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

[BobbyHeenan]

Tripping balls > shrinking balls

It’s happening. The one time he listens to
SDN.

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[Old rad onc]

I have to admit that I never considered retraining because I quite honestly thought that at my age I couldn't tolerate 2-4 years of a grueling residency, but I didn't realize that palliative care is relatively short and not like that at all. Plus we obviously have a lot of experience with many aspects. Perhaps best of all for those of us with families who need structure and at least a reasonable ability to plan, it's well defined: find a program, apply, these are the dates of training, this is when you'll graduate.

I am sure that there are other "ways out" but it takes a certain personality (which I will admit I don't have) to first become a colorectal surgeon then in ones 50's earn a JD and start a second career in a law firm in NJ!

Thanks you all for the recommendations. I am going to look through and hopefully engage in the Facebook and other online groups that were recommended above while thinking more seriously about a palliative care fellowship.

I had a situation similar to yours 20 years ago and started my own practice and here is how and why you do it……. I was 6 years into practice after being promised 3 years to partnership. You have been in practice 15 years so you know many of the referring docs: med oncs, urologists, ent, Derm , GI, pulmonary, general surgeons, primary care docs, other rad oncs. By 6years I had gotten to know a lot of the docs and polled them. They all agreed I was getting screwed and would help if I started my own center. Problem is it takes 2 years to build. I was 40 and looked for other jobs. Some close some far. But same problem…. Old guys who wanted 4-5 years to partnership. I realized I would likely never get a good partnership . So I risked all and started my own. It’s not easy but if you have truth in being well liked you will make it as long as you have some independent docs. You must think outside the box. I have had 20-25 patients as a solo rad Onc and have an interesting mix of referrers and insurances. I would actually thank the guy screwing me for forcing me into an ideal situation in a very good location . So my advice is do locums to survive while you build a center and thrive. But I warn you it’s not for anyone who is not brave and willing to take a risk. But after 15 years serving a community it’s worth a shot.

A restrictive covenant will only hold if you were a partner or got paid something to sign the agreement…. I am in a state that others have said you cannot build unless you have ……1,2,3and 4. I was able to but maybe the laws have changed . I don’t know. I believe I will be able to sell my practice some day but I won’t regret it even if it becomes worthless. You only go around once in life and after 15 years of liking an area don’t give up just yet. Contact me if you want any help or advice.

I’m not saying absolutely do it, but at least look at it. I get vacation and days off through hiring locums myself.

 

[elementaryschooleconomics]

I had a situation similar to yours 20 years ago and started my own practice and here is how and why you do it……. I was 6 years into practice after being promised 3 years to partnership. You have been in practice 15 years so you know many of the referring docs: med oncs, urologists, ent, Derm , GI, pulmonary, general surgeons, primary care docs, other rad oncs. By 6years I had gotten to know a lot of the docs and polled them. They all agreed I was getting screwed and would help if I started my own center. Problem is it takes 2 years to build. I was 40 and looked for other jobs. Some close some far. But same problem…. Old guys who wanted 4-5 years to partnership. I realized I would likely never get a good partnership . So I risked all and started my own. It’s not easy but if you have truth in being well liked you will make it as long as you have some independent docs. You must think outside the box. I have had 20-25 patients as a solo rad Onc and have an interesting mix of referrers and insurances. I would actually thank the guy screwing me for forcing me into an ideal situation in a very good location . So my advice is do locums to survive while you build a center and thrive. But I warn you it’s not for anyone who is not brave and willing to take a risk. But after 15 years serving a community it’s worth a shot.

A restrictive covenant will only hold if you were a partner or got paid something to sign the agreement…. I am in a state that others have said you cannot build unless you have ……1,2,3and 4. I was able to but maybe the laws have changed . I don’t know. I believe I will be able to sell my practice some day but I won’t regret it even if it becomes worthless. You only go around once in life and after 15 years of liking an area don’t give up just yet. Contact me if you want any help or advice.

I’m not saying absolutely do it, but at least look at it. I get vacation and days off through hiring locums myself.

God, I respect this so much.

 

[medgator]

God, I respect this so much.

Reimbursement what it was back then made this way more tenable in the 90s-00s. With freestanding/Medicare PFS reimbursement the way it is now compared to hospitals or PPS exempt, i wouldn't venture it unless i could immediately have 18-20 under tx the day i opened

 

[TheWallnerus]

Reimbursement what it was back then made this way more tenable in the 90s-00s. With freestanding/Medicare PFS reimbursement the way it is now compared to hospitals or PPS exempt, i wouldn't venture it unless i could immediately have 18-20 under tx the day i opened

The profit margin in rad onc in the 2001-10 time frame was insane. Without paying the MDs, perhaps only 20 to 30% of revenue at 20/day under treatment would have to go to overhead. Large freestanding centers could have easily supported labs and researchers they were raking in so much dough.

 

[medgator]

The profit margin in rad onc in the 2001-10 time frame was insane. Without paying the MDs, perhaps only 20 to 30% of revenue at 20/day under treatment would have to go to overhead. Large freestanding centers could have easily supported labs and researchers they were raking in so much dough.

Once the IMRT code reached a billion in billing for Medicare and made it visible to Congressional scrutiny, the punch bowl started to be drained each year

 

[RickyScott]

Owning your own linac is just not feasible where referrings are part of large groups/systems.

 

[Neuronix]

A restrictive covenant will only hold if you were a partner or got paid something to sign the agreement….

This is state dependent.

I have been counseled by a labor attorney in my state that the large area and time non-competes that all jobs in my state require are enforceable.

 

[elementaryschooleconomics]

This is state dependent.

I have been counseled by a labor attorney in my state that the large area and time non-competes that all jobs in my state require are enforceable.

Same with my state.

But come on, we live in America. Whether or not something in a contract is "enforceable" is only a matter of money, lawyers, and friends.

 

[RickyScott]

Same with my state.

But come on, we live in America. Whether or not something in a contract is "enforceable" is only a matter of money, lawyers, and friends.

I heard from a colleague that Baptist hospital in Miami is making their physicists sign non competes!

 

[elementaryschooleconomics]

Owning your own linac is just not feasible where referrings are part of large groups/systems.

I'm curious to hear what others are observing regarding networks:

For me, I'm in a non-metropolitan region of the country. While definitely not at the level of "middle of nowhere Kansas" rural, looking at 2020 Census data, a significant portion of my surrounding geography is officially defined as "rural". The Census Interactive Maps are fun!

Anyway, against all odds, there have been community, non-affiliated hospitals which have managed to survive for many years out here. These are hospitals that are not in academic health systems and don't have "franchise" branding either (like whenever some place 1,000 miles from Texas flies the MD Anderson flag).

Until recently. Talking to colleagues in hospitals for a few hours in each direction, it seems like every 5 years there are "big" affiliation changes. It seems to have started around 2010, then a second wave around 2015, and then a third wave around now (started a little before COVID hit). The hospital I primarily staff was one of the last "hold outs", and even we have fallen into some weird regional academic health system. As far as I can tell, it's mostly just in name at the moment, even though the "deal" was inked perhaps two years ago.

As an aside, I can't figure out what they're doing with this. I was talking with some of the C-suite guys and asked if we were using our new alliance to negotiate better insurance contracts. Most of them seem to be planning their retirements and running out the clock, and questions of this nature are met with some shrugs and vague "eventually, we'll see". But they definitely spend a lot of time on branding and graphic design! I'm told that maybe, sometime in the next 5 years, maybe we'll all use the same EMR. Maybe.

But, with the formation of this new system I am told I am a part of, I honestly can only think of one hospital within 1-2 hours of me that is "independent" and also has an Oncologist. However, that hospital is 60-90 minutes away, I only know about it because it's in a vacation area my patients go to, and it might already be a part of a network and I just haven't checked.

Even if I could get out of my non-compete, get capital for a linac/freestanding center, get the CON approved by the state...I don't know where my patients would come from, because there are no doctors around me who aren't already in systems with their own Radiation Oncologists.

 

[JumpingShip]

“Even if I could get out of my non-compete, get capital for a linac/freestanding center, get the CON approved by the state...I don't know where my patients would come from”

This sums it up perfectly … this was a systematic effort of first acquiring the PCP’s, then specialists (most relevant to me medical oncologists but also others), so they “own” the entire referral base.

 

[RadRadRad]

I heard from a colleague that Baptist hospital in Miami is making their physicists sign non competes!

Hard to believe
The physics market is so skewed in favor of the physicist they’d be crazy to sign a non compete. Can’t imagine the employers have leverage for this….maybe I’m underestimating draw of south beach

 

[jondunn]

“Even if I could get out of my non-compete, get capital for a linac/freestanding center, get the CON approved by the state...I don't know where my patients would come from”

This sums it up perfectly … this was a systematic effort of first acquiring the PCP’s, then specialists (most relevant to me medical oncologists but also others), so they “own” the entire referral base.

‘first you get the PCPs then you get the money’

 

[seper]

once in a while, a RadOnc tries to ignore non-compete in the area where I’m working. they always lose

 

[Old rad onc]

I'm curious to hear what others are observing regarding networks:

For me, I'm in a non-metropolitan region of the country. While definitely not at the level of "middle of nowhere Kansas" rural, looking at 2020 Census data, a significant portion of my surrounding geography is officially defined as "rural". The Census Interactive Maps are fun!

Anyway, against all odds, there have been community, non-affiliated hospitals which have managed to survive for many years out here. These are hospitals that are not in academic health systems and don't have "franchise" branding either (like whenever some place 1,000 miles from Texas flies the MD Anderson flag).

Until recently. Talking to colleagues in hospitals for a few hours in each direction, it seems like every 5 years there are "big" affiliation changes. It seems to have started around 2010, then a second wave around 2015, and then a third wave around now (started a little before COVID hit). The hospital I primarily staff was one of the last "hold outs", and even we have fallen into some weird regional academic health system. As far as I can tell, it's mostly just in name at the moment, even though the "deal" was inked perhaps two years ago.

As an aside, I can't figure out what they're doing with this. I was talking with some of the C-suite guys and asked if we were using our new alliance to negotiate better insurance contracts. Most of them seem to be planning their retirements and running out the clock, and questions of this nature are met with some shrugs and vague "eventually, we'll see". But they definitely spend a lot of time on branding and graphic design! I'm told that maybe, sometime in the next 5 years, maybe we'll all use the same EMR. Maybe.

But, with the formation of this new system I am told I am a part of, I honestly can only think of one hospital within 1-2 hours of me that is "independent" and also has an Oncologist. However, that hospital is 60-90 minutes away, I only know about it because it's in a vacation area my patients go to, and it might already be a part of a network and I just haven't checked.

Even if I could get out of my non-compete, get capital for a linac/freestanding center, get the CON approved by the state...I don't know where my patients would come from, because there are no doctors around me who aren't already in systems with their own Radiation Oncologists.

You guys are probably right that starting your own center is no longer possible. But retraining after 15 years as an attending seems crazy. How many of you could be a resident again at age 47?

By the way, a restrictive covenant was included in my contract, but an employment lawyer reviewed it and I was up against a large catholic hospital system. They attempted to kick me off of the medical staff. But I prevailed.There own attorneys said the hospital and system would be at risk. As I look back at it now I was probably too mad and stupid to realize risking my house and money was a crazy risk. And Medgator is correct to point out that IMRT was prime during that time.

For many years it was only used by me 25-30 percent of the time as I did not feel right using it unless it would benefit a patient. My competitors were using it 70-80 percent including bone Mets . That’s when I foresaw the start of the downfall of our field. Today it’s protons. And the over spending in targeted agents with sparse data. And it is interesting that I have not seen a big drop yet in locums fees or unemployed Rad oncs. But I think it is pretty well hidden and once it appears it will be a tidal wave.

It would be hard to be a resident and maybe the 3 A’s are not enough to be successful anymore. Not when you got some big A’s controlling the info and future control of desirable areas. Maybe we are like the Jedi and we will need to hide out away from the Empire. Anyway, you guys at SDN are still the best and the brightest. Keep thinking outside the Box to save our wonderful field!

 

[Neuronix]

And it is interesting that I have not seen a big drop yet in locums fees or unemployed Rad oncs. But I think it is pretty well hidden and once it appears it will be a tidal wave.

What rates for locums are you seeing? $1000/day is going rate here. I've even seen $800/day.

 

[medgator]

What rates for locums are you seeing? $1000/day is going rate here. I've even seen $800/day.

High 1s to $2k+ in rural Midwest... Like everything, location, location, location. Hard to recruit perm jobs are going to pay better for locums, obviously

 

[deleted1111261]

I have never seen lower than $1400 before.

 

[communitydoc13]

I was talking with some of the C-suite guys and asked if we were using our new alliance to negotiate better insurance contracts. Most of them seem to be planning their retirements and running out the clock, and questions of this nature are met with some shrugs and vague "eventually, we'll see". But they definitely spend a lot of time on branding and graphic design! I'm told that maybe, sometime in the next 5 years, maybe we'll all use the same EMR. Maybe.

I don't know what C-suite guys think but this has been my experience with smaller, community hospitals.

Success for CEOs is measured financially of course and this can be difficult. Growth of system is best but aside from growth, sale of hospital to larger system and public collaboration with a name brand system may be second best. I suspect that CEOs may not be rewarded very much for overseeing a well run hospital with good employee and patient satisfaction.

The types of folks who are hired as CEOs at community places can be quite dangerous. They may look to sale as a legacy move. They may look to collaboration with potential reduction in local physician autonomy as a legacy move. They often have very nice deferred compensation (saw a CEO walked out of a hospital with parachute ensuring lifelong financial security).

Just as dangerous as the CEO is the board, which in principle should not be engaged in operational aspects of the hospital but may stray into this area. The board of large systems is drawn from many enormously wealthy and influential people. There is some safety in this as a single board member is unlikely to be able to drive strategic decisions autocratically. In a small community hospital (or school, or town) often there is a single or couple individuals who are overwhelming more financially influential than the remainder of the board. These folks can drive radical decisions (such as sale) relatively quickly.

 

[medgator]

I have never seen lower than $1400 before.

Outside of locums agencies, not uncommon in saturated markets. Win win for both sides potentially if you cut out a middleman taking potentially 30% off the top

 

[Neuronix]

Outside of locums agencies, not uncommon in saturated markets. Win win for both sides potentially if you cut out a middleman taking potentially 30% off the top

I've tried to do this, but practices offer me the same as the locums agencies. Cut out the middle man, pocket the difference seems to be the mantra of the practices. There's already a crew of perma or semi-permalocums here filling a lot of practices at $1,000/day. These tend to be small physician owned practices who are not offering real partnership positions.

I know around here everyone loves to hate on academics and hospital employers, but I always say they're all out to get you.

 

[medgator]

I've tried to do this, but practices offer me the same as the locums agencies. Cut out the middle man, pocket the difference seems to be the mantra of the practices. There's already a crew of perma or semi-permalocums here filling a lot of practices at $1,000/day. These tend to be small physician owned practices who are not offering real partnership positions.

I know around here everyone loves to hate on academics and hospital employers, but I always say they're all out to get you.

supply and demand... don't hate the player, hate the game, which is why I would tell any MS to stay the hell away from this field unless a decent job market (for now) in the midwest is your ultimate goal.

The only difference between greedy PP boomers and greedy academic chair boomers is one group is mainly responsible for our problems collectively as a specialty, while both are equally guilty of exploiting the mismatch in RO supply and demand

 

[Ray D. Ayshun]

I've tried to do this, but practices offer me the same as the locums agencies. Cut out the middle man, pocket the difference seems to be the mantra of the practices. There's already a crew of perma or semi-permalocums here filling a lot of practices at $1,000/day. These tend to be small physician owned practices who are not offering real partnership positions.

I know around here everyone loves to hate on academics and hospital employers, but I always say they're all out to get you.

I have no skin in the game as I don't pay for the locums. At the same time, the schedule is structured during my vacation such that they might write a script, review some images, and see an urgent consult (which has yet to happen). I think they're still getting $15-1800 daily, but they're pretty much surfing the web, reading or sleeping. I'm generally more worried about the locums dying in clinic than any of my patients. I wouldn't feel terribly bad if they were "only" getting $1000/day for that. Obviously, they may be expected to do more in other situations.

 

[RadOncDoc21]

I have no skin in the game as I don't pay for the locums. At the same time, the schedule is structured during my vacation such that they might write a script, review some images, and see an urgent consult (which has yet to happen). I think they're still getting $15-1800 daily, but they're pretty much surfing the web, reading or sleeping. I'm generally more worried about the locums dying in clinic than any of my patients. I wouldn't feel terribly bad if they were "only" getting $1000/day for that. Obviously, they may be expected to do more in other situations.

This was pretty much my situation also. I still think for the job market and competition, pay rates need to be higher. Hell, travel nurses and PA’s make more per hr now a days.

 

[medgator]

This was pretty much my situation also. I still think for the job market and competition, pay rates need to be higher. Hell, travel nurses and PA’s make more per hr now a days.

I agree.... The covid labor shortage has affected all sectors in medicine (including RO) and elsewhere, which is why the job market is better this year and now I'm seeing a lot of locums demand again (a year or two ago it was emails asking if we needed a locums BC RO with XYZ state licenses in place).

We are still in a bad place going forward with all the major issues that have already been beaten to death ad nauseam, but for now things are better in perm and locums

 

[fiji128]

Got a direct text yesterday, Locums in Arkansas $2,100/day multiple weeks needed starting ASAP. That is about as high as I've seen. Sounds like a locums job where you will actually have to work and not just babysit though.

 

[yesmaster]

I have never seen lower than $1400 before.

$1400/day for rad oncs or for radiation therapists? It seems accurate, either way.

 

[yesmaster]

I went on a coffee date with an i-banker who helped one of the largest managed care companies grow with massive bond sales.

“I was doing meaningful, high impact work.” Nod and smile.

Anyways, mom & pop PP in any semi-desirable area is doomed. Academic leaders are not looking out for us, they’re in a race with private healthcare systems to grow as much as possible.

 

[elementaryschooleconomics]

I don't know what C-suite guys think but this has been my experience with smaller, community hospitals.

Success for CEOs is measured financially of course and this can be difficult. Growth of system is best but aside from growth, sale of hospital to larger system and public collaboration with a name brand system may be second best. I suspect that CEOs may not be rewarded very much for overseeing a well run hospital with good employee and patient satisfaction.

The types of folks who are hired as CEOs at community places can be quite dangerous. They may look to sale as a legacy move. They may look to collaboration with potential reduction in local physician autonomy as a legacy move. They often have very nice deferred compensation (saw a CEO walked out of a hospital with parachute ensuring lifelong financial security).

Just as dangerous as the CEO is the board, which in principle should not be engaged in operational aspects of the hospital but may stray into this area. The board of large systems is drawn from many enormously wealthy and influential people. There is some safety in this as a single board member is unlikely to be able to drive strategic decisions autocratically. In a small community hospital (or school, or town) often there is a single or couple individuals who are overwhelming more financially influential than the remainder of the board. These folks can drive radical decisions (such as sale) relatively quickly.

At this point I think I come to SDN to confirm I'm not living in some bizarre, alternative-reality universe. This type of attitude/behavior must be incentivized for them, somehow, for it to be observed across multiple hospitals.

I'm sort of flabbergasted, though. Logically, if the hospital generates more revenue, the C-suite generates more revenue, right? Leveraging network power for even marginally better contracts seems to be the absolute lowest hanging fruit...

 

[CaesarRO]

At this point I think I come to SDN to confirm I'm not living in some bizarre, alternative-reality universe. This type of attitude/behavior must be incentivized for them, somehow, for it to be observed across multiple hospitals.

I'm sort of flabbergasted, though. Logically, if the hospital generates more revenue, the C-suite generates more revenue, right? Leveraging network power for even marginally better contracts seems to be the absolute lowest hanging fruit...

I think it's exactly what's been said. They tend to think on 5-7 year horizons before planning their exit so the incentive is to squeeze as much out of the system in the short term as possible so that they can point to success and have no regard for long term effects.

 

[JumpingShip]

You guys are probably right that starting your own center is no longer possible. But retraining after 15 years as an attending seems crazy. How many of you could be a resident again at age 47?

I initially totally disregarded retraining, as simply impossible or not sensible (why not take one of those $1000 babysitting locums jobs vs working 80 hours at this age as a resident for whatever slave wage they're paying these days).

That is until somebody told me to look into palliative care fellowships. I intend to do so in earnest this week but it appears to be quite unique in many regards, for us at least. Perhaps it would benefit others if we started a list ranking best fellowships/residencies for radiation oncologists (not current residents who are looking to switch but practicing and perhaps "old" ones like me). I'll start:

1. Palliative care: We all have some experience with palliative care and I'm sure I'm not the only one who has waited way too long for a consult and thought "damn, I hate to see cancer patients suffering like this ... we really need more palliative care specialists! As far as I know, it's the only fellowship that is one year that we could do without additional training. In addition, I assume the work hours and schedule are as good as it gets for a resident for sure and maybe even fellow? It appears as though the vast majority of those who complete the fellowship did residencies in primary care but that's definitely not exclusively the case.

It's not competitive from what I understand so basically apply to the closest program and honestly tell them that they are your not only number one but only program. I doubt they care about your 10-20 year old 260+ step I board score and would use the two dozen retrospective review papers you sacrificed much of the best years of your life to publish as toilet paper, but I'd imagine they'd like the diversity of a specialist with years of practice vs another 28 year old internal medicine applicant. I have no idea about the variance in quality of programs, but I assume that "rankings" don't really matter since those are based mostly on research and faculty recognition (am I correct?) and all we are looking for is being competent clinicians who can will easily pass the board exams.

It would be great if anybody with more first hand or direct knowledge could review and modify the above if anything I stated is incorrect. Perhaps the SDN rad onc moderator could even contact their palliative care counterpart to review and comment?).

2. No idea. I can't imagine going back and doing a three year internal medicine residency then primary care or another two years of medical oncology. I doubt a transitional year counts for anything but also for those of us who did a medicine intern year does it "count" or "expire" after a certain number of years? More importantly after how many years away could one honestly say they would feel comfortable as a PGY-2 in internal medicine . . . 2 maximum and honestly probably 1 . . . hell one must get rusty after even 3-4 months so obviously not 10-20 years like some of us!

 

[jondunn]

I see palliative Med brought up - but how is the reimbursement? Would it really be better than even a lower paying rad onc job?

 

[Sheldor]

I initially totally disregarded retraining, as simply impossible or not sensible (why not take one of those $1000 babysitting locums jobs vs working 80 hours at this age as a resident for whatever slave wage they're paying these days).

That is until somebody told me to look into palliative care fellowships. I intend to do so in earnest this week but it appears to be quite unique in many regards, for us at least. Perhaps it would benefit others if we started a list ranking best fellowships/residencies for radiation oncologists (not current residents who are looking to switch but practicing and perhaps "old" ones like me). I'll start:

1. Palliative care: We all have some experience with palliative care and I'm sure I'm not the only one who has waited way too long for a consult and thought "damn, I hate to see cancer patients suffering like this ... we really need more palliative care specialists! As far as I know, it's the only fellowship that is one year that we could do without additional training. In addition, I assume the work hours and schedule are as good as it gets for a resident for sure and maybe even fellow? It appears as though the vast majority of those who complete the fellowship did residencies in primary care but that's definitely not exclusively the case.

It's not competitive from what I understand so basically apply to the closest program and honestly tell them that they are your not only number one but only program. I doubt they care about your 10-20 year old 260+ step I board score and would use the two dozen retrospective review papers you sacrificed much of the best years of your life to publish as toilet paper, but I'd imagine they'd like the diversity of a specialist with years of practice vs another 28 year old internal medicine applicant. I have no idea about the variance in quality of programs, but I assume that "rankings" don't really matter since those are based mostly on research and faculty recognition (am I correct?) and all we are looking for is being competent clinicians who can will easily pass the board exams.

It would be great if anybody with more first hand or direct knowledge could review and modify the above if anything I stated is incorrect. Perhaps the SDN rad onc moderator could even contact their palliative care counterpart to review and comment?).

2. No idea. I can't imagine going back and doing a three year internal medicine residency then primary care or another two years of medical oncology. I doubt a transitional year counts for anything but also for those of us who did a medicine intern year does it "count" or "expire" after a certain number of years? More importantly after how many years away could one honestly say they would feel comfortable as a PGY-2 in internal medicine . . . 2 maximum and honestly probably 1 . . . hell one must get rusty after even 3-4 months so obviously not 10-20 years like some of us!

Depending on where you live there may be an opportunity to practice as a palliative care physician without going and doing a fellowship, your license and board certification qualifies you to do nearly everything. If you really want to get into advanced stuff like pain pumps/etc then sure, but worth exploring. In a big city I'm sure you need the fellowship, but otherwise maybe?

I see palliative Med brought up - but how is the reimbursement? Would it really be better than even a lower paying rad onc job?

For right now the lowest rad onc are still higher than palliative care, i believe. I think that palliative care is going to be in the 200-ish range.

 

[JumpingShip]

I see palliative Med brought up - but how is the reimbursement? Would it really be better than even a lower paying rad onc job?

Definitely not now, but we all know which direction radiation oncology is going and I'd imagine (again somebody with direct knowledge please comment) that palliative care is at least very stable? Also of course actually going to work and helping people who desperately need help vs the soul crushing daily experience that radiation oncology has increasingly become.

 

[JumpingShip]

Depending on where you live there may be an opportunity to practice as a palliative care physician without going and doing a fellowship, your license and board certification qualifies you to do nearly everything. If you really want to get into advanced stuff like pain pumps/etc then sure, but worth exploring. In a big city I'm sure you need the fellowship, but otherwise maybe?

I believe you are correct but recall that I'm "old" . . . 12-15 years out of radiation oncology residency means literally 20ish years since graduating medical school and intern year. Of course the palliative care MD isn't directly managing all aspects of medical care but I don't see how I can provide even palliative care with a 20 year old understanding of management of even common medical conditions. I'd imagine that during the one year palliative care fellowship people like me would be simultaneously learning advanced palliative care stuff like the pain pumps you mentioned but also brushing up on/relearning non Radiation Oncology stuff (which is like 99.5% of medicine).

I guess a more recent graduate could just straight up switch to palliative care and start practicing? It seems like that's perfectly "legal and acceptable" but not sure if it's practical.

It would be great if somebody with first hand experience in either of the two scenarios (obviously doesn't have to be radiation oncology but any specialty) could comment.

Can the moderator of this forum please alert the moderator of the palliative care forum that we are having this discussion (maybe they personally know people who have done what we are brainstorming here) or otherwise invite them to comment?

 

[jondunn]

soul crushing daily experience that radiation oncology has increasingly become.

speak more on this - I think view of many of us is despite all the issues with the field, the daily work is satisfying. interested to hear your perspective

 

[JumpingShip]

speak more on this - I think view of many of us is despite all the issues with the field, the daily work is satisfying. interested to hear your perspective

That was the case for me as well for the first 12-15 or so years of my career and even my residency (how many residents can honestly say that they thoroughly enjoyed the vast majority of their residency, even the daily work was so satisfying . . . I certainly can). I'm the guy who started the thread and I've added more posts throughout . . . perhaps you could review those?

 

[jondunn]

ah forgot you were OP. my bad

 

[elementaryschooleconomics]

I am starting to lean more towards this is a pretty well done troll thread

If this is a troll thread (and yeah, I think we should always be reading with skepticism, whether SDN or NEJM) then hopefully OP is a fiction novelist on the side, because he has woven a rich tapestry well-grounded in reality.

Jokes aside, I've been thinking about this a lot recently, and these academic satellite gigs feel a lot like being at a company for 20 years and finding out the new guy they just hired makes 40% more than you. Moving forward, I think it will probably be advantageous to be "the new guy" rather than the "company man" who has been loyal for decades. You want to be hired for the satellite, you don't want to already be there when you find out you're becoming a satellite.

I don't think I've ever heard a version the "company man" experience where someone says "oh yeah, they hired a new guy and realized how much of an asset my knowledge and experience is, so even though they're starting the new guy at a higher salary than I was making, they gave me a raise which I feel is appropriate for what I bring to the table".

 

[medgator]

If this is a troll thread (and yeah, I think we should always be reading with skepticism, whether SDN or NEJM) then hopefully OP is a fiction novelist on the side, because he has woven a rich tapestry well-grounded in reality.

Jokes aside, I've been thinking about this a lot recently, and these academic satellite gigs feel a lot like being at a company for 20 years and finding out the new guy they just hired makes 40% more than you.

No reason to not out these jobs and departments/hospitals for what they are, even if that's what a lot of the job market is these days.. more edification for those wondering what the big deal is, job wise

 

[seper]

I don't think OP is a troll. In my part of the country over past 6 m:

1) A hospital was taken over. The existing solo RadOnc had her compensation cut about 350K. She still has the job for now.
2) Another independent hospital (rural-lish) was taken over by a different system, and the existing solo RadOnc was asked to leave. Replaced by a locum. No signs of them wanting to hire a permament RadOnc whatsoever.
3) A rural independent hospital saw their RadOnc retired and they officially (and openly) replaced them by a "long-term locum"

 

[RickyScott]

I don't think OP is a troll. In my part of the country over past 6 m:

1) A hospital was taken over. The existing solo RadOnc had her compensation cut about 350K. She still has the job for now.
2) Another independent hospital (rural-lish) was taken over by a different system, and the existing solo RadOnc was asked to leave. Replaced by a locum. No signs of them wanting to hire a permament RadOnc whatsoever.
3) A rural independent hospital saw their RadOnc retired and they officially (and openly) replaced them by a "long-term locum"

Know of several cases of number one. Also seen takeover by hospital/academic center where longstanding radonc let go and replaced with new grad.

 

[Gfunk6]

I can confirm that I've seen it in my neck of the woods too. Academic centers took over formerly free standing RO vaults with the following results:

1. Existing ROs offered flat comp based on academic salary guidelines for clinical faculty. They would be taking a > 50% haircut on comp. The ROs balked and left. They were replaced by new grads from the same institution.

2. Existing RO was in the community for many years and knew the landscape well. Transition after academic take over was so jarring and bureaucratic that the RO eventually was forced out and got a new position out of state. Replaced by new grads.

 

[TheWallnerus]

Know of several cases of number one. Also seen takeover by hospital/academic center where longstanding radonc let go and replaced with new grad.

I can confirm that I've seen it in my neck of the woods too. Academic centers took over formerly free standing RO vaults with the following results:

1. Existing ROs offered flat comp based on academic salary guidelines for clinical faculty. They would be taking a > 50% haircut on comp. The ROs balked and left. They were replaced by new grads from the same institution.

2. Existing RO was in the community for many years and knew the landscape well. Transition after academic take over was so jarring and bureaucratic that the RO eventually was forced out and got a new position out of state. Replaced by new grads.

OTOH I am so glad our new grads are still getting jobs. Mathematical predictions could NOT have accounted for ruthlessness. The chaotic attractor!

 

[fiji128]

This type of behavior is very indicative of a supply/demand imbalance in our specialty. You sure don't hear of this stuff happening in Urology or Ortho. I'm sure many of these docs will be forced into locums as their next best option. I hope the Astro work force study picks up on this type of stuff.

 

[RadRadRad]

I don't think OP is a troll. In my part of the country over past 6 m:

1) A hospital was taken over. The existing solo RadOnc had her compensation cut about 350K. She still has the job for now.
2) Another independent hospital (rural-lish) was taken over by a different system, and the existing solo RadOnc was asked to leave. Replaced by a locum. No signs of them wanting to hire a permament RadOnc whatsoever.
3) A rural independent hospital saw their RadOnc retired and they officially (and openly) replaced them by a "long-term locum"

Interesting that long term locums being used. I’ve seen a couple rural practices decimated by loss of stable presence radonc (ie lost about half their volume) despite no other competitor in town. Patients and referring mds just started sending them to centers about an hour away so they could get decent care

 

[elementaryschooleconomics]

Just repeating myself on the off chance fresh eyes find this post in the future:

Yes, you probably have heard the counter-argument that "even with the pay cut, you still make more than a Pediatrician"!

In some cases that may be true, and yes, we (as in, doctors) still make more than the average American.

HOWEVER, even if the end result is still "good" compared to the average American (or PCP) salary, a sudden 30-50% cut in salary is never, ever, ever a "good" thing. Ever. Unless you're the employer.

Do not feel bad for being upset at a 50% cut, even though the final number is still "higher than starting PCP salary". That is not the point.

 

[RO28]

Just repeating myself on the off chance fresh eyes find this post in the future:

Yes, you probably have heard the counter-argument that "even with the pay cut, you still make more than a Pediatrician"!

In some cases that may be true, and yes, we (as in, doctors) still make more than the average American.

HOWEVER, even if the end result is still "good" compared to the average American (or PCP) salary, a sudden 30-50% cut in salary is never, ever, ever a "good" thing. Ever. Unless you're the employer.

Do not feel bad for being upset at a 50% cut, even though the final number is still "higher than starting PCP salary". That is not the point.

also, pediatricians should make more!!!! They also have a lot more job flexibility.

 

[medgator]

I hope the Astro work force study picks up on this type of stuff.

Even if they did, would it matter? Fox guarding the henhouse