M4 thinking strongly about applying to Rad Onc: Why is there so much dissonance between opinions real life and the internet?

[xrthopeful]

It worries me when we cannot even agree on a simple thing that Chairs selfishly expanding is a clearly a bad thing. Some people are excellent pretzel twisters, good semantic gymnasts. It is how we get here to our present condition, however you want to describe it, people disingenuously equivocating that we don't have any trend yet and that we don't know anything about the future, now a clearly Selfish act if somehow not selfish to some. I don't get it and it leaves me without a full set of words of describe the situation, definitely a bad taste in my mouth. We will see what happens, as Trump likes to say!

It’s as ‘selfish’ as a PP guy like medgator deciding he only wants to hire experienced grads. You remember saying that right.

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Members don't see this ad.

 

[thecarbonionangle]

Do you have personal knowledge of this job posting? @fiji128 appears to have inside knowledge about this job, like IRL. A recent PM from somebody who knows of this job personally says it's the red-headed stepchild of UKentucky.

The job posting can say whatever it wants - people are posting personal first or second-hand experiences. None of the stuff on the job posting is binding, it's the contract that is.

I wish people would actually post what they knew and be helpful to people. In this job market, it would be nice to know what people know about the UK jobs. if you know something, post it. Somebody reading may be interested. it is an anonymous forum!

 

[medgator]

It’s as ‘selfish’ as a PP guy like medgator deciding he only wants to hire experienced grads. You remember saying that right.

Not what I said and I even added caveats later. But feel free to make it personal

 

[xrthopeful]

Not what I said and I even added caveats later. But feel free to make it personal

That’s not what I said, that’s what carbonionangle said. Context.

 

[evilbooyaa]

Lol at chairmen/women working for a bonus like CEOs? Are you basing this on anything specific? Like have you heard of this happening before? What?


Also holy major intellectual dishonesty at acting like the rhetoric here is ‘equivalent’ in being anti-Pp and anti-academic. Even you don’t believe that

In recent history, it is more anti-academic, sure, due to concerns that have been discussed ad nauseum.

Fine, maybe it's not an actual monetary bonus. Obviously I'm not actually privvy to anything like this. I'll withdraw that point. Let's go with point #2 - taking the easy way to solve a solution rather than having to make a more difficult decision. Rest of my post holds.

I was replying to the NAM guy with the partnership part of the post/

And you’re a resident. Let me know when a PP job in an undesirable area offers 250k. The guy said ‘probably’ and not in a good faith way.

I'll let you know once I start getting offer(s). Richmond, KY is only 40 minutes outside of Lexington, it's a desireable area for the current job market!

/s

 

[Mandelin Rain]

My God.

Who wouldn't want to work with colleagues like these?

 

[thecarbonionangle]

My God.

Who wouldn't want to work with colleagues like these?

we already work with you probably.

 

[fiji128]

It said in the posting it was for a partnership track. I posted it here, you know, to actually help people.

'probably around the 250k neighborhood' - lol I'm sorry this has been your experience but this is not realistic for this job, dude. Don't spread bad info.

Not bad info. I know that's around what this particular university starts their junior faculty at, this is public info. That's who your job will be with. The job at this particular clinic site has been posted on and off Astro and with private recruiters for years, even going back to when it was fully with the private clinic. The issue with it previuolsy was that it advertised a high start salary but then would be highly dependent on production at what is a low volume clinic, which is why no one lasted there. Now the university is taking it over or is at least in some sort of partnership. If this position offered a decent opportunity they wouldn't have the trouble filling and retaining staff.

I'm not at all against folks helping other folks getting a decent job but I have some familiarity with this exact posted position and it illustrates what people are ranting about on this board with a real world example. Not trying to troll anyone, just thought I had something of substance to add.

 

[thecarbonionangle]

Not bad info. I know that's around what this particular university starts their junior faculty at, this is public info. That's who your job will be with. The job at this particular clinic site has been posted on and off Astro and with private recruiters for years, even going back to when it was fully with the private clinic. The issue with it previuolsy was that it advertised a high start salary but then would be highly dependent on production at what is a low volume clinic, which is why no one lasted there. Now the university is taking it over or is at least in some sort of partnership. If this position offered a decent opportunity they wouldn't have the trouble filling it.

I'm not at all against folks helping other folks getting a decent job but I have some familiarity with this exact posted position and it illustrates what people are ranting about on this board with a real world example. Not trying to troll anyone, just thought I had something of substance to add.

interesting that they offer "partnership track", would be interested to hear what that may mean to them based on what you say

 

[thecarbonionangle]

Lots of recent fellowship postings. One in "Miami cancer institute", is that a pp? WOW

 

[deleted941485]

Lots of recent fellowship postings. One in "Miami cancer institute", is that a pp? WOW

I definitely LOL’d when I saw all those fellowships on the ASTRO website. Someone said there is usually a boils of jobs that come around the time of ASTRO but honestly all I see are an explosion in fellowships which for the most part are simply exploitative.

 

[thecarbonionangle]

I definitely LOL’d when I saw all those fellowships on the ASTRO website. Someone said there is usually a boils of jobs that come around the time of ASTRO but honestly all I see are an explosion in fellowships which for the most part are simply exploitative.

still time for the huge bloom of jobs some predict to come. Like I said, "we will see". Time will reveal and tell. The fellowships are clearly trying to take advantage of people, IMO. SAD.

 

[Mandelin Rain]

About the "disconnect"...

Some of us who are more established in our jobs and have it good remember when we had/could've had it even better. I entered med school 15 years ago and ensconced myself in rad onc world 14 years ago. It is not exaggeration to say that rad onc was a bubble at that time. I fully expected to be making 750k-1mil mid career with an ownership stake in my own linac/clinic, full autonomy to practice how I saw fit, command respect at tumor boards, and participate in important clinical research. All of that had crash landed 7 years later by the time I started practice, and I got a much watered down version of my expectation. Perhaps the expectations were too lofty, but they were the reality at the time. Still love my life and my job. I work a bit harder for less money, ownership, respect, etc... but it's still really good.

Guys coming out today weren't really around for this bubble time and see making 350k for an easy gig, in an adequate place, while being a cog in the system of a teetering field for some chairman/CEO as being perfectly acceptable. And it still is. 7 years later, they are essentially getting a further watered down version of what I got. Still a good job that 99.9999% of the world would love to have etc, etc... Hell, I'd probably do it again if I was guaranteed this outcome.

But.... The same trends that drove the changes I've seen during the past 2 two seven year intervals (declining reimbursement, declining autonomy/increased scrutiny, no ownership potential, intellectually bankrupt academia) all continue and worsen by the year, but now with the added threat of supply/demand imbalance and payment model. Current medical students are probably on a seven year horizon. I am definitely not bullish on the future job prospects at that time interval having witnessed the change that has occurred during the last two.

I would hazard to say those trolling every post here with the only the rosiest colored glasses may have some ulterior motive. They may not even be entirely (read: at all) truthful about their position in all this mess.

For my part, it always comes back to math. Less money (whether due to less fractions/indications/utilization or APM or whatever) + More Rad Oncs to fight for that money = The future for rad onc. You can argue however you want, but there is no denying math.

But, but, but... there are more old people now than 20 years ago. Really? Are there more that twice as many old people? Because there are twice as many rad onc residents per year and average reimbursement per patient has dropped for years.

But, but. but... oligomets are a thing now. True. Not that they weren't before, but we treat more of them than we used to. Pending payment reform (bundling), I can't see "bone met" or "lung met" or "brain met" being particularly highly compensated indications for radiation but maybe I'm wrong. Certainly not enough to make up for losses elsewhere.

This continues to be the issue. Trends are unfavorable, math is unfavorable, future is ___________? No one knows for sure, anything can happen in 7 years, but buyer beware.

 

[deleted941485]

About the "disconnect"...

Some of us who are more established in our jobs and have it good remember when we had/could've had it even better. I entered med school 15 years ago and ensconced myself in rad onc world 14 years ago. It is not exaggeration to say that rad onc was a bubble at that time. I fully expected to be making 750k-1mil mid career with an ownership stake in my own linac/clinic, full autonomy to practice how I saw fit, command respect at tumor boards, and participate in important clinical research. All of that had crash landed 7 years later by the time I started practice, and I got a much watered down version of my expectation. Perhaps the expectations were too lofty, but they were the reality at the time. Still love my life and my job. I work a bit harder for less money, ownership, respect, etc... but it's still really good.

Guys coming out today weren't really around for this bubble time and see making 350k for an easy gig, in an adequate place, while being a cog in the system of a teetering field for some chairman/CEO as being perfectly acceptable. And it still is. 7 years later, they are essentially getting a further watered down version of what I got. Still a good job that 99.9999% of the world would love to have etc, etc... Hell, I'd probably do it again if I was guaranteed this outcome.

But.... The same trends that drove the changes I've seen during the past 2 two seven year intervals (declining reimbursement, declining autonomy/increased scrutiny, no ownership potential, intellectually bankrupt academia) all continue and worsen by the year, but now with the added threat of supply/demand imbalance and payment model. Current medical students are probably on a seven year horizon. I am definitely not bullish on the future job prospects at that time interval having witnessed the change that has occurred during the last two.

I would hazard to say those trolling every post here with the only the rosiest colored glasses may have some ulterior motive. They may not even be entirely (read: at all) truthful about their position in all this mess.

For my part, it always comes back to math. Less money (whether due to less fractions/indications/utilization or APM or whatever) + More Rad Oncs to fight for that money = The future for rad onc. You can argue however you want, but there is no denying math.

But, but, but... there are more old people now than 20 years ago. Really? Are there more that twice as many old people? Because there are twice as many rad onc residents per year and average reimbursement per patient has dropped for years.

But, but. but... oligomets are a thing now. True. Not that they weren't before, but we treat more of them than we used to. Pending payment reform (bundling), I can't see "bone met" or "lung met" or "brain met" being particularly highly compensated indications for radiation but maybe I'm wrong. Certainly not enough to make up for losses elsewhere.

This continues to be the issue. Trends are unfavorable, math is unfavorable, future is ___________? No one knows for sure, anything can happen in 7 years, but buyer beware.

Sounds like you have broken down the math for everyone. Question is weather their collective denial outweighs the facts here.

The govt is in the process of destroying err changing medicine. Rad Onc is unique in that it is poorly positioned relative the many other specialties.

 

[Burt Radnolds]

About the "disconnect"...

Some of us who are more established in our jobs and have it good remember when we had/could've had it even better. I entered med school 15 years ago and ensconced myself in rad onc world 14 years ago. It is not exaggeration to say that rad onc was a bubble at that time. I fully expected to be making 750k-1mil mid career with an ownership stake in my own linac/clinic, full autonomy to practice how I saw fit, command respect at tumor boards, and participate in important clinical research. All of that had crash landed 7 years later by the time I started practice, and I got a much watered down version of my expectation. Perhaps the expectations were too lofty, but they were the reality at the time. Still love my life and my job. I work a bit harder for less money, ownership, respect, etc... but it's still really good.

Guys coming out today weren't really around for this bubble time and see making 350k for an easy gig, in an adequate place, while being a cog in the system of a teetering field for some chairman/CEO as being perfectly acceptable. And it still is. 7 years later, they are essentially getting a further watered down version of what I got. Still a good job that 99.9999% of the world would love to have etc, etc... Hell, I'd probably do it again if I was guaranteed this outcome.

But.... The same trends that drove the changes I've seen during the past 2 two seven year intervals (declining reimbursement, declining autonomy/increased scrutiny, no ownership potential, intellectually bankrupt academia) all continue and worsen by the year, but now with the added threat of supply/demand imbalance and payment model. Current medical students are probably on a seven year horizon. I am definitely not bullish on the future job prospects at that time interval having witnessed the change that has occurred during the last two.

I would hazard to say those trolling every post here with the only the rosiest colored glasses may have some ulterior motive. They may not even be entirely (read: at all) truthful about their position in all this mess.

For my part, it always comes back to math. Less money (whether due to less fractions/indications/utilization or APM or whatever) + More Rad Oncs to fight for that money = The future for rad onc. You can argue however you want, but there is no denying math.

But, but, but... there are more old people now than 20 years ago. Really? Are there more that twice as many old people? Because there are twice as many rad onc residents per year and average reimbursement per patient has dropped for years.

But, but. but... oligomets are a thing now. True. Not that they weren't before, but we treat more of them than we used to. Pending payment reform (bundling), I can't see "bone met" or "lung met" or "brain met" being particularly highly compensated indications for radiation but maybe I'm wrong. Certainly not enough to make up for losses elsewhere.

This continues to be the issue. Trends are unfavorable, math is unfavorable, future is ___________? No one knows for sure, anything can happen in 7 years, but buyer beware.

Post of the year. Couldn't have said it any better.

 

[scarbrtj]

About the "disconnect"...

Some of us who are more established in our jobs and have it good remember when we had/could've had it even better. I entered med school 15 years ago and ensconced myself in rad onc world 14 years ago. It is not exaggeration to say that rad onc was a bubble at that time. I fully expected to be making 750k-1mil mid career with an ownership stake in my own linac/clinic, full autonomy to practice how I saw fit, command respect at tumor boards, and participate in important clinical research. All of that had crash landed 7 years later by the time I started practice, and I got a much watered down version of my expectation. Perhaps the expectations were too lofty, but they were the reality at the time. Still love my life and my job. I work a bit harder for less money, ownership, respect, etc... but it's still really good.

Guys coming out today weren't really around for this bubble time and see making 350k for an easy gig, in an adequate place, while being a cog in the system of a teetering field for some chairman/CEO as being perfectly acceptable. And it still is. 7 years later, they are essentially getting a further watered down version of what I got. Still a good job that 99.9999% of the world would love to have etc, etc... Hell, I'd probably do it again if I was guaranteed this outcome.

But.... The same trends that drove the changes I've seen during the past 2 two seven year intervals (declining reimbursement, declining autonomy/increased scrutiny, no ownership potential, intellectually bankrupt academia) all continue and worsen by the year, but now with the added threat of supply/demand imbalance and payment model. Current medical students are probably on a seven year horizon. I am definitely not bullish on the future job prospects at that time interval having witnessed the change that has occurred during the last two.

Plan to have this engraved and put on plaque somewhere.
The only thing I'd quibble with: "a good job 99.9999% of the world would love to have..." World, maybe. But all politics is local said Tip O'Neill. What with the outsize tumescence the govt has for rad onc (it produces more OIG opinions for rad onc than any other specialty), the supply/demand outlook, "will you even pass boards?", the slow elimination of private practice in favor of academics in rad onc... I'd say "a good job 95% of San Francisco would love to have."

 

[radoncgrad2019]

Yup. Everything is great. Everyone is getting jobs, all 190-200 them/year. Go long RO!!!

Tbh, no one has actually posited that as a problem, but thanks for trolling

Yes, they have posited that as a problem.

 

[radoncgrad2019]

There IS a disconnect. Here's the disconnect:

You have people on this forum (really a group of about 5-10 regular posters) who have jobs they love - they are private guys making bank and have for a few years or many years. Some have made million(s) a year and this is public information. They see the rad onc world THEY know changing and also see the increase in employed docs, less autonomy, etc. They have fears about the future of the field, rightfully so, but are also disconnected from the current job market/job hunt.

On the other hand, med students in real life are talking to residents who are graduating, and most seem happy with the jobs they are getting. Obvious exceptions of course, but all you have to do is look at the two threads that were created, and one has WAY more posts. Many many people are happy with their jobs.

That's the disconnect. I wish some of you would understand this. yes, by all means, worry about the future. But the reality is many people are still happy with their job and their lives Maybe it makes YOU sick to your stomach because you never would have gone into rad onc if you were going to max out making 400k in some academic satellite working 9 - 5. But for a lot of people they are happy with that. And many more people are getting great PP group jobs clearly than you understand perhaps.

Everything would make a lot more sense here if everyone just accepts/understands this disconnect. Especially since that was the initial basis of this thread.

Good post, Mandelin Rain. I agree this is where a big part of the disconnect is, like I said here last week. re-posting.

 

[Mandelin Rain]

Good post, Mandelin Rain. I agree this is where a big part of the disconnect is, like I said here last week. re-posting.

Unfortunately, my concern and belief is that with further impact to reimbursement and oversupply of trainees, the next generation of rad oncs (current med students with other options) will not have those 9-5, 350-400k, satellite/employed positions readily available to them. Water it down further and you're looking at 200-250k jobs where you may need a year long fellowship to even be competitive and/or even unemployed graduates. That is far from certain, but that would be my honest belief seeing what has happened the past 14 years. Maybe there is a clutch of med students still okay with that, probably not the caliber programs have grown used to seeing, but I'm sure some would still be really happy. With my stats and options as a student, I would have likely drawn my personal line well short of that, but that's me. Maybe there's a black swan deus ex machina somewhere in the near future similar to IMRT, that returns us to a gilded age. I'm not hopeful that's the case, but I wouldn't go so far as to call it impossible.

 

[xrthopeful]

Unfortunately, my concern and belief is that with further impact to reimbursement and oversupply of trainees, the next generation of rad oncs (current med students with other options) will not have those 9-5, 350-400k, satellite/employed positions readily available to them. Water it down further and you're looking at 200-250k jobs where you may need a year long fellowship to even be competitive and/or even unemployed graduates. That is far from certain, but that would be my honest belief seeing what has happened the past 14 years. Maybe there is a clutch of med students still okay with that, probably not the caliber programs have grown used to seeing, but I'm sure some would still be really happy. With my stats and options as a student, I would have likely drawn my personal line well short of that, but that's me. Maybe there's a black swan deus ex machina somewhere in the near future similar to IMRT, that returns us to a gilded age. I'm not hopeful that's the case, but I wouldn't go so far as to call it impossible.

This is a possiblity. Honestly most of it IMO is going to have to do with how reimbursement plays out. If it takes a big hit, then it doesn't really matter if supply is low or high, pay will be low.

I feel like if this did happen this would probably not be for a good amount of time, salaries in other high paying fields have fluctuated, but slipping to the low 200s is not something we see a lot. If it happened it would be part of a change for the downwards we would be seeing across all of medicine, which is CERTAINLY not outside the realm of possibility.

 

[medgator]

Yes, they have posited that as a problem.

Links to the posts griping about not making millions a year? Pretty sure geography trumps the seven figure salary desire. The stories here have been about not finding jobs even remotely close to a preferred geographic locale.

Someone even posted about not taking a rural job and then having to settle for something closer to graduating with less pay, still rural. The issue was geography, not pay.

 

[xrthopeful]

Medgator, you keep saying this, but I'm not sure why?

Clearly money matters and is part of the discussion. big part. There's so many examples in this thread. I don't think that's a wrong thing, money matters.

 

[Mandelin Rain]

This is a possiblity. Honestly most of it IMO is going to have to do with how reimbursement plays out. If it takes a big hit, then it doesn't really matter if supply is low or high, pay will be low.

I feel like if this did happen this would probably not be for a good amount of time, salaries in other high paying fields have fluctuated, but slipping to the low 200s is not something we see a lot. If it happened it would be part of a change for the downwards we would be seeing across all of medicine, which is CERTAINLY not outside the realm of possibility.

I think if there there is a "big hit" in reimbursement and we continue to train 200+ residents per year, pay will be $0 for a significant number of graduating residents in the near future. Most of us can work harder, see more patients, etc... in an effort to maintain our salaries. This means less jobs. That, plus more residents equals unemployed grads. Again, it comes down to math.

 

[medgator]

Unfortunately, my concern and belief is that with further impact to reimbursement and oversupply of trainees, the next generation of rad oncs (current med students with other options) will not have those 9-5, 350-400k, satellite/employed positions readily available to them. Water it down further and you're looking at 200-250k jobs where you may need a year long fellowship to even be competitive and/or even unemployed graduates. That is far from certain, but that would be my honest belief seeing what has happened the past 14 years. Maybe there is a clutch of med students still okay with that, probably not the caliber programs have grown used to seeing, but I'm sure some would still be really happy. With my stats and options as a student, I would have likely drawn my personal line well short of that, but that's me. Maybe there's a black swan deus ex machina somewhere in the near future similar to IMRT, that returns us to a gilded age. I'm not hopeful that's the case, but I wouldn't go so far as to call it impossible.

Nailed it. Exactly where I see the field heading

 

[medgator]

Medgator, you keep saying this, but I'm not sure why?

Clearly money matters and is part of the discussion. big part. There's so many examples in this thread. I don't think that's a wrong thing, money matters.

No one said it doesn't. Re read my posts. There was an example in one of these threads of a pgy5 last year avoiding a rural $350k job not because of salary but because of location, now who is still "two plane rides" away in a different rural job because they needed something before they graduated and I'm guessing the employer figured out they had leverage to low ball the salary.

No one is complaining about making millions at this point, they can't even get $400k in a rural job before graduation these days

 

[scarbrtj]

Along the theme of "disconnect" and pay rates potentially dropping significantly... here's some related but seemingly disparate thoughts...
Every year ASTRO complains about even a 2% or so cut to radiation oncology being bad, or at least worthy of ASTRO's condemnation. But how much of a pay cut is it for a doctor where at least half of his or her patients are breast/prostate in terms of today's dollars versus 10 years ago? If the fraction numbers are down ~33%, then the reimbursement is off at least 25%. And if that's half your patient load, then your reimbursement is down at least ~12.5%. And if you're also hypofractionating palliative cases etc. then your reimbursement hits could push toward 20%. So on one hand, ASTRO lobbies for less breast fractions (and yes, yes, yes this is clinically appropriate and I do it!) and then on the other hand it gets freaked out by 2% payment cuts. Disconnect and a half! Ten years ago, before the "hypofractionation rush," ASTRO claimed ~20-30% payment cuts would be "devastating." Well guess what. The devastation is here. It came. From a mathematical/economics perspective, we are now in the Devastation Era just per ASTRO's own claims. I mean, 20-30% cuts are devastating or they're not: if you see differently (e.g. the cuts didn't really happen, or if they happened they weren't impactful), please argue how so. Perhaps that is why ASTRO is really actually pushing for APM... because it realizes a monster was birthed and it could only be contained, not destroyed.

 

[GapCalc]

I think if there there is a "big hit" in reimbursement and we continue to train 200+ residents per year, pay will be $0 for a significant number of graduating residents in the near future. Most of us can work harder, see more patients, etc... in an effort to maintain our salaries. This means less jobs. That, plus more residents equals unemployed grads. Again, it comes down to math.

Radiology did this as pay was cut. They just read more studies. Makes sense. What established doc is going to throw up his/her hands and say “oh well, I’ll take home 30% less this year.” Most of us have families, mortgages, older parents, etc. I know I would try to work more to maintain my standard of living (longer hours, more patients) before I’d settle for a big pay cut.

 

[scarbrtj]

Amazing what I’ve seen happen to radiology over my short career. It went from one of the most competitive fields to unfilled spots/IMGs/Caribbean grads virtually overnight when their reimbursements were slashed around 2008-2012 (market crash also delayed many older docs retirements), and now has recovered due to strong underlying growth for the field.

We will have the same acute shock (arguably has already begun, but imagine a recession hitting at the same time as the APM and it’ll make the job market now seem robust...) but no recovery because our indications (in terms of overall # of treatments required) are shrinking rather than expanding.

This goes without saying, but radiology also didn’t double their number of trainees for no apparent legitimate reason.

Who are the best "businessmen" in medicine? Radiologists? They understand volume/economies of scale/RVUs pretty well I'd reckon.

 

[xrthopeful]

they can't even get $400k in a rural job before graduation these days

listen i am in no way going to discount the story of someone who says they took a job less than 300k in a rural area.

However - I would venture to guess that almost anyone who has looked in the last few years or who is looking now can vouch for the fact that there are many jobs in rural areas that are paying a LOT more than 400k. if you're willing to live in a random place, at least now in 2019, you can do quite well.

This isn't me trying to be 'rosy' like I get accused of, it's just adding a different part of the perspective. lots of people read this, including people like you who perhaps haven't looked or needed to look in many years. I just want you to know that's not the norm.

 

[deleted18755]

Radiology did this as pay was cut. They just read more studies. Makes sense. What established doc is going to throw up his/her hands and say “oh well, I’ll take home 30% less this year.” Most of us have families, mortgages, older parents, etc. I know I would try to work more to maintain my standard of living (longer hours, more patients) before I’d settle for a big pay cut.

This is a fair point I think everybody can agree on: I don't know about older physicians in their 60's or whatever* but if there is a 10-25% pay cut the vast majority of practicing radiation oncologists will definitely work 10-25% more to maintain their income/lifestyle, further constricting the job market.

(* but then again we all know 65-75+ year old radiation oncologists with no intention of retiring anytime soon . . . if they didn't retire after a 30+ year career that included the glory years/decade or two of radiation oncology followed by a decade or so of ridiculous market returns I bet most will keep working until they literally can't stand anymore regardless of what happens with compensation)

 

[medgator]

there are many jobs in rural areas that are paying a LOT more than 400k. if you're willing to live in a random place, at least now in 2019, you can do quite well.

This isn't me trying to be 'rosy' like I get accused of, it's just adding a different part of the perspective. lots of people read this, including people like you who perhaps haven't looked or needed to look in many years. I just want you to know that's not the norm.

Maybe it is. Someone posted their experience now and that's what it was. Neither of us are in that situation now

 

[thecarbonionangle]

Not going to post about my experience yet until I'm done but I can vouch that there are still some jobs in my limited experience out there in "middle of nowhere" practically begging me to consider them, 500-600k+, very high bonuses and other perks. Completely undesirable areas but these places are literally bombarding me weekly by emails and I've spoken to multiple of them over the phone as I'm casting a wide net in this market.

Idk why the poster took a 300k or less job in rural USA, certainly not doubting his story but this is probably still an anomaly. "two flights away"----pretty meaningless thing, many places are "two flights away", so not sure that is very important...

 

[Mandelin Rain]

There are still plenty of high paying jobs out there based on desirability. I would warn against believing numbers until you see a contract though. Bait and switch to get you there for an interview is not uncommon. I had an experience with the 600k "offer" in the middle of nowhere and when I got there it was actually 380k plus bonus and to get to 600k you'd need to be rolling at like 12,000 RVUs (not possible at the center in all likelihood) and have a directorship or something.

 

[evilbooyaa]

There are still plenty of high paying jobs out there based on desirability. I would warn against believing numbers until you see a contract though. Bait and switch to get you there for an interview is not uncommon. I had an experience with the 600k "offer" in the middle of nowhere and when I got there it was actually 380k plus bonus and to get to 600k you'd need to be rolling at like 12,000 RVUs (not possible at the center in all likelihood) and have a directorship or something.

Exactly this. I don't really trust salary numbers posted online or in recruiting e-mails. You put 500-600k base or with a reasonable RVU threshold (in a center that is busy enough to meet that) in a contract, and I'll take it much more seriously. Agree that I'm happy to talk and discuss with them, but the job market is not good enough for me to open with "so are you serious about that compensation? break it down for me"

 

[deleted18755]

Exactly this. I don't really trust salary numbers posted online or in recruiting e-mails. You put 500-600k base or with a reasonable RVU threshold (in a center that is busy enough to meet that) in a contract, and I'll take it much more seriously. Agree that I'm happy to talk and discuss with them, but the job market is not good enough for me to open with "so are you serious about that compensation? break it down for me"

The good thing is that unlike residency interviews, they should be paying for everything for job interviews, so you might as well go to as many as you can with an open mind but even if they "bait and switch" it shouldn't cost you anything (except your wasted time of course!) and will give you first hand, "real world" experiences.

 

[xrthopeful]

Agree - talkto as many people as you can and the more people you talkto the more site visits you go on and then the more offers you will have on hand

 

[Mandelin Rain]

The good thing is that unlike residency interviews, they should be paying for everything for job interviews, so you might as well go to as many as you can with an open mind but even if they "bait and switch" it shouldn't cost you anything (except your wasted time of course!) and will give you first hand, "real world" experiences.

Not sure about anyone else, but I had to take vacation for interviews senior year. I had 15 days. Once they realized I wasn't staying there as junior faculty, no one was bending over backward to accommodate my interviews elsewhere. You gotta be a little selective.

 

[xrthopeful]

Not sure about anyone else, but I had to take vacation for interviews senior year. I had 15 days. Once they realized I wasn't staying there as junior faculty, no one was bending over backward to accommodate my interviews elsewhere. You gotta be a little selective.

guess this depends on how nice your program is. good point.

 

[evilbooyaa]

The good thing is that unlike residency interviews, they should be paying for everything for job interviews, so you might as well go to as many as you can with an open mind but even if they "bait and switch" it shouldn't cost you anything (except your wasted time of course!) and will give you first hand, "real world" experiences.

Agreed. Process has begun.

Not sure about anyone else, but I had to take vacation for interviews senior year. I had 15 days. Once they realized I wasn't staying there as junior faculty, no one was bending over backward to accommodate my interviews elsewhere. You gotta be a little selective.

Oof. We have interview dates on top of vacation dates. Outrageous to make a chief resident use vacation to go interview!

 

[RadOncDoc21]

Agreed. Process has begun.



Oof. We have interview dates on top of vacation dates. Outrageous to make a chief resident use vacation to go interview!

Can’t have you missing out on covering your attendings. Having a chief resident on your service is like gold! You basically get the best and the cheapest labor. Why else expand residency programs if you’re not going to reap the rewards!

 

[medgator]

Can’t have you missing out on covering your attendings. Having a chief resident on your service is like gold! You basically get the best and the cheapest labor. Why else expand residency programs if you’re not going to reap the rewards!

Having an "advanced/palliative radiation therapy" fellow s/p acgme accredited residency must be platinum in that case

 

[RadOncDoc21]

Having an "advanced/palliative radiation therapy" fellow s/p acgme accredited residency must be platinum in that case

That’s Epstein money there!

 

[xrthopeful]

 

[medgator]

Throw in this graph (and the other graph I can't find showing decreased fractions per course of xrt) and then you really see the special problem in RO

 

[xrthopeful]

I don’t think we are going to be talking about fractions/course much longer. One, the rise of SBRT has already made it hard to interpret ‘on Beam’ numbers as Neuronix nicely alluded to the other day. But more importantly and more universally, with bundled payments taking effect at some point, this vocabulary of the economic implications of number of fractions will be a thing of the past. Like using the term ‘rads’ clinically haha.

 

[medgator]

I don’t think we are going to be talking about fractions/course much longer. One, the rise of SBRT has already made it hard to interpret ‘on Beam’ numbers as Neuronix nicely alluded to the other day. But more importantly and more universally, with bundled payments taking effect at some point, this vocabulary of the economic implications of number of fractions will be a thing of the past.

Think of our work in terms of fractions delivered per RO though.... That isn't going to change. A person doesn't become less productive because the available work drops...

 

[xrthopeful]

Think of our work in terms of fractions delivered per RO though.... That isn't going to change. A person doesn't become less productive because the available work drops...

I don’t know, I think maybe the easier way to quantify it is new Consults or new starts per week or per month? Because that’s where most of the work is right? I mean a five fraction Prostate SBRT case shouldn’t be counted as one eighth the work (to the physician) of a standard 40 frac prostate case should it? I don’t think it bills one eighth either. I feel like measuring productivity of a rad onc in number of fractions a week doesn’t necessarily capture everything. This is hard stuff to figure out

 

[medgator]

I don’t know, I think maybe the easier way to quantify it is new Consults or new starts per week or per month? Because that’s where most of the work is right? I mean a five fraction Prostate SBRT case shouldn’t be counted as one eighth the work (to the physician) of a standard 40 frac prostate case should it? I don’t think it bills one eighth either. I feel like measuring productivity of a rad onc in number of fractions a week doesn’t necessarily capture everything. This is hard stuff to figure out

Not really. How far out are you again from training?

 

[xrthopeful]

I'm not saying the consult itself or the sim itself is most of the work. I'm saying that is a way to represent each 'case' you take on - the contouring, the planning, the consult, the discussion with the referring provider, the family, the patient, the ensuing follow-ups, the coordination of care, etc. And perhaps case number/week represents how productive an RO is. Yes by definition you will see a few more OTRs and a few more films to check for a longer fractionated course, but that is not ultimately that much more work, in reality.

Continuing to think about things in number of fractions/week is going to make you a dinosaur, quickly. I don't care if someone is 10 years out or 15 years out. The way to think about this is obviously changing.

 

[Neuronix]

Not really. How far out are you again from training?

I think it's a reasonable question. We all know that wRVUs don't really reflect physician hours worked.

This is a re-hash of the age old question of how to measure physician productivity and number of needed physicians for the caseload since wRVUs don't well reflect physician effort. That is, is the physician generating 9000 wRVUs on prostate SBRT working more or less hard than the physician generating 9000 wRVUs on conventional prostate IMRT? If physicians are working harder for the equivalent number of SBRT RVUs, does this mean you need to hire more physicians and split the money or suck it up and work harder to keep your income steady? This doesn't even account for the fact that the equipment necessary to do SBRT is more expensive.

Unfortunately we already know the answer when it comes to 38 fraction IMRT vs. 15 fraction IMRT, for example. Pays less and less work. That means less need for physicians.