For all the people who are saying rad onc market is improving

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Do starter private planes have climate control? Do they smell like gasoline? Can I wear headphones to cut the engine noise? What’s the annual recurring expense for once a week round trip flights 350 miles one way, including hangar, licenses, fuel? How likely am I to crash or die doing this for the next 30 years? What kind of sunglasses do you wear?

Honest questions.
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Starter private planes climate control? How "starter" are we talking? If you're hoping for air conditioning, no. Heat, yes. But.. Don't buy a junker.

You should wear noise cancelling headphones always. They aren't cheap.

Hangar and licensing isn't where the pain is.. but in boonie land I pay 160/mo for hangar and 20/d to hangar it at the metro airport on the weekend (because I take care of my plane, ramp parking is often free). Excel tables with operating costs vary on so many variables, its impossible to boil it down with out some assumptions. I flew most weekends.. excluding interest and principal payments (which depend entirely on the type of plane you have) it was ~160/hobbs hr / 43k yr. But your insurance costs vary with experience/ratings and hull value/liability limits (figure 2% or so of your first year hull value).

Crash and die? Here's a phrase you're going to learn to love with flying .. "It depends." Are you inclined to do things correct, spend the time and effort to be trained properly, utilize excellent risk management and utilize good aeronautical decision making (go/no go/turn back/land)? You can crash and die driving to work tomorrow too.

I've flown 2k hours and for nearly 20 years. I'm still here. I'm flying later today. Do I still get scared? Sometimes but not enough to allow it to interfere with my flying. There is much to learn.. might as well get started now. Go take an intro flight with a flight instructor at your airport.
 
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sirspamalot said:
Starter private planes climate control? How "starter" are we talking? If you're hoping for air conditioning, no. Don't buy a junker.

You should wear noise cancelling headphones always.

Hangar and licensing isn't where the pain is.. but in boonie land I pay 160/mo for hangar and 20/d to hangar it at the metro airport on the weekend (because I take care of my plane, ramp parking is often free).

Crash and die? Here's a phrase you're going to learn to love with flying .. "It depends." Are you inclined to do things correct, spend the time and effort to be trained properly, utilize excellent risk management and utilize good aeronautical decision making (go/no go/turn back/land)?

I've flown 2k hours and for 18 years. I'm still here. I'm flying later today. Do I still get scared? Sometimes but not enough to allow it to interfere with my flying. There is much to learn.. might as well get started now. Go take an intro flight with a flight instructor at your airport.
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I used to play flight simulator does that count?
 
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sirspamalot said:
youre right GIF


But you too can be a unicorn. First, set aside several years to learn how to fly. This will be.. challenging. Don't forget, you'll need to get your instrument rating, buy a plane and learn how to manage it. But hey, you like challenges right?

Second, your learning curve of new EHR's will be, and this is putting it nicely, vertical. The cherry on top is mastering how to walk the line of every place that has obvious problems, otherwise, you wouldn't be there. Fun times. Enjoy learning the intricacies of frequent stay programs from various hotel chains.

Having done all this, Third, you will be away from home 4 days a week. Your family will have to tolerate this. All of this happens until you of course upgrade to the jet, reducing the time and discomfort of traveling longer distance.

Fourth, and this is a gem, you'll have to master dealing with the locums agencies. Negotiate contracts properly, edit language, watch their reimbursement of your expenses like a hawk, and never, ever agree to anything less than 2600 a day, paid as a DAILY rate. Oh, did you say they need you yesterday? 3k/day. 25-30 on treatment routinely? 3.5k. You got this fam. No? "No thank you call me when you're serious."

But but..

top 100 movie quotes surely you cant be serious GIF
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I feel like the daily for a locums for any MD should be 1.5x above MGMA. That’s ordinary for most other specialties, and makes sense given the… extra things… to which you rightly allude. For rad onc this would mean… (1.5x550000)/250… a minimum of $3300 a day. I have never seen a locums offer for $3300 a day. YMMV.
 
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TheWallnerus said:
I feel like the daily for a locums for any MD should be 1.5x above MGMA. That’s ordinary for most other specialties, and makes sense given the… extra things… to which you rightly allude. For rad onc this would mean… (1.5x550000)/250… a minimum of $3300 a day. I have never seen a locums offer for $3300 a day. YMMV.
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I get the sense some of these open offer/name your own price postings might pay you $3k+ a day
 
medgator said:
I get the sense some of these open offer/name your own price postings might pay you $3k+ a day
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Would like to see to believe there’s a 3300 to 3500 a day rad onc locums gig out there. Probably have to network your anus off for it.

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There is mos def a 3k a day gig, just depends how badly they need someone, and whether you are going to sell yourself out. Tell the recruiter what is required, and you may be surprised. You get what you negotiate.

You want, you pay.

#
 
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TheWallnerus said:
I feel like the daily for a locums for any MD should be 1.5x above MGMA. That’s ordinary for most other specialties, and makes sense given the… extra things… to which you rightly allude. For rad onc this would mean… (1.5x550000)/250… a minimum of $3300 a day. I have never seen a locums offer for $3300 a day. YMMV.
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MGMA 90th percentile is 900k how much do you guys think the top 1% are making?
 
Ultra busy dudes who actually get 90-95% of their pro fees are typically owners of the practice. And even then, if they are 'the minority' ie working for a gang of uro or medonc types.. you can bet they are closer to 80%... and they get a bonus check year end if they make partner. In theory.
 
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Neuronix said:
Is it? That's actually the first time I've seen $2000/day locums in Florida except the 2 days a week prison gig that used to get sent around a lot in north Florida.
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Can confirm from others that locums pays dookie in FL. The recruiters even tell you that. So many old ROs there...
 
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sam1234567 said:
MGMA 90th percentile is 900k how much do you guys think the top 1% are making?
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Is it 900K now? The 1%ile Medicare reimbursement in rad onc is around $3m and up if I recall correctly. Multiply by 3 and that’s the global 1%ile probably. Given a 20% of the global, the 1%ile is likely $1.5-$1.8m a year. The pay distribution in rad onc is in no ways bell shaped, and the average is a lot higher than the median (despite the impression one might get from reading MGMA %iles).
 
The guys doing 1.5m based on pro fees alone are WORKING hard at it 5 days a week.

There are also plenty of W2 slaves doing a similar workload and getting paid roughly 1/3 of that.

Then, there are the unicorns.
 
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sirspamalot said:
The guys doing 1.5m based on pro fees alone are WORKING hard at it 5 days a week.

There are also plenty of W2 slaves doing a similar workload and getting paid roughly 1/3 of that.

Then, there are the unicorns.
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Almost impossible to get 1.5 from pro fees alone. I’m thinking more the freestanding dudes
 
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I did 1.8 in pro but that was in (checks notes).. ah right, the golden years of 2004-2009.. working at 2.5FTE workload. I loved the test. But.. I'm older now and would def not want to work that hard again. At least, not without seriously good PA level help... and even then.. its just a lot.

I'm happy to get my # nut now and do it working at a quarter (or an eighth) of the pace.
 
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TheWallnerus said:
I feel like the daily for a locums for any MD should be 1.5x above MGMA. That’s ordinary for most other specialties, and makes sense given the… extra things… to which you rightly allude. For rad onc this would mean… (1.5x550000)/250… a minimum of $3300 a day. I have never seen a locums offer for $3300 a day. YMMV.
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there's two types of locums in rad onc. There's the come in to a hell-hole for as long as you can take it and there's the 3 day babysitter octogenarian. I almost recently lost coverage due to a hospitalization. I told him he could still cover for me if he could get transferred here, even if intubated. It seems like the agencies are paying the same for both.
 
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They are paying whatever you'll accept. The hell hole (location) is often also a babysitter almost type job (5-15 on treatment).

But if there is NO ONE THERE and NO ONE COMING they have no choice as the clock ticks down but to pay what you demand.

Its amazing the calls I've gotten by simply saying "NO."

If you are going to make me go to a highly geographically undesirable location.. then I'm getting paid.
 
Ray D. Ayshun said:
there's two types of locums in rad onc. There's the come in to a hell-hole for as long as you can take it and there's the 3 day babysitter octogenarian. I almost recently lost coverage due to a hospitalization. I told him he could still cover for me if he could get transferred here, even if intubated. It seems like the agencies are paying the same for both.
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An intubated rad onc providing supervision.

I think that would not be legal (“immediately available” and all that) but, I guess if he were awake (ouch!) and extubatable it would be.
 
TheWallnerus said:
An intubated rad onc providing supervision.

I think that would not be legal (“immediately available” and all that) but, I guess if he were awake (ouch!) and extubatable it would be.
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Can someone with locked in syndrome supervise? There's never a question in the department that has to be answered that day, so even if you misinterpreted eye blinks things would still be fine.
 
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Ray D. Ayshun said:
Can someone with locked in syndrome supervise? There's never a question in the department that has to be answered that day, so even if you misinterpreted eye blinks things would still be fine.
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The Diving Bell and the Butterfly just came out on blu ray, can highly recommend; and yes locked-ins could fully supervise, and if they were not allowed it would be a violation of the ADA Act.
 
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ah yeah the narrative of the magic fountain of amazing jobs out there is back after ASTRO jobs report. The field is healthier than it has ever been is what many people are saying. You only need to outhustle, outnetwork, out golden handshake your way to the magical extremely high paying job. Just network bro! Lots of losers who suck at networking ya know.

It is funny to me for as much as people talk of “meritocracies”, a field with supposedly secret jobs is not a meritocracy at all. This is a field replete with elitism and nepo babies. And somehow we are told this is a good thing. You know what they say about the breadlines folks!
 
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TheWallnerus said:
Hard $2000/day ceiling settling in. Except for pilots and go-getters!

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Carlsbad NM was blowing up my inbox a month ago starting at $220 an hour which was negotiable. Kearney ne and lake havasu AZ were starting at $2k a day last year with no takers i don't think. If they are still looking I'm sure all 3 are going to be paying above that rate now
 
Meanwhile..

Northeast- $500-550 per hour! Midwest- $550-600 per hour!

Kat with VeloSource checking to see if you would be interested in a new Medical Oncology or Hematology/Oncology opportunity in the Northeast or Midwest?
 
medgator said:
Carlsbad NM was blowing up my inbox a month ago starting at $220 an hour which was negotiable. Kearney ne and lake havasu AZ were starting at $2k a day last year with no takers i don't think. If they are still looking I'm sure all 3 are going to be paying above that rate now
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I just got call re: some place in NM today. Sounds like they're still looking!
 
thecarbonionangle said:
ah yeah the narrative of the magic fountain of amazing jobs out there is back after ASTRO jobs report. The field is healthier than it has ever been is what many people are saying. You only need to outhustle, outnetwork, out golden handshake your way to the magical extremely high paying job. Just network bro! Lots of losers who suck at networking ya know.

It is funny to me for as much as people talk of “meritocracies”, a field with supposedly secret jobs is not a meritocracy at all. This is a field replete with elitism and nepo babies. And somehow we are told this is a good thing. You know what they say about the breadlines folks!
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Just gotta be able to swim faster then everyone else, not any harder then that. I’m hearing the same in ER world too.
 
fiji128 said:
Just gotta be able to swim faster then everyone else, not any harder then that. I’m hearing the same in ER world too.
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Gotta keep the plebs hopeful so they don’t stop working
 
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medgator said:
Sounds rough. Probably a sister city to this one:

www.latimes.com

Can this town save itself from fentanyl addiction? The race to turn around a threatened community

The town of Española, N.M., has struggled with drug addiction for generations. But fentanyl has contributed to rising homelessness and overdose rates.
www.latimes.com www.latimes.com
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The Carlsbad NM job has been advertised for 10+ plus years off and on. It hasn’t been advertised lately the last few years but has been again over the last few months. I guess they lost their doc.
 
Carlsbad Caverns and then GTFO cause there is nothing else there. They will hire anyone without a felony conviction desperate AF
 
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MDbecomesMD said:
Hello, rad oncs. I am a medical student who is very interested in oncology (along with a few other specialities.. still figuring things out). It is my understanding that rad onc (similarly to EM) is having a crisis of sorts regarding the future job market. What suggestions do you have for a young student trying to plan for the future? Heme-Onc? Med-Onc? Something else entirely? Would love any tips you all have :) Happy Hump day.
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When I was matching in 2013, Rad Onc was considered to be one of those specialities where, when you match, you are "set for life", never having to worry about having a lucrative job again. A lot of people went into the field with that expectation. Due to oversupply of residents and decreasing indications for radiation, this dynamic has changed. While, on a whole, we remain well compensated (far higher than the average physician) and have a relatively awesome QOL, the job market is tight and there isn't a whole lot of flexibility in terms of finding a job in a given city (i.e. you may have to live somewhere you don't want to live). We are no longer considered "elite", which bugs some folks to immensely (I am sure you will see this in others' comments).

I personally love this field and would do it again, even knowing how things have changed since I applied... but there are many others who do not feel the same way and are very frustrated about how the job market has changed. I would only go into radiation oncology if you truly love the field... I would NOT count on the lifestyle/compensation remaining as they are now. Things, of course, may improve... but I don't want to give you an overly rosy perspective.
 
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Lamount said:
When I was matching in 2013, Rad Onc was considered to be one of those specialities where, when you match, you are "set for life", never having to worry about having a lucrative job again. A lot of people went into the field with that expectation. Due to oversupply of residents and decreasing indications for radiation, this dynamic has changed. While, on a whole, we remain well compensated (far higher than the average physician) and have a relatively awesome QOL, the job market is tight and there isn't a whole lot of flexibility in terms of finding a job in a given city (i.e. you may have to live somewhere you don't want to live). We are no longer considered "elite", which bugs some folks to immensely (I am sure you will see this in others' comments).

I personally love this field and would do it again, even knowing how things have changed since I applied... but there are many others who do not feel the same way and are very frustrated about how the job market has changed. I would only go into radiation oncology if you truly love the field... I would NOT count on the lifestyle/compensation remaining as they are now. Things, of course, may improve... but I don't want to give you an overly rosy perspective.
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i dont disagree with you, but you will have a minimum 15+ good yrs in the field. Would not expect that at all for a present MS4
 
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Lamount said:
When I was matching in 2013, Rad Onc was considered to be one of those specialities where, when you match, you are "set for life", never having to worry about having a lucrative job again. A lot of people went into the field with that expectation. Due to oversupply of residents and decreasing indications for radiation, this dynamic has changed. While, on a whole, we remain well compensated (far higher than the average physician) and have a relatively awesome QOL, the job market is tight and there isn't a whole lot of flexibility in terms of finding a job in a given city (i.e. you may have to live somewhere you don't want to live). We are no longer considered "elite", which bugs some folks to immensely (I am sure you will see this in others' comments).

I personally love this field and would do it again, even knowing how things have changed since I applied... but there are many others who do not feel the same way and are very frustrated about how the job market has changed. I would only go into radiation oncology if you truly love the field... I would NOT count on the lifestyle/compensation remaining as they are now. Things, of course, may improve... but I don't want to give you an overly rosy perspective.
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Not being elite doesn’t seem to bug as many people as I would have expected

Not having a solid 30 year career however does.
 
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Fpg1245 said:
Not being elite doesn’t seem to bug as many people as I would have expected

Not having a solid 30 year career however does.
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Once you get out of academia no one really cares which specialty you are, except for insecure physicians, and no one really cares about their opinion anyway.

Physicians in the community who do well realize that, while we make a lot of money compared to the general population, compared with the Masters of the Universe we're all just working stiffs in the end. A helluva lot nicer to be a working stiff with job security than without.
 
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OTN said:
Once you get out of academia no one really cares which specialty you are, except for insecure physicians, and no one really cares about their opinion anyway.

Physicians in the community who do well realize that, while we make a lot of money compared to the general population, compared with the Masters of the Universe we're all just working stiffs in the end. A helluva lot nicer to be a working stiff with job security than without.
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Well apparently the masters of our universe have figured all all they need to do to export the living hell that is Academic Rad Onc is to pump out as much cheap labor as possible.
 
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Fpg1245 said:
Well apparently the masters of our universe have figured all all they need to do to export the living hell that is Academic Rad Onc is to pump out as much cheap labor as possible.
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The Masters of the Universe are in no way academic physicians who run radonc departments. They are masters of a tiny little village in a remote area of the world no one cares about.

Radonc department expansion was a great example of the tragedy of the commons being applied to a particular field which was run by a group of clinicians/academicians who did not have even the slightest understanding of supply and demand.
 
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Lamount said:
When I was matching in 2013, Rad Onc was considered to be one of those specialities where, when you match, you are "set for life", never having to worry about having a lucrative job again. A lot of people went into the field with that expectation. Due to oversupply of residents and decreasing indications for radiation, this dynamic has changed. While, on a whole, we remain well compensated (far higher than the average physician) and have a relatively awesome QOL, the job market is tight and there isn't a whole lot of flexibility in terms of finding a job in a given city (i.e. you may have to live somewhere you don't want to live). We are no longer considered "elite", which bugs some folks to immensely (I am sure you will see this in others' comments).

I personally love this field and would do it again, even knowing how things have changed since I applied... but there are many others who do not feel the same way and are very frustrated about how the job market has changed. I would only go into radiation oncology if you truly love the field... I would NOT count on the lifestyle/compensation remaining as they are now. Things, of course, may improve... but I don't want to give you an overly rosy perspective.
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Thanks so much for the thorough reply :) I'm not sure what happened to my original post-- I believe I may have removed it on accident. But this is certainly a lot for me to consider.
 
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Maybe this is the time to buy the rad onc stock!
 
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We do okay but in general, we probably underestimate how much other professions make, and also underestimate the variety of folks that make as much or more than us.

Humbling, for example, that a 28 yo Youtuber makes $1m pretax and $0.5m after tax. You got to wonder what you’ll do when AI takes your job.

 
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