Job Market Effects on Current Attendings

[RadDoc11]

I am a longtime lurker of this message board and remember looking here frequently as a student applying to med school and then later after I chose to apply to rad onc residencies. I went to Ivy league schools and a highly regarding training program, and genuinely felt (and still do) that rad onc was a really cool and interesting field unique from others. I have been very lucky to be able to obtain highly coveted jobs.

However, as I recently changed jobs and entered a new contract with a hospital, I have become increasingly concerned about the job market and what will happen once my contract is up for renewal (despite being many years out of training now). I have watched my friends struggle to find jobs in second tier markets and seen them uproot their families to totally new locations just to find viable opportunities. I have had to do the same myself. I have actually even given consideration recently to retraining in another specialty, not because I'm unhappy with my current job (my current situation is ideal - I'm in a great city working 4 days a week earning >500k), but because I know that this situation in untenable and that I will be very limited for options once my contract renews. Students/residents may not be aware of this, but hospitals are keenly aware of job markets and salary medians and everyone is replaceable at the end of the day, even if you're a great "employee." Their goal is simply to save money, so if a cheaper option is available, they generally will take it if it will not impact patient volumes. The issue with rad onc is that we are downstream as far as referrals. We are dependent upon referrals often from other employed specialists in a hospital setting. We are not the ones generally attracting the patients to the system.

I just wanted to add my 2 cents because I know many of the same people frequently post on this site, but I wanted to sincerely share my experience for others who may be reading. I am positive about the field of rad onc, but I am certain that the job market will continue to constrict which makes real life things that one may not think of as a resident or med student very difficult.. for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities.
I would love to be a rad onc in my current situation for the rest of my career however I know it is unrealistic. This had made me consider alternative careers within and outside of medicine. I just think it's important for young students to be aware. This problem is not shared by my friends in other specialties. Many of them have switched jobs and they've mainly worked for other groups within our metro area. They don't understand why we do not have the same luxury until I explain it to them.

Bottom line - yes I like rad onc and my current job but I simply do not think even many of the "good jobs" at least at hospitals are tenable in the long term currently which is difficult when you're "adulting."

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[deleted941485]

I am a longtime lurker of this message board and remember looking here frequently as a student applying to med school and then later after I chose to apply to rad onc residencies. I went to Ivy league schools and a highly regarding training program, and genuinely felt (and still do) that rad onc was a really cool and interesting field unique from others. I have been very lucky to be able to obtain highly coveted jobs.

However, as I recently changed jobs and entered a new contract with a hospital, I have become increasingly concerned about the job market and what will happen once my contract is up for renewal (despite being many years out of training now). I have watched my friends struggle to find jobs in second tier markets and seen them uproot their families to totally new locations just to find viable opportunities. I have had to do the same myself. I have actually even given consideration recently to retraining in another specialty, not because I'm unhappy with my current job (my current situation is ideal - I'm in a great city working 4 days a week earning >500k), but because I know that this situation in untenable and that I will be very limited for options once my contract renews. Students/residents may not be aware of this, but hospitals are keenly aware of job markets and salary medians and everyone is replaceable at the end of the day, even if you're a great "employee." Their goal is simply to save money, so if a cheaper option is available, they generally will take it if it will not impact patient volumes. The issue with rad onc is that we are downstream as far as referrals. We are dependent upon referrals often from other employed specialists in a hospital setting. We are not the ones generally attracting the patients to the system.

I just wanted to add my 2 cents because I know many of the same people frequently post on this site, but I wanted to sincerely share my experience for others who may be reading. I am positive about the field of rad onc, but I am certain that the job market will continue to constrict which makes real life things that one may not think of as a resident or med student very difficult.. for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities.
I would love to be a rad onc in my current situation for the rest of my career however I know it is unrealistic. This had made me consider alternative careers within and outside of medicine. I just think it's important for young students to be aware. This problem is not shared by my friends in other specialties. Many of them have switched jobs and they've mainly worked for other groups within our metro area. They don't understand why we do not have the same luxury until I explain it to them.

Bottom line - yes I like rad onc and my current job but I simply do not think even many of the "good jobs" at least at hospitals are tenable in the long term currently which is difficult when you're "adulting."

It’s difficult to convince people of the hardships they will face in the future. Usually t takes first hand experience which is why I don’t really interact with medical students that are interested.

I’m in a similar boat as my 3 year contract is up. Can’t wait to see what the admin will pull this year.

 

[OTN]

I am a longtime lurker of this message board and remember looking here frequently as a student applying to med school and then later after I chose to apply to rad onc residencies. I went to Ivy league schools and a highly regarding training program, and genuinely felt (and still do) that rad onc was a really cool and interesting field unique from others. I have been very lucky to be able to obtain highly coveted jobs.

However, as I recently changed jobs and entered a new contract with a hospital, I have become increasingly concerned about the job market and what will happen once my contract is up for renewal (despite being many years out of training now). I have watched my friends struggle to find jobs in second tier markets and seen them uproot their families to totally new locations just to find viable opportunities. I have had to do the same myself. I have actually even given consideration recently to retraining in another specialty, not because I'm unhappy with my current job (my current situation is ideal - I'm in a great city working 4 days a week earning >500k), but because I know that this situation in untenable and that I will be very limited for options once my contract renews. Students/residents may not be aware of this, but hospitals are keenly aware of job markets and salary medians and everyone is replaceable at the end of the day, even if you're a great "employee." Their goal is simply to save money, so if a cheaper option is available, they generally will take it if it will not impact patient volumes. The issue with rad onc is that we are downstream as far as referrals. We are dependent upon referrals often from other employed specialists in a hospital setting. We are not the ones generally attracting the patients to the system.

I just wanted to add my 2 cents because I know many of the same people frequently post on this site, but I wanted to sincerely share my experience for others who may be reading. I am positive about the field of rad onc, but I am certain that the job market will continue to constrict which makes real life things that one may not think of as a resident or med student very difficult.. for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities.
I would love to be a rad onc in my current situation for the rest of my career however I know it is unrealistic. This had made me consider alternative careers within and outside of medicine. I just think it's important for young students to be aware. This problem is not shared by my friends in other specialties. Many of them have switched jobs and they've mainly worked for other groups within our metro area. They don't understand why we do not have the same luxury until I explain it to them.

Bottom line - yes I like rad onc and my current job but I simply do not think even many of the "good jobs" at least at hospitals are tenable in the long term currently which is difficult when you're "adulting."

This is a great synopsis of how the job market has VERY real-world consequences. Thanks for sharing your experience.

 

[fiji128]

"for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities."

This 100% describes me being 3 years out from residency.

 

[Chartreuse Wombat]

I am a longtime lurker of this message board and remember looking here frequently as a student applying to med school and then later after I chose to apply to rad onc residencies. I went to Ivy league schools and a highly regarding training program, and genuinely felt (and still do) that rad onc was a really cool and interesting field unique from others. I have been very lucky to be able to obtain highly coveted jobs.

However, as I recently changed jobs and entered a new contract with a hospital, I have become increasingly concerned about the job market and what will happen once my contract is up for renewal (despite being many years out of training now). I have watched my friends struggle to find jobs in second tier markets and seen them uproot their families to totally new locations just to find viable opportunities. I have had to do the same myself. I have actually even given consideration recently to retraining in another specialty, not because I'm unhappy with my current job (my current situation is ideal - I'm in a great city working 4 days a week earning >500k), but because I know that this situation in untenable and that I will be very limited for options once my contract renews. Students/residents may not be aware of this, but hospitals are keenly aware of job markets and salary medians and everyone is replaceable at the end of the day, even if you're a great "employee." Their goal is simply to save money, so if a cheaper option is available, they generally will take it if it will not impact patient volumes. The issue with rad onc is that we are downstream as far as referrals. We are dependent upon referrals often from other employed specialists in a hospital setting. We are not the ones generally attracting the patients to the system.

I just wanted to add my 2 cents because I know many of the same people frequently post on this site, but I wanted to sincerely share my experience for others who may be reading. I am positive about the field of rad onc, but I am certain that the job market will continue to constrict which makes real life things that one may not think of as a resident or med student very difficult.. for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities.
I would love to be a rad onc in my current situation for the rest of my career however I know it is unrealistic. This had made me consider alternative careers within and outside of medicine. I just think it's important for young students to be aware. This problem is not shared by my friends in other specialties. Many of them have switched jobs and they've mainly worked for other groups within our metro area. They don't understand why we do not have the same luxury until I explain it to them.

Bottom line - yes I like rad onc and my current job but I simply do not think even many of the "good jobs" at least at hospitals are tenable in the long term currently which is difficult when you're "adulting."

Classic supply demand in a labor market. Excess labor drives down wages and gives the employers all the leverage. Residency expansion is bad for everyone except the employers. Good luck.

 

[RickyScott]

This is a great synopsis of how the job market has VERY real-world consequences. Thanks for sharing your experience.

Spitting image of my present situation.

 

[taserlaser]

Was in a position where after I found out I matched for residency, my then partner and I bought a house. Now that that’s done, I am one of those doing a fellowship year in rare sites elsewhere. I’ve been trying to sell my house (location in a downturn market, is what it is. Same with my current partner - selling their place in the same area) but given market, job uncertainty I’m not going to rush to rebuy for a long time.

 

[scarbrtj]

It’s difficult to convince people of the hardships they will face in the future. Usually t takes first hand experience which is why I don’t really interact with medical students that are interested.

I’m in a similar boat as my 3 year contract is up. Can’t wait to see what the admin will pull this year.

Speaking hypothetically. I wonder why hospital admin couldn’t purchase some “rad onc coverage lite” (one day per week minimum obv), continue to pocket the technical, but now also pocket all the professional.

 

[medgator]

Speaking hypothetically. I wonder why hospital admin couldn’t purchase some “rad onc coverage lite” (one day per week minimum obv), continue to pocket the technical, but now also pocket all the professional.

Question would be practice development... Unless the administrator is basically sending a ton of consults to RO from the other hospital employed specialists

I know this from experience, having developed two practices from scratch, both in rural locations. You need someone there to network, market and engage with referrings to drive linac volume, even in a captive market. Many patients may just leave town and get treated elsewhere

 

[Mandelin Rain]

My guess is A LOT of the cush 15 patient hospital employed jobs suddenly become "part time jobs" where the same amount of work is done in 3 days and the base salary goes down 30-40%.

Ever see what they do to therapists for "low census"? Nothing to stop them from doing this with docs.

 

[evilbooyaa]

I have moved this discussion into its own thread as I think it is valuable to see how current attendings are being affected by the job market.

 

[Gfunk6]

How the RO "apocalypse" will impact me as an attending? Honestly, as others alluded, I believe I will make off quite well.

1. We own our machines so collect all the pro + technical fees - this is a tremendous benefit as you can remain profitable even with relatively low patient loads (e.g. 12-13 on beam per day is break even).

2. We hypofractionate very aggressively at most sites already so the RO APM (once implemented) will be a boon for us. We have also invested in SRS/SBRT technology so moving to extreme hypofractionation will not be problematic.

3. Though we are freestanding, I presume that the edict from CMS relaxing supervisory requirements will eventually make its way to us. I think we can make do with less RO MDs if we adopt NPs/PAs and train them up. Thus I anticipate less need to recruit for ROs who are leaving/retiring.

4. Flooded labor market = cream of the crop applicants to any positions that we have. Plus their negotiating power will likely be minimal. Great for us, not so good for them.

5. The nature of the RO APM removes the burden of having to upgrade your machines just because your competition is doing so. If a proton center is getting reimbursed the same as our 10 year old linac then that is one less (significant) capital expense.

6. The process of hospitals/academic centers buying up private practices, employing the MDs, and massively driving up prices is incongruent with the current trajectory of CMS. Eventually there will be a private practice renaissance again; although whether my group survives long enough to enjoy this before being squashed like a bug is an open question.

 

[deleted941485]

How the RO "apocalypse" will impact me as an attending? Honestly, as others alluded, I believe I will make off quite well.

1. We own our machines so collect all the pro + technical fees - this is a tremendous benefit as you can remain profitable even with relatively low patient loads (e.g. 12-13 on beam per day is break even).

2. We hypofractionate very aggressively at most sites already so the RO APM (once implemented) will be a boon for us. We have also invested in SRS/SBRT technology so moving to extreme hypofractionation will not be problematic.

3. Though we are freestanding, I presume that the edict from CMS relaxing supervisory requirements will eventually make its way to us. I think we can make do with less RO MDs if we adopt NPs/PAs and train them up. Thus I anticipate less need to recruit for ROs who are leaving/retiring.

4. Flooded labor market = cream of the crop applicants to any positions that we have. Plus their negotiating power will likely be minimal. Great for us, not so good for them.

5. The nature of the RO APM removes the burden of having to upgrade your machines just because your competition is doing so. If a proton center is getting reimbursed the same as our 10 year old linac then that is one less (significant) capital expense.

6. The process of hospitals/academic centers buying up private practices, employing the MDs, and massively driving up prices is incongruent with the current trajectory of CMS. Eventually there will be a private practice renaissance again; although whether my group survives long enough to enjoy this before being squashed like a bug is an open question.

Then again The inevitable passage of M4A or any of its iterations will make it a moot point.

 

[medgator]

Then again The inevitable passage of M4A or any of its iterations will make it a moot point.

Pretty sure M4A won't involve the "state" coming over and usurping your linacs for the "communal" good. This isn't Cuba.

It'll be possibly a hyper APM/capitated type environment though, so lean cost structure will be paramount..... Least number of partners, and cheapest, depreciated, functional equipment wins

 

[deleted941485]

Pretty sure M4A won't involve the "state" coming over and usurping your linacs for the "communal" good. This isn't Cuba.

It'll be possibly a hyper APM/capitated type environment though, so lean cost structure will be paramount..... Least number of partners, and cheapest, depreciated equipment wins

Yeah about the lean cost structure. As you have probably seen or experienced nobody has to seize anything CMS or comm ins can just not pay you for your services and keep whacking that number down every year indefinitely making the machines Unprofitable to run.

You’ve already got 2 presidential Candidates are already saying 40% of what we spend on HC is an utter waste.

I mean I don’t really don’t like businesses where the only question is how low can you go because eventually you end up cutting into muscle and bone.

I’m not much of a bussiness man but in this risky environment I’d be looking for a buyer seriously. Consider it severance for a job well done and retire.

 

[Burt Radnolds]

Eventually there will be a private practice renaissance again; although whether my group survives long enough to enjoy this before being squashed like a bug is an open question

And there's the rub.

In a similar situation and this is where I see all of my risk.

 

[medgator]

And there's the rub.

In a similar situation and this is where I see all of my risk.

Once we get real site neutrality (that occurs despite the best lobbyists hospitals can buy), that's when you'll start to see the pendulum swing back

 

[RadDoc11]

It’s difficult to convince people of the hardships they will face in the future. Usually t takes first hand experience which is why I don’t really interact with medical students that are interested.

I’m in a similar boat as my 3 year contract is up. Can’t wait to see what the admin will pull this year.

The question I get the most from family and friends is why I “can’t just get another job in (blank city)” since (in their minds at least) I have a great CV and went to prestigious schools and training programs. People, even those in other fields of medicine, just do not believe how difficult it is as a radiation oncologist to find even average jobs in large cities even if you’re willing to travel 50 miles outside of the city. They think I’m exaggerating when I say certain major cities literally have no jobs, or only have one notoriously exploitative revolving door position open. This is reality though.

I know people have criticized this forum as being overly negative but as someone who has never posted here prior to today, I just thought I would share my experience which I think reflects many of the legitimate concerns others have previously stated. Most of my friends in rad onc have had similar experiences. This historically has never been a great field for those with major geographic constraints, but as medicine as a whole becomes increasingly unstable, this disproportionately affects our field more significantly than others. It’s common now to see CVs of docs in many fields where people have changed jobs several times as hospitals change contracts, systems merge, personal situations change, etc. Most people don’t stay in one position their whole career as physicians did in the past. This trend affects rad onc much differently though. A job change for us generally doesn’t mean joining another hospital system in the area. It often requires a full move which impacts families in a very real way. I think it’s irresponsible to mask this reality from students considering rad onc which I why I opted to share my experience today.

 

[DukeNukem]

Do I even need to comment? Last time I posted I was accused of lying or there being something wrong with me.

Summary: job market sucks for attendings too. Being out a few years means little to nothing. Most posted or available jobs I can't even get to return my emails or calls, but the ones that do are pretty much the exact same job they'd offer a new grad. I have never had a job offer or discussion with a path (within 10 years anyway) to current MGMA median salary no matter where it is located.

My boss is super happy. He tells faculty if they're unhappy that they'll be replaced by a new grad. Some faculty have had their salaries cut. We continue to try to expand the residency despite matching difficulties and poor job placements among most of our grads.

My salary has barely changed since I came out of residency. When we hire it's very clear that we're hiring assistant professors only, but looking for associate level CVs. It doesn't matter if it's a new grad or someone 5+ years out. We lose around 2 faculty per year on average because they're miserable and see no path to advancement. Around half of departures are lateral moves to another academic satellite elsewhere just to get out of here and half have no job to go to with some leaving clinical rad onc entirely.

I'm personally sick of hearing about this geographic maldistribution. If there was a real rural job with a salary guarantee over MGMA median with a reasonable setup, I'd be interested. Where are they? The good ones still fill through word of mouth and are never posted. The ones that are posted get 50+ applications. There are plenty of gimmick jobs (antiquated equipment, fraudulent billing, crazy fractionations, salary guarantee for one year then no way to keep it up) or lowball salaries (little volume due to location or owner of the practice makes all the cash off your back while you have no path or ridiculously expensive path to technicals) when you go rural too.

 

[seper]

Well, that's how you chip away at this - lateral moves to add 20-30 K to your academic salary at a time, and eventually someone will name you an Associate Professor, eventually you'll find a nicer group of colleagues. Hard on one's family.

 

[XRT_doc]

I am a longtime lurker of this message board and remember looking here frequently as a student applying to med school and then later after I chose to apply to rad onc residencies. I went to Ivy league schools and a highly regarding training program, and genuinely felt (and still do) that rad onc was a really cool and interesting field unique from others. I have been very lucky to be able to obtain highly coveted jobs.

However, as I recently changed jobs and entered a new contract with a hospital, I have become increasingly concerned about the job market and what will happen once my contract is up for renewal (despite being many years out of training now). I have watched my friends struggle to find jobs in second tier markets and seen them uproot their families to totally new locations just to find viable opportunities. I have had to do the same myself. I have actually even given consideration recently to retraining in another specialty, not because I'm unhappy with my current job (my current situation is ideal - I'm in a great city working 4 days a week earning >500k), but because I know that this situation in untenable and that I will be very limited for options once my contract renews. Students/residents may not be aware of this, but hospitals are keenly aware of job markets and salary medians and everyone is replaceable at the end of the day, even if you're a great "employee." Their goal is simply to save money, so if a cheaper option is available, they generally will take it if it will not impact patient volumes. The issue with rad onc is that we are downstream as far as referrals. We are dependent upon referrals often from other employed specialists in a hospital setting. We are not the ones generally attracting the patients to the system.

I just wanted to add my 2 cents because I know many of the same people frequently post on this site, but I wanted to sincerely share my experience for others who may be reading. I am positive about the field of rad onc, but I am certain that the job market will continue to constrict which makes real life things that one may not think of as a resident or med student very difficult.. for example, myself and my colleague do not feel comfortable buying homes currently because we know there is a large chance we may have to uproot our lives to find new employment again once our contracts expire (we work in a major metro area, yet the opportunities are few and far between particularly for those who no longer want new grad salaries). My friends are concerned about having to pull their children out of schools in order to move for new work. They worry about their spouses having to find new jobs in new cities.
I would love to be a rad onc in my current situation for the rest of my career however I know it is unrealistic. This had made me consider alternative careers within and outside of medicine. I just think it's important for young students to be aware. This problem is not shared by my friends in other specialties. Many of them have switched jobs and they've mainly worked for other groups within our metro area. They don't understand why we do not have the same luxury until I explain it to them.

Bottom line - yes I like rad onc and my current job but I simply do not think even many of the "good jobs" at least at hospitals are tenable in the long term currently which is difficult when you're "adulting."

I disagree with you. Most administrators will not want to let you go if you're a good established radonc. The admins want continuity of care within their hospital and so do the referring physicians. Unless of course your hospitals doing poorly financially and the issue of the hospitals viability is at stake, then yes I would be worried in that situation.

 

[deleted18755]

I disagree with you. Most administrators will not want to let you go if you're a good established radonc. The admins want continuity of care within their hospital and so do the referring physicians. Unless of course your hospitals doing poorly financially and the issue of the hospitals viability is at stake, then yes I would be worried in that situation.

I was under the impression that at academic centers and even larger hospital systems referrals are more often made for "radiation oncology consult" and it just goes into a list that is distributed by a formula or random schedule, not "refer to Dr. X in department of radiation oncology," so it's more that the department or center is "established" than an individual physician (and therefore it is easier to replace the physician).

Just curious: when you guys get consults do they come to you as an individual or to your group (or maybe some of both?) and likewise when you refer to others do you generally have a "got to guy" or just a practice or center?

 

[medgator]

I was under the impression that at academic centers and even larger hospital systems referrals are more often made for "radiation oncology consult" and it just goes into a list that is distributed by a formula or random schedule, not "refer to Dr. X in department of radiation oncology," so it's more that the department or center is "established" than an individual physician (and therefore it is easier to replace the physician).

Just curious: when you guys get consults do they come to you as an individual or to your group (or maybe some of both?) and likewise when you refer to others do you generally have a "got to guy" or just a practice or center?

In our practice, it is by physician. Some referrings have their preference. In larger, equal partner groups, I think that still happens but they try to even things out

 

[elementaryschooleconomics]

I was under the impression that at academic centers and even larger hospital systems referrals are more often made for "radiation oncology consult" and it just goes into a list that is distributed by a formula or random schedule, not "refer to Dr. X in department of radiation oncology," so it's more that the department or center is "established" than an individual physician (and therefore it is easier to replace the physician).

Just curious: when you guys get consults do they come to you as an individual or to your group (or maybe some of both?) and likewise when you refer to others do you generally have a "got to guy" or just a practice or center?

At my giant academic center it's mixed. Many of our RadOnc docs have been here for a long time and have established relationships with physicians both within and without our system and receive referrals accordingly. We definitely receive generic "RadOnc Consult" from community practices unfamiliar with us though.

The few times we do refer out (due to geographic restrictions of the patient), it's either to a specific person or the practice that a specific person works at.

 

[XRT_doc]

I was under the impression that at academic centers and even larger hospital systems referrals are more often made for "radiation oncology consult" and it just goes into a list that is distributed by a formula or random schedule, not "refer to Dr. X in department of radiation oncology," so it's more that the department or center is "established" than an individual physician (and therefore it is easier to replace the physician).

Just curious: when you guys get consults do they come to you as an individual or to your group (or maybe some of both?) and likewise when you refer to others do you generally have a "got to guy" or just a practice or center?

So I'm in a community hospital not a giant academic center. Also I'm the only radonc here so they do refer directly to me. But yes I could see how your position is more tenuous if there is too little work for the multiple radoncs working at a single center. This is why I have not asked for another radonc to be hired to decrease my workload (in addition to the increased income for seeing more patients).

 

[DukeNukem]

Just curious: when you guys get consults do they come to you as an individual or to your group (or maybe some of both?) and likewise when you refer to others do you generally have a "got to guy" or just a practice or center?

On the one hand our chair has made it very clear that we are replaceable widgets. "The referring does not get to choose" (which rad onc sees/treats the patient). This does create friction between our department and other departments. There are some departments that actually don't like to refer to us due to our lack of consistency (inpatient coverage is a mess, docs in many different locations), stability (revolving door practice, docs reassigned to other locations frequently), and a mixed desire among faculty to go the extra mile for referrings given job dissatisfaction with pay and hours. Our chair doesn't seem to care about any of that. He has said to me that he doesn't want anyone to "get a big head."

On the other hand, many consults come to me directly anyway by way of my relationships with other docs. If the consult is appropriate for me and there's no particular politics involved, I'll usually take them if they're sent my way.

When we refer to others it depends on the department. Usually I can pick who I want.

 

[RadDoc11]

I disagree with you. Most administrators will not want to let you go if you're a good established radonc. The admins want continuity of care within their hospital and so do the referring physicians. Unless of course your hospitals doing poorly financially and the issue of the hospitals viability is at stake, then yes I would be worried in that situation.

It actually comes down to dollars. If the cost they're paying you can significantly be reduced without losing many patients, they are happy to offer you the same reduced salary upon contract renewal with which they know that they attract someone else. Most employed docs are encouraged by hospitals to keep referrals in house. Hospitals are employing more and more docs. Radiation oncology is downstream in referrals - we are essentially the bottom of the food chain. As hospitals employ more docs and more of your referrals come from in-house, it really does not matter as much if you have strong relationships with referring docs. Those same docs will be forced to refer to the new rad onc who may be 50% cheaper from the hospital's perspective.

 

[RickyScott]

It actually comes down to dollars. If the cost they're paying you can significantly be reduced without losing many patients, they are happy to offer you the same reduced salary upon contract renewal with which they know that they attract someone else. Most employed docs are encouraged by hospitals to keep referrals in house. Hospitals are employing more and more docs. Radiation oncology is downstream in referrals - we are essentially the bottom of the food chain. As hospitals employ more docs and more of your referrals come from in-house, it really does not matter as much if you have strong relationships with referring docs. Those same docs will be forced to refer to the new rad onc who may be 50% cheaper from the hospital's perspective.

Yes, exactly: I have been told "we are the end of a process."

 

[MegaVoltagePhoton]

I think it's probably highly dependent on the situation. Some services in my department (which is an academic center) have reasonably well known people, who I think do "pull in" some referrals. Whereas other services have either less well known people or people who have zero enthusiasm or charisma to build a practice. Those people are very dependent on the just being bodies in a role, meaning, no one refers to them because of who they are but because of where they are.

 

[XRT_doc]

It actually comes down to dollars. If the cost they're paying you can significantly be reduced without losing many patients, they are happy to offer you the same reduced salary upon contract renewal with which they know that they attract someone else. Most employed docs are encouraged by hospitals to keep referrals in house. Hospitals are employing more and more docs. Radiation oncology is downstream in referrals - we are essentially the bottom of the food chain. As hospitals employ more docs and more of your referrals come from in-house, it really does not matter as much if you have strong relationships with referring docs. Those same docs will be forced to refer to the new rad onc who may be 50% cheaper from the hospital's perspective.

I agree its situational. In my hospital 95% of the docs are independent and can choose whichever doc they send patients to (Including a radiation center less than 15 minutes away)). If you make yourself invaluable to the admins by providing good service and make a name for yourself in the community, they won't try to screw you over, because ultimately, they'll lose by driving me (and the patients) to go to the competitor.

However if I was in a situation where all the docs were employed and they couldn't even decide to refer to me directly (which many of the above have posted), you would be easily replaceable.

 

[XRT_doc]

On the one hand our chair has made it very clear that we are replaceable widgets. "The referring does not get to choose" (which rad onc sees/treats the patient). This does create friction between our department and other departments. There are some departments that actually don't like to refer to us due to our lack of consistency (inpatient coverage is a mess, docs in many different locations), stability (revolving door practice, docs reassigned to other locations frequently), and a mixed desire among faculty to go the extra mile for referrings given job dissatisfaction with pay and hours. Our chair doesn't seem to care about any of that. He has said to me that he doesn't want anyone to "get a big head."

On the other hand, many consults come to me directly anyway by way of my relationships with other docs. If the consult is appropriate for me and there's no particular politics involved, I'll usually take them if they're sent my way.

When we refer to others it depends on the department. Usually I can pick who I want.

Honestly sounds like a really $hitty institution you work for.

 

[RickyScott]

I agree its situational. In my hospital 95% of the docs are independent and can choose whichever doc they send patients to (Including a radiation center less than 15 minutes away)). If you make yourself invaluable to the admins by providing good service and make a name for yourself in the community, they won't try to screw you over, because ultimately, they'll lose by driving me (and the patients) to go to the competitor.

However if I was in a situation where all the docs were employed and they couldn't even decide to refer to me directly (which many of the above have posted), you would be easily replaceable.

depending on state, non competes will prevent you from going to competitor.

 

[XRT_doc]

depending on state, non competes will prevent you from going to competitor.

Yes, if you signed one. I negotiated that out of my contract.

 

[MegaVoltagePhoton]

Yes, if you signed one. I negotiated that out of my contract.

I assume the argument is that new grads would have a tough time negotiating that

 

[RO28]

The question I get the most from family and friends is why I “can’t just get another job in (blank city)” since (in their minds at least) I have a great CV and went to prestigious schools and training programs. People, even those in other fields of medicine, just do not believe how difficult it is as a radiation oncologist to find even average jobs in large cities even if you’re willing to travel 50 miles outside of the city. They think I’m exaggerating when I say certain major cities literally have no jobs, or only have one notoriously exploitative revolving door position open. This is reality though.

I know people have criticized this forum as being overly negative but as someone who has never posted here prior to today, I just thought I would share my experience which I think reflects many of the legitimate concerns others have previously stated. Most of my friends in rad onc have had similar experiences. This historically has never been a great field for those with major geographic constraints, but as medicine as a whole becomes increasingly unstable, this disproportionately affects our field more significantly than others. It’s common now to see CVs of docs in many fields where people have changed jobs several times as hospitals change contracts, systems merge, personal situations change, etc. Most people don’t stay in one position their whole career as physicians did in the past. This trend affects rad onc much differently though. A job change for us generally doesn’t mean joining another hospital system in the area. It often requires a full move which impacts families in a very real way. I think it’s irresponsible to mask this reality from students considering rad onc which I why I opted to share my experience today.

Thank you for your honesty with the OP. I am a young attending and reading this thread has me nodding in agreement and worried because I don't know what will happen in the next 5-10 years. For those looking into alternative careers what resources or thoughts have you had? I'm not leaving my current job anytime soon, but I want to start brainstorming in case I end up in a challenging situation. I have no interest in going back to training of some sort.

 

[XRT_doc]

Thank you for your honesty with the OP. I am a young attending and reading this thread has me nodding in agreement and worried because I don't know what will happen in the next 5-10 years. For those looking into alternative careers what resources or thoughts have you had? I'm not leaving my current job anytime soon, but I want to start brainstorming in case I end up in a challenging situation. I have no interest in going back to training of some sort.

The alternative is to go back to residency and do another specialty.

 

[XRT_doc]

I assume the argument is that new grads would have a tough time negotiating that

True

 

[deleted1002574]

Yes, if you signed one. I negotiated that out of my contract.

Was this is a major metro? I pleaded and begged and even said to put in a clause that if I violated I would pay $200k. Still wouldn't remove. Big desirable city.

 

[XRT_doc]

Was this is a major metro? I pleaded and begged and even said to put in a clause that if I violated I would pay $200k. Still wouldn't remove. Big desirable city.

Yes, its in a top 10 metro area. This was 5 years ago though. I'm not sure what it would be like now.

 

[medgator]

Yes, its in a top 10 metro area. This was 5 years ago though. I'm not sure what it would be like now.

From what some are saying, you have to pay to break a contact early.

 

[deleted941485]

yeah I’m seeing more postings with 3-5 year experience but the problem is that if you are already in a large graduate cohort even having experience doesn’t really help all that much because literally there are a ton of people that are in the same boat.

 

[taserlaser]

Don’t feel like starting a new thread for this as it seems tangentially related, but mods feel free to move as necessary. And I may regret posting this but man oh man is this frustrating me to no end and I feel the need to rant.

So doing a fellowship, that’s been established here on SDN already, etc etc. Waiting for something to come up locally, and not that there’s much options now, although this is making me rethink that seriously. Because of the whole university/hospital/department bureaucracy, I have yet to see a drop of my salary since I started. I’ve been pestering them since day 1 with my banking info, etc etc. It took just over 2 months and the same afternoon I called a lawyer, I finally saw a modest research stipend hand delivered from the organization president. The promise was that it salary would be back paid starting a few weeks from then, as someone went on sick leave, yada yada, so called the lawyer back and left things as is. So that was a month ago, and following up on things then things STILL had not been submitted or processed. Ring things up the chain of command again and all I get this time from the dept head are shoulders shrug and the option of a personal cheque from the group to tide things over until the hospital starts depositing my paycheck, at which I would repay it. Obviously not solving problems, but a token gesture. I should say I started July 1.

So still following up on payroll after having the appearence of my file being actually worked on, and again I’m getting slowrolled. HR had no record of me until beginning of this week, and yet I’ve had a hospital ID, EMR access, license, and malpractice, orientation, everything. All the while I’m working my tail off and impressing the staff and my preceptors, of which reassure me the money is there, and just it’s the usual bureaucratic nonsense.

There might be a spot opening up here, which would be OK paycheck notwithstanding, as it’s a large city with excellent work being done. I would need references either way. We all know RO is a hella small field. So I’m grinning and bearing it as much as possible without a desire to aggressively escalate (but will happen at some point if this isn’t resolved for whatever reason). In any other sector or field this would be hella illegal and unprofessional. I really do feel used and abused at the moment, as there’s a huge power imbalance and lack of options for me to just get up and file a wage claim while working here, for fear of reprisal. The situation is absolute nonsense.

The point of this post, apart from therapeutic ranting, is not specifically the not getting paid part, or the bureaucratic nonsense of the health system. That will be sorted out one way or another. But rather, emphasizing another aspect of the lack of job fluidity and options even allows for this sort of situation to even be remotely possible or ‘acceptable’ as I seem to be dealing with it. Because if there were other reasonable options open close to home/family I would have taken them up a while back, believe me.

(This should remain unsaid too, but please don’t make an attempt to name/shame/dox - all I will say this is a big research institution that you likely have heard of, but probably not the one you are thinking of.)

 

[elementaryschooleconomics]

Don’t feel like starting a new thread for this as it seems tangentially related, but mods feel free to move as necessary. And I may regret posting this but man oh man is this frustrating me to no end and I feel the need to rant.

So doing a fellowship, that’s been established here on SDN already, etc etc. Waiting for something to come up locally, and not that there’s much options now, although this is making me rethink that seriously. Because of the whole university/hospital/department bureaucracy, I have yet to see a drop of my salary since I started. I’ve been pestering them since day 1 with my banking info, etc etc. It took just over 2 months and the same afternoon I called a lawyer, I finally saw a modest research stipend hand delivered from the organization president. The promise was that it salary would be back paid starting a few weeks from then, as someone went on sick leave, yada yada, so called the lawyer back and left things as is. So that was a month ago, and following up on things then things STILL had not been submitted or processed. Ring things up the chain of command again and all I get this time from the dept head are shoulders shrug and the option of a personal cheque from the group to tide things over until the hospital starts depositing my paycheck, at which I would repay it. Obviously not solving problems, but a token gesture. I should say I started July 1.

So still following up on payroll after having the appearence of my file being actually worked on, and again I’m getting slowrolled. HR had no record of me until beginning of this week, and yet I’ve had a hospital ID, EMR access, license, and malpractice, orientation, everything. All the while I’m working my tail off and impressing the staff and my preceptors, of which reassure me the money is there, and just it’s the usual bureaucratic nonsense.

There might be a spot opening up here, which would be OK paycheck notwithstanding, as it’s a large city with excellent work being done. I would need references either way. We all know RO is a hella small field. So I’m grinning and bearing it as much as possible without a desire to aggressively escalate (but will happen at some point if this isn’t resolved for whatever reason). In any other sector or field this would be hella illegal and unprofessional. I really do feel used and abused at the moment, as there’s a huge power imbalance and lack of options for me to just get up and file a wage claim while working here, for fear of reprisal. The situation is absolute nonsense.

The point of this post, apart from therapeutic ranting, is not specifically the not getting paid part, or the bureaucratic nonsense of the health system. That will be sorted out one way or another. But rather, emphasizing another aspect of the lack of job fluidity and options even allows for this sort of situation to even be remotely possible or ‘acceptable’ as I seem to be dealing with it. Because if there were other reasonable options open close to home/family I would have taken them up a while back, believe me.

(This should remain unsaid too, but please don’t make an attempt to name/shame/dox - all I will say this is a big research institution that you likely have heard of, but probably not the one you are thinking of.)

I'm so sorry about your situation, that sounds terrible!

 

[taserlaser]

I'm so sorry about your situation, that sounds terrible!

Thanks. Keeping my head up but at some point it starts to affect general affect and enjoyment of life. Job stress SUCKS.

 

[deleted1002574]

You’re right. Too small of a field but damn I would love to out the bastards

 

[Mandelin Rain]

at the end of residency I had like $500 to my name. Not sure how I’d have gone 4 months without a paycheck.

 

[deleted774703]

Don’t feel like starting a new thread for this as it seems tangentially related, but mods feel free to move as necessary. And I may regret posting this but man oh man is this frustrating me to no end and I feel the need to rant.

So doing a fellowship, that’s been established here on SDN already, etc etc. Waiting for something to come up locally, and not that there’s much options now, although this is making me rethink that seriously. Because of the whole university/hospital/department bureaucracy, I have yet to see a drop of my salary since I started. I’ve been pestering them since day 1 with my banking info, etc etc. It took just over 2 months and the same afternoon I called a lawyer, I finally saw a modest research stipend hand delivered from the organization president. The promise was that it salary would be back paid starting a few weeks from then, as someone went on sick leave, yada yada, so called the lawyer back and left things as is. So that was a month ago, and following up on things then things STILL had not been submitted or processed. Ring things up the chain of command again and all I get this time from the dept head are shoulders shrug and the option of a personal cheque from the group to tide things over until the hospital starts depositing my paycheck, at which I would repay it. Obviously not solving problems, but a token gesture. I should say I started July 1.

So still following up on payroll after having the appearence of my file being actually worked on, and again I’m getting slowrolled. HR had no record of me until beginning of this week, and yet I’ve had a hospital ID, EMR access, license, and malpractice, orientation, everything. All the while I’m working my tail off and impressing the staff and my preceptors, of which reassure me the money is there, and just it’s the usual bureaucratic nonsense.

There might be a spot opening up here, which would be OK paycheck notwithstanding, as it’s a large city with excellent work being done. I would need references either way. We all know RO is a hella small field. So I’m grinning and bearing it as much as possible without a desire to aggressively escalate (but will happen at some point if this isn’t resolved for whatever reason). In any other sector or field this would be hella illegal and unprofessional. I really do feel used and abused at the moment, as there’s a huge power imbalance and lack of options for me to just get up and file a wage claim while working here, for fear of reprisal. The situation is absolute nonsense.

The point of this post, apart from therapeutic ranting, is not specifically the not getting paid part, or the bureaucratic nonsense of the health system. That will be sorted out one way or another. But rather, emphasizing another aspect of the lack of job fluidity and options even allows for this sort of situation to even be remotely possible or ‘acceptable’ as I seem to be dealing with it. Because if there were other reasonable options open close to home/family I would have taken them up a while back, believe me.

(This should remain unsaid too, but please don’t make an attempt to name/shame/dox - all I will say this is a big research institution that you likely have heard of, but probably not the one you are thinking of.)

Sorry to hear that! Ridiculous

Hope you get your job and then oust them in the future so future residents don’t fall in the trap

 

[XRT_doc]

Don’t feel like starting a new thread for this as it seems tangentially related, but mods feel free to move as necessary. And I may regret posting this but man oh man is this frustrating me to no end and I feel the need to rant.

So doing a fellowship, that’s been established here on SDN already, etc etc. Waiting for something to come up locally, and not that there’s much options now, although this is making me rethink that seriously. Because of the whole university/hospital/department bureaucracy, I have yet to see a drop of my salary since I started. I’ve been pestering them since day 1 with my banking info, etc etc. It took just over 2 months and the same afternoon I called a lawyer, I finally saw a modest research stipend hand delivered from the organization president. The promise was that it salary would be back paid starting a few weeks from then, as someone went on sick leave, yada yada, so called the lawyer back and left things as is. So that was a month ago, and following up on things then things STILL had not been submitted or processed. Ring things up the chain of command again and all I get this time from the dept head are shoulders shrug and the option of a personal cheque from the group to tide things over until the hospital starts depositing my paycheck, at which I would repay it. Obviously not solving problems, but a token gesture. I should say I started July 1.

So still following up on payroll after having the appearence of my file being actually worked on, and again I’m getting slowrolled. HR had no record of me until beginning of this week, and yet I’ve had a hospital ID, EMR access, license, and malpractice, orientation, everything. All the while I’m working my tail off and impressing the staff and my preceptors, of which reassure me the money is there, and just it’s the usual bureaucratic nonsense.

There might be a spot opening up here, which would be OK paycheck notwithstanding, as it’s a large city with excellent work being done. I would need references either way. We all know RO is a hella small field. So I’m grinning and bearing it as much as possible without a desire to aggressively escalate (but will happen at some point if this isn’t resolved for whatever reason). In any other sector or field this would be hella illegal and unprofessional. I really do feel used and abused at the moment, as there’s a huge power imbalance and lack of options for me to just get up and file a wage claim while working here, for fear of reprisal. The situation is absolute nonsense.

The point of this post, apart from therapeutic ranting, is not specifically the not getting paid part, or the bureaucratic nonsense of the health system. That will be sorted out one way or another. But rather, emphasizing another aspect of the lack of job fluidity and options even allows for this sort of situation to even be remotely possible or ‘acceptable’ as I seem to be dealing with it. Because if there were other reasonable options open close to home/family I would have taken them up a while back, believe me.

(This should remain unsaid too, but please don’t make an attempt to name/shame/dox - all I will say this is a big research institution that you likely have heard of, but probably not the one you are thinking of.)

i guess the chairs got what they wanted for radonc. Increase the number of residents so much that you get free work from Attending radoncs.

 

[qwerty89]

Do I even need to comment? Last time I posted I was accused of lying or there being something wrong with me.

Summary: job market sucks for attendings too. Being out a few years means little to nothing. Most posted or available jobs I can't even get to return my emails or calls, but the ones that do are pretty much the exact same job they'd offer a new grad. I have never had a job offer or discussion with a path (within 10 years anyway) to current MGMA median salary no matter where it is located.

My boss is super happy. He tells faculty if they're unhappy that they'll be replaced by a new grad. Some faculty have had their salaries cut. We continue to try to expand the residency despite matching difficulties and poor job placements among most of our grads.

My salary has barely changed since I came out of residency. When we hire it's very clear that we're hiring assistant professors only, but looking for associate level CVs. It doesn't matter if it's a new grad or someone 5+ years out. We lose around 2 faculty per year on average because they're miserable and see no path to advancement. Around half of departures are lateral moves to another academic satellite elsewhere just to get out of here and half have no job to go to with some leaving clinical rad onc entirely.

I'm personally sick of hearing about this geographic maldistribution. If there was a real rural job with a salary guarantee over MGMA median with a reasonable setup, I'd be interested. Where are they? The good ones still fill through word of mouth and are never posted. The ones that are posted get 50+ applications. There are plenty of gimmick jobs (antiquated equipment, fraudulent billing, crazy fractionations, salary guarantee for one year then no way to keep it up) or lowball salaries (little volume due to location or owner of the practice makes all the cash off your back while you have no path or ridiculously expensive path to technicals) when you go rural too.

As the job market worsens each faculty member will be forced to do more work for the same or less pay. One way of mitigating this is adding more cheap labor (i.e. residents). As more residents graduate the year the job market worsens. As the job market worsens each faculty member will be forced to do more work for the same or less pay. One way of mitigating this is adding more cheap labor (i.e. residents). As more residents graduate the year the job market worsens...

 

[RadOncDoc21]

You guys are not helping my re-negotiation arguments!