Is rad onc job market … rebounding?

[NotMattSpraker]

I didn't mean to imply that you did. Its just funny to me how some coastal people lump Missouri into a rural state even though half of the population lives in St. Louis or KC which are huge metro centers. KC is far and away the better of the 2 to live in IMO. St. Louis has improved quite a bit and is fun for a visit, but it earned its bad rap fair and square. The western burbs and around Forest Park are fine but even during the day, you need to pay attention to your surroundings downtown (even by the ball park).

Lived in STL, subject to no crime. Literally car jacked in KC. Still agree with you

KC is also 4 hours closer to the mountains!

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[deleted1180461]

But now they are starting to retire and the fantasy that resident oversupply means these positions will be easy to fill has been laid bare for the world to see. Both of the ones that I am aware of have been reposted 3 times now. I will bet a lot of money they eventually get filled by FMGs.

I could talk about this for hours. I believe a lot of these places are explicitly looking for someone who needs a visa and will accept bottom dollar. They use locums forever until this comes along. It’s sad, for all parties involved. This became clear to me after being ghosted by many of these places. Huh, your job’s been posted for years in the middle of nowhere and you won’t even schedule a phone call with me? BC with ties to the Midwest and rural solo experience. Recently trained. No interest? Really? Oh, you’re looking for something very specific. Got it. They are not going to waste their time talking to me about profit sharing and RVU rates.

 

[deleted1180461]

Lived in STL, subject to no crime. Literally car jacked in KC. Still agree with you

KC is also 4 hours closer to the mountains!

Similar cities. Very segregated. Very nice parts of town and uhhh, some of the most dangerous areas in the country. Think both are near the top murder rate list.

 

[ramsesthenice]

Similar cities. Very segregated. Very nice parts of town and uhhh, some of the most dangerous areas in the country. Think both are near the top murder rate list.

East St. Louis is right up there with southside Chicago. The similarities don't end there. Murder rate in the hood is super high but your chances of getting murdered in a mugging in Downtown St Louis or the Loop are extremely low. The spill over of petty crime...I've seen a lot more of it in St. Louis than any other midwest City. Doesn't stop me from going. I love Cardinal Stadium and even if you don't drink Bud, the Beerhall is worth a visit.

Perspective matters. I grew up in Jacksonville Florida and the line between safe and not safe is not always clear. You can definitely park 500 feet too far down the street from a nice restaurant and get yourself into trouble. Chicago is hands down my favorite city and as long as you know the boundaries, you are fine. Its unfortunate that McCormick place is essentially one of them .

 

[Doctorer]

I thought no one doctor is that special, especially in academics. I have had a senior academic rad onc tell me that before, as “friendly advice”.

Yup, I've had more than one person tell me that. Barring a few who bring in serious grant funding, no one's going to work too hard to hold on to an academic who runs a few IITs/treats patients, especially in a desirable metro area. See: the exodus of faculty from every large department every few years.

 

[ramsesthenice]

Yup, I've had more than one person tell me that. Barring a few who bring in serious grant funding, no one's going to work too hard to hold on to an academic who runs a few IITs/treats patients, especially in a desirable metro area. See: the exodus of faculty from every large department every few years.

Academic departments are political machines. Im a physician scientist and I can tell you people vastly overestimate the actual "value" they bring in with research. The department directly benefits from the salary support a nice grant brings in but that is usually still a loss against the clinical revenue that person could have generated. Most of the money from grants comes from F&A (indirect costs). At most major centers, its over 50% of the direct costs. Thing is, that goes to the institution and not the department. The departmental incentive is that they typically have quotas they are expected to meet for the SOM. Industry sponsored IITs bring in less F&A (ours is capped I think at 24%) but the direct costs which go to the department can be exponentially higher than extramural grants. As in, several of mine pay up to $15K per subject for research nursing for them to do weekly CTCAE assessments and infusions for a 5 week course of chemorads. So who does leadership value more? The guy bringing in all of the industry money or the big NCI/DOD grants? Usually the answer comes down to the background of leadership. If they are hard core physician scientists, they like to thump their chests about all of the grant funding their people are securing. If they are more clinical/business oriented, chances are they have a balance in mind and are much happier to bring in enough grant support to keep the SOM happy but are more interested in the industry/pharma funding.

Everything I just said highlights the fluid nature of "value." More often than not, politics matter more than value. Chairs really want to have people that understand the system and don't need to be "managed." This comes down to things like utilizing machines with a higher return (protons, MRL, etc) without being told, meeting retention/RVU goals, and generally keeping the people around you happy.

 

[DrProtonX]

The same reason that people are willing to accept the crap they do to be in a specific metro...family. They are almost all older folks who have been practicing at these centers for 20+ years and are from the area. But now they are starting to retire and the fantasy that resident oversupply means these positions will be easy to fill has been laid bare for the world to see. Both of the ones that I am aware of have been reposted 3 times now. I will bet a lot of money they eventually get filled by FMGs.

From my personal experience, decent portion of rad onc residents and med students (those I met during interview season) are coming from upper middle class AND from big metro / coastal areas. So those rural midwest positions won’t be attractive to them unless they pay SIGNIFICANTLY more ($1M+). Then there’s increase in FMGs, i don’t think they will be interested because of societal issues and population diversity. So I think it’ll be interesting to see what’s gonna happen in the next few years.

 

[NotMattSpraker]

From my personal experience, decent portion of rad onc residents and med students (those I met during interview season) are coming from upper middle class AND from big metro / coastal areas. So those rural midwest positions won’t be attractive to them unless they pay SIGNIFICANTLY more ($1M+). Then there’s increase in FMGs, i don’t think they will be interested because of societal issues and population diversity. So I think it’ll be interesting to see what’s gonna happen in the next few years.

I hope you come back and tell us because there is very little data on this topic.

The FMG thing is very interesting. It's not just the applicants and trainees. In some states, large hospital networks are pushing for essentially reciprocity for their country's training. Some may come directly over to work those jobs in some states without any barriers at all.

Overall the average applicant gets <2 offers. Tons of good points made on this board from many authors, but many are not practical if you are standing there deciding between one job and unemployment. I think that is the reality for most unfortunately. Of course I am rooting for you (and everyone else) to get a great job in a place you like.

 

[ramsesthenice]

From my personal experience, decent portion of rad onc residents and med students (those I met during interview season) are coming from upper middle class AND from big metro / coastal areas. So those rural midwest positions won’t be attractive to them unless they pay SIGNIFICANTLY more ($1M+). Then there’s increase in FMGs, i don’t think they will be interested because of societal issues and population diversity. So I think it’ll be interesting to see what’s gonna happen in the next few years.

You are correct. We have placed some of our residents in these kind of rural clinics but guess what? They have all been within 100 miles of where they grew up and since I have been here, only one has been in our state. Most of our residents don't have any family ties to the area and end up in metro/coastal practices. Opening a residency program in X state does next to NOTHING to increase physician recruitment save for at the main academic center. The only way to fill these spots is to make them more desirable

 

[DrProtonX]

I hope you come back and tell us because there is very little data on this topic.

The FMG thing is very interesting. It's not just the applicants and trainees. In some states, large hospital networks are pushing for essentially reciprocity for their country's training. Some may come directly over to work those jobs in some states without any barriers at all.

Overall the average applicant gets <2 offers. Tons of good points made on this board from many authors, but many are not practical if you are standing there deciding between one job and unemployment. I think that is the reality for most unfortunately. Of course I am rooting for you (and everyone else) to get a great job in a place you like.

I will. I might even conduct a study. I’m still working to figure out the best approach.
Unfortunately <2 is not ideal. But you only need one good one.

 

[TheWallnerus]

I will. I might even conduct a study. I’m still working to figure out the best approach.
Unfortunately <2 is not ideal. But you only need one good one.

For rad onc residents, median number of interviews is 5 and job offers is 2

x.com

x.com

This contrasts rather sharply to the average medical resident’s experience

 

[NotMattSpraker]

For rad onc residents, median number of interviews is 5 and job offers is 2

x.com

x.com

This contrasts rather sharply to the average medical resident’s experience

View attachment 389895

I forgot that some had their contracts delayed. That shocked me and knocked my faith in “the system” down a peg.

 

[RickyScott]

Academic departments are political machines. Im a physician scientist and I can tell you people vastly overestimate the actual "value" they bring in with research. The department directly benefits from the salary support a nice grant brings in but that is usually still a loss against the clinical revenue that person could have generated. Most of the money from grants comes from F&A (indirect costs). At most major centers, its over 50% of the direct costs. Thing is, that goes to the institution and not the department. The departmental incentive is that they typically have quotas they are expected to meet for the SOM. Industry sponsored IITs bring in less F&A (ours is capped I think at 24%) but the direct costs which go to the department can be exponentially higher than extramural grants. As in, several of mine pay up to $15K per subject for research nursing for them to do weekly CTCAE assessments and infusions for a 5 week course of chemorads. So who does leadership value more? The guy bringing in all of the industry money or the big NCI/DOD grants? Usually the answer comes down to the background of leadership. If they are hard core physician scientists, they like to thump their chests about all of the grant funding their people are securing. If they are more clinical/business oriented, chances are they have a balance in mind and are much happier to bring in enough grant support to keep the SOM happy but are more interested in the industry/pharma funding.

Everything I just said highlights the fluid nature of "value." More often than not, politics matter more than value. Chairs really want to have people that understand the system and don't need to be "managed." This comes down to things like utilizing machines with a higher return (protons, MRL, etc) without being told, meeting retention/RVU goals, and generally keeping the people around you happy.

Yip, more and more it is just abt the profit.

New York’s Largest Hospital System Is Setting Its Sights on the Entertainment Business

Northwell Health, which operates 21 hospitals and 900 outpatient facilities, is launching a studios division that is developing scripted and unscripted content.

www.hollywoodreporter.com

 

[drowsy12]

Yip, more and more it is just abt the profit.

New York’s Largest Hospital System Is Setting Its Sights on the Entertainment Business

Northwell Health, which operates 21 hospitals and 900 outpatient facilities, is launching a studios division that is developing scripted and unscripted content.

www.hollywoodreporter.com

this is quite literally an example of the power of corporate hospitals. this is about capitalism, baby. modern medicine is about powerful hospitals and large systems, which we all work for more and more.

 

[yesmaster]

Hospital systems getting that sweet, sweet pharma money is so last decade

Sloan Kettering Cancer Researchers Correct the Record by Revealing Company Ties

The hospital’s chief medical officer resigned last month after failing to disclose company ties in medical journals. Now, Memorial Sloan Kettering researchers, including chief executive Dr. Craig B. Thompson, are updating their own conflict-of-interest disclosures.

www.propublica.org

Academia meets biotech in new institute

www.mdanderson.org

Netflix content creation, AI testing bed, selling data to big tech is in! Let’s go, monetization baby

Hospital execs say they are getting flooded with requests for your health data

Technology companies are building algorithms that are fueled by vast stores of patient health information.

www.cnbc.com

 

[deleted1180461]

this is quite literally an example of the power of corporate hospitals. this is about capitalism, baby. modern medicine is about powerful hospitals and large systems, which we all work for more and more.

Capitalism is awesome. What’s happening with medicine in America is not capitalism. That ship sailed in 1966. Talk to a dentist and you’ll realize the difference reeeeeeeeeealy fast.

 

[drowsy12]

Capitalism is awesome. What’s happening with medicine in America is not capitalism. That ship sailed in 1966. Talk to a dentist and you’ll realize the difference reeeeeeeeeealy fast.

It is capitalism. You just don’t like it when it impacts you. The same forces drive consolidation and an obsessed need for growth in every major industry. For those who would come in and say ‘yeah but it’s crony capitalism’ I would say yep, same as every other industry. There’s always rules and systems that favor large groups over smaller groups (because large corporations have the money to influence policy!). Dentists are being bought up way more than existed 20 years ago.

It’s no different

 

[deleted1180461]

It is capitalism. You just don’t like it when it impacts you. The same forces drive consolidation and an obsessed need for growth in every major industry. For those who would come in and say ‘yeah but it’s crony capitalism’ I would say yep, same as every other industry. There’s always rules and systems that favor large groups over smaller groups (because large corporations have the money to influence policy!). Dentists are being bought up way more than existed 20 years ago.

It’s no different

Can you explain how price fixing and certificate of need laws fit into a free market model? Maybe I don’t understand capitalism, but I didn’t have these issues with the non medical business I owned.

I agree that there are political forces opposed to small business and prefer all citizens to be employees of a mega corp or government. I don’t agree that this is the natural end state of a free market system.

 

[fiji128]

Nothing free market/enterprise, ie "capitalism," about modern medicine. Almost the exact opposite really. Tons of hugely burdensome regulations, price transparency largely does not exist, many of the markets operate with near monopoly health/payor systems and there are nearly insurmountable barriers to entry for smaller players.

 

[NotMattSpraker]

Capitalism is awesome. What’s happening with medicine in America is not capitalism. That ship sailed in 1966. Talk to a dentist and you’ll realize the difference reeeeeeeeeealy fast.

Medicine in America is crony capitalism.

 

[drowsy12]

Tons of hugely burdensome regulations, price transparency largely does not exist, many of the markets operate with near monopoly health/payor systems and there are nearly insurmountable barriers to entry for smaller players.

yeah exactly. thanks for making my point. this is corporate capitalism.

 

[medgator]

To be a radiologist in a city where they can't find anyone else besides you...

x.com

x.com

 

[DrProtonX]

To be a radiologist in a city where they can't find anyone else besides you...

x.com

x.com

$620k starting salary for private practice is insane! What do we get in rad onc, $300-350k?

 

[medgator]

$620k starting salary for private practice is insane! What do we get in rad onc, $300-350k?

$620k above median BC pay in rad onc as well

 

[DrProtonX]

Man looking at radworking.com is depressing. They can legit pick anywhere in the country and there’s a $500k+ job is available!

 

[seper]

Rads went through their own market slump 10-15 y ago but it rebounded fast

 

[medgator]

Rads went through their own market slump 10-15 y ago but it rebounded fast

Rad onc is in a slow burn down, going nowhere fast. Expansion+dropping indications/fractions

 

[Fpg1245]

Rad onc is in a slow burn down, going nowhere fast. Expansion+dropping indications/fractions

Imaging is a cornerstone of western medicine. AI isn’t the panacea everyone thought it would be so it would turn around.

Rad onc is crumbling fast.

It’s just so lacking in any tangible fundamentals that make a specialty flourish.

 

[yesmaster]

Radiology is an amazing field. Work from anywhere, either get a regular $1M W2 job with 12-16 weeks vacation and do some locums to push that to $1-1.5M, or do two 1099 rads jobs and make $1.5-2M if you cover facilities with lower volumes of reads. AI has only helped them improve their efficiency.

I’m sure IR is killing it too. But with DR being solid and better lifestyle, I wonder if IR will regret becoming an integrated residency.