I don't think those are caveats haha - I think those are some of the core problems which I feel are unsolvable and, ultimately, why I feel maldistribution in medicine (RadOnc or otherwise) is unsolvable.
"Well intentioned" people have been trying to fix this maldistribution problem forever. Ronnie said it couldn't be done... unless you wanna turn commie.
The rural WV can’t fill because they’re probably offering $500k. If they offered $1.2m, i don’t think they’d have any issue filling up the spot whatsoever. For me and my classmates, money matters ALOT (thanks to Powell increasing interest rates astronomically) more than location. But if the rural WV is paying $500k and job in NYC is paying $380k, I have a hard time imagining anyone in my class would take the rural WV
One way to get around the problem of "they're probably offering $500K" is to start your own practice. I know, I know...
If only starting your own practice in rad onc was as easy as doing it in FM, Derm etc.
Pretty close to needing light boxes during residency, so I will own that all day
It’s even hard for those chaps these days. But yes, much easier than rad onc. If only ASTRO would do things to support the independent private rad onc practitioner (fight CONs, hype practical treatments like breast IMRT, support supervision autonomy, work with Medicare and insurances to codify expanded indications, help “intensity modulate” the workforce) it might help fix maldistribution!
I've always wondered. What is the argument in favor of CONs? I can imagine reasons that a large health system would like to suppress competition, but what is the good or bad faith argument proponents would make in public for this requirement?
We are all seeing this through our own lens. That's the beauty of SDN...fairly atypical perspectives get represented.
I think of it more as a therapeutic window.
IMO, an argument for CON is stabilization of regional healthcare environments.
This is the trend for jobs that are posted in undesirable rural areas. I have investigated dozens of these jobs. It’s the same stupid model at every one of them. They don’t care about the quality of rad onc services and they’re not willing to pay for it. They will do whatever it takes to staff at bottom dollar just to be able to bill. They have no interest in determining what that costs them in terms of referrals, underutilization of tech, imaging, and ancillary services, etc.
Protons scream needing CONs imo
Not me. I can't wait to get out of NYC LA or Miami (concrete jungles) after a few days.
This is precisely my point. The economic realities of these places do not change because someone trained nearby or may have even “loved the area”. People will always decide what is best for them not because they trained nearby. Only way to fill these jobs is to offer higher pay or flood market with so many graduates, people essentially have no other choice.
I agree, but the spouse and family get inpt as well. I hear all the time now that radonc always had geographic restrictions and this is simply false. When I graduated there where jobs in every desirable city. A good program could land you a partinership track in northern Jersey or southern cal. Otherwise, you went academic or into an exploitative practice. The rbest path would have been to seek out a lucrative practice in a second tier location but I was overruled.
The second one. It’s the second one.
Perhaps, but some smaller markets didn't have jobs every year. That's the still the case now. There is definitely more saturation to be sure now vs a decade or two ago. And definitely way less private/independent job availability
That's true for every specialty. The US has been losing rural population for years to the cities.
We should rename ourselves Biryani Forum
No place will let you. They all want to employ and pay you per wRVU. A lot will even refuse to pay you 1099.
Yeah, it’s an issue in medicine in general. Noticeably more prevalent in competitive subspecialties, which I’m sure we all remember from med school there were those kids who basically made their specialty choice based on perceived status. LOL at the ones that chose rad onc for status back then.
Some lucky folks who couldn't match into anything else got lucky in the 70s-90s too (like buying amzn after the dot com crash)
I know people with 9 figure net worth mostly from rad onc this applies too. The D students in med school. Meanwhile the 2010-2017 peak rad onc crew got nothing close to that . Funny how the universe works isn’t it?
I know of 1 place that does. Rad Onc has a pro fee agreement with hospital. Most others (med onc, surgeons) employed. I interviewed for the job. Short partner track (like 6 mo) and the salary was high as an associate (i.e. MGMA median). The area is actually nice for people that are okay with "rural life". It is not that rural really. Nice state university there, state parks etc. But 2 hr from a good airport. Probably 2 hr from good biryani.
I know of a similar one. Billing pro fees only. Split between the docs came out to about 400 each. PSA with hospital required 2 docs. Pass.
MD Anderson has locations of 2017-2023 grads on their website. Looks about 50/50 academic vs pvt practice depending on how you count. I know of some residents prior to that who filled private jobs in maine, alaska, etc.
I sure hope not. Job market is already mediocre. We should send some rad oncs to other countries instead of bringing in more
Yes this was common several decades ago in the US, also Canadians came down and took jobs, not just docs from overseas.
floridaphoenix.com
The alternative pathway still exists. There are multiple people per year and more than people think end up staying and taking a job in the US.
I think the number is about 2-3 per year and they have to do 2 years of clinical fellowship, 2 years as attendings before board eligible.
There’s that practice in Atlanta that was almost entirely Canadian grads. Weird.
Yup, I've noticed this in my network as well. I'm sure the WFH aspect doesn't hurt.
I guess that explains the little dead cat bounce in the job market. But with almost 200 new grads per year in the next few years, i’m not sure how long it’ll last. Such a shame that residency spots weren’t cut, we could’ve had a pretty hot job market!
I don’t know about 6 years ago but right now they have a job post offering $668k base, $100k sign on bonus, upto 10% salary incentive bonus and $200k student loan assistant and 34days PTO! Location aside, probably one of the best positions financially. Also he went to University of Cincinnati for medical school so could be from that area
It's crazy. I'm not sure how Portsmouth compares to Chillicothe, OH but I remember that practice was offering a similar package (maybe even a higher base salary, I seem to remember 750k) like 13 years ago when I was last actively looking.
750k back then is 900 or so today which is what that job should be paying. Factor in PTO and Bennies and you can probably get close to it.
