Is rad onc job market … rebounding?

[DrProtonX]

I just came across couple job posts one $600k in San Antonio and one $400/hr in Ohio. Those numbers are pretty rare these days. Was there a time that rad onc job market looked as robust as current rad or gas job market? Or is this as good as it gets for rad onc?

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[elementaryschooleconomics]

I just came across couple job posts one $600k in San Antonio and one $400/hr in Ohio. Those numbers are pretty rare these days. Was there a time that rad onc job market looked as robust as current rad or gas job market? Or is this as good as it gets for rad onc?

The past two years or so had a "pandemic bubble" - significantly more retirements or reducing clinical presence etc

Early chatter seems to be we're returning to our normal tight market. I don't think we're back to 2018/2019 just yet, but it definitely seems different than last year

 

[DrProtonX]

The past two years or so had a "pandemic bubble" - significantly more retirements or reducing clinical presence etc

Early chatter seems to be we're returning to our normal tight market. I don't think we're back to 2018/2019 just yet, but it definitely seems different than last year

If this trend continues, even just 10% reduction in residency spots might prevent the bleak job market outlook the report predicted. Hopefully ASTRO new leadership does the right thing

 

[Gfunk6]

Hopefully ASTRO new leadership does the right thing

 

[NotMattSpraker]

If this trend continues, even just 10% reduction in residency spots might prevent the bleak job market outlook the report predicted. Hopefully ASTRO new leadership does the right thing

That’s Anti trust bro.

It is true that one possible president elect has a lot of experience…. Uh…. working with the feds?

I try to see the positive aspects of things

 

[TheWallnerus]

That’s Anti trust bro.

It is true that one possible president elect has a lot of experience…. Uh…. working with the feds?

I try to see the positive aspects of things

“Working with the feds”

Hilarious

 

[deleted1180461]

I want to know who exactly the person is who accepts the 1099 work in Kearney (literally pronounced Carney), NE for $200/hr.

Edit: also something to remember: 600k in 2024 is equivalent to 452k in 2014 and 488k in 2019. How many of us are making 23% more than we were 5 years ago for the same work? My base pay is exactly the same as 2019.

 

[TheWallnerus]

I want to know who exactly the person is who accepts the 1099 work in Kearney (literally pronounced Carney), NE for $200/hr.

Edit: also something to remember: 600k in 2024 is equivalent to 452k in 2014 and 488k in 2019. How many of us are making 23% more than we were 5 years ago for the same work? My base pay is exactly the same as 2019.

According to the MGMA, the lowest 10th percentile salaried rad oncs have gotten a 40% raise over the last 5 years; the 90th percentile, a 20% raise. According to ROCR authors, rad onc itself though has sustained huge cuts. So I think all this means if we can lower reimbursement to zero for everything we’re all gonna be rich.

 

[elementaryschooleconomics]

According to the MGMA, the lowest 10th percentile salaried rad oncs have gotten a 40% raise over the last 5 years; the 90th percentile, a 20% raise. According to ROCR authors, rad onc itself though has sustained huge cuts. So I think all this means if we can lower reimbursement to zero for everything we’re all gonna be rich.

I see you did a statistics fellowship with ASTRO.

 

[ramsesthenice]

I want to know who exactly the person is who accepts the 1099 work in Kearney (literally pronounced Carney), NE for $200/hr.

Edit: also something to remember: 600k in 2024 is equivalent to 452k in 2014 and 488k in 2019. How many of us are making 23% more than we were 5 years ago for the same work? My base pay is exactly the same as 2019.

Let’s not make Econ sound as simple as that. For new grads starting out, I think the math works pretty close. For us…not so much. A huge component of COLA even now is housing costs. I'm still locked into a 1.9% 15 year mortgage. My compensation is only up 15% from 2019 but even with inflation and an infant, I’m saving more now than I did then.

To your point, if I bought my house now at $250K over what I paid about 10 years ago with 8% interest…not good. It would be doable in my area but nothing like it was for me. I was able to pay off my med school loans and my wife’s MBA in under 3 years without completely abandoning discretionary spending. I’d almost certainly still be working on those under current conditions.

We can whine about it but you know better. Our incomes have always been divorced from COL. That’s not going to change now.

 

[yesmaster]

I just came across couple job posts one $600k in San Antonio and one $400/hr in Ohio. Those numbers are pretty rare these days. Was there a time that rad onc job market looked as robust as current rad or gas job market? Or is this as good as it gets for rad onc?

San Antonio isn’t a bad city but isn’t desirable for most Millennials/Gen Z doctors completing training. Similarly, Cleveland and Columbus aren’t desirable, the other smaller places of Ohio even less so.

A Ohio cancer center was offering $650k on ASTRO job board in 2015. Glad to see our pay has kept up with inflation and COL these last 9 years.

In contrast, in heme onc:

Community Oncology | San Jose, CA | 4 Day Week | Top 100 Hospital in US - California job with Jackson Physician Search | 783340

Join a state-of-the-art, 400-bed hospital system in an outpatient Hem/Onc role. This award-winning system opened their own Cancer Center in 2007 an...

www.nejmcareercenter.org

LOS ANGELES, HEMATOLOGY/ONCOLOGY - Los Angeles, California job with Hematology-Oncology Specialists | 763023

$550,000 Starting base salary. Private Oncology Practice with multiple locations in Los Angeles area looking for BC\BE Oncologists to join our...

www.nejmcareercenter.org

When was the last time there was an open rad onc position for $550k base and $900k TC in Los Angeles or Silicon Valley, with a 4 day work week?

Tons of other heme onc jobs in desirable metros like Seattle, Denver, etc. I’m guessing these jobs aren’t exclusively available to MDA and MSKCC fellowship graduates either.

Yes, rad onc will have mgma median $600k jobs in small towns 50-200k people for the foreseeable future. Heme onc by the way is paid 2.5x our comp for these rural positions.

We’re not the same.

 

[OTN]

I just came across couple job posts one $600k in San Antonio and one $400/hr in Ohio. Those numbers are pretty rare these days. Was there a time that rad onc job market looked as robust as current rad or gas job market? Or is this as good as it gets for rad onc?

These numbers are relatively poor for specialists physicians in the house of medicine.

 

[drowsy12]

San Antonio isn’t a bad city but isn’t desirable for most Millennials/Gen Z doctors completing training. Similarly, Cleveland and Columbus aren’t desirable, the other smaller places of Ohio even less so.

it's just funny to me that we write off cities with sports teams, airports, clearly major cities.

rad oncs are a special breed that refuse to live in anything other than NYC/SF/LA?

maybe we do need an influx of FMGs?

 

[yesmaster]

A huge component of COLA even now is housing costs. I'm still locked into a 1.9% 15 year mortgage.

1.9%! 🤤

 

[TexasMed22]

San Antonio isn’t a bad city but isn’t desirable for most Millennials/Gen Z doctors completing training. Similarly, Cleveland and Columbus aren’t desirable, the other smaller places of Ohio even less so.

A Ohio cancer center was offering $650k on ASTRO job board in 2015. Glad to see our pay has kept up with inflation and COL these last 9 years.

In contrast, in heme onc:

Community Oncology | San Jose, CA | 4 Day Week | Top 100 Hospital in US - California job with Jackson Physician Search | 783340

Join a state-of-the-art, 400-bed hospital system in an outpatient Hem/Onc role. This award-winning system opened their own Cancer Center in 2007 an...

www.nejmcareercenter.org

LOS ANGELES, HEMATOLOGY/ONCOLOGY - Los Angeles, California job with Hematology-Oncology Specialists | 763023

$550,000 Starting base salary. Private Oncology Practice with multiple locations in Los Angeles area looking for BC\BE Oncologists to join our...

www.nejmcareercenter.org

When was the last time there was an open rad onc position for $550k base and $900k TC in Los Angeles or Silicon Valley, with a 4 day work week?

Tons of other heme onc jobs in desirable metros like Seattle, Denver, etc. I’m guessing these jobs aren’t exclusively available to MDA and MSKCC fellowship graduates either.

Yes, rad onc will have mgma median $600k jobs in small towns 50-200k people for the foreseeable future. Heme onc by the way is paid 2.5x our comp for these rural positions.

We’re not the same.

The bolded seems unlikely. Every salary survey at every percentile has rad onc out earning heme onc. Obviously their job market is much better in terms of choosing location though

 

[yesmaster]

it's just funny to me that we write off cities with sports teams, airports, clearly major cities.

It’s just funny to me when we compare rad onc compensation in Akron to heme onc or rads comp in San Diego.

 

[TheWallnerus]

Every salary survey at every percentile has rad onc out earning heme onc.

"Salary survey" imho is not the most accurate way to determine what doctors actually make, especially med onc doctors. My med oncs are running their own pharmacy out of their practice now... it's making huge profits. Plus, other things...

 

[communitydoc13]

We’re not the same.

It will only get worse. I'm preparing to run my clinic as lean as possible going forward with less indications and 5 fractions for most things. AI will bring the house down regarding targeted therapies for medonc. I predict that (away from major metros) we will have to move to a remote attending model for medonc with only APPs living in regular Merica and giving the drugs. At some point the locums contracts just don't make sense.

That whole narrative about "high touch" doctors being valued? Only in affluent communities. Everyone else will just be scrambling...high touch APPs may be valued. Right now, there are too many patients and too many drugs to give (in most fields...no ours).

1.9%! 🤤

Kids are still out there trying to buy their first house. There is a whole culture of loan envy out there regarding folks who missed the low interest loan environment by just years. I'd keep the 1.9% close to the chest! Pitchforks a coming.

 

[yesmaster]

"Salary survey" imho is not the most accurate way to determine what doctors actually make, especially med onc doctors.

View attachment 388526

Med oncs have ownership, I’m guessing at higher rates than rad oncs, and practice owners aren’t captured in mgma employed salaryman surveys…

 

[deleted1180461]

Let’s not make Econ sound as simple as that. For new grads starting out, I think the math works pretty close. For us…not so much. A huge component of COLA even now is housing costs. I'm still locked into a 1.9% 15 year mortgage. My compensation is only up 15% from 2019 but even with inflation and an infant, I’m saving more now than I did then.

To your point, if I bought my house now at $250K over what I paid about 10 years ago with 8% interest…not good. It would be doable in my area but nothing like it was for me. I was able to pay off my med school loans and my wife’s MBA in under 3 years without completely abandoning discretionary spending. I’d almost certainly still be working on those under current conditions.

We can whine about it but you know better. Our incomes have always been divorced from COL. That’s not going to change now.

Housing inflation varies by market but in general has been consistent with inflation in most things we buy. The value of the dollar went down dramatically from 2021-2023. It's not really that housing suddenly became more valuable, it's that our money became worth less because, well, I think we know why (inflation of the money supply). Yes, there was a supply squeeze in housing when everyone was desperately trying to lock in low rates in 2021 that drove up prices on the resale market. But the persistently high costs we are seeing now with 8% 30 years are at this point due to inflation of what the house is made of and the labor to build it. If you have tried to spec out the cost for a new build, you know what I'm talking about. Resale here is suddenly coming on the market and it's not selling. Something interesting is going to happen in the market. In Las Vegas, for example, they have built sooo much rental housing. When people lose their houses or want to move, what do you think is more appealing? Buying a 2800 sq ft home for $900,000 at 8% and paying $5k/month for your mortgage + inflated taxes, insurance, HOA, and maintenance or renting the same house for $3800k/month and having none of the above? Or getting a unit in a multifamily complex which is experiencing rent deflation for half the cost and just putting an extra 5k a month in the stock market? This is a long winded way of saying, probably not a good time to buy a house. There is a widespread conception in America that everyone who owned a house is now rich. No, you've just kept up with inflation, which I guess is a laudable goal at this point. Now if you have a 1.8% mortgage, that's a different story. You are renting your house from the bank and can arbitrage your monthly housing costs to make a real return just with 5.5% in treasuries.

Congrats on having (presumably your base salary) go up 15% since 2019. If you're RVU based and your $/RVU went up by 15%, that's awesome and I'm jealous. Most doctors in most specialties have gotten a double hit of both CMS cuts and inflation without COL raises.

 

[drowsy12]

Med oncs have ownership, I’m guessing at higher rates than rad oncs, and practice owners aren’t captured in mgma employed salaryman surveys…

You live in a strange world where you think ownership is standard in med onc

I encourage you to come down to reality.

Widespread Ownership in 2024? Don’t make me laugh.

Cherry picking helps no one

 

[thecarbonionangle]

"Salary survey" imho is not the most accurate way to determine what doctors actually make, especially med onc doctors. My med oncs are running their own pharmacy out of their practice now... it's making huge profits. Plus, other things...

View attachment 388526

Imagine walking into a RO job and demanding 20 percent profit sharing from day one. You are lucky if you even get partnership or any “profit sharing”. I would imagine this can be negotiated up for med onc. Comapare this to the same similar job in KY small town that refuses to pay what they should and are just “holding out for the right fit” staffing it with boomers who can barely stay awake.

 

[drowsy12]

I know of rad onc a practice right now that is being perma-locumd by an 85 year old

It’s wild out there

 

[deleted1180461]

You live in a strange world where you think ownership is standard in med onc

I encourage you to come down to reality.

Widespread Ownership in 2024? Don’t make me laugh.

Cherry picking helps no one

Med onc is a weird market.

Employed W2 med oncs make 500-600k
Full time locums can make 4-5k/day, so conservatively averaging this with 10 weeks not working 950k/year
Pro only groups covering multiple hospitals, I don't know but has to be a lot better than number 1
Brick and mortar practice owners with in house imaging, lab, and pharmacy 2M is not unreasonable.

I've never been clear why med oncs choose #1 when they have the others as viable options. The rad onc situation is basically the opposite of the above.

 

[ramsesthenice]

1.9%! 🤤

Total luck. Locked in at the very bottom. I went from a 30 year at 3.2% to a 15 year and payment went up around $400 a month. I will never see numbers like this again.

 

[deleted1180461]

I know of a practice right now that is being perma-locumd by an 85 year old

It’s wild out there

A practice? I've encountered at least a dozen and can name 6-7 off the top of my head. Once unethical administrators get a taste of the $1600/day 85 year old shuffling-gait-locum model, they don't want to go back. They can't see the forest for the trees of lost revenue from referrals being sent out, treatment mismanagement, imaging not ordered, what-is-this-referral-sbrt-what's-that?, etc, because that first hit of crack $1600/day geriatric locums was just so good on cutting down physician salary expense on paper but still being able to bill they will always chase it.

 

[ramsesthenice]

Housing inflation varies by market but in general has been consistent with inflation in most things we buy. The value of the dollar went down dramatically from 2021-2023. It's not really that housing suddenly became more valuable, it's that our money became worth less because, well, I think we know why (inflation of the money supply). Yes, there was a supply squeeze in housing when everyone was desperately trying to lock in low rates in 2021 that drove up prices on the resale market. But the persistently high costs we are seeing now with 8% 30 years are at this point due to inflation of what the house is made of and the labor to build it. If you have tried to spec out the cost for a new build, you know what I'm talking about. Resale here is suddenly coming on the market and it's not selling. Something interesting is going to happen in the market. In Las Vegas, for example, they have built sooo much rental housing. When people lose their houses or want to move, what do you think is more appealing? Buying a 2800 sq ft home for $900,000 at 8% and paying $5k/month for your mortgage + inflated taxes, insurance, HOA, and maintenance or renting the same house for $3800k/month and having none of the above? Or getting a unit in a multifamily complex which is experiencing rent deflation for half the cost and just putting an extra 5k a month in the stock market? This is a long winded way of saying, probably not a good time to buy a house. There is a widespread conception in America that everyone who owned a house is now rich. No, you've just kept up with inflation, which I guess is a laudable goal at this point. Now if you have a 1.8% mortgage, that's a different story. You are renting your house from the bank and can arbitrage your monthly housing costs to make a real return just with 5.5% in treasuries.

Congrats on having (presumably your base salary) go up 15% since 2019. If you're RVU based and your $/RVU went up by 15%, that's awesome and I'm jealous. Most doctors in most specialties have gotten a double hit of both CMS cuts and inflation without COL raises.

When I said housing, I didn’t just mean buying a house. Rent increases in most markets have far outpaced inflation and property management companies/private renters have zero incentives to bring them down. The alternative is out of reach for most people.

 

[Reaganite]

Med onc is a weird market.

Employed W2 med oncs make 500-600k
Full time locums can make 4-5k/day, so conservatively averaging this with 10 weeks not working 950k/year
Pro only groups covering multiple hospitals, I don't know but has to be a lot better than number 1
Brick and mortar practice owners with in house imaging, lab, and pharmacy 2M is not unreasonable.

I've never been clear why med oncs choose #1 when they have the others as viable options. The rad onc situation is basically the opposite of the above.

Older med oncs killed it in the heyday of medicine, have their big houses in desirable areas next to celebrities they bought in the 80s that no new grad could ever hope to purchase in their lifetime, etc. 550k can still sustain the lifestyle. Young guys don't want to live in North Dakota even for 900k.

 

[medgator]

San Antonio isn’t a bad city but isn’t desirable for most Millennials/Gen Z doctors completing training. Similarly, Cleveland and Columbus aren’t desirable, the other smaller places of Ohio even less so.

A Ohio cancer center was offering $650k on ASTRO job board in 2015. Glad to see our pay has kept up with inflation and COL these last 9 years.

In contrast, in heme onc:

Community Oncology | San Jose, CA | 4 Day Week | Top 100 Hospital in US - California job with Jackson Physician Search | 783340

Join a state-of-the-art, 400-bed hospital system in an outpatient Hem/Onc role. This award-winning system opened their own Cancer Center in 2007 an...

www.nejmcareercenter.org

LOS ANGELES, HEMATOLOGY/ONCOLOGY - Los Angeles, California job with Hematology-Oncology Specialists | 763023

$550,000 Starting base salary. Private Oncology Practice with multiple locations in Los Angeles area looking for BC\BE Oncologists to join our...

www.nejmcareercenter.org

When was the last time there was an open rad onc position for $550k base and $900k TC in Los Angeles or Silicon Valley, with a 4 day work week?

Tons of other heme onc jobs in desirable metros like Seattle, Denver, etc. I’m guessing these jobs aren’t exclusively available to MDA and MSKCC fellowship graduates either.

Yes, rad onc will have mgma median $600k jobs in small towns 50-200k people for the foreseeable future. Heme onc by the way is paid 2.5x our comp for these rural positions.

We’re not the same.

it's just funny to me that we write off cities with sports teams, airports, clearly major cities.

rad oncs are a special breed that refuse to live in anything other than NYC/SF/LA?

maybe we do need an influx of FMGs?

💯

 

[deleted1180461]

When I said housing, I didn’t just mean buying a house. Rent increases in most markets have far outpaced inflation and property management companies/private renters have zero incentives to bring them down. The alternative is out of reach for most people.

I have been a renter since 2020 and I have not noticed this. Rent has gone up almost exactly the same as the 23% CPI inflation over this time in the 2 different markets I lived in. My expectation is that the cost-of-living crisis middle and lower class Americans are experiencing and the overbuilding in many markets of rental units will result in rent deflation. The incentive to lower rents are empty units, which is a new problem. In 2021 finding an apartment to rent was almost as hard as finding a house. It's not now at all, but the higher rents are lingering. The rent-vs-own calculations is still heavily in favor of renting for the foreseeable future. I'm not sure I want to own a house anymore. My savings will do better in stocks rather than as equity in a house I own and live in, and if a mortgage is chosen over a cash purchase, then the extra $3k/month I'll have in fixed housing expenses (3k/month rent vs. 6/month mortgage, HOA, tax, insurance, upkeep, and maintenance) will almost certainly do better in the long run invested in the stock market. It ends up just being a space where you collect clutter and have to deal with broken things. There is something liberating about having zero responsibility for the building you sleep in. I think this reality is starting to hit home with all of the whining of never being able to afford a house because that is how you get rich and seeing the regret buyers of the past few years have, so the demand is going to continue to decline while supply increases. This will eventually flip the rent-vs-own back in favor of owning.

I could be wrong, but I don't think they (builders, realtors, lenders, financial media clickbait, and tiktok) can keep selling young people on why they need to spend double per month to own vs. rent because that's how you get ahead in life. That should raise questions immediately to anyone with a 4th grade understanding of how money works. This idea that renter = poor failure at life is a psy-op, one that I was admittedly sucked into for a while.

 

[ramsesthenice]

I have been a renter since 2020 and I have not noticed this. Rent has gone up almost exactly the same as the 23% CPI inflation over this time in the 2 different markets I lived in. My expectation is that the cost-of-living crisis middle and lower class Americans are experiencing and the overbuilding in many markets of rental units will result in rent deflation. The incentive to lower rents are empty units, which is a new problem. In 2021 finding an apartment to rent was almost as hard as finding a house. It's not now at all, but the higher rents are lingering. The rent-vs-own calculations is still heavily in favor of renting for the foreseeable future. I'm not sure I want to own a house anymore. My savings will do better in stocks rather than as equity in a house I own and live in, and if a mortgage is chosen over a cash purchase, then the extra $3k/month I'll have in fixed housing expenses (3k/month rent vs. 6/month mortgage, HOA, tax, insurance, upkeep, and maintenance) will almost certainly do better in the long run invested in the stock market. It ends up just being a space where you collect clutter and have to deal with broken things. There is something liberating about having zero responsibility for the building you sleep in. I think this reality is starting to hit home with all of the whining of never being able to afford a house because that is how you get rich and seeing the regret buyers of the past few years have, so the demand is going to continue to decline while supply increases. This will eventually flip the rent-vs-own back in favor of owning.

I could be wrong, but I don't think they (builders, realtors, lenders, financial media clickbait, and tiktok) can keep selling young people on why they need to spend double per month to own vs. rent because that's how you get ahead in life. That should raise questions immediately to anyone with a 4th grade understanding of how money works. This idea that renter = poor failure at life is a psy-op, one that I was admittedly sucked into for a while.

Without a sizable down payment, it’s is hard to imagine a situation in most markets where buying is the best financial decision anymore even in locations like ours where rent is up over 35% from 2-3 years ago. I can’t believe what people are paying for rent near me now. Renting a 2 bedroom townhome casts over 50% my total monthly payment for a near 4000sft home that I bought new < 10 years ago on a 15 year. Had I kept it on a 30 year, the difference would have been even smaller.

Unfortunately, this has essentially no relevance for people starting out now. Getting into my house now would cost almost double what it’s costing me and they won’t see a $250K increase in value over the first 5 years like I did. Every possible market force in 2017 favored me buying over renting. Only considering economics, it would be completely the opposite today.

I think all of this misses the point. Homeownership as a financial investment is over rated unless your goal is to live in the same home for many years. There are always many other options to make money on investments even in times when buying technically makes sense. You should only buy a house if you want to own a house. If you are like me and you genuinely enjoy landscaping and doing reno projects, buy a house. I get excited when I see a board on the deck needs to get replaced or a seem needs repair. I don’t get to use my tools as much as I would like. If you don’t want to do those things or hire someone to do them…don’t buy. Ever.

 

[fiji128]

I sent in my CV to a few of the better looking positions from the Astro Career over the past 6 months or so. Never heard anything back from anyone. n=1 but I suspect when most people think the job market in rad onc is not completely awful they are only comparing it the bottom of the market circa 2019 and not to the larger house of medicine.

 

[ramsesthenice]

Older med oncs killed it in the heyday of medicine, have their big houses in desirable areas next to celebrities they bought in the 80s that no new grad could ever hope to purchase in their lifetime, etc. 550k can still sustain the lifestyle. Young guys don't want to live in North Dakota even for 900k.

100%. Rad oncs should expect to be comfortable with a good amount of discretionary spending. But don’t expect to be rich. The days of expect to be able to indulge in most/all personal vices are long gone.

 

[elementaryschooleconomics]

100%. Rad oncs should expect to be comfortable with a good amount of discretionary spending. But don’t expect to be rich. The days of expect to be able to indulge in most/all personal vices are long gone.

So no more daily in vivo measurements?

Can I still do the EKGs?

 

[deleted1180461]

Without a sizable down payment, it’s is hard to imagine a situation in most markets where buying is the best financial decision anymore even in locations like ours where rent is up over 35% from 2-3 years ago. I can’t believe what people are paying for rent near me now. Renting a 2 bedroom townhome casts over 50% my total monthly payment for a near 4000sft home that I bought new < 10 years ago on a 15 year. Had I kept it on a 30 year, the difference would have been even smaller.

Unfortunately, this has essentially no relevance for people starting out now. Getting into my house now would cost almost double what it’s costing me and they won’t see a $250K increase in value over the first 5 years like I did. Every possible market force in 2017 favored me buying over renting. Only considering economics, it would be completely the opposite today.

I think all of this misses the point. Homeownership as a financial investment is over rated unless your goal is to live in the same home for many years. There are always many other options to make money on investments even in times when buying technically makes sense. You should only buy a house if you want to own a house. If you are like me and you genuinely enjoy landscaping and doing reno projects, buy a house. I get excited when I see a board on the deck needs to get replaced or a seem needs repair. I don’t get to use my tools as much as I would like. If you don’t want to do those things or hire someone to do them…don’t buy. Ever.

Agree with you completely and you are likely in a very different market than me (sounds like CA with high rents and property-tax protected homes). Buying vs. renting heavily favored buying in both med school and residency. My monthly expenses were lower than renting, in med school by a lot (I actually rented out extra rooms and made a profit), I could deduct mortgage interest (which is insane tax policy when you think about). I never made a cent from 2010-2020 owning 2 houses since they appreciated with inflation, which was very low during this time, and the slightly inflated price just barely covered closing costs. I've been slightly bitter since unloading my low interest rate home right before the run-up, but the reality is that the stock market is up 90% since that time, whereas my home basically tracked with inflation (basically that same 450k to 600k we just saw in the rad onc salary above). Moral of the story is get as much money into the market as you can, not into your house. I wish someone had told me that in 2010. I saved and tried to throw a few extra hundred each month at my mortgage because I thought I was smart paying down my debt. In retrospect borrowing as much money as you can at 1.9% and paying the bare minimum for as long as possible is a no-brainer. At 8%, buying a house in cash actually makes sense.

 

[TexasMed22]

It will only get worse. I'm preparing to run my clinic as lean as possible going forward with less indications and 5 fractions for most things. AI will bring the house down regarding targeted therapies for medonc. I predict that (away from major metros) we will have to move to a remote attending model for medonc with only APPs living in regular Merica and giving the drugs. At some point the locums contracts just don't make sense.

That whole narrative about "high touch" doctors being valued? Only in affluent communities. Everyone else will just be scrambling...high touch APPs may be valued. Right now, there are too many patients and too many drugs to give (in most fields...no ours).

Kids are still out there trying to buy their first house. There is a whole culture of loan envy out there regarding folks who missed the low interest loan environment by just years. I'd keep the 1.9% close to the chest! Pitchforks a coming.

Can you elaborate on what you mean by "AI will bring the house down" in this context?

 

[ramsesthenice]

Agree with you completely and you are likely in a very different market than me (sounds like CA with high rents and property-tax protected homes). Buying vs. renting heavily favored buying in both med school and residency. My monthly expenses were lower than renting, in med school by a lot (I actually rented out extra rooms and made a profit), I could deduct mortgage interest (which is insane tax policy when you think about). I never made a cent from 2010-2020 owning 2 houses since they appreciated with inflation, which was very low during this time, and the slightly inflated price just barely covered closing costs. I've been slightly bitter since unloading my low interest rate home right before the run-up, but the reality is that the stock market is up 90% since that time, whereas my home basically tracked with inflation (basically that same 450k to 600k we just saw in the rad onc salary above). Moral of the story is get as much money into the market as you can, not into your house. I wish someone had told me that in 2010. I saved and tried to throw a few extra hundred each month at my mortgage because I thought I was smart paying down my debt. In retrospect borrowing as much money as you can at 1.9% and paying the bare minimum for as long as possible is a no-brainer. At 8%, buying a house in cash actually makes sense.

Ha! I’m actually in a Midwest college town. The latter being the driving force that keeps availability low and rent prices up.

 

[communitydoc13]

Can you elaborate on what you mean by "AI will bring the house down" in this context?

If I were to bet on a high impact space for AI within the next ten years, it would be with regard to selecting drug candidates and targeted drug design. These are traditionally, tremendously laborious and low yield processes. AI has already done ridiculous things with protein structure determinations and creating target libraries.

I remember medonc circa 2010 with the first Ipi in melanoma paper. There had been Gleevec trials in leukemia in the early 2000s, but this was the first really exciting, solid tumor systemic therapy I could appreciate. (For anyone who wants to see KM curves when you are really changing outcomes, please reference these papers).

Just think about how the armamentarium for medonc in solid tumors has changed in the past 14 years!

I suspect it's about to progress a whole lot faster in the next 10-15.

I can only imagine what this will mean for radonc, but it is also catastrophic for the working model of medonc. Lots of these therapies are administered indefinitely (or for a year plus). The guidelines for frequency of on treatment visits are vague and not terribly evidence based up front. The attending medoncs simply can't see (and probably shouldn't) all of their patients on treatment. Thus, the expansion of oncology APPs in nearly every medical oncology practice that I am aware of. Combine this with the demographics of boomers and the age distribution of CA diagnosis and it is a certifiable crisis.

Medoncs should be careful (as should we all). At times, extreme scarcity of a specialist can itself lead to the diminution of specialist value.

 

[TexasMed22]

If I were to bet on a high impact space for AI within the next ten years, it would be with regard to selecting drug candidates and targeted drug design. These are traditionally, tremendously laborious and low yield processes. AI has already done ridiculous things with protein structure determinations and creating target libraries.

I remember medonc circa 2010 with the first Ipi in melanoma paper. There had been Gleevec trials in leukemia in the early 2000s, but this was the first really exciting, solid tumor systemic therapy I could appreciate. (For anyone who wants to see KM curves when you are really changing outcomes, please reference these papers).

Just think about how the armamentarium for medonc in solid tumors has changed in the past 14 years!

I suspect it's about to progress a whole lot faster in the next 10-15.

I can only imagine what this will mean for radonc, but it is also catastrophic for the working model of medonc. Lots of these therapies are administered indefinitely (or for a year plus). The guidelines for frequency of on treatment visits are vague and not terribly evidence based up front. The attending medoncs simply can't see (and probably shouldn't) all of their patients on treatment. Thus, the expansion of oncology APPs in nearly every medical oncology practice that I am aware of. Combine this with the demographics of boomers and the age distribution of CA diagnosis and it is a certifiable crisis.

Medoncs should be careful (as should we all). At times, extreme scarcity of a specialist can itself lead to the diminution of specialist value.

This seems almost entirely beneficial for med oncs. Basically every non-procedural specialty has to deal with an influx of midlevels, at least (according to your AI thesis) med oncs will have a dramatic increase in demand to help counteract that influx.

 

[medgator]

I have been a renter since 2020 and I have not noticed this. Rent has gone up almost exactly the same as the 23% CPI inflation over this time in the 2 different markets I lived in. My expectation is that the cost-of-living crisis middle and lower class Americans are experiencing and the overbuilding in many markets of rental units will result in rent deflation. The incentive to lower rents are empty units, which is a new problem. In 2021 finding an apartment to rent was almost as hard as finding a house. It's not now at all, but the higher rents are lingering. The rent-vs-own calculations is still heavily in favor of renting for the foreseeable future. I'm not sure I want to own a house anymore. My savings will do better in stocks rather than as equity in a house I own and live in, and if a mortgage is chosen over a cash purchase, then the extra $3k/month I'll have in fixed housing expenses (3k/month rent vs. 6/month mortgage, HOA, tax, insurance, upkeep, and maintenance) will almost certainly do better in the long run invested in the stock market. It ends up just being a space where you collect clutter and have to deal with broken things. There is something liberating about having zero responsibility for the building you sleep in. I think this reality is starting to hit home with all of the whining of never being able to afford a house because that is how you get rich and seeing the regret buyers of the past few years have, so the demand is going to continue to decline while supply increases. This will eventually flip the rent-vs-own back in favor of owning.

I could be wrong, but I don't think they (builders, realtors, lenders, financial media clickbait, and tiktok) can keep selling young people on why they need to spend double per month to own vs. rent because that's how you get ahead in life. That should raise questions immediately to anyone with a 4th grade understanding of how money works. This idea that renter = poor failure at life is a psy-op, one that I was admittedly sucked into for a while.

Like everything else all real estate is local.

So is that argument to rent vs buy. The property appreciation and ability to pay $0 in CG taxes after 2 years of ownership has allowed many of us to bank away equity with upgrading our primary residence. Some markets are far more stable/anemic.

https://www.cnbc.com/2024/01/31/why-self-made-millionaire-tori-dunlap-still-rents.html

 

[communitydoc13]

med oncs will have a dramatic increase in demand

They are already in exceptional demand. When there is an abject lack of availability, solutions outside of an on-site medonc are pursued. (e.g. virtual onc or expansion of APP scope). These will ultimately devalue the specialty.

I believe there can be an excess of scarcity at times.

 

[drowsy12]

med onc APPs do tons, in almost every setting I am aware of. modern day med onc IMO is really not workable without them. doesnt really have to do with just availabilities IMO

 

[DrProtonX]

Imagine walking into a RO job and demanding 20 percent profit sharing from day one. You are lucky if you even get partnership or any “profit sharing”. I would imagine this can be negotiated up for med onc. Comapare this to the same similar job in KY small town that refuses to pay what they should and are just “holding out for the right fit” staffing it with boomers who can barely stay awake.

I think it’s the same practice looking for a rad onc offering 20% profit sharing day as well

 

[NotMattSpraker]

If I were to bet on a high impact space for AI within the next ten years, it would be with regard to selecting drug candidates and targeted drug design. These are traditionally, tremendously laborious and low yield processes. AI has already done ridiculous things with protein structure determinations and creating target libraries.

I hate betting against the future, but I have to wonder if there are diminishing returns here and it wont be as successful as people think.

It is already true that most novel designs never even make it to human testing and the new drugs we have now are rarely significantly impactful (other than to get applause, approvals, and sales).

I really dont know but still feel that I disagree with med oncs that its just a matter of time until we can drug everyone in to a cure. That just isn't consistent with the reality I saw hanging out with them in academics.

For example, take a "blockbuster" effect like dostarlimab. if you pool all patients and all cancers, dostarlimab's impact is a water molecule in the bucket.

 

[StIGMA]

I hate betting against the future, but I have to wonder if there are diminishing returns here and it wont be as successful as people think.

It is already true that most novel designs never even make it to human testing and the new drugs we have now are rarely significantly impactful (other than to get applause, approvals, and sales).

I really dont know but still feel that I disagree with med oncs that its just a matter of time until we can drug everyone in to a cure. That just isn't consistent with the reality I saw hanging out with them in academics.

For example, take a "blockbuster" effect like dostarlimab. if you pool all patients and all cancers, dostarlimab's impact is a water molecule in the bucket.

We already have libraries of millions of compounds tested on cancer cells spanning most functional/practical chemical groups

Also wouldnt bet so highly on AI in drug design as a panacea. Still have to test things in humans which is cost prohibitive

 

[deleted1180461]

If they are offering you 20% of global, that is basically just pro fees.
If they are offering base MGMA + 20% of operating margin for the service line without buy-in, that's a different story.

 

[communitydoc13]

Still have to test things in humans which is cost prohibitive

I think this will be a scary space. There has been a push away from the time consuming, high volume, phase IIII model for a while and there have been approvals based on relatively small phase II trials recently (and even approvals based on remarkable responses in very small trials).

In the setting of personalized therapies, trials are almost always going to be small. They are looking for large effects in relatively small groups of patients with actionable targets.

Robust evidence based medicine and personalized medicine are almost oppositional things.

I hate betting against the future

I would have bet against the future years ago. I remember in training, the medonc leaders (who happened to be national leaders) alluding to the fact that there was going to be a so called "damn break" in therapeutics. They certainly knew some things about early IO trials that were not public. I was very skeptical, thinking about the aggregate impact to date, but the last 12 years has been markedly different than any time before in terms of systemic therapeutic development.

if you pool all patients and all cancers, dostarlimab's impact is a water molecule in the bucket

I agree, but the incrementalism is how progress is almost always made. (again, for anyone looking at the way PFS and OS survival curves should look, the dostarlimab paper is example A...no difference in PFS until 6 mos and no difference in OS until 12, then with clear divergence...this the shape of curves that are demonstrating a real effect).

 

[NotMattSpraker]

All totally reasonable.

The financial instability of the healthcare system and really the country may be an insurmountable barrier.

The research halts without profitability.

 

[ramsesthenice]

I hate betting against the future, but I have to wonder if there are diminishing returns here and it wont be as successful as people think.

It is already true that most novel designs never even make it to human testing and the new drugs we have now are rarely significantly impactful (other than to get applause, approvals, and sales).

I really dont know but still feel that I disagree with med oncs that its just a matter of time until we can drug everyone in to a cure. That just isn't consistent with the reality I saw hanging out with them in academics.

For example, take a "blockbuster" effect like dostarlimab. if you pool all patients and all cancers, dostarlimab's impact is a water molecule in the bucket.

The concept is called QSAR (quantitative structure activity relationship) drug design and I fist learned about it when I started grad school for pharmacology….in 1999. I fully admit, computers and machine learning are advancing at exponential pace but they have been pretty good for a while and not made a real splash yet. Probably better at refining candidates with some promise than inventing something de novo.

 

[sam1234567]

You should always look at supply and demand and number of new attendings graduating every year not a job or two in the middle of no where paying 600k.