Finding a job?

[eklope2000]

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The job market seems so tight in large desirable cities for radiation oncology. Beyond the salaries being lower, I'm concerned I'm going to be geographically limited in finding a job at graduation, and definitely not be able to move around or have much flexibility in relocating should I want a change periodically.

Does anyone have suggestions for what to do earlier on in your residency to prepare for a private practice job in a tight geographic market?

Thanks

 

[DrJD]

I am by no means an expert but I believe this question was asked a while back and the consensus was "land a residency at MD Anderson or BWH."

Meaning, name of the residency matters and all things being equal the competitive private practice in the large city will take the guy from Harvard over the guy from timbucktwo residency. (Obviously there are no bad residencies, but you get my point.) In the internet age patients look at their doctors and where they were trained and the website of a practice will be buoyed if their newest recruit has the word Harvard in their bio.

Also, making connections at national conferences with docs in the city you are thinking about would probably be quite helpful.

Those with more knowledge can feel free to correct!

 

[Gfunk6]

BE AGGRESSIVE!

No matter how good you think you are, the ideal private job will not arrive on a silver platter. From day one of your residency aggressively collect information about private groups in your area of interest. Obviously it helps if you are doing residency where you want to eventually work. If not, the ARRO directory is your friend. Get to know residents in your area of interest and they can help you.

If you can, get involved in ARRO as it will help you make connections up the wazoo.

Starting mid PGY-4 or so, start sending out feelers to private groups. Depending on the group and how well you know them (ie. former residents) you can email your CV and cover letter or talk to them directly on the phone.

Be discreet! If you've done all the hard footwork making contacts don't just give them away to other residents.

I personally do not find head hunters useful, but I'm not shy about giving them my info as you never know if they can give you a sweet lead.

Post your CV on the ASTRO website early and look for new job openings frequently.

A final bit of advice: many of the best private jobs are not publicly advertised. This is why contacts are so important.

In my case, since I post under one identifiable username (ie. not radoncanon) I have personally made numerous contacts from this forum alone. Many current and former users have been a tremendous help in landing a residency spot as well as the current job search.

 

[medgator]

BE AGGRESSIVE!

No matter how good you think you are, the ideal private job will not arrive on a silver platter. From day one of your residency aggressively collect information about private groups in your area of interest. Obviously it helps if you are doing residency where you want to eventually work. If not, the ARRO directory is your friend. Get to know residents in your area of interest and they can help you.

If you can, get involved in ARRO as it will help you make connections up the wazoo.

Starting mid PGY-4 or so, start sending out feelers to private groups. Depending on the group and how well you know them (ie. former residents) you can email your CV and cover letter or talk to them directly on the phone.

Be discreet! If you've done all the hard footwork making contacts don't just give them away to other residents.

I personally do not find head hunters useful, but I'm not shy about giving them my info as you never know if they can give you a sweet lead.

Post your CV on the ASTRO website early and look for new job openings frequently.

A final bit of advice: many of the best private jobs are not publicly advertised. This is why contacts are so important.

In my case, since I post under one identifiable username (ie. not radoncanon) I have personally made numerous contacts from this forum alone. Many current and former users have been a tremendous help in landing a residency spot as well as the current job search.

All that is great advice, especially the bolded part. In larger private practice groups that cover multiple areas, this may be especially true. I ended up taking a job in a place that wasn't posted on the ASTRO site but that I was able to interview for secondary to contacts that I developed early on.

If you definitely know your desired geographic area, it will help to start the process before your PGY-5 year, particularly if you are looking at competitive markets in the major northeastern cities and much of the west coast.

 

[DoctwoB]

Just a med student very interested in RadOnc chiming in here.

Are people saying that it is difficult for new radonc graduates to find a decent job or just that it may be difficult to land the perfect job in NYC or San Francisco? If the former, that's pretty worrying as it would be a huge bummer to bust your a** getting the numbers to get into radonc and not have a job afterwards.

 

[medgator]

Just a med student very interested in RadOnc chiming in here.

Are people saying that it is difficult for new radonc graduates to find a decent job or just that it may be difficult to land the perfect job in NYC or San Francisco? If the former, that's pretty worrying as it would be a huge bummer to bust your a** getting the numbers to get into radonc and not have a job afterwards.

we're talking about the latter, not the former. Rad Onc has a very good job market and outlook right now, but there can be some difficulty if you are trying to land a job in some metro areas.

 

[Scatter]

Good question, eklope. I was thinking of posting it, too. For others who've been through the process, what, if any, advice do you have regarding important questions to ask of the employer, what ought to be very clear in the contract, should one have an attorney look over the contract, etc? Anything you would've done differently if you had an opportunity to do it again?

 

[deleted4401]

Everyone says to get an attorney, but I'm getting the idea that all the groups know that you are going to get one, so any quality group won't put anything ridiculous in there. Regardless, for the first time you probably won't feel comfortable without a lawyer. It'll put you back $400-800 for them to evaluate/redline some things and a lot more if you want them to actually negotiate/haggle for you (not the best way to start a job).

The important stuff is how well defined the non-compete clause is, malpractice (occurrence vs claims, tail coverage), termination clauses, and defining how long/what it will take to become partner and whether or not there is a buy-in (they won't usually tell you exactly how much that is, in most cases). Other than that, the rest of it is just numbers (compensation, benefits, vacation, CME, disability). Most quality groups have pretty boilerplate contracts and you can't get much of the aforementioned "important stuff" changed, but the latter numbers can usually be negotiated to a point.

S

 

[ToasterThief]

So what are the competitive job markets in radonc? SF/NYC/BOS? How about cities like Philly and DC? I'm a third year med student who's been interested in radonc since first year and I'm doing my best to put together a solid CV, but I'll admit the job situation scares me a bit.

 

[hot sauce]

So what are the competitive job markets in radonc? SF/NYC/BOS? How about cities like Philly and DC? I'm a third year med student who's been interested in radonc since first year and I'm doing my best to put together a solid CV, but I'll admit the job situation scares me a bit.

I would say at this point don't worry a lot about the job market. It will be close to 7 years before you are finishing residency and a lot could have changed by then. Compensation could be completely different and the job market could have shifted dramatically. I mean I guess if you really have to live in a major city it might be worth thinking about it but isn't what field you are practicing more important than where you practice?

You may have to spend some time in a more rural area to get some experience for your CV but if it is your goal to move to a certain city you should be able to get there eventually while you will probably be practicing whatever field of medicine you go into for your entire career (obviously you can do a second residency but who wants to do that).

 

[ToasterThief]

I mean I guess if you really have to live in a major city it might be worth thinking about it but isn't what field you are practicing more important than where you practice?

Nope. I'd rather do something that I like (instead of love) and have a happy family instead.

 

[deleted4401]

Location is important - I agree very much.

I don't think that it would be impossible to go to a city you want that is desirable. It is just that you may not get it at the right time. Since there isn't that many jobs (relative to Family Practice or something), sometimes certain regions/cities don't have openings. So, maybe when you graduate and you want to move to New York City (god knows why), you either go somewhere lower on your list (Philadelphia or NJ or something) until there is an opening where you want or you can do locums or you can do a fellowship. The other thing is that, and I'm not sure exactly why it's the case, but as a candidate you are significantly more desirable after you have worked for a few years (even one year) compared to a fresh grad.

 

[Gfunk6]

Seriously, how can you expect to waltz into an ultra-competitive, ultra-saturated market with the red carpet rolled out for you?

You want to live on one of the coasts or Chicago, huh? Well guess what? So does everyone else!

Many of the skills that got you into Rad Onc in the first place will also help in the eventual job search. Desirable skills include those who can network, work hard, are inquisitive thinkers, and have affable personalities.

If you are afraid already (without even being in residency) I suggest a reality check or migration to primary care.

 

[Pewl]

Amen to that!
Is it just me or have the attitudes and expectations of medical students become increasingly entitled and unrealistic over the past 2-3 years?

I think part of it is the life investment is getting larger and larger as well. The average student debt is much, much higher today compared to 10 years ago. Certain specialties are getting more and more competitive. People care more and more about lifestyle and eventual compensation down the road if they're going to spend such a large majority of their livelihood pursuing something like this. Yes, passion for your career and field of choice is important but we're all human. We have ambitions and interests outside of academics and medicine as well.

 

[Gfunk6]

Yes, passion for your career and field of choice is important but we're all human. We have ambitions and interests outside of academics and medicine as well.

Lifestyle and location are critical, there is no debate about that. If you are in Rad Onc you have already chosen the former. The latter is tricky and can be very hard to get. A lot of people are competing for a few spots in compeitive metro areas so I think it is very important to be realistic.

That's all I'm trying to point out.

 

[subatomicdoc]

Getting a job in certain competitive metro areas depend upon several factors.

1. Time.

If you know you want to go to NYC/SF/wherever very early in residency or before, you can research it methodically, get background information, and arrange visiting rotations in the area. Even if you want private practice, going to the local 'Mecca' academic program may be worthwhile.

If you're in fourth year, then it should be more directed and 'aggressive' as GFunk suggested. I would say 'proactive' is better because you don't want to come across as overly aggressive to prospective employers (e.g. me).

2. Networking.

RadOnc is a ridiculously small field, so the mechanics are easy. But this also means transparency. Expect that what you say here should be consistent with how you present yourself to employers.

3. Luck.

Part of it is sometimes just timing whether a group is hiring in a given year. But if you do a good job with #1 and #2 it can sometimes tip the balance for groups deciding whether to hire if you seem like the right fit.

4. Don't believe the hype about 'top' academic training.

I speak only for myself, but residency has become so competitive many are highly qualified candidates and just being at a top program (MDACC etc) is not a rubber stamp for community medicine. It's not the same feel, demeanor or skill set that fits well for the academic career track. Both are great, but see what feels right.

 

[medgator]

4. Don't believe the hype about 'top' academic training.

I speak only for myself, but residency has become so competitive many are highly qualified candidates and just being at a top program (MDACC etc) is not a rubber stamp for community medicine. It's not the same feel, demeanor or skill set that fits well for the academic career track. Both are great, but see what feels right.

Can't overstate that enough. Fit and personality are VERY important to a potential group. In that regard, having local ties to an area can carry you far in the job search process. It's good to ensure compatibility on both ends before signing on the dotted line

 

[ToasterThief]

Seriously, how can you expect to waltz into an ultra-competitive, ultra-saturated market with the red carpet rolled out for you?

You want to live on one of the coasts or Chicago, huh? Well guess what? So does everyone else!

Many of the skills that got you into Rad Onc in the first place will also help in the eventual job search. Desirable skills include those who can network, work hard, are inquisitive thinkers, and have affable personalities.

If you are afraid already (without even being in residency) I suggest a reality check or migration to primary care.

So I'm reluctant to live in North Dakota. I'm sorry if that comes off as entitled to you, but I think few of us here would be jumping at that job. Look, I'm fairly flexible when it comes to location. I don't WANT to live in NYC/SF. I'd much prefer to live in Philly. I don't expect (or really want) to live in NYC/SF/CHI/BOS. All I'm asking is whether finding a job in a larger city is an issue. From what you guys are saying, that shouldn't be an issue.

 

[deleted4401]

Definitely not picking on anyone in specific, as I was very interested in location ... But it's funny that before everyone was just interested in getting in the field (as my old posts can attest to), and now so many people post about wanting to also be able to practice in a major metro. Pretty seen maybe we'll field some questions about being able to work 4 day weeks...

-S

 

[Gfunk6]

All I'm asking is whether finding a job in a larger city is an issue. From what you guys are saying, that shouldn't be an issue.

I understand. Though your question is straightforward enough I hope that you've learned from this thread that the answer is not simply yes/no.

For instance, let's take your specific case: Philadelphia. If your stated employment goal was, "I am willing to take any Rad Onc job in the metro Philly area (including close areas like Bucks county and southern NJ)," then I say your chance of success would be pretty good in the current market. Every additional restriction you throw in however, would damage your chances (i.e. academic jobs only, no buy-in private group, only would consider two year partnership track).

In other areas of the country, you might have to throw an even wider net. For example, "SF Bay Area or bust" is a pretty unreasonable restriction unless you have some specific connection to a practice in the area. It would be prudent to expand such a search to Northern California. However, this would include areas north of Sacremento that many would not choose to live.

In my own case, I of course have my own set of geographic restrictions/preferences. However to maximize my chances I selected a couple of large regions.

Here's the take home message: you may not get a job exactly where you want but if you're cautious about it you can almost always get pretty close. You will not be forced to an undesirable area unless you put many restrictions on your search.

Practice type
Salary
Location

Pick 2 out of 3, that's usually what it boils down to.

 

[fettucine]

My advice, if it is a big city you're interested in. Instead of focusing on the city itself look for practices at a 40 mile radius or a 45 minute drive and email the radoncs. For example in chicago, look ar the suburbs. Most of the times the further you are away from the city, the better the pay gets and lower the cost of living (but not always). With a family, being accessible to a big city was more important to me than living in one.
-f8

 

[qwert]

Bump

Need some advice re: job interviews

At which point (initial phone interview, ASTRO interview, site visit) is it appropriate to bring up compensation?
Is there a decent source on median starting salaries, preferably by region?

 

[Gfunk6]

This advice is coming from someone in the middle of the job search, so take with a grain of salt.

Compensation is the very LAST thing you should bring up. Personally, I would not touch it until you actually get an offer at which point you can negotiate. However, if you are interviewing somewhere where salary is critically important to you (e.g. you would not consider moving unless your salary was above a certain point) then I think it is appropriate to bring it up during the site visit.

Look at the FAQ for an idea of starting salaries. If you are talking about private groups on the East/West coast (e.g. parternship-track, free standing cancer center) then your salary will probably range from $180K - $250K starting. Obviously this will go up dramatically once you make partner. If you are entering private practice under a physician-employed model then I think $300K - $350K is a more appropriate starting salary.

I don't know about Mid-Western or Southeastern salaries but I suspect they would be a bit higher.

 

[qwert]

thanks, it's very helpful

 

[medgator]

Bump

Need some advice re: job interviews

At which point (initial phone interview, ASTRO interview, site visit) is it appropriate to bring up compensation?
Is there a decent source on median starting salaries, preferably by region?

This advice is coming from someone in the middle of the job search, so take with a grain of salt.

Compensation is the very LAST thing you should bring up. Personally, I would not touch it until you actually get an offer at which point you can negotiate. However, if you are interviewing somewhere where salary is critically important to you (e.g. you would not consider moving unless your salary was above a certain point) then I think it is appropriate to bring it up during the site visit.

Look at the FAQ for an idea of starting salaries. If you are talking about private groups on the East/West coast (e.g. parternship-track, free standing cancer center) then your salary will probably range from $180K - $250K starting. Obviously this will go up dramatically once you make partner. If you are entering private practice under a physician-employed model then I think $300K - $350K is a more appropriate starting salary.

I don't know about Mid-Western or Southeastern salaries but I suspect they would be a bit higher.

What GFunk said

Be wary of a very high starting salary your first year out (unless you are going to go practice in podunkville), which you can sometimes see in shadier practices like urorads setups (or groups that are looking to lure you into a temporary setup that won't lead to partnership).

 

[Knucklehead]

Interesting data

http://www.physicianspractice.com/best-states-to-practice/content/article/1462168/1653715

looks like the most desirable states pay poorly, have higher state income tax, and in some cases have high malpractice insurance (eg New York)

 

[medgator]

Interesting data

http://www.physicianspractice.com/best-states-to-practice/content/article/1462168/1653715

looks like the most desirable states pay poorly, have higher state income tax, and in some cases have high malpractice insurance (eg New York)

That's probably true for most specialties.

 

[Gfunk6]

For those of you who may have missed Terry Wall's (now FASTRO!) annual talk at ARRO, the median STARTING salary for the class who just entered the market (graduated June 2010) was . . . <drum roll please>



278K

The range was 180 - 350.

 

[medgator]

For those of you who may have missed Terry Wall's (now FASTRO!) annual talk at ARRO, the median STARTING salary for the class who just entered the market (graduated June 2010) was . . . <drum roll please>



278K

The range was 180 - 350.

sounds like that's up from last year. Pretty interesting considering the economy.

I kinda wonder about these practices that start people at 180-200 K a year.

 

[academia]

I kinda wonder about these practices that start people at 180-200 K a year.

Those are likely some of the academic positions, especially physician-scientist pathways, no?

 

[Gfunk6]

Should have clarified that these are private practice salaries. The median for academics wasn't far off, around $245k or so.

 

[Gfunk6]

Those are likely some of the academic positions, especially physician-scientist pathways, no?

sounds like that's up from last year. Pretty interesting considering the economy.

I kinda wonder about these practices that start people at 180-200 K a year.

He mentioned it was up from last year too. Probably the poor job market last year was more perception than reality.

There are good practices that low ball salaries (<200k) as the cost of entering a prestige, successful group and subsidizing your buy-in. A friend of mine started off on the very low end at a well-known group but is now kicking it as partner.

 

[subatomicdoc]

He mentioned it was up from last year too. Probably the poor job market last year was more perception than reality.

There are good practices that low ball salaries (<200k) as the cost of entering a prestige, successful group and subsidizing your buy-in. A friend of mine started off on the very low end at a well-known group but is now kicking it as partner.

Caveat job candidate: First year salary is one factor but not the critical one. And as Gfunk6 said, that's a later part of the discussion once the bigger pieces seem to fit.

 

[Leapfrog80]

I know graduates in other specialties are having a hard time finding a job once they graduate due to changes in reimbursement trickling down to salary cuts, tighter market. How hard is it to find a job in rad onc? I imagine it might be tough given how small a field it is. How important is it to come from a "top" program vs an average one? I would hope clinical competence trumps pedigree.
thanks for any comments.

 

[radiaterMike]

Salary cuts does not equate with "trouble finding a job" in any specialty. If there are patients, there will be jobs.

I know graduates in other specialties are having a hard time finding a job once they graduate due to changes in reimbursement trickling down to salary cuts, tighter market. How hard is it to find a job in rad onc? I imagine it might be tough given how small a field it is. How important is it to come from a "top" program vs an average one? I would hope clinical competence trumps pedigree.
thanks for any comments.

 

[medgator]

I know graduates in other specialties are having a hard time finding a job once they graduate due to changes in reimbursement trickling down to salary cuts, tighter market. How hard is it to find a job in rad onc? I imagine it might be tough given how small a field it is. How important is it to come from a "top" program vs an average one? I would hope clinical competence trumps pedigree.
thanks for any comments.

Many of us had this same qualms last year with the political/legislative environment, and in retrospect, it was probably a bit more paranoia that was truly mandated for the situation.

The caveat, of course, is that it's completely location dependent. I ended up taking a job in the southeast, and that was a whole heckuva lot easier than trying to land the one job in Portland, Oregon last year (And yes, there was literally one job in Portland last year, and not even 48 hours after it was posted, my graduating co-resident received a response back that they had filled their interview slots) that popped up on the ASTRO job site.

At the end of the day, the job market is very much a locoregional phenomenon, and the best way to handle it is to start EARLY to get a handle on areas where YOU have a strong interest in going. Generally speaking, you'll have an easier time in the southeast and midwest, as opposed to the northeast or west coast, and generally speaking, there's a lot more need in rural areas rather than metro ones.

 

[Haybrant]

A question that has not been addressed on this thread: Once you do find that first job which may not be in your desired location, what are the opportunities and pitfalls of mobility afterward if you are looking to make the move to your location of interest?

 

[qwert]

Something like 70% of RadOnc grads change jobs within first 3 years. An obvious disadvantage of doing so is that you may loose your earned "seniority".

A question that has not been addressed on this thread: Once you do find that first job which may not be in your desired location, what are the opportunities and pitfalls of mobility afterward if you are looking to make the move to your location of interest?

 

[deleted4401]

I'm under the assumption that when you join a new group, you go back to employee status and your years put towards being a partner restart from 0, which means the salary/vacation/benefits all go back to entry level status. So, once you make partner, it seems like it would be really punishing to switch jobs. Is that true, or is there some sort of reciprocity or decrease in time it takes to make partner if you join a new group?

-S

 

[medgator]

I'm under the assumption that when you join a new group, you go back to employee status and your years put towards being a partner restart from 0, which means the salary/vacation/benefits all go back to entry level status. So, once you make partner, it seems like it would be really punishing to switch jobs. Is that true, or is there some sort of reciprocity or decrease in time it takes to make partner if you join a new group?

-S

I've seen in some job descriptions (and have heard anecdotally) the phrase "salary/benefits commensurate with experience" Basically, they should take your experience and such into account when you start looking for another job.

Now as to whether that shortens your partnership track/buy-in, I have no idea.

 

[G'ville Nole]

I've seen in some job descriptions (and have heard anecdotally) the phrase "salary/benefits commensurate with experience" Basically, they should take your experience and such into account when you start looking for another job.

Now as to whether that shortens your partnership track/buy-in, I have no idea.

I've had several colleagues in this situation. In essence no one really starts back at entry level salary/benefits, and most of the time the partnership track is also reduced, although 18-24 months is about as short as you'll ever see it, since the new employers will need enough time to assess for appropriate fit. This doesn't fully take into account that a lateral salary move may be a de facto regression as one moves to a place with a higher cost of living, and employers in those more expensive places are not likely to account for this difference in their offers.

 

[faramir34]

I understand that the job market is generally better in less desirable places to live such as the midwest and southeast. How about the large metro areas in Texas, such as Houston, Dallas, Austin etc? Do these places fall into the midwest/ good job market bracket?

 

[medgator]

I understand that the job market is generally better in less desirable places to live such as the midwest and southeast. How about the large metro areas in Texas, such as Houston, Dallas, Austin etc? Do these places fall into the midwest/ good job market bracket?

I've seen jobs posted in all of those areas last year. Can't tell you much more than that as I wasn't looking there too much