Charting Outcomes 2022 - Rad Onc

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Mandelin Rain said:
Not responding to anyone in particular but I don’t love seeing my colleagues trying to convince themselves that decreasing salaries in a moment of record inflation as anything but a horrifying problem.

Sure, we have food on the table. Sure, others in the world have it far worse. But if we can’t even admit it’s a problem to each other, who else is going to care?

If you can’t think of what you’d do with an extra 100k that may make you happier, feel free to Venmo me. I have a vivid imagination. I’ll have enough fun for the both of us.
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Things certainly aren’t going in the right direction in our field… the trend line is negative (p<0.001). Best I can tell, there are three ways to improve the job market 1) decrease supply of rad oncs (discussed ad infinitum here), 2) increase the indications for RT, 3) increase the value of the treatments we perform.

2) and 3) require good old-fashioned research… using old technologies to treat new problems and new technologies to treat old problems.

SDN led the way in pointing out the problem… but now that everyone knows, is there a point to continuing to kick the dirt? They aren’t going to pay us more just because they used to pay us more.

Rather than helping cheer on development in our field, SDN seems to mock any small advances into 2) or 3)… because nothing will ever compare to IMRT in the 2000s. Where I work, we are working on some pretty cool stuff… things that have a small chance of making things better, and it’s exciting.

So… I am grateful for my job and have just a glimmer of optimism about the future. Would it somehow be better for our field if I were neither grateful nor optimistic?
 
Lamount said:
Things certainly aren’t going in the right direction in our field… the trend line is negative (p<0.001). Best I can tell, there are three ways to improve the job market 1) decrease supply of rad oncs (discussed ad infinitum here), 2) increase the indications for RT, 3) increase the value of the treatments we perform.

2) and 3) require good old-fashioned research… using old technologies to treat new problems and new technologies to treat old problems.

SDN led the way in pointing out the problem… but now that everyone knows, is there a point to continuing to kick the dirt? They aren’t going to pay us more just because they used to pay us more.

Rather than helping cheer on development in our field, SDN seems to mock any small advances into 2) or 3)… because nothing will ever compare to IMRT in the 2000s. Where I work, we are working on some pretty cool stuff… things that have a small chance of making things better, and it’s exciting.

So… I am grateful for my job and have just a glimmer of optimism about the future. Would it somehow be better for our field if I were neither grateful nor optimistic?
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number 3 if you define value as price/reimbursement, this has occurred defacto at price gouging large systems, but fundamentally it should not improve the job market, although I am convinced that certain centers purposely over-hire/over-expand (upenn puts satellites right next to each other) to "flush every single bird out of the bushes."

number 2- the base reality very well may be that substantially more oncological indications for radiation just dont exist and no amount of effort/talent/research can change this. I actually would guess this is the case. I certainly see a much clearer path to decreasing the indications for radiation. .ie I would be shocked if we arent radiating less breast ca in 10-15 years.

The real value of SDN is that it helps save medstudents from this field.
 
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Lamount said:
So… I am grateful for my job and have just a glimmer of optimism about the future. Would it somehow be better for our field if I were neither grateful nor optimistic?
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No way. We absolutely need folks like you in the field. We just need folks like you doing meaningful new tool/physics research at like one of ten centers nationally. (Why I estimated roughly 10-20 new candidates nationally each year for residency positions who had a reasonable chance of pursuing hard core physics based clinical research).

What we don't need is ripping smart, physics oriented residents getting jobs using a standard linac at a satellite without enough time to think hard about problems or working at a procure center giving protons to prostates.

Thanks for what you do.
 
Moonbeams said:
Just got offered 1900/day for locums in Kearney (rural Nebraska). I think I have a pretty good idea of why they have been advertising that job for 4 years at this point.

Other specialties are getting 5000/day in these places. On the anesthesia forum they are talking about 24 hour shift rates up to 10k.

What a joke.
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This might be an extreme example. I just had dinner with a med onc who told me the rates are more commonly like 2-4K a day in rural places, but this includes call, inpatient, and longer hours of infusion center coverage. This is still higher than RadOnc, but Im doing locums right now for 2000 a day... but an 8 hour day, not a 24 hour day. And it's an easy day. So to me that "scales" to almost 10,000 for 24 hours (that I would not do).

If a place is struggling to find coverage and they are offering you 1900, ask for 2400. I never even thought to negotiate, but it was recommended to me by the company middle man! You can feel very good negotiating especially if this is a job you can do on a recurring basis and they like you. I will be doing that next time.

Im no economist, but these seem like basic market forces on a local scale. If the local Rad Onc is pissed s/he can't take a vacation, the hospital is struggling to find coverage, and you're the only one that will offer it... sounds like you are in a pretty strong position to ask for a (IMO) more reasonable rate than 1900.

I'm on board with complaining about the overall market, but certainly you can get a much better deal locally in many circumstances.

Note: just thoughts based on my very narrow experience doing some repeat locums for a single clinic.
 
Lamount said:
but now that everyone knows, is there a point to continuing to kick the dirt?
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Isn’t fei fei liu in her institutional rad onc leadership role pushing misinformation to medical students & deans that our job market for the foreseeable future is incredibly healthy?

Even the money lizards at the Fed respond to supply & demand by actually doing something, as opposed to just telling people to stop complaining about inflation. Everyone knows it’s a problem!
 
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NotMattSpraker said:
This might be an extreme example. I just had dinner with a med onc who told me the rates are more commonly like 2-4K a day in rural places, but this includes call, inpatient, and longer hours of infusion center coverage. This is still higher than RadOnc, but Im doing locums right now for 2000 a day... but an 8 hour day, not a 24 hour day. And it's an easy day. So to me that "scales" to almost 10,000 for 24 hours (that I would not do).

If a place is struggling to find coverage and they are offering you 1900, ask for 2400. I never even thought to negotiate, but it was recommended to me by the company middle man! You can feel very good negotiating especially if this is a job you can do on a recurring basis and they like you. I will be doing that next time.

Im no economist, but these seem like basic market forces on a local scale. If the local Rad Onc is pissed s/he can't take a vacation, the hospital is struggling to find coverage, and you're the only one that will offer it... sounds like you are in a pretty strong position to ask for a (IMO) more reasonable rate than 1900.

I'm on board with complaining about the overall market, but certainly you can get a much better deal locally in many circumstances.

Note: just thoughts based on my very narrow experience doing some repeat locums for a single clinic.
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My vacation coverage locums was paid 2500/day + expenses. This is the correct rate for a very rural place with single rad onc like Kearney that's going to involve actually managing the clinic, and it's what I have been paid when I did rural coverage in the past. At least the 1600 number these places used to offer has moved up slightly. The problem is that these places WILL usually be able to fill at these rates with octolocums. You can bid 2400, but if there is an available octolocums they will go as low as it takes to get it. I swear these people would work for a gift certificate to the Golden Corral if it gave them something to do for the day.

Also, if I had the option of working 24 hours in a row for 10k, you can bet that I would not be leaving that hospital and pumped full of near lethal levels of caffeine. Not an option for us, not even picking up extra shifts on weekends or nights like other specialties can.
 
Moonbeams said:
My vacation coverage locums was paid 2500/day + expenses. This is the correct rate for a very rural place with single rad onc like Kearney that's going to involve actually managing the clinic, and it's what I have been paid when I did rural coverage in the past. At least the 1600 number these places used to offer has moved up slightly. The problem is that these places WILL usually be able to fill at these rates with octolocums. You can bid 2400, but if there is an available octolocums they will go as low as it takes to get it. I swear these people would work for a gift certificate to the Golden Corral if it gave them something to do for the day.

Also, if I had the option of working 24 hours in a row for 10k, you can bet that I would not be leaving that hospital and pumped full of near lethal levels of caffeine. Not an option for us, not even picking up extra shifts on weekends or nights like other specialties can.
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Thats cool, that just hasn't been my experience at all, again limited to this one center. I was told this person moved their vacation to the dates I could cover. Missouri is the show-me state but I guess no one wants to see. Understandable, Im not sticking around, I dont want to see any more either 🙂

Ill be asking for $2500 next time! Expenses should always be covered!
 
The thing that people need to remember when tbis topic comes up is that Med onc coverage is NOTHING like rad onc Linac babysitting
 
jondunn said:
The thing that people need to remember when tbis topic comes up is that Med onc coverage is NOTHING like rad onc Linac babysitting
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From your posts, I sometimes wonder if you are hospital admin.

Med onc and other specialties get paid more for locums because of supply and demand, not because they have to work harder. If you overnight cut the rad onc locums pool by 75%, I promise you we would be making that much too, even if all we have to do is see a few OTVs and sign off on imaging.
 
Moonbeams said:
From your posts, I sometimes wonder if you are hospital admin.

Med onc and other specialties get paid more for locums because of supply and demand, not because they have to work harder. If you overnight cut the rad onc locums pool by 75%, I promise you we would be making that much too, even if all we have to do is see a few OTVs and sign off on imaging.
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its not simple supply and demand. a bit more complicated than that. the fact is that when a med onc is covering, they are generating more revenue. most/many times for rad onc its not.

encourage you to start to think
 
jondunn said:
its not simple supply and demand. a bit more complicated than that. the fact is that when a med onc is covering, they are generating more revenue. most/many times for rad onc its not.

encourage you to start to think
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Even if physicians were paid based on "difficulty", which is subjective, I would still disagree. This is also a crazy general statement haha come on.
 
when medgator is out, he is paying someone to babysit his linac.

hospitals that are paying for a locum med onc are paying for someone to see patients, treat patients,manage patients - to be their med onc! just not a permanet one.

its not the same.

also rad onc locums are largely old people that have no business practicing modern medicine but can certainly sit in an office. the supply demand dynamics are totally different
 
jondunn said:
its not simple supply and demand. a bit more complicated than that. the fact is that when a med onc is covering, they are generating more revenue. most/many times for rad onc its not.

encourage you to start to think
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It sounds like you are arguing that med onc locums generate more revenue when they are there as opposed to the full-time med onc. Not that that makes any sense. So when a locums covers a rad onc clinic for a week, are you arguing that if they just babysit and don't do sims or see consults that those consults just go to a competing center and those charges aren't captured the next week? That locums is resulting in a loss of capturing volume? I mean, no matter how you interpret this, it doesn't make any sense. Rad onc not generating revenue with a covering doc? OK.

That stupid LINAC, such a giant hole of a cost center for the hospital. Unlike all that slam packed heme follow-up clinic.

Sorry if you don't think rad onc locums is worth $2500/day. Good news is there are plentiful $1600/day jobs out there that will allow you to sleep at night without worrying about ripping off the hospital if that is a concern to you.
 
As always: these things are very situation dependent.

I'm sure there are plenty of infusion babysitting/be available for urgent consults or side effects type med onc locums jobs as well.
 
CurbYourExpectations said:
I think s/he is saying that MedOncs are covering multiple medical issues and doing inpatient stuff, when RadOnc is covering they are referring these things
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The point is that rad onc generates an enormous amount of revenue from technical fees for the treatments, and a rad onc is needed on site in order to deliver these treatments. It's not like the only qualification is someone who can sit there with a pulse, as that would be a minimum wage job. The reason locums rate are often so disconnected from the profit made on the treatments is an oversupply of locums. It's that simple. Also, there are plenty of locums that staff for weeks/months and do everything. Even the guys who only cover for a few days, admin will often still force them to see consults and do sims/plans anyway (happened all the time when I was out despite my protests). This is the way admin thinks. They "want their moneys worth" even though they will get the money regardless if the locums does the work or the full-time guy does it when he gets back from the beach. JD is trolling.
 
CurbYourExpectations said:
Money is probably great, never had it. Do you think RadOnc is doing harder work at locums than MedOnc?
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I know some freestanding places that just have them cover infusions for a few days... New patients wait till the doc comes back. Not sure that's any worse than RO, esp when the larger groups are already creating onc hospitalist positions or a call schedule where the locums isn't participating
 
medgator said:
I know some freestanding places that just have them cover infusions for a few days... New patients wait till the doc comes back. Not sure that's any worse than RO, esp when the larger groups are already creating onc hospitalist positions or a call schedule where the locums isn't participating
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I have had to cover infusions myself before, so I have technically done med onc locums. Worked my butt off!
 
CurbYourExpectations said:
Guys/gals, if the consensus is JD is the one trolling... what is happening here? Am I living in crazy town?
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He didn't earn that "probationary status" for nothing. Give the guy a little credit here. @Moonbeams nailed it.. that's why rad onc locums are more plentiful this year and day rates are up... Supply and demand.

A year or two ago we were all getting emails from comphealth and WeatherBy trying to pimp out available board certified locums and what states they were ready to provide coverage in, now it is a complete 180 and day rates have gone up

It's not like rad onc work suddenly got easier or harder to do in the last 1-2 years which is a pretty absurd lens to view it through
 
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CurbYourExpectations said:
Money is probably great, never had it. Do you think RadOnc is doing harder work at locums than MedOnc?
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"Hardness" of work is essentially meaningless for salary in any field of life. Steph Curry can make 500k playing 36 minutes of basketball, while a ditchdigger wouldn't see that in 15 years. Supply and demand is what matters. A lot more backs that can use a shovel than dudes who can shoot like Steph.

I've seen plenty of rad onc locums jobs listed with expectations that go far beyond, "pick your nose for 7 hours". Obviously, in any longer term gig, you're going to have to see and start new patients, whereas in very short term gigs (<1 week) much of that can be deferred to the main doc. I doubt it's much different in the med onc world. I can't see a guy flying in for 3 days to provide Christmas coverage dropping BMT orders.
 
Mandelin Rain said:
I've seen plenty of rad onc locums jobs listed with expectations that go far beyond, "pick your nose for 7 hours". Obviously, in any longer term gig, you're going to have to see and start new patients, whereas in very short term gigs (<1 week) much of that can be deferred to the main doc. I doubt it's much different in the med onc world. I can't see a guy flying in for 3 days to provide Christmas coverage dropping BMT orders.
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Likewise... Some require inpt/hospital privs, some have no call, some require brachy etc etc, obviously they are going to pay the guy doing brachy with inpatient responsibilities a different than the guy picking his nose checking igrts at the end of the day
 
CurbYourExpectations said:
Guys/gals, if the consensus is JD is the one trolling... what is happening here? Am I living in crazy town?
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I post something totally crazy like we are all valuable and locums rates are driven by supply and demand, not the perceived difficulty of the work, and JD literally told me I needed to think and then tried to doxx medgator's twitter (is he even MROGA?), and suddenly we are all crapping on JD. Yep, crazy town.
 
medgator said:
Likewise... Some require inpt/hospital privs, some have no call, some require brachy etc etc, obviously they are going to pay the guy doing brachy with inpatient responsibilities a different than the guy picking his nose checking igrts at the end of the day
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Sometimes those boogers can get lodged back there. I try to at least get it out before it becomes my lunch!
 
CurbYourExpectations said:
Not the hugest fan of the SDN RO narrative being that people aren't making 500k in major metros and not making 1 mil in the outskirts. Especially when people want to crap on residents and other attendings. I would prefer not to comment about some of the outrageous comments on here and talk about constructive things.
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Preach
 
RickyScott said:
number 3 if you define value as price/reimbursement, this has occurred defacto at price gouging large systems, but fundamentally it should not improve the job market, although I am convinced that certain centers purposely over-hire/over-expand (upenn puts satellites right next to each other) to "flush every single bird out of the bushes."

number 2- the base reality very well may be that substantially more oncological indications for radiation just dont exist and no amount of effort/talent/research can change this. I actually would guess this is the case. I certainly see a much clearer path to decreasing the indications for radiation. .ie I would be shocked if we arent radiating less breast ca in 10-15 years.

The real value of SDN is that it helps save medstudents from this field.
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I see the logic in your argument…

…but I wonder whether radiation may start to have a bigger role in metastatic disease. I find myself playing “goalie” with stage IV patients, trying to keep the cancer away from airways. Metastatic cancer tends to kill people in a limited number of ways (e.g. CNS death, airway obstruction/PNA, GI obstruction, general FTT). As systemic therapy has gotten better and disease spread takes longer, I am getting asked more and more to see people to stave off these fatal modes of progression.

EDIT obviously RT can’t do anything for FTT

Another growing indication I am seeing is for these folks with long-term metastatic ca who are getting worn out on TKIs or IO who have just one or two sites of persistent disease and the pt/med onc are looking for justification to take a break from systemic therapy.

These are hard things to test in RCTs, but that’s where I see our field going… non-invasive cytoreduction.
 
Lamount said:
I see the logic in your argument…

…but I wonder whether radiation may start to have a bigger role in metastatic disease. I find myself playing “goalie” with stage IV patients, trying to keep the cancer away from airways. Metastatic cancer tends to kill people in a limited number of ways (e.g. CNS death, airway obstruction/PNA, GI obstruction, general FTT). As systemic therapy has gotten better and disease spread takes longer, I am getting asked more and more to see people to stave off these fatal modes of progression.

EDIT obviously RT can’t do anything for FTT

Another growing indication I am seeing is for these folks with long-term metastatic ca who are getting worn out on TKIs or IO who have just one or two sites of persistent disease and the pt/med onc are looking for justification to take a break from systemic therapy.

These are hard things to test in RCTs, but that’s where I see our field going… non-invasive cytoreduction.
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Even if it could it won't be enough to make a living off of and the fact of the matter is there's a new drug(s) born every year just itching to remove another RT indication. The options here are get out now, combine with med-onc, or die.
 
Lamount said:
I see the logic in your argument…

…but I wonder whether radiation may start to have a bigger role in metastatic disease. I find myself playing “goalie” with stage IV patients, trying to keep the cancer away from airways. Metastatic cancer tends to kill people in a limited number of ways (e.g. CNS death, airway obstruction/PNA, GI obstruction, general FTT). As systemic therapy has gotten better and disease spread takes longer, I am getting asked more and more to see people to stave off these fatal modes of progression.

EDIT obviously RT can’t do anything for FTT

Another growing indication I am seeing is for these folks with long-term metastatic ca who are getting worn out on TKIs or IO who have just one or two sites of persistent disease and the pt/med onc are looking for justification to take a break from systemic therapy.

These are hard things to test in RCTs, but that’s where I see our field going… non-invasive cytoreduction.
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I have had referrals from med onc for this scenario and the clearinghouses have routinely denied.
 
Fpg1245 said:
Even if it could it won't be enough to make a living off of and the fact of the matter is there's a new drug(s) born every year just itching to remove another RT indication. The options here are get out now, combine with med-onc, or die.
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You should write children’s books!

All joking aside, you are falling into the same trap that led many to think the sky was the limit in the era of IMRT… you are assuming the first derivative is sufficient to predict the future of a higher-order polynomial.

Certainty is silly, regardless of whether you are optimist or a pessimist
 
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madchemist89 said:
I have had referrals from med onc for this scenario and the clearinghouses have routinely denied.
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There are some games that can played, depending on what’s nearby. happy to talk through strategies in private forum
 
Lamount said:
You should write children’s books!

All joking aside, you are falling into the same trap that led many to think the sky was the limit in the era of IMRT… you are assuming the first derivative is sufficient to predict the future of a higher-order polynomial.

Certainty is silly, regardless of whether you are optimist or a pessimist
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You don’t need a course in calculus to know where RO is going. You really don’t. Small field. Largely confined to cancer and a shrinking foot print overall. No one is doing anything innovative anyway and these no money out there to really push it forward.
 
Fpg1245 said:
You don’t need a course in calculus to know where RO is going. You really don’t. Small field. Largely confined to cancer and a shrinking foot print overall. No one is doing anything innovative anyway and these no money out there to really push it forward.
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You can always fall back on PHD and go to industry?
 
Fpg1245 said:
You don’t need a course in calculus to know where RO is going. You really don’t. Small field. Largely confined to cancer and a shrinking foot print overall. No one is doing anything innovative anyway and these no money out there to really push it forward.
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If you have watched the management of cancer in the past two decades evolve, and have walked away thinking you are sure you know what is coming next… I would love to hear your input on the options market.
 
Lamount said:
If you have watched the management of cancer in the past two decades evolve, and have walked away thinking you are sure you know what is coming next… I would love to hear your input on the options market.
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Oh I’ll be waiting with bells on waiting for that new indication the reinvigorates RO…ha!
 
Fpg1245 said:
Oh I’ll be waiting with bells on waiting for that new indication the reinvigorates RO…ha!
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It’s an easy perspective to hold… you’re either right or you’re happy… right? Professional level hedging!

Maybe you do have a good perspective on the options market after all 🤔
 
Lamount said:
It’s an easy perspective to hold… you’re either right or you’re happy… right? Professional level hedging!

Maybe you do have a good perspective on the options market after all 🤔
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The difference is I make money with options…the same can’t be said for radiation
 
CurbYourExpectations said:
Not the hugest fan of the SDN RO narrative being that people aren't making 500k in major metros and not making 1 mil in the outskirts.
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I don't think that this has to be taboo.

Scarb has posted the data multiple times that we have been subject to the largest decrease in reimbursement in medicine over the past couple decades. That sucks. That's a problem for us as radiation oncologists. Still, there is an imminent threat in the form of APM to further, dramatically reduce reimbursement while fundamentally changing the way we bill for services. ASTRO has been impotent to stop any of it.

If most people here are being honest with themselves, they choose this specialty based on these three things with varying degrees of importance:
1. It's a pretty cool job.
2. High salary when applied (500k-1 million the norm when I applied)
3. Great lifestyle for above salary

Now, the salary is dropping or the lifestyle is worsening to maintain salary. Personally, I also think that the "coolness" of the job (as defined by me) has dropped as we become closer and closer to 1-5 fraction technicians. Though, I can see how others think that's even more cool.

Regardless, 1 of the main draws of this specialty is plunging. I have no doubt that this has impacted med student decisions much more than the misanthropes here.
 
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Mandelin Rain said:
Regardless, 1 of the main draws of this specialty is plunging. I have no doubt that this has impacted med student decisions much more than the misanthropes here.
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agree with most of your post - but I think this part is untrue.

SDN IS the source of the opinion shift. We can be aloof and think that students have ways of finding out info about this stuff but how would they? SDN is the ground truth. Back when we applied, we looked at SDN and it was all positive so it added to the desire that rad onc was the secret grift and would be all that and a can of whipped cream.

there is no point denying it - the goal of the discussion here IS to inform anyone reading what we feel. This of course, and by design, has had the major impact on medical student opinion of the field.
 
Mandelin Rain said:
I bet if new grads were still being offered 850k in Chilicothe, med students would look past the musings on this website.
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.... there wouldnt be postings on this page if everything was great.

also - there absolutely are 800k jobs to new grads in the boonies available. you know this.

most importantly - how the F would med studeents know about specific salaries for specific jobs?

not sure why there is this weird sentiment to deny the CLEAR role SDN plays?
 
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