Future of rad onc job market

[RSAOaky]

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.

As a health system, having 2 physicians making 350 rather than 1 making 700 gives you redundancy, protection, and stifles negotiating power. Let's say you have a satellite run by 1 doc making 700k. If that person needs to take vacation, maternity/paternity leave, sick leave, etc, the health system need to find coverage. If that doc has any employment demands, the hospital has more pressure to accommodate.

Now let's say you have 2 physicians covering that satellite. These coverage problems disappear. If one of them threatens to walk unless they get a raise, the health system has built-in coverage while they find a replacement. If the health system needs coverage at a separate satellite, they have an extra body to float.

The problem with the model is that it becomes a revolving door. When the new grad making 350k hits year 3 and doesn't get the raise they'd like, they leave. However, you have the other doc to pick up the slack while they're gone, maybe even to their benefit ala RVU bonus, and if the clinic is in a desirable location there are a lot of new grads willing to step in and fill the void. Rinse and repeat.

---

Members don't see this ad.

 

[thesauce]

As a health system, having 2 physicians making 350 rather than 1 making 700 gives you redundancy, protection, and stifles negotiating power. Let's say you have a satellite run by 1 doc making 700k. If that person needs to take vacation, maternity/paternity leave, sick leave, etc, the health system need to find coverage. If that doc has any employment demands, the hospital has more pressure to accommodate.

Now let's say you have 2 physicians covering that satellite. These coverage problems disappear. If one of them threatens to walk unless they get a raise, the health system has built-in coverage while they find a replacement. If the health system needs coverage at a separate satellite, they have an extra body to float.

The problem with the model is that it becomes a revolving door. When the new grad making 350k hits year 3 and doesn't get the raise they'd like, they leave. However, you have the other doc to pick up the slack while they're gone, maybe even to their benefit ala RVU bonus, and if the clinic is in a desirable location there are a lot of new grads willing to step in and fill the void. Rinse and repeat.

Absolutely true. Add in that academic networks get referrals based on their name and not the reputation or quality of the individual physician. So long as doc’s identity is tied to the name of the institution, they can simply be replaced and business goes on as usual.

The entire Mayo faculty could walk out in a day and be replaced with locums and patients would still be referred there like it never happened.

 

[RadOncDoc21]

Absolutely true. Add in that academic networks get referrals based on their name and not the reputation or quality of the individual physician. So long as doc’s identity is tied to the name of the institution, they can simply be replaced and business goes on as usual.

The entire Mayo faculty could walk out in a day and be replaced with locums and patients would still be referred there like it never happened.

Funny thing is a lot of docs represent their institution as if it is their favorite sports team and go in hard drinking the kool-aid believing they are “special” when we are all the same!

 

[Neuronix]

Funny thing is a lot of docs represent their institution as if it is their favorite sports team and go in hard drinking the kool-aid believing they are “special” when we are all the same!

Leadership at a lot of places expect and reward that kind of attitude. It's a bit of a survival skill, especially for people who want to climb the ranks.

The problem becomes magnified and self-sustaining when MDs with no substance become leaders themselves and expect that attitude from those under them. Meaningful change requires pushing the envelope and rocking the boat.

Just don't lose sight that if the politics turn, you could be a pariah in an instant. It still won't hurt you to be superficial about these things since the next academic shop you apply to may also expect that "rah rah" attitude for the home team and may appreciate your bobbleheaded appearance.

I agree that most institutions generally do their best to minimize the reputation of any individual doctor to keep us all easily replaceable. The surgeons do the best to push back against it. Rad oncs are basically being equated with radiologists at many academic shops nowadays.

 

[TheWallnerus]

Funny thing is a lot of docs represent their institution as if it is their favorite sports team and go in hard drinking the kool-aid believing they are “special” when we are all the same!

It’s the same human being!

 

[OTN]

Absolutely true. Add in that academic networks get referrals based on their name and not the reputation or quality of the individual physician. So long as doc’s identity is tied to the name of the institution, they can simply be replaced and business goes on as usual.

The entire Mayo faculty could walk out in a day and be replaced with locums and patients would still be referred there like it never happened.

I saw a good example of this in our local market. A large academic medical center was built, but it was relatively new. They paid a lot of money to bring in some "big name" docs and thought those names would drive patient volumes. The needle was not moved at all. No one cared who they were, with the notable exception of pediatric cardiac surgery.

I would argue that in certain markets (SoCal of course, and probably Vegas and Manhattan) plastic surgeons and cosmetic dentists and dermatologists can drive patient volumes with their names and reputations, but that's a very tiny number of docs.

 

[madchemist89]

Physician name can matter, but generally we are talking about small markets.

 

[IonsAreOurFuture]

Physician name can matter, but generally we are talking about small markets.

Mobility also matters. If a patient is in a closed network or narrow HMO like Kaiser in SoCal, they can't really go elsewhere without paying out of pocket.
When I was at UCLA, we would have patients come for their surgery but seldom stay for radiation unless they lived within half an hour. Just being 5 miles away in the San Fernando valley was often a bridge too far, I'm sure going into Manhattan from New Jersey is a similar adventure for some older, busier or poorer folks.

 

[BobbyHeenan]

Edit - wrong thread.