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

[XRT_doc]

I don’t see how comparing X fractions vs Y fractions is considered academic research. The research in our field has become more and more stupid.

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[medgator]

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

Used to be fairly common, but I still remember private groups posting on ASTRO fairly often in decent locales.

Now it is pretty much the only way the precious few good jobs that are out there will be found.

Fwiw, I was in the same boat for getting my current job... Word of mouth

 

[OTN]

Used to be fairly common, but I still remember private groups posting on ASTRO fairly often in decent locales.

Now it is pretty much the only way the precious few good jobs that are out there will be found.

Fwiw, I was in the same boat for getting my current job... Word of mouth

Got mine by word of mouth 10 years ago- former resident I worked with called me. Job was never posted. Radonc is a small field, so this happens a lot. Another reason small and new programs are at a disadvantage.

Also at a disadvantage are those who do not have parents in the field, to be blunt. There are a surprisingly large number of radiation oncologists who are the offspring of radoncs, though perhaps it is the same in other specialties as well. I wouldn’t know. Either way, it obviously makes it much easier to find a job, as your network includes that of your family as well.

 

[Becquerel]

Examining $ per RVU isn't the best metric IMO. It will tell you if your employer is making $$ off you, but not if you are paid fairly. The most obvious example is in academics where a lymphoma doc earning $80 per RVU could be grossly underpaid while a beam-only prostate doc earning $40 per RVU could be overpaid.

Same is true for pp. Imagine 2 practices: In practice A, you pound the pavement on nights and weekends so the referrings send you 9 consults a week, and then you sim 5 that are mostly 2D palliative or 3DCRT b/c payers decline IMRT and you generate 5K RVUs. In practice B, your employer spoon feeds cases onto your schedule, you see 4-5 consults per week that are 75% prostate, convert them all to IMRT, take Fridays off and generate 11K RVUs. If each of these jobs offered the same comp, I'd take the second one despite a $$ per RVU that is much lower.

Also, I'd say that 13K RVUs is relatively standard for a moderately busy pp doc. If you're in Southern Cali or Southern FL where commercial payers are lousy then you're not doing great, but in a good geography with good commercial payers that would translate to 800K prof collections.

 

[medgator]

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.

RadOnc's version of the housing bubble and subprime. Happened right around the same time too! There was a company called oncure that overpaid for a bunch of mediocre practices around the country, mainly FL and cali and they went bankrupt and were eventually taken over by 21C which then went bankrupt and well you get the idea

https://www.bizjournals.com/tampabay/news/2013/10/29/bradenton-cancer-centers-acquired-by.html

Radiation Therapy Services Signs Agreement to Acquire OnCure Holdings, Inc.

FORT MYERS, Fla., June 24, 2013 (GLOBE NEWSWIRE) -- Radiation Therapy Services Holdings, Inc. (

www.globenewswire.com

The folks that sold to oncure, 21C, vantage etc made the real killing pre 2008. Many of them continued to hold ownership of the buildings and land, like DD, which could easily produce six to seven figures of income/year.

21st Century Oncology facing continued legal troubles as it tries to put troubled past behind it

The company is facing a fresh round of lawsuits from former executives as it struggles to rebuild after emerging from bankruptcy last year.

www.news-press.com

I guarantee no one on this forum probably saw that kind of money, and likely no one ever will again.

Maybe @elementaryschooleconomics can add a chapter regarding Private equity takeovers into his compendium of RadOnc the last few decades

 

[metview]

I think the same can be said of other specialties as well. I remember opthos making huge bucks in the late 90s/early 2000s, with salaries > 1mil not being out of the norm. I think that has at least dropped by 30% now. It seems like the same has happened to rad onc, with salaries in the high 700s now being in the mid 500s for PP.

 

[elementaryschooleconomics]

I think the same can be said of other specialties as well. I remember opthos making huge bucks in the late 90s/early 2000s, with salaries > 1mil not being out of the norm. I think that has at least dropped by 30% now. It seems like the same has happened to rad onc, with salaries in the high 700s now being in the mid 500s for PP.

I wonder if there's data on average RadOnc salaries in the 70s/80s/90s. Maybe when I duck off from my family during the holidays I'll look into it.

I suspect the difference between RadOnc and other specialties was the sudden change. "Back in the day" medicine was generally far more lucrative than it is now - see: House of God, "the GI workup". I have no idea what RadOnc compensation was like in the 90s, but it probably rapidly increased with the introduction of IMRT.

I've been thinking about what @scarbrtj said in the other IMRT thread - that there's no analogy to IMRT in the rest of medicine. The closest I can come up with is outside of medicine and cell phones. IMRT was the iPhone of Radiation Oncology.

 

[PhotonBomb]

Rad onc was still competitive in late 90s based on the stats posted few days ago. It must have been still seen as appealing for some reason even before IMRT

 

[radiaterMike]

are you saying DD is not lurking around here and posting ?

I guarantee no one on this forum probably saw that kind of money, and likely no one ever will again.

 

[medgator]

are you saying DD is not lurking around here and posting ?

Touche. My guess is not, but you know what they say when you assume...

 

[medgator]

Rad onc was still competitive in late 90s based on the stats posted few days ago. It must have been still seen as appealing for some reason even before IMRT

Market picked up a bit as spots were trimmed?

 

[Mandelin Rain]

are you saying DD is not lurking around here and posting ?

Too many ongoing lawsuits to log on.

 

[Burt Radnolds]

I've been thinking about what @scarbrtj said in the other IMRT thread - that there's no analogy to IMRT in the rest of medicine. The closest I can come up with is outside of medicine and cell phones. IMRT was the iPhone of Radiation Oncology.

Endoscopy and gastroenterology?

 

[w00tz]

These stories from the 2000s seem so mythical. I'm guessing the rad oncs back then were also popping Quaaludes and driving Lambos

 

[Mandelin Rain]

These stories from the 2000s seem so mythical. I'm guessing the rad oncs back then were also popping Quaaludes and driving Lambos

Never having experienced the former, I can still assure you that 1 million dollars in 2004 was sooooooooooooooo much different than 500k in 2019.

 

[thecarbonionangle]

Never having experienced the former, I can still assure you that 1 million dollars in 2004 was sooooooooooooooo much different than 500k in 2019.

seems like making 500+ with decent QOL is the general ceiling for most now, obviously exceptions but talking average here

 

[PhotonBomb]

seems like making 500+ with decent QOL is the general ceiling for most now, obviously exceptions but talking average here

this is what most rad oncs should expect entering PP (not starting of course but after few years).

if you set expectations here, you should be ok.

 

[Mandelin Rain]

this is what most rad oncs should expect entering PP (not starting of course but after few years).

if you set expectations here, you should be ok.

I think this is pretty fair at this moment. There are threats to this everywhere though. Obviously PP jobs continue to disappear particularly in desirable metros. Reimbursement under target (despite stay of APM which is excellent). Over supply of residents means negotiating power lower and lower.

This is the current snapshop in time. The trendline is obviously downward though. In 5 years, I suspect 500k PP jobs will be like yetis or bigfoots.

 

[thecarbonionangle]

Anybody right now who has a contract in a tolerable place with potential to 500+k within the 5 year mark should sign and never look back.

 

[evilbooyaa]

Got mine by word of mouth 10 years ago- former resident I worked with called me. Job was never posted. Radonc is a small field, so this happens a lot. Another reason small and new programs are at a disadvantage.

Also at a disadvantage are those who do not have parents in the field, to be blunt. There are a surprisingly large number of radiation oncologists who are the offspring of radoncs, though perhaps it is the same in other specialties as well. I wouldn’t know. Either way, it obviously makes it much easier to find a job, as your network includes that of your family as well.

I have been blown away by how much pedigree there is in regards to kids or siblings of radiation oncologists becoming radiation oncologists. Out of a small field there are at least 10-15 I am aware of, with the understanding that there are likely at least 10x that number nationwide.

Not going to complain about nepotism, but having your fathers/mother's network certainly can't hurt as you look to find a job.

 

[evilbooyaa]

I guarantee no one on this forum probably saw that kind of money, and likely no one ever will again.

Maybe @elementaryschooleconomics can add a chapter regarding Private equity takeovers into his compendium of RadOnc the last few decades

I will say that Private Equity takeovers are commonplace throughout medicine, and this, specifically, is not a Rad Onc-unique issue. Check out the EM, Derm, or Path forums for more information on the issues of private equity or 'management' companies.

 

[medgator]

I will say that Private Equity takeovers are commonplace throughout medicine, and this, specifically, is not a Rad Onc-unique issue. Check out the EM, Derm, or Path forums for more information on the issues of private equity or 'management' companies.

Yeah, but I bet the valuations were much higher in RO for practice owners, based on sky high imrt reimbursement in the years leading up to those buyouts.

 

[DrRealistic]

I will never understand. Even if docs charged 1000 for each fraction that would still make them underpaid. Yet, here you are talking about getting swatted by FBI and whatnot. When a random NFL guy gets a sign-on bonus of 15 million USD (10-20 times greater the entire cumulative income of a physician in his/her career) thats' not frowned upon but when somebody who has gone through the most arduous path and is said to charge 1k/fraction things get suspicious.

 

[PhotonBomb]

I will never understand. Even if docs charged 1000 for each fraction that would still make them underpaid. Yet, here you are talking about getting swatted by FBI and whatnot. When a random NFL guy gets a sign-on bonus of 15 million USD (10-20 times greater the entire cumulative income of a physician in his/her career) thats' not frowned upon but when somebody who has gone through the most arduous path and is said to charge 1k/fraction things get suspicious.

Put the bottle down, son.

 

[medgator]

I will never understand. Even if docs charged 1000 for each fraction that would still make them underpaid. Yet, here you are talking about getting swatted by FBI and whatnot. When a random NFL guy gets a sign-on bonus of 15 million USD (10-20 times greater the entire cumulative income of a physician in his/her career) thats' not frowned upon but when somebody who has gone through the most arduous path and is said to charge 1k/fraction things get suspicious.

Analogy fail: my FICA taxes aren't going to pay that NFL player's salary.

 

[Gfunk6]

I will never understand. Even if docs charged 1000 for each fraction that would still make them underpaid. Yet, here you are talking about getting swatted by FBI and whatnot. When a random NFL guy gets a sign-on bonus of 15 million USD (10-20 times greater the entire cumulative income of a physician in his/her career) thats' not frowned upon but when somebody who has gone through the most arduous path and is said to charge 1k/fraction things get suspicious.

The Fallacy of Comparable Worth | Peter S. Heinecke

fee.org

 

[thecarbonionangle]

I will never understand. Even if docs charged 1000 for each fraction that would still make them underpaid. Yet, here you are talking about getting swatted by FBI and whatnot. When a random NFL guy gets a sign-on bonus of 15 million USD (10-20 times greater the entire cumulative income of a physician in his/her career) thats' not frowned upon but when somebody who has gone through the most arduous path and is said to charge 1k/fraction things get suspicious.

if i went to my future employer and demanded a sign on bonus in millions, what do you think they would say? Would they laugh at my face? Would they put put their hand on my back condescendingly or just agree? I mean im pretty shifty between the consults like a good running back. i also have very good hands to draw circles. Some of us may be out of a job and on breadlines not because of CTE, but chronic residency expansion (CRE), so you do have a good point, we are similar and different to NFL

 

[PhotonBomb]

I drafted thecarbonionangle in the second round last year

total bust!

 

[RadOncDoc21]

I drafted thecarbonionangle in the second round last year

total bust!

I’m tanking this year to get a good proton fellow but may just settle for a PA to watch over the clinic while I’m out.

 

[PhotonBomb]

Gotta get a high volume GU guy/gal to really get that spread offense going

 

[elementaryschooleconomics]

Gotta get a high volume GU guy/gal to really get that spread offense going

I use SpaceOAR for man coverage