Astro Career Center and "A Roadmap for Recruiting Medical Students into Radiation Oncology during a Period of Waning Interest"

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fiji128 said:
Update of the current Astro Career Center Job posting on 6/10/2021:


1) Rad Onc private practice with Lake Region Medical Group (Fergus Falls, MN).
2) Rad Onc private practice with Avera Medical Group (Marshal, MN).
3) Rad Onc private practice with Shorepoint Radiation Oncology Center (Lakewood, NJ).
4) Rac Onc hospital employed at Methodist Hospital (Omaha, NE).
5) Rad Onc academics with Vanderbilt (Nashville, TN).
6) Rad Onc private practice with Herbert Herman Cancer Center (Lansing, MI).
7) Rad Onc academics at Northwell Health at a satellite clinic (Staten Island, NY).
8) Rad Onc private practice with Radiation Oncology Care at Meridian Park (Portland, OR).
9) Rad Onc private practice with and unnamed group (Fredericksburg, VA).
10) Rad Onc private practice with Mercy Clinic (Fort Smith, AR).
11) Rad Onc community academics with U Pittsburg (Williamsport, PA).
12) Rad Onc academics at Henry Ford Health System (Detroit, MI).
13) Rad Onc academic at Yale (New Haven, CT).
14) Rad Onc community academics University of Pennsylvania (Lancaster, PA).
15) Rad Onc private practice with Radiation Oncology Associates of Northern Virginia (Fairfax, VA).
16) Rad Onc hospital employed with Baptist Health Medical Group (New Albany, IN).
17) Rad Onc private practice with Advanced Radiation Centers of NY (Metro NY).
18) Rad Onc community academics at City of Hope (Irvine, CA).
19) Rad Onc private practice with Precision Cancer Care (Kansas City, KS).
20) Rad Onc private practice with Avera Medical Group (Pierre, SD).
21) Rad Onc private practice with Therapy Associates (Evansville, IN).
22) Rad Onc private practice with Spectrum Healthcare Partners (Portland, ME).
23) Derm/Rads part time with Water’s Edge Dermatology (Melbourne, FL).
24) Rad Onc academics with U of Arkansas (Little Rock, AK).
25) Rad Onc hospital employed with Cleveland Clinic (Vero Beach, FL).
26) Rad Onc private practice with US Oncology (Prescott Valley, AZ).
27) Rad Onc hospital employed with Intermountain Healthcare (Logan, UT).
28) Rad Onc hospital employed with Ballad Health (Abingdon, VA).
29) Rad Onc academics LSU/Ochsner (Shreveport, LA).
30) Rad Onc employed at the VA (Memphis, TN).
31) Rad Onc hospital employed at the Marshfield Medical Center (Eau Claire, WI).
32) Rad Onc private practice at Kadlec Clinic (Kennewick, WA).
33) Rad Onc employed at the VA (Jackson, MS).
34) Rad Onc employed at the Guthrie Clinic (Corning, NY).
35) Rad Onc employed at the VA (East Orange, NJ).
36) Rad Onc hospital employed with Geisinger (Danville, PA).

37-bonus) University of Maryland at Baltimore is looking for a PGY-3 resident.

Also saw an ad for New York Urology. 600K guaranteed base with RVU bonus added and 35K sign on bonus. Also tons of heme onc positions listing 500K, 4 days a week, and 100K loan forgiveness. Didn't see a single rad onc job that mentioned salary or bonuses.

Today the Astro website list 361 total MD jobs of which 36 are for BE/BC rad oncs.
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What's BE/BC?
 
Members don't see this ad :)
Rad Onc positions in Colorado are rarely posted but there have been a few. It will be interesting to see if they will now disclose salary as required by law.

www.wsj.com

Many Companies Want Remote Workers—Except From Colorado

After a new state law that requires employers to disclose salaries for open positions, some are advertising jobs available anywhere in the U.S. but Colorado.
www.wsj.com www.wsj.com
 

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medgator said:
Astro with the hard sell now

Medical Students - Affiliate - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

Are you a medical student who want to learn more about radiation oncology? Learn more about the field, explore FAQ’s on application and interview processes and hear from radiation oncologist about what it’s like to treat and cure cancer patients.
www.astro.org www.astro.org
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Do you guys remember those old GIJOE cartoon public service announcements?

<Kids playing hide and seek in junkyard>
Kid #1: Ollie Ollie Oxen Free!!! <runs and hides in old refrigerator and gets trapped>
Kid #2: Where's John?

<Kids look around for him>
GIJOE: What's all the excitement?
Kid #2: We can't find John.
Kid #3: He was heading that way . . . <points to old abandoned refrigerator>

GIJOE: Oh no! Let's check inside this old fridge!
<Opens fridge with difficulty revealing a frightened but otherwise unharmed child>

John: Thanks GIJOE!
GIJOE: Never get in anything that could close up and trap you!
Kid #2: Like a Radiation Oncology residency?

GIJOE: Yes, now you know.
Kids: And knowing is half the battle!

1624574782174.png
 
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Members don't see this ad :)
medgator said:
Imagine how the biryani will taste in the places that have jobs in 3-5 years.... Microwaveable, reheated leftovers
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You’ll be surprised… Publix actually has some good ones you can reheat. Now do these places have a Publix or even grocery store?
 
DoctwoB said:
Give me Wheeling WV off that list. Live outside washington PA, and you're 30-40 min to work and 30-40 min to Pittsburgh proper.
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To be fair, that’s likely closer than half the UPMC satellites to Pittsburgh.
 
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I know we like to poke fun, but some of these jobs are not that bad. I'd prefer to have 6-8wk PTO w/4 day work week + make 600k w/ability to travel or FIRE vs. 225k at an academic satellite at UNC.
 
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radoncftw said:
I know we like to poke fun, but some of these jobs are not that bad. I'd prefer to have 6-8wk PTO w/4 day work week + make 600k w/ability to travel or FIRE vs. 225k at an academic satellite at UNC.
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To each his or her own but unfortunately unlike many other fields, we don’t really have that much of a choice in the matter.
 
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radoncftw said:
I know we like to poke fun, but some of these jobs are not that bad. I'd prefer to have 6-8wk PTO w/4 day work week + make 600k w/ability to travel or FIRE vs. 225k at an academic satellite at UNC.
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Who said you get any of that at these places. The trend at the rural places is lower pay, nobody gets 8 weeks I know of... and what is this "4 day work week" of which you speak. Sounds like an Unidentified Aerial Phenomenon.
 
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I know about 1 or 2 of these jobs. I don’t think any of them are offering 4 days/week. But for sure your chances of 🔥’ing it are probably much better in these positions then grinding it out at a UNC satellite clinic. Considering the future projections for the speciality how do you do anything but try to 🔥. At least for new/recent grads.
 
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TheWallnerus said:
Who said you get any of that at these places. The trend at the rural places is lower pay, nobody gets 8 weeks I know of... and what is this "4 day work week" of which you speak. Sounds like an Unidentified Aerial Phenomenon.
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I know multiple people earning 700k+ in rural hospital employed positions. The time off is a trickier part as many of these are solo. If you're in a rural place with enough volume to support 2+ rad oncs and they're all on the same page, you are golden and can negotiate for 8-10 weeks without a problem. Just convince the admins it's not their problem and they will still meet their numbers and you all will just split the mythical production bonuses.

As I have said multiple times on this forum, nobody should touch a rural (truly rural, not fake rural like 20 miles out of Nashville or something) for less than 700k. If you have 15+ patients on treatment, you should decline any rural offer that does not pay a minimum of 90% pro collections (or let you bill independently, which is even better as you get the tax benefits of being self-employeed). Ideally > 100%. Less than 15 patients, try and get 700-800k flat salary. Rules of thumb obviously. YMMV. (e.g west Virginia do not go collections based under any circumstance)
 
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You all bring up good points. As a 2022 new grad going through the search...I have realized there is a great deal of variability in jobs. Not just in terms of salary/compensation, but also time off, CME, etc. If you talk to rural docs, many have a pretty good QOL in terms of hours worked, time off, and call responsibilities. The coverage requirements (or lack thereof) have certainly helped. If I end up taking something rural, I will try to negotiate for >700k+ guaranteed. Many places are offering 550k guaranteed for like 2 years + bonus. Some of the job postings state this outright...so no harm in asking for more.
 
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radoncftw said:
You all bring up good points. As a 2022 new grad going through the search...I have realized there is a great deal of variability in jobs. Not just in terms of salary/compensation, but also time off, CME, etc. If you talk to rural docs, many have a pretty good QOL in terms of hours worked, time off, and call responsibilities. The coverage requirements (or lack thereof) have certainly helped. If I end up taking something rural, I will try to negotiate for >700k+ guaranteed. Many places are offering 550k guaranteed for like 2 years + bonus. Some of the job postings state this outright...so no harm in asking for more.
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They may tell you that all employee compensation is reviewed by a consultant so as to not violate Stark Law. The retort to this is, ok I understand that you are worried that you might pay me a salary that my level of work does not justify just so you can recruit somebody way out here. To solve this concern, you can just pay me 100% of my professional collections or allow me to contract with you and do my own billing. That way I am only collecting what I earn and in no way can be in violation of stark law. The hospital will think about this an either reluctantly agree to it or else decide to keep using locums until they find somebody more desperate or less educated (or they will flat out lie and tell you it's still a stark law violation).

Rural jobs definitely do pay better and come with better QOL, but I don't think many understand what "rural" really is as most of our field likely comes from wealthy populated suburbs in metro areas and don't understand how truly isolated these places can be and the shocking lack of resources many have making it difficult to practice. As a result, I think these places typically don't interview people from the coasts or without rural experience, so the confuse attitudes of many towards them regarding why they never get interviews there and when they do they are offered very low salaries (because they are a flight risk, but the hospital will take that risk for the right price). On the flip side, once you pigeon hole yourself jumping around the Dakotas, it's going to be hard to get your foot in the door at a coastal Florida practice, and you're not going to like the fact that most of your pro fees will belong to the senior partners there.

All that said, there are definitely BFE hospitals that are on the permalocums model and will literally laugh at you if you try to negotiate from their initial $400k offer. Why anyone would want to work for one of these places is beyond me. Go to Florida in that case. The regular "rural" list I get in my inbox likely includes many of these places as they never, ever fill. I have called some of these places before just for kicks to see what they say when I offer to contract independently and staff their middle of nowhere clinic. They act like I am speaking Greek and like such a think could not possibly exist. A doctor.... who is not ... an employee? Don't you want our benefits of crappy health insurance and a 401k match? I'm sorry sir, you must be mistaken.

VincennesINTerre Haute 58m; Evansville 51m
MiddlesboroKYKnoxville 62m
AlmaMIDetroit 120m
Fergus FallsMNFargo, ND 60m
Poplar BluffMOSt. Louis 150m
Grand ForksNDFargo, ND 80m; Bemidji, MN 110m
OgdensburgNYMontreal 190km (2 hrs 15min)
Wilkes-BarrePAPhilly & NYC 100m
WilliamsportPAScranton, PA 100m
BrownwoodTXDallas 184m
WheelingWVPittsburgh 45m ; Morgantown 70m
 
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Wilkes Barre, which is adjacent to Scranton, references NY/Philly. But, Williamsport references Scranton as nearest big city. Weird way to report.
 
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elementaryschooleconomics said:
I love that for the NY job, the nearest metro is in another country.
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I locumsed there as resident in early 2000s for 2000day (would never see those rates today through an agency) to buy an engagement ring. remember a patient hitting a deer next to the hospital, and a near brawl starting over how to divide up the carcass with some nearby road workers.
 
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RickyScott said:
I locumsed there as resident in early 2000s for 2000day (would never see those rates today through an agency) to buy an engagement ring. remember a patient hitting a deer next to the hospital, and a near brawl starting over how to divide up the carcass with some nearby road workers.
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Why let the meat go to waste? These are practical folk! I’ll eat any bone thrown my way. This was a preview of the future of our field: take any scraps you can get to survive.
 
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RickyScott said:
I locumsed there as resident in early 2000s for 2000day (would never see those rates today through an agency) to buy an engagement ring. remember a patient hitting a deer next to the hospital, and a near brawl starting over how to divide up the carcass with some nearby road workers.
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It depends. The correct locums rate for a rural job is $2500-2800/day. I have been paid this at multiple sites and so have other locums docs I know.
However if you go through Weatherby or Comphealth or another agency you're probably looking at $1600. The hospital will pay Weatherby more than this, so if you cold call those places you can potentially work out the fair rate directly. You CAN negotiate with an agency but it's unlikely to be productive. I have done it before. They will offer their standard $1600/day. You say, no it's the middle of nowhere it's not worth it to me for less than $2800/day. They will literally laugh then say, hold on let me ask my boss, and come back with a more reasonable number depending on how badly they want to grab that contract as many of these hospitals are using multiple locums agencies at the same time (presumably to see who can present the cheapest candidate?). However more likely another agency will present a cheaper candidate. The lengths some facilities will go to to staff the rad onc clinic as cheaply as possible is truly amazing. And it's a double hit for you. If you take one of these low paying jobs, you are likely walking into an environment where they are in constant chaos mode and putting out fires and you get to try and manage the tornado of patients on treatment in various stages of mismanagement by the prior 5 non-BC/BE or 1985-era practicing docs that were there in the 4 weeks prior. Put your license and clean malpractice lawsuit history on the line for that!

I can't imagine living the nightmare of trying to make a living off locums work in rad onc in the present environment. I remember in internship, my IM attending (who was probably only 45 years old but had clearly already won the game and didn't need to work anymore) had us all over to his mansion for dinner one night and talked about the days in recent years past when he and his wife would pick up and go to Hawaii and staff EDs for months at a time and make serious bank. In rad onc, you get to go to the Canadian border in New York for $1600 and pray your rental malibu don't slide off the snowpack road and hit a moose because the locums company wouldn't upgrade you to an SUV. But one of the locals will probably save you.
 
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@Turaco

I have a lot of familiarity with professional billing and rural positions. It’s my observation that the 15-20 under treat job billing pro fees only won’t get you to $700k unless you have an extraordinary mix of fantastic commercial insurance and tons of Imrt…even then I’m not sure you hit that number.
For that kind of salary I think you’d need to ask for a medical director stipend on top of pro fees…which is completely reasonable in areas hard to recruit.

Could others weigh in here?
 
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BobbyHeenan said:
@Turaco

I have a lot of familiarity with professional billing and rural positions. It’s my observation that the 15-20 under treat job billing pro fees only won’t get you to $700k unless you have an extraordinary mix of fantastic commercial insurance and tons of Imrt…even then I’m not sure you hit that number.
For that kind of salary I think you’d need to ask for a medical director stipend on top of pro fees…which is completely reasonable in areas hard to recruit.

Could others weigh in here?
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Agree. The numbers people throw around here are completely made up. The range of professional reimbursement 15-20 on treat can give you is so broad I couldn't even quote it here. But to insert some objectivity:

Assume 20 prostates on treatment at all times getting 28 fractions. A reasonable estimate of prof reimbursement at 100% of Medicare is 3,000-ish. The range will probably depend mostly on how you plan (i.e. arcs vs. multi-field IMRT (extra 77300's) and single plan vs. phased plan (additional 77338 and 77300s if you do a boost). (Some insurers are limiting the 77300s, so this may not hold true for long).

52 weeks x 5 days per week= 260 treatment days. (260/28) x 20 x $3,000= $557k. This doesn't take into account holidays, imperfect billing (you'll NEVER collect 100% of what you should be collecting), etc.

So to get to 700k, you would need an average contracted rate of 125% of medicare, 20 IMRT patients on treatment at all times, perfect collections/billing...
 
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Reaganite said:
Agree. The numbers people throw around here are completely made up. The range of professional reimbursement 15-20 on treat can give you is so broad I couldn't even quote it here. But to insert some objectivity:

Assume 20 prostates on treatment at all times getting 28 fractions. A reasonable estimate of prof reimbursement at 100% of Medicare is 3,000-ish. The range will probably depend mostly on how you plan (i.e. arcs vs. multi-field IMRT (extra 77300's) and single plan vs. phased plan (additional 77338 and 77300s if you do a boost). (Some insurers are limiting the 77300s, so this may not hold true for long).

52 weeks x 5 days per week= 260 treatment days. (260/28) x 20 x $3,000= $557k. This doesn't take into account holidays, imperfect billing (you'll NEVER collect 100% of what you should be collecting), etc.

So to get to 700k, you would need an average contracted rate of 125% of medicare, 20 IMRT patients on treatment at all times, perfect collections/billing...
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I mean you're right. But it may not have to be so out of bounds. Assuming 20 under treatment on average, and averaging 5.5 weeks of treatment per patient, that's 4 new patients a week or 200 new patients a year. At $3500 per patient, you hit $700K. This is how fractionation/treatment style can very dramatically affect private practice salaries though. It's not unreasonable to assume that if your average treatment course per patient is 4 weeks instead of 5.5, you'd average $2500 per patient. And with the same patient load of 4 new patients per week, you're down from $700K collections to $500K collections. After overhead which can easily be 15%, then your salary is doing well if it hits $400-$450K in that rural locale. If you drop from 4 a week to 3 a week because of the latest and greatest not-XRT thing, you're at $300-$350K a year salary.

Then employed positions start looking better.

YkxV6jW.png
 
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TheWallnerus said:
I mean you're right. But it may not have to be so out of bounds. Assuming 20 under treatment on average, and averaging 5.5 weeks of treatment per patient, that's 4 new patients a week or 200 new patients a year. At $3500 per patient, you hit $700K. This is how fractionation/treatment style can very dramatically affect private practice salaries though. It's not unreasonable to assume that if your average treatment course per patient is 4 weeks instead of 5.5, you'd average $2500 per patient. And with the same patient load of 4 new patients per week, you're down from $700K collections to $500K collections. After overhead which can easily be 15%, then your salary is doing well if it hits $400-$450K in that rural locale. If you drop from 4 a week to 3 a week because of the latest and greatest not-XRT thing, you're at $300-$350K a year salary.

Then employed positions start looking better.

YkxV6jW.png
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Actually I completely agree with your numbers...was gonna post a range of 300k to 700k, but too lazy to go beyond the simplest example. In the absolute worst reimbursing geographies, it could even dip to <250k.
 
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Reaganite said:
Actually I completely agree with your numbers...was gonna post a range of 300k to 700k, but too lazy to go beyond the simplest example. In the absolute worst reimbursing geographies, it could even dip into the 250k range.
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Yup... Medicare isn't a single payor. Multiple geographic divisions per state in the larger states each with their own reimbursement level, plus many Medicaid/Medicare advantage contracts pay below Medicare rates in more competitive markets
 
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That’s just collections though. Billing will take a cut and there are other costs as mentioned
Good posts above though.

It’s not as simple as just bill your own pro fees…unless a practice has a long history of excellent volumes (regularly 20+).

Things get dicey when when you’re in the 15-20 range.
 
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BobbyHeenan said:
That’s just collections though. Billing will take a cut and there are other costs as mentioned
Good posts above though.

It’s not as simple as just bill your own pro fees…unless a practice has a long history of excellent volumes (regularly 20+).

Things get dicey when when you’re in the 15-20 range.
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Yep, MedMal (>1k per month), DEA/licensing, locums fees for vacations, billing and credentialing (4-10%) may take another 70k+ off your gross collections. The money is in the technical; prof only arrangements aren't always worth the headache especially with the income unpredictability and hassle of finding good coverage.
 
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BobbyHeenan said:
That’s just collections though. Billing will take a cut and there are other costs as mentioned
Good posts above though.

It’s not as simple as just bill your own pro fees…unless a practice has a long history of excellent volumes (regularly 20+).

Things get dicey when when you’re in the 15-20 range.
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Would only consider it these days with a generous cut of global collections considering where pro vs technical fees have been going the last several years, as mentioned above. 15 pts isn't a FT pp workload imo
 
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I’m in a pro only group. But we’re very busy. I’m happy.

I’d be nervous about pro only (assuming no med director stipend) rural 15 patient set up.

It may be the only option one may have, but I was just posting some thoughts that may be a little divergent from those previously posted.
 
Turaco said:
They may tell you that all employee compensation is reviewed by a consultant so as to not violate Stark Law. The retort to this is, ok I understand that you are worried that you might pay me a salary that my level of work does not justify just so you can recruit somebody way out here. To solve this concern, you can just pay me 100% of my professional collections or allow me to contract with you and do my own billing. That way I am only collecting what I earn and in no way can be in violation of stark law. The hospital will think about this an either reluctantly agree to it or else decide to keep using locums until they find somebody more desperate or less educated (or they will flat out lie and tell you it's still a stark law violation).


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For the benefit of those looking for jobs now.... This is what admins tell naive physicians in order to manipulate them. Stark law prohibits self-referral by the physician to receive services from entities in which the physician has a financial relationship. As an employed rad onc you aren't making any referrals and you don't own the machines.

They can pay you whatever the hell they want.

Another lie they use is "fair market value," as if they aren't allowed to pay you more than the average rad onc makes in the US.

Bull****... fair market value is whatever it takes to get someone to practice there. 75% MGMA is well within that range.
 
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BobbyHeenan said:
I’m in a pro only group. But we’re very busy. I’m happy.

I’d be nervous about pro only (assuming no med director stipend) rural 15 patient set up.

It may be the only option one may have, but I was just posting some thoughts that may be a little divergent from those previously posted.
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Which is why I mentioned it depends on geography. It depends on payor mix. Hence my caveat about why it would be a terrible idea in rural Appalachia, but in rural TX where everyone is employed in the beef industry or in the oil fields you could do amazingly well. I had a billing company run numbers for me at a rural practice with about 15-20 on treat and they estimated "conservatively" $900k in pro collections and said it would be very possible to hit 1.2M but did not want to promise me that. Whereas in rural Appalachia, you could be looking at 400k or less as most are medicaid or self-pay.

They took a 5% cut to do the billing, which is fairly typical. Obviously not for everybody, especially new grads who need immediate income coming in. Crucial for hospital employees to understand what the actual collections are when negotiating with the hospital in non-saturated ("take-it-or-leave-it") areas. There is no reason they should not show you data for collections from prior years if you sign an NDA.

Also, it's worth pointing out that the tax loopholes that being self-employed offers you are not insignificant. You can get a large amount of money into tax advantaged accounts with solo 401ks, mega-backdoor roths, etc, as well as writing off business expenses (company car, home office space, etc). Whether that makes more sense for you than a typical hospital benefit package with more affordable health insurance, PTO, and retirement matches is a case-by-case basis. You need a good accountant to advise you.
 
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dieABRdie said:
For the benefit of those looking for jobs now.... This is what admins tell naive physicians in order to manipulate them. Stark law prohibits self-referral by the physician to receive services from entities in which the physician has a financial relationship. As an employed rad onc you aren't making any referrals and you don't own the machines.

They can pay you whatever the hell they want.

Another lie they use is "fair market value," as if they aren't allowed to pay you more than the average rad onc makes in the US.

Bull****... fair market value is whatever it takes to get someone to practice there. 75% MGMA is well within that range.
Click to expand...

Absolutely correct. They are likely not lying in that they contract a 3rd party risk management consultant to sign off on comp packages to protect themselves; however, these risk assessments are extremely conservative. Their purpose for PAYING these consultants is not so much as to legally protect themselves, but rather to muck up the waters and get candidates to accept lower salaries. Their value is obviously not as much in risk reduction, but rather in capital preservation for the hospital. Why anyone would believe otherwise is beyond me.

There is no law that says the hospital must have a comp package approved by an outside consultant. My response to this was always "ok, I don't know why you are explaining to me why you have to have somebody else figure out what the maximum you can pay me is. I literally do not care. This is my price. I do not believe I am in any way violating stark law based on my assessment of your volume, collections, and my proposed comp package. You can either pay me my fee, or I will find work elsewhere. It makes absolutely no difference to me if you say "No, we would like to pay you that much, but our consultant won't let us," or "No, your price is too high for us, bye." All I hear or care about is "yes" or "no." The latter is far more simple. The former is emotionally manipulative. I am not an idiot. Only an idiot would believe that a company would not always act in its own best financial interest.

Also, it is possible to violate stark law by paying a salary is too high. For example, if you pay a radiation oncologist a 1.2 million dollar salary but you are only treating 10 patients and on site a few days a week, and the radiation clinic is actually losing money, but your income is tied to keeping patients in the system, ordering imaging, and other things that justify your salary such that the system as a whole is not losing money. But that's not what we're talking about here. Not even close. Paying a rad onc treating 15 patients $750k in a rural area is not a violation of Stark Law. That is a flat out lie.
 
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Turaco said:
Which is why I mentioned it depends on geography. It depends on payor mix. Hence my caveat about why it would be a terrible idea in rural Appalachia, but in rural TX where everyone is employed in the beef industry or in the oil fields you could do amazingly well. I had a billing company run numbers for me at a rural practice with about 15-20 on treat and they estimated "conservatively" $900k in pro collections and said it would be very possible to hit 1.2M but did not want to promise me that. Whereas in rural Appalachia, you could be looking at 400k or less as most are medicaid or self-pay.

They took a 5% cut to do the billing, which is fairly typical. Obviously not for everybody, especially new grads who need immediate income coming in. Crucial for hospital employees to understand what the actual collections are when negotiating with the hospital in non-saturated ("take-it-or-leave-it") areas. There is no reason they should not show you data for collections from prior years if you sign an NDA.

Also, it's worth pointing out that the tax loopholes that being self-employed offers you are not insignificant. You can get a large amount of money into tax advantaged accounts with solo 401ks, mega-backdoor roths, etc, as well as writing off business expenses (company car, home office space, etc). Whether that makes more sense for you than a typical hospital benefit package with more affordable health insurance, PTO, and retirement matches is a case-by-case basis. You need a good accountant to advise you.
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Yes, good points.

We in our group have opportunity for a defined benefit cash balance retirement plan on top of 401K. A really nice tax avoidance opportunity you don't have as employed (though with caveats it assumes your tax burden in retirement less than what it is now).
 
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BobbyHeenan said:
Yes, good points.

We in our group have opportunity for a defined benefit cash balance retirement plan on top of 401K. A really nice tax avoidance opportunity you don't have as employed (though with caveats it assumes your tax burden in retirement less than what it is now).
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With a defined benefit cash balance retirement plan, though, isn't your practice on the hook for the value of the investments moving forward? That is, if the market crashes, you have to make up the difference, correct?
 
OTN said:
With a defined benefit cash balance retirement plan, though, isn't your practice on the hook for the value of the investments moving forward? That is, if the market crashes, you have to make up the difference, correct?
Click to expand...

We invest that very conservatively, fixed income, high grade bonds, CD ladders, etc. Return goal is only 2-3%. Save equities for 401k or taxable account.
 
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dieABRdie said:
For the benefit of those looking for jobs now.... This is what admins tell naive physicians in order to manipulate them. Stark law prohibits self-referral by the physician to receive services from entities in which the physician has a financial relationship. As an employed rad onc you aren't making any referrals and you don't own the machines.

They can pay you whatever the hell they want.

Another lie they use is "fair market value," as if they aren't allowed to pay you more than the average rad onc makes in the US.

Bull****... fair market value is whatever it takes to get someone to practice there. 75% MGMA is well within that range.
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One of the reasons I started posting on sdn was to highlight the obvious that salaries are set by supply and demand. Administrators can certainly pay you in 90% for 30% prodcuctivity, but at some outlying point (95% for 5 %?) it can become a legal issue. Medoncs can get 600k+ easily for 7 k RVUs because that is the market.
 
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