Future of Rad Onc Salery??

[radoncmonkey]

To all the Rad Onc knowledgeable people reading this I wanted to ask an important question, one that I would never ask at an interview, but I am sure other people are thinking too. What is the future of reimbursements in this field? I recently talked to a resident that had a very grim picture of the future salary of radiation oncologists saying "they are going to dramatically but reimbursements for rad onc, In the future we will make little more than GP's or Neurologists, maybe 150-250k at most." I was (very sadly) a little concerned. Not that it matters (seriously, I LOVE rad onc) but when you have close to 200k med school debt, and you work your butt off to graduate at the top of your class, AOA, 240+ boards, great pubs, etc, it would be nice to know your specialty is one of the better paid, and you will be living well. Right now my understanding is that on average Rad Oncs start at around 240k, then in 5 years or so it goes up to maybe 450k for private practice? Does that sound about right? Anyone see that dropping really significantly? I am not saying I need to make a million/year or even more like some spine surgeons or whatever but I don't want to be hurting at 90k after taxes either. I know it’s a sad question, hence the rad onc monkey post, but some info would be great to hear. THANKS!

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[herbalgarden]

To all the Rad Onc knowledgeable people reading this I wanted to ask an important question, one that I would never ask at an interview, but I am sure other people are thinking too. What is the future of reimbursements in this field? I recently talked to a resident that had a very grim picture of the future salary of radiation oncologists saying "they are going to dramatically but reimbursements for rad onc, In the future we will make little more than GP's or Neurologists, maybe 150-250k at most." I was (very sadly) a little concerned. Not that it matters (seriously, I LOVE rad onc) but when you have close to 200k med school debt, and you work your butt off to graduate at the top of your class, AOA, 240+ boards, great pubs, etc, it would be nice to know your specialty is one of the better paid, and you will be living well. Right now my understanding is that on average Rad Oncs start at around 240k, then in 5 years or so it goes up to maybe 450k for private practice? Does that sound about right? Anyone see that dropping really significantly? I am not saying I need to make a million/year or even more like some spine surgeons or whatever but I don't want to be hurting at 90k after taxes either. I know it’s a sad question, hence the rad onc monkey post, but some info would be great to hear. THANKS!

For some reason, the future of rad onc came up several times during my interviews, mostly in the form of ethics surrounding treatments performed in the community that may not be in the patient's best interest. Interestingly, all the chairmans and attendings I've talked to agreed that salary will decline (as with all specialties, but maybe more so with ROnc). A lot of people are in denial, but it's simple math, really. The amount of money in health care expenditure far exceeds what is coming in for health care.. it's only a matter of time before it all buckle... I've also met a lot of residents who also feel this way. No one can predict the future, but for Rad Onc, I presume it's currently at its best time and can only have a leveled or downward trajectory in term of salary.

I think salary shouldn't be a big motivator though, especially when it come to oncology patients (not that any other type of patients deserve to be ripped off). If you think that a 200K debt is a lot of money, then logically, a 200K a year salary should be a lot of money too.

I'm no saint, I'll take a higher salary over a lower salary any day. But at the end of the day, it's still a great field though, even if the salary decline dramatically... considering the patient population, the balanced lifestyle, and the nature of the work. If you want a sure thing, consider dermatology or plastic surgery, both of which are cash-based and not likely affected much by health care reform and cuts (I think anyone competitive enough for ROnc would also be competitive for those fields). Sorry that was a little long. goodluck

 

[deleted4401]

Well ... in this economy, there is definitely issues with dermatology/plastic surgery, as much of their procedures are elective, cash-based, and disposable income related. If anything, they are taking even greater hits in this population. I'd think physicians that treat people with conditions that are necessary to treat are safest when the economy is in trouble.

I'd imagine that reimbursement for IMRT/proton for favorable-risk prostate cancer (our bread and butter) is going to take a hit... who knows, though?

-S

 

[medgator]

I've always viewed the salary as a bonus --- the job itself is fantastic in the realm of medical specialties. I'd still do this over neurology or general practice any day (cue Seinfeld: "Not that there's anything wrong with that").

 

[Ursus Martimus]

I've always viewed the salary as a bonus --- the job itself is fantastic in the realm of medical specialties. I'd still do this over neurology or general practice any day (cue Seinfeld: "Not that there's anything wrong with that").

Agreed for the most part. However, if there was no "bonus" I don't think you would be so happy-go-lucky - aside form being independently wealthy.

 

[nod]

I think most medical specialties should expect their income to decline. Like said above, it is just simple math, the healthcare system cannot afford to pay what it currently pays. Exactly which specialties will be hit hardest and how hard is unknown. It mostly depends on medicare reimbursement policies, which involve complex bureaucracies that few can predict. We will always make more than most general practioneers, but less than derm doing botox in souther cali.

 

[Palex80]

On a side note:

How much does a normal non-IMRT prostate cancer photon based irradiation cost in the US?

 

[herbalgarden]

Well ... in this economy, there is definitely issues with dermatology/plastic surgery, as much of their procedures are elective, cash-based, and disposable income related. If anything, they are taking even greater hits in this population. I'd think physicians that treat people with conditions that are necessary to treat are safest when the economy is in trouble.

I'd imagine that reimbursement for IMRT/proton for favorable-risk prostate cancer (our bread and butter) is going to take a hit... who knows, though?

-S

I was speaking more in the sense that health care dollars will continue to decline even in a time when the economy pick up again. I assume the OP is still a med student thus speaking in the long term is more relevant.

 

[herbalgarden]

I think most medical specialties should expect their income to decline. Like said above, it is just simple math, the healthcare system cannot afford to pay what it currently pays. Exactly which specialties will be hit hardest and how hard is unknown. It mostly depends on medicare reimbursement policies, which involve complex bureaucracies that few can predict. We will always make more than most general practioneers, but less than derm doing botox in souther cali.

I would think the ones that are over-utilized or has the highest absolute cost... radiology? maybe anesthesia?

 

[hypersomniac_]

I would think the ones that are over-utilized or has the highest absolute cost... radiology? maybe anesthesia?

Well, I was thinking that rad onc might be the most vulnerable specialty because they use a narrow number of billing codes and have no ability to shift in response to ridiculous reimbursement cuts. Like when they cut hormone therapy reimbursement urologists just stopped doing it (as much) because they have so many things (clinic visits, diagnostic procedures, same day surgery, big cancer whacks) they could just move on to something else. If they cut reimbursement for prostate IMRT tomorrow by 50%, rad oncs would still be doing the same amount of prostate IMRT because there's just nothing else to replace it for them. They'd just lose 25% of their salaries or something.

On the other hand this has been true for years and medicare has never taken advantage of the opportunity yet. I read somewhere one time that the medicare's entire yearly expenditure on RT was less than it spends on some expensive antineoplastic biologic. Not sure if that's true, but if so maybe it's just totally off the radar. So far.

 

[Gfunk6]

If they cut reimbursement for prostate IMRT tomorrow by 50%, rad oncs would still be doing the same amount of prostate IMRT because there's just nothing else to replace it for them.

Ummmm . . . how about protons, HDR, LDR, and CyberKnife?

 

[hypersomniac_]

Ummmm . . . how about protons, HDR, LDR, and CyberKnife?

The way I see it, the only way what you've suggested is feasible is in academics which is a minority of rad onc. What private practice group is going to switch to protons? What PP group has the machine capacity to just dump IMRT for cyberknife at the drop of a hat? Also, I just picked prostate because someone referenced it upthread; it does have some variety in modalities. Head and neck IMRT might be a better example.

It's entirely possible I'm wrong. But I heard medicare arbitrarily cut the surgeon rate for radiosurgery by a third this year. In response the surgeons are now referring for radiosurgery less (according to the grapevine). They were probably overpaid for what they did, but it's certainly concerning as to whether next year they'll just cut radiosurgery in general by a third. I guess I'm being devil's advocate.

 

[medgator]

On a side note:

How much does a normal non-IMRT prostate cancer photon based irradiation cost in the US?

Does anyone even do non-IMRT prostate anymore? The rectal toxicity benefit is pretty well documented

 

[medgator]

Well, I was thinking that rad onc might be the most vulnerable specialty because they use a narrow number of billing codes and have no ability to shift in response to ridiculous reimbursement cuts. Like when they cut hormone therapy reimbursement urologists just stopped doing it (as much) because they have so many things (clinic visits, diagnostic procedures, same day surgery, big cancer whacks) they could just move on to something else. If they cut reimbursement for prostate IMRT tomorrow by 50%, rad oncs would still be doing the same amount of prostate IMRT because there's just nothing else to replace it for them. They'd just lose 25% of their salaries or something.

On the other hand this has been true for years and medicare has never taken advantage of the opportunity yet. I read somewhere one time that the medicare's entire yearly expenditure on RT was less than it spends on some expensive antineoplastic biologic. Not sure if that's true, but if so maybe it's just totally off the radar. So far.

I think you are referring to a speech made at ASTRO regarding the costs of Radiation Oncology services being equilavent to Epo (erythropoeitin) use by medical oncology. The jist of it was that radiation gives a good bang for the cancer-treating buck.

I think rad onc has been able to fly under the radar in recent years simply because of the size of the field and the utilization of our services. I would guess that radiology, for example, as a part of medicare spending is several-fold higher than rad onc simply because of utilization.

 

[deleted4401]

Well, I think the toxicity benefit is confirmed in terms of single-institution reports and in calculating dose-volume parameters, but there hasn't been a head to head comparison.

And just for kicks, if you have a good dosimetrist, work with them to put together a conformal (6 field) plan for a favorable risk prostate case ... You'd be surprised how often you can make your constraints without using IMRT.

S

 

[temujim]

I'm told that even in these countries, e.g. Germany, where MDs make little more than US residents, the Rad Oncs still make the most. So there's that silver lining, even if health care socialist style comes to America. Nevertheless, if that day comes, I'm quitting medicine.

 

[OTN]

Salaries could be cut by 2/3rds and I'd still be very happy with radiation oncology reimbursements. A (busy, humming actually) private practice with good billing support can lead to a $700-900k salary...professional collections only. With the growth in the older segments of the population, we'll all likely be in this "very busy" category for most of our careers.

I never thought/cared/imagined that I'd be making that much money, so if the salaries get cut severely and I end up making what I anticipated...oh well.

The problem: What else am I going to do? Anybody seen Friday Night Lights? I'm like Booby Miles: "THIS IS ALL I KNOW HOW TO DO, MAN..."

Keep in mind, too, those of you looking to get into the field: A fellow co-resident of mine actively discourages as many people as he can from going into the field. Wants to keep the competition down. Take ANYTHING that people tell you with a grain the size of a salt lick.

t

 

[IRISH22]

I recently heard similar news from one of the private IM attendings at my hospital. As a GP, he keeps his ear pretty close to the street regarding Medicare physician reimbursement (medicare literally sets the payment standard for all other private insurance). Apparently Medicare has been urged to restructure its reimbursments in an effort to "redistribute" the health care dollar to primary care. As no suprise to the med students out there, primary care reimbursement sucks; consequently, no one wants to do it. As a "stimulus" to those fields, Medicare (and a primary care lobby?) may take the initiative to cut specialist's reimbursements.

Unfortunately, this doesnt work well for either party. Since there are thousands more GP's than radoncs, our salaries would have to be cut by around 10% to give each GP a meager 1% raise.

 

[herbalgarden]

Keep in mind, too, those of you looking to get into the field: A fellow co-resident of mine actively discourages as many people as he can from going into the field. Wants to keep the competition down. Take ANYTHING that people tell you with a grain the size of a salt lick.

t

Your fellow resident is a jerk , and his/her effort is futile since there are much more applicant than residency spot, convincing one or two person out of the field is not going to change anything.

 

[Palex80]

Does anyone even do non-IMRT prostate anymore? The rectal toxicity benefit is pretty well documented

In Europe 3D-radiotherapy and non-IMRT-radiotherapy for prostate cancer is still the golden standard. Surely there are some departments that do IMRT, but the majority still does 3D-conformal therapy.

 

[3dtp]

In Europe 3D-radiotherapy and non-IMRT-radiotherapy for prostate cancer is still the golden standard. Surely there are some departments that do IMRT, but the majority still does 3D-conformal therapy.

And there are some insurance companies that will not pay for IMRT as it is "experimental."

 

[Palex80]

And there are some insurance companies that will not pay for IMRT as it is "experimental."

They don't necessarily describe it as "experimental". They merely say, that there are no studies which show that it is superior to standard 3D-conformal therapy.
And in fact their claim is right.
Some would argue that soft tissue sparing is better managed with IMRT. And that's true, at least when it comes to DVHs. However we still do not have a direct comparison of IMRT with 3D in terms of late effects.
Some would argue that dose escalation is better managed with IMRT.
And that's true as well in some cases. However we still lack the evidence, that we need dose escalation over 74-76 Gy for primary therapy or 64 Gy for salvage therapy.
Until those answers are dealt with in randomised trials I can see their points.

On the other hand, IMRT is paid for in example for head and neck cancer or more seldom indications (children, meningeomas, etc.). There you have either cases where evidence is there for benefits through IMRT (sparing salivary glands in head and neck cancer) or you have cases where evidence is lacking because the cases are so seldom.

It's actually all a question of cash. If IMRT was paid for good and we had the machine capacity to do it, we would do it. But when you have to treat 40-50 patients/day per LINAC, you simply can't do IMRT for everybody.
Perhaps new techniques like Rapid Arc, etc will solve the issue of IMRT machine capacity, but unless payment is guaranteed for IMRT I can't see it happening on a large scale.

Another area where insurance companies sometimes don't pay and which tends to be kind of disturbing is PET-CT.
If only they would pay for it, it would make our work so much easier...

 

[OTN]

Your fellow resident is a jerk , and his/her effort is futile since there are much more applicant than residency spot, convincing one or two person out of the field is not going to change anything.

I definitely agree with you on the jerk part, but not so much on the futility. As this forum demonstrates, one person's opinion can be amplified many times over. Just be careful what you hear, from general practicioners (see above post) to specialists and so on.

As I've learned more about the private practice world, I've begun to understand more and more than underlying financial motives...unfortunately...always have to be taken into consideration.

 

[herbalgarden]

I definitely agree with you on the jerk part, but not so much on the futility. As this forum demonstrates, one person's opinion can be amplified many times over. Just be careful what you hear, from general practicioners (see above post) to specialists and so on.

As I've learned more about the private practice world, I've begun to understand more and more than underlying financial motives...unfortunately...always have to be taken into consideration.

Well, within the last 5 years, all the residency spots have been filled. If there's a fluke, then the spot are filled immediately during the scrambles. With a 70-80% match rate, I don't think there's going to be a drop in the residency graduating class, but your friend can keep trying though.

private practice with good billing support can lead to a $700-900k salary

I think statement like this raises unrealistic expectations of people looking into this field. I've heard similar things said about a lot of other fields out there also. To make this kind of salary, I would assume the attending would be working pretty hard, hiring PAs and NPs to see on-treatment patients, utilizing technology that may not be indicated, and and turning their practice into an assembly line.

 

[OTN]

Well, within the last 5 years, all the residency spots have been filled. If there's a fluke, then the spot are filled immediately during the scrambles. With a 70-80% match rate, I don't think there's going to be a drop in the residency graduating class, but your friend can keep trying though.



I think statement like this raises unrealistic expectations of people looking into this field. I've heard similar things said about a lot of other fields out there also. To make this kind of salary, I would assume the attending would be working pretty hard, hiring PAs and NPs to see on-treatment patients, utilizing technology that may not be indicated, and and turning their practice into an assembly line.

Your assumption would be incorrect.

 

[OTN]

Your assumption would be incorrect.

When I said busy, though...I mean BUSY- 35, 40 pts on treatment, doing procedures, being full partner, etc. Some might want to hire a N.P. for that, but some might not.

My point wasn't that we're all going to make that kind of money, just that as radiation oncologists we're likely going to be in the fortunate position to be able to choose a job based on location, family, etc.

Just my 2c.