Compensation:Work ratio. Highest in oncology out of all specialties?

[GrassrootMaltan]

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Years of self-reflection and deliberation have brought me to this postulation. The compensation:work ratio is the highest or probably one of the highest in oncology. Yes, neurosurgery, interventional cardiology, and cardiothoracic surgery pay well, but the amount of work and grind and middle-of-the-night calls are stressful. Yes, endocrinology, rheumatology and allergy/immunology have good lifestyle with minimal emergencies, but the pay is relatively on the lower side. This is the case for most specialties. Except for oncology. Does this resonate with you? Isn’t this true? What do you feel about this?

 

[MifflinDunder]

I don’t think any of those specialties ever had to spend 4-5 hours the evening before getting ready for clinic the next day.

 

[gutonc]

Years of self-reflection and deliberation have brought me to this postulation. The compensation:work ratio is the highest or probably one of the highest in oncology. Yes, neurosurgery, interventional cardiology, and cardiothoracic surgery pay well, but the amount of work and grind and middle-of-the-night calls are stressful. Yes, endocrinology, rheumatology and allergy/immunology have good lifestyle with minimal emergencies, but the pay is relatively on the lower side. This is the case for most specialties. Except for oncology. Does this resonate with you? Isn’t this true? What do you feel about this?

We're oncologists. How do you think we feel about this?

Also, why did it take you years of self-reflection and deliberation?10 minutes with any physician salary report you can find on the internet will tell you this information.

 

[HemeOncHopeful19]

First off we all work hard including our colleagues in other specialties and I think the whole premise is pretty dumb.

That being said… in 30 seconds off the top of my head

Gastroenterology
Derm
Rad Onc (despite what their forum will claim I am still waiting on MGMA to list them lower than us)
Ophtho
Orthodontics

/end thread

But yeah if you’re asking “hey does it maybe kinda suck to be a Neurosurgeon even with all the $$” I’d say l do agree I suspect I’d be miserable

 

[MD46]

I don’t think any of those specialties ever had to spend 4-5 hours the evening before getting ready for clinic the next day.

How many patients are you seeing every day as an Oncologist to spend 4-5 hrs every night prepping for clinic?

 

[MifflinDunder]

How many patients are you seeing every day as an Oncologist to spend 4-5 hrs every night prepping for clinic?

That’s what @GrassrootMaltan was doing before.

 

[GrassrootMaltan]

That’s what @GrassrootMaltan was doing before.

For a Maltan experiencing life in the grassroots, it does take 4-5 hours. Your mileage may vary, though.

 

[GrassrootMaltan]

First off we all work hard including our colleagues in other specialties and I think the whole premise is pretty dumb.

That being said… in 30 seconds off the top of my head

Gastroenterology
Derm
Rad Onc (despite what their forum will claim I am still waiting on MGMA to list them lower than us)
Ophtho
Orthodontics

/end thread

But yeah if you’re asking “hey does it maybe kinda suck to be a Neurosurgeon even with all the $$” I’d say l do agree I suspect I’d be miserable

I agree with this premise.

 

[GrassrootMaltan]

We're oncologists. How do you think we feel about this?

Also, why did it take you years of self-reflection and deliberation?10 minutes with any physician salary report you can find on the internet will tell you this information.

I agree with this about most things in life. But sometimes, some things are nuanced, and it might be better to deliberate and self-reflect for years than to arrive at a hasty conclusion. So I was just giving myself the benefit of time.

 

[MifflinDunder]

For a Maltan experiencing life in the grassroots, it does take 4-5 hours. Your mileage may vary, though.

We should probably consider the total hours of work (vs scheduled hours of work) when considering such questions.

 

[HemeOncHopeful19]

Thought about this again today, I’d say Med Onc more than any other field in Medicine constantly requires you to keep up with the latest studies etc. on a whole other level than GI or Cards etc. which isn’t reflected in what people consider their “work hours”

 

[dozitgetchahi]

First off we all work hard including our colleagues in other specialties and I think the whole premise is pretty dumb.

That being said… in 30 seconds off the top of my head

Gastroenterology
Derm
Rad Onc (despite what their forum will claim I am still waiting on MGMA to list them lower than us)
Ophtho
Orthodontics

/end thread

But yeah if you’re asking “hey does it maybe kinda suck to be a Neurosurgeon even with all the $$” I’d say l do agree I suspect I’d be miserable

Derm and maybe optho I agree with.

I would add oral surgery and plastic surgery.

Orthodontics income isn’t as good as many think it is, at least not now. Like $300-400k at best from the dentist friends I have. And they have to see a lot of pts.

 

[TexasMed22]

Optho is obviously a great gig, but I really feel like its overhyped these days given all the reimbursement cuts they've experienced in the last decade. Per Marit Health, which is a nice physician salary sharing site with pretty solid sample sizes, non academic ophthalmologist average is ~460k and works 40 hours a week. Compare that to non academic heme/onc, which is ~628k at 44 hours a week.

 

[cards67]

My gen cards gig isn't too shabby.

 

[MifflinDunder]

Optho is obviously a great gig, but I really feel like its overhyped these days given all the reimbursement cuts they've experienced in the last decade. Per Marit Health, which is a nice physician salary sharing site with pretty solid sample sizes, non academic ophthalmologist average is ~460k and works 40 hours a week. Compare that to non academic heme/onc, which is ~628k at 44 hours a week.

For heme/onc, any salary survey that doesn't distinguish between scheduled vs actual daily hours worked is useless in my opinion.

 

[Hoos2004]

This is a good view to see salaries / hr worked by specialty. This uses reported hrs worked, so does not capture the nuances of prep-time, etc.
Physician Salary (Jun 2025)

Based on this - neurosurgery still seems to top the list. It'd be interesting to compare salary / clinical hour, to get a more apples to apples between academic and community

 

[TexasMed22]

My gen cards gig isn't too shabby.

Don't most gen cards positions take quite a bit of overnight call + come in for consults on weekends?

 

[cards67]

Don't most gen cards positions take quite a bit of overnight call + come in for consults on weekends?

Every job is different, this is true of all specialties. A lot can be handled over the phone or can just wait until the next morning.

 

[gutonc]

For heme/onc, any salary survey that doesn't distinguish between scheduled vs actual daily hours worked is useless in my opinion.

Again, as a fellow, you have a skewed vision of what a typical workload is like. Is there work outside of "clinic hours"? Of course. That's true for pretty much every specialty though. Did I spend an hour or more prepping for a new patient when I was a baby attending? Yes. Do I do that now? Absolutely not. 5-10 min max. I started prepping for clinic 30 min before my first patient today and walked out the door with all of my charts closed 10 minutes before my clinic was technically done for the day.

 

[IMres85]

Just out of curiosity and I know this matters a lot on how many new patients you see - but how many patients a day would most see as a disappointment? I try to get 22-26 a day (would really like 18-22. However if I see less than 17 or so I’m feeling guilty or like it was a wasted day

 

[gutonc]

Just out of curiosity and I know this matters a lot on how many new patients you see - but how many patients a day would most see as a disappointment? I try to get 22-26 a day (would really like 18-22. However if I see less than 17 or so I’m feeling guilty or like it was a wasted day

Unless 5 of them are new, under 16 and I'm kind of bored. 18-20 is my sweet spot. I can see 25-ish without much difficulty, I just choose not to.

 

[IMres85]

Unless 5 of them are new, under 16 and I'm kind of bored. 18-20 is my sweet spot. I can see 25-ish without much difficulty, I just choose not to.

It it weren’t for my inbox I could probably see 28 a day comfortably. That can make or break my day

 

[faelivrin]

What are your heme and onc mixes? I'd find it difficult to see 20 if the vast majority are onc patients.

 

[MD46]

have 12 treatment patients in am, 4 heme malignancies, 8 solid tumors. 2 onc consults: new breast, new lung adeno. 8 heme followups, 4 onc followups today . total: 26ish

 

[Mehena]

have 12 treatment patients in am, 4 heme malignancies, 8 solid tumors. 2 onc consults: new breast, new lung adeno. 8 heme followups, 4 onc followups today . total: 26ish

Last year, I had occasional days with 24-26 patients, which felt overwhelming & rushed, with inbox messages piling up. Those days were crushing, and if I had kept that pace, I would have burned out. It would have taken a toll on my marriage and time with my kids.
This year has been more manageable, ~20 pts. As expected, RVUs have trended down

If you don’t mind me asking, What RVUs do you typically accumulate around this time of year and by year-end? What time do you usually start and finish seeing patients?
Do you care much about the notes? I feel like I spend too much time on them, and no one really reads them. Even my nurse often asks questions that are explicitly answered in the note.

 

[MD46]

My Average for last year was 10200, this year might be more as we have been covering for a colleague.

My first patient nowadays at 830, last usually 345-4p. I dont think I recall being in office after 5pm this year even once, all notes are done and close before I leave. I dont chart prep anymore the night before, I usually am here in am due to meetings etc and try to do a quick review and plan for the day while sipping coffee.

In order to be efficient, I have spent a good amount of time on training nursing staff so they can do better triage, unless its urgent or a chemo reaction they arent supposed to bug us back here. Most things are assigned to our nurse coordinator for example, following up on Imaging results, pathology, ordering NGS, getting medical records for referral, oncotype DX followup etc. There is a shared reminder list in EPIC which we all follow and keep tabs on.

My notes are pretty concise, initially as you stated were bloated but I have learned to only write relevant information.

I start my note prior to going into the room, as soon as I come back and dictate/finish before going to the next patient. (for new Onc patients I will take some extra time to be sure to have a good initial note so subsequent ones are easier to do).

Heme followup notes- 2-3 mins max
Onc followup notes- 3-5 mins max
New heme notes- 5-8 mins max
New Onc notes- 8-15 mins max

We take inpatient consults on rotating basis q3-4 weeks , 1 week at a time including weekends. Fortunately inpatient isnt very busy and hospital is across the road. I will usually go in lunch time quickly see 3-4 patients and come back. This is not usually every day. EMR is the same so it helps.


BTW I dont plan on doing this for ever, will grind now for the next 10 years and have enough to Retire in my early 50s 😀
(enough for me might be different for enough for anyone else, I also understand that)

Hope this helps

 

[guildsman]

My Average for last year was 10200, this year might be more as we have been covering for a colleague.

My first patient nowadays at 830, last usually 345-4p. I dont think I recall being in office after 5pm this year even once, all notes are done and close before I leave. I dont chart prep anymore the night before, I usually am here in am due to meetings etc and try to do a quick review and plan for the day while sipping coffee.

In order to be efficient, I have spent a good amount of time on training nursing staff so they can do better triage, unless its urgent or a chemo reaction they arent supposed to bug us back here. Most things are assigned to our nurse coordinator for example, following up on Imaging results, pathology, ordering NGS, getting medical records for referral, oncotype DX followup etc. There is a shared reminder list in EPIC which we all follow and keep tabs on.

My notes are pretty concise, initially as you stated were bloated but I have learned to only write relevant information.

I start my note prior to going into the room, as soon as I come back and dictate/finish before going to the next patient. (for new Onc patients I will take some extra time to be sure to have a good initial note so subsequent ones are easier to do).

Heme followup notes- 2-3 mins max
Onc followup notes- 3-5 mins max
New heme notes- 5-8 mins max
New Onc notes- 8-15 mins max

We take inpatient consults on rotating basis q3-4 weeks , 1 week at a time including weekends. Fortunately inpatient isnt very busy and hospital is across the road. I will usually go in lunch time quickly see 3-4 patients and come back. This is not usually every day. EMR is the same so it helps.


BTW I dont plan on doing this for ever, will grind now for the next 10 years and have enough to Retire in my early 50s 😀
(enough for me might be different for enough for anyone else, I also understand that)

Hope this helps

Could you share what is your mix of patients in a day on active systemic therapy (benign heme/surveillance onc. versus active treatments on cytotoxics/high side effect meds)?

The nurse coordinator is 1:1, almost like a PA/NP?

 

[HemOncCheng]

My Average for last year was 10200, this year might be more as we have been covering for a colleague.

My first patient nowadays at 830, last usually 345-4p. I dont think I recall being in office after 5pm this year even once, all notes are done and close before I leave. I dont chart prep anymore the night before, I usually am here in am due to meetings etc and try to do a quick review and plan for the day while sipping coffee.

In order to be efficient, I have spent a good amount of time on training nursing staff so they can do better triage, unless its urgent or a chemo reaction they arent supposed to bug us back here. Most things are assigned to our nurse coordinator for example, following up on Imaging results, pathology, ordering NGS, getting medical records for referral, oncotype DX followup etc. There is a shared reminder list in EPIC which we all follow and keep tabs on.

My notes are pretty concise, initially as you stated were bloated but I have learned to only write relevant information.

I start my note prior to going into the room, as soon as I come back and dictate/finish before going to the next patient. (for new Onc patients I will take some extra time to be sure to have a good initial note so subsequent ones are easier to do).

Heme followup notes- 2-3 mins max
Onc followup notes- 3-5 mins max
New heme notes- 5-8 mins max
New Onc notes- 8-15 mins max

We take inpatient consults on rotating basis q3-4 weeks , 1 week at a time including weekends. Fortunately inpatient isnt very busy and hospital is across the road. I will usually go in lunch time quickly see 3-4 patients and come back. This is not usually every day. EMR is the same so it helps.


BTW I dont plan on doing this for ever, will grind now for the next 10 years and have enough to Retire in my early 50s 😀
(enough for me might be different for enough for anyone else, I also understand that)

Hope this helps

Do you do 5 days or 4 days per week or something else?

 

[Mehena]

My Average for last year was 10200, this year might be more as we have been covering for a colleague.

BTW I dont plan on doing this for ever, will grind now for the next 10 years and have enough to Retire in my early 50s 😀
(enough for me might be different for enough for anyone else, I also understand that)

Hope this helps

That’s very impressive and a very helpful post. Definitely very top in productivity %ile. I may have edged close to it before, and I’d be happy to break 9K this year.
We seem to have similar goals, and things are going well so far, barring any unexpected life surprises around the corner. Good luck!

 

[MD46]

Could you share what is your mix of patients in a day on active systemic therapy (benign heme/surveillance onc. versus active treatments on cytotoxics/high side effect meds)?

The nurse coordinator is 1:1, almost like a PA/NP?

Elaborating on this day I quoted above "have 12 treatment patients in am, 4 heme malignancies, 8 solid tumors. 2 onc consults: new breast, new lung adeno. 8 heme followups, 4 onc followups today . total: 26ish"

12 treatment patients

Onc: FOLFOX x2 , FOLFIRI x2 , Carbo/taxol x2, Carbo/Pemetrexed/Keytruda x 1, Ipi/Nivo x 1
Heme: RCHOPx1, AVD-Nivo x1, VRDD x1, Rituxan x1

Heme followups; mostly benign, one patient on oral acalibrutinib

Onc followsups: surveillance patients q3m scans etc.

Nurse coordinator doesnt see patients like an NP does, however she will help with authorizations, PEER to PEER stuff, records fetching, followup up on surgical referrals, port placements, radiology, genetic testing, oral chemoeducation, oral chemo pills etc etc. very useful.

She isnt 1:1, its 2 coordinators for group of 6 at the moment.
Good thing is not all of the doctors utilize her to the fullest hence I am able too 😀 makes life easy and efficient


Hope this helps

 

[MD46]

That’s very impressive and a very helpful post. Definitely very top in productivity %ile. I may have edged close to it before, and I’d be happy to break 9K this year.
We seem to have similar goals, and things are going well so far, barring any unexpected life surprises around the corner. Good luck!

yep, Have 2 little ones right now, love to travel, parents still working full time, would not like to follow their foot steps in that at least.

Plan to be FIRE soon hence will be able to travel loads in my late 40s early 50s while my back and bones can handle it 😀

 

[sloh]

yep, Have 2 little ones right now, love to travel, parents still working full time, would not like to follow their foot steps in that at least.

Plan to be FIRE soon hence will be able to travel loads in my late 40s early 50s while my back and bones can handle it 😀

What’s your FIRE number?

 

[MD46]

What’s your FIRE number?

I am aiming for 8-10mil , give me 9.3 yrs based on current estimate