ERAS Stats- RadOnc Uptrending

[sirspamalot]

380K? #.. CLEVELAND? Seriously?

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[medgator]

380K? #.. CLEVELAND? Seriously?

When you look at the breakdown of regions of recent mgma data, definitely true for the Midwest

Mistake on the lake should be paying at least mid $400s easy

 

[sirspamalot]

400? "Please call me back when you're serious."

#

 

[A_DeMichele]

I've never worked there, but it is probably pretty slow and generally staffed. Also, hasn’t their building collapsed?

 

[radoncftw]

380K? #.. CLEVELAND? Seriously?

i think its a calculated risk.
The way I see it 3 types of jobs
true PP - lowest floor highest ceiling
hospital employed - highest floor low ceiling
academic - middle floor low ceiling (unless you become a chair or something)

out of the people in my graduating class, the range of starting salaries varied significantly and I think the resident that chose academics is making more than those in PP including myself. however in 2 yr i hope to double that individual.

 

[deleted1116990]

 

[sirspamalot]

You win the internet for today. I tried though, I really did.

 

[Dan Spratt]

who pays well in the midwest? I've heard case is really fair under spratt...but place like michigan, washu, iowa (well just look at the job postings for that sateliite position) pay not so well.

For a regional job that is full clinical I aim for 75th-85th percentile by MGMA at UH/CWRU. Based on many things but range for this job type is $460k for new grad to approaching $700k for experience and good volume and aligned with mission and vision. Could be higher but ultra busy clinically and take on multiple other roles, but not many ppl like having 40 pts under tx 😁 and can do this well.

Not setting records compared to some PP where I know ppl pay more, but you only have 2 weeks of call per year, residents field call and an inpatient APP, lots of resources made by people across system to use, and get to work with a amazing team (no traveling physics, dosi, RTTs, nursing) with good backup coverage so taking vacation zero issue (that is huge problem in Midwest and locums costs a lot). Have tried to make it a good and fair job that you really feel you are on the team. Patients are not all simmed at main and farmed out to regional sites. I expect and thus respect the expertise of docs at all sites.

I can tell you my last job hires in at ~$300-$330k for new grads (I made less when started) and almost no one makes over $450k even as Professor.

I am fairly transparent and keep things equitable across physicians so it is not a secret.

Hope this sheds some light.

 

[radoncftw]

For a regional job that is full clinical I aim for 75th-85th percentile by MGMA at UH/CWRU. Based on many things but range for this job type is $460k for new grad to approaching $700k for experience and good volume and aligned with mission and vision. Could be higher but ultra busy clinically and take on multiple other roles, but not many ppl like having 40 pts under tx 😁 and can do this well.

Not setting records compared to some PP where I know ppl pay more, but you only have 2 weeks of call per year, residents field call and an inpatient APP, lots of resources made by people across system to use, and get to work with a amazing team (no traveling physics, dosi, RTTs, nursing) with good backup coverage so taking vacation zero issue (that is huge problem in Midwest and locums costs a lot). Have tried to make it a good and fair job that you really feel you are on the team. Patients are not all simmed at main and farmed out to regional sites. I expect and thus respect the expertise of docs at all sites.

I can tell you my last job hires in at ~$300-$330k for new grads (I made less when started) and almost no one makes over $450k even as Professor.

I am fairly transparent and keep things equitable across physicians so it is not a secret.

Hope this sheds some light.

thanks - honestly what you just posted is pretty remarkable. basically allow people to do academic work and get compensated fairly for the clinical revenue they generate.
i get why you are able to recruit some of the best in our field

 

[elementaryschooleconomics]

For a regional job that is full clinical I aim for 75th-85th percentile by MGMA at UH/CWRU. Based on many things but range for this job type is $460k for new grad to approaching $700k for experience and good volume and aligned with mission and vision. Could be higher but ultra busy clinically and take on multiple other roles, but not many ppl like having 40 pts under tx 😁 and can do this well.

Not setting records compared to some PP where I know ppl pay more, but you only have 2 weeks of call per year, residents field call and an inpatient APP, lots of resources made by people across system to use, and get to work with a amazing team (no traveling physics, dosi, RTTs, nursing) with good backup coverage so taking vacation zero issue (that is huge problem in Midwest and locums costs a lot). Have tried to make it a good and fair job that you really feel you are on the team. Patients are not all simmed at main and farmed out to regional sites. I expect and thus respect the expertise of docs at all sites.

I can tell you my last job hires in at ~$300-$330k for new grads (I made less when started) and almost no one makes over $450k even as Professor.

I am fairly transparent and keep things equitable across physicians so it is not a secret.

Hope this sheds some light.

All things considered, this is likely on the better/best end of the academic spectrum (with the disclaimer that I'm trusting Dan is telling the truth, but as anyone with a Twitter account knows, Dan is usually pretty blunt/honest - which is a very sharp double-edged sword).

I'm curious about what's "under the hood", though. And Dan - I don't expect you to comment on this, given your position, and I'm talking about the system at large, not just you.

I know there are various models that academic health systems use to make and disseminate money. It's all a giant shell game, once you actually understand the numbers.

It's very, VERY hard for anyone not a partner in traditional private practice to truly "know" how much money their day-to-day actions are generating. Heck, even if you're in a "classic" PSA and control your books, you can't be certain how much the hospital is getting from the technical component.

I'm not going to give the real numbers, because SDN isn't actually anonymous, but I was able to calculate what I consider to be a reasonable ballpark estimate of how much I was generating for my hospital and my old group, not just charges but also revenue.

As a function of my salary, I was making far less than the partners (duh) but seeing the facility revenue was astonishing. I would estimate my salary was somewhere between 5-10% of what the hospital made off my labor.

"BUT THEY HAVE OVERHEAD", etc etc. Well my hospital, like many, was a non-profit, which means they have to disclose a lot of their financials. And I was able to get RadOnc-specific numbers (the same way I could get the charge/revenue data). So that's how I know I generated several million dollars in profit...I mean margin. Sorry, we can't say profit.

Where did that money go? Into the black box of "the system".

And it's even worse in academic institutions. A common arrangement is for the university to collect the ungodly amount of revenue all the physicians generate and then "pay" each department a certain amount that the university promises is reasonable, and only THEN will the department pay individual physician salaries.

Maybe I'm wrong, maybe I've just randomly seen that university model in my corner of the universe.

The point being: everyone reading this is more valuable than they think they are.

 

[communitydoc13]

Well my hospital, like many, was a non-profit, which means they have to disclose a lot of their financials. And I was able to get RadOnc-specific numbers (the same way I could get the charge/revenue data). So that's how I know I generated several million dollars in profit...I mean margin. Sorry, we can't say profit.

I understand that this is an intuitive way to think about things, but I don't go there myself. Nor do I think most docs should.

The schedules for payment (as in CMS) are pretty arbitrary IMO. Adjuvant XRT reimburses orders of magnitude more than an oncologic groin dissection, however one is much harder to do than the other (not the one we do). We are in a field that generates lots and lots of revenue, as is medical oncology. Are we worth 3-5x what a surgeon is?

Any functioning health care system needs to serve the community, manage COPD exacerbations, provide pediatric and prenatal care. Lots of loss leaders here.

Your revenue helps float everything else in the system.

As @RickyScott is famous for saying, it's the supply/demand, not how much you produce that determines compensation. This is why in the community, medoncs are now worth more than radoncs. This is why that surgical recruit got a sweeter deal than you did financially.

The exception of course is physician ownership, which is why when you start hearing some of those numbers, you realize that it is completely different economic class entirely.

I would consider @Dan Spratt 's numbers to be fair. Fair is a weird calculation, but the point is he seems to be rewarding high volume clinical docs for their work (which admittedly has some significant drudgery (It's what I do)) and is paying the true academics less (they presumably get to think for a living).

 

[A_DeMichele]

460K for a 5 days per week job in a small Midwest town? pretty normal I’d say.

how do they know what to pay? his admin is on a group chat with other comparable admins (TN, WV) and they have salaries figured out supposedly down to + / - 10K

 

[temujim]

The schedules for payment (as in CMS) are pretty arbitrary IMO. Adjuvant XRT reimburses orders of magnitude more than an oncologic groin dissection, however one is much harder to do than the other (not the one we do).

SMH at how this field runs itself down.

 

[RickyScott]

460K for a 5 days per week job in a small Midwest town? pretty normal I’d say.

how do they know what to pay? his admin is on a group chat with other comparable admins (TN, WV) and they have salaries figured out supposedly down to + / - 10K

Collusion?

 

[Doctorer]

I understand that this is an intuitive way to think about things, but I don't go there myself. Nor do I think most docs should.

The schedules for payment (as in CMS) are pretty arbitrary IMO. Adjuvant XRT reimburses orders of magnitude more than an oncologic groin dissection, however one is much harder to do than the other (not the one we do). We are in a field that generates lots and lots of revenue, as is medical oncology. Are we worth 3-5x what a surgeon is?

Any functioning health care system needs to serve the community, manage COPD exacerbations, provide pediatric and prenatal care. Lots of loss leaders here.

Your revenue helps float everything else in the system.

As @RickyScott is famous for saying, it's the supply/demand, not how much you produce that determines compensation. This is why in the community, medoncs are now worth more than radoncs. This is why that surgical recruit got a sweeter deal than you did financially.

The exception of course is physician ownership, which is why when you start hearing some of those numbers, you realize that it is completely different economic class entirely.

I would consider @Dan Spratt 's numbers to be fair. Fair is a weird calculation, but the point is he seems to be rewarding high volume clinical docs for their work (which admittedly has some significant drudgery (It's what I do)) and is paying the true academics less (they presumably get to think for a living).

This post is ridiculous.

 

[A_DeMichele]

Collusion?

transparency but only via a one-way-mirror

 

[elementaryschooleconomics]

I understand that this is an intuitive way to think about things, but I don't go there myself. Nor do I think most docs should.

The schedules for payment (as in CMS) are pretty arbitrary IMO. Adjuvant XRT reimburses orders of magnitude more than an oncologic groin dissection, however one is much harder to do than the other (not the one we do). We are in a field that generates lots and lots of revenue, as is medical oncology. Are we worth 3-5x what a surgeon is?

Any functioning health care system needs to serve the community, manage COPD exacerbations, provide pediatric and prenatal care. Lots of loss leaders here.

Your revenue helps float everything else in the system.

As @RickyScott is famous for saying, it's the supply/demand, not how much you produce that determines compensation. This is why in the community, medoncs are now worth more than radoncs. This is why that surgical recruit got a sweeter deal than you did financially.

The exception of course is physician ownership, which is why when you start hearing some of those numbers, you realize that it is completely different economic class entirely.

I would consider @Dan Spratt 's numbers to be fair. Fair is a weird calculation, but the point is he seems to be rewarding high volume clinical docs for their work (which admittedly has some significant drudgery (It's what I do)) and is paying the true academics less (they presumably get to think for a living).

Ah - we're wandering into philosophical territory.

I don't disagree with you, and I also don't agree. The question is one of "value", and value is not something that can be calculated.

I think it's borderline criminal how low some things are reimbursed, heck, how low entire specialties are reimbursed.

But I consider that to be an independent issue of my own reimbursement. When I go to work in the morning, I take my 20 years of dedicated education, training, and experience after high school to - on a good day, of course - cure cancer. In the process, I am accepting the liability of my actions either directly or indirectly leading to the injury or death of another person.

For me, the "liability" is both financial/professional, but also personal in that I'll live with them forever.

What, then, is the value of my work? Your work?

Even if we're expressly agreeing to subsidize other specialties - which it's almost always implicit, we don't actually know what's happening in the black box - then heck, we should be making even more.

It's a slippery slope argument, I know. It can go in circles. I could also point out the "invisible" revenue I generate through my referrals, tests, labs, etc. Or downstream, to things like the employees at the Aquaphor factory, etc etc.

Most of these things are ephemeral. And again, I don't really disagree, because yeah, in the current system, if Infectious Disease needs to get a cut of my revenue to stick around, so be it, I need them around!

But I'd rather we all get paid consummate to our value.

 

[communitydoc13]

SMH at how this field runs itself down.

Field is great and is right now filled with incredibly smart people.

I don't know what we should get paid, but I know what goes into my calculation.

What people around me make.

Per Mencken, "A wealthy man is one who earns $100 a year more than his wife's sister's husband.”

If I went to a better college, knew more people in finance, or had more ortho friends, I'd be wanting more.

I am jelly of the medoncs getting raises.

 

[A_DeMichele]

what does a hospital get out of groin dissection? I bet it's not much less than 25fx of EBRT if you count anesthesia

 

[RickyScott]

what does a hospital get out of groin dissection? I bet it's not much less than 25fx of EBRT if you count anesthesia

Hard to value if the pt came to the hospital because of the surgeons reputation.

 

[elementaryschooleconomics]

I don't know what we should get paid, but I know what goes into my calculation.

What people around me make.

Per Mencken, "A wealthy man is one who earns $100 a year more than his wife's sister's husband.”

One of the fundamental problems of discussing, or even thinking about this: we all are defining "wealth" or "value" in financial terms.

Wealth can also mean your reputation ("We pay you in prestige" - a certain school in Boston when they heard the starting salary of a different institution)

Wealth could be time or attention (the phrase "Pay attention!" can be considered literal)

And so on.

Per ElementarySchoolEconomics: "I wouldn't say no to getting paid the same as my wife's sister's husband if I could go home an hourly earlier than him".

But if YOUR personal calculation involves subsidizing some of your colleagues in your hospital, in your specific geography, I find that beyond reproach. It's where you, as an individual, finds value.

I still think you deserve to have double your salary, though.

 

[TheWallnerus]

For a regional job that is full clinical I aim for 75th-85th percentile by MGMA at UH/CWRU. Based on many things but range for this job type is $460k for new grad to approaching $700k for experience and good volume and aligned with mission and vision. Could be higher but ultra busy clinically and take on multiple other roles, but not many ppl like having 40 pts under tx 😁 and can do this well.

Not setting records compared to some PP where I know ppl pay more, but you only have 2 weeks of call per year, residents field call and an inpatient APP, lots of resources made by people across system to use, and get to work with a amazing team (no traveling physics, dosi, RTTs, nursing) with good backup coverage so taking vacation zero issue (that is huge problem in Midwest and locums costs a lot). Have tried to make it a good and fair job that you really feel you are on the team. Patients are not all simmed at main and farmed out to regional sites. I expect and thus respect the expertise of docs at all sites.

I can tell you my last job hires in at ~$300-$330k for new grads (I made less when started) and almost no one makes over $450k even as Professor.

I am fairly transparent and keep things equitable across physicians so it is not a secret.

Hope this sheds some light.

This is kind of the LIV Golf approach to academic rad onc? I like it.

I understand that this is an intuitive way to think about things, but I don't go there myself. Nor do I think most docs should.

But I'd rather we all get paid consummate to our value.

I don't know what we should get paid, but I know what goes into my calculation.

What people around me make.

Tom Cruise goes for ~10-20% of the gross. I think there's some sort of calculation or something... it's mysterious... where they have to tell him how much his films make. And then he gets a cut of that? I don't know. It's kind of "over my head" ***5th gen fighter WHOOOSH noise***

 

[sirspamalot]

This post is ridiculous.

Anyone taking 460k as a W2 to work in a rural area (clears desk while falling down laughing) DESERVES to be castigated. You have sold yourself short. Badly. No experienced person will take that nonsense unless they are willfully ignorant or have some black mark and have no other choice.

# send it

 

[sirspamalot]

For a regional job that is full clinical I aim for 75th-85th percentile by MGMA at UH/CWRU. Based on many things but range for this job type is $460k for new grad to approaching $700k for experience and good volume and aligned with mission and vision. Could be higher but ultra busy clinically and take on multiple other roles, but not many ppl like having 40 pts under tx 😁 and can do this well.

Not setting records compared to some PP where I know ppl pay more, but you only have 2 weeks of call per year, residents field call and an inpatient APP, lots of resources made by people across system to use, and get to work with a amazing team (no traveling physics, dosi, RTTs, nursing) with good backup coverage so taking vacation zero issue (that is huge problem in Midwest and locums costs a lot). Have tried to make it a good and fair job that you really feel you are on the team. Patients are not all simmed at main and farmed out to regional sites. I expect and thus respect the expertise of docs at all sites.

I can tell you my last job hires in at ~$300-$330k for new grads (I made less when started) and almost no one makes over $450k even as Professor.

I am fairly transparent and keep things equitable across physicians so it is not a secret.

Hope this sheds some light.

Kudos and if only some Hospital Admins would take this approach more seriously - you get what you pay for if you are buying wisely.

Since Admins often rely on consultants, when it comes time to do their actual job like selecting good staff.. they often fail. Then they get bitter and resort to treating the job as a McDonalds level slot, "see if we can pay them the minimum" and sadly many docs for whatever reason will submit.

Glad one of our own is raising the bar.