How is Rad-Onc job market?

[Lilyhopeless]

Full disclosure: I am a PGY3 medicine resident who did not match HemOnc this year and plan to do chief year or hospitalist for a couple year to apply again later.

Recently I went to a social event by the hospital for "better collegial environment", I was talking about my woe to a friend from med school who matched to Rad-Onc (presently PGY3). I seemed to touch a nerve and the dude just unloaded on me on "be thankful that you can at least get a job in a tolerable place with good schedule and expected salary of 300k", my graduating class is struggling to even get 300k in a dead-beat place and will probably be pummeled by the admin and it will likely be worsened in a couple year". I wisely shut up and talked about the latest episodes of the Crown on Netflix...

Have I missed something since I graduated from med school in the ancient year of 2020? I remembered that Rad-Onc was up there in competitiveness with researches and some event comes with PhD. That friend of mine was one of the smartest person I know too! Is my friend here just catastrophising everything like all neurotic medicine people we all are or I just have completely missed something?

As someone who is hoping to apply to HemOnc again, I know that HemOnc has a very good job market so I am not sure why RadOnc would be any different...

I apologize, if by my ignorant, I just insulted a specialty... but I still remember that RadOnc was the most competitive when I was in med school just 3 years ago!

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[qldking]

HemOnc is horribly boring and unfulfilling, but, at least it has jobs. RadOnc is great on the face of it until you realise you are a slave to a sole modality of treatment and the grifters who for whatever reason run the profession. Your friend is 100% right.

 

[deleted1116990]

As someone who is hoping to apply to HemOnc again, I know that HemOnc has a very good job market so I am not sure why RadOnc would be any different...

There's enough reading here for weeks, if not months to answer this for you. The one liner is that about 3-4 times as many med oncs are needed for every cancer patient in america compared to rad oncs. Digging into this, like other very small fields, geographic areas will quickly saturate and there is little to no opportunity to hang your own shingle. So you are either waiting for someone to leave or retire, or in a handful of markets that have expanding populations -- expand. There are only so many cancer patients. When you combine this with overtraining, which is a major problem in rad onc, when someone does finally leave from the city you want to live in, it will be difficult to get the job and if you do to negotiate pay approaching your actual pro collections because so many others also want to fill that opening. These problems are minor, if non-existent for med onc. Many locations have to staff with locums, who rates are double that of rad onc.

Bottom line: Work as a hospitalist for a few years. I know a few who went this path as a backdoor into med onc. Hospitalist on the onc floor at an academic center for a few years until that academic center finally makes a spot for them.

 

[Gfunk6]

As someone who is hoping to apply to HemOnc again, I know that HemOnc has a very good job market so I am not sure why RadOnc would be any different...

I apologize, if by my ignorant, I just insulted a specialty... but I still remember that RadOnc was the most competitive when I was in med school just 3 years ago!

 

[Ray D. Ayshun]

 

[Neuronix]

Everyone, this is not a COVID thread. Many posts deleted.

 

[RSAOaky]

My satellite of an academic health system in a top NE metro area has been trying to recruit medoncs for the last year with no hires to date. We had 40 radonc applicants for a single position and had an offer accepted by one of our top 5 choices within 2 months.

 

[medgator]

My satellite of an academic health system in a top NE metro area has been trying to recruit medoncs for the last year with no hires to date. We had 40 radonc applicants for a single position and had an offer accepted by one of our top 5 choices within 2 months.

@Lilyhopeless here's your RO vs MO job market in a nutshell

 

[yesmaster]

I wish I could work as a hospitalist for a couple years and then do a heme onc fellowship
- Rad onc attending

HemOnc is horribly boring and unfulfilling

What? Heme onc ain’t boring. They do what we do plus systemic tx, minus radiation treatment planning.

We're not going to be doing radiation treatment planning either in several years if the AI people in academics and industry get their way.

 

[communitydoc13]

Heme onc ain’t boring.

Community hemonc is pretty demanding, but it is definitely not boring. That three legged stool of oncology (surgery, radiation, chemotherapy) is totally bogus now. It is systemic therapy (new agents and indications every year) contextualizing what type of surgery or radiation (if any) you are going to use on a patient.

It's hemonc's world now. They have a fair bit to learn every year. They have gone through 4-5 iterations of care regarding triple negative breast cancer in the last 3-4 years alone.

Meanwhile, I could answer nearly all of our OLA continuous certification questions 10 years ago.

 

[RickyScott]

Community hemonc is pretty demanding, but it is definitely not boring. That three legged stool of oncology (surgery, radiation, chemotherapy) is totally bogus now. It is systemic therapy (new agents and indications every year) contextualizing what type of surgery or radiation (if any) you are going to use on a patient.

It's hemonc's world now. They have a fair bit to learn every year. They have gone through 4-5 iterations of care regarding triple negative breast cancer in the last 3-4 years alone.

Meanwhile, I could answer nearly all of our OLA continuous certification questions 10 years ago.

and they are only getting started.

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www.cnn.com

 

[RSAOaky]

To flesh this out more, you should know what the business model is for medonc. The majority of the money that medoncs generate is from E&M, infusions, labs, and markups on systemic therapy/medication (i.e. they buy the drug for X and sell it for X + Y, their profit being Y). This link gives you an idea of what infusions reimburse. If someone has more intimate knowledge about this they can correct me. Patients are living longer and have more and more expensive treatment options, resulting in a booming demand for medonc. I mean, just look at definitive lungs which now get Q2W infusions of durvalumab for 6-12 months. That's a lot of infusin'! To add to this, most medoncs I know make a substantial amount on the side (i.e. 6 figures) doing pharma surveys or consulting work, and they always have the option if they get tired of clinical medicine of going into industry.

The RadOnc business model is that the vast majority of our money comes from the definitive treatment of primary tumors, with the occasional trickle here and there from palliative treatments of varying complexity. ~20-30% of this is professional billings with the rest being technical. The radonc boom didn't really come from us treating more patients, it came from us increasing the complexity of the treatments we were already providing.

To make these two situations as analogous as possible, in medonc your professional services are your E&M and everything else mentioned above is technical. In RadOnc, your professional services are your E&M, on treatment visits, review of on-treatment images, and treatment planning, whereas the technical services are essentially the usage of the machines (each individual treatment).

The general deal with hospitals is that physicians get some or all of their professional fees and the hospital keeps the technical to cover overhead and make a profit. If your field is in high demand and low supply, hospitals need to offer you a sweeter deal to hire you. They may offer to pay you more than your professional billings (i.e. you eat into the technical revenue) because the overall revenue you bring in is so high that it's justified. When there is low demand and high supply, hospitals can do whatever they want. Maybe they're totally fair and give you all your professional fees and they keep the technical ones. Maybe they start paying you LESS than your professional fees because, if you decide to leave, they can easily replace you with a new grad. This is the current situation with radonc. For various reasons, the majority self inflicted, the supply/demand curve in radonc has shifted in favor of the employer and will continue to do so, and our field has gone to **** as a result.

Medonc on the other has shifted the other way. The demand for medonc has absolutely f*cking exploded. As a result, hospitals (like mine) that are offering medoncs their professional billings as salary are unable to hire medoncs. The ones that realize that more medoncs = more infusions = more money are willing to give medoncs a cut of the technical revenue (higher salaries) because this means their overall revenue increases and everyone is happy.

The most important part of this equation is that the majority of money that radoncs make is from new cancer diagnoses and new diagnoses are increasing at a constant rate while new radoncs are being produced at a rate that exceeds their need. Medoncs make money when patients are newly diagnosed with cancer, but they make more money on patients that are living with cancer. There is a lot of pharma money being spent on keeping patients with terminal cancers alive...

 

[Gfunk6]

To flesh this out more, you should know what the business model is for medonc. The majority of the money that medoncs generate is from E&M, infusions, labs, and markups on systemic therapy/medication (i.e. they buy the drug for X and sell it for X + Y, their profit being Y). This link gives you an idea of what infusions reimburse. If someone has more intimate knowledge about this they can correct me. Patients are living longer and have more and more expensive treatment options, resulting in a booming demand for medonc. I mean, just look at definitive lungs which now get Q2W infusions of durvalumab for 6-12 months. That's a lot of infusin'! To add to this, most medoncs I know make a substantial amount on the side (i.e. 6 figures) doing pharma surveys or consulting work, and they always have the option if they get tired of clinical medicine of going into industry.

The RadOnc business model is that the vast majority of our money comes from the definitive treatment of primary tumors, with the occasional trickle here and there from palliative treatments of varying complexity. ~20-30% of this is professional billings with the rest being technical. The radonc boom didn't really come from us treating more patients, it came from us increasing the complexity of the treatments we were already providing.

To make these two situations as analogous as possible, in medonc your professional services are your E&M and everything else mentioned above is technical. In RadOnc, your professional services are your E&M, on treatment visits, review of on-treatment images, and treatment planning, whereas the technical services are essentially the usage of the machines (each individual treatment).

The general deal with hospitals is that physicians get some or all of their professional fees and the hospital keeps the technical to cover overhead and make a profit. If your field is in high demand and low supply, hospitals need to offer you a sweeter deal to hire you. They may offer to pay you more than your professional billings (i.e. you eat into the technical revenue) because the overall revenue you bring in is so high that it's justified. When there is low demand and high supply, hospitals can do whatever they want. Maybe they're totally fair and give you all your professional fees and they keep the technical ones. Maybe they start paying you LESS than your professional fees because, if you decide to leave, they can easily replace you with a new grad. This is the current situation with radonc. For various reasons, the majority self inflicted, the supply/demand curve in radonc has shifted in favor of the employer and will continue to do so, and our field has gone to **** as a result.

Medonc on the other has shifted the other way. The demand for medonc has absolutely f*cking exploded. As a result, hospitals (like mine) that are offering medoncs their professional billings as salary are unable to hire medoncs. The ones that realize that more medoncs = more infusions = more money are willing to give medoncs a cut of the technical revenue (higher salaries) because this means their overall revenue increases and everyone is happy.

The most important part of this equation is that the majority of money that radoncs make is from new cancer diagnoses and new diagnoses are increasing at a constant rate while new radoncs are being produced at a rate that exceeds their need. Medoncs make money when patients are newly diagnosed with cancer, but they make more money on patients that are living with cancer. There is a lot of pharma money being spent on keeping patients with terminal cancers alive...

You can make it even simpler.

Rad Onc is fixed cost. You still have to pay for vault, linac, CT sim, RTTs, dosi, physics, electricity, and support staff whether you are treating 1 or 100 patients per day. The cost of all these things are ever going up because of inflation. Since Rad Onc is fixed cost, the idea (historically) is that you keep the machine busy and once you pay off costs, it is just pure profit after that. Unfortunately, reimbursement is being continually cut. So you have increased costs and decreased reimbursement - not a winning combination.

Med Onc is variable cost. You only pay for what you need and get reimbursed for what you use. Never prescribe Herceptin? Then you never buy it. In addition to E&M reimbursements (which are going down just like Rad Onc), Med Onc buys chemo agents from a GPO (e.g. McKesson, Cardinal, etc.) and sells them for a profit (after sales price, ASP). Unlike Rad Onc, Medicare cannot legally haggle or cut the price of drugs - it is whatever the pharma company wants it to be. Drugs are becoming more advanced and more expensive. Also Med Oncs can use generics and biosimilars to drive up profit further.

 

[medgator]

To flesh this out more, you should know what the business model is for medonc. The majority of the money that medoncs generate is from E&M, infusions, labs, and markups on systemic therapy/medication (i.e. they buy the drug for X and sell it for X + Y, their profit being Y). This link gives you an idea of what infusions reimburse. If someone has more intimate knowledge about this they can correct me. Patients are living longer and have more and more expensive treatment options, resulting in a booming demand for medonc. I mean, just look at definitive lungs which now get Q2W infusions of durvalumab for 6-12 months. That's a lot of infusin'! To add to this, most medoncs I know make a substantial amount on the side (i.e. 6 figures) doing pharma surveys or consulting work, and they always have the option if they get tired of clinical medicine of going into industry.

The RadOnc business model is that the vast majority of our money comes from the definitive treatment of primary tumors, with the occasional trickle here and there from palliative treatments of varying complexity. ~20-30% of this is professional billings with the rest being technical. The radonc boom didn't really come from us treating more patients, it came from us increasing the complexity of the treatments we were already providing.

To make these two situations as analogous as possible, in medonc your professional services are your E&M and everything else mentioned above is technical. In RadOnc, your professional services are your E&M, on treatment visits, review of on-treatment images, and treatment planning, whereas the technical services are essentially the usage of the machines (each individual treatment).

The general deal with hospitals is that physicians get some or all of their professional fees and the hospital keeps the technical to cover overhead and make a profit. If your field is in high demand and low supply, hospitals need to offer you a sweeter deal to hire you. They may offer to pay you more than your professional billings (i.e. you eat into the technical revenue) because the overall revenue you bring in is so high that it's justified. When there is low demand and high supply, hospitals can do whatever they want. Maybe they're totally fair and give you all your professional fees and they keep the technical ones. Maybe they start paying you LESS than your professional fees because, if you decide to leave, they can easily replace you with a new grad. This is the current situation with radonc. For various reasons, the majority self inflicted, the supply/demand curve in radonc has shifted in favor of the employer and will continue to do so, and our field has gone to **** as a result.

Medonc on the other has shifted the other way. The demand for medonc has absolutely f*cking exploded. As a result, hospitals (like mine) that are offering medoncs their professional billings as salary are unable to hire medoncs. The ones that realize that more medoncs = more infusions = more money are willing to give medoncs a cut of the technical revenue (higher salaries) because this means their overall revenue increases and everyone is happy.

The most important part of this equation is that the majority of money that radoncs make is from new cancer diagnoses and new diagnoses are increasing at a constant rate while new radoncs are being produced at a rate that exceeds their need. Medoncs make money when patients are newly diagnosed with cancer, but they make more money on patients that are living with cancer. There is a lot of pharma money being spent on keeping patients with terminal cancers alive...

You're ignoring the lucrative area of oral pharmaceuticals where a bunch of med oncs can get together and open a pharmacy and dispense specialty drugs with high margins. No infusion nurse/overhead required

Can be very profitable if they have insurance contracts to dispense with less of a hassle than worrying about infusions, nursing and clinic overhead etc. Obviously not happening in the hospital setting, but rather in community practice. The big mega groups may also have in house rads, path etc in addition to infusions which can further juice revenue and take home pay

 

[TheWallnerus]

Full disclosure: I am a PGY3 medicine resident who did not match HemOnc this year and plan to do chief year or hospitalist for a couple year to apply again later.

Recently I went to a social event by the hospital for "better collegial environment", I was talking about my woe to a friend from med school who matched to Rad-Onc (presently PGY3). I seemed to touch a nerve and the dude just unloaded on me on "be thankful that you can at least get a job in a tolerable place with good schedule and expected salary of 300k", my graduating class is struggling to even get 300k in a dead-beat place and will probably be pummeled by the admin and it will likely be worsened in a couple year". I wisely shut up and talked about the latest episodes of the Crown on Netflix...

Have I missed something since I graduated from med school in the ancient year of 2020? I remembered that Rad-Onc was up there in competitiveness with researches and some event comes with PhD. That friend of mine was one of the smartest person I know too! Is my friend here just catastrophising everything like all neurotic medicine people we all are or I just have completely missed something?

As someone who is hoping to apply to HemOnc again, I know that HemOnc has a very good job market so I am not sure why RadOnc would be any different...

I apologize, if by my ignorant, I just insulted a specialty... but I still remember that RadOnc was the most competitive when I was in med school just 3 years ago!

Busy slide but once understood explains part of the problem

 

[Ray D. Ayshun]

Busy slide but once understood explains part of the problem


View attachment 363411

You'd be arrested for displaying this chart at the world cup

 

[NotMattSpraker]

My satellite of an academic health system in a top NE metro area has been trying to recruit medoncs for the last year with no hires to date. We had 40 radonc applicants for a single position and had an offer accepted by one of our top 5 choices within 2 months.

You know its funny. It really seemed like this year had a hot Rad Onc market back in July. But July is a time when residents from prominent programs get a lot of interviews all at once and things are busy.

We are also hiring and based on the number of applicants and how hairs are split even deciding on who to interview, I am not so sure its as hot as advertised. Im very interested to see how things seem in February. We just have so many graduates, is there a place for everyone?

Say there is, the contracts I've seen are disappointing. We are supposedly in an industry where there is all this enthusiasm about retention and increasing pay. That is not what I am seeing for new grad contracts in academics or prominent private practices. They are only slightly better than my first contract pre-COVID, pre-inflation.

Layer on the number of 2024 graduates already reaching out now. Damn, the anxiety does seem justified.

 

[TheWallnerus]

You know its funny. It really seemed like this year had a hot Rad Onc market back in July. But July is a time when residents from prominent programs get a lot of interviews all at once and things are busy.

We are also hiring and based on the number of applicants and how hairs are split even deciding on who to interview, I am not so sure its as hot as advertised. Im very interested to see how things seem in February. We just have so many graduates, is there a place for everyone?

Say there is, the contracts I've seen are disappointing. We are supposedly in an industry where there is all this enthusiasm about retention and increasing pay. That is not what I am seeing for new grad contracts in academics or prominent private practices. They are only slightly better than my first contract pre-COVID, pre-inflation.

Layer on the number of 2024 graduates already reaching out now. Damn, the anxiety does seem justified.

Math doesn’t lie. I’m like Burry in Big Short. Barefoot. Headbanging. Everyone doubting me. You’ll see.

 

[Lilyhopeless]

Thank you everyone for sharing! It is really frustrating that we, doctors, allow our specialties to be dictated to this extent by people in the tower; it is just sad and it seems to happen in most specialties.

I still feel as if I am just walking through a mirror here that this is happening and I did not even know about it. As you can imagine, med students pick a specialty not only because they like it but also for money, prestige and work-life balance (I can't imagine anyone can ever see a rash and think that this is my life goal to take care of it...) Back in 2018, I did briefly think about Rad-Onc but changed my mind as 1. I am a DO and B. It is very competitive.

My question: Has this change been going on for some time now or it is a relatively new thing (the past 4-5 years or so)? Because I am still in awe with Rad-Onc resident and the Rad-Onc attending still have the look of the guys earning a million bucks a year!

Further, math doesn't lie and that graph from @TheWallnerus is troubling. However, is my friend, who is a resident at admittedly not the most glorious institution, not over exaggerating the doom? I find it hard to believe that a Rad-Onc attending would have difficulty getting a job in an urban place and pull in at least 400k! A nephro fellow I know just signed a contract half an hour out of Charlotte NC for 350k with RVU; he is graduating from my hospital; a not impressive teaching hospital in Midwest; his fellowship goes unmatched year after year!

This is surprising; I felt as if you are telling me now that Derm is now going into SOAP or something!

 

[medgator]

This is surprising; I felt as if you are telling me now that Derm is now going into SOAP or something!

Derm would never be stupid enough to research ways to reduce its services while simultaneously expanding residency slots. Quite the opposite, AFAIK derm is super protective regarding expansion which is why, unlike rad onc, it has always remained competitive, while rad onc is coming full circle back to the uncompetitive gutter it came from (1970s-1990s)

Decent salaries can be had for now as the job market has recently and likely temporarily improved, but math doesn't lie long term

 

[communitydoc13]

I find it hard to believe that a Rad-Onc attending would have difficulty getting a job in an urban place and pull in at least 400k! A nephro fellow I know just signed a contract half an hour out of Charlotte NC for 350k with RVU;

Supply and demand. Even with the slightly improved market for radonc (and a near catastrophic shortage of medoncs, which is causing lots of pain) there are plenty of radoncs who have had to take jobs away from their goal locations for better than a decade at this point. Any radonc job in an urban/suburban location will have 30-40 applicants at least.

We have not interviewed a single US medical school MD under age 65 for a permanent medical oncology position in over 10 years (we have essentially always had an opening over this time period). Some locums, yes.

Regarding radonc, we only interviewed folks from excellent radonc programs to fill the single radonc position available in the same time period.

I'm 2 hours from a major metro (but coastal).

 

[fiji128]

Supply and demand. Even with the slightly improved market for radonc (and a near catastrophic shortage of medoncs, which is causing lots of pain) there are plenty of radoncs who have had to take jobs away from their goal locations for better than a decade at this point. Any radonc job in an urban/suburban location will have 30-40 applicants at least.

We have not interviewed a single US medical school MD under age 65 for a permanent medical oncology position in over 10 years (we have essentially always had an opening over this time period). Some locums, yes.

Regarding radonc, we only interviewed folks from excellent radonc programs to fill the single radonc position available in the same time period.

I'm 2 hours from a major metro (but coastal).

Truth

 

[evilbooyaa]

Thank you everyone for sharing! It is really frustrating that we, doctors, allow our specialties to be dictated to this extent by people in the tower; it is just sad and it seems to happen in most specialties.

I still feel as if I am just walking through a mirror here that this is happening and I did not even know about it. As you can imagine, med students pick a specialty not only because they like it but also for money, prestige and work-life balance (I can't imagine anyone can ever see a rash and think that this is my life goal to take care of it...) Back in 2018, I did briefly think about Rad-Onc but changed my mind as 1. I am a DO and B. It is very competitive.

My question: Has this change been going on for some time now or it is a relatively new thing (the past 4-5 years or so)? Because I am still in awe with Rad-Onc resident and the Rad-Onc attending still have the look of the guys earning a million bucks a year!

Further, math doesn't lie and that graph from @TheWallnerus is troubling. However, is my friend, who is a resident at admittedly not the most glorious institution, not over exaggerating the doom? I find it hard to believe that a Rad-Onc attending would have difficulty getting a job in an urban place and pull in at least 400k! A nephro fellow I know just signed a contract half an hour out of Charlotte NC for 350k with RVU; he is graduating from my hospital; a not impressive teaching hospital in Midwest; his fellowship goes unmatched year after year!

This is surprising; I felt as if you are telling me now that Derm is now going into SOAP or something!

In regards to the bolded, that is not at all uncommon, especially for new graduates. 400k Total by the time you hit bonus may be more common, but not going to see 400k base over 25-50% of the time, especially as a new grad, ESPECIALLY in an urban location.

As you get more experienced, the cost of your services should theoretically go up (given the discount the institution gets you on initially), but the difference between floor and ceiling is shrinking day by day.

 

[TheWallnerus]

Supply and demand. Even with the slightly improved market for radonc (and a near catastrophic shortage of medoncs, which is causing lots of pain) there are plenty of radoncs who have had to take jobs away from their goal locations for better than a decade at this point. Any radonc job in an urban/suburban location will have 30-40 applicants at least.

We have not interviewed a single US medical school MD under age 65 for a permanent medical oncology position in over 10 years (we have essentially always had an opening over this time period). Some locums, yes.

Regarding radonc, we only interviewed folks from excellent radonc programs to fill the single radonc position available in the same time period.

I'm 2 hours from a major metro (but coastal).

In regards to the bolded, that is not at all uncommon, especially for new graduates. 400k Total by the time you hit bonus may be more common, but not going to see 400k base over 25-50% of the time, especially as a new grad, ESPECIALLY in an urban location.

As you get more experienced, the cost of your services should theoretically go up (given the discount the institution gets you on initially), but the difference between floor and ceiling is shrinking day by day.

New grads from top quartile programs could get 500 base… maybe not exactly where they wanted, granted… in the 2003-2010 timeframe quite easily. So my viewpoint on this will remain skewed the rest of my life.

 

[Ray D. Ayshun]

In this gif, Curly Bill, the leader of the "cowboys" is taking aim at Wyatt Earp. Just prior to this, Wyatt had reached his breaking point as he and his group were hemmed in by the cowboys. Wyatt just stood up and started walking directly into the gunfire yelling "No!" and shooting men down. Every time I see a thread about the job market, particularly from an unknown name, I feel like Wyatt Earp.

 

[NotMattSpraker]

Thank you everyone for sharing! It is really frustrating that we, doctors, allow our specialties to be dictated to this extent by people in the tower; it is just sad and it seems to happen in most specialties.

I still feel as if I am just walking through a mirror here that this is happening and I did not even know about it. As you can imagine, med students pick a specialty not only because they like it but also for money, prestige and work-life balance (I can't imagine anyone can ever see a rash and think that this is my life goal to take care of it...) Back in 2018, I did briefly think about Rad-Onc but changed my mind as 1. I am a DO and B. It is very competitive.

My question: Has this change been going on for some time now or it is a relatively new thing (the past 4-5 years or so)? Because I am still in awe with Rad-Onc resident and the Rad-Onc attending still have the look of the guys earning a million bucks a year!

Further, math doesn't lie and that graph from @TheWallnerus is troubling. However, is my friend, who is a resident at admittedly not the most glorious institution, not over exaggerating the doom? I find it hard to believe that a Rad-Onc attending would have difficulty getting a job in an urban place and pull in at least 400k! A nephro fellow I know just signed a contract half an hour out of Charlotte NC for 350k with RVU; he is graduating from my hospital; a not impressive teaching hospital in Midwest; his fellowship goes unmatched year after year!

This is surprising; I felt as if you are telling me now that Derm is now going into SOAP or something!

There is a lot of frustration with leadership and how the jobs issue is being managed, that is for sure.

Just remember "Doom" is subjective. One of our big problems is that people coming from high prestige institutions with priorities that exactly match being a Rad Onc think there are no issues.

You need to think about your priorities and see how they might be impacted by the peculiarities of this field. Of course I am jealous of the med onc job market, but I'd never be one as I don't like many aspects of that field.

 

[IonsAreOurFuture]

Thank you everyone for sharing! It is really frustrating that we, doctors, allow our specialties to be dictated to this extent by people in the tower; it is just sad and it seems to happen in most specialties.

I still feel as if I am just walking through a mirror here that this is happening and I did not even know about it. As you can imagine, med students pick a specialty not only because they like it but also for money, prestige and work-life balance (I can't imagine anyone can ever see a rash and think that this is my life goal to take care of it...) Back in 2018, I did briefly think about Rad-Onc but changed my mind as 1. I am a DO and B. It is very competitive.

My question: Has this change been going on for some time now or it is a relatively new thing (the past 4-5 years or so)? Because I am still in awe with Rad-Onc resident and the Rad-Onc attending still have the look of the guys earning a million bucks a year!

Further, math doesn't lie and that graph from @TheWallnerus is troubling. However, is my friend, who is a resident at admittedly not the most glorious institution, not over exaggerating the doom? I find it hard to believe that a Rad-Onc attending would have difficulty getting a job in an urban place and pull in at least 400k! A nephro fellow I know just signed a contract half an hour out of Charlotte NC for 350k with RVU; he is graduating from my hospital; a not impressive teaching hospital in Midwest; his fellowship goes unmatched year after year!

This is surprising; I felt as if you are telling me now that Derm is now going into SOAP or something!

Hey Lilyhopeless,

There's still lot's of room for optimism in oncology as a professional, even if you don't hear if from most of the people on here. Both radiation oncology and medical oncology will still be here in 30 years, but in vastly different forms - if not, then no medical progress will have occurred.

Both will have less toxicity in their treatments and more patient friendly administration schedules. Both will still be life-saving and emotionally rewarding when we see our patients get better. Both will have great opportunities for expansion globally, as economies mature and billions more people can afford X-ray therapy, protons, and immunotherapy.

For medical oncology, we'll continue to see new drugs and new monthly indications into earlier and later phases of illness and sometimes replacing surgery and radiation (witness lymphoma - when's the last time a patient had a splenectomy for lymphoma?).

For radiation oncology, we'll continue to see treatment becoming more focal and less morbid, potentially reducing drug intensities or need for certain unpopular surgeries, as a replacement for some surgeries, and local option for visible tumors in metastatic patients. Higher doses and lower side effects will open up new opportunities just like SBRT and SRS did.

If you are somebody potentially interested in going into Med Onc or Rad Onc, I wouldn't advise you ask yourself about how many weeks of vacation or relative prestige one field may have over the other at this time, because those things change. Consider instead the inherent nature of the work, and which approach has more appeal to you individually: Making people better with drugs, molecular biology and medicine, or using technology, hardware and software to cure cancer, using a more anatomy-based approach. Some of our future treatments will not even be for cancer, quite possibly for non-invasive ablation of things currently done in cath labs, like this new paper on radiosurgery for A-fib:

https://www.researchgate.net/publication/364639300_Paroxysmal_Atrial_Fibrillation_in_Elderly_Worldwide_Preliminary_Data_of_Linac-Based_Stereotactic_Arrhythmia_Radioablation_Prospective_Phase_II_Trial

Please see if you can spend some time in Rad Onc and med onc clinic and back offices. I have a friend who studied nuclear engineering as an undergrad, who went on to become, you guessed it: a medical oncologist, and a very good one at that. Why? He just enjoyed those clinical interactions more once he actually got his hands wet doing the work.