In Memoriam: Radiation Oncology 1969-2019-A Tribute

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Why? When speaking of dinosaurs I think the reptilian brain's self-preservation instinct takes precedence over the desire to continue sunbathing and feasting off the hunts of the younger lizards.

401ks took a hit, rad onc is a field you can continue until the day you die, gotta make sure they got enough money to do the money dance

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401ks took a hit, rad onc is a field you can continue until the day you die, gotta make sure they got enough money to do the money dance

Its like if they arent dying of COVID they are actively sucking ever last drop of life out of you, the system they work in, and everyone else. Certainly didn't age gracefully.

Anyway, Im waiting for our dept to downsize and rescind contracts for the fresh meat supposed to be coming in the summer. ofcourse the young ones are the first to get culled. I feel bad if you have a family to support.
 
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It’s just no one will consider retiring from a high paying job until the economy has stabilized and looks solidly back on the up swing.

it’s not even about recouping losses at this point. It’s about knowing the full extent of the downside.
 
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Its like if they arent dying of COVID they are actively sucking ever last drop of life out of you, the system they work in, and everyone else. Certainly didn't age gracefully.

have put several of these guys out of business. It's a highly gratifying experience :). One major old-timer had to be dragged out of the hospital by security but still attended tumor boards for a year after just to give me the stink eye. These are the boomer leaders of our field...
 
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have put several of these guys out of business. It's a highly gratifying experience :). One major old-timer had to be dragged out of the hospital by security but still attended tumor boards for a year after just to give me the stink eye. These are the boomer leaders of our field...

Petty and past their prime and irrelevant. No longer contributing to anything other then to my rising BP. Its the ugly side of medicine in general but since there isnt anything pretty going on over in RO all we have is an ugly side.
 
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Its like if they arent dying of COVID they are actively sucking ever last drop of life out of you, the system they work in, and everyone else. Certainly didn't age gracefully.

I laugh, but I feel bad about it.
 
have put several of these guys out of business. It's a highly gratifying experience :). One major old-timer had to be dragged out of the hospital by security but still attended tumor boards for a year after just to give me the stink eye. These are the boomer leaders of our field...
We oughtta make all these guys/gals undergo routine, weekly dementia screening. I do it. It's also known as ABR OLA.
 
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We oughtta make all these guys/gals undergo routine, weekly dementia screening. I do it. It's also known as ABR OLA.

I don’t mean to brag but I am batting a perfect score. I wish the annual residency tests were this easy! It would have spared me a bunch of nasty meetings with my PD.
 
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I don’t mean to brag but I am batting a perfect score. I wish the annual residency tests were this easy! It would have spared me a bunch of nasty meetings with my PD.
You're better than I. I've missed 1. One of those "which one of these is never the case when such and such is never present" questions, and I hadn't had my coffee. Or....... I'm getting dementia.
 
Some nurses in America now making more money at their job than radiation oncologists. That's a pretty bad death.

Hit my inbox today:

"Good Evening,



I hope you are having a nice week. I wanted to see if you needed any help with staffing at your own practice. If so – feel free to forward this on to the person that schedules that for you. I have a lot of physicians that are ready to work, and they would love to help. Reach out to me with any questions."
 
Now that a new year is upon us, let us take a moment to remember those we have lost in the last year. I ran across this tribute to our old friend radiation oncology.

Radiation Oncology, the formerly competitive and inspiring specialty, died in late 2019, the American Board of Radiology announced.

The once prominent specialty struggled in recent years to attract talent. At the end of 2019 it was clear that the end was eminent. Hospice was initiated. The pearly gates opened, and Radiation Oncology reunited with its old friend nuclear medicine.

Radiation oncology was born in the late 1960s to the American Board of Radiology. The early years were quite a struggle for the specialty. The only prerequisite for admission was a pulse. “We used to have so much free time we convinced ourselves that radiation biology was useful” quipped Paul Wallner, one of the first radiation oncologists. “We continued this time-wasting charade until 2018 when residents started to understand the uselessness.”

Over time the specialty grew. Residents that spoke some English and were on the spectrum began to matriculate in the mid to late 1990s.

The heyday began in the early 2000s with the advent and growth of IMRT. The fossilized founders of the field were kicking and screaming. “You mean to tell me I have to know the tumor’s location and draw it on this computer? I’ll just keep 100% resident staffing for attendings in perpetuity instead” Ralph Weichselbaum, one of the oldest fossils in medicine, was quoted as saying at the time.

Reimbursement increased significantly and lagging not too far behind was competitiveness of the specialty. Nearly two decades of highly qualified residents followed the reimbursement increase.

Academic radiation oncologists became jealous of their ever-richer private practice friends. They went to their chairs and threatened to only remain in academia with 100% support with a highly qualified nurse practitioner. A “resident” as they called them.

Over time the academic attending’s skills died faster than radiation for lymphoma. Fortunately, Chairs protected the fossils. While the resident was doing all the work, the fossils did research to show that radiation was unnecessary. They spent the remainder of their careers advocating for omission of radiation.

Cracks began to form in 2013 when a brave resident published that physician supply may outstrip radiation demand. He made such controversial statements as “If demand decreases and supply increases the job market may be impacted” he continued his verbal assault by saying “maybe we should look into this”

The consternation was quick and harsh. “We knew he was right, but we had to pretend like everything was great. I couldn’t have attendings contouring and writing notes” said Dennis Hallahan, his former chair at Washington University. “Instead I just blackballed his a** and had the fossils play along. That probably ended up buying us about 5 more years where we could expand the residency cohort into oblivion.”

“I knew ASTRO was going to sit on their hands because I paid Ben Falit to tell them the Feds would do a raid if they advocated for their constituents job prospects.” Hallahan chuckled. “I knew they were gullible, but I didn’t know they were that gullible…hahahahah”

Over time residents caught on to their limited job prospects. It remained quiet until 2018.

“That’s when all hell broke loose” said Lisa Kachnic. “These kids didn’t know their radiation biology and Paul Wallner was mad about it. We wrote an editorial calling residents stupid. Then we failed half of them on their boards.” Lisa was becoming increasingly agitated during the interview.

“Back in my day you just kept your head down and bowed to the fossils. I said prayers to a shrine of Luther Brady. Now these residents have the gall to ask questions.” Kachnic continued her diatribe. “They even criticized me online. The millennial's call that cyberbullying. I mean, I know we failed them all, but I was the victim of some tough questions. They made me explain myself.”

Lisa Kachnic became too upset to continue the interview. When her term ended with the ABR she started a cyberbullying support group for baby boomers.

After failing worthless boards, the residents realized their colossal mistake. They went through 5 years of training in a dying specialty only to be called stupid for not knowing protein MDE876ER56821.

Attendings and residents alike gathered on an underground, dark web forum called Student Doctor.

“I tried for two hours to access it but couldn’t quite get there. I was hooking up my phone cord, blowing on it, checking for a dial tone, calling tech support, powering down power up. I even went on my roof to make sure there wasn’t any fresh Minnesota snow on my satellite dish. The neighborhood kids that won’t get off my lawn thought I was Santa. After all that I still couldn’t get dialed into Student Doctor. Instead I dialed up twitter and called them malcontents” said Ken Olivier who is one of the newest radiation oncology fossils.

When Olivier was told everyone can access and post on Student Doctor, he paused in disbelief.

“They don’t have real doctors there. How am I supposed to black ball the career of someone named ‘medgator’? I can’t find medgator’s healthgrades page. Is medgator their first name or last name? If I see them on twitter, I could personally attack them for having opinions.”

In the interim jobs continued to decline, and residents continued to complain. They started publishing papers about their concerns.

“As soon as I read that paper, I knew I had to act” said Louis Potters. “We just recently opened a program and I knew we would get criticism if residents had concerns about the job market. I pulled out my typewriter and pecked away. The first thing I came up with was “concerns”. It was ingenious. I PUT IT IN QUOTES!!! HAHAHAHAH” he exclaimed while slapping his knee.

Since his department now has resident slave labor, Potters had his resident transcribe his scroll into electronic form for journal submission. “When I was a resident, we had chalk and X-ray film. Now that I have residents, I have reverted to typewriters and stone tablets. It’s like the good ole days when residents didn’t speak unless spoken to.”

The divide between academics and everyone else increased. Some wise academics removed their heads from the hind quarters of Simon Powell. “It was quite refreshing to listen to different points of view” said Rahul Tendulkar. “I realized other people can also make points.”

This was controversial.

When we asked Paul Wallner if people under the age of 70 can have opinions he said “Lisa Kachnic and I are brainstorming and drafting a manuscript on this very topic. Since it is not yet published, I cannot divulge many details. The title will be ‘Not Only No, but Hell to The No’. The millennials like saying ‘hell to the no’, I’m not sure what it means.”

Wallner was clearly trying to placate the millennials with the title. He was still distraught after his google search of “Ok boomer” only showed pictures of himself counting money that he received from the fraudulent billing practices at 21st century oncology. “Only the government thought it was fraud, the ABR saw it as a resume building experience to qualify me to fail residents on their boards.”

As controversy increased and jobs decreased, medical students stopped applying to radiation oncology. “Why would I waste all this training to be lucky to get a job practicing on the Frontier” said one medical student.

“Neha Vapiwala thought she was helping the field when she said there were plenty of jobs in Cambodia and on the Frontier” the medical student continued referring to a recent article on alternative careers for unemployed radiation oncologists. “I couldn’t help but think to myself, ‘Why in the f**k would I want to have to be lucky to practice on a Frontier’?”.

“When Neha Vapiwala packs her Conestoga wagon and heads out West maybe I can take her job.” The medical student went on to say medical oncologists can practice in the same country in which they train. There are no publications in JAMA oncology talking about helping Russian physicians learn about chemotherapy as a career.

The final nail was bundled payments and a change in the supervision requirements. Private practices stopped hiring. When they needed more physicians, they offered “fellowships.”

The last qualified radiation oncology residents will finish up and head to the Dakotas or Cambodia if they’re lucky. The rest will leave medicine to make room for reentry of non-English speaking foreign medical graduates on the spectrum seeking visa sponsorship opportunities.

Ralph Weichselbaum was at the funeral but did not show remorse. “Residents can go be pediatricians. In the meantime, I’m going to keep terrorizing University of Chicago residents until they come with a body bag and wheel barrel into my office.”

ASTRO was also present for the funeral but declined to comment because they think they are under surveillance by the anti-trust division of the feds. “We can’t comment on radiation oncology’s death. We aren’t allowed to advocate for the specialty” they whispered under their breath.

Lisa Kachnic gave the euology. She blamed small programs for the demise of the specialty. She said the data to back up her claim is still maturing. She was confident she was right this time as opposed to the last time she claimed small programs did worse on board exams. That statement led to a forced retraction one year later. “I still make no apologizes for the ABR board fiasco and I am the victim of cyberbullying so f**k off” were her final departing words to radiation oncology.

In lieu of flowers, donations may be made to the debt of current residents. Cambodia does not pay as well as we had hoped.

No idea how I missed this but holy **** was that entertaining.
 
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Hit my inbox today:

"Good Evening,



I hope you are having a nice week. I wanted to see if you needed any help with staffing at your own practice. If so – feel free to forward this on to the person that schedules that for you. I have a lot of physicians that are ready to work, and they would love to help. Reach out to me with any questions."

Radiation Oncology, it's all about people just trying to help!
 
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Found on the medicine subreddit. “Path and radonc” are one and the same for everyone now. Going to take some very real action by academia to turn this around. I’m not holding my breath.
 

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We are in times of pervasive wrathful deceit. Telling the truth can be a revolutionary act. Keep up the good fight!
 
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Found on the medicine subreddit. “Path and radonc” are one and the same for everyone now. Going to take some very real action by academia to turn this around. I’m not holding my breath.

I wonder if any of these people have even tried to network, that's where all the jobs are.
 
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In Memoriam...

Do you think our field is ready for 800 cGy/1fx and call the priest for the last rite...
 
Back to beating this dead horse I see

We should just sticky this thread, for the public good
 
Back to beating this dead horse I see

We should just sticky this thread, for the public good

People tend to get upset when they pursue something for years at immense personal cost only to find out they are an unemployable superfluous commodity.
 
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Back to beating this dead horse I see

We should just sticky this thread, for the public good

People tend to get upset when they pursue something for years at immense personal cost only to find out they are an unemployable superfluous commodity.

Yes, the "dead horse" is the rotting corpse of the RadOnc job market. We must beat it to scatter the flies so medical students can behold its full glory and run in a different direction!
 
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I'm far more pessimistic about things right now. A day of reckoning was due for medicine in general. COVID accelerated it. Artificial intelligence, more mid-levels, declining reimbursement will affect other specialties as well.

Before you know it the landscape of medicine in the US will be identical to the one in Canada.

North of the border folks doing Ortho need 2-year fellowships to practice somewhere in the boonies. Want to be a hospitalist? No problem. GIM is 4 years in Canada (it's only 3 years if you match into a sub-specialty fellowship) and good luck getting a hospitalist job without doing a "hospitalist fellowship" which can be 1-2 years. And don't even think about "falling back" with your GIM training if you can't get hired as a sub-specialist. If you did the abbreviated 3 years of GIM to pursue a sub specialty you can't compete with those folks that did 4 years of GIM +1-2 years of hospitalist fellowship.

Radiology pays handsomely, but you need those 2 years of fellowship. Gotta read scans 12 hours a day. When on-call must co-sign that resident/fellow note in 1 hour. Your computer/vpn/internet doesn't work? No excuses. You have to come in to the hospital then. Free-standing centers? what are those? Oh you mean the ones that got grandfathered in before single payer. Good luck getting hired in one of those.

The number of neurosurgery grads that I know who are now consultants for healthcare/medical tech companies is absurd.

I don't feel comfortable advising any undergrad into going into medicine. Medical training is incredibly protracted and if the US is going the way of Canada but with US levels of educational debt? All I can say is run. Do something in computer science or engineering. Far more viable, until the robots take all those jobs.

It's been a while since I opened up the red journal I have to admit.
 
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Covid definitely made things more depressing. Not even an ARS or ACRO meeting to look forward to. No after work happy hour.
 
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Covid definitely made things more depressing. Not even an ARS or ACRO meeting to look forward to. No after work happy hour.

So true. I miss the after work happy hour.

Hey, this will cheer you up.

Screenshot_20201017-155118.jpg


Here we have veritable proof that the powers that be know that matching this year will be a cakewalk hence, "welcome to the fam" and what a "fam" it is

gettyimages-463629668.jpg
 
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I genuinely wonder if doing this kind of outreach makes academic radoncs feel good about themselves. I simply cannot believe so many are mustache-twirlingly evil, doing this on purpose to get cheap labor for their department. I believe KO, for example, for all the crap we give him, genuinely cares for his trainees and wants them to succeed. Impossible for me to reconcile that with their complete unwillingness to even admit we have a major issue for so long, let alone do anything about it.

I guess everyone really does want to become the hero of their own story.
 
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I genuinely wonder if doing this kind of outreach makes academic radoncs feel good about themselves. I simply cannot believe so many are mustache-twirlingly evil, doing this on purpose to get cheap labor for their department. I believe KO, for example, for all the crap we give him, genuinely cares for his trainees and wants them to succeed. Impossible for me to reconcile that with their complete unwillingness to even admit we have a major issue for so long, let alone do anything about it.

I guess everyone really does want to become the hero of their own story.

Many honestly don't believe there's a problem, survivorship bias and all that ("I got a job, it worked out for me"). I believe this is KO's issue (and I simultaneously think KO is a good person/good doctor/wants what's best for trainees). In the ACR medical student thing this summer, KO said that when he was a medical student some senior residents took him aside and warned him to stay away from Radiation Oncology. He said he was glad he ignored their advice and has had a long and successful career.

Small problem with that story - KO was a medical student in the late 90s/early 2000s, as RadOnc really was struggling and was actively contracting. When he graduated and got a job...IMRT cracked on the scene, and he has had 20 years of being an attending during PEAK RadOnc.

He's telling his personal story/truth without embellishment, I think he honestly believes everything he says. He's just believing this story without appreciating the greater context.

Edit: I just checked, he graduated med school in 1997 and RadOnc residency in 2002. That is literally the most skewed experience someone could have based on what we know now.
 
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I genuinely wonder if doing this kind of outreach makes academic radoncs feel good about themselves. I simply cannot believe so many are mustache-twirlingly evil, doing this on purpose to get cheap labor for their department. I believe KO, for example, for all the crap we give him, genuinely cares for his trainees and wants them to succeed. Impossible for me to reconcile that with their complete unwillingness to even admit we have a major issue for so long, let alone do anything about it.

I guess everyone really does want to become the hero of their own story.

The road to hell is paved with good intentions
 
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Many honestly don't believe there's a problem, survivorship bias and all that ("I got a job, it worked out for me"). I believe this is KO's issue (and I simultaneously think KO is a good person/good doctor/wants what's best for trainees). In the ACR medical student thing this summer, KO said that when he was a medical student some senior residents took him aside and warned him to stay away from Radiation Oncology. He said he was glad he ignored their advice and has had a long and successful career.

Small problem with that story - KO was a medical student in the late 90s/early 2000s, as RadOnc really was struggling and was actively contracting. When he graduated and got a job...IMRT cracked on the scene, and he has had 20 years of being an attending during PEAK RadOnc.

He's telling his personal story/truth without embellishment, I think he honestly believes everything he says. He's just believing this story without appreciating the greater context.

Edit: I just checked, he graduated med school in 1997 and RadOnc residency in 2002. That is literally the most skewed experience someone could have based on what we know now.
OMG the golden decade
 
Don’t we mainly work Monday-Friday and usually are done with clinic by 5ish? Not bad for a doc no? Get paid at least 250ish
 
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Don’t we mainly work Monday-Friday and usually are done with clinic by 5ish? Not bad for a doc no? Get paid at least 250ish

If you can get a job, it’s a great job. Everyone here agrees with that.

Big “if” there, and now add on another: IF you can get a job and IF you can get one in a place you will like, then you could be happy.

Not good for a doc no?
 
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Don’t we mainly work Monday-Friday and usually are done with clinic by 5ish? Not bad for a doc no? Get paid at least 250ish
I have a new friend who’s a PCP. He’s a few years older than me. Good vacation time. Works about 4.5 days a week. Got a check from Humana for 65K last month, something to do with Medicare wellness checks. Makes 450k a year. Don’t get me wrong, he works hard. But he’s not killing himself. I made him pay for dinner tonite put it that way.
If you can get a job, it’s a great job. Everyone here agrees with that.

Big “if” there, and now add on another: IF you can get a job and IF you can get one in a place you will like, then you could be happy.

Not good for a doc no?
got a new pcp friend who got a check from Humana for 65k last week and he makes 450 plus a year. So I made him buy dinner tonite. Not so much envious of his pay but all the options he has in terms of jobs and geography
 
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I have a new friend who’s a PCP. He’s a few years older than me. Good vacation time. Works about 4.5 days a week. Got a check from Humana for 65K last month, something to do with Medicare wellness checks. Makes 450k a year. Don’t get me wrong, he works hard. But he’s not killing himself. I made him pay for dinner tonite put it that way.

got a new pcp friend who got a check from Humana for 65k last week and he makes 450 plus a year. So I made him buy dinner tonite. Not so much envious of his pay but all the options he has in terms of jobs and geography

No need to be so envious. Geography? pffft, who cares about that these days? The entire world is a dog's breakfast.

Jobs on the other hand? It would take a lot for me to be envious of a PCP who has to spend 80% of their time telling patients to lay off the cheeseburgers and take their BP meds. Now , a radiologist? I would be envious of a radiologist's job.
 
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I have a new friend who’s a PCP. He’s a few years older than me. Good vacation time. Works about 4.5 days a week. Got a check from Humana for 65K last month, something to do with Medicare wellness checks. Makes 450k a year. Don’t get me wrong, he works hard. But he’s not killing himself. I made him pay for dinner tonite put it that way.

got a new pcp friend who got a check from Humana for 65k last week and he makes 450 plus a year. So I made him buy dinner tonite. Not so much envious of his pay but all the options he has in terms of jobs and geography
Grass is always greener on the other side, don't forget that. I'll never be envious of a PCP and the unique train wrecks they always deal with.
 
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Don’t we mainly work Monday-Friday and usually are done with clinic by 5ish? Not bad for a doc no? Get paid at least 250ish

Unfortunately, that logic has led *MANY* radiation oncologists to work for companies like Evicore
 
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Unfortunately, that logic has led *MANY* radiation oncologists to work for companies like Evicore

Flexible hours, flexible choice of location, and pay on par with many academic gigs. I've heard more than one resident and/or rad onc fantasizing about it. I got on there one day and the attending was someone from residency who trained me :laugh:

Meanwhile they can't even find specialty reviewers for radiology or med onc. Most of those reviewers are generalists (IM/FM). Why would radiology or med onc do it? There's no problem finding a radiology or med onc position in almost any locale that pays far better than Evicore. That isn't so in rad onc.
 
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Flexible hours, flexible choice of location, and pay on par with many academic gigs. I've heard more than one resident and/or rad onc fantasizing about it. I got on there one day and the attending was someone from residency who trained me :laugh:

Meanwhile they can't even find specialty reviewers for radiology or med onc. Most of those reviewers are generalists (IM/FM). Why would radiology or med onc do it? There's no problem finding a radiology or med onc position in almost any locale that pays far better than Evicore. That isn't so in rad onc.
Only matter of time before evicore offers fellowships in xrt review.
 
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Flexible hours, flexible choice of location, and pay on par with many academic gigs. I've heard more than one resident and/or rad onc fantasizing about it. I got on there one day and the attending was someone from residency who trained me :laugh:

Meanwhile they can't even find specialty reviewers for radiology or med onc. Most of those reviewers are generalists (IM/FM). Why would radiology or med onc do it? There's no problem finding a radiology or med onc position in almost any locale that pays far better than Evicore. That isn't so in rad onc.

Yeah I’ve run into my former attending on Evicore recently
 
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It's close. I know some rad onc locums making $1000/day. Factoring in tax-freeness for the nurse pay, the distribution curves overlap. I just never thought the curves would ever even touch. Also not to be overlooked: the nurse is making ~$5000/week for 4 days work.
Just saw this on a physician side gigs FB thread for CCM/ICU doc locums DAILY rate... Supply/demand:

"depends on volume, proximity to start date, and geographic location.

2k on low side
5k on extreme high side"
 
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Just saw this on a physician side gigs FB thread for CCM/ICU doc locums DAILY rate... Supply/demand:

"depends on volume, proximity to start date, and geographic location.

2k on low side
5k on extreme high side"
15 years ago as resident, we used to locums for 2k a day.
 
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I got 800-1000/day. Still offered the same rate as an attending, though I do see $1200/day offers out there sometimes.
I got 800-1000/day. Still offered the same rate as an attending, though I do see $1200/day offers out there sometimes.
Years ago, Wally Curran had hooked his residents up with covering an inpt drug treatment facility on weekends. As I understand it, they basically slept the whole time, studied radonc, and wrote occasional order for anti-diarrhea and sleeping meds. It was more than 1k a day.
 
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Years ago, Wally Curran had hooked his residents up with covering an inpt drug treatment facility on weekends. As I understand it, they basically slept the whole time, studied radonc, and wrote occasional order for anti-diarrhea and sleeping meds. It was more than 1k a day.

Sounds great - wish I had those kind of hookups in residency. Radiology residents had some good internal locums/moonlight opportunities.

I recall that UAB had a weight loss clinic setup and Vanderbilt had some hospice stuff going on. A lot easier to moonlight/locums as a resident when it's built into your program's history.
 
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UC chair also said RO should be paid less than pediatrician and this would be “good living” running gels in his lab.

Steinberg clearly colluded with Wallner and is partly to blame for bullying of lactating female rad oncs

Marcus Randall said “where is the evidence”, as he has no issue placing his grads in Kentucky.

Dennis Hallahan said you get paid too much. The other grifters who ran hit job on Shah on IJROP also in same list with their coordinated “editorials”.

see a pattern?
 
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Several years back UCLA was paying Steinberg 1 million after he sold multiple practices to 21 c for who knows how much. Be interesting to see if his salary is still 1 million or has now risen into Lou potters territory?
california
 
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