Few Jobs in Rad Onc?

[OneStrongBro]

Just talked to some of the senior residents at one of the top programs and she mentioned that the seniors are having trouble finding jobs.

Is rad onc more prone to the economy then some of the other specialties?

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[IndyXRT]

I imagine that some groups may be hesitant to hire until they find out whether the proposed 20% cut in radiation oncology reimbursement goes through.

 

[Zap]

It's a little early in the year for most seniors to have job offers as ASTRO hasn't even happened yet. I would reserve judgment until the spring as far as the job market is concerned. While the proposed cuts may have an effect this year, they may well not be as dire as proposed. I think the overall economic situation definitely affects physician jobs, however. Many potential employers (from small practices to large HMOs) have slowed down hiring in pretty much all specialties in the last year. Higher unemployment = less patients with private insurance = less clinical revenue = lower likelihood of hiring new physicians.

 

[deleted4401]

I think all specialties are having to re-evaluate needs, and rad-onc no different. If CMS cuts go through, I'm sure many places will reconsider hiring, but I'm hoping there is still a job left for me

I think overall, though, maybe we are a little bit more protected, since we have elderly patients and many/most of them are Medicare, thus not dependent on employer-based coverage.
-S

 

[OneStrongBro]

IMHO, since rad onc is a very small field it is logical that it would be hindered more by the economy. There are much fewer jobs in radiation oncology than internal medicine, surgery, pediatrics etc.


The same thing happened in the 90's. There was an increase interest in primary care jobs because of the fear of finding a job in the area that you want.

Rad Onc is a great field but the chance of finding a job in your ideal location (i.e. San Diego, Miami, or Denver ) is very remote.

So the question boils down to this. Are you willing to compromise where you live to do radiation oncology or do a primary care specialty/ER/radiology in any city in America regardless of the economy.

I say if you truly love Rad Onc go for it. But keep in mind that it will be very difficult to pick your location.

 

[deleted4401]

That's very true - ideal location is a bit trickier. But that's always the case, regardless of the economy. Because if there is x amount of jobs (I'm guessing 250-300 available positions), if the economy is crap it may go down to 200 and if it's good it may go to 400-500, and those don't necessarily pop up in San Diego, Austin, Portland, and the East Village.

-S

 

[OTN]

One factor not yet mentioned is the size of retirement accounts in the "just about to retire" population- they were looking good in the early 2000s, but I'm sure there are more than a handful of radiation oncologists who may be pushing back retirement a bit after the value of their IRAs dropped a couple of years ago.

 

[radonc]

http://www.asco.org/ascov2/Press+Ce...ng,+Leading+Cancer+Groups+Study+New+Solutions

"The number of Americans aged 65 and older will double by 2030"

The mean age of any American developing any cancer is 67, breast is 61, prostate is 68, and lung is 70. Basically, the utilization of RT has the potential to increase significantly by 2030.

that being said, i think too much emphasis is placed on the financial health of our field.

 

[p53]

No one will question the need for oncologists. However, the CMS cuts will force many private practice rad onc facilities to close. Thus, rad onc will be even more concentrated in academic environments.

Also keep in mind that future patient demand does not equal to reimbursement. The feds believe physicians are overpaid thus they are targeting radiologists, cardiologists, and rad oncologists.

Rad Onc will always have a great lifestyle. However, future pay will be comparable to Opthalmology of today. The feds will cut the fat off prices.

If you love oncology go for it but you will definitely not get rich in this specialty nor ever have the flexibility to live anywhere that you want.

http://www.asco.org/ascov2/Press+Ce...ng,+Leading+Cancer+Groups+Study+New+Solutions

"The number of Americans aged 65 and older will double by 2030"

The mean age of any American developing any cancer is 67, breast is 61, prostate is 68, and lung is 70. Basically, the utilization of RT has the potential to increase significantly by 2030.

that being said, i think too much emphasis is placed on the financial health of our field.

 

[p53]

There will definitely be a narrower distribution of income for specialists and generalists in the future.

If you take out the outliers such as neurosurgeons on one spectrum and pediatrics in the other spectrum, in the future most physicians will make between $200,000 to $300,000. I would put radiology and radiation oncology in the $250,000 to $300,000 range after the dust clears.

The questions that you have to ask yourself is this. Do you really love the specialty? Do you want job security? Do you want flexibility to live any where you want?

Rad Onc is one of the top five best specialties in medicine. Just keep in mind that it has its downside just like every other specialty.

Medical students always PM and ask what specialty that they should do. I tell them. Focus on the worst part of that particular specialty. If you can tolerate it go for it. In the end, every specialty will become a job. What will matter most is your true interest in the specialty and your family.

 

[Pewl]

I think it'll be closer to 350-400

There will definitely be a narrower distribution of income for specialists and generalists in the future.

If you take out the outliers such as neurosurgeons on one spectrum and pediatrics in the other spectrum, in the future most physicians will make between $200,000 to $300,000. I would put radiology and radiation oncology in the $250,000 to $300,000 range after the dust clears.

The questions that you have to ask yourself is this. Do you really love the specialty? Do you want job security? Do you want flexibility to live any where you want?

Rad Onc is one of the top five best specialties in medicine. Just keep in mind that it has its downside just like every other specialty.

Medical students always PM and ask what specialty that they should do. I tell them. Focus on the worst part of that particular specialty. If you can tolerate it go for it. In the end, every specialty will become a job. What will matter most is your true interest in the specialty and your family.

 

[radonc]

No one will question the need for oncologists. However, the CMS cuts will force many private practice rad onc facilities to close. Thus, rad onc will be even more concentrated in academic environments.

Also keep in mind that future patient demand does not equal to reimbursement. The feds believe physicians are overpaid thus they are targeting radiologists, cardiologists, and rad oncologists.

Rad Onc will always have a great lifestyle. However, future pay will be comparable to Opthalmology of today. The feds will cut the fat off prices.

If you love oncology go for it but you will definitely not get rich in this specialty nor ever have the flexibility to live anywhere that you want.

explain to me how POTENTIAL CMS cuts would cause private facilities to close? even if the cuts prove to be real, private docs will still reel in the money. at present, it takes a practice about 1-1.5 years to pay off a 4million dollar machine. so what if it takes 5 years in the future? and, a reduction in private practices and centralizing health care in radonc would be a great thing. there are too many private docs abusing the healthcare system anyways: treating WBRT in 1.8Gy fractions, using IMRT for palliative cases, using IGRT for palliative cases, shipping inpatients to outpatient facilities for increased billing, and a whole lote more.

by the way, this field never had the flexibility of choosing where you would want to live; talk to mid- to senior- level practitioners. have heard of people waiting 10+ years for jobs in certain areas to open up. and this was in the past 2 decades, during the heyday of radonc.

 

[G'ville Nole]

explain to me how POTENTIAL CMS cuts would cause private facilities to close? even if the cuts prove to be real, private docs will still reel in the money. at present, it takes a practice about 1-1.5 years to pay off a 4million dollar machine. so what if it takes 5 years in the future? and, a reduction in private practices and centralizing health care in radonc would be a great thing. there are too many private docs abusing the healthcare system anyways: treating WBRT in 1.8Gy fractions, using IMRT for palliative cases, using IGRT for palliative cases, shipping inpatients to outpatient facilities for increased billing, and a whole lote more.

by the way, this field never had the flexibility of choosing where you would want to live; talk to mid- to senior- level practitioners. have heard of people waiting 10+ years for jobs in certain areas to open up. and this was in the past 2 decades, during the heyday of radonc.

-Re: Potential CMS cuts. Agreed that facilities won't close if the proposed cuts are tabled in the 11th hour, as they frequently are. If they do go through, however, those practices that leveraged themselves to the gills financing that CyberKnife or Tomo unit are going to be in trouble, because those profit margins will take a big hit.

-Re: Centralizing rad onc. In the face of an aging population, how is decreasing access to care in underserved areas a good idea? I suppose I'd agree with the concept of thinning the heard in metropolitan areas where free standing rad onc clinics are as ubiquitous as Burger Kings, but to paint all community rad onc clinics with the same "abusing the system" brush while ignoring the profound benefit to populations who would otherwise face 6 or more hours of daily driving to get their XRT at Ivory Tower U just seems a bit short-sighted to me.

 

[p53]

I think it'll be closer to 350-400

HAHA....KEEP DREAMING. What do you think the average is right now?

Regardless, go into a specialty because you really like it. Even Rad Onc will get old very fast if you go into it for the money. One cannot become an oncologist during the day and become someone else outside of work. It requires tremendous commitment to patient care.

Rad Onc is a great field but there is no perfect specialty. The closest to a perfect specialty is Dermatology.

 

[p53]

Read below. Consider that if 40%-62% of practices will lay off physicians, what are the chances that jobs are available for new radiation oncology graduates? Plus, what is the fall back position if one cannot get a job as a radiation oncologist?

Answer: urgent care centers. However how many radiation oncologists will be comfortable treating anything that comes across the door.

Straight from ASTRO....39% of the practices will close shop...

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18225

here is what is going to happen if CMS cuts go through.

Although several centers anticipate closing or consolidating treatment locations, others anticipate significant changes to the staffing of their cancer centers.

Those surveyed anticipated 40 percent of practices will lay off physicians if the cuts are 20 percent, and 62 percent of practices will reduce their physician staff if the cuts are 30 percent. The respondents also said they expect 78 percent of practices will lay off non-physician staff if the cuts are 20 percent, and up to 90 percent of practices will implement these types of cuts if CMS slashes reimbursements by 30 percent.


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[p53]

agree that these are proposed cuts. However, the political landscape this time around is very dubious. We have a democratic president and 59 members of the senate and majority of the house is in one party. Remember the bailout plan? The reason it went through so fast is because two republican senators (from a liberal Maine) voted with the Democrats. Everyone else voted with their party line.

As for the CMS cuts, the person with the most influence is Kathleen Sebelius. Who by the way used to be the chief lobbyist for the trial lawyers. President Obama is giving her free rein on this. Plus, we all know that Obama does not like specialists, as he mentioned several times that specialists are overpaid.

BOTTOMLINE: Due to the majority of Democrats in both the Senate and House a healthcare bill will pass (with small concessions to the two republican senators in Maine). Also, the CMS cuts will get a minor revision however radiology, rad onc, and cardiology will stick get a huge cut in the final draft.

I am willing to bet anyone on here for that. In fact, the official CMS cuts will be available this November.

 

[G'ville Nole]

BOTTOMLINE: Due to the majority of Democrats in both the Senate and House a healthcare bill will pass (with small concessions to the two republican senators in Maine). Also, the CMS cuts will get a minor revision however radiology, rad onc, and cardiology will stick get a huge cut in the final draft.

I am willing to bet anyone on here for that. In fact, the official CMS cuts will be available this November.

I wouldn't take that bet, as I think that's exactly what will happen. In this climate, I don't think the powers that be will find any discernable political capital in shelving the cuts. Remember, though, that CMS is basically a government-run shell game, intended to be revenue neutral, so that it cuts one specialty and boosts another (IIRC, neurology and primary care are the winners this year). Chances are it'll cycle back over time, although I share the concerns of many that the trend will continue in a downward direction. It seems that people value health care, just not the individuals who actually provide it.

 

[radonc]

i think we just see things differently, which is fine. most people on this thread are feel the glass is half empty which i see as half full.

 

[BraggPeak]

P53: I would definitely disagree with the comment that "dermatology is the ideal specialty." Funny that in one sentence you say "go into a specialty because you like it" but then say derm is the closest to the perfect specialty.

Every field has it's pros and cons. I know a few residents who got academic jobs that are 300+, so I don't see why you would say "HAHA...keep dreaming" to the 350-400 projection for private practice.

Did you apply for rad onc and end up doing radiology as your back-up?

 

[TarHeelRadOnc]

I think that some of the comments on this thread suggest a poor understanding of the business of medicine, and specifically radiation oncology. To say that all salaries will be confined within a +/-$100,000 ($200-300K) range is inherently ignorant.

There is a wide range of reimbursement in radiation oncology that goes far beyond the simple academics versus private practice setting. I strongly encourage anyone looking for a job in the private sector to carefully evaluate the business aspects of a candidate practice, the same way that you would evaluate the practice's reputation, quality of the partners, treatment appropriateness (commonly used WBRT regimens, bone met regimens), etc.

Reimbursement varies by state (medicare is state specific), setting (urban vs small town/rural), facility (freestanding vs hospital-based), etc. Moreover, for practices that generate technical reimbursement, there is a significant variation with regard to the percentage of technical revenues retained by the practice. Health care will likely change, but it is rather unlikely that all of these aspects will change, especially with the public option fading. In short, the sweeping generalizations above are innacurate and add little to the reader's knowledge of the job market in our field.

 

[p53]

It is assumed when I say something is ideal that it is based on my personal preferences.

Secondly, we are talking about future income i.e. for residents that are R3 and below. If you truly believe Radiation Oncologists will continue to make the same I am willing to bet you $100 on this. It isn't about the money but rather the principle. We can even get stephew to hold the money.

Plus, why do we propagate this discussion about money. We all know money is good in radiology and radiation oncology. They will both continue to be paid as the highest paying subspecialties. So does it really matter if future income is $250,000 to $300,000 compared to radiologistss and radiation oncologists that get paid $350,000-$400,000 now for centers that are in danger of being closed down? Let's put everything into perspective, primary care physicians are severly underpaid compared to radiologists and radiation oncologists.

We are both in good gigs. That is what matters. I am just trying to temper the unrealistic expectations of the OP and the medical students chasing money and lifestyle. Interested students in Radiation Oncology should focus on whether they have the personality and empathy to become outstanding oncologists not future reimbursement. Plus, you really have to like being in the Clinic. Also, I wouldn't be surprised if there is an increase push to admit oncology patients to the hospital and round on them. Do I like being in Clinic all day and potentially rounding on patients in the future?

Let's face it. I am in radiology so I am also adversely affected by the future. Still salaries for radiologists, radiation oncologists, and cardiologists will go down. If the American Board of Radiation and ASTRO all believe that reimbursement is going down, what makes you think otherwise? Do you know something that the leaders in radiation oncology and radiology don't know?

As for your question about applying to Rad Onc. Radiology and radiation oncology have nothing in common so why would I apply to both? No, I didn't apply to rad onc. Would have likely been happy in it just like radiology (but NOT as happy because I am not much of a clinic person). Plus, I much prefer the geographic freedom of radiology over radiation oncology. It is a matter of preference though.

Bottomline: Radiation Oncology is a great field. It offers better lifestyle than radiology but does not give you the geographic freedom to live anywhere that you want. It is a matter of choice. Plus, both specialties are going to take a beating in the upcoming reimbursement cuts. There is nothing wrong with inducing due diligence in medical students interested in radiology and radiation oncology.

P53: I would definitely disagree with the comment that "dermatology is the ideal specialty." Funny that in one sentence you say "go into a specialty because you like it" but then say derm is the closest to the perfect specialty.

Every field has it's pros and cons. I know a few residents who got academic jobs that are 300+, so I don't see why you would say "HAHA...keep dreaming" to the 350-400 projection for private practice.

Did you apply for rad onc and end up doing radiology as your back-up?

 

[G'ville Nole]

p53, when it comes to oncology, I have to say you're frequently over-expressed.

Jokes aside, your point about selecting a field based upon personal compatibility rather than lifestyle/reimbursement is spot on in this or any other time.

In regards to the future of overall compensation in radiation oncology, I remain concerned that the trajectory over time may remain flat or backslide. However, I tend to align more with the thoughts of TarHeel on this. Namely, that the distribution of rad onc salaries varies widely depending on the practice structure and location. The bottom of the distribution is populated with folks like me, newly minted docs on salary, either in the community or academia. Our reimbursement will likely remain fixed even in the face of CMS cuts, so you're correct in assuming that the distribution would become narrower, but not as narrow as you are envisioning. The time frame for any readjusment will also likely be longer than most would imagine, barring some completely disruptive legislation. I think it's a common and natural reaction to hear all of the screaming on both sides of this argument and to assume that the day after legislation/policy changes are put into place, everything we know about medical practice will change irrevocably. Inertia has the same properties for cumbersome bureaucracies as it does for ocean-liners; nothing that big turns on a dime.

--You wrote: "If the American Board of Radiation and ASTRO all believe that reimbursement is going down, what makes you think otherwise? Do you know something that the leaders in radiation oncology and radiology don't know?"

You provided the numbers that ASTRO used to lobby for a hold in the CMS cuts in an earlier post. The numbers are based on a survey that was distributed in July and filled out by practitioners across the country. I think that many if not most docs who filled out the survey shaded their responses toward a doomsday scenario, since it was clear that the intent of the survey was to provide ASTRO some "alarming" numbers when lobbying to preserve the current reimbursement scale. ASTRO is doing what any professional society would do in this situation: defending the livelihoods of it's constituent doctors. Of course reimbursement will go down if the proposed cuts are put into practice, but I'd be willing to bet that the lay-offs and clinic closures will not come anywhere near ASTRO's survey-based projections. Addtionally, if the history of CMS gives us an indication of the future, it wouldn't surprise me to see an increase in reimbursement for these same CPT codes within 3-4 years.

To the OP's point: Do these cuts impact the job market this year? I'm in regular contact with about 4 graduating seniors, and they seem to be doing okay. But I could definitely understand if jobs are less plentiful this year. Practices are running their 2010 budgets now, and the smart ones are baking in the CMS cuts. All of the previous points about potential retirees hanging around longer, and not being able (or willing) to take on an additional physician's salary are valid. I certainly wish the graduating seniors the best of luck in their search, and hope they all find good jobs.

 

[deleted4401]

The proposed cuts clearly affect free-standing centers more. I'm sure that if they pass, there will be a shift to hospital-based services. If the free-standing clinics start losing money, they'll gradually partner with hospitals to provide a mutually beneficial venture for both parties.

The major problem is trying to drum up sympathy for us. The average salary in the NY Times survey was $555,000k. A 40% cut of that number is going to bring out a symphony of tiny violins.

Who knows what will happen? I know that the groups/universities know more than I do about the economic structure and potential changes, yet there are very few certain hiring freezes. Groups I've interviewed with have plans to hire multiple physicians, and there are brisk postings on the ASTRO website (which obviously leaves out the practices that don't advertise, but hire through word of mouth). I think there will be plenty of jobs, but as usual for rad-onc, many will be in undesireable locations.

-S