were cut back. The wages havent really got that much better and in fact i think have flattened out.

so i dont buy it. but again i havent examined numbers; just lived through the era when it was the topic of conversation all the time.

 

[deleted4401]

Don't have hard numbers either, but my interpretation is based on the fact that 1) the article does not have the numbers for private practice 2) the article does not have the salary numbers for other fields of medicine for academic practice.

Point 1: from anecdotal evidence (friends and family in the business), the salary for rad-onc private practice has always been outstanding. From the 80s on up. I have a friend's whose father earned nearly a million dollars a year in the late 80s - early 90s. I think the article would have to show a reciprocal similar change in salary for private practice for this to make any sense.

Point 2: All of academic medicine has seen an increase in salary. The compensation was absolutely pathetic. Even though now it's still not competitive with private practice (i.e. starting salary for IM in academics is $90k at most medical centers across the country, and this article the OP has shown, $180k for rad onc, both ~30-50% less than private practice), the pecuniary benefits of an academic career make it pretty appealing now, at least for me.

My theories:

3 Cynical reason:

1) Lifestyle is so key. More than money. Comfortable hours, and no call is so desirable --> surge in popularity for anesthesia, radiology, PM&R, allergy, recently in rheum, and of course rad-onc.

2) Money is so key. Enough said.

3) Saying you want to do any type of "oncology" sets you apart from derm, plastics, anesthesia, or rads. Nobody really questions the lifestyle/money thing when you're out there "curing cancer".

2 non-cynical reasons

4) Young people are technology savvy. This is a high tech field, with great toys, fascinating research (both basic and clinical), and intelligent people.

5) Practice is so unique and interesting. You see new patients. You follow up with old ones. You may handle the primary care of your current on-treatment patients. You spend time on physics/dosimetry. You do sims and check port films. There's tumor boards. During a rotation, I was always on the move, going from one thing to another.

 

[stephew]

Don't have hard numbers either, but my interpretation is based on the fact that 1) the article does not have the numbers for private practice 2) the article does not have the salary numbers for other fields of medicine for academic practice.

Point 1: from anecdotal evidence (friends and family in the business), the salary for rad-onc private practice has always been outstanding. From the 80s on up. I have a friend's whose father earned nearly a million dollars a year in the late 80s - early 90s. I think the article would have to show a reciprocal similar change in salary for private practice for this to make any sense.

Point 2: All of academic medicine has seen an increase in salary. The compensation was absolutely pathetic. Even though now it's still not competitive with private practice (i.e. starting salary for IM in academics is $90k at most medical centers across the country, and this article the OP has shown, $180k for rad onc, both ~30-50% less than private practice), the pecuniary benefits of an academic career make it pretty appealing now, at least for me.

My theories:

3 Cynical reason:

1) Lifestyle is so key. More than money. Comfortable hours, and no call is so desirable --> surge in popularity for anesthesia, radiology, PM&R, allergy, recently in rheum, and of course rad-onc.

2) Money is so key. Enough said.

3) Saying you want to do any type of "oncology" sets you apart from derm, plastics, anesthesia, or rads. Nobody really questions the lifestyle/money thing when you're out there "curing cancer".

2 non-cynical reasons

4) Young people are technology savvy. This is a high tech field, with great toys, fascinating research (both basic and clinical), and intelligent people.

5) Practice is so unique and interesting. You see new patients. You follow up with old ones. You may handle the primary care of your current on-treatment patients. You spend time on physics/dosimetry. You do sims and check port films. There's tumor boards. During a rotation, I was always on the move, going from one thing to another.

while money and lifestyle are very good features of radonc and play a part it is appeal, it doesnt explain why its MORE attractive now as these have always been factors. See my faq. I think number 4 from simul D is right. But that's just my unsubstantiated theory.

 

[Zap]

Thanks for the interesting info.
My inference from this is that competitiveness of the field is transient. All you folks who's going into RadOnc for money may regret some day

Competitiveness and income don’t always go hand in hand. The competitiveness of medical specialties is cyclical, and this is not always tied to income but can be influenced by things like perceived job opportunities, prestige, life style, etc.

While reimbursements for pretty much all physicians were higher in the past, the earning potential in Radiation Oncology is still at the upper end of specialties and this is unlikely to change any time soon. Average starting salaries (per the ARRO practice entry survey) in recent years were in the range of ~$200-$250K with the academic mean being at the lower end and the private practice mean being at the upper end. Remember, however, that for private practice jobs the time to becoming partner and the income increase that this represents is much more important than the starting salary. Average time to partnership in Radiation Oncology practices is in the ballpark of ~3 yrs. The income increase at that point is in the range of ~2 to much greater than 4 fold, depending at least in part on the geographic region, the nature of the practice, how the corporation/partnership is structured, the average number of patients on treatment, and whether or not the group owns its treatment machines (so that it can collect both professional and equipment fees). Many academic Rad Onc departments also have "productivity bonuses" which are based on the number of patients seen and can significantly supplement base salaries.

You should not choose a specialty based solely on potential income, as an unhappy/bored/unfulfilled wealthy person is still an unhappy/bored/unfulfilled person. However, if this information is to play any role in your decision making you owe it to yourself to get correct data. I suggest talking to senior residents on the interview trail if you want to get some first hand accounts.

 

[RadOncMan]

It is regrettable that many applicants are attracted to Radiation Oncology because of earning potential and lifestyle, while their interest in eradicating cancer is only secondary at best.

I wonder if this has anything to do with why research types are viewed much more favorably in Radiation Oncology than in other specialties.

 

[stephew]

It is regrettable that many applicants are attracted to Radiation Oncology because of earning potential and lifestyle, while their interest in eradicating cancer is only secondary at best.

I wonder if this has anything to do with why research types are viewed much more favorably in Radiation Oncology than in other specialties.

While we all find selfish greedy people unattractive, please dont make the mistake of equating someone who considers income and time committment to the professional aspect of their life with someone who isn't fully dedicated to excellence as a doctor.


Im fortunate in that i never had to choose between a desire for a field that i loved and something that permitted me to enjoy family and friends as a substantial part of my life. but there are those who might otherwise have been interested in, say, neurosurgery, but who realized that the long hours dont stop after residency, and they didn't want to be away from those thye loved so much. Thus they chose something that left them more a more rounded life. This doesnt make them greedy, uncaring or a lesser doctor in their field of choice. The issue only is an issue when someone makes a decision to persue a field based solely on the extrinsics and doesnt care about being a good doc. in which case they should go into something other than medicine altogether.

People choosing residency are often young in age. It can be hard to imagine that in 5 or 10 years, the long weeks may no longer be acceptable due to family, age, other interests, ect. Your income will matter, particularly after med school debt. My friend is an excellent neurosurgeon and loves it. But says that if they knew then what they know now about day to day life in as an attending neurosurgeon in their 30's, that what they wanted in their life would evolve, they'd have chosen a different field.

Just strive to be intellectually honest in these discussions.

 

[deleted4401]

That's a very cool way to look at it, Steph. The moment a med-student or resident brings up "work life balance", she's looked at as lazy or too lifestyle oriented. Even when I say to my fellow interns how nice it would be to have 2 days off in a row, I almost feel guilty doing it.

S

 

[RadOncMan]

I don't think you need to feel guilty about wanting lifestyle and/or money because I think we all would not mind having more of it. I do think however that many doctors are hypocrites, desiring first a nice income and high lifestyle and second a job that satisifies one's desire to help others and do good in the world.

I don't buy the fact that you need to be earning >$300,000 per year to pay off debt and be able to provide for your family. Even a psychiatrist earning $130,000 still would have an income in the top 1% in the U.S. and after paying off all debts, would have more means to provide for their family than most Americans. Its the extrinsic desires, i.e having a 5 bedroom penthouse in downtown Manhatten, driving a BMW, buying the latest ipod video that has superseded many doctors intrinsic need and gratification for helping other people. Its this type of greed and superificiality that has corrupted individuals such as former MSKCC chair Zvi Fuks, who last I heard was indicted and imprisoned for insider trading.

Does anyone feel it's fair Radiation Oncologists earn $300,000 per year while teachers who also help other people, play a crucial role in educating and serving as role models for our children, and who work as hard if not harder than some doctors (if you personally know anyone who is a schoolteacher, you would know the number of hours they work afterhours), earn less than a sixth of what we do?

 

[stephew]

that is morphing the question into a whole different topic regarding the sociology of economics/capitalism which is beyond our scope.

 

[jb2]

Does anyone feel it's fair Radiation Oncologists earn $300,000 per year while teachers who also help other people, play a crucial role in educating and serving as role models for our children, and who work as hard if not harder than some doctors (if you personally know anyone who is a schoolteacher, you would know the number of hours they work afterhours), earn less than a sixth of what we do?

You could always donate part of your salary to teachers to help offset the difference. No one forced them to teach, they knew how much they would make before they accepted the position, just as you did with medicine and your specialty.

 

[RadOncMan]

While we all find selfish greedy people unattractive, please dont make the mistake of equating someone who considers income and time committment to the professional aspect of their life with someone who isn't fully dedicated to excellence as a doctor.

Unfortunately there is often a conflict of interest between income/time commitment and excellence as a doctor. Being an excellent physician often requires spending TIME with your patient which inevitably will be compromised when doctors are squeezing in as many patients as possible a day to maximize income. You could argue that an excellent doctor might be more "efficient," thus being able to see more patients, but I wonder how many of his or her patients wouldn't mind having a little more face time with their "efficient" doctor.

 

[stephew]

again i see this as a different issue surronding the general topic of "money". the original question was choice of field. youre now bringing up issues of reimburements which is present in the richest and poorest of specialites. one can slide left, right, up and down with regard to what we're talking about.

 

[doctalaughs]

Does anyone feel it's fair Radiation Oncologists earn $300,000 per year while teachers who also help other people, play a crucial role in educating and serving as role models for our children, and who work as hard if not harder than some doctors (if you personally know anyone who is a schoolteacher, you would know the number of hours they work afterhours), earn less than a sixth of what we do?

Do you know any teachers? I do - half my family are school teachers - high school, jr high, elementary. It's a noble profession, and perhaps they are underpaid but you GROSSLY distort the real world.

First, they do not work NEARLY as hard as 99.9% of doctors. Sure, they work some after-hours but not even 8am-5pm. Second, most get the summers off. I would estimate if you divide their hours over the year, including the summer, it would be a 30 hour workweek. Third, most school teachers could NOT get through medical school. Sure there are exceptions, but sorry, most couldn't. Finally, they require less training and have less debt. Should we earn six times more? Maybe not quite, but all in all, I think it's pretty fair. Most doctors work harder, don't get (80%+) pensions, work summers, and accumulate lots of debt and lost opportunity cost. I dont know your background, but being a teacher isn't such a bad gig considering.

 

[Thaiger75]

I do agree that some noble professions such as teaching don't get the respect that they should probably deserve, but I also agree that you can't belittle the amount of sacrifices that docs put into shaping their careers, including personal, time, money...oh, and more money. Sure the responsibilities that teachers have of educating the future generation are important, but docs have people's lives in their hands. Put it into another perspective, compared to CEOs or top of the line business people, do any of you think they should be paid more than docs?

 

[RadOncMan]

There is a purity to dedicating your life to a profession because you love it without foremost regard to compensation, which I believe has been lost for most physicians.

The numbers don't lie - the most competitive specialities have become the ones with better compensation and better lifestyle. Hence GI and Cards are the most competetive IM speciaties, Allergy and Immunology the most competitive Peds specialty. And likewise the high interest in Radiation Oncology, Rads, Derm, Plastics, and increasingly Anesthesiology and Path.

CONCLUSION: The reason why Radiation Oncology has become so competitive is because of the increased visibility and knowledge that it is a cush field which pays well, has minimal call, and also does not bore people like some of the other specialties. The technology, research opportunities, etc. help but wouldn't by themselves contribute to the increased interest without the compensation or lifestyle.

Is the money there for pure basic scientists who must go through many years of postdoctoral research and slowly rise through the ranks only to earn substantialy less than doctors? Ditto for musicians, architects, university professors, artisits, and teachers? They go into their respective professions because of a pure love for it. I am ashamed to admit that most physicians don't.