Job Offers

[Ursus Martimus]

So I have not seen t thread like this in our forum. I have been asked by a number of times by groups and academics what other groups are offering. Outside of the offers I got I am not sure what the trends for this year are. But I thought it would be interested to post what people are seeing out there. As many groups have low starting and higher partnershop tracks it might be interested to see how different they are. I would suggest a form like below. Let see what people are being offered.

Area: Midwest City location private practice
Staring Salary: $225K/yr
Years to partner: 3 years
Vacation to start - 6 weeks
Vacation as partner: 11 weeks
Partner Salary: 525K
Additional benefits: Possible buy in to technical as partner

Area: South Academic
Starting Salary: $265K
Additional benefits: about $30K/year in bonus, Generous 401K contribution.

Who's up next?, don't be shy.

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Members don't see this ad.

 

[deleted4401]

Exactly the type of post "Impressions" was suitable for

-S

 

[Gfunk6]

If you would like anonymity feel free to PM me the information and I will post it myself.

 

[deleted4401]

I'm pretty open, but I'm not about to post #s.

In general though, this is what I took, and I think b/c of location, the starting salary was lower than expected, but I'm not going to starve.

Southern Maryland (DC area) large private practice
~ 18-20 on treatment
3 year partner track
Nominal buy in ($500), revenue shared equally amongst all partners
4, 5, 6 weeks of vacation first 3 years
Cell phone subscription (that cracked me up... but I'll take it)

 

[bragmt]

I'm pretty open, but I'm not about to post #s.

In general though, this is what I took, and I think b/c of location, the starting salary was lower than expected, but I'm not going to starve.

Southern Maryland (DC area) large private practice
~ 18-20 on treatment
3 year partner track
Nominal buy in ($500), revenue shared equally amongst all partners
4, 5, 6 weeks of vacation first 3 years
Cell phone subscription (that cracked me up... but I'll take it)

Tell me, how do these "buy ins" work for practices, do you have to take loans out again for buy ins? How common are they? are we talking 500k average cost to buy in? Shed some light for a curious resident please.

 

[deleted4401]

I probably won't need a loan for $500 - I can make that in a few hours of work

In the groups with larger buy-ins for the equipment, you finance it. In some groups, once you make partner, you get partner salary, but have to invest a significant proportion of it to buy your stake. I do know that there is some groups which this is very worth it, and other groups where its a waste of money.

Partnership means different things to different groups - some do even splits, some do proportionate revenue sharing (you earn some percentage of what you bring in), and some do a hybrid. I think that the ones where you earn a percentage of what you bring in encourage some adverse behaviors: overtreating, competing with your colleagues, and utilizing expensive technology. I think the "flat" partnerships made more sense for me, but allow other incentives - see less patients, undertreat, etc. Both have their pros/cons.

-S

 

[DrJD]

I'm pretty open, but I'm not about to post #s.

In general though, this is what I took, and I think b/c of location, the starting salary was lower than expected, but I'm not going to starve.

Southern Maryland (DC area) large private practice
~ 18-20 on treatment
3 year partner track
Nominal buy in ($500), revenue shared equally amongst all partners
4, 5, 6 weeks of vacation first 3 years
Cell phone subscription (that cracked me up... but I'll take it)

So SimulD, it sounds like you are in private practice in a larger metropolitan area. I'm curious, when you were looking, on average how much less did positions in cities like DC offer than in smaller cities in the south or midwest? Granted there aren't a lot of Rad Onc practices in super small cities, but I'm curious none the less.

 

[G'ville Nole]

So SimulD, it sounds like you are in private practice in a larger metropolitan area. I'm curious, when you were looking, on average how much less did positions in cities like DC offer than in smaller cities in the south or midwest? Granted there aren't a lot of Rad Onc practices in super small cities, but I'm curious none the less.

I went through the process last year, and was able to compare notes with some of my colleagues along the way. Although we're talking about a relatively small sample size, the starting salaries I was seeing were within 25K of the MGMA average ($250,000), both on the high side and low side when looking in the Midwest and Southeast. On the West coast, it was a bit less, and I have no good direct info on the Northeast.

Keep in mind that salary may be a big draw, but is by no means the only one. The other perks that Simul alluded to (yes, even the cell phone!) can really combine to elevate one practice over another. I've seen vacation time ranging from 3 to 6 weeks in the 1st year, partnerships from 2 to 5 years (3 is pretty standard), and details of partnership are indeed all over the place. The other aspect which should be obvious but bears repeating is that bad practices will habitually lure new grads with high salaries. If it sounds too good to be true, it probably is. Either that or it's a urorads.

 

[ghgi8]

Can you please define a "bad practice"

 

[G'ville Nole]

Can you please define a "bad practice"

I think it can best be defined in one word. That word is "turnover".

Some practices have a consistent history of bringing in newly minted attendings, advertising a nice salary and two year partnership track, then firing the individual just prior to partnership and repeating the process all over again. It's not always easy to identify these groups, but this is where the uncomfortable questions are necessary during the interview process. You should ask about any docs who have left the group over the last 5-10 years, and evasiveness on the part of the practice should be viewed as a red flag. It's also instructive to talk to therapists, physicists, nurses etc. and ask about the turnover in those arenas as well. Ask how long they've worked at the practice; if everyone's answers are less than 3 years, it's probably not a good sign. A stable practice is in general a happy practice.

 

[deleted4401]

Agreed. Quality of practice is inversely related to turnover.

The best practices will even tell you exactly who didn't make partner/left the practice and tell you to give them a call and talk to them about why they left.

I generally looked at bigger cities, and so I don't have a feel for what smaller cities offered. I think the #s quoted by the OP are higher than the places I interviewed at.

-S

 

[OTN]

Ha ha ha ha ha ha ha ha: "Either that or it's a urorads."

No joke there.

I interviewed for private practice jobs last year and can give some examples from some of the numbers I saw. In general, each practice will be entirely different from each other practice, in nearly every way possible. For me, location was paramount...and I guess that's why I ended up in Austin

One important piece of advice before going into the numbers: When looking for jobs, you have to ask yourself "where are my patients going to come from?" If you're taking over a practice from a radonc who is retiring (ideal situation, obviously), that won't be as much of a problem. If you're entering a competitive market and are going to be 100% responsible for building your own base...think about that carefully.

Practices that were radiation-oncologist owned seemed to start out around$250k and nearly all had a three-year partnership track. The buy-ins I heard about with these groups ranged from $200k to $2 million, but these numbers mean nothing without know what you're getting with the buy-in. Technical component? How much? How split? Real estate? Etc. You also have to ask yourself how much of your future time you want to spend being a businessperson.

Hospital-based practices offer the benefit of a high starting salary (my experience was in the $400-$500k range), and usually building a practice is a little easier, as the hospital has incentive to keep their machine busy. You'll hear the "yeah, but there's a ceiling to how much you can make with hospital practices," but those are great salaries without ever having to pony up for a buy-in. Urorads practices usually offer great starting salaries as well (a colleague of mine was quoted $650-$700 to start, but I can't confirm this)- dignity is expensive, right?

When looking at jobs with USOncology, Vantage, 21C, etc, keep in mind that each practice can be very different from the next. Most starting salaries with these organizations seemed to be similar to the private-practice ones, but with shorter time (and less money) needed for partnership (18 months vs 3 years, for example), which usually (but not always) excludes the technical component. Keep your eyes open when interviewing for SOME of these jobs, but it would be unwise to write these off from the start. In some markets they're the best jobs.

As a general rule, you're going to make more money in the middle of nowhere, in the Midwest, or in the South compared with either coast or more desirable locales.

Vacation, signing bonuses, benefits, call, coverage, etc...These all vary from practice to practice and are important.

There are so many variables, I think the best thing to do is decide which single one or two are going to be the most important for you. As much money as possible? As much vacation as you can get? (I interviewed with one group who was looking for a third person to split a two-person practice...4 months off a year!) Location? As I mentioned, I chose location and happened to get lucky when it came to the particular job.

Good luck! At least this time you shouldn't have to pony up for the flights and hotels yourselves...

 

[DrJD]

So, I feel like I may be going crazy. I could have sworn there was a "Future of Rad Onc" thread recently about the future of reimbursements, but now I can't seem to find it...

This seems like as good a place as any to ask though.

What do you guys think the future of rad onc job offers will look like for those of us in medical school right now? Obviously no one has a crystal ball.

I am asking because as I express my interest in Radiation Oncology to those in the medical field I keep getting told some version of, "You don't want to go in to that, by the time you get there they'll be making less than primary care docs..." Since I've heard this from numerous people, I figured I would post it here and see what those of you further down the road are hearing.

My disclaimer is that I'm not hearing this from those in Radiation Oncology, rather they are in different fields.

Thanks!

 

[bragmt]

Those types of statements from other specialties about the future of radiation oncology salaries always surprise me, although I must say I rarely hear them. My response to anyone that says comments like that is usually "What’s your basis for that." I mean really...lets step back and do what Rad Oncers do best, look at the evidence. (The larger question is what is going to happen to ALL physician's salaries that take Medicare...that is a more interesting issue, but I digress.)

To think for some strange reason that the field of radiation oncology, which is incredibly complicated, and absolutely essential to cancer treatment, would be singled out and out salaries would be cut to the averages of primary care is pretty insane. The only way that would happen is if some other miracle cure for cancer comes out that does not require radiation, which would be great for our common goal. We are in huge demand, our equipment is very expensive, and we do numerous procedures. If our salaries go anywhere then neurosurg, ent, optho, cards, gi, gen surg, interventional rads, (which largely get their profits from the same billing structures as radiation oncology) are going to take a massive hit as well...unlikely. But let the PCP's keep dreaming about one day making more than the most profitable departments in most medical centers.

Bottom line, if you want to join the amazing, groundbreaking and cancer curing specialty of Rad Onc start your emphasis on evidence based living now. If someone says something that makes no sense, ask to see the evidence. Listen to them babble in dismay, and then return to their patients insulin dose scheduling, which they likely will not take correctly anyway.

 

[OTN]

"You don't want to go in to that, by the time you get there they'll be making less than primary care docs..."

Wishful thinking. Now that I'm in private practice, the only question I hear from other docs is "How did you get so lucky to discover radonc?"

 

[Ursus Martimus]

So I can see this was a terrible idea, no one wanting to contribute and others just wanting to babble.

 

[GoodmanBrown]

In my experience that is about all SDN is good for

qft.

IMHO, that's the only thing the internet is really good for.

 

[JoeMudPhud]

The only way that would happen is if some other miracle cure for cancer comes out that does not require radiation, which would be great for our common goal.

OR

if the trend to become technicians to other specialties continues in the name of "lifestyle", there is a possibility of being "squeezed" out by medicare. i.e. in some places with SRS, the neurosurgeon decides what to treat and what dose to give.. the rad onc is there for technical support and the "license" to use radiation... medicare may decide it doesn't want to pay 2 physicians for 1 procedure to save costs...

coronary artery catheterization used to be a "radiology" procedure. hopefully, we won't say that CNS SRS "used" to be a "radonc" procedure.

i hope we don't see the day when a urologist refers a patient with a prescription pad that reads "i want >78 Gy to the prostate only using IMRT"... oh wait... does that kind of happen already? urorads?

i think we decide who to treat, where to treat, and how much to treat with radiation. that's our job and that's why we go to 4 years of residency (plus a prelim year)... at least that's what i think i'm in residency for... i'm only a pgy-2, what do i know? at least the internet gives me a podium to rant/rave. /

 

[subatomicdoc]

As a community radiation oncologist involved in recruiting, this topic is a gem. Some good posts.

 

[joewilly]

agree with ursus. can we get back to the original format. I'm a PGY-4, plan on contacting programs in the near future. Just want more info about what people are getting offered so I can recognize reasonable offers. Please, no more discussions about the future of medicine. And what's wrong with posting numbers? It's something I have absolutely no clue about.

 

[fettucine]

I had couple interviews at ASTRO, and I was actually surprised to spot the bad practices right away. Two interviews for Private practice in Florida. Both startups (<2y old and freestanding) run by 2-3 people. I think he quoted ~275 (low by FL standards). The first practice seemed like a nightmare, all he talked about was how he has to see you work hard to get the referrals, keep the numbers up or you're out. The other, I was interviewed by a therapist (who didn't read my CV), and the whole time she is trying to text the partner to come and join us, by the end I was so annoyed that I just walked out to go to a lecture.

Moffit - what a nightmare of an interview (maybe it was just me), $280 plus I think 10K sign on bonus (heresay, we never got to talking about money).

The good interviews -

Private Practice Carolinas. Great group, great people, great model. Many centers, two of them were hospital based, and I think 2 other were free standing. The practice was >15y old. $315 (1st y), $340(2nd y), and $365 (3rd y). Partnership after 3y, and partners were making around $600. No buy in - Partners share prof. component. Lot of academic (they were writing their own clinical trials). Downside, 1 best-buy in town, and biggest shopping center was walmart! Tourist dependent area. Not great reasons I know but we wanted to be in a big metropolitan city.

Ohio State- Great place, up and coming with tons of opportunity to research.
I think they were throwing numbers around like $300, which was pretty high for fully academic position.

Chicago- Private practice: 1st group- first year ~215-220. Partners are around $400, possible buyin. 2nd group- first year 235 and then increases by 15 until year 3. 3y to partnership with ~300-400 buyin which you pay from your now partner salary for the next 2-3 years with interest rate. Partners I believe make around 400, but none of the junior people in the practice really knew how much partners made.

East coast- Private practice, hospital based. $325 for first year, $347 for 2nd and 390 for 3rd then stay the same. 20K sign on bonus, and additional bonus each year. Obviously no partnership and no profit sharing (bonus not based on RVU). Great people and beautiful facility with new toys.

Southern California - Private practice. Free standing, single person practice (owned themachine, and all the diagnostic equipment). $280 with additional year end bonus. Just scary to be in a free standing (but established) private practice. Poor history of retaining people, I think they fired one person three years ago for personality issues, second person will last 2y, again letting go due to low numbers and referrals to that person.

Personally I liked Certificate of Need (CON) states more than non-CON states when you're in a private practice, helps in job security. I didn't interview at 21st century. But the Vantage group was a decent interview, but low salary (~210-215).

Hopefully this helps people.
-f8

 

[bragmt]

Not that it matters, Rad Onc never appealed to me for the money, however I am assuming these salaries are all PRE tax right? IE after the 50% taxes or whatever are taken out your actual take home is about half of these numbers? Either way we are very lucky to be looking at such great numbers down the line.

 

[G'ville Nole]

Not that it matters, Rad Onc never appealed to me for the money, however I am assuming these salaries are all PRE tax right? IE after the 50% taxes or whatever are taken out your actual take home is about half of these numbers? Either way we are very lucky to be looking at such great numbers down the line.

Correct. Discount these numbers by about 40%, and you get a sense of the take-home pay.