Future of rad onc job market

[DrProtonX]

As most are aware, rad onc job market started to decline sometime around 2016-2017 due to multiple reasons (residency expansion, loss of indications, hypofrac etc). After covid-19, job market hit all time low and as a result rad onc went from one of the most competitive and prestigious specialties to the least competitive one. Since then, the job market has gotten better. Now my question for people who have been in the field for quite some time, do you think it keeps getting better for the next 5-10 years or do you think it was a dead cat bounce and unless major changes happen, it’ll decline again?

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[medgator]

 

[ramsesthenice]

As most are aware, rad onc job market started to decline sometime around 2016-2017 due to multiple reasons (residency expansion, loss of indications, hypofrac etc). After covid-19, job market hit all time low and as a result rad onc went from one of the most competitive and prestigious specialties to the least competitive one. Since then, the job market has gotten better. Now my question for people who have been in the field for quite some time, do you think it keeps getting better for the next 5-10 years or do you think it was a dead cat bounce and unless major changes happen, it’ll decline again?

It really depends on what you mean by the jab market. Do you mean number of jobs or quality of jobs? Either way, it is very, very hard for me to see it continuously improving over the near to mid term. I just don’t know what the driving force would be. I’m more optimistic than most in that I think there will be wins and losses and the overall availability of jobs will probably be fairly stable over the next 5-10 years. However, I don’t see anything stopping the continuous acquisitions by bigger players and I suspect the vast majority of rad onc jobs will become hospital employed in that time. For new grads who don’t know any different, that’s not necessarily the end of the world. In these jobs, you can still do interesting clinical work and have rewarding experiences caring for your patients for a decent (but probably not exceptional) salary (usually). But that doesn’t change the fact that a global loss of autonomy and bargaining power will be the result. As someone who values a certain degree of both, even in a research academic position, I think the quality of many jobs will suffer.

 

[IonsAreOurFuture]

As most are aware, rad onc job market started to decline sometime around 2016-2017 due to multiple reasons (residency expansion, loss of indications, hypofrac etc). After covid-19, job market hit all time low and as a result rad onc went from one of the most competitive and prestigious specialties to the least competitive one. Since then, the job market has gotten better. Now my question for people who have been in the field for quite some time, do you think it keeps getting better for the next 5-10 years or do you think it was a dead cat bounce and unless major changes happen, it’ll decline again?

You forgot to mention the RO APM program that ASTRO was pushing for (and was eventually defeated in congress, I think in part due to concentrated efforts by people in the proton world, among others).

Market/payment uncertainty is the biggest hiring killer in my opinion; why take on a new employee if you're not sure you're going to need them in a year?

 

[fiji128]

I would say compared to a few years ago, jobs and even decent ones are easier to find in not very desirable locations. Jobs in areas that most people would consider as desirable (lets say a location with at least one professional sports team) are still hard to come by and are often only available to those with an inside track. Great looking private practice jobs are still exceptionally rare.

As an example in locums market, I got a recruiter text yesterday offering $4,500k/day for clinic locums heme onc in New Orleans. You won't see anything like that for rad onc in that or a similar location.

 

[yesmaster]

As President Trump says, “there hasn’t been real job growth, those are bounceback jobs!”

In the long term, cancer vaccines cure or prevent most cancers.

In the medium to long term, AI takes our jobs.

In the short to medium term, we’re all employed by Optum, large hospital systems, academic systems, or the VA making mgma median with fierce competition for big city locations, limited lateral mobility, and no opportunity for growth.

 

[NotMattSpraker]

You forgot to mention the RO APM program that ASTRO was pushing for (and was eventually defeated in congress, I think in part due to concentrated efforts by people in the proton world, among others).

Market/payment uncertainty is the biggest hiring killer in my opinion; why take on a new employee if you're not sure you're going to need them in a year?

So, interestingly, this remains the official public stance of CMS on the RO-APM: Radiation Oncology Model | CMS. I agree it is dead, but it also seems like ROCR is dead. I am unaware of any alternatives being discussed.

On the second point, Im curious if that is really true that "payment uncertainty" is the hiring killer. I could easily see this being a propaganda point used by people to push ROCR that doesn't really generalize to most practices.

My personal anecdotal experience leads me to think that might not be true outside of small physician owned practices. The median RVU in academic centers, the most common job now, is quite low (at least per SCAROP data, with caveats of using median). Yet, academic centers continue to hire. In my own employed hospital network practice, it seems like coverage requirements have driven hiring decisions more than patient volume.

Id be interested in more discussion around this point. I genuinely don't know.

 

[IonsAreOurFuture]

So, interestingly, this remains the official public stance of CMS on the RO-APM: Radiation Oncology Model | CMS. I agree it is dead, but it also seems like ROCR is dead. I am unaware of any alternatives being discussed.

On the second point, Im curious if that is really true that "payment uncertainty" is the hiring killer. I could easily see this being a propaganda point used by people to push ROCR that doesn't really generalize to most practices.

My personal anecdotal experience leads me to think that might not be true outside of small physician owned practices. The median RVU in academic centers, the most common job now, is quite low (at least per SCAROP data, with caveats of using median). Yet, academic centers continue to hire. In my own employed hospital network practice, it seems like coverage requirements have driven hiring decisions more than patient volume.

Id be interested in more discussion around this point. I genuinely don't know.

Lots of consolidation of practices where I am right now. The big, rich systems are getting bigger and richer, for sure. What used to feel like 60 hospitals in 12 or more groups is now like 55 hospitals as part of 3 academic-ish mega-groups. The new mega-groups don't necessarily keep the old staff on board, or they might rehire them at lower salaries as junior faculty.

I don't expect the consolidation to end anytime soon, unless regulators realize the monopoly power of only 1 major healthcare player covering huge tracts of land.

 

[NotMattSpraker]

Lots of consolidation of practices where I am right now. The big, rich systems are getting bigger and richer, for sure. What used to feel like 60 hospitals in 12 or more groups is now like 55 hospitals as part of 3 academic-ish mega-groups. The new mega-groups don't necessarily keep the old staff on board, or they might rehire them at lower salaries as junior faculty.

I don't expect the consolidation to end anytime soon, unless regulators realize the monopoly power of only 1 major healthcare player covering huge tracts of land.

Right. So I am curious to understand how radiation oncology billing "uncertainty" matters to a mega group that employs thousands of doctors in every specialty.

 

[yesmaster]

In terms of maximal number of jobs, best case scenario is more academic and community hospital network expansion. Simply put, they get the highest rates, and have the least requirements as far as patient load per physician. Many would say a low patient load per physician is a feature of the system - that way there’s no way to build a large personal referral base that you can take with you when you leave the practice. Depends on geography and practice environment but 3-5 new consults a week, 10-15 on treat is very safe/financially sustainable and doable for large systems with good insurance rates and hospital based billing.

These are usually iffy quality jobs. Best thing for private practice and to boost quality of jobs is for DOGE to realize how inefficient hospital or university based care is, or site neutral billing. Then with competition hospital and academic systems will likely lose market share, but there’ll be fewer number of jobs as well.

 

[randomname2018]

do you think it keeps getting better for the next 5-10 years

No. There is a difference between climate change and weather. The radiation oncology job market improvement post covid was transient.

I have not seen any compelling action from any major Radiation Oncology organization that portends improvement in any measurable metric. RVUs, geographic distribution, legitimate payment reform, resident numbers, case minimums, expanding indications, supervision, etc.

 

[Lamount]

No. There is a difference between climate change and weather. The radiation oncology job market improvement post covid was transient.

I have not seen any compelling action from any major Radiation Oncology organization that portends improvement in any measurable metric. RVUs, geographic distribution, legitimate payment reform, resident numbers, case minimums, expanding indications, supervision, etc.

FWIW, depending on your timeframe, the crash could also be considered transient. In 2016 (when I was in residency) it was great. It seemed like it crashed right after I signed in early 2019, and now it’s back. There are definitely headwinds, but it would be hubris to assume we know all the factors at play.

 

[NotMattSpraker]

My question back to @DrProtonX is: how do you define a "better job market"? Im just curious, love the topic, and as you may know the leadership of this field actively try to quash any organized discussion.

I graduated in 2018 and think the market was not good at that time by my own subjective definition. It seems much better now, but Im curious what that means to you.

Related, how do people define a "crash"?

 

[ramsesthenice]

FWIW, depending on your timeframe, the crash could also be considered transient. In 2016 (when I was in residency) it was great. It seemed like it crashed right after I signed in early 2019, and now it’s back. There are definitely headwinds, but it would be hubris to assume we know all the factors at play.

I don’t think we had a crash. The ratio of jobs to new grads progressively got worse and job opportunities predictably followed. Expansion has slowed and I think we are in a place it will be generally stable for some time. There will naturally be good years and bad years, but I doubt there will be many consistent trends in the near to mid term. Of course, if we do see anything consistent, odds are it won’t be great.

The thing is, it’s all about perspective. A good year now means there will be multiple good jobs in decent places up for grabs and applicants may have a couple of offers. Even around 10 years ago when I finished, it was reasonable to expect 3-4 offers in a good year. Go back 15-20 years…provably better you don’t know. Ignorance is bliss sometimes.

 

[evilbooyaa]

I don’t think we had a crash. The ratio of jobs to new grads progressively got worse and job opportunities predictably followed. Expansion has slowed and I think we are in a place it will be generally stable for some time. There will naturally be good years and bad years, but I doubt there will be many consistent trends in the near to mid term. Of course, if we do see anything consistent, odds are it won’t be great.

The thing is, it’s all about perspective. A good year now means there will be multiple good jobs in decent places up for grabs and applicants may have a couple of offers. Even around 10 years ago when I finished, it was reasonable to expect 3-4 offers in a good year. Go back 15-20 years…provably better you don’t know. Ignorance is bliss sometimes.

This assumes 200 a year is what is necessary for steady state, when it was 110s for over a decade before that. I strongly think that to be unlikely. I think the wave of post-COVID retirements are still riding pretty high overall and at some point the game of musical chairs will become problematic.

 

[IonsAreOurFuture]

No. There is a difference between climate change and weather. The radiation oncology job market improvement post covid was transient.

I have not seen any compelling action from any major Radiation Oncology organization that portends improvement in any measurable metric. RVUs, geographic distribution, legitimate payment reform, resident numbers, case minimums, expanding indications, supervision, etc.

That's a great analogy, climate change vs weather.

On the macro scale, IMRT and SRS/SBRT and HDR were all ways of getting paid a lot more to deliver basically the same tumor control with fewer side effects. There was huge uptake, and a lot of smaller community hospitals that never had a rad onc before built linacs that had to be staffed by someone on site (ROCR re-attempting this?). Our professional codes didn't change, but salaries went up as long as hospitals (i.e. machine owners) were paying. The rising tide of technical innovation lifted all boats.

There are some new modalities that could be IMRT-esque in impact, but they require a significant capital investment and vault retrofit:

MRI linac - if daily online adaptive or real-time tracking got some great CPT codes

Reflexion - seems to have good codes but workflow seems really slow even for multiple met cases - will probably improve with experience

Protons - current consensus guidelines support use in about 15% of patients and this is going up over time, especially if upcoming trial results are positive.

Large institutions like university networks, NCI and NCCN can likely support at least one of the above if not all 3, and would rely on their community practices to send cases. Guidelines like NCCN are beginning to include these new modalities more and more.

Consolidation of community practices could help justify getting a machine that treats 15% of cases. There are still plenty of Gamma Knife units, and they're even more niche nowadays and nothing special code-wise. That vault could be re-filled with something that a Truebeam can't duplicate.

We as a field (and our patients) could potentially benefit from embracing new alternatives to IMRT.

 

[NotMattSpraker]

That's a great analogy, climate change vs weather.

Good time to re-share this article from Ol' Graypeace -

Closing paragraph:

The crisis in the field is real. One cannot look at the data honestly and say “The job market will be fine in the future.” RO has double the number of residents and a steadily decreasing workload. There are measures to delay (fellowships) or maintain employment (artificial “props” like direct supervision and underutilization of hypofractionation). Interest in the field is decreasing amongst American medical students and it has nothing to do with lack of awareness of RO. In fact, it has to do with increasing awareness of the problems in RO. Climate change debate rhetoric limiting effective solutions and cooperation arguably led to the climate problems seen today getting worse and worse. This would be tragic were a similar scenario to play out in radiation oncology. Bad-faith arguments, ad hominem attacks, and less-than-candid discussions with future physicians can’t be allowed to continue. Students, residents, and young faculty must be the change as senior leadership have abandoned their duty. Having communicated with so many of our young stars over the last few years, we remain optimistic that our field can take corrective action and strengthen the foundation so the field can sustain, and hopefully improve, the outlook for the specialty.

😳

 

[ramsesthenice]

This assumes 200 a year is what is necessary for steady state, when it was 110s for over a decade before that. I strongly think that to be unlikely. I think the wave of post-COVID retirements are still riding pretty high overall and at some point the game of musical chairs will become problematic.

I can’t remember who said it above, but I think that’s going to be partially offset by the academmunity model (my terminology) of more people carrying lower loads. I’ve definitely seen a fair bit of this first hand. Which, even if true, gets back to the original question about what one means when they say job market. Number of jobs is only 1 variable.

 

[NotMattSpraker]

I can’t remember who said it above, but I think that’s going to be partially offset by the academmunity model (my terminology) of more people carrying lower loads. I’ve definitely seen a fair bit of this first hand. Which, even if true, gets back to the original question about what one means when they say job market. Number of jobs is only 1 variable.

I did.

Median RVU for all comers in the SCROP 2021 survey is <7500. It would be interesting to know what it is in later surveys if that data is available.

My "community" hospital network employed RVU target based on median of a "mixed model" is around 10,000.

 

[Gfunk6]

Good time to re-share this article from Ol' Graypeace -

Closing paragraph:



😳

What an outstanding article - and it was written nearly five years ago!

 

[medgator]

I can’t remember who said it above, but I think that’s going to be partially offset by the academmunity model (my terminology) of more people carrying lower loads. I’ve definitely seen a fair bit of this first hand. Which, even if true, gets back to the original question about what one means when they say job market. Number of jobs is only 1 variable.

ASTRO definitely tried to keep the direct supervision reg battle going as long as it could to find employment for grads 150-200 going forward

 

[ramsesthenice]

I did.

Median RVU for all comers in the SCROP 2021 survey is <7500. It would be interesting to know what it is in later surveys if that data is available.

My "community" hospital network employed RVU target based on median of a "mixed model" is around 10,000.

That is very believable. A common academic benchmark is in the range of 1000 RVU per 0.1 clinical FTE.

 

[Chartreuse Wombat]

I did.

Median RVU for all comers in the SCROP 2021 survey is <7500. It would be interesting to know what it is in later surveys if that data is available.

My "community" hospital network employed RVU target based on median of a "mixed model" is around 10,000.

More context. From the SCAROP survey in 2021

wRVU percentiles 25% 50% 75%

SCAROP 2021 (All, including 0.1-1.0 FTE) 5,253 7,461 9,427



SCAROP 2021 (Clinical, generally 0.8 FTE) 6,803 8,668 10,208

Apples to oranges but agree it would be interesting to see the numbers in 2025-2026

 

[evilbooyaa]

I can’t remember who said it above, but I think that’s going to be partially offset by the academmunity model (my terminology) of more people carrying lower loads. I’ve definitely seen a fair bit of this first hand. Which, even if true, gets back to the original question about what one means when they say job market. Number of jobs is only 1 variable.

Rather than one person hauling ass and making 900k, you'll have 2 people doing the work and clearing 350k each. Institution gets to pocket the 200k difference. Sounds promising.

 

[ramsesthenice]

Rather than one person hauling ass and making 900k, you'll have 2 people doing the work and clearing 350k each. Institution gets to pocket the 200k difference. Sounds promising.

There you go saying the quiet part out loud. But yes, that’s precisely the point of the academic community employed model. Promising indeed 🙁. This is precisely what I meant by loss of autonomy and bargaining power in the employment model.

 

[NotMattSpraker]

More context. From the SCAROP survey in 2021

wRVU percentiles 25% 50% 75%

SCAROP 2021 (All, including 0.1-1.0 FTE) 5,253 7,461 9,427



SCAROP 2021 (Clinical, generally 0.8 FTE) 6,803 8,668 10,208

Apples to oranges but agree it would be interesting to see the numbers in 2025-2026

Apples to oranges depends on what we are talking about. My comment was definitely; I was comparing SCAROP data on performance to my target. Im not sure SCAROP data isn't generalizable to most graduating ROs though, regardless of whether they join a university.

The point above about job quality is important. As academics expand, the problem will be coverage not patient volume (assumes most still doing direct supervision). It is better in that situation to have 2 docs making 400K doing 6000 RVU than 1 doc doing 12000 RVU even if the money scales. Many contracts the physician gets more expensive as they produce more, so even better to have lots of slow docs.

In my relatively short career Ive had a range of production including 1 year at about 6000 RVU. That is really slow. If you are young and eager and wanting to make more than academic base with no way up, thats frustrating. Its also kind of boring. Its not like there is loads of academic research funding floating around in our field.

I don't think well see a "crash" with unemployment but certainly could see a lot of unhappy and bored early career docs with very little mobility. We know for a fact that is exactly what at least one academic chair wanted, it's published in Red 🤷‍♂️

 

[DrProtonX]

My question back to @DrProtonX is: how do you define a "better job market"? Im just curious, love the topic, and as you may know the leadership of this field actively try to quash any organized discussion.

I graduated in 2018 and think the market was not good at that time by my own subjective definition. It seems much better now, but Im curious what that means to you.

Related, how do people define a "crash"?

Great question. I think there are somewhat objective markers like average compensation, number of jobs available. Then there are some subjective ones like quality of those available jobs. For each job I think the main criteria are compensation, location and type of practice. So for me, the strength of job market is what percent of new grads (or anyone looking for a position) get a job that checks off at least 2 out of 3.

 

[RickyScott]

There you go saying the quiet part out loud. But yes, that’s precisely the point of the academic community employed model. Promising indeed 🙁. This is precisely what I meant by loss of autonomy and bargaining power in the employment model.

My first chair out of residency told me that hiring more docs "brings more birds out of the bushes" when it comes to patients. At 10x cms prices, it does not take many "extra/overtreated/overfractionated" pts to justify a salary (2-3 prostate pts?).

 

[metallica81788]

My first chair out of residency told me that hiring more docs "brings more birds out of the bushes" when it comes to patients

I've heard that before from some hospital systems and while it could make sense in other specialties - absolutely laughable for RadOnc

 

[evilbooyaa]

Great question. I think there are somewhat objective markers like average compensation, number of jobs available. Then there are some subjective ones like quality of those available jobs. For each job I think the main criteria are compensation, location and type of practice. So for me, the strength of job market is what percent of new grads (or anyone looking for a position) get a job that checks off at least 2 out of 3.

The tough part is that compensation expectations are pretty different. New grads are accustomed to, if staying in a city they want to live in, starting in the 300-400k range. 500k+ for a new grad is unlikely unless it's a less desireable (smaller population) city/town/village, most of the time.

This is likely different than what people were getting say 20 years ago.

 

[NotMattSpraker]

I've heard that before from some hospital systems and while it could make sense in other specialties - absolutely laughable for RadOnc

Yea its funny how this phenomenon never comes up in the Rad Onc financial toxicity literature.

 

[medgator]

Yea its funny how this phenomenon never comes up in the Rad Onc financial toxicity literature.

Financial toxicity is a funny thing in rad onc. Depends on who is talking about it and who the audience is

 

[yesmaster]

Financial toxicity is parking lot fees. It’s definitely not protons or PPS exempt NCI designated legal robbery rates.

 

[RickyScott]

The tough part is that compensation expectations are pretty different. New grads are accustomed to, if staying in a city they want to live in, starting in the 300-400k range. 500k+ for a new grad is unlikely unless it's a less desireable (smaller population) city/town/village, most of the time.

This is likely different than what people were getting say 20 years ago.

coming up on 20 years. 20 years ago, jobs were available in almost every desirable location and a starting salary in major east coast cities was around 250k. Best jobs were high paying partnership tracks in desirable locations w/groups like Coia, Princeton, sero etc.

 

[DoctwoB]

Rather than one person hauling ass and making 900k, you'll have 2 people doing the work and clearing 350k each. Institution gets to pocket the 200k difference. Sounds promising.

Doesn't make a ton of sense to me from the perspective of a chair/admin. Benefits are an extra 50k per person which cuts into margins of employing more. Sure you may be better off with 2 at 350 then one at 900, but that's not savings maximizing.

If the labor market supports it, hire one person full time at 500k who works hard instead of two at 350 who are working at half capacity. One person at 500 with maybe an extra 50k in per diem payments for coverage as needed. Academic departments that i know aren't in the business of handouts to support jobs for underutilized faculty.

 

[ramsesthenice]

Doesn't make a ton of sense to me from the perspective of a chair/admin. Benefits are an extra 50k per person which cuts into margins of employing more. Sure you may be better off with 2 at 350 then one at 900, but that's not savings maximizing.

If the labor market supports it, hire one person full time at 500k who works hard instead of two at 350 who are working at half capacity. One person at 500 with maybe an extra 50k in per diem payments for coverage as needed. Academic departments that i know aren't in the business of handouts to support jobs for underutilized faculty.

Conceptually, I agree with you. In practice though, this is what is happening in my current region and where I trained. There is a lot about the acquisition model I don’t entirely understand.

There is also a big part of me that thinks a lot of what we are seeing has less to do with strategy and more to do with systems just doing what they have always done. They have it in their mind what they think is fair pay per clinical FTE based on what they have always done internally. Same for how they define a full clinical volume. Or pay based on rank (even for the non academic faculty). And don’t get me started on the absolute fealty to maintaining uniformity. It rears its head in the form of comments like “We can’t pay Dr X that much money. If we did, we’d have to give everyone at a raise!” In short, I’m not always convinced there is a rational method to the madness.

Personally, I think I would take a more Babylonian approach to governance. If I acquired a profitable center, I’d focus on incorporating them into our referral network, and then stay out of their was as much as possible. Why tinker with the culture if its working? As you can imagine, that’s not how it has typically gone in my experience.

 

[Chartreuse Wombat]

Doesn't make a ton of sense to me from the perspective of a chair/admin. Benefits are an extra 50k per person which cuts into margins of employing more. Sure you may be better off with 2 at 350 then one at 900, but that's not savings maximizing.

If the labor market supports it, hire one person full time at 500k who works hard instead of two at 350 who are working at half capacity. One person at 500 with maybe an extra 50k in per diem payments for coverage as needed. Academic departments that i know aren't in the business of handouts to support jobs for underutilized faculty.

That makes financial sense but most of the *****s that are running RO departments seem to take pride in the number of people that they "manage".

 

[Chartreuse Wombat]

Is AI deleting the word *****?

 

[Chartreuse Wombat]

Starts with M then the letter O and ends with the name of actor that played OPIE (also a film maker).

Gee whiz...the robot overlords have taken over this space

 

[OTN]

Conceptually, I agree with you. In practice though, this is what is happening in my current region and where I trained. There is a lot about the acquisition model I don’t entirely understand.

There is also a big part of me that thinks a lot of what we are seeing has less to do with strategy and more to do with systems just doing what they have always done. They have it in their mind what they think is fair pay per clinical FTE based on what they have always done internally. Same for how they define a full clinical volume. Or pay based on rank (even for the non academic faculty). And don’t get me started on the absolute fealty to maintaining uniformity. It rears its head in the form of comments like “We can’t pay Dr X that much money. If we did, we’d have to give everyone at a raise!” In short, I’m not always convinced there is a rational method to the madness.

Personally, I think I would take a more Babylonian approach to governance. If I acquired a profitable center, I’d focus on incorporating them into our referral network, and then stay out of their was as much as possible. Why tinker with the culture if its working? As you can imagine, that’s not how it has typically gone in my experience.

A friend of mine was a CFO for a hospital and was very successful because he did precisely this- greased the skids as much as possible for us docs to be happy and do the doctoring. Who woulda thunk?

 

[NotMattSpraker]

“We can’t pay Dr X that much money. If we did, we’d have to give everyone at a raise!”

Haha a well known department clinical leader once said exactly this to me. I said yes that would be great. Of course it did not happen. Within a year or so a huge portion of the faculty had left.

Leaders respond to incentives and beyond that only act rationally with respect to their own priorities.

 

[evilbooyaa]

Doesn't make a ton of sense to me from the perspective of a chair/admin. Benefits are an extra 50k per person which cuts into margins of employing more. Sure you may be better off with 2 at 350 then one at 900, but that's not savings maximizing.

If the labor market supports it, hire one person full time at 500k who works hard instead of two at 350 who are working at half capacity. One person at 500 with maybe an extra 50k in per diem payments for coverage as needed. Academic departments that i know aren't in the business of handouts to support jobs for underutilized faculty.

The hard part is that paying someone to do the work of 2 full-time people only $500k (instead of $350k) is very hard to maintain in Rad Onc. Nearly all jobs have a $/RVU amount that they get paid after they exceed their clinical expectations.

Places that don't offer a $/RVU bonus above a certain threshold either 1) pay VERY well off the bat (I believe Mayo is in this boat), not sure if Kaiser LA? or 2) Have a revolving door of attendings who get churned and burned.

Even in academics, being known as the academic center that can't retain is a hard reputation to fight off. Wash U Rad Onc had a huge exodus of some of their best and brightest in the past 5-10 years that people STILL talk about to this day. Probably the reason they have a new chair....

 

[yesmaster]

For the academic chairs, the natural end goal of rad onc job market is to deliver care in the highest cost setting (maximal billing) with the lowest paid providers.

Cancer patients in the next ROCR cms bill will get a $2k travel voucher to go to Fred Hutch, Harvard, MDA, or one of the UC’s to get protons. Progress?!

 

[fiji128]

ROCR cms bill will get a $2k travel voucher to go to Fred Hutch, Harvard, MDA, or one of the UC’s to get protons.

This is such an important point about ROCR. It hasn't gotten nearly enough attention with most people previously thinking this was good for everyone. Hopefully a mute point because is ROCR still a thing?

 

[RickyScott]

For the academic chairs, the natural end goal of rad onc job market is to deliver care in the highest cost setting (maximal billing) with the lowest paid providers.

Cancer patients in the next ROCR cms bill will get a $2k travel voucher to go to Fred Hutch, Harvard, MDA, or one of the UC’s to get protons. Progress?!

Is it actually 2k?

 

[NotMattSpraker]

Is it actually 2k?

It's a $500 technical payment to hospitals for patients that quality for a Z-code with no mechanism for accountability to ensure these funds are spent on actually helping patients. I genuinely cant tell if the people pushing this initiative are naive or malicious.

A big limitation of ROCR last year was that they never got a CBO score. I just googled and this popped, had not seen it before:

https://www.astro.org/blog/november-2024/the-rocr-act-past,-present-and-future

If this ever gets legs, I will be reaching out to my representatives with my concerns about consolidation, conflicts of interest, and the propagation of site of service payment inequality. I care about these things because they impact competition and the leverage of large networks, which in my opinion should be the biggest concerns of employed radiation oncologists.

Meanwhile, it seems like meaningful updates to the MPFS are possible in the coming years. There are growing concerns about consolidation among politicians. It would be very disappointing if we remove ourselves at a time where there is a chance medicare could improve and make the environment better for physicians.

 

[fiji128]

It's a $500 technical payment to hospitals for patients that quality for a Z-code with no mechanism for accountability to ensure these funds are spent on actually helping patients. I genuinely cant tell if the people pushing this initiative are naive or malicious.

A big limitation of ROCR last year was that they never got a CBO score. I just googled and this popped, had not seen it before:

https://www.astro.org/blog/november-2024/the-rocr-act-past,-present-and-future

If this ever gets legs, I will be reaching out to my representatives with my concerns about consolidation, conflicts of interest, and the propagation of site of service payment inequality. I care about these things because they impact competition and the leverage of large networks, which in my opinion should be the biggest concerns of employed radiation oncologists.

Meanwhile, it seems like meaningful updates to the MPFS are possible in the coming years. There are growing concerns about consolidation among politicians. It would be very disappointing if we remove ourselves at a time where there is a chance medicare could improve and make the environment better for physicians.

Thanks for that link, seems like the strategy is to get it into some giant bill (as it seems like most thing are) probably with the hope that it otherwise goes unnoticed. Still don't really understand why congress would generally want to pass this carve out from Medicare for rad onc.

 

[IonsAreOurFuture]

Thanks for that link, seems like the strategy is to get it into some giant bill (as it seems like most thing are) probably with the hope that it otherwise goes unnoticed. Still don't really understand why congress would generally want to pass this carve out from Medicare for rad onc.

There is pretty good data that patients who live further from a rad onc center don't get the radiation they need.

I think there's good clinical justification to help patients with travel, just like Medicare Advantage plans have started giving patients Uber rides to their primary care doctors, hoping to avoid ambulance rides to the ER.

I can't believe I just saw something good about a Medicare disAdvantage plan!

 

[NotMattSpraker]

There is pretty good data that patients who live further from a rad onc center don't get the radiation they need.

I think there's good clinical justification to help patients with travel, just like Medicare Advantage plans have started giving patients Uber rides to their primary care doctors, hoping to avoid ambulance rides to the ER.

I can't believe I just saw something good about a Medicare disAdvantage plan!

Im not sure the retrospective data captures the whole picture, but my issue is actually not with transportation or housing support. I do believe this is an important problem to solve. My opinion on this has changed so much moving from academics to community, working some rural, and taking a quality leadership role for a large network.

The biggest problem in my opinion is with giving centers a no strings attached $500 technical payment for simply assigning a code. I would have zero confidence that the company I work for now would take this money and put it towards real patients' transportation.

MedPAC is recommending an add-on payment bonus for low income patients because low income status is associated with poor access. Why not do it that way? After all, one of the critiques of ROCR was that it does not adequately compensate centers that primarily care for complex/low income patients.

I think Beckta captures the issues with HEART well in his podcast:

I am sure it is well intentioned, but it comes off as an Ivory Tower vision that is an inadequate real life solution.

 

[evilbooyaa]

Im not sure the retrospective data captures the whole picture, but my issue is actually not with transportation or housing support. I do believe this is an important problem to solve. My opinion on this has changed so much moving from academics to community, working some rural, and taking a quality leadership role for a large network.

The biggest problem in my opinion is with giving centers a no strings attached $500 technical payment for simply assigning a code. I would have zero confidence that the company I work for now would take this money and put it towards real patients' transportation.

MedPAC is recommending an add-on payment bonus for low income patients because low income status is associated with poor access. Why not do it that way? After all, one of the critiques of ROCR was that it does not adequately compensate centers that primarily care for complex/low income patients.

I think Beckta captures the issues with HEART well in his podcast:

I am sure it is well intentioned, but it comes off as an Ivory Tower vision that is an inadequate real life solution.

Relying on any large institution (profit or non-profit) to act in anyway that is not, at the end of the day, a business is a losing proposition.