Can you imagine being a Rad Onc in the early 2000s?

[PhotonBomb]

back when IMRT was billing 1000 bucks a fraction? People must have felt like they were living life on cheat mode. It must have been like going to work every day and being scared the FBI was going to swarm your office

It must have been like in the second act of a Scorsese gangster movie when they play a montage of everything going well and the money rolling in.

Literally letting the good times roll and hoping you didn’t end up dead, in jail, or in rehab.

Man those days. Tell some tales.

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[RadOncMegatron]

back when IMRT was billing 1000 bucks a fraction? People must have felt like they were living life on cheat mode. It must have been like going to work every day and being scared the FBI was going to swarm your office

It must have been like in the second act of a Scorsese gangster movie when they play a montage of everything going well and the money rolling in.

Literally letting the good times roll and hoping you didn’t end up dead, in jail, or in rehab.

Man those days. Tell some tales.

I heard abuses like that lead the SBRT arbitrarily being limited to 5 fractions or less. Can anyone confirm this?

 

[seper]

I started hanging out around RadOnc departments around 2003 and I remember a lot of jealousy and outright animosity toward RadOncs by other specialists.

 

[medgator]

 

[thecarbonionangle]

Many of the posters here made that sort of money... MILLIONS a year?

 

[PhotonBomb]

Many of the posters here made that sort of money... MILLIONS a year?

But at what cost?

 

[thecarbonionangle]

But at what cost?

cost of doing business. The banks have figured this out. Why haven't you?

 

[deleted18755]

back when IMRT was billing 1000 bucks a fraction? People must have felt like they were living life on cheat mode. It must have been like going to work every day and being scared the FBI was going to swarm your office

It must have been like in the second act of a Scorsese gangster movie when they play a montage of everything going well and the money rolling in.

Literally letting the good times roll and hoping you didn’t end up dead, in jail, or in rehab.

Man those days. Tell some tales.

As always it was location dependent but there were definitely physicians who owned machines and got technical $$$ while using IMRT for bone mets and working 4 day weeks with literally 8-10 weeks vacation (which is of course one of the reasons we are in this mess now!)

Hard to believe but early 2000's was literally 18-20 years ago so I'm not sure if many, if any, of the regular posters on this forum own a practice back then (they'd have to be closer to 60 years old right now).

 

[thecarbonionangle]

If you talk to any older doc they will tell you about back in day. Talk to an old path, gi, cards, etc they used to make a KILLING. younger people would be SHOOK. They had to come for our field at some point

 

[thecarbonionangle]

you still making it rain brotha?

 

[PhotonBomb]

you still making it rain brotha?

Medgator hypofracs.

Instead of 20 fractions for a bone met, he does 19!

 

[thecarbonionangle]

Medgator hypofracs.

Instead of 20 fractions for a bone met, he does 19!

CHOOSE WISELY folks!

 

[medgator]

If you talk to any older doc they will tell you about back in day. Talk to an old path, gi, cards, etc they used to make a KILLING. younger people would be SHOOK. They had to come for our field at some point

Med oncs in the early 90s >>>> rad oncs at any point in history afaik, like minimum low 7 figures, neulasta reimbursed like $10k etc.

Even now, MOs in big private groups with centralized rads, path, even some rad onc ownership are making seven figures easily between all that and their drug margins

 

[medgator]

CHOOSE WISELY folks!

Medgator hypofracs.

Instead of 20 fractions for a bone met, he does 19!

 

[scarbrtj]

Radiation Therapy Services (RTSX) aka 21st Century Oncology traded on the stock market briefly, IPO about 2004. "Net patient service revenue" ~$60 million in 2000 and $358 million in 2008. Once their profit got into the hundreds of millions, venture capital couldn't resist and they were bought out for ~$1.1 billion in 2008, shares sold at ~$32.50 in the deal and most people bought in at $10-20 a share. This all could not have happened without IMRT.

 

[Mandelin Rain]

Definitely knew rad oncs making >1 million in that 2003-2006 era, even without technical ownership. They would just have a portion of the global and the money would roll in. And yes, there was a lot of animosity.

During my internship (mind you, I'm dead broke at the time), I was on an anesthesia rotation and remember a pediatric ENT becoming disgusted with me for no reason other than I said I was going into rad onc. He started calling me "Buck a Rad". Probably repeated it 20 times as I sat there in stunned silence before he eventually asked me to leave. Literally couldn't stand being in my presence because I was presumably going to be making lots of money. Really funny in retrospect.

FWIW, he was putting in ear tubes while this was happening and had ear tube cases lined up in two ORs alternating every 15 minutes that day. Not sure how much tubes pay, but I'm guessing it ain't bad.

 

[XRT_doc]

Definitely knew rad oncs making >1 million in that 2003-2006 era, even without technical ownership. They would just have a portion of the global and the money would roll in. And yes, there was a lot of animosity.

During my internship (mind you, I'm dead broke at the time), I was on an anesthesia rotation and remember a pediatric ENT becoming disgusted with me for no reason other than I said I was going into rad onc. He started calling me "Buck a Rad". Probably repeated it 20 times as I sat there in stunned silence before he eventually asked me to leave. Literally couldn't stand being in my presence because I was presumably going to be making lots of money. Really funny in retrospect.

FWIW, he was putting in ear tubes while this was happening and had ear tube cases lined up in two ORs alternating every 15 minutes that day. Not sure how much tubes pay, but I'm guessing it ain't bad.

I made 800K this year off professional. You can still make good money if you're in a high volume center.

 

[DebtRising]

Medicine as a field continues to be a worse deal for the current generation of physicians in almost every single metric - debt level, autonomy, administrative tasks, financial compensation, total work hours. The only aspect that has improved is residency hours, and in a lot of fields this has traded off with increased training length through mandatory fellowships.

Rad onc is in the same boat , but the trend is magnified by the overtraining this same generation has sanctioned, longer time to retirement helped both by overtraining residents and abandoning a real re-recertification method in favor of continuous activities that don’t force or evaluate any level of competence, and Medicare targeting rad onc for large mandatory cuts, as well as indirectly the fact that oncology spending is considered one bucket and immunotherapy and Pharma will always effectively take more of that bucket from us due to their lobbying resources.

There is a lot of justified anger inter generationally in this and other countries because for the first time in a while it’s very clear the next generation will have it worse than the previous. In rad onc this is abundantly clear and no one in the generation before seems to have any care about this, and knowing the societal view of physicians in general no one will come defend us. So while some posts here seem over the top, like my own, what do you do when you realize you paid hundreds of thousands more for a more constrained in every aspect job than the person making the decision to expand residency slots to have 24/7 physician coverage? They will ride us into the ground to protect what they have, and expanding residencies and fake fellowships is the realization of that statement.

 

[Mandelin Rain]

I made 800K this year off professional. You can still make good money if you're in a high volume center.

I've collected that much and more in years past, though probably not since routinely hypofractionating everything. I've never taken home anything close to that though.

 

[XRT_doc]

I've collected that much and more in years past, though probably not since routinely hypofractionating everything. I've never taken home anything close to that though.

I'm hospital employed so luckily I have no overhead. What are your expenses?
The reason for my high income is because of my high volume. I see about ~8 consults a week. If it wasn't for flooding the market with radoncs we could all have that many patients under treatment and still make good money.

 

[Mandelin Rain]

Typical group management expenses. Billers, coders, manager, office space, health insurance for everyone, malpractice, retirement plans for everyone, consultants, analysts, marketing, recruitment, etc... etc... etc... We treat our employees very fairly so luckily we retain people. But it costs money at every turn. EDIT: I'm still doing fine

I'm surprised you got 100% Pro arrangement as an employed doc. Seems rare.

 

[XRT_doc]

Typical group management expenses. Billers, coders, manager, office space, health insurance for everyone, malpractice, retirement plans for everyone, consultants, analysts, marketing, recruitment, etc... etc... etc... We treat our employees very fairly so luckily we retain people. But it costs money at every turn. EDIT: I'm still doing fine

I'm surprised you got 100% Pro arrangement as an employed doc. Seems rare.

Just to be clear I don't get 100% professional, I get a certain $$$ per rvu (MGMA median). You have to pay for office space and managers w/ only a professional arrangement?

 

[thecarbonionangle]

Interesting. I have not seen a single hospital employed job with potential to make that much. Rural area?

these jobs pretty rare nowadays?

 

[XRT_doc]

Interesting. I have not seen a single hospital employed job with potential to make that much. Rural area?

these jobs pretty rare nowadays?

No, I'm in a major metro area w/ >3 million population. I'm not a new grad and unfortunately w/ the flooding the market these jobs are rare now.

 

[Mandelin Rain]

Just to be clear I don't get 100% professional, I get a certain $$$ per rvu (MGMA median). You have to pay for office space and managers w/ only a professional arrangement?

Larger group setup. We have staff, including a practice manager, not clinic manager.

 

[PhotonBomb]

Interesting. I have not seen a single hospital employed job with potential to make that much. Rural area?

these jobs pretty rare nowadays?

not common but I don't think that crazy rare. He has a productivity based salary and he works pretty hard

what people have to remember is that a LOT of groups these days are set up around quality of life. Norm is to work 4 days a week, etc etc etc. they hire people to not have to work that hard and they are okay making 500-600k.

This guy is not in that kind of group.

 

[Bequerel]

RVU based compensation can often times be more lucrative than professional only arrangements.

 

[Mandelin Rain]

RVU based compensation can often times be more lucrative than professional only arrangements.

Definitely. Pending payer mix and $/RVU negotiated.

 

[medgator]

I'm hospital employed so luckily I have no overhead. What are your expenses?
The reason for my high income is because of my high volume. I see about ~8 consults a week. If it wasn't for flooding the market with radoncs we could all have that many patients under treatment and still make good money.

That's a very nice contract. Pro fees would be less I think

 

[deleted18755]

If you talk to any older doc they will tell you about back in day. Talk to an old path, gi, cards, etc they used to make a KILLING. younger people would be SHOOK. They had to come for our field at some point

Oh yeah I don’t know about peds and of course cardiologists and gastroenteritis but even lowly pathologists and nephrologist used to make a ton of money with excellent lifestyles!

 

[Mandelin Rain]

That's a very nice contract. Pro fees would be less I think

Agreed. In years that I was collecting that much, I was seeing >>>8 consults per week.

 

[evilbooyaa]

I'm hospital employed so luckily I have no overhead. What are your expenses?
The reason for my high income is because of my high volume. I see about ~8 consults a week. If it wasn't for flooding the market with radoncs we could all have that many patients under treatment and still make good money.

8 consults a week gets you 800k? That's a great contract.

 

[medgator]

8 consults a week gets you 800k? That's a great contract.

Maybe he sees a lot of conventional prostate?

 

[Neuronix]

8 consults a week gets you 800k? That's a great contract.

I was seeing 8 consults a week until recently making $300-$350k including bonus. Call me jealous!

 

[XRT_doc]

I

I was seeing 8 consults a week until recently making $300-$350k including bonus. Call me jealous!

I honestly think you were underpaid. I calculated the average per patient and i make between 2-3k per patient and the majority are not prostates.

 

[Neuronix]

I honestly think you were underpaid. I calculated the average per patient and i make between 2-3k per patient and the majority are not prostates.

Oh I know I was. My $/RVU was pretty sad. I was above 9k wRVUs at that point to make 350k. There are guys here who push 12k-14k wRVUs to get up another 100k. Backing off to do more research but keep my salary roughly where it was is a great option for me because to kill myself clinically to make less than MGMA median was a painful prospect to me.

This is one of the many reasons why I don't exactly throw gasoline on the fire here on SDN, but I'm totally fine to let it burn.

 

[XRT_doc]

Oh I know I was. My $/RVU was pretty sad. I was above 9k wRVUs at that point to make 350k. There are guys here who push 12k-14k wRVUs to get up another 100k. Backing off to do more research but keep my salary roughly where it was is a great option for me because to kill myself clinically to make less than MGMA median was a painful prospect to me.

This is one of the many reasons why I don't exactly throw gasoline on the fire here on SDN, but I'm totally fine to let it burn.

It's tough to make above median salary in academics, unless of course you're the chairman who keeps adding residents.

 

[RadOncDoc21]

It's tough to make above median salary in academics, unless of course you're the chairman who keeps adding residents.

Now they can add fellows!

 

[scarbrtj]

Definitely knew rad oncs making >1 million in that 2003-2006 era, even without technical ownership. They would just have a portion of the global and the money would roll in. And yes, there was a lot of animosity.

During my internship (mind you, I'm dead broke at the time), I was on an anesthesia rotation and remember a pediatric ENT becoming disgusted with me for no reason other than I said I was going into rad onc. He started calling me "Buck a Rad". Probably repeated it 20 times as I sat there in stunned silence before he eventually asked me to leave. Literally couldn't stand being in my presence because I was presumably going to be making lots of money. Really funny in retrospect.

FWIW, he was putting in ear tubes while this was happening and had ear tube cases lined up in two ORs alternating every 15 minutes that day. Not sure how much tubes pay, but I'm guessing it ain't bad.

Residents from "Top 10" in that era literally laughed at starting job offers <$500K.

 

[medgator]

Oh I know I was. My $/RVU was pretty sad. I was above 9k wRVUs at that point to make 350k. There are guys here who push 12k-14k wRVUs to get up another 100k. Backing off to do more research but keep my salary roughly where it was is a great option for me because to kill myself clinically to make less than MGMA median was a painful prospect to me.

This is one of the many reasons why I don't exactly throw gasoline on the fire here on SDN, but I'm totally fine to let it burn.

I think I literally watched myself and a few buddies that finished a few years later in 2013-2014 grab the last few great jobs in RadOnc while the academics started torching this once great specialty with expansion. It was an awful thing to watch as I would be pissed if I had graduated 2015+. It's been getting worse every year through the grapevine and it clearly is the fault of the academics

I'm happy to bring my gas cans and burn it all down to start afresh.

This absolutely could continue to be an awesome field for those coming out with half the number of residents graduating per year.

Until then, burn, baby, burn

 

[Aphtalyfe]

I made 800K this year off professional. You can still make good money if you're in a high volume center.

Just to be clear I don't get 100% professional, I get a certain $$$ per rvu (MGMA median). You have to pay for office space and managers w/ only a professional arrangement?

If the normal RVU to dollar conversion is around $35... then you're doing 22k+ RVUs a year? That's pretty impressive. I don't think I'd want to work that hard... !

 

[Neuronix]

If the normal RVU to dollar conversion is around $35... then you're doing 22k+ RVUs a year? That's pretty impressive. I don't think I'd want to work that hard... !

MGMA median is $61/RVU (check out the private forum). To get to $800k would require 13,115 wRVUs. That's pretty busy but not unheard of. Of course XRT may be making more than $61/RVU as well.

Your results may vary. I have never been offered anywhere close to $60/RVU when I was looking in the past and I strongly considered non-academic.

 

[PhotonBomb]

I think I literally watched myself and a few buddies that finished a few years later in 2013-2014 grab the last few great jobs in RadOnc while the academics started torching this once great specialty with expansion. It was an awful thing to watch as I would be pissed if I had graduated 2015+. It's been getting worse every year through the grapevine and it clearly is the fault of the academics

I'm happy to bring my gas cans and burn it all down to start afresh.

This absolutely could continue to be an awesome field for those coming out with half the number of residents graduating per year.

Until then, burn, baby, burn

There are still many great jobs, dont be fooled. Lol at idea of no good jobs after 2014

Neuronix is a true academic, Whole diff ball game.

 

[XRT_doc]

If the normal RVU to dollar conversion is around $35... then you're doing 22k+ RVUs a year? That's pretty impressive. I don't think I'd want to work that hard... !

The median is $60/rvu not 35.

 

[medgator]

Neuronix is a true academic, Whole diff ball game.

That ball game has been getting bigger every year....

 

[PhotonBomb]

That ball game has been getting bigger every year....

true academic? not really

the general reach of academics sure, but not people doing science and writing grants like this neuronix cat

 

[thecarbonionangle]

There are jobs out there where you can make 500+ in midsized cities but i never saw 600+ in a large metro. These jobs must be pretty rare, unposted... or i just completely missed them lol

 

[medgator]

true academic? not really

the general reach of academics sure, but not people doing science and writing grants like this neuronix cat

More academic satellite gigs, less true private opportunities in desirable and semi desirable areas

 

[XRT_doc]

There are jobs out there where you can make 500+ in midsized cities but i never saw 600+ in a large metro. These jobs must be pretty rare, unposted... or i just completely missed them lol

This job was never posted. I got the job through connections from a previous job.

 

[scarbrtj]

Definitely knew rad oncs making >1 million in that 2003-2006 era, even without technical ownership. They would just have a portion of the global and the money would roll in. And yes, there was a lot of animosity.

During my internship (mind you, I'm dead broke at the time), I was on an anesthesia rotation and remember a pediatric ENT becoming disgusted with me for no reason other than I said I was going into rad onc. He started calling me "Buck a Rad". Probably repeated it 20 times as I sat there in stunned silence before he eventually asked me to leave. Literally couldn't stand being in my presence because I was presumably going to be making lots of money. Really funny in retrospect.

FWIW, he was putting in ear tubes while this was happening and had ear tube cases lined up in two ORs alternating every 15 minutes that day. Not sure how much tubes pay, but I'm guessing it ain't bad.

"It's a centigray" would have been a true l’esprit de l’escalier.