Curious about rad onc

[TheWallnerus]

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At almost every post above I want to yell "oversupply!"

Guys we don't have to speculate. Per most recent MGMA. median is about 520k. 75th percentile is like 650k. So only a very small percentage make over 700k. And of course 50% make 500 or less. Keep in mind mgma is the highest of all salary surveys

Kim Jong-un can come on TV and tell me the median household income in N Korea is $100K/year, and I would be very skeptical. I know why he would have his reasons to fib. I have no idea why MGMA would fib. But...

MGMA does occasionally offer a "database" of salaries, yet it's kind of mathematically sketchy. It's a big 'ol spreadsheet and rad onc is in one row amongst many specialties and there are 80 columns that start with "10%ile, 11%ile, ..." all the way to "90%ile." No individual data points, just rows labeled as percentiles. The spreadsheet is therefore actually a histogram. How did they bin? Did they bin properly? They do not let you peek under the hood at the points. Occasionally a dollar value in one column will be the exact same dollar value in the next column even though MGMA says it has 100s of data points for rad onc now (ie they claim they're sampling about 10% of the total rad onc population nationally). Once you graph the columnal data, the salaries slope smoothly on a gentle line from about $300K 10%ile to about $800K 90%ile IIRC. Given the ubiquity of Pareto distributions in rad onc this is also suspicious as the MGMA average is almost the same as the MGMA median. The MGMA's spreadsheet models salaries as normally distributed; a normal distribution has a very low probability of being correct IMHO.

"And of course 50% make 500 or less." So 50% make 501K or more. Now how can this be? Does anybody have any skepticism over this? 50% of all rad oncs collect $150K or less per year from Medicare (the median is $150K, the average is $335K/yr), and Medicare makes up about 30% of the payor mix nationally in rad onc. 50% of all rad oncs have 12 patients under beam per day or less. 50% of all RT patients nationally receive 15 fractions or less.

 

[RickyScott]

At almost every post above I want to yell "oversupply!"

Kim Jong-un can come on TV and tell me the median household income in N Korea is $100K/year, and I would be very skeptical. I know why he would have his reasons to fib. I have no idea why MGMA would fib. But...

MGMA does occasionally offer a "database" of salaries, yet it's kind of mathematically sketchy. It's a big 'ol spreadsheet and rad onc is in one row amongst many specialties and there are 80 columns that start with "10%ile, 11%ile, ..." all the way to "90%ile." No individual data points, just rows labeled as percentiles. The spreadsheet is therefore actually a histogram. How did they bin? Did they bin properly? They do not let you peek under the hood at the points. Occasionally a dollar value in one column will be the exact same dollar value in the next column even though MGMA says it has 100s of data points for rad onc now (ie they claim they're sampling about 10% of the total rad onc population nationally). Once you graph the columnal data, the salaries slope smoothly on a gentle line from about $300K 10%ile to about $800K 90%ile IIRC. Given the ubiquity of Pareto distributions in rad onc this is also suspicious as the MGMA average is almost the same as the MGMA median. The MGMA's spreadsheet models salaries as normally distributed; a normal distribution has a very low probability of being correct IMHO.

"And of course 50% make 500 or less." So 50% make 501K or more. Now how can this be? Does anybody have any skepticism over this? 50% of all rad oncs collect $150K or less per year from Medicare (the median is $150K, the average is $335K/yr), and Medicare makes up about 30% of the payor mix nationally in rad onc. 50% of all rad oncs have 12 patients under beam per day or less. 50% of all RT patients nationally receive 15 fractions or less.

love the north korea reference. A hallmark of north korean propaganda is that the rest of the world is worse off than north korea and its citizens should consider themselves fortunate to exist in the democratic republic of korea. KO type ostriches spout similar message how all other small specialties have drawbacks/ geographic limitations, even though this is so easy to verify

 

[TheWallnerus]

love the north korea reference. A hallmark of north korean propaganda is that the rest of the world is worse off than north korea and its citizens should consider themselves fortunate to exist in the democratic republic of korea. KO type ostriches spout similar message how all other small specialties have drawbacks/ geographic limitations, even though this is so easy to verify

KO is either really uninformed, or malicious; both are bad

He gets on Twitter saying stuff like "the ARRO surveys show things are good," when surveys look horrible; he gets on Twitter and says rad onc salaries are going up when the contemporary literature is saying we had the biggest drop of any specialty over the past decade; he says insurance prices are confidentially negotiated as if he's never heard of price transparency; he feigns ignorance that individual proton patients can and do occasionally net a facility $500K/pt... yada yada!

 

[RSAOaky]

I'm not even mid-career (almost 3 years out) and I'm treating every year as this is the most I will ever make going forward.

I'm similar to RSAOaky in that I am productivity based and lucked into a fairly good setup that gives me above average pay but I work for it (although I should get more by all accounts). However there are pressures of hiring an additional doctor which would tank everything for me while simultaneously saving our entire field by giving someone A job that is not needed. I'm trying to make hay while the sun shines but the clouds creep ever closer.

Almost all academic systems would rather have 2 docs at 300-350 seeing 3-4 new pts per week vs one doc at 500-600 seeing 6- 8 new pts per week.

Exactly this. We're just moving money around the table. We're opening up a new satellite in reasonable driving distance from my current location. It will bring in very few patients, if any, while simultaneously pulling patients from both my site and main site. We'll hire a new doc at 350k, everyone's production/salary will go down as we cannibalize ourselves, and admin will pat themselves on the back with how successful the new site is while asking everyone else why their numbers are down. Two docs are better than one. More people available to attend pointless meetings and to take on new leadership roles. They're not wrong though, more is more.

 

[Gfunk6]

I am currently a 1st year radiology resident (already did prelim) and I am not truly enjoying radiology. I just can’t imagine doing this for the rest of my life. I honestly have enjoyed patient interaction during med school and my prelim year.I am exploring other options. I did post similar question on the IM thread. I feel like I radiation oncology sounds really cool. Can you guys tell me more about it? I have already read a lot of threads telling people not to go into it because of job prospects dying field, etc.. Is it a difficult field? Do you guys take any call during residency?

I have never done a radiation oncology rotation. I am def very interested to learn about the field. I honestly don’t mind putting in the extra years if it will mean I find the work more interesting in the long run. Could I even get a spot? No research, step 1 220s, step 2 240s. I kind of have an idea what people are going to say but maybe I’ll be surprised.

 

[elementaryschooleconomics]

A new grad in 2022?

Sorry exaggeration helps no one

I don't think there has been anything exaggerated in this thread at all. Hopefully we can keep this in the public forum because I know a lot of people are picking specialties based on projected income, even if they will never admit it to anyone.

I'll just ignore numbers from the past, because that world is dead to us. I'm also only going to use numbers I have personally seen or heard (i.e. a friend telling me they are making X salary for reason Y, not a friend telling me about rumors).

For the medical student lurkers, important definitions that are confusing because the way physicians "work" and get paid are different than other sectors of the economy:

"Private practice" can mean a few different things:
- "physician-owned" private practice means at least one or more docs formed an LLC (well, usually a PLLC) to provide services
- "employed" private practice usually means a doc is an employee of a community hospital and is paid in a similar way to "other" jobs (as in, they are given a W2 form to pay their taxes, hence the distinction you'll see between "W2 jobs" and other ways to get paid)

Within "physician-owned" private practice:
- there are groups that own the linear accelerators used to treat patients (and sometimes the property/real estate as well)
- there are groups that do not own the linear accelerators

When a private practice doctor treats a patient, how they are paid changes drastically based on who owns the equipment. Reimbursement from insurance is broken into "technical" and "professional" components, which is really like "overhead" and "expertise". If they own the equipment, they get both. If they don't own the equipment, the technical money goes to the hospital, and the professional component goes to the physician. Employed physicians are paid by the hospital in various ways, sometimes as a fixed salary, sometimes as a percentage of what they generate for the hospital, etc etc.

That's grossly oversimplified, but again...this isn't part of the med school curriculum.

1) Within the last 3-5 years, I know that private docs with technical revenue with a salary of $900k-$1.2mil. This is, of course, exceedingly rare now. This is not a number most of us can dream about, this is a number only for those with luck and pedigree...and an extra dose of luck. There are not a lot of private practices with technical revenue left.

2) For private docs (LLC) on professional revenue contracts on the moderate-to-high busy scale (meaning, 25-35 patients on beam per doc), full partner salary is generally $675k-$750k. There are more of these types of groups out there than the linac-owning groups, but they're also selling out and vanishing as founding partners retire. These are the groups that generally start new (associate) physicians at $290k-$350k, and path to full partner ranges from 2-7 years.

3) For private docs employed by a hospital, max salary seems to be hovering in the $550k range right now. I know of "hybrid" groups (not traditional physician-owned LLCs but more "corporate") who max out closer to $600k. For these hybrid groups, there is also a period of 3-5 years of a lower/flat salary before switching more to a production-based salary, and that number seems to hover around $375k-$425k.

4) Finally, for "academia" (whatever that means in 2022), starting salaries last year and this year seem to mostly be around $280-$380k. Ceiling depends on geography - as always, more desirable areas make less. I know senior faculty in the northeast stuck at basically $450-500k, and the same level faculty making maybe $550k in semi-rural south/southeast.

So, yeah. Based on trends for the last 10 years, I would say that anyone who starts RadOnc residency in 2022 and graduates in 2027: the odds are overwhelming high that they will work either as a W2-employed physician for a hospital or as some flavor of "faculty" in an academic medical center (also as a W2 employee), will probably start around $300k (not adjusted for inflation), have a ceiling around $500k, and can expect to make less if they practice in a more "desirable" geography.

 

[Ray D. Ayshun]

We have a nearly dead salary megathread in the business section if anyone wants to contribute

 

[jondunn]

I don't think there has been anything exaggerated in this thread at all.

He said that a 2022 residency grad would be VERY unlikely (first said they wouldn't at all) to make more than 500k in their careers.

You don't think that is an exaggeration? Based on your posts you graduated in 2021. I am confident you believe you will make more than 500k at some point in your career.

 

[elementaryschooleconomics]

He said that a 2022 residency grad would be VERY unlikely (first said they wouldn't at all) to make more than 500k in their careers.

You don't think that is an exaggeration? Based on your posts you graduated in 2021. I am confident you believe you will make more than 500k at some point in your career.

Definitely 2021 grad, and I would agree re: salary. However, I have lucked my way into A LOT of things, and my experience is probably not generalizable, based on what I hear from friends.

I did forget a few things:

Anderson salaries are significantly higher but also not "average".
There are a few practices in "nice" areas that do get people into the 600-700k range.
Then there are the practices that...well, you probably need to be from the area to work in the area. But the pay is good!

 

[elementaryschooleconomics]

My life motto:

 

[deleted1116990]

Kim Jong-un can come on TV and tell me the median household income in N Korea is $100K/year, and I would be very skeptical.

Not to be outdone by Kim Jong Il shooting 5 holes in one on his first day playing golf ever on a 7700 yard course, it is said that Paul Wallner recently took all 3 USMLE exams cold in an attempt to demonstrate inferiority of today's MDs finishing before the first break with a perfect score.

I am pretty sure it must be true because I saw the one star review he left for the test center on Yelp.

 

[jondunn]

I don't think there has been anything exaggerated in this thread at all. Hopefully we can keep this in the public forum because I know a lot of people are picking specialties based on projected income, even if they will never admit it to anyone.

I'll just ignore numbers from the past, because that world is dead to us. I'm also only going to use numbers I have personally seen or heard (i.e. a friend telling me they are making X salary for reason Y, not a friend telling me about rumors).

For the medical student lurkers, important definitions that are confusing because the way physicians "work" and get paid are different than other sectors of the economy:

"Private practice" can mean a few different things:
- "physician-owned" private practice means at least one or more docs formed an LLC (well, usually a PLLC) to provide services
- "employed" private practice usually means a doc is an employee of a community hospital and is paid in a similar way to "other" jobs (as in, they are given a W2 form to pay their taxes, hence the distinction you'll see between "W2 jobs" and other ways to get paid)

Within "physician-owned" private practice:
- there are groups that own the linear accelerators used to treat patients (and sometimes the property/real estate as well)
- there are groups that do not own the linear accelerators

When a private practice doctor treats a patient, how they are paid changes drastically based on who owns the equipment. Reimbursement from insurance is broken into "technical" and "professional" components, which is really like "overhead" and "expertise". If they own the equipment, they get both. If they don't own the equipment, the technical money goes to the hospital, and the professional component goes to the physician. Employed physicians are paid by the hospital in various ways, sometimes as a fixed salary, sometimes as a percentage of what they generate for the hospital, etc etc.

That's grossly oversimplified, but again...this isn't part of the med school curriculum.

1) Within the last 3-5 years, I know that private docs with technical revenue with a salary of $900k-$1.2mil. This is, of course, exceedingly rare now. This is not a number most of us can dream about, this is a number only for those with luck and pedigree...and an extra dose of luck. There are not a lot of private practices with technical revenue left.

2) For private docs (LLC) on professional revenue contracts on the moderate-to-high busy scale (meaning, 25-35 patients on beam per doc), full partner salary is generally $675k-$750k. There are more of these types of groups out there than the linac-owning groups, but they're also selling out and vanishing as founding partners retire. These are the groups that generally start new (associate) physicians at $290k-$350k, and path to full partner ranges from 2-7 years.

3) For private docs employed by a hospital, max salary seems to be hovering in the $550k range right now. I know of "hybrid" groups (not traditional physician-owned LLCs but more "corporate") who max out closer to $600k. For these hybrid groups, there is also a period of 3-5 years of a lower/flat salary before switching more to a production-based salary, and that number seems to hover around $375k-$425k.

4) Finally, for "academia" (whatever that means in 2022), starting salaries last year and this year seem to mostly be around $280-$380k. Ceiling depends on geography - as always, more desirable areas make less. I know senior faculty in the northeast stuck at basically $450-500k, and the same level faculty making maybe $550k in semi-rural south/southeast.

agree with every point. I think you posted this to disagree with me, but this exactly what I think. Repeat median salary posts.

Attn Ricky Scott and @TheWallnerus

Good post for lurking med students as well. this is what you should expect.

 

[thesauce]

How do you feel about working in Iowa for 239k/year after you graduate?

By the time he gets out, that will be a dream job

 

[longshot1710]

Intern years are good for any specialty

Not true, anesthesia has a very specific requirements including ?3 months in the ICU, EM, etc. I am assuming many surgical subspecialities would have similar

 

[medgator]

Not true, anesthesia has a very specific requirements including ?3 months in the ICU, EM, etc. I am assuming many surgical subspecialities would have similar

Generally a good rule of thumb for most specialties though. I think psych and neuro might be slightly modified as well

 

[allseasons]

What's the opinion on this now? Has there been any modification of the projection regarding 2030 oversupply? Situation seems to be improving from 2023-2025.

 

[medgator]

What's the opinion on this now? Has there been any modification of the projection regarding 2030 oversupply? Situation seems to be improving from 2023-2025.

Nope

 

[yesmaster]

You are welcome to try.

 

[allseasons]

Nope

Why do you say that? Residents don’t seem to be having as much trouble finding jobs out of residency rn, and the offers seem pretty good. Out of my institution, the starting offer range for residents was 350k(academic) to 650k (more rural, “city” of about 100k). I am from a relatively well known uni with a good rad onc program, but it’s not Harvard/Anderson/Sloan. Even online, residents don’t seem to be complaining about the lack of jobs anymore.

Do you know any recent grads that are struggling to find jobs above 300k? Or do you think the market will turn dire again in a few years?

 

[yesmaster]

Why do you say that?

more rural, “city” of about 100k

Do you know any recent grads that are struggling to find jobs above 300k?

Lol try raising a family of 4 on a pretax W2 of 300k in California

 

[allseasons]

Lol try raising a family of 4 on a pretax W2 of 300k in California

I mean that’s how much the average IM and FM doc is making in California anyway. I’d rather do rad onc than IM if I’m gonna make the same amount.

You know… I’m starting to realize the standards may have changed for applicants 😂

 

[yesmaster]

Lol low expectations will help

Some FM doctors can kill it actually

100k is a state university plus staff, not a city

 

[deleted1217978]

Why do you say that? Residents don’t seem to be having as much trouble finding jobs out of residency rn, and the offers seem pretty good. Out of my institution, the starting offer range for residents was 350k(academic) to 650k (more rural, “city” of about 100k). I am from a relatively well known uni with a good rad onc program, but it’s not Harvard/Anderson/Sloan. Even online, residents don’t seem to be complaining about the lack of jobs anymore.

Do you know any recent grads that are struggling to find jobs above 300k? Or do you think the market will turn dire again in a few years?

This AI thing is not a fad. It will be the most disruptive technology likely in history.

AI already can write our notes and do most contours. This within 2 years since it became mainstream. Where do you think it will be in a decade when you are still early in your career? Other fields are more at risk, but ours especially is since we are already saturated.

The practice of medicine will become about learning how to best prompt AI in many cases. Choose wisely if you want to avoid become an AI shepherd.

 

[OTN]

This AI thing is not a fad. It will be the most disruptive technology likely in history.

AI already can write our notes and do most contours. This within 2 years since it became mainstream. Where do you think it will be in a decade when you are still early in your career? Other fields are more at risk, but ours especially is since we are already saturated.

The practice of medicine will become about learning how to best prompt AI in many cases. Choose wisely if you want to avoid become an AI shepherd.

AI cannot do most contours, at least to a level to which I am remotely satisfied. Currently it takes me longer to adjust AI-based contours than it does to just do them myself.

 

[deleted1217978]

AI cannot do most contours, at least to a level to which I am remotely satisfied. Currently it takes me longer to adjust AI-based contours than it does to just do them myself.

Hot take: AI can draw better than many boomer rad onc.

We've all been using the same version of auto contour for a while now. I am with you on some disease sites where I just draw everything including normals because i am a control freak (prostate, for example). Will be surprising to see how it updates. While I am comfortable taking the AI's hippocampal contours now (because they are nearly perfect), why would I not think it will soon be able to use the mpMRI and PSMA pet and fuse and delineate the urethra and DIL way better than I ever could? Does anybody really think it's not going to get there at this point?

I am seeing as many patients as I can, spending little, and investing heavily in semiconductor stocks. If I'm wrong, well, good for us all I guess. I'm not putting all my eggs in the basket of relying on 40 hrs a week of cognitive rad onc work being needed 20 years from now.

 

[OTN]

Hot take: AI can draw better than many boomer rad onc.

We've all been using the same version of auto contour for a while now. I am with you on some disease sites where I just draw everything including normals because i am a control freak (prostate, for example). Will be surprising to see how it updates. While I am comfortable taking the AI's hippocampal contours now (because they are nearly perfect), why would I not think it will soon be able to use the mpMRI and PSMA pet and fuse and delineate the urethra and DIL way better than I ever could? Does anybody really think it's not going to get there at this point?

I am seeing as many patients as I can, spending little, and investing heavily in semiconductor stocks. If I'm wrong, well, good for us all I guess. I'm not putting all my eggs in the basket of relying on 40 hrs a week of cognitive rad onc work being needed 20 years from now.

Low bar to clear in the hot take

 

[communitydoc13]

You know… I’m starting to realize the standards may have changed for applicants 😂

I think the right people are probably applying to radonc now. Some of the pathos on this board is due to folks who were sold a bill of goods, had found ways to differentiate themselves on paper (in a remarkably competitive environment) for what they felt was an exceptional opportunity, and with the exception of a select few...found out that it's just a job.

100k is a state university plus staff, not a city

Sounds like a pretty cool small city to me. Wish I lived in a place like this.

 

[medgator]

I think the right people are probably applying to radonc now.

Sure and some are applying as a safety or soaping in when they can't match into a more competitive lifestyle specialty