Lost my job and can't move . . . now what?

[TheWallnerus]

Would you like to be a respected physician? Stay away from RadOnc

This is essentially what Ed Halperin said in his editorial way back when… but then attempted to walk it back in the same editorial by optimistically predicting a hard working, industrious rad onc could get respect. And become a med school dean. LOLOL

If a rad onc gets appointed as a med school dean between now and 2030, the first person to DM me I will Venmo a hundred bucks.

DEFINE_ME

---

Members don't see this ad.

 

[JumpingShip]

Hello JumpingShip! It saddens me to hear what you are going through, though I believe this is becoming a trend within medicine.

How about an alternative option?

You have a marketable skill set and your specialty is niche.

I think there is a reasonable likelihood that there is an industry/pharma/remote opportunity that you could fulfill. It is unlikely that industry/pharma is advertising for exactly what you need, though there are ways to create your own headwinds. Yeah, it may not pay Rad Onc money in the short term, though could be lucrative in the long run and/or give you the freedom to find the right clinical Rad Onc job or part time remote Rad Onc clinical or some type of hybrid that could work for your family without having to immediately move.

Trying to think outside the box for you. Best wishes!

Sorry I don't post on forums or use social media other than to look at pictures of my out of state friends and families children while drinking coffee a few times a week (maybe I should get more involved since I might need to sleep on their couches while doing locums an hour from their houses on short notice!) so I'm not sure if I'm supposed to just type into the end of the thread or reply directly to each post that is asking me a question, or do so in what appears to be a private messaging function on this site, but this one I think needs to be expanded upon. I also apologize in advance if replying directly to a specific part of a specific individual's post is not proper etiquette or seen as a person attack or something, but please expand upon this statement:

(quote from VectorPhoton):

"I think there is a reasonable likelihood that there is an industry/pharma/remote opportunity that you could fulfill"

I have literally spent many hours per week, every single week for many months and even multiple years trying to find such a position (and I will definitely accept way less than "Rac Onc" money not just in the short term but permanently as long as it comes with health insurance and other benefits and I can be near my kids, wife, and deteriorating/actively dying parents). I am quite honestly a happily married older white Christian man who can work anywhere and would literally take the job in the deep south or rural Midwest if I can then get back to my home/family for weekends or work for weeks or a month or two then be at home for a similar period of time. I understand that the vast majority of American MD's would not feel comfortable living or working in a large portion of the country, especially for locums pay that is literally somehow less than actual pay, and that this creates downward pressure on the future opportunities for everybody else in radiation oncology, but just like I can't be mad at the desperate young graduate taking whatever he can to survive and in doing so is displacing me, I hope that others realize even though I'm older I'm in the same position and gotta do what's best for my family.

Anyway, why do you (VectorPhoton) think that there is a "reasonable likelihood" that I could find such a job? If you know of such positions and especially how to acquire them please let me know and others know. That would be a HUGE help and exactly why I started this thread. I'm not expecting you to say "my friend is actively recruiting . . . here's a link to the job description". It would be incredibly helpful if you could provide specific guidance or even just tips and advice based on actual experience and knowledge.

If you're just assuming this is the case then may I respectfully ask that you not state things like "there is a reasonable likelihood" just out of optimism or assumptions because it makes people overconfident thinking "hey if this doesn't work out I could always get a job in industry/pharma, etc" and quite frankly makes desperate people like me who have actually spent so much time and energy trying to do exactly that and concluded that it's nearly impossible think we're crazy when others are doing it with "likelihood"

 

[radoncle]

Title kind of says it all. I'm a 46 year old man with three kids who has been in private practice for over 15 years and I love my job and this community, unless everybody has been lying to me for all these years I'm well liked and respected, but my practice was bought out not that long ago by a juggernaut academic center (I'm not sure if my "boss" is the 75 year old chair I've met once and had 2-3 zoom calls with or one of the people I've never met with an MBA who emails me from time to time about RVU's and "metrics") and now my options are either quit or agree to terms I simply cannot accept. I am very sure that the offer is purposely ridiculous so they know I won't take it and a fresh young PGY-5 replacement has already been assigned to replace me.

Anyway, my wife is from here, this is the only home my children have ever known, and we are juggling multiple elderly parents so I cannot move. What are my options?
Please provide any productive advice that you may have. I'm in an unbelievably desperate situation and would appreciate constructive advise or "silent prayers" and don't want this to turn into a "see the job market is terrible . . . look at this poor guy" thread as I'm well aware of that and it doesn't help. Please note that I am well into my 40's with a lot of responsibilities so I definitely can't go back and do another residency and it's been over 20 years since my intern year so I can't even work in an urgent care next to a 28 year old PA/NP (unless they were supervising me!)

I’m so sorry for you. Your situation really sucks yet seems to be more and more common.

The only option I can think of if you’re absolutely bound to that geographic area other than accepting the crappy new terms may be to work for one of those Evicore/insurance pre-auth type companies and maybe supplement your income with some Locums work. Unfortunately, you’d probably still end up making less that you probably do currently but maybe you’d have more time with your kids? It’s just a question of picking the lesser of the two evils. I’m so sorry you’re going through this.

 

[radiation]

This is essentially what Ed Halperin said in his editorial way back when… but then attempted to walk it back in the same editorial by optimistically predicting a hard working, industrious rad onc could get respect. And become a med school dean. LOLOL

If a rad onc gets appointed as a med school dean between now and 2030, the first person to DM me I will Venmo a hundred bucks.

DEFINE_ME

President and CEO Dr. Mohan Suntha

Dr. Mohan Suntha is appointed President and CEO of University of Maryland Medical System.

www.umms.org

Mohan Suntha is president and CEO of university of Maryland, not dean of medicine but equivalent title prestige wise

 

[maxxor]

This is essentially what Ed Halperin said in his editorial way back when… but then attempted to walk it back in the same editorial by optimistically predicting a hard working, industrious rad onc could get respect. And become a med school dean. LOLOL

If a rad onc gets appointed as a med school dean between now and 2030, the first person to DM me I will Venmo a hundred bucks.

DEFINE_ME

Did the rad onc have to complete residency?

Biden taps Newark hospital CEO, former NJ health commissioner for Veterans Affairs post

President Joe Biden nominated Shereef Elnahal, CEO of University Hospital and former NJ state health commissioner, to a Veterans Administration post.

www.northjersey.com

 

[elementaryschooleconomics]

Hello JumpingShip. Thanks for the message!

I have experienced my own rock bottom with medicine and been in horrible employment situations. I have experienced clawing my way into non-clinical and clinical career opportunities. It is hard, low yield and often miserable.

Some of my own non-clinical career successes were rooted in tracking down people in industries that I felt could understand how my experience could further their company, industry, product development, business, marketing etc. I had to find ways to get my face in front of people with hiring authority. This required a lot of research and networking.

Because of my own personal experiences and subsequently helping others in similar scenarios, that is why I believe there is a reasonable likelihood. I apologize if I did not choose the best wording.

As an entry step, there are physician groups online such as “Physician Nonclinical Career Hunters” and “Remote Careers for Physicians” on facebook that routinely post opportunities within various segments of medicine. This could give you some ideas.

Best wishes!

Since I'm a Radiation Oncologist, and (relatively) young, I aggressively follow these groups and others (literally the only thing I've used Facebook for since like...2019).

Just as a spoiler alert, there's no clear answers there either, so holding a "bad" satellite gig (for now) is still the safe answer.

Hilariously, jumping ship into a non-clinical career warrants the same advice we always hear: network! But when using network as a verb, networking for "A" job in RadOnc requires 1/4th the effort that networking for a non-clinical job approaching the salary of a satellite gig takes.

 

[deleted1111261]

“Industry”
“Consulting”
“BioTech”

Buzzwords of non-clinical jobs that are thrown around as an out.

You are entry level (or worse from their perspective). Your knowledge and certification doesn’t get you a $500k compensation. It would take a very long time to approach a median salary. When I spoke the the largest “industry” in our field, the salary was ~$275k with 50% of time on the road.

This works if you’ve never had an RO job before or were associate in a partner track job. Otherwise, the money is just not the reason. A select few will do well and enter leadership and kill it.

You’re probably screwed if you can’t move.

Thank you oversupply and consolidation.

 

[jondunn]

this will happen more and more often. Mom and Pop book stores turned into Barnes and Nobles before they're turned into Amazon warehouses

capitalism works, sadly sometimes.


my advice is that of The Wallnernus.

 

[RickyScott]

this will happen more and more often. Mom and Pop book stores turned into Barnes and Nobles before they're turned into Amazon warehouses

capitalism works, sadly sometimes.


my advice is that of The Wallnernus.

I like capitalism, but this is not really capitalism, but monopolist/price gouging. Barnes and nobles and Amazon are cheaper and better.

 

[jondunn]

I like capitalism, but this is not really capitalism, but monopolist/price gouging. Barnes and nobles and Amazon are cheaper and better.

consolidation and monopolies are completely part of capitalism. corporations will use every adv they have to get bigger and increase profits.

 

[theradiator]

I like capitalism, but this is not really capitalism, but monopolist/price gouging. Barnes and nobles and Amazon are cheaper and better.

When radiation oncologists in my area have been displaced, whether due to academic medical center expansion or private equity, I have seen people have taken the following actions in real world experience

1) remained in place taking the worse terms while continuing to look for something better
2) worked for a local hospital
3) worked for a multispecialty group in a different county
4) worked for a local VA
5) locums
6) moved away

 

[RickyScott]

When radiation oncologists in my area have been displaced, whether due to academic medical center expansion or private equity, I have seen people have taken the following actions in real world experience

1) remained in place taking the worse terms while continuing to look for something better
2) worked for a local hospital
3) worked for a multispecialty group in a different county
4) worked for a local VA
5) locums
6) moved away

Everyone is supposed to benefit in capitalism, with minimal gov intervention. It is the minomal gov intervention that is key here. Monopolies and externalities are considered flaws of capitalism which is why they are regulated. This is why the power and water company can’t charge you whatever they want. Nor can the power company dump nuclear waste into the ocean and claim thats capitalism! It is the job of proffesional societies/trades to protect their members. That is why historically us didn’t produce more doctors than they need. Astro turned on us.

If even 10-20% of a cohort of aoa medstudents are unemployed, would be a terrible disgrace. Btw, some of the academic centers seem to be adopting rituals to fill up the work day ie that a radonc needs to be physically present inside the sim from start to finish and conduct time outs etc.

 

[JumpingShip]

Hello JumpingShip. Thanks for the message!

I have experienced my own rock bottom with medicine and been in horrible employment situations. I have experienced clawing my way into non-clinical and clinical career opportunities. It is hard, low yield and often miserable.

Some of my own non-clinical career successes were rooted in tracking down people in industries that I felt could understand how my experience could further their company, industry, product development, business, marketing etc. I had to find ways to get my face in front of people with hiring authority. This required a lot of research and networking.

Because of my own personal experiences and subsequently helping others in similar scenarios, that is why I believe there is a reasonable likelihood. I apologize if I did not choose the best wording.

As an entry step, there are physician groups online such as “Physician Nonclinical Career Hunters” and “Remote Careers for Physicians” on facebook that routinely post opportunities within various segments of medicine. This could give you some ideas.

Best wishes!

Thank you very much for this information. I had come across some groups on Facebook but I didn't want to engage since it's not anonymous like here (although this field is so small with so many sharks and parasites I'm becoming increasingly paranoid that this account can be relatively easily linked back to me), but I will definitely find a way to at least make a more professional version of my account strictly for this purpose.

 

[jondunn]

 

[RickyScott]

Thank you very much for this information. I had come across some groups on Facebook but I didn't want to engage since it's not anonymous like here (although this field is so small with so many sharks and parasites I'm becoming increasingly paranoid that this account can be relatively easily linked back to me), but I will definitely find a way to at least make a more professional version of my account strictly for this purpose.

Sharks and parasites is right. Seems to be quite common for the academic center when they come in to just trash the existing radoncs to the admin?

 

[JumpingShip]

When radiation oncologists in my area have been displaced, whether due to academic medical center expansion or private equity, I have seen people have taken the following actions in real world experience

1) remained in place taking the worse terms while continuing to look for something better
2) worked for a local hospital
3) worked for a multispecialty group in a different county
4) worked for a local VA
5) locums
6) moved away

My theory is that things have been very bad for a few years but it wasn't as obvious people were still employed in one of the 1-4 situations above. It is probably noteworthy to realize that people my age are probably much more private (the only people who know about my situation are literally my wife, only a few of my siblings, my best friend, and 2-3 people I've met in similar situations). It took me years to make an anonymous account on this site . . . there is no way middle aged radiation oncologists are on social media talking about this openly and Good Heaven's not at ASTRO or other meetings.

If could have even taken a huge pay cut to acquire 1-4 above I would have done so and just pretended like "I was just looking for a change" or otherwise as if it had been my decision. In any event it would NOT be counted as an "unemployed" so I suspect the situation is far worse than it appears.

 

[elementaryschooleconomics]

My theory is that things have been very bad for a few years but it wasn't as obvious people were still employed in one of the 1-4 situations above. It is probably noteworthy to realize that people my age are probably much more private (the only people who know about my situation are literally my wife, only a few of my siblings, my best friend, and 2-3 people I've met in similar situations). It took me years to make an anonymous account on this site . . . there is no way middle aged radiation oncologists are on social media talking about this openly and Good Heaven's not at ASTRO or other meetings.

If could have even taken a huge pay cut to acquire 1-4 above I would have done so and just pretended like "I was just looking for a change" or otherwise as if it had been my decision. In any event it would be counted as an "unemployed radiation oncologist" so I suspect the situation is far worse than it appears.

Additional factors at play:

1) Doctors are conditioned to not talk about this. To feel shame worrying about their salary and quality of life. How dare we?

2) The absolute number is still "good" compared to the average American.

In the end, we (and our families) sacrificed at least 13 years of our youth to get to this position, to have specialized knowledge to use a dangerous modality to cure cancer. That knowledge/skill/sacrifice has tremendous value to society and should not be forgotten.

Regardless of the absolute number in the setting of average American salaries: Radiation Oncologists in 2022 are facing >50% salary cuts even when NOT adjusting for inflation.

And what has our leadership been doing? Measuring the health of the market based on the unemployment number from a survey of new graduates, completed before they even graduate.

This would be like me measuring how good I was at treating Stage III NSCLC by only recording "deaths while receiving radiation treatment". If someone suggested I get a CT Chest, I would shriek that my on-beam death metric was 0%, how dare they?

These giant economic hits to our specialty have been hidden and labeled "fringe".

To the benefit of academic Chairs everywhere.

 

[TheWallnerus]

In any event it would be counted as an "unemployed radiation oncologist" so I suspect the situation is far worse than it appears.

I am so worried the tipping point is here. Rad onc has been in slow-mo fail mode for 10 plus years. The salve that would have covered all ills would have been having far more jobs than rad oncs nationally (NB: the number of jobs is and always was FAR less modifiable than the number of rad oncs.) We live on the fringe of medicine as it is, and the yearly “new injection” of patients into rad onc has been pretty stagnant the last 10 years too. And by nature of the disease we treat and modality we use, we also have very little repeat business relative to other specialties (even med onc). Now couple in falling fractions, APM, Evicore, consolidation, ever growing rad onc MD numbers… the situation will only appear better than it actually is for a little while longer imho.

 

[medgator]

When radiation oncologists in my area have been displaced, whether due to academic medical center expansion or private equity, I have seen people have taken the following actions in real world experience

1) remained in place taking the worse terms while continuing to look for something better
2) worked for a local hospital
3) worked for a multispecialty group in a different county
4) worked for a local VA
5) locums
6) moved away

7) evilcore, AIM, HealthHell

I've seen #7 quite a bit actually. Work from home, still pull in a 6 figure salary with benefits

 

[TheWallnerus]

7) evilcore, AIM, HealthHell

I've seen #7 quite a bit actually. Work from home, still pull in a 6 figure salary with benefits

Evicore is not the worst gig. Work from home and it’s easy. Can start at 250K a year. You need to be very ready to limit good quality care when necessary (per company guidelines) or you can get fired. But it’s kind of neat that you can go from unemployed on Monday to telling Dan Spratt how to treat prostate cancer on Tuesday.

 

[Mandelin Rain]

I literally can't do anything else, not even in medicine, and not even in oncology. I have come to the conclusion that I need to literally leave my children and get a job someplace else and see them on the weekends and holidays. Now the question is where is this job and is the same thing just going to happen again?

If you're considering rad onc, prepare yourself for this exact reality.

I'm sorry you're experiencing it so acutely. I hazard to say it's persistent anxiety in the back of many/all of our minds even absent an imminent threat to our job. Can't fall back on IM training. Can't hang a shingle. Can't do diagnostics. Can't do much else.

My advice (other than the grin and bear it advice others have given) would be to leave medicine behind to pursue a passion that pays. It certainly won't pay as well and you'll have to modify your lifestyle, but so many fields are having terrible problems attracting reasonable human beings. If you find one you like, you'll rise quickly.

 

[deleted1116990]

My thoughts:

Assuming this is not a troll post, as I have a somewhat hard time believing a 46 year old 15 years into practice could have written this as some of it sounds like it could be coming from a first year resident. however:

- I am assuming you are in a somewhat desirable area (not rural Iowa) and are talking about former compensation in the 700-1M range probably with plentiful days off now cut to about 400k with 4 weeks of PTO.

- This exact scenario happened where I trained. Academic system bought up most of the private practices in town. Existing MDs were brought on as "faculty" at their previous compensation, which was upper 6 figures, some very high producers probably over 1M. Everyone happy for a while. Slowly the new satellite "faculty" are incorporated into the academic machine and have annoying academic tasks added to their plate, defending their work in chart rounds, etc. Main site faculty become jealous due to compensation. There is a change in leadership. Within a couple of years, new leadership presents 25% take it or leave it pay cut and a contract that says your pay can change at any time. Many leave. Many new grads hired. Continue the slow grind of redistributing and smoothing out the outlying high incomes with the goal of everyone having the same contract. Negotiation is simply not possible. If you want to work there, you take what they choose to give you, end of story. Supply and demand makes this possible.

- You can pretty much forget about the idea of flying out to some rural area, working for your previous compensation then flying back home on the weekends. Problems with this:
- Rural hospitals do not want doctors that are trying to do this. They want someone to relocate to their community and work 5 days a week. They will hire locums over people trying to fly in and fly out. There are lots of locums and they WILL staff without you.
- They will not pay you what you were making in PP. You will probably be offered mid 500s and should be able to negotiate it up to mid 600s. Beyond this they are going to whine about Stark law/fair market value and just keep going with locums instead.
- These places are many hours drive from a decent size airport, some many hours drive from any airport, often with only 1 or 2 flights a day that can be very expensive to fly out of. Unless you have a private plane (at which point the cost of commuting would erode whatever extra you are making), the idea of taking a late Sunday flight then flying back after work on Friday is logistically not going to happen. You would have to fly out Saturday, then fly back on Sunday, spending most of your time travelling, all for one Saturday evening a week with your family.
- Your only realistic option if you don't want to move your family but want to make more money is finding a rural hospital within 4-5 hours driving distance of where you live now, convincing them to pay you 700k and give you a 4 day work week. IF you can do this, then the idea of commuting out could possibly work. Good luck.
- Is your standard of living really so high and your savings so low such that you cannot survive on 400k/year or whatever you are being offered? Surely your family is worth more than trying to make sure you are in the top 1% of earners that top 2%? You used the word "desperate." At least you got to experience 15 years of the good life in PP. 400k employment with zero leverage is all many coming out of the pipeline now will ever know.

- Why would any quality med student choose this field when there are a dozen other specialties where you can reliably make over 500k and not have to move your family to rural Iowa if your job sucks? If the academics continue to build a system where income and lifestyle is eroded away, they will end up having the bottom of the class staffing their satellites and creating endless headaches for them.

- Taking a 50% income hit to take a job that ends up having even worse working conditions sucks. I have been there. Look on the bright side, though. You aren't having to move and leave your formerly not-so-terrible life behind to do it and live in conditions comparable to what you had in college like I did. Unless you have huge debt obligations on your mansion, vacation homes, and exotic cars, you can probably stay right were you are and continue to make ends meet. If you do have those things, it's going to be hard to garner sympathy from your new boss about your "desperate" situation.

 

[TheWallnerus]

Why would any quality med student choose this field when there are a dozen other specialties where you can reliably make over 500k and not have to move your family to rural Iowa if your job sucks

This is one of the most interesting questions in medicine right now. There are not many plausible answers

1) The med student has been lied to, did some job research, and because they value the liar so much, believe the liar and disbelieve the “bad info”
2) the med student has done no job research
3) the med student is buoyed by their lifetime of awesome success and decision making and think they can hit a rad onc “inside straight”
4) the med student was born to be a rad onc and has been groomed for this career since infancy
5) the med student can inherit an RT center after residency

 

[deleted1116990]

I am quite honestly a happily married older white Christian man who can work anywhere and would literally take the job in the deep south or rural Midwest if I can then get back to my home/family for weekends or work for weeks or a month or two then be at home for a similar period of time.

Reading the rest of the OP's posts, locums is probably your best bet. Work with an agency and tell them you want to work 2 weeks out of the month. Locums opportunities seem to be a lot better than they were a year ago. No idea how long this will last, but there seem to be lots of gigs and they are paying 2000-2200 instead of 1500-1600 now.

I still struggle to understand how this would be better than whatever your new boss is offering you to stay on and allow you to see your family every night. $2000/day working 26 weeks a year comes out to $260k. Surely they are offering you more than that for full-time work? Nothing surprises me any more though. Specifics would be helpful.

 

[JumpingShip]

“Industry”
“Consulting”
“BioTech”

Buzzwords of non-clinical jobs that are thrown around as an out.

You are entry level (or worse from their perspective). Your knowledge and certification doesn’t get you a $500k compensation. It would take a very long time to approach a median salary. When I spoke the the largest “industry” in our field, the salary was ~$275k with 50% of time on the road.

This works if you’ve never had an RO job before or were associate in a partner track job. Otherwise, the money is just not the reason. A select few will do well and enter leadership and kill it.

You’re probably screwed if you can’t move.

Thank you oversupply and consolidation.

It seems like everybody says/thinks "hey if you burn out in clinical medicine or can't find a job practicing medicine you can just 'go into industry or do consulting'" Then if you ask for details or an example of somebody who has done it, or even how to start the process it's just silence.

I do kind of know or have heard of some who have been successful but (again in my limited experience) they are either extremely senior and already well known people (who are "empty nesters" and furthermore probably could afford to retire at any time) or very young people with a lot of flexibility (a spouse with a far more stable and secure job with full benefits who can support the family on their own if necessary). I'm not sure if most people realize but these jobs require A LOT of travelling. Like the poster above notes literally 50% of the time on the road.

It's just not something that a middle aged family man (who is the only "breadwinner") who lives 90-120 minutes from an airport with limited direct flights can do even if such a position were easy to acquire and even after accepting a 50-75% pay decrease.

 

[medgator]

This is one of the most interesting questions in medicine right now. There are not many plausible answers

1) The med student has been lied to, did some job research, and because they value the liar so much, believe the liar and disbelieve the “bad info”
2) the med student has done no job research
3) the med student is buoyed by their lifetime of awesome success and decision making and think they can hit a rad onc “inside straight”
4) the med student was born to be a rad onc and has been groomed for this career since infancy
5) the med student can inherit an RT center after residency

Med students are smarter than many in academic rad onc are giving them credit for.... Hence those are all rare situations and it should surprise no one outside of the inbred echo chambers at ASTRO that our specialty is a dumpster fire in the match

 

[JumpingShip]

Reading the rest of the OP's posts, locums is probably your best bet. Work with an agency and tell them you want to work 2 weeks out of the month. Locums opportunities seem to be a lot better than they were a year ago. No idea how long this will last, but there seem to be lots of gigs and they are paying 2000-2200 instead of 1500-1600 now.

I still struggle to understand how this would be better than whatever your new boss is offering you to stay on and allow you to see your family every night. $2000/day working 26 weeks a year comes out to $260k. Surely they are offering you more than that for full-time work? Nothing surprises me any more though. Specifics would be helpful.

I'm already very uncomfortable sharing all of this online, even though it is (I sincerely hope) anonymous.

No need for details: if a "small town family man" is considering (and at this point planning) on "doing locums" anywhere else in the country vs accepting the current terms in his home town and where he has happily worked for all these years then the current terms must really be that bad...

 

[JumpingShip]

Evicore is not the worst gig. Work from home and it’s easy. Can start at 250K a year. You need to be very ready to limit good quality care when necessary (per company guidelines) or you can get fired. But it’s kind of neat that you can go from unemployed on Monday to telling Dan Spratt how to treat prostate cancer on Tuesday.

I'm not sure that even these Evicore jobs (at least for full time and steady and certainly long term employment) are that easy to acquire.

I have to admit that I've actually "interacted" with some very reasonable Evicore "peers" and sure there are some wild treatments being offered by a small minority of MD's for whom this process actually benefits all. However, like I'm sure everybody else, I've had very reasonable and even what I would consider standard of care plans/treatments denied for no reason.

 

[deleted1116990]

4) the med student was born to be a rad onc and has been groomed for this career since infancy
5) the med student can inherit an RT center after residency

These situations are actually not so rare. I would bet all of us know at least one or two people like this -- totally oblivious -- Job market? Huh, what's that? However, certainly not enough to fill 200 spots a year.

I'm already very uncomfortable sharing all of this online, even though it is (I sincerely hope) anonymous.

No need for details: if a "small town family man" is considering (and at this point planning) on "doing locums" anywhere else in the country vs accepting the current terms in his home town and where he has happily worked for all these years then the current terms must really be that bad...

Don't worry. There are probably at least 30 other people reading this thinking "Oh crap, I hope my chairman doesn't think I posted this"! It sounds like the terms involve more than just a massive pay cut. No mechanism for time off and making you drive hours to cover multiple satellites at your own expense likely. Genuinely curious what other evil things they could have come up with to push you out.

 

[DoctwoB]

Just replying to give my sympathies. It’s a terrible situation to be in. To those replying that 3 or 400k is still good income; it is. But when you are coming from making twice that it may mean downsizing the house, pulling kids out of private school, etc that is a quite bitter pill to swallow.

If it is at all possible to fight it by forming a freestanding center (depending on referral base, CON, non-compete issues, etc) then I would absolutely do it. Even the threat of it may garner you far more favorable terms, but if you threaten it you also need to be prepared to follow through meaning having done the legwork.

 

[JumpingShip]

My thoughts:

Assuming this is not a troll post, as I have a somewhat hard time believing a 46 year old 15 years into practice could have written this as some of it sounds like it could be coming from a first year resident. however:

- I am assuming you are in a somewhat desirable area (not rural Iowa) and are talking about former compensation in the 700-1M range probably with plentiful days off now cut to about 400k with 4 weeks of PTO.

- This exact scenario happened where I trained. Academic system bought up most of the private practices in town. Existing MDs were brought on as "faculty" at their previous compensation, which was upper 6 figures, some very high producers probably over 1M. Everyone happy for a while. Slowly the new satellite "faculty" are incorporated into the academic machine and have annoying academic tasks added to their plate, defending their work in chart rounds, etc. Main site faculty become jealous due to compensation. There is a change in leadership. Within a couple of years, new leadership presents 25% take it or leave it pay cut and a contract that says your pay can change at any time. Many leave. Many new grads hired. Continue the slow grind of redistributing and smoothing out the outlying high incomes with the goal of everyone having the same contract. Negotiation is simply not possible. If you want to work there, you take what they choose to give you, end of story. Supply and demand makes this possible.

- You can pretty much forget about the idea of flying out to some rural area, working for your previous compensation then flying back home on the weekends. Problems with this:
- Rural hospitals do not want doctors that are trying to do this. They want someone to relocate to their community and work 5 days a week. They will hire locums over people trying to fly in and fly out. There are lots of locums and they WILL staff without you.
- They will not pay you what you were making in PP. You will probably be offered mid 500s and should be able to negotiate it up to mid 600s. Beyond this they are going to whine about Stark law/fair market value and just keep going with locums instead.
- These places are many hours drive from a decent size airport, some many hours drive from any airport, often with only 1 or 2 flights a day that can be very expensive to fly out of. Unless you have a private plane (at which point the cost of commuting would erode whatever extra you are making), the idea of taking a late Sunday flight then flying back after work on Friday is logistically not going to happen. You would have to fly out Saturday, then fly back on Sunday, spending most of your time travelling, all for one Saturday evening a week with your family.
- Your only realistic option if you don't want to move your family but want to make more money is finding a rural hospital within 4-5 hours driving distance of where you live now, convincing them to pay you 700k and give you a 4 day work week. IF you can do this, then the idea of commuting out could possibly work. Good luck.
- Is your standard of living really so high and your savings so low such that you cannot survive on 400k/year or whatever you are being offered? Surely your family is worth more than trying to make sure you are in the top 1% of earners that top 2%? You used the word "desperate." At least you got to experience 15 years of the good life in PP. 400k employment with zero leverage is all many coming out of the pipeline now will ever know.

- Why would any quality med student choose this field when there are a dozen other specialties where you can reliably make over 500k and not have to move your family to rural Iowa if your job sucks? If the academics continue to build a system where income and lifestyle is eroded away, they will end up having the bottom of the class staffing their satellites and creating endless headaches for them.

- Taking a 50% income hit to take a job that ends up having even worse working conditions sucks. I have been there. Look on the bright side, though. You aren't having to move and leave your formerly not-so-terrible life behind to do it and live in conditions comparable to what you had in college like I did. Unless you have huge debt obligations on your mansion, vacation homes, and exotic cars, you can probably stay right were you are and continue to make ends meet. If you do have those things, it's going to be hard to garner sympathy from your new boss about your "desperate" situation.

I'm not sure why anybody would go through the trouble of making an account and spending all this time posting on such a specific topic on a specific forum but there's obviously a lot of weird and bored people and stuff online.

As I kind of outlined, the timeline, it comes on kind of insidiously over several years and human nature is one of optimism and "that can't happen to me" but at some point one has to either be later in his career and figure "wow this is getting worse and worse every year but it's still not that bad and I'm just going to retire in 3-4 years anyway" or "sure I could do this but not for the rest of my career, I need a long term plan." As recently as 1-2 years ago I had just accepted that life is getting harder for everybody, the days of making a fortune in radiation oncology with a great lifestyle are long, long gone and every coming back, I will readily admit that I made (I would argue "earned") an exceptional income for well over a decade (that furthermore correlated with a never again bull market) and therefore even taking a reasonable decrease in compensation and increase in work every year for the rest of my career wouldn't be that bad.

Actually, if somebody offered me a 10 year contract at the exact terms of last year I would honestly sign on the dotted line in two seconds. It's just that it's so obvious that every year it is going to get so much worse at the same time that alternatives are drying up so I need to make a move now to "get ahead" of others in my same position, which I assume is increasingly common.

Also realize that as recently as a few years ago locums was obviously not a long-term plan but it was readily available at a very good pay as a "safety net." I know plenty of people who literally celebrated Thanksgiving or Christmas the week before or after with their family so they could make 2-4 times their weekly salary just last minute babysitting a practice during holidays. Now I fee like the safety nets are becoming more and more difficult to find with more people looking so need to get a head start and position myself before those too are gone.

Overall I think this post above is by far the best advise, which make sense since this individual appears to have first or at least second hand experiences with this exact situation.

 

[JumpingShip]

Just replying to give my sympathies. It’s a terrible situation to be in. To those replying that 3 or 400k is still good income; it is. But when you are coming from making twice that it may mean downsizing the house, pulling kids out of private school, etc that is a quite bitter pill to swallow.

Not just that but more so it's inevitable that even that 300-400 is only going to be around for so much longer, at least here, I'm still hardly mid-career, so don't be the "frog in the slowly boiling pot" especially after you not only noticed but now feel the uncomfortable heat and realize it's just being turned up at an increasing rate.

The one specific issue I will highlight is that once a practice is acquired and you become employed by the "network" then you are thrown into the "coverage pool" and required to cover the other sites as well. They may "only" be 30-90 minutes in any direction from the main center but that means they can be twice that distance from one another. I'm not sure how it is everywhere, but there might be a group of "main site" MD's and another group of "satellite/network MD's" and they are I guess in the same department and there might even be an "academic title" of "instructor" or "clinical associate professor" but have totally different coverage and other clinical responsibilities.

 

[deleted1116990]

The one specific issue I will highlight is that once a practice is acquired and you become employed by the "network" then you are thrown into the "coverage pool" and required to cover the other sites as well. They may "only" be 30-90 minutes in any direction from the main center but that means they can be twice that distance from one another. I'm not sure how it is everywhere, but there might be a group of "main site" MD's and another group of "satellite/network MD's" and they are I guess in the same department and there might even be an "academic title" of "instructor" or "clinical associate professor" but have totally different coverage and other clinical responsibilities.

Called it! They want you to be a float rad onc. This seems to be a relatively recent creation and is the worst job in the whole system. You will be underpaid compared to a locums, but actually have to plan and treat your own patients, not just cover like a locums, in addition to getting pulled anywhere for sick/PTO coverage, and get the privilege of putting 20k miles a year on your car with $6/gal fuel you can't expense. This would be a hard pass for anybody interviewing but the chair thinks he can force an employee he inherited (and thus doesn't care if he loses) into it because you have no other option being established in the community.

Sucks man, I'm sorry.

 

[JumpingShip]

Just replying to give my sympathies. It’s a terrible situation to be in. To those replying that 3 or 400k is still good income; it is. But when you are coming from making twice that it may mean downsizing the house, pulling kids out of private school, etc that is a quite bitter pill to swallow.

If it is at all possible to fight it by forming a freestanding center (depending on referral base, CON, non-compete issues, etc) then I would absolutely do it. Even the threat of it may garner you far more favorable terms, but if you threaten it you also need to be prepared to follow through meaning having done the legwork.

One last post: several have suggested trying to start a new freestanding center. Even if non-competes, CON, or financial constraints were not an issue, how would one do this with no referral base? They aren't stupid, it's not like they just randomly one day decided to target us and see what happens . . . the first step, which occurred years ago, was acquiring the primary care offices and medical oncologists. Sure there are some private urologists, pulm, etc but that's not enough to sustain a practice and as far as I know (actually I'm quite sure of it) most are already in the process of being acquired themselves. Even if not, as one poster pointed out "there is no such thing as an exceptional radiation oncologist" I will admit. I might be well liked and have provided excellent patient care with a strong referral base but is it really worth it for a referring provider to "rock the boat" or deal with even a little sticking his neck out there to help me when he can just refer to the new guy who takes my job (who admittedly might not be experienced but was probably top of his class since high school and actually very well trained)?

 

[TheWallnerus]

Called it! They want you to be a float rad onc. This seems to be a relatively recent creation and is the worst job in the whole system. You will be underpaid compared to a locums, but actually have to plan and treat your own patients, not just cover like a locums, in addition to getting pulled anywhere for sick/PTO coverage, and get the privilege of putting 20k miles a year on your car with $6/gal fuel you can't expense. This would be a hard pass for anybody interviewing but the chair thinks he can force an employee he inherited (and thus doesn't care if he loses) into it because you have no other option being established in the community.

Sucks man, I'm sorry.

Prereq’s for a rad onc (or Doordash) job these days:
Active drivers license
Auto insurance
Car in good working condition

This driving hither thither and yon BS has gotta stop. Go with modern, legal supervision rules already, people.

 

[JumpingShip]

Called it! They want you to be a float rad onc. This seems to be a relatively recent creation and is the worst job in the whole system. You will be underpaid compared to a locums, but actually have to plan and treat your own patients, not just cover like a locums, in addition to getting pulled anywhere for sick/PTO coverage, and get the privilege of putting 20k miles a year on your car with $6/gal fuel you can't expense. This would be a hard pass for anybody interviewing but the chair thinks he can force an employee he inherited (and thus doesn't care if he loses) into it because you have no other option being established in the community.

Sucks man, I'm sorry.

Ok I am way past the point of how comfortable I am sharing my experience but yes this is the biggest issue.

The people at the "big house" don't seem to understand that 45 minutes (actually it's probably over an hour but they've never actually been to those centers) becomes over two hours when one is going from one side to the other. It's somehow fair to make the guy who lives an hour in one direction cover the site in the other direction (two hours away for him) instead of one of the guys who is central, since he's in the "regional coverage pool" not the "academic faculty."

For me it's not the driving time and cost so much as when I cover the other sites it's not like a locums where you show up, do your best, then leave and your done. I'm responsible for everything as if I work there (including signing plans for things that due to unique referral patterns or quite frankly differences in technology since I graduated I'm not familiar with or comfortable doing) AND then getting called by the staff literally weeks later to follow-up or plan for a patient I randomly saw one day.

I'd rather take a huge pay cut and sleep well at night knowing that I provided the best patient care I could (I know everybody looks down on locums but in many situations they are actually providing a huge service to that community who desperately needs them) vs take a more moderate pay cut and run around all over staying up all night horrified that I despite my best efforts and experience I messed something up on a patient I hardly saw one day for a disease site or more likely treatment modality that I'm very far from an expert in and certainly never trained in to proficiency. Even that would just be temporary so what's the point in just delaying the inevitable and trying now to find a long term solution while even those are drying up.

 

[deleted1116990]

Ok I am way past the point of how comfortable I am sharing my experience but yes this is the biggest issue.

The people at the "big house" don't seem to understand that 45 minutes (actually it's probably over an hour but they've never actually been to those centers) becomes over two hours when one is going from one side to the other. It's somehow fair to make the guy who lives an hour in one direction cover the site in the other direction (two hours away for him) instead of one of the guys who is central, since he's in the "regional coverage pool" not the "academic faculty."

For me it's not the driving time and cost so much as when I cover the other sites it's not like a locums where you show up, do your best, then leave and your done. I'm responsible for everything as if I work there (including signing plans for things that due to unique referral patterns or quite frankly differences in technology since I graduated I'm not familiar with or comfortable doing) AND then getting called by the staff literally weeks later to follow-up or plan for a patient I randomly saw one day.

I'd rather take a huge pay cut and sleep well at night knowing that I provided the best patient care I could (I know everybody looks down on locums but in many situations they are actually providing a huge service to that community who desperately needs them) vs take a more moderate pay cut and run around all over staying up all night horrified that I despite my best efforts and experience I messed something up on a patient I hardly saw one day for a disease site or more likely treatment modality that I'm very far from an expert in and certainly never trained in to proficiency. Even that would just be temporary so what's the point in just delaying the inevitable and trying now to find a long term solution while even those are drying up.

It's really a slap in the face, isn't it? Your job is to make the other more valuable MD's lives more tolerable so they can stay at the main site and not have to cover and of course funnel income back into the system. Locums expense just to cover, forget about treating patient from consult to EOT, would be $600k minimum to the system. They want you to do far more than that for significantly less and act like driving 1-2 hours a day and not always being on site for your patients is not a big deal. Of course, none of this would be a problem if the system would just pay a rad onc $700k to live at the rural satellite and staff it full time. Instead they bend themselves into pretzels to save some money and get everybody all worked up about who is going to cover satellite X this week.

Again, don't worry, this is happening all over the place.

 

[Gfunk6]

JumpingShip,

First off, you have my sympathies for what you are going through.

Second, I echo the notion that getting jobs outside of clinical Rad Onc is very, very hard. Recruiters who don't know the difference between a Rad Onc and Med Onc will harass you continually for pharma jobs and you may even get to the interview process until someone wakes up and realizes that you are not a Med Onc. These guys are looking for people with experience with pharma clinical trials, federal regulations, and deep medical oncology experience - none of which we have.

Third, although you are acutely in this bad situation - I honestly feel that many/most of us are a few years away from where you are. The endless encroachment of academic/big hospitals into niches formerly occupied by private practice Rad Onc is inexorable. I would recommend that everyone seriously consider what their "exit strategy" from this field is going to be. There are way too many new grads coming out - someone is going to be unemployed.

Fourth, the only useful advice I can give you is to echo what others have said - pick up and move. That is obviously easier said than done but I think long-term you would be happier in a stable working environment rather than the bleakness of a locums position going from one cesspool to another.

 

[jondunn]

I make 900-1 mill yearly but live like I make much less.

I’ve posted again and again about how it’s only a matter of time until my community shop gets taken over, like every community shop should expect. The location is prime for takeover

As an aside - if I lived in Austin Texas, I would consider my time limited. You WILL be taken over

As they say in the departed - ‘we’re all on our way out. Act accordingly’


I’m on the lookout for a good private group PSA setup with a major hospital - that’s the best long term setup IMO

 

[JumpingShip]

JumpingShip,

First off, you have my sympathies for what you are going through.

Second, I echo the notion that getting jobs outside of clinical Rad Onc is very, very hard. Recruiters who don't know the difference between a Rad Onc and Med Onc will harass you continually for pharma jobs and you may even get to the interview process until someone wakes up and realizes that you are not a Med Onc. These guys are looking for people with experience with pharma clinical trials, federal regulations, and deep medical oncology experience - none of which we have.

Third, although you are acutely in this bad situation - I honestly feel that many/most of us are a few years away from where you are. The endless encroachment of academic/big hospitals into niches formerly occupied by private practice Rad Onc is inexorable. I would recommend that everyone seriously consider what their "exit strategy" from this field is going to be. There are way too many new grads coming out - someone is going to be unemployed.

Fourth, the only useful advice I can give you is to echo what others have said - pick up and move. That is obviously easier said than done but I think long-term you would be happier in a stable working environment rather than the bleakness of a locums position going from one cesspool to another.

first: thanks
second: exactly!!! That exact situation happened to me!
third: I think this is a very smart idea, but now do you see why I'm trying to make my moves now? Even though things are tolerable I don't know what I fear more in the coming years: the 200 new desperate graduates every year or the (insert your best guess) established radiation oncologists who appear to be doing fine and happy now that will be trying to leave their positions and entering the same shrinking labor market. I want to at least get a head start!
fourth: I just don't think I can do that for personal reasons, at least until my kids are out of the house and parents don't need supervision, but you might be right. Especially since at that point even though it's 4-5 years from now nothing might be left.

 

[deleted1116990]

I’m on the lookout for a good private group PSA setup with a major hospital - that’s the best long term setup IMO

Unless you are in one of the 3 or 4 states that protects these groups by prohibiting direct employment or it's an extremely large group, I would not be so confident. The small groups and independent rad oncs are dropping like flies as hospitals cut their contracts and employee directly. I interviewed for a job with a group like this only to find out the job no longer existed, but a new job popped up advertised as a hospital employee.

 

[jondunn]

Unless you are in one of the 3 or 4 states that protects these groups by prohibiting direct employment or it's an extremely large group, I would not be so confident. The small groups and independent rad oncs are dropping like flies as hospitals cut their contracts and employee directly. I interviewed for a job with a group like this only to find out the job no longer existed, but a new job popped up advertised as a hospital employee.

In my experience - it’s easier said than done to turn a group of 5 rad oncs who are independent into employees Over night. Even if the hospital wants to, they can’t easily replace 5 rad oncs with a snap of The finger

It is of course an ever present existential threat though

 

[medgator]

I make 900-1 mill yearly but live like I make much less.

I’ve posted again and again about how it’s only a matter of time until my community shop gets taken over, like every community shop should expect. The location is prime for takeover

As an aside - if I lived in Austin Texas, I would consider my time limited. You WILL be taken over

Not bad less than three years out from training... How did you swing that?

As an aside, probably should keep the job location jelly to yourself

 

[deleted1116990]

In my experience - it’s easier said than done to turn a group of 5 rad oncs who are independent into employees Over night. Even if the hospital wants to, they can’t easily replace 5 rad oncs with a snap of The finger

It is of course an ever present existential threat though

Not overnight. One by one, the hospitals they cover cut their contracts and hire directly. Seen it.
The best bet, besides ownership in a single specialty practice in a rural area with no competition, is probably employed for a stable independent hospital also in a difficult-to-recruit area. That should be relatively safe for a while.

OP can also try making buddies with the local urologist and convince them to buy a machine if in a non-CON state. Would be a good way to not have to move and fight back.

 

[JumpingShip]

It's really a slap in the face, isn't it? Your job is to make the other more valuable MD's lives more tolerable so they can stay at the main site and not have to cover and of course funnel income back into the system. Locums expense just to cover, forget about treating patient from consult to EOT, would be $600k minimum to the system. They want you to do far more than that for significantly less and act like driving 1-2 hours a day and not always being on site for your patients is not a big deal. Of course, none of this would be a problem if the system would just pay a rad onc $700k to live at the rural satellite and staff it full time. Instead they bend themselves into pretzels to save some money and get everybody all worked up about who is going to cover satellite X this week.

Again, don't worry, this is happening all over the place.

I'm way, way past the point of worrying about pride. And no it wouldn't require $700,000 . . . at this point I'd accept half that and they could slap me in the face from time to time, especially if the coverage were fair and occasional and to help somebody who really needed to take a sudden day off for a family emergency or illness but most importantly safe.

As I summarized above, my problem isn't even the pay or driving or getting an email at 6am saying that my clinic patients for that day have been rescheduled and double booked for later in the week while I have been re-assigned to cover a practice two hours away.

It's just a totally different situation to cover as locums where the practicing MD has planned a vacation and done his best to take care of whatever he can before and after and the expectation is that I will hold down the clinic and of course see patients if necessary. These centers are usually very similar to mine and I'm very comfortable seeing patients. In the current situation the coverage is usually instant and due to an unforeseen issue, so I'm expected to just show up and not cover but take the place of the person who is out. Sure I'm not even mid career but I graduated from residency about 15 years ago (stop and think how much SRS/SBRT has changed in even the past 5-7 years).

I cannot in good conscience start signing plans for very complicated SRS/SBRT cases and even doing procedures that I haven't done in years (or literally ever on my own) but that is the expectation. The craziest thing is that I am expected to drive two hours to do something I am obviously not comfortable doing while an expert who travels all over the world lecturing about that exact treatment who is 30 minutes away is not!

 

[deleted1116990]

I cannot in good conscience start signing plans for very complicated SRS/SBRT cases and even doing procedures that I haven't done in years (or literally ever on my own) but that is the expectation. The craziest thing is that I am expected to drive two hours to do something I am obviously not comfortable doing while an expert who travels all over the world lecturing about that exact treatment who is 30 minutes away is not!

I've never seen this personally, but I have heard stories of people in situations like yours where they are expected to finish head and neck contours and stuff for a doctor that went on vacation or a conference in China or something for 3 weeks. I cannot even fathom leaving a treatment plan for someone else to approve, let alone finish my contours on. It's astonishing that academic centers, which purport to be centers of excellence with superior treatment planning and delivery compared to community centers, allow this as if it's totally normal. Good for you for taking a stand on it. You gotta take care of your family number one, but otherwise that's certainly a hill worth dying on.

 

[jondunn]

I'm way, way past the point of worrying about pride. And no it wouldn't require $700,000 . . . at this point I'd accept half that and they could slap me in the face from time to time, especially if the coverage were fair and occasional and to help somebody who really needed to take a sudden day off for a family emergency or illness but most importantly safe.

As I summarized above, my problem isn't even the pay or driving or getting an email at 6am saying that my clinic patients for that day have been rescheduled and double booked for later in the week while I have been re-assigned to cover a practice two hours away.

It's just a totally different situation to cover as locums where the practicing MD has planned a vacation and done his best to take care of whatever he can before and after and the expectation is that I will hold down the clinic and of course see patients if necessary. These centers are usually very similar to mine and I'm very comfortable seeing patients. In the current situation the coverage is usually instant and due to an unforeseen issue, so I'm expected to just show up and not cover but take the place of the person who is out. Sure I'm not even mid career but I graduated from residency about 15 years ago (stop and think how much SRS/SBRT has changed in even the past 5-7 years).

I cannot in good conscience start signing plans for very complicated SRS/SBRT cases and even doing procedures that I haven't done in years (or literally ever on my own) but that is the expectation. The craziest thing is that I am expected to drive two hours to do something I am obviously not comfortable doing while an expert who travels all over the world lecturing about that exact treatment who is 30 minutes away is not!

honest advicee then - if it's not about the money or the driving - then ask more questions and get into the nitty gritty of what you would have to do. I think perhaps you may be worried about worst case scenarios in terms of being asked to contour a case you never knew anything about in a short amount of time. that may not be what youll have to do

can you ask around to the other regional docs in that network?

 

[JumpingShip]

I've never seen this personally, but I have heard stories of people in situations like yours where they are expected to finish head and neck contours and stuff for a doctor that went on vacation or a conference in China or something for 3 weeks. I cannot even fathom leaving a treatment plan for someone else to approve, let alone finish my contours on. It's astonishing that academic centers, which purport to be centers of excellence with superior treatment planning and delivery compared to community centers, allow this as if it's totally normal. Good for you for taking a stand on it. You gotta take care of your family number one, but otherwise that's certainly a hill worth dying on.

I have definitely NOT been in that situation, and I agree that would be unacceptable since nobody drops everything to go to a conference or China at the last minute. But what does happen is the relatively new MD who works as a highly specialized MD at the academic center part time and then part time at the center 45 minutes away in a more "general practice" (which appears to be the model for new "academic" radiation oncologists) instead of referring complex cases to the main academic center naturally just treats the complex patients within her own sub-specialty herself at the satellite center (makes sense . . . as long as the technology is available why essentially refer to oneself at the main center). This actually sounds great to everybody since it allows that person to build a practice and now those services are available closer to home for the patients.

The problem is when that person has to suddenly take time off (family emergency, baby came early, and of course covid)? The center is covered by the "generalists" who work at the "satellite/regional network" but a lot of her practice at the regional site is actually highly specialized and not something any of us have ever done or are comfortable with doing. Sure those events are rare for an individual, but keep in mind that there are more than a few satellite centers and each one may offer a different specialty service depending on the technology and whatever the part time main center/part time satellite center MD's particularly specialty may be.

Of course it would make sense for her counterpart at the mother ship to cover those cases at least, which is what she does all day everyday at the main site and travels the world lecturing about, but she can't be bothered to leave her nice full time, full resident coverage site and drive 45 minutes even for emergency coverage for the specialty service of which she is an expert specialist! Then I look like I'm lazy or stupid since I'm an MD who has been practicing for 15 years but can't even cover the clinic of a 35 year old five years out.

I've long ago accepted the decreased pay, increased administrative hurdles and other things the new center now requires, and even that I'm one of the "internal locums" for all of the sites all over the place literally hours and hours and hundreds of miles apart. I couldn't have asked for a more perfect job in all regards for the first 10 maybe even 12 years of my career and I can deal with the changes, not sure about for the next 15 or even 10 years but definitely for awhile, but the above situation is just not something I can in good conscious sign off on and this is just one particular example (there are many more and they just keep coming!)

Ok, I have shared way too much and I think I've made it clear what the problem is, but I also gained a lot from this thread. I'm a very private person and definitely not from the social media/post everything online generation. I'm also getting increasingly depressed and vicariously full of anxiety and nausea imaging what it must be like for those who didn't get the greater than 10-12 years of very high income and job satisfaction that I did in this amazing field and heaven help the current residents and my God the medical students who currently applying.

 

[theradiator]

One word of general advice. If some type of administrative policy seems wrong, don't assume that it is malice. Sheer incompetence is perhaps more likely in the differential diagnosis because after all, the decision makers are not affected by their decisions. They are too busy counting their money. Plus in this scenario, it sounds like the regional network expanded rapidly thus not a well oiled machine.

 

[RadOncDoc21]

This thread is sad for many reasons but selfishly because I’ve experienced this myself but decided to move and switch positions before they had the chance to proceed with their plan. This is a legit concern in our field which it seems is becoming more common.