Ghosting during the job hunt

[deleted1180461]

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What constitutes “screwing around?” Interviewing other candidates? Not sure that they’re actually going to fill the position one is being interviewed for? Something else?

They don’t care about the candidate they just want a warm body with a license who will take their terrible non negotiable pay package. I think they can usually get a sense of this during the interview.

If they actually want you for you they will give you a reasonable offer off the bat expecting that you will counter it. Any place that doesn’t do this you should move on from immediately.

This is the difference between an employer that thinks you should beg for the privledge of working there vs. you thinking they should beg you because of the value you demonstrated to them during the interview.

 

[evilbooyaa]

Has the job market tanked again? There’s a significant amount of post-interview ghosting happening.

I did not receive a reply to 80% of the requests I sent out when I was looking for jobs (these were all jobs posted somewhere), with the caveat that this was a few years ago (< 7)

Of the 20% that replied to me, 50% of them ghosted me after initial discussions
Of the remaining 10% of applications I sent out, 50% I decided were not a good fit for me off the bat
Of the remaining 5% of applications, I went on interviews for.

This is not the case, and is strongly dependent on the 'caliber' of your residency institution, alumni network, alternative networking, and residency attendings willingness to help you get a job (and your willingness to come to them for assistance).

 

[DrProtonX]

I did not receive a reply to 80% of the requests I sent out when I was looking for jobs (these were all jobs posted somewhere), with the caveat that this was a few years ago (< 7)

Of the 20% that replied to me, 50% of them ghosted me after initial discussions
Of the remaining 10% of applications I sent out, 50% I decided were not a good fit for me off the bat
Of the remaining 5% of applications, I went on interviews for.

This is not the case, and is strongly dependent on the 'caliber' of your residency institution, alumni network, alternative networking, and residency attendings willingness to help you get a job (and your willingness to come to them for assistance).

Does residency ‘caliber’ matter for pp or just for academic positions?

 

[OTN]

Does residency ‘caliber’ matter for pp or just for academic positions?

For some private practices it does

 

[deleted1180461]

For some private practices it does

I have a gut feeling rule-for-life on this: You don't want to work for one of these practices.

 

[zy42]

I did not receive a reply to 80% of the requests I sent out when I was looking for jobs (these were all jobs posted somewhere), with the caveat that this was a few years ago (< 7)

Of the 20% that replied to me, 50% of them ghosted me after initial discussions
Of the remaining 10% of applications I sent out, 50% I decided were not a good fit for me off the bat
Of the remaining 5% of applications, I went on interviews for.

This is not the case, and is strongly dependent on the 'caliber' of your residency institution, alumni network, alternative networking, and residency attendings willingness to help you get a job (and your willingness to come to them for assistance).

I shared the same experience during my job search from slightly more recent past (<3 yr).

 

[Neuronix]

For some private practices it does

I hope they're adjusting for the fact that there was a decade when top medical students struggled to get any residency position at all, while other decades you could basically be in the bottom of your medical school class and easily obtain a top tier residency position.

 

[radoncle]

I hope they're adjusting for the fact that there was a decade when top medical students struggled to get any residency position at all, while other decades you could basically be in the bottom of your medical school class and easily obtain a top tier residency position.

This is so key and is forgotten consistently. People who trained at MSKCC and MDA in the 90s did not even have the credentials of those people who trained at bottom institutions when rad onc was competitive (generally speaking of course).

 

[evilbooyaa]

Does residency ‘caliber’ matter for pp or just for academic positions?

Yes, matters, especially for the 'premier' PPs. I can't imagine SERO or ROA or INOVA recruiting from a non top-10 to 15 residency program (and which would fall into that is obviously in the eye of the beholder, AKA the hiring manager).

 

[kimplera]

I shared the same experience during my job search from slightly more recent past (<3 yr).

My experience as well except ~ 15 years ago

 

[medgator]

I shared the same experience during my job search from slightly more recent past (<3 yr).

My experience as well except ~ 15 years ago

It's always been a tough job hunt. Residency expansion hasn't helped except to lower people's expectations from 2/3 to 0-1/3 (location, salary, hours/job QOL) when it comes to finding a "good" job

Former ASTRO president Tom Eichler set the expectations on Twitter that the goal is "a" job.

My personal experience is landing into my current great job because of a combination of luck, connections and timing after being exploited at my first job out of residency having to travel 2.5+ hours a day round-trip to a rural place that wasn't in my contract while getting paid a quarter mil a year generating multiples of that in PC/TC for malignant boomer partners who trained with China markers on ximatron and then having to leave the area because of a wide non-compete.

The job market has always been tough unless you wanted a crap employed job. Now it is just tougher post expansion.

 

[deleted1180461]

It's always been a tough job hunt. Residency expansion hasn't helped except to lower people's expectations from 2/3 to 0-1/3 (location, salary, hours/job QOL) when it comes to finding a "good" job

Former ASTRO president Tom Eichler set the expectations on Twitter that the goal is "a" job

Being able to graduate and start your own practice should be a reasonable option without forces colluding to make that difficult or impossible for any healthy profession.

A “job” should be one of many options open for a professional to sell his skills, not the only one, and certainly not one should be lucky to have with the other option as driving Ubers.

 

[maxxor]

Being able to graduate and start your own practice should be a reasonable option without forces colluding to make that difficult or impossible for any healthy profession.

A “job” should be one of many options open for a professional to sell his skills, not the only one, and certainly not one should be lucky to have with the other option as driving Ubers.

God I hate CON. That BS kills your brothers in Radiology too.

It is illegal for me to buy a PETCT. Because “I could drive up the cost of care”, ignoring that the mega centers near me charge 10-13k list for an fdg pet…

 

[deleted1180461]

God I hate CON. That BS kills your brothers in Radiology too.

It is illegal for me to buy a PETCT. Because “I could drive up the cost of care”, ignoring that the mega centers near me charge 10-13k list for an fdg pet…

Speaking of PETs, why are so many centers reluctant to get them? You are interested in buying one, but smaller hospitals are not, viewing them as negative ROI, and instead prefer to have a mobile unit once a week with appointments booked a month out. I've never been privy to the pro forma on these, but I've seen this at multiple places. Why do you think this would be profitable but these hospitals view it as an unacceptable cost center? Is it the initial capital outlay that's the problem or is reimbursement actually negative for this service? What's the typical break-even in terms of volume?

 

[maxxor]

Speaking of PETs, why are so many centers reluctant to get them? You are interested in buying one, but smaller hospitals are not, viewing them as negative ROI, and instead prefer to have a mobile unit once a week with appointments booked a month out. I've never been privy to the pro forma on these, but I've seen this at multiple places. Why do you think this would be profitable but these hospitals view it as an unacceptable cost center? Is it the initial capital outlay that's the problem or is reimbursement actually negative for this service? What's the typical break-even in terms of volume?

It’s almost always due to CON rules.

In many states, there are cost thresholds where if you are below the cost threshold, the level of regulatory review (aka the degree of uncertainty to getting the damn scanner approved) is lower.

For example, in my state, imaging equipment was partially exempt from review if the total cost of the project was less than $3mil. However, PETCT specifically is carved out as always requiring extra scrutiny with population assessments of expected cancer rates and other anticompetitive garbage.

If they opt for a mobile scanner with limited service AND there is more than enough volume to fill it every day, that decision was almost certainly to skirt under some threshold.

They are very profitable for FDG & even more so in an IDTF situation because you can bill the tracer separately. Cms rates are excellent. I’d jump at the chance to buy one and be bound to accept only cms reimbursement. But I can’t even do that. And I have tried multiple times.

Hospitals have an accounting dislike because of the quirk of pass thru billing in that tracers get bundled after 2-4 years. Some tracers are very expensive. PYL was 4500 for us at cost. That eclipses the total reimbursement and is why most places have switched to GaPSMA because the kits and cheaper even when you have to buy the Gallium generator.

It’s actually best to have a fleet of hospital based and IDTF scanners and actually schedule the tracers based on pass thru status.

In my area, next available appointment are more than 5 weeks at the mega system I used to work at.

I would love to get a truck scanner and would get my CDL and drive it myself. But it’s illegal. For now.

And I live in a “red state”. It’s a 100% anticompetitive legal framework that should be burned to the ground.

 

[medgator]

It’s almost always due to CON rules.

Have seen mobile units in both con and non con states. I am guessing it's just easier/more efficient to service multiple places in a 2-3 county area with a mobile unit in a different geography daily with a packed schedule.

 

[maxxor]

Have seen mobile units in both con and non con states. I am guessing it's just easier/more efficient to service multiple places in a 2-3 county area with a mobile unit in a different geography daily with a packed schedule.

The hospitals are choosing mobile (where they pay some contractor to do it) vs buying a fixed unit themselves. It is rare to see a mobile unit moved around by a hospital system themselves imo. Which gets back to CON shenanigans. Hilariously, I have seen hospitals BUY a mobile unit and just…park it… because it’s cheaper and slides under the cost rules lol.

There are some NRC considerations. If a hospital doesn’t do much nucs, they may not have the equipment, staff, or expertise to deal with the NRC stuff and would rather outsource that.

 

[medgator]

. It’s a 100% anticompetitive legal framework that should be burned to the ground.

Window dressing compared to the real meat and potatoes of PPS exempt vs HOPPS vs Medicare PFS billing and differences in absolute reimbursement imo. That is screwing everyone the most and has been for decades

 

[maxxor]

Window dressing compared to the real meat and potatoes of PPS exempt vs HOPPS vs Medicare PFS billing and differences in absolute reimbursement imo. That is screwing everyone the most and has been for decades

While PPS exempt is a big deal on this forum, (and i agree that tele-onc from MSKCC or COH or other places is kinda evil), there isn't a PPS-exempt institution in my state of 10 million.

OPPS / SOS / MPFS are one head of cerberus. CON is another, particularly in my state. Basically, anyone that does anything capital intensive or in a regulated area of medical practice, is literally forced to bribe the government and/or litigate to the supreme court for permission to operate. It's absurd.

An onc practice wanted to buy a petct for their sizable cancer patient population. 2 years later and a trip to the supreme court, they finally have approval. It's insane.

I just saw a CON filing denial for a rad-owned MR. Machine is 20 years old. He requested to upgrade it. Some hospital sued. He was denied, so he's still running his 20 year old 0.5 tesla POS because the state won't let him buy a 1.5T.

It feels like I'm a sharecropper, bound to either private equity or the hospitals.

 

[elementaryschooleconomics]

Speaking of PETs, why are so many centers reluctant to get them? You are interested in buying one, but smaller hospitals are not, viewing them as negative ROI, and instead prefer to have a mobile unit once a week with appointments booked a month out. I've never been privy to the pro forma on these, but I've seen this at multiple places. Why do you think this would be profitable but these hospitals view it as an unacceptable cost center? Is it the initial capital outlay that's the problem or is reimbursement actually negative for this service? What's the typical break-even in terms of volume?

I'm currently helping my hospital through the process of getting a PET in a CON state.

We've been using a mobile service for many years before this.

It is 1000% because the hospital has viewed them as negative ROI.

Fortunately, there was a lot of turnover at the executive level here (part of the reason I took the job) and the current crew is primarily younger and former healthcare workers themselves (not a lot of those "straight MBA" folks).

They "get it". It still took a ton of cheerleading on my part, assuring them this was a good plan, but the gears are finally, slowly grinding in the right direction.

It's really bizarre to me how the healthcare system invents the same problems over and over and over again so we're all living similar versions of the same insanity.

 

[maxxor]

I'm currently helping my hospital through the process of getting a PET in a CON state.

We've been using a mobile service for many years before this.

It is 1000% because the hospital has viewed them as negative ROI.

Fortunately, there was a lot of turnover at the executive level here (part of the reason I took the job) and the current crew is primarily younger and former healthcare workers themselves (not a lot of those "straight MBA" folks).

They "get it". It still took a ton of cheerleading on my part, assuring them this was a good plan, but the gears are finally, slowly grinding in the right direction.

It's really bizarre to me how the healthcare system invents the same problems over and over and over again so we're all living similar versions of the same insanity.

If that’s the case, then these people are drones who have no original thoughts themselves.

A quick glance at the financials shows the machines are profitable. How exactly would a mobile service (aka extra overhead) be able to exist if the finances were so poor?

The only meaningful argument on “poor-ROI” is with hospitals concerned about losing their shirt with the cost of nonFDG tracers which has only mattered starting in 2019 or so.

Unless they are so low volume that they literally don’t have enough patients to scan…at which point, I’d question if they have enough patients to keep you guys in business….

Yet again, CON killing innovation and restricting service availability. Had it not existed, someone would have built the IDTF once they realized the need.

 

[elementaryschooleconomics]

If that’s the case, then these people are drones who have no original thoughts themselves.

Hospital administration is, for the most part, a jobs program for the average students in high school who got an undergraduate degree in Psychology or equivalent and the system needs a place to plug them in to make the average annual wage for expanding 3-5 hours of work to fill a 40-hour week.

 

[deleted1180461]

A quick glance at the financials shows the machines are profitable. How exactly would a mobile service (aka extra overhead) be able to exist if the finances were so poor?

Same. I went through this in a non-CON state. They would not show me the numbers but claimed that it was due to negative ROI. I didn't believe them, especially after working in a PP that owned multiple scanners. And never understood the real reason. My comments that it was a very bad look to send patients to the parking lot on a semi they had to wait weeks for was a very bad look for a cancer center touting "state of the art" treatment were not welcome. You would think they would say "Yeah, we know..." or something. No, it was more like "it's fine, what are you talking about?"

 

[brushbeamscanning]

Same. I went through this in a non-CON state. They would not show me the numbers but claimed that it was due to negative ROI. I didn't believe them, especially after working in a PP that owned multiple scanners. And never understood the real reason. My comments that it was a very bad look to send patients to the parking lot on a semi they had to wait weeks for was a very bad look for a cancer center touting "state of the art" treatment were not welcome. You would think they would say "Yeah, we know..." or something. No, it was more like "it's fine, what are you talking about?"

The one where I work has a custom recessed driveway for the semi and an elevated patio with a facade for the front so it doesn't even look like you're walking into a truck.

 

[TheWallnerus]

The one where I work has a custom recessed driveway for the semi and an elevated patio with a facade for the front so it doesn't even look like you're walking into a truck.

Previously identified as mobile unit. Now identifies as stationary. Fun times.