ASTRO Workforce Study

[RadOncMegatron]

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The AEI...not sure why a faux academic thinktank is being treated as a trustworthy source for a sociological question...this is like cutting and pasting from Democratic Socialists of America paper to explain capitalism.

I am sure the best way to tackle these problems are to not actual attack the arguments, but malign the character of anyone who disagrees with you. Dr. Sommers has a Ph.D. in philosophy, was a university professor for over 20 years, written multiple books on topics like these, is invited all across the world as a guest lecture and debator - what the heck are you talking about "faux thinktank"? Just come out and say it - You mean conservative think tank, thus must be all terrible and stupid. Look at the list of scholars they have and their influence. Your criticism of AEI simply has no merit.

If you are on this board you must be smart and I know lot of this is fun internet trolling, but surely you actually have something cogent to say about the criticisms against microaggressions. If not then continue the trolling

 

[KHE88]

The AEI...not sure why a faux academic thinktank is being treated as a trustworthy source for a sociological question...this is like cutting and pasting from Democratic Socialists of America paper to explain capitalism.

Ad hominem. Come on, leave that level of discourse to the cable news crowd. If you take issue, attack the points made with reasoned arguments, don't attack the points using only the name of the source.

 

[KHE88]

Except at the industry of Netflix. Medicine? Fuhgeddaboutit. Get a job at Netflix instead of being a rad onc if $ is a concern.

According to employees, managers make roughly $150,000 to $400,000, directors from $400,000 to $800,000, and vps can easily make $1 million or more, with department heads like Cindy Holland, Lisa Nishimura, Bela Bajaria and Scott Stuber said to be cashing multimillion-dollar paychecks. One top publicity exec, for example, makes a base salary of $1.5 million, per sources, with Bloomberg reporting earlier this year that the streaming service was hiring a movie publicist for $400,000. "It's not comparable to anywhere else," says an insider. "It's like play money."

The vast majority of IT professionals are not going to be able to work at Netflix, Google, or any other silicon valley outlier in terms of pay. It's silly to think, oh, I should have just been an engineer because I would have gotten one of those super rare jobs and beaten out the hundreds of other engineers trying to get promoted up to management and end up making $500k+. I would have been that exception! The reality is that the avg midcareer salary of engineers and IT professionals is in the 100-150k/year range, and that's what you very most likely would have been making. Whereas the average salary of rad oncs is 400-500k/year, and that's what we very most likely would be making (except those foolish enough to choose to live in silicon valley!)

 

[PleaseRemainCalm]

Ad hominem. Come on, leave that level of discourse to the cable news crowd. If you take issue, attack the points made with reasoned arguments, don't attack the points using only the name of the source.

I don't waste brain space on this organization. I don't have energy and time to do my independent research to fact check every statement they make being presented as historical fact, which I'd need to do because from my past experience with them they have not been trustworthy. But at least people who are not familiar with AEI should know that is a partisan organization and citing it is not like citing an independent and well researched academic paper.

It's like how I know that since a particular politician lies repeatedly, I can no longer take the "facts" they state at face value and have to look up everything they say. At some point it just gets tiresome and I just have to start from the baseline that it's probably a lie and focus on more truthful people.

 

[PointA]

I think the real issue is that the typical RO attending won't get their first real paycheck until they are in their mid-30's and the average student debt coming out of medical school is approaching $200k so even if the RO has a higher salary than a typical engineer, they might not do as well over the course of their career. There have been well known analyses showing that a high school teacher/ plumber/ trash collector can actually come out ahead over a PCP when you consider the high costs of medical education and delayed earning potential.

 

[medgator]

I think the real issue is that the typical RO attending won't get their first real paycheck until they are in their mid-30's and the average student debt coming out of medical school is approaching $200k so even if the RO has a higher salary than a typical engineer, they might not do as well over the course of their career. There have been well known analyses showing that a high school teacher/ plumber/ trash collector can actually come out ahead over a PCP when you consider the high costs of medical education and delayed earning potential.

WSJ compared dentistry to primary care over a decade ago and figured that out

Tale of Two Docs: Why Dentists Are Earning More - WSJ

Dr. Bryson Focuses On

www.wsj.com

 

[KHE88]

Look bro. You have no idea what you're talking about. Just sit down.

To get to the point, it's easier for people to exploit you if you believe "we rad onc's are doing pretty well!" Instead, you should believe "rad onc compensation is in line with similar professions in-and-outside of medicine." The latter is closer to the truth.

While I really don't want to respond to this foolishness, I just can't resist as it's one of my biggest pet peeves. Median rad onc compensation is not even close to being "in line" with median compensation with similar professions outside of medicine (which is what we're talking about -- not comparisons to med onc or derm).

You are the one who has no idea what he's talking about. I worked for multiple years in the tech industry, and most of my family members and close friends did/do as well. I do, in fact, have some insight into this.

I am consistently frustrated by this attitude from privileged kids, often premeds and med students, who encounter their first little bit of adversity in life well into their 20s and whine that "oh if only I had gone into law/finance/engineering/facebooknetflixgoogle-bro/bitcoin-savant/app-developer-extraordinaire/etc then I would have been making so much money and had so much a better life! Most of them earning their first paycheck ever and paying taxes for the first time when they start residency. I even hear this nonsense from attendings. The common theme is that without fault all of them grew up very priveleged and never worked before residency. In others words, a massive lack of perspective.

Maybe literally all of my friends and family members were just lazy and stupid that their incomes maxed out in the $150k range just like >90% of everyone else in their fields?

Here are some facts for you, "bro":

Average lawyer income: $72,921 (indeed), $120,910 (BLS median)
For the tiny, tiny percentage of lawyers who are able to get in big law firms, this is in the $200-300k/year range unless you are an even tinier (at a fraction of a percent of all lawyers) that are somehow able to stick out the torture and make it to partner at a big law firm. Still well under a rad onc's income with double the work hours.

Average computer scientist income: $99,831 (indeed), $101,790 (BLS median for software developers)
The distribution tails off around $160,000 with the most desirable companies paying around this level
FWIW, the extreme end of this, the netflixes, are paying their engineers around $200-250k. You can look this data up.

Average mechanical engineer income: $82,631 (indeed), $85,880 (BLS median)
The distribution tails off around $140,000 with the most desirable companies paying around this level

Investment analyst: $109,031 (indeed), $84,300 (BLS median)

I could keep going. But you get the point.
There are multiple factors that pull the averages a little low when looking at professions at a whole. The more revealing data is the top end of the curve, which maxes around $200k for nearly every other elite profession besides specialists in medicine.

You are not going to be getting W-2 income > $300k in virtually any other field. You just are not. There are a handful of exceptions, but it's asinine to boldly proclaim that you would have been that exception. Yet I hear it all the time. I went to med school and got into such-and-such residency, I'm clearly so smart, I would have been at the top of my field making millions in tech or on wall street. I'm sure of it! I would have been that one who got promoted up to CEO. Or, I would have gone out and started my own company and surely would have been successful. The reality is that the smartest people I have ever known in my life were a handful of engineers I worked with in the tech industry. They made around $100-$120k.

I am not denying that rad onc and medicine in general has lots of problems. I am not saying that we don't deserve to make $600k/year. What I am saying is that literally no other profession offers anywhere close to such a high average and MEDIAN income with such a high distribution of workers earning close to that average (i.e., not a profession where 90% of people are earning 100k and 10% of people are earning > 1 mil skewing the average but not the median -- most rad oncs are making $300-$800k. Nobody is making $100k).

What I am saying is that you're a God-damned fool if you honestly believe you would most likely be making $700k/year at age 40 if you chose to go into any other field as a 20 year old. The level of idiocy in these arguments is simply astonishing.

"Just get a job at netflix instead of being a rad onc" GTFOutta here dude. Might as well say "Just be an NBA player, bro" "Just be a federal judge bro" "Just be a fortune 500 CEO bro" "Just be a hedge fund manager bro" "Just code the next facebook bro" "Just trade bitcoin bro" "Just open a 3 star Michelin restaurant bro" "Just drill some oil wells in Alaska bro" "Just invent the cure for baldness bro" "Just marry a Kardashian bro"

Maybe we should require a minimum of 3-4 years work experience prior to med school to give these silver spoon types even a tiny modicum of perspective.

Rant over.

 

[xrthopeful]

While I really don't want to respond to this foolishness, I just can't resist as it's one of my biggest pet peeves. Median rad onc compensation is not even close to being "in line" with median compensation with similar professions outside of medicine (which is what we're talking about -- not comparisons to med onc or derm).

You are the one who has no idea what he's talking about. I worked for multiple years in the tech industry, and most of my family members and close friends did/do as well. I do, in fact, have some insight into this.

I am consistently frustrated by this attitude from privileged kids, often premeds and med students, who encounter their first little bit of adversity in life well into their 20s and whine that "oh if only I had gone into law/finance/engineering/facebooknetflixgoogle-bro/bitcoin-savant/app-developer-extraordinaire/etc then I would have been making so much money and had so much a better life! Most of them earning their first paycheck ever and paying taxes for the first time when they start residency. I even hear this nonsense from attendings. The common theme is that without fault all of them grew up very priveleged and never worked before residency. In others words, a massive lack of perspective.

Maybe literally all of my friends and family members were just lazy and stupid that their incomes maxed out in the $150k range just like >90% of everyone else in their fields?

Here are some facts for you, "bro":

Average lawyer income: $72,921 (indeed), $120,910 (BLS median)
For the tiny, tiny percentage of lawyers who are able to get in big law firms, this is in the $200-300k/year range unless you are an even tinier (at a fraction of a percent of all lawyers) that are somehow able to stick out the torture and make it to partner at a big law firm. Still well under a rad onc's income with double the work hours.

Average computer scientist income: $99,831 (indeed), $101,790 (BLS median for software developers)
The distribution tails off around $160,000 with the most desirable companies paying around this level
FWIW, the extreme end of this, the netflixes, are paying their engineers around $200-250k. You can look this data up.

Average mechanical engineer income: $82,631 (indeed), $85,880 (BLS median)
The distribution tails off around $140,000 with the most desirable companies paying around this level

Investment analyst: $109,031 (indeed), $84,300 (BLS median)

I could keep going. But you get the point.
There are multiple factors that pull the averages a little low when looking at professions at a whole. The more revealing data is the top end of the curve, which maxes around $200k for nearly every other elite profession besides specialists in medicine.

You are not going to be getting W-2 income > $300k in virtually any other field. You just are not. There are a handful of exceptions, but it's asinine to boldly proclaim that you would have been that exception. Yet I hear it all the time. I went to med school and got into such-and-such residency, I'm clearly so smart, I would have been at the top of my field making millions in tech or on wall street. I'm sure of it! I would have been that one who got promoted up to CEO. Or, I would have gone out and started my own company and surely would have been successful. The reality is that the smartest people I have ever known in my life were a handful of engineers I worked with in the tech industry. They made around $100-$120k.

I am not denying that rad onc and medicine in general has lots of problems. I am not saying that we don't deserve to make $600k/year. What I am saying is that literally no other profession offers anywhere close to such a high average and MEDIAN income with such a high distribution of workers earning close to that average (i.e., not a profession where 90% of people are earning 100k and 10% of people are earning > 1 mil skewing the average but not the median -- most rad oncs are making $300-$800k. Nobody is making $100k).

What I am saying is that you're a God-damned fool if you honestly believe you would most likely be making $700k/year at age 40 if you chose to go into any other field as a 20 year old. The level of idiocy in these arguments is simply astonishing.

"Just get a job at netflix instead of being a rad onc" GTFOutta here dude. Might as well say "Just be an NBA player, bro" "Just be a federal judge bro" "Just be a fortune 500 CEO bro" "Just be a hedge fund manager bro" "Just code the next facebook bro" "Just trade bitcoin bro" "Just open a 3 star Michelin restaurant bro" "Just drill some oil wells in Alaska bro" "Just invent the cure for baldness bro" "Just marry a Kardashian bro"

Maybe we should require a minimum of 3-4 years work experience prior to med school to give these silver spoon types even a tiny modicum of perspective.

Rant over.

10,000% agree.

nothing worse than elitism/entitlement mixed in with cluelessness.

 

[udrag14]

While I really don't want to respond to this foolishness, I just can't resist as it's one of my biggest pet peeves. Median rad onc compensation is not even close to being "in line" with median compensation with similar professions outside of medicine (which is what we're talking about -- not comparisons to med onc or derm).

You are the one who has no idea what he's talking about. I worked for multiple years in the tech industry, and most of my family members and close friends did/do as well. I do, in fact, have some insight into this.

I am consistently frustrated by this attitude from privileged kids, often premeds and med students, who encounter their first little bit of adversity in life well into their 20s and whine that "oh if only I had gone into law/finance/engineering/facebooknetflixgoogle-bro/bitcoin-savant/app-developer-extraordinaire/etc then I would have been making so much money and had so much a better life! Most of them earning their first paycheck ever and paying taxes for the first time when they start residency. I even hear this nonsense from attendings. The common theme is that without fault all of them grew up very priveleged and never worked before residency. In others words, a massive lack of perspective.

Maybe literally all of my friends and family members were just lazy and stupid that their incomes maxed out in the $150k range just like >90% of everyone else in their fields?

Here are some facts for you, "bro":

Average lawyer income: $72,921 (indeed), $120,910 (BLS median)
For the tiny, tiny percentage of lawyers who are able to get in big law firms, this is in the $200-300k/year range unless you are an even tinier (at a fraction of a percent of all lawyers) that are somehow able to stick out the torture and make it to partner at a big law firm. Still well under a rad onc's income with double the work hours.

Average computer scientist income: $99,831 (indeed), $101,790 (BLS median for software developers)
The distribution tails off around $160,000 with the most desirable companies paying around this level
FWIW, the extreme end of this, the netflixes, are paying their engineers around $200-250k. You can look this data up.

Average mechanical engineer income: $82,631 (indeed), $85,880 (BLS median)
The distribution tails off around $140,000 with the most desirable companies paying around this level

Investment analyst: $109,031 (indeed), $84,300 (BLS median)

I could keep going. But you get the point.
There are multiple factors that pull the averages a little low when looking at professions at a whole. The more revealing data is the top end of the curve, which maxes around $200k for nearly every other elite profession besides specialists in medicine.

You are not going to be getting W-2 income > $300k in virtually any other field. You just are not. There are a handful of exceptions, but it's asinine to boldly proclaim that you would have been that exception. Yet I hear it all the time. I went to med school and got into such-and-such residency, I'm clearly so smart, I would have been at the top of my field making millions in tech or on wall street. I'm sure of it! I would have been that one who got promoted up to CEO. Or, I would have gone out and started my own company and surely would have been successful. The reality is that the smartest people I have ever known in my life were a handful of engineers I worked with in the tech industry. They made around $100-$120k.

I am not denying that rad onc and medicine in general has lots of problems. I am not saying that we don't deserve to make $600k/year. What I am saying is that literally no other profession offers anywhere close to such a high average and MEDIAN income with such a high distribution of workers earning close to that average (i.e., not a profession where 90% of people are earning 100k and 10% of people are earning > 1 mil skewing the average but not the median -- most rad oncs are making $300-$800k. Nobody is making $100k).

What I am saying is that you're a God-damned fool if you honestly believe you would most likely be making $700k/year at age 40 if you chose to go into any other field as a 20 year old. The level of idiocy in these arguments is simply astonishing.

"Just get a job at netflix instead of being a rad onc" GTFOutta here dude. Might as well say "Just be an NBA player, bro" "Just be a federal judge bro" "Just be a fortune 500 CEO bro" "Just be a hedge fund manager bro" "Just code the next facebook bro" "Just trade bitcoin bro" "Just open a 3 star Michelin restaurant bro" "Just drill some oil wells in Alaska bro" "Just invent the cure for baldness bro" "Just marry a Kardashian bro"

Maybe we should require a minimum of 3-4 years work experience prior to med school to give these silver spoon types even a tiny modicum of perspective.

Rant over.

Maybe we should start paying all doctor minimum wage. That reflects better the "real" world.

 

[Mandelin Rain]

What is a comparable profession to any physician outside of medicine? God given abilities that most aren't blessed with. Single minded focus to highly achieve throughout your entire life. Countless hours/years given in pursuit of your profession. Delayed financial compensation while working for someone else.Sacrifice after sacrifice (many of which you have no choice in), including to both personal and family well-being at times.

Like an NBA/NFL player?

By that metric, we're grossly underpaid.

 

[Chartreuse Wombat]

Bad analogy.

More than 1 million physicians in US. <2000 NFL players, <500 NBA players

Median length of NFL career is 3.3 years; NBA is 4.8 years. Physicians typically work 30+ years after residency.

Professional athletes do make lots of money but it is for a short period of time and they are several logs more selective than we are

 

[Mandelin Rain]

Incredibly off topic but anyway...

Honest question. If you presented a referendum to our American voters that said...

Choose one to go away tomorrow:
1. The NBA and NFL
2. All Physicians

...which would win?

 

[evilbooyaa]

Incredibly off topic but anyway...

Honest question. If you presented a referendum to our American voters that said...

Choose one to go away tomorrow:
1. The NBA and NFL
2. All Physicians

...which would win?

What?
3. Neither

People need physicians (despite how much fringe groups want to hate them) and wouldn't want to give up the entertainment of the NBA and NFL.

I feel like I'm missing the point of this post.

 

[evilbooyaa]

Look bro. You have no idea what you're talking about. Just sit down.

To get to the point, it's easier for people to exploit you if you believe "we rad onc's are doing pretty well!" Instead, you should believe "rad onc compensation is in line with similar professions in-and-outside of medicine." The latter is closer to the truth.

Actually, you don't. KHE is 100% right on this. The bolded is a laughable statement.

 

[bluebubbles]

You are the one who has no idea what he's talking about. I worked for multiple years in the tech industry, and most of my family members and close friends did/do as well. I do, in fact, have some insight into this.

Maybe literally all of my friends and family members were just lazy and stupid that their incomes maxed out in the $150k range just like >90% of everyone else in their fields?

Here are some facts for you, "bro":

Average lawyer income: $72,921 (indeed), $120,910 (BLS median)

Average computer scientist income: $99,831 (indeed), $101,790 (BLS median for software developers)

Average mechanical engineer income: $82,631 (indeed), $85,880 (BLS median)
The distribution tails off around $140,000 with the most desirable companies paying around this level

Investment analyst: $109,031 (indeed), $84,300 (BLS median)

You are not going to be getting W-2 income > $300k in virtually any other field. You just are not.

Rant over.

10,000% agree.

nothing worse than elitism/entitlement mixed in with cluelessness.

Actually, you don't. KHE is 100% right on this. The bolded is a laughable statement.

I appreciate your Google-fu.

My spouse in her late 20's/early 30's has had all-in offers from HR in the last 6 months in the $400k/year range (W-2 income) as an early-career employee at over a dozen software companies, across the spectrum of public/private/big/small. This is for rank-and-file L4/L5, and similar to dozens of our friends in major coastal cities (not SF). This does not include folks that were lucky (joined a pre-IPO) company or good (exceptional technical and/or management skills). She speculates these people are making >$1 M/year. These numbers are in-line with radiation oncology, as I previously stated.

We attended public non-magnet secondary schools and come from modest family backgrounds, but we did attend a top university on full merit scholarship with other entitled & clueless kids.

My older family members in tech do max out at ~$150k, but they didn't have a dedicated CS education and don't work for native software companies, but instead for other companies that use software to support their core service. In addition, outside of software, I'm not aware that traditional engineers (electrical, mechanical, civil, etc.) have seen significant income growth in the last decade or two. My guess is that you and your smart & hardworking friends/family fall into these buckets.

Your Google figures represent all the "computer scientists" in flyover country and only include salary, not total income.

Believe it or not. Moving along now.

 

[KHE88]

I appreciate your Google-fu.

My spouse in her late 20's/early 30's has had all-in offers from HR in the last 6 months in the $400k/year range (W-2 income) as an early-career employee at over a dozen software companies, across the spectrum of public/private/big/small. This is for rank-and-file L4/L5, and similar to dozens of our friends in major coastal cities (not SF). This does not include folks that were lucky (joined a pre-IPO) company or good (exceptional technical and/or management skills). She speculates these people are making >$1 M/year. These numbers are in-line with radiation oncology, as I previously stated.

We attended public non-magnet secondary schools and come from modest family backgrounds, but we did attend a top university on full merit scholarship with other entitled & clueless kids.

My older family members in tech do max out at ~$150k, but they didn't have a dedicated CS education and don't work for native software companies, but instead for other companies that use software to support their core service. In addition, outside of software, I'm not aware that traditional engineers (electrical, mechanical, civil, etc.) have seen significant income growth in the last decade or two. My guess is that you and your smart & hardworking friends/family fall into these buckets.

Your Google figures represent all the "computer scientists" in flyover country and only include salary, not total income.

Believe it or not. Moving along now.

Thanks for clearing that up. So this either is grossly exaggerated or your wife/husband has some incredibly unique and valuable skill. It's not like Facebook, Netflix, and Microsoft are doing cattle calls for experienced programmers and paying them $400k/year. That's not how the labor market works. There is lots of talent available for far less.

It's frankly insulting to tell people that "rank and file" early career coders and others with a CS background should be expecting $40k direct deposited in their bank account each month and make them feel like there's something wrong with them for not having that top 0.01% outlier job at Netflix. This is a flat out lie and gaslighting. While the FANG companies do pay well, perhaps in the $300-$400k/year range for select senior software engineers, it's not like just anyone can walk into these places and get a job there. The competition is immense, far greater numbers-wise than getting into med school. The vast, vast majority of software engineers are going to be earning $100k-150k/year despite their competence.

Congrats though to your spouse being the n=1 exception to the rule.

Every radiation oncologist I know makes > $300k. Many way, way more that.
Every software engineer I know makes < $200k, most around $100k/year.

"Rad onc compensation is in line with similar professions outside of medicine."
Simply unbelievable that you actually believe this or are intellectually dishonest to apply it to a super, super rare outlier job.

Move on and keep your fingers plugging your ears if you want, but the fact is that the odds are way way against you that you would be earning anywhere near $600k/year in the form of a salary from an employer in any other industry. Whereas for rad onc, all we have to do finish residency, and that salary is basically guaranteed for you tomorrow in any undesirable flyover part of the country. Literally no other non-medical career can say that. Despite all of the problems with rad onc and medicine in general, we have everyone else beat by ten thousand miles when it comes to job security and security of maintaining a top 1% income throughout our entire career. We all know this because it's at least part of why all of us, either conciously or subconciously, chose to embark on an 11 year training process rather than start that sweet, sweet coding job for $100k/year at the age of 22.

Gimme a break.

 

[deleted18755]

I appreciate your Google-fu.

My spouse in her late 20's/early 30's has had all-in offers from HR in the last 6 months in the $400k/year range (W-2 income) as an early-career employee at over a dozen software companies, across the spectrum of public/private/big/small. This is for rank-and-file L4/L5, and similar to dozens of our friends in major coastal cities (not SF). This does not include folks that were lucky (joined a pre-IPO) company or good (exceptional technical and/or management skills). She speculates these people are making >$1 M/year. These numbers are in-line with radiation oncology, as I previously stated.

We attended public non-magnet secondary schools and come from modest family backgrounds, but we did attend a top university on full merit scholarship with other entitled & clueless kids.

My older family members in tech do max out at ~$150k, but they didn't have a dedicated CS education and don't work for native software companies, but instead for other companies that use software to support their core service. In addition, outside of software, I'm not aware that traditional engineers (electrical, mechanical, civil, etc.) have seen significant income growth in the last decade or two. My guess is that you and your smart & hardworking friends/family fall into these buckets.

Your Google figures represent all the "computer scientists" in flyover country and only include salary, not total income.

Believe it or not. Moving along now.

I have zero personal or even second hand experience with salaries in the tech industry (or quite frankly anything outside of medicine) but find it hard to believe that jobs that pay $400k are readily available to even the top 10% (let alone rank and file) of those in their late 20’s/early 30’s in any field ...

You mean they graduated college with a bachelors degree at 22 and landed a job paying $100,000 then received an average raise of about $$40,000-50,000 per year, every year for ~ 8 straight years? Or are the starting salaries for 22 year olds $200k with annual $25,000 raises or you start low and after a few years get a $100,000- $250,000 raise or two!?!

I honestly don’t see how anybody (let alone a sizable minority) can get to a $400,000 straight salary by 30 years old without some unreal starting salary and/or annual increases so I’m having trouble believing this but would love to learn more!

 

[maruchan]

There's a lot more variance in other industries in the types of jobs (and correspondingly the salary).

I actually agree with bluebubbles here. If you know mostly tech employees doing individual contributor work at various companies (I'm guessing KHE's network is like this), then yes their salary maxes out around 150k. But if you're talking about tech executives/VPs in the silicon valley and other tech hubs, then their salary is easily 400k+. For someone who is smart, motivated, and ambitious (and with the right circumstances) it's completely doable to achieve that by mid-30s (late 20s might be a bit of a stretch, but you would be making six figures throughout your 20s unlike medicine), and I know multiple people who have done so. To oldking: monetary raises aren't linear by year, once you move into an executive or VP type position (or in law or finance, a partner type position) your pay takes a massive leap.

The floor and median in medicine are way higher. But if you're at the top of a field such as tech, law, finance it's far more lucrative than medicine. Arguably, the effort it takes to do something like match in a highly competitive specialty in medicine would get you to the top of other fields.

Of my classmates who have gone into those other fields and worked hard to be successful, they all have far far greater earning potential than me. And you know what, that's fine with me, because our job is much more meaningful and has other non-monetary benefits compared to those fields. If you're a top student in college, you shouldn't go into medicine for the money, but I don't think that's exactly new news....

 

[KHE88]

The floor and median in medicine are way higher. But if you're at the top of a field such as tech, law, finance it's far more lucrative than medicine. Arguably, the effort it takes to do something like match in a highly competitive specialty in medicine would get you to the top of other fields.

This was basically my point regarding floor and median in medicine. But the latter part I disagree with and was basically my other point. There's this idea that if you put the same effort in that you otherwise would have put in to get in and through rad onc then you most likely would have been just as successful getting a job at Netflix and getting promoted up to management and earn $700k/year. And that's just not true. It requires a lot of connections and outright luck. It's not like the very smart people I know and have known in the tech fields haven't been trying as hard as they possibly can their whole careers to try and get promoted and move up. They weren't in the right place at the right time and it just didn't happen for them. It's not like they aren't "smart, motivated, and ambitious" enough. It's just their attempts at pulling the slot machine lever haven't panned out meanwhile their colleague comes in and tries it for the first time and hits a jackpot. Then they're looking around saying "huh, you mean you guys didn't get jackpots too? maybe you're not just ambitious enough." That's the insulting part.

The advantage to medicine, and particularly sub-specialties is that there is no random slot machine lever, at least for income. You're rich before you even walk in the casino. Name one other field that that's the case for. And "Netflix" isn't a field.

Sorry... still a little ticked off.

 

[RadOncDoc21]

The advantage to medicine, and particularly sub-specialties is that there is no random slot machine lever, at least for income. You're rich before you even walk in the casino. Name one other field that that's the case for. And "Netflix" isn't a field.

I walked in the casino with over 200k in debt and started my first “real” job in my 30’s. If I could go back in time, I would take my chances in admin/exec vs being a doctor.

 

[maruchan]

This was basically my point regarding floor and median in medicine. But the latter part I disagree with and was basically my other point. There's this idea that if you put the same effort in that you otherwise would have put in to get in and through rad onc then you most likely would have been just as successful getting a job at Netflix and getting promoted up to management and earn $700k/year. And that's just not true. It requires a lot of connections and outright luck. It's not like the very smart people I know and have known in the tech fields haven't been trying as hard as they possibly can their whole careers to try and get promoted and move up. They weren't in the right place at the right time and it just didn't happen for them. It's not like they aren't "smart, motivated, and ambitious" enough. It's just their attempts at pulling the slot machine lever haven't panned out meanwhile their colleague comes in and tries it for the first time and hits a jackpot. Then they're looking around saying "huh, you mean you guys didn't get jackpots too? maybe you're not just ambitious enough." That's the insulting part.

The advantage to medicine, and particularly sub-specialties is that there is no random slot machine lever, at least for income. You're rich before you even walk in the casino. Name one other field that that's the case for. And "Netflix" isn't a field.

Sorry... still a little ticked off.

Sorry but...it's nowhere near as luck-based as you're painting it out to be. Someone who comes out of college and works at Google/Facebook/Apple/Amazon, does well at their job and rises steadily through the ranks for a few years, is with high probability going to hit that 400k mark by their 30s. Same with someone who comes out of a top 10 law school and lands a big law job at one of the top firms.

If anything I feel like medicine is more luck-based since you only match once, on the other hand you can apply to Google/Facebook at multiple different points in your career.

I don't mean to dismiss the people you know as being not as smart/capable as others. To look at an analogous situation: there are extremely smart and capable people who aren't able to match into derm, ortho, etc. Arguably some of them are more capable than the people who actually matched into derm/ortho. Bad luck and poor timing on circumstances might play a role in that. But it's not purely luck-based either. Desire, ability, circumstances, etc all play a role. Same thing with other fields. Luck might play a role in getting to the "top" of the field but there's much more that goes into it.

I mean, again, I think medicine is a great profession. But money is not the reason to do it.

 

[puahate]

Sorry but...it's nowhere near as luck-based as you're painting it out to be. Someone who comes out of college and works at Google/Facebook/Apple/Amazon, does well at their job and rises steadily through the ranks for a few years, is with high probability going to hit that 400k mark by their 30s. Same with someone who comes out of a top 10 law school and lands a big law job at one of the top firms.

If anything I feel like medicine is more luck-based since you only match once, on the other hand you can apply to Google/Facebook at multiple different points in your career.

I don't mean to dismiss the people you know as being not as smart/capable as others. To look at an analogous situation: there are extremely smart and capable people who aren't able to match into derm, ortho, etc. Arguably some of them are more capable than the people who actually matched into derm/ortho. Bad luck and poor timing on circumstances might play a role in that. But it's not purely luck-based either. Same thing with other fields. Luck might play a role in getting to the "top" of the field but there's much more that goes into it.

I mean, again, I think medicine is a great profession. But money is not the reason to do it.

Anecdotally, a friend of mine had a 2.9 gpa in CS. Got an average job making 80k. Now has a Google offer nearing 200k in Cali. He will have an interview with FB which he will probably be able to leverage way more now.

Highly doubt this kind of mobility and leverage is possible now in radonc especially for the amount of work you guys put in.

 

[medgator]

This was basically my point regarding floor and median in medicine. But the latter part I disagree with and was basically my other point. There's this idea that if you put the same effort in that you otherwise would have put in to get in and through rad onc then you most likely would have been just as successful getting a job at Netflix and getting promoted up to management and earn $700k/year. And that's just not true. It requires a lot of connections and outright luck.

Some would say the same thing with finding the perfect RO job and setup after residency. I feel fortunate I got into a pp freestanding setup outside a major metro, considering how rare most report that to be these days

Amazon has paid its workers in part with stock compensation for years, even all the way down to the warehouse ones. Let's just say if you were an average white collar tech worker with them over a decade ago, you're doing just fine with stock compensation alone, let alone the six figure salary. And you typically didn't need 9 years post college to get there

 

[TheIllusionist]

Medicine is a dumb ass way to make money. I have friends at Big Law that are making 200k first year out at like age 26-27. I have friends working at investment banks who made moves into HF and PE and are making 200-300k at 25-26. I have friends working in silicon valley making 200k+ in their mid 20s too. Not all of these people went to elite tier undergrads either. Some, especially CS ones, just dominated at state flagship, and it worked out well.

Frankly, I definite;y go through periods of regretting my choice. But then days where I feel like I made a difference, even as a med students, I feel like I have something that those other people don't. But that might just be me rationalizing away, so I don't feel bad. To a blue collar background kid or someone who didn't grow up in a highly competitive environment in general, this field is still living the dream.

When all the kids you grew up with are in other fields killing it and so are a good chunk of your college classmates, all people you did just as well as and are really similar to, you don't feel as lucky. But that's just human nature. Gotta learn to be thankful for what you have.

 

[bronx43]

Medicine is a dumb ass way to make money. I have friends at Big Law that are making 200k first year out at like age 26-27. I have friends working at investment banks who made moves into HF and PE and are making 200-300k at 25-26. I have friends working in silicon valley making 200k+ in their mid 20s too. Not all of these people went to elite tier undergrads either. Some, especially CS ones, just dominated at state flagship, and it worked out well.

Frankly, I definite;y go through periods of regretting my choice. But then days where I feel like I made a difference, even as a med students, I feel like I have something that those other people don't. But that might just be me rationalizing away, so I don't feel bad. To a blue collar background kid or someone who didn't grow up in a highly competitive environment in general, this field is still living the dream.

When all the kids you grew up with are in other fields killing it and so are a good chunk of your college classmates, all people you did just as well as and are really similar to, you don't feel as lucky. But that's just human nature. Gotta learn to be thankful for what you have.

I have friends in high finance, and high positions in corporate as well. My best friend is in a HF in Asia, and my other buddy was IBD at Goldman. I know tons of other acquaintances who worked IBD at various bulge bracket banks. They made good money coming out of undergrad (at the height of financial boom) and I can't say I wasn't envious of their decision then. However, now that I'm out in practice (medical subspecialist), I am rather grateful that I stuck it out all these years. Finance isn't what it used to be as yield is being decimated globally by central banks. The HF model is quickly dying, and stress is quite high. The people that jumped ship to corporate all took large pay cuts.
Meanwhile, a lot of my physician buddies are doing well making anywhere from 300-600k with stable gigs and working 40-50 hours a week. Even with potential changes to the health care industry, I rather have a tangible skill as a MD than making pitch books for Morgan Stanley.

 

[deleted18755]

There's a lot more variance in other industries in the types of jobs (and correspondingly the salary).

I actually agree with bluebubbles here. If you know mostly tech employees doing individual contributor work at various companies (I'm guessing KHE's network is like this), then yes their salary maxes out around 150k. But if you're talking about tech executives/VPs in the silicon valley and other tech hubs, then their salary is easily 400k+. For someone who is smart, motivated, and ambitious (and with the right circumstances) it's completely doable to achieve that by mid-30s (late 20s might be a bit of a stretch, but you would be making six figures throughout your 20s unlike medicine), and I know multiple people who have done so. To oldking: monetary raises aren't linear by year, once you move into an executive or VP type position (or in law or finance, a partner type position) your pay takes a massive leap.

The floor and median in medicine are way higher. But if you're at the top of a field such as tech, law, finance it's far more lucrative than medicine. Arguably, the effort it takes to do something like match in a highly competitive specialty in medicine would get you to the top of other fields.

Of my classmates who have gone into those other fields and worked hard to be successful, they all have far far greater earning potential than me. And you know what, that's fine with me, because our job is much more meaningful and has other non-monetary benefits compared to those fields. If you're a top student in college, you shouldn't go into medicine for the money, but I don't think that's exactly new news....

Damn I had no idea there were more than a few people in these tech hubs (or even finance . . . what does a 25-26 year old even do with $200-$300k/year!?!) making that kind of money that young. It's almost impossible for me to believe (but so too is paying more than a million dollars for anything less than a mansion, let alone a modest 3 bedroom house, as appears to be the case in an increasing number of these areas).

 

[Radz08]

I'm going back to school to go into the tech industry....maybe its not too late 😀

 

[Krukenberg]

Sorry but...it's nowhere near as luck-based as you're painting it out to be. Someone who comes out of college and works at Google/Facebook/Apple/Amazon, does well at their job and rises steadily through the ranks for a few years, is with high probability going to hit that 400k mark by their 30s. Same with someone who comes out of a top 10 law school and lands a big law job at one of the top firms.

If anything I feel like medicine is more luck-based since you only match once, on the other hand you can apply to Google/Facebook at multiple different points in your career.

I don't mean to dismiss the people you know as being not as smart/capable as others. To look at an analogous situation: there are extremely smart and capable people who aren't able to match into derm, ortho, etc. Arguably some of them are more capable than the people who actually matched into derm/ortho. Bad luck and poor timing on circumstances might play a role in that. But it's not purely luck-based either. Desire, ability, circumstances, etc all play a role. Same thing with other fields. Luck might play a role in getting to the "top" of the field but there's much more that goes into it.

I mean, again, I think medicine is a great profession. But money is not the reason to do it.

Disagree with you. Anyone at those companies making near $400k is management. You need strong leadership skills and a dose of charisma to make it to management at top companies—something many successful doctors do not have. If you work hard in medicine and have a non-malignant personality you can get rich. To get rich in corporate America requires leadership skills, political skills, and strong networking.

 

[scarbrtj]

If you work hard in medicine and have a non-malignant personality you can get rich. To get rich in corporate America requires leadership skills, political skills, and strong networking.

Watch 'The Big Short.' (Pay attention to the M.D., the young kids, etc.)
You can't make it in academic medicine, much less get rich, e.g., without political skills and strong networking.
When you can be a solo practitioner, you are probably right. A solo practitioner (owner of clinic and equipment) rad onc is about as rare as a hen's tooth though.
Or, just go into corporate medical America; forget the M.D. That's real money.

 

[Haybrant]

Damn I had no idea there were more than a few people in these tech hubs (or even finance . . . what does a 25-26 year old even do with $200-$300k/year!?!) making that kind of money that young. It's almost impossible for me to believe (but so too is paying more than a million dollars for anything less than a mansion, let alone a modest 3 bedroom house, as appears to be the case in an increasing number of these areas).

The world is changing very rapidly or at least has been the past 5 years. The seeds were there about 10 years ago. There’s always a camp that believes economy and prosperity will take a hit and things will go backwards. The chance of this is actually fairly low at present. We may well be in a 20s era boom but that boom will obviously not be shared. Being in medicine is not a bad gig and you really can’t complain, you will have time to live comfortably and you don’t have to have the same level of political savvy and skill that you do to make it in the other fields mentioned above. But quality of life will matter more than ever. You think a difference in 50-75k (35 after taxes if that?) is going to change your life? You’re fooling yourself, strive for QOL and live w a smaller footprint bc real money adjusted for today is gone from medicine.

 

[Neuronix]

You can't make it in academic medicine, much less get rich, e.g., without political skills and strong networking.

Becoming famous in academics and obtaining leadership positions requires these things, sure.

Hanging out in an academic satellite for the long-term making academic salary for private practice work doesn't require politics or strong networking.

 

[HeyDalaron]

Thanks for clearing that up. So this either is grossly exaggerated or your wife/husband has some incredibly unique and valuable skill. It's not like Facebook, Netflix, and Microsoft are doing cattle calls for experienced programmers and paying them $400k/year. That's not how the labor market works. There is lots of talent available for far less.

It's frankly insulting to tell people that "rank and file" early career coders and others with a CS background should be expecting $40k direct deposited in their bank account each month and make them feel like there's something wrong with them for not having that top 0.01% outlier job at Netflix. This is a flat out lie and gaslighting. While the FANG companies do pay well, perhaps in the $300-$400k/year range for select senior software engineers, it's not like just anyone can walk into these places and get a job there. The competition is immense, far greater numbers-wise than getting into med school. The vast, vast majority of software engineers are going to be earning $100k-150k/year despite their competence.

Congrats though to your spouse being the n=1 exception to the rule.

Every radiation oncologist I know makes > $300k. Many way, way more that.
Every software engineer I know makes < $200k, most around $100k/year.

"Rad onc compensation is in line with similar professions outside of medicine."
Simply unbelievable that you actually believe this or are intellectually dishonest to apply it to a super, super rare outlier job.

Move on and keep your fingers plugging your ears if you want, but the fact is that the odds are way way against you that you would be earning anywhere near $600k/year in the form of a salary from an employer in any other industry. Whereas for rad onc, all we have to do finish residency, and that salary is basically guaranteed for you tomorrow in any undesirable flyover part of the country. Literally no other non-medical career can say that. Despite all of the problems with rad onc and medicine in general, we have everyone else beat by ten thousand miles when it comes to job security and security of maintaining a top 1% income throughout our entire career. We all know this because it's at least part of why all of us, either conciously or subconciously, chose to embark on an 11 year training process rather than start that sweet, sweet coding job for $100k/year at the age of 22.

Gimme a break.

Anecdote time:

I know a guy who has zero formal CS education, or any formal education at all beyond high school, but just did freelance coding as he was interested in it. He built up enough of a reputation over a decade to snag a job making approximately 200K USD working from home four days a week for a large tech company.

Another friend of mine, in his late 20s, works for one of the FANG companies as a developer. He is pulling more than 200K (maybe a lot more, it's hard to tell and he won't say) and can take as much vacation as he wants, whenever he wants to. Every weekend he's off at some EDM rave in Europe.

Given the training length, conceptual difficulty, and high stakes of medicine, its unfortunate that the pay is going down.

It is also unfortunate that the determination of the worth of our services is decided by voodoo economics and not by free-market principles.

 

[scarbrtj]

If you work hard in medicine and have a non-malignant personality you can get rich. To get rich in corporate America requires leadership skills, political skills, and strong networking.

You can't make it in academic medicine, much less get rich, e.g., without political skills and strong networking.

Becoming famous in academics and obtaining leadership positions requires these things, sure.
Hanging out in an academic satellite for the long-term making academic salary for private practice work doesn't require politics or strong networking.

I was focusing on the getting rich part which is impossible to do at academic pay levels, but the monetary fringe benefits (retirement etc) are good. The intangibles like maybe being an ostracized academic pariah, not so good. Half of all rad oncs go academic, immediately (theoretically) automatically excluding half of all rad oncs from ever "getting rich." Of course it depends on the definition of "rich." No way you can be "rich" in a large city unless you're making more than a million. Anything under that, you're very comfortable. And can afford really nice TVs, etc. But rich, IDK. (Although when I got out of residency and started making $185K a year I thought I was rich, and my brand new Infiniti G35 showed everyone I was.)

This is a weird, navel-gazing topic!

 

[deleted941485]

Disagree with you. Anyone at those companies making near $400k is management. You need strong leadership skills and a dose of charisma to make it to management at top companies—something many successful doctors do not have. If you work hard in medicine and have a non-malignant personality you can get rich. To get rich in corporate America requires leadership skills, political skills, and strong networking.

And probably a degree of sociopathy masked by virtue signaling and a smile. Also not something docs are very good at.

 

[Chartreuse Wombat]

Don't sell docs short on virtue signalling; they can be self-righteous with the best of them. Plenty of it happening on ROHub right now.

 

[KHE88]

I was wrong guys. This thread has opened my eyes.

Not happy with your job search outcome of $250k for 60 hours a week at a satellite 60 miles out of the city and 50 mile non-compete? Bummed about having to retake radbio and pray that one day you can sit for and fail orals?

No worries. Why waste another 5-6 years at a dead end rad onc job that barely covers your loans only to burnout as your BE expires and end up doing medicare physicals? Just do a 6 month coding boot camp, write a few apps to demonstrate your mad skills and get some play money, and apply for a job at Netflix. Your medical background will prove how smart you are and you will instantly get hired and move up to a $500k management job in a couple of years because your background just means you're going to work harder than everybody else. You're on cruise control all the way to retirement. At a bare minimum you will be making more than your rad onc job from the get go. There are, what, 5,000 rad oncs? Last I heard Netflix has openings for around 75,000 entry level programmers making $400k - plenty of room for all of us to switch.

It's not too late! If 22 year olds are doing it, surely you can too. Netflix app development is totally stable, their profit and revenue stream totally healthy, and that business model and industry will be around for multiple lifetimes. No question. Everybody's always going to need Netflix. When the bottom falls out, you've got your gold hoarders, subsistence farmers, weed doctors, and of course Netflix. They'll all be fine. Rad onc? Forget about it. Trimodality therapy is a luxury and what do you think will be the first excess therapy to go?

It's a sure thing. Med school is for suckers. I'm going to put up flyers all over the med school tomorrow telling the kids not to waste their prime years buried in books for nothing.

P.S. Sorry to go full-Sphinx on you all. Couldn't help myself.

 

[KHE88]

I was focusing on the getting rich part which is impossible to do at academic pay levels, but the monetary fringe benefits (retirement etc) are good. The intangibles like maybe being an ostracized academic pariah, not so good. Half of all rad oncs go academic, immediately (theoretically) automatically excluding half of all rad oncs from ever "getting rich." Of course it depends on the definition of "rich." No way you can be "rich" in a large city unless you're making more than a million. Anything under that, you're very comfortable. And can afford really nice TVs, etc. But rich, IDK. (Although when I got out of residency and started making $185K a year I thought I was rich, and my brand new Infiniti G35 showed everyone I was.)

This is a weird, navel-gazing topic!

If you can't become "rich" off of a $400k academic salary, you are doing something seriously wrong with your financial planning. $400k leaves you with $275-300k after taxes. If you take $100k and invest it into the S&P 500 every year and "live off of" the meager $200k remainder each year, that leaves you with $18,292,807 after a 30 year career.

So living off $200k per year and 18 million dollars at retirement isn't rich?

Dude, between this and the Netflix stuff, your perspective needs some checking.

 

[Haybrant]

If you can't become "rich" off of a $400k academic salary, you are doing something seriously wrong with your financial planning. $400k leaves you with $275-300k after taxes. If you take $100k and invest it into the S&P 500 every year and "live off of" the meager $200k remainder each year, that leaves you with $18,292,807 after a 30 year career.

So living off $200k per year and 18 million dollars at retirement isn't rich?

Dude, between this and the Netflix stuff, your perspective needs some checking.

275-300 after taxes?! Haha. I take you don’t make 400k.

 

[KHE88]

275-300 after taxes?! Haha. I take you don’t make 400k.

Yes, that's about what you'll bring home if you're doing things right (including money to tax advantaged savings plans). Although given that we have actual socialists polling at nearly 50% in this country, who knows for how long. I'm not sure if I'm just being trolled in this thread or what because this really is getting ridiculous.

If you have a salary of $400,000 you do not pay taxes on $400,000. You pay taxes on some dollar amount less than this based on a variety of factors.
If you do, you have the worst accountant and financial advisers on the planet.

There is a difference between gross income, adjusted gross income, and modified adjusted gross income.
I made the silly assumption that we all knew this.

But for the sake of argument, lets say every penny of the $400k you earn you pay taxes on each year.
In a zero tax state like TX or AK, that leaves you with $273k after FIT, SIT, and FICA. In a middle of the road state (VA is commonly the "average" tax state), this comes out to 250k.

Fine, so you suck at taxes and you live in an average state, your bank account is seeing 250k each year.

Lets say you want to keep that plebian bare-bones subsistence level annual living expense of $200k/year or $16.7k per month in your checking account (btw which by the 36% rule allows you to have up to a $6k/month mortgage -- which in VA means you can buy up to a 1.2 million dollar home). Anyway, now you only have $50k/year to invest in the S&P for your retirement and results in around 8 million at retirement.

Summary:
You make 400k, suck at taxes, live in a 1.2MM home, and still have >10k month to live off of after housing costs, and have a retirement portfolio worth 7-9MM (which will allow you to live off of up to ~45k per MONTH over a 35 year retirement until you die).

And this is not considered rich?
In what world is being in the top 1% in America ($421k income) only considered "living comfortably" and not rich? Are the people living only in the top 5% ($299k income) not "living comfortably"?

But that Netflix money tho... SMH
Maybe we should extend training another year to include finance and economics classes in residency. Win-win? Eases some pressure on the job market in the short term, helps mitigate our inevitably declining salaries with improved personal finance, and prevents "just work for netflix bro" and "400k is not rich" threads in the future?

 

[scarbrtj]

Yes, that's about what you'll bring home if you're doing things right (including money to tax advantaged savings plans). Although given that we have actual socialists polling at nearly 50% in this country, who knows for how long. I'm not sure if I'm just being trolled in this thread or what because this really is getting ridiculous.

If you have a salary of $400,000 you do not pay taxes on $400,000. You pay taxes on some dollar amount less than this based on a variety of factors.
If you do, you have the worst accountant and financial advisers on the planet.

There is a difference between gross income, adjusted gross income, and modified adjusted gross income.
I made the silly assumption that we all knew this.

But for the sake of argument, lets say every penny of the $400k you earn you pay taxes on each year.
In a zero tax state like TX or AK, that leaves you with $273k after FIT, SIT, and FICA. In a middle of the road state (VA is commonly the "average" tax state), this comes out to 250k.

Fine, so you suck at taxes and you live in an average state, your bank account is seeing 250k each year.

Lets say you want to keep that plebian bare-bones subsistence level annual living expense of $200k/year or $16.7k per month in your checking account (btw which by the 36% rule allows you to have up to a $6k/month mortgage -- which in VA means you can buy up to a 1.2 million dollar home). Anyway, now you only have $50k/year to invest in the S&P for your retirement and results in around 8 million at retirement.

Summary:
You make 400k, suck at taxes, live in a 1.2MM home, and still have >10k month to live off of after housing costs, and have a retirement portfolio worth 7-9MM (which will allow you to live off of up to ~45k per MONTH over a 35 year retirement until you die).

And this is not considered rich?
In what world is being in the top 1% in America ($421k income) only considered "living comfortably" and not rich? Are the people living only in the top 5% ($299k income) not "living comfortably"?

But that Netflix money tho... SMH
Maybe we should extend training another year to include finance and economics classes in residency. Win-win? Eases some pressure on the job market in the short term, helps mitigate our inevitably declining salaries with improved personal finance, and prevents "just work for netflix bro" and "400k is not rich" threads in the future?

You're saying you'll be rich in retirement as a doctor, not rich during your working years whilst you're young and middle aged. Also, rich = minimal disposable income. ">10k month to live off of after housing costs" comes out to about $300 a day... rich? Rich?? OK. All would agree w/ you on those terms.

 

[medgator]

275-300 after taxes?! Haha. I take you don’t make 400k.

That only has a possibility of happening in a zero income tax state. Effective rate is almost always going to be higher than 25% at $400k for most individuals once you kick in state income tax

Summary of the Latest Federal Income Tax Data, 2025 Update

New IRS data shows the US federal income tax system continues to be progressive as high-income taxpayers pay the highest average income tax rates. Average tax rates for all income groups remain lower after the Tax Cuts and Jobs Act (TCJA).

taxfoundation.org

And if you live in a blue state? Trump just screwed you bigly with the SALT deduction cap of $10k

 

[evilbooyaa]

Are people seriously arguing that having 10k a month cash in the bank is not 'rich'? It seems 421k of income is required to be in the top 1%. Assuming salary of 400k, maybe we're in the top 2% of Americans I completely agree with KHE88 on this. What is an objective definition of rich? Does it need to go up to 450k so we can be in the top 1% of all americans? Maybe 500k to account for debt and delayed start? Or is your definition of rich to be int he top 0.01% of Americans, with an annual income of 7 million?

As a rad onc, I would be happy with 400-500k/year without having to sell my soul to get it.

 

[Neuronix]

I think this entire discussion is ridiculous.

If you want to discuss medicine vs. other careers, I think you should go to pre-allo.

We're all doctors here. We signed up for medical school to be physicians. I'm not saying we took a vow of poverty to be physicians, but you all knew what you were signing up for--long training, student debt, and a relatively stable and high salary within a certain range.

Keep some perspective. What were you expecting exactly that you're not getting in rad onc? Do you really no longer want to be a doctor at all?

There are some serious issues with rad onc (declining job market, board pass rates, etc), but that's what we're here to discuss. Specifically, I think we should be discussing (in no particular order) what's wrong with rad onc, how to improve rad onc, comparisons to other specialties, topics and improvements in cancer care and health care in general.

This discussion has gone off the rails comparing rad onc to Netflix or other types of careers. It makes us all look silly even discussing it. We made our choices, so let's advocate for ourselves and future rad oncs, not imagine grass is greener fantasies.

 

[thecarbonionangle]

Yes, that's about what you'll bring home if you're doing things right (including money to tax advantaged savings plans). Although given that we have actual socialists polling at nearly 50% in this country, who knows for how long. I'm not sure if I'm just being trolled in this thread or what because this really is getting ridiculous.

If you have a salary of $400,000 you do not pay taxes on $400,000. You pay taxes on some dollar amount less than this based on a variety of factors.
If you do, you have the worst accountant and financial advisers on the planet.

There is a difference between gross income, adjusted gross income, and modified adjusted gross income.
I made the silly assumption that we all knew this.

But for the sake of argument, lets say every penny of the $400k you earn you pay taxes on each year.
In a zero tax state like TX or AK, that leaves you with $273k after FIT, SIT, and FICA. In a middle of the road state (VA is commonly the "average" tax state), this comes out to 250k.

Fine, so you suck at taxes and you live in an average state, your bank account is seeing 250k each year.

Lets say you want to keep that plebian bare-bones subsistence level annual living expense of $200k/year or $16.7k per month in your checking account (btw which by the 36% rule allows you to have up to a $6k/month mortgage -- which in VA means you can buy up to a 1.2 million dollar home). Anyway, now you only have $50k/year to invest in the S&P for your retirement and results in around 8 million at retirement.

Summary:
You make 400k, suck at taxes, live in a 1.2MM home, and still have >10k month to live off of after housing costs, and have a retirement portfolio worth 7-9MM (which will allow you to live off of up to ~45k per MONTH over a 35 year retirement until you die).

And this is not considered rich?
In what world is being in the top 1% in America ($421k income) only considered "living comfortably" and not rich? Are the people living only in the top 5% ($299k income) not "living comfortably"?

But that Netflix money tho... SMH
Maybe we should extend training another year to include finance and economics classes in residency. Win-win? Eases some pressure on the job market in the short term, helps mitigate our inevitably declining salaries with improved personal finance, and prevents "just work for netflix bro" and "400k is not rich" threads in the future?

I don’t think you understand what “socialism” actually means.

 

[RadOncMegatron]

Hopefully, this talk will be good and not either 1) An ASTRO sycophants paradise or 2) The end of this young man's career.

Seriously, hoping for a good discussion on this important topic

 

[medgator]

I think the time is right for someone to take a strong stance. Hope he does. We need a leader. What kind of rotten field would punish a resident for pointing out that relentless residency expansion in the face of shrinking XRT demand is bad? Disgusting. Let’s see any of these people stand up and defend expansion publicly.

Agree, esp to call out things like this:



So apparently extra otv visits don't require physician/RO work? And I guess surveillance in prostate and breast ca still means we are needed?

 

[medgator]

It’s just absolute ignorance of how radonc works as a business and I’m not surprised that a resident and someone who has spent his years in academics would argue a strawman like that - they just haven’t spent any time thinking about the economics.

Most on here would agree that hypofrac is great for breast and SBRT prostate is likely the future for most-all risk groups. The APM is also a good thing because it divorces reimbursement from fractionation.

But the fact is IF YOU ARE DELIVERING FEWER FRACTIONS YOU NEED FEWER PHYSICIANS.

What is so hard to understand about this?!

It's easy to be divorced from the reality of RO labor when you carry less pts (10-20/MD) than those of us out in the real world (25-35/MD minimum, 35-40 is not unheard of as some on this forum will attest to), while treating 1-2 disease sites and being covered by a resident, and sometimes even an NP/fellow in certain circumstances

 

[OTN]

Agree, esp to call out things like this:



So apparently extra otv visits don't require physician/RO work? And I guess surveillance in prostate and breast ca still means we are needed?

I don't think it makes the field look good if some of "the best work our field has done" led to exactly 0% increase in survival.

 

[fiji128]

I don't think it makes the field look good if some of "the best work our field has done" led to exactly 0% increase in survival.

or reduces the utilization of resources with no decrement in survival! Wish I would've had the heads up about that 10 years ago.

 

[OTN]

It's good for patients and society that we can treat certain cancers more quickly, no doubt. However, to say that it will have no effect on the RO workforce means you're either being intentionally misleading or dangerously ignorant.