Med student trying to understand the field

[proverbial_soup]

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Hello. Med student here. I’m writing because I’m trying to understand the concern with radiation oncology.

From my perspective, radiation oncology seems like a great field. So much time with patients. Meaningful work. Cool tech. Work hours that are amenable to raising a family. All the radiation oncologists I’ve met are happy, compassionate, and excited about their jobs. The residents graduating from my school get good gigs right out of the program and are excited about interested med students.

I acknowledge there are some problems with radiation oncology. It’s a small field, so you have to move to where the jobs are, and you might not get a job that aligns perfectly with your interests. I know there’s speculation that too many residents are being trained, although I haven’t heard about residents who haven’t gotten jobs (correct me if I’m wrong). That much I understand.

But are these cons worth the stern “don’t go into radiation oncology unless you can’t see yourself doing anything else”? For me personally, my top priorities are working a job that interests me, maximizing time with patients, and maximizing time to raise my children. I’m willing to move for my job, as long as it’s <2 hour flight from my extended family. As far as money goes, as long as I make >$200k I’m happy. Radiation oncology fits this bill, at least to me. Can I see myself doing anything else? I mean, sure, but this seems like a great field. Not to mention that a lot of problems I see listed on this thread seem ubiquitous to many/all fields, not just radiation oncology (declining pay, AI, midlevel creep, “things aren’t how they used to be”)

My second choice after radiation oncology is palliative care. Is there something I’m missing that should make me put this field to the side, and instead consider palliative care, medical oncology, and even things like emergency medicine more seriously?

Thanks in advance

 

[drowsy12]

Most people you’re going to meet in rad onc are generally happy. The vast majority really. That causes some cognitive dissonance naturally when you read the concerns versus who you may meet in real life, as the warnings are mostly about the future. Im sure many others will reply with why you should be concerned, but wanted to make that point.

 

[Neuronix]

I've known a few people who have gone underemployed or unemployed in rad onc. This was worse during and pre-COVID. The job market seems to have picked up a bit post-COVID.

You still may run into serious issues if you have to be in one specific locale or have strong priorities as to practice type (i.e. disease site specific, physician-scientist, good partnership, etc).

I tell the students who come to me that if they love rad onc and are willing to take any job and any location to do it, come on aboard. Certainly, the average pay and hours aren't bad. If you want to see what a job market on fire looks like with a ton of choices post-graduation, go rotate with med onc or radiology.

The expectations now among students interested in rad onc are much lower than they were in the golden days. I'm happy for this. Nobody is disappointed this way, and I suspect that many will end up happy in the current environment.

As for 10 years from now? Who the heck knows. The less overtraining we do and the more practice expanding studies we do, the better off we will be.

 

[Gfunk6]

Well, if you want to earn $200,000 and live within 2 hours of a major, international airport, your bar of entry is probably low enough to seriously consider Rad Onc.

Just don't get too upset when you find out the Chief Physicist and Chief Therapist are making more money than you.

 

[medgator]

Well, if you want to earn $200,000 and live within 2 hours of a major, international airport, your bar of entry is probably low enough to seriously consider Rad Onc.

Just don't get too upset when you find out the Chief Physicist, Chief Therapist, the head dosimetrist and the practice manager are making more money than you.

Ftfy....

 

[Neuronix]

This is a bit of hyperbole. 300k is the lower limit for clinical rad onc jobs. Less than that is basically going to be by choice.

 

[DrProtonX]

I’m a PGY-1 who has matched into rad onc, here’s my two cents. I did it because I love physics and found working with patients with cancer very rewarding. Most of the graduating residents that I worked with or interviewed with had already found jobs and were happy about it. I was only close enough to one of them to be able to ask about the compensation and it was $400-450k total comp (location midwest). As other people have mentioned here, if you take quick look at radiology or med onc jobs, you can barely find one below $500k.
Rad onc probably has one of best residency lifestyle. Almost every residents (except the ones at couple “malignant” programs which I didn’t rank) were really happy with their work/life balance.
Attending lifestyle: well I let all the attendings in this forum talk about it. I talked to 20 maybe 25 and all of them were happy with the work they were doing.
The other issue is the leadership. Unfortunately, not only they’re not actively trying to fix the problems, they barely even acknowledge them!

At the end of the day, no one knows what’s gonna happen in the future. I believe the most important thing is to do something you enjoy. So if you only enjoy, rad onc, then rad onc it is! If you enjoy other specialties as well, then you have to decide if you enjoy rad onc more than the other specialties enough that overweighs the risk of the unknown future!

 

[TheWallnerus]

I don't know any rad oncs right now that fully understand the field. I don't think I fully understand it.

I will say that just in general regarding huge financial decisions (or investments etc), if you don't feel like you fully understand it... walk away. Until time machines are invented, this is always the smartest move.

 

[NotMattSpraker]

If you love Rad Onc, you will love the job. You will be well paid.

You wont really get to pick where you live. It is very common people wait for their dream location.

I love my job a lot and feel extremely lucky to have it. If it starts to suck though, I probably cant leave without a pay cut and/or having to move.

I have autonomy, but people above me can make my life suck... and then I cant leave.

You really have to do what you love or you wont be happy, but you better be crystal clear on the challenges of this field.

I have zero optimism things will get better when it comes to "QoL" (need to define what that means to you), pay, and mobility. It'll probably worse, potentially much worse, but of course only time will tell.

The other thing you really need to consider is that you have no "exit". This is unique among radiation oncologists. You have 1 skill and it's tied to a very, very expensive machine. I am advising trainees to develop a second skill if they choose Rad Onc, informatics is a very popular choice.

A lot of doctors have exits because they have internal medicine training. Most medical oncologists can go be a hospitalist tomorrow, same with palliative care (I think?). You would take a pay cut, but hospitalists have pretty nice work-life balance and if you're just like "***k this" you can actually end with "Im out".

You definitely cant do that in Rad Onc unless you have enough money to not work.

Your examples are wildly different from one another. The day to day and challenges of med onc, rad onc, palliative care, and EM are soooo different. I would suggest getting very detailed info from a range of docs in all those fields to help decide.

Last thing to consider, be honest with yourself about priorities. Rad onc (and radiology and med onc) median is a lot of money, even with our scummy anti-trust leadership. If even more money is important, great, just be honest with yourself.

If money is the top priority, Id go med onc or radiology. Palliative care will frustrate you, they are under paid and also way under supported, so like at work youll feel poor too haha.

Good luck!

 

[deleted1180461]

I just saw someone who did literally of all their education in New York City now working in rural Iowa. Somehow I don’t think this was planned.

I just got an email advertising $500/hr for med onc plus $1800/day call pay with hourly rate beyond that if called in.

Rad onc is half that without call pay.

 

[medgator]

I just saw someone who did literally of all their education in New York City now working in rural Iowa. Somehow I don’t think this was planned.

I just got an email advertising $500/hr for med onc plus $1800/day call pay with hourly rate beyond that if called in.

Rad onc is half that without call pay.

 

[elementaryschooleconomics]

If you love Rad Onc, you will love the job. You will be well paid.

You wont really get to pick where you live. It is very common people wait for their dream location.

I love my job a lot and feel extremely lucky to have it. If it starts to suck though, I probably cant leave without a pay cut and/or having to move.

I have autonomy, but people above me can make my life suck... and then I cant leave.

You really have to do what you love or you wont be happy, but you better be crystal clear on the challenges of this field.

I have zero optimism things will get better when it comes to "QoL" (need to define what that means to you), pay, and mobility. It'll probably worse, potentially much worse, but of course only time will tell.

The other thing you really need to consider is that you have no "exit". This is unique among radiation oncologists. You have 1 skill and it's tied to a very, very expensive machine. I am advising trainees to develop a second skill if they choose Rad Onc, informatics is a very popular choice.

A lot of doctors have exits because they have internal medicine training. Most medical oncologists can go be a hospitalist tomorrow, same with palliative care (I think?). You would take a pay cut, but hospitalists have pretty nice work-life balance and if you're just like "***k this" you can actually end with "Im out".

You definitely cant do that in Rad Onc unless you have enough money to not work.

Your examples are wildly different from one another. The day to day and challenges of med onc, rad onc, palliative care, and EM are soooo different. I would suggest getting very detailed info from a range of docs in all those fields to help decide.

Last thing to consider, be honest with yourself about priorities. Rad onc (and radiology and med onc) median is a lot of money, even with our scummy anti-trust leadership. If even more money is important, great, just be honest with yourself.

If money is the top priority, Id go med onc or radiology. Palliative care will frustrate you, they are under paid and also way under supported, so like at work youll feel poor too haha.

Good luck!

Yeah...yeah.

I highlighted what I want to echo 10000x.

The most important thing:

If deep down you're interested in money (we all are, whether we know it or not) RadOnc is not the specialty for you.

RadOnc salaries have a "high floor/low ceiling". Meaning the starting salaries can be nice compared to other specialties - but often, the starting salaries are the same as the mid-and-late career salaries.

My total comp is good, but I make about half of what the top earning doctors in my hospital make.

And I can't just work harder if I want to make more. I can't decide to have a half-day Saturday clinic, for example.

Just throwing that out there.

 

[temujim]

Yeah...yeah.

I highlighted what I want to echo 10000x.

The most important thing:

If deep down you're interested in money (we all are, whether we know it or not) RadOnc is not the specialty for you.

RadOnc salaries have a "high floor/low ceiling". Meaning the starting salaries can be nice compared to other specialties - but often, the starting salaries are the same as the mid-and-late career salaries.

My total comp is good, but I make about half of what the top earning doctors in my hospital make.

And I can't just work harder if I want to make more. I can't decide to have a half-day Saturday clinic, for example.

Just throwing that out there.

Know some practices that open their doors on the weekends. Mostly to do a concierge type practice and eg treat prostate SBRTs qweek Sat mornings. In my mind only really worth it when you control the levers. Hospital employed position... well I think admin would come to see it as part of the job rather than an extra. But YMMV.

 

[deleted1180461]

Yeah...yeah.

I highlighted what I want to echo 10000x.

The most important thing:

If deep down you're interested in money (we all are, whether we know it or not) RadOnc is not the specialty for you.

RadOnc salaries have a "high floor/low ceiling". Meaning the starting salaries can be nice compared to other specialties - but often, the starting salaries are the same as the mid-and-late career salaries.

My total comp is good, but I make about half of what the top earning doctors in my hospital make.

And I can't just work harder if I want to make more. I can't decide to have a half-day Saturday clinic, for example.

Just throwing that out there.

You mean you didn’t negotiate 300 hours of private jet time in your contract? Should have networked harder lol

 

[elementaryschooleconomics]

Know some practices that open their doors on the weekends. Mostly to do a concierge type practice and eg treat prostate SBRTs qweek Sat mornings. In my mind only really worth it when you control the levers. Hospital employed position... well I think admin would come to see it as part of the job rather than an extra. But YMMV.

Oh sure - I mean, for everything I say on SDN, I know of at least one practice that "proves me wrong", as it were, hahahaha

But for the VAST majority of Radiation Oncologists, in the era of W2 employment and consolidation, this is not an option.

 

[deleted1180461]

Oh sure - I mean, for everything I say on SDN, I know of at least one practice that "proves me wrong", as it were, hahahaha

But for the VAST majority of Radiation Oncologists, in the era of W2 employment and consolidation, this is not an option.

If you’re doing more than 4 days a week as an employed w2 rad onc you’re doing it wrong. Coming in 6 days a week for flat salary is an epic fail.

 

[TheWallnerus]

If you’re doing more than 4 days a week as an employed w2 rad onc you’re doing it wrong. Coming in 6 days a week for flat salary is an epic fail.

I agree

The “Supervision Apocalypse” shouldn’t have turned out to be an apocalypse, and it didn’t. It should have turned out to be a supervision nirvana of 4 day work weeks.

For many though nirvana never came. 🙁

 

[NotMattSpraker]

Know some practices that open their doors on the weekends. Mostly to do a concierge type practice and eg treat prostate SBRTs qweek Sat mornings. In my mind only really worth it when you control the levers. Hospital employed position... well I think admin would come to see it as part of the job rather than an extra. But YMMV.

Haha is it worth it even if you control the levers?

My med onc does Saturday clinics. I love them. I am out doing something in the mountains and there are referrals when I come back the next week.

Works great for me.

 

[temujim]

Haha is it worth it even if you control the levers?

My med onc does Saturday clinics. I love them. I am out doing something in the mountains and there are referrals when I come back the next week.

Works great for me.

Only practices I know that do this have a large piece of the technical. Who knows when the rad onc apocalypse cometh? Pessimism on this board is palpable. Can't blame them for working the angles and getting while the getting good.

If a W2 employee? Avoid avoid avoid.

 

[NotMattSpraker]

Only practices I know that do this have a large piece of the technical. Who knows when the rad onc apocalypse cometh? Pessimism on this board is palpable. Can't blame them for working the angles and getting while the getting good.

If a W2 employee? Avoid avoid avoid.

What is the optimistic view of a lack of mobility? I guess like you build equity in your home haha

Seriously though I do agree and was only half serious about the Saturday. But, new entrants can’t rely on an opportunity for ownership as has been discussed.

If employed, my goal would be to pursue a really high base or 4 days a week.

 

[yesmaster]

I’d say the objective goodness of a job as a doctor boils down to:

- location
- QOL, workload, flexibility
- pay

For any specialty, if you compromise on 1 parameter, you get a boost in the other parameters.

For rad onc, you automatically have to compromise on location unless you’re lucky or connected (ideally, you have family in rad onc as an owner/partner/chair).

If you’re somewhere rural or otherwise undesirable as a IM subspecialist or surgeon or med onc or radiologist, your QOL and pay will be good, oftentimes better than rad onc.

Yes rad onc will always have better pay than primary care (peds, ob gyn, IM, geriatrics).

 

[NotMattSpraker]

And I can't just work harder if I want to make more. I can't decide to have a half-day Saturday clinic, for example.

This is also huge and is way under discussed.

Some contracts are structured so that you have to build a referral base to make any money at all but give you no real shot at doing that successfully.

 

[deleted1180461]

What is the optimistic view of a lack of mobility? I guess like you build equity in your home haha

Seriously though I do agree and was only half serious about the Saturday. But, new entrants can’t rely on an opportunity for ownership as has been discussed.

If employed, my goal would be to pursue a really high base and 3 days a week.

FTFY.

 

[RadRadRad]

Hello. Med student here. I’m writing because I’m trying to understand the concern with radiation oncology.

From my perspective, radiation oncology seems like a great field. So much time with patients. Meaningful work. Cool tech. Work hours that are amenable to raising a family. All the radiation oncologists I’ve met are happy, compassionate, and excited about their jobs. The residents graduating from my school get good gigs right out of the program and are excited about interested med students.

I acknowledge there are some problems with radiation oncology. It’s a small field, so you have to move to where the jobs are, and you might not get a job that aligns perfectly with your interests. I know there’s speculation that too many residents are being trained, although I haven’t heard about residents who haven’t gotten jobs (correct me if I’m wrong). That much I understand.

But are these cons worth the stern “don’t go into radiation oncology unless you can’t see yourself doing anything else”? For me personally, my top priorities are working a job that interests me, maximizing time with patients, and maximizing time to raise my children. I’m willing to move for my job, as long as it’s <2 hour flight from my extended family. As far as money goes, as long as I make >$200k I’m happy. Radiation oncology fits this bill, at least to me. Can I see myself doing anything else? I mean, sure, but this seems like a great field. Not to mention that a lot of problems I see listed on this thread seem ubiquitous to many/all fields, not just radiation oncology (declining pay, AI, midlevel creep, “things aren’t how they used to be”)

My second choice after radiation oncology is palliative care. Is there something I’m missing that should make me put this field to the side, and instead consider palliative care, medical oncology, and even things like emergency medicine more seriously?

Thanks in advance

Idk
Radonc and palliative care are very different fields. Yes we palliate patients that are dying and that is a similarity but that is about it. Radonc is technical, procedural, and often aimed at cure. Palliative care is very different. I like helping alleviate patients pain but I don’t think palliative care would be in my top 20 for medical careers. I can’t ever recall hearing a radonc I know say they would choose palliative care as their second choice.

If your fallback is palliative care and you don’t care about income why not just do palliative care. You will have way more flexibility in terms of location and practice set up

 

[thecarbonionangle]

I do not recommend most people to go into rad onc. For most it is not a good choice. People’s priorities and situations change over time. Who you are in medical school is different than who you are 5-10 years later. You might tell yourself you don’t mind being in middle of nowhere. Yeah your partner might have something to say about that. You are single and move to middle of nowhere and see the miserable dating scene where everyone is is tatted up, multiple kids out of wedlock, uneducated and missing teeth. You run out of swipes and cry yourself to sleep. You are 2-3 hours from an airport and have to take 2 connections to get anywhere meaningful. You lose an entire day traveling. Flights are also significantly more expensive. This is the reality for some. I know of multiple people in middle of nowhere. Imagine being gay or another minority and living 3.5 hours from an airport. Great brunch scene! Top biryani! Out of this world mala! Wake up from this nightmare. It is not too late to turn around.

 

[RickyScott]

I’m a PGY-1 who has matched into rad onc, here’s my two cents. I did it because I love physics and found working with patients with cancer very rewarding. Most of the graduating residents that I worked with or interviewed with had already found jobs and were happy about it. I was only close enough to one of them to be able to ask about the compensation and it was $400-450k total comp (location midwest). As other people have mentioned here, if you take quick look at radiology or med onc jobs, you can barely find one below $500k.
Rad onc probably has one of best residency lifestyle. Almost every residents (except the ones at couple “malignant” programs which I didn’t rank) were really happy with their work/life balance.
Attending lifestyle: well I let all the attendings in this forum talk about it. I talked to 20 maybe 25 and all of them were happy with the work they were doing.
The other issue is the leadership. Unfortunately, not only they’re not actively trying to fix the problems, they barely even acknowledge them!

At the end of the day, no one knows what’s gonna happen in the future. I believe the most important thing is to do something you enjoy. So if you only enjoy, rad onc, then rad onc it is! If you enjoy other specialties as well, then you have to decide if you enjoy rad onc more than the other specialties enough that overweighs the risk of the unknown future!

The real issue is the chance of an unmitigated disaster that exists in radonc but not other specialties. For example, There is a very real chance that xrt will be drastically cut back in favorable breast. Something like that along with bundled payments and consolidation would totally wreck the job market. I don’t know of another specialty where there is a downside risk of serious under/un employment.

 

[deleted1180461]

Idk
Radonc and palliative care are very different fields. Yes we palliate patients that are dying and that is a similarity but that is about it. Radonc is technical, procedural, and often aimed at cure. Palliative care is very different. I like helping alleviate patients pain but I don’t think palliative care would be in my top 20 for medical careers. I can’t ever recall hearing a radonc I know say they would choose palliative care as their second choice.

If your fallback is palliative care and you don’t care about income why not just do palliative care. You will have way more flexibility in terms of location and practice set up

This. If you truly do not care about income and want to be involved in end of life care palliative care is the obvious choice. Rad oncs are technicians. We draw circles and go home. We use dangerous and expensive equipment so get paid fairly well, but that’s why. We don’t guide people through the end of life.

 

[DebtRising]

Radiation is a narrow hallway in terms of skills learned, service to society, ability to live close to family, and chance to not be an employee. The hallway continues to narrow.

According to the ASTRO funded supply / demand paper, the upper limit of projection was an oversupply of 1600 rad oncs around when you would graduate. Let me tell you from being in practice, there is no shortage of either hospital administrators or even your fellow (often older) MDs ready and willing to exploit that (read: you) for their gain.

This field is almost a text book example of the previous generation cashing out, and how consolidation of businesses empowers a certain class.

 

[deleted1180461]

Radiation is a narrow hallway in terms of skills learned, service to society, ability to live close to family, and chance to not be an employee. The hallway continues to narrow.

According to the ASTRO funded supply / demand paper, the upper limit of projection was an oversupply of 1600 rad oncs around when you would graduate. Let me tell you from being in practice, there is no shortage of either hospital administrators or even your fellow (often older) MDs ready and willing to exploit that (read: you) for their gain.

This field is almost a text book example of the previous generation cashing out, and how consolidation of businesses empowers a certain class.

Brutal truth. If I encounter one more hospital “holding out” for “the right fit” rad onc willing to “live in our community (of 7000, 120 miles from an airport)” in rural North Dakota for 2 year guarantee mgma median as a w2 to be “their provider” with no collections transparency I might vomit up my duodenum infected with norovirus from the doctors providers lounge interview lunch “chicken” patties leftover from the med floor lunch delivery.

I am really interested to see what happens when the baby boomer “I-need-moooooreee” locums pool that all sold their PPs to the hospitals and engenders all of this absurdity finally dries up but that could take literally 20 years as rad onc is one of the few specialities where we can and do work up until the point we are approving images from hospice for those sweet sweet extra 0.85 wRVU per click. CBCTs, OTVs talks about fishing. My precioussss. What has it (comphealth) gotsss in its pocketesesss? (spoiler, it’s a half dozen extra 77427s a 5 hour drive away for $1k and there’s time for a dialysis break).

 

[Mandelin Rain]

The real issue is the chance of an unmitigated disaster that exists in radonc but not other specialties. For example, There is a very real chance that xrt will be drastically cut back in favorable breast. Something like that along with bundled payments and consolidation would totally wreck the job market. I don’t know of another specialty where there is a downside risk of serious under/un employment.

This is it. The downside risk here is huge. Smoking rates WAY down (awesome). HPV vaccines widely used (though still underused). Lose (most) breast. Lose (many) rectal. Lose (many) esophagus. Game over for your (all of our) career. You're retraining. It takes one drug, one genomic test, one study. You have no control over any of it. You could be the nicest, most talented person in the world and suddenly you might as well be a nuc med doc.

Continuing, there is no corresponding high upside. Your 90% most likely upside is making a high upper-middle-class salary (that seemingly decreases every year) working 40-50 hours as an employee of a corporation. It's a very nice living, but for almost everyone there's nothing beyond that. You could live that lifestyle doing any number of non-medicine or medicine careers. Even if there is a deus ex machina innovation, it will not benefit physicians like IMRT did in the 00s because we've ceded pretty much all ownership long ago and CMS will be highly reluctant to repeat the error they made then.

Low upside, tremendous downside is not a great gamble with your life unless it's something you need to do to feel fulfilled. If so, cool. You'll like rad onc a lot. Almost all of us do.

 

[RickyScott]

Let’s be very optimistic and assume there is an 80% chancel that radiation will be fine and 20% chance the job market implodes in 10-20 yrs, why would would anyone take the risk when there are many great specialties?

 

[NotMattSpraker]

According to the ASTRO funded supply / demand paper, the upper limit of projection was an oversupply of 1600 rad oncs around when you would graduate. Let me tell you from being in practice, there is no shortage of either hospital administrators or even your fellow (often older) MDs ready and willing to exploit that (read: you) for their gain.

I wish more people were talking about efficiency gains. This is how I am seeing the job market dry up. Its not that departments are sitting empty, its that a practice with 3 docs that maybe needs 4 now says... nah lets do it with 3. And they totally can.

Saw a post on X that the average junior academic faculty works <56 hours a week. If thats true (?), it wont be like that for much longer. Or, the salary will drop. It cant be both if efficiency goes up and volume at best stays stable.

This is so insidious and I worry that ego-driven Rad Oncs are blindly driving people into the field so that they can feel "competitive" or something. They will never see these changes because they happen so quietly, even if they understand them (doubtful).

 

[deleted1180461]

Let’s say be very optimistic and assume there is an 80% chancel that radiation will be fine and 20% chance the job market implodes in 10-20 yrs, why would would anyone take the risk when there are many great specialties?

There are no existential threats to cosmetic plastic surgery, dermatology, weight loss clinics, and dentistry. Even in the inevitable eventual recession that affects wage earners, the top 1% will still be paying cash for their vanity. I mean, that’s not why I went to med school but that’s the reality.

If you own a proton center that attracts a large number of cash paying prostate patients you are probably tapping into the same pool and could potentially be ok. It’s been made overwhelmingly clear protons for prostates isn’t going anywhere, ever.

 

[medgator]

There are no existential threats to cosmetic plastic surgery, dermatology, weight loss clinics, and dentistry. Even in the inevitable eventual recession that affects wage earners, the top 1% will still be paying cash for their vanity. I mean, that’s not why I went to med school but that’s the reality.

If you own a proton center that attracts a large number of cash paying prostate patients you are probably tapping into the same pool and could potentially be ok. It’s been made overwhelmingly clear protons for prostates isn’t going anywhere, ever.

The biggest difference is that derm/plastics/GU etc are smart enough to control their numbers coming out while we are full bore off the cliff at this point with residency expansion and the prisoner's dilemma

 

[DrProtonX]

There are no existential threats to cosmetic plastic surgery, dermatology, weight loss clinics, and dentistry. Even in the inevitable eventual recession that affects wage earners, the top 1% will still be paying cash for their vanity. I mean, that’s not why I went to med school but that’s the reality.

If you own a proton center that attracts a large number of cash paying prostate patients you are probably tapping into the same pool and could potentially be ok. It’s been made overwhelmingly clear protons for prostates isn’t going anywhere, ever.

Rad onc and plastic surgeons are both physicians but that’s about the only thing they have in common. I think rad onc is more similar to software engineer than to plastics. For many students 5 years of brutal gen surg residency and then 3 years of plastics fellowship is an immediate no regardless of the income potential. Every field has its own challenges. You just have to be honest with yourself that what your priorities and passions are.

 

[RickyScott]

I wish more people were talking about efficiency gains. This is how I am seeing the job market dry up. Its not that departments are sitting empty, its that a practice with 3 docs that maybe needs 4 now says... nah lets do it with 3. And they totally can.

Saw a post on X that the average junior academic faculty works <56 hours a week. If thats true (?), it wont be like that for much longer. Or, the salary will drop. It cant be both if efficiency goes up and volume at best stays stable.

This is so insidious and I worry that ego-driven Rad Oncs are blindly driving people into the field so that they can feel "competitive" or something. They will never see these changes because they happen so quietly, even if they understand them (doubtful).

a competent radonc in an efficient outpt setting should have no problem with 10 new pts a week (with less than 50 hrs), which is more than double the present average.

 

[yesmaster]

a competent radonc in an efficient outpt setting should have no problem with 10 new pts a week (with less than 50 hrs), which is more than double the present average.

Rad onc would be GREAT field and in the company of derm, rads, ophtho, etc. if we had maintained our residency numbers at 100/year for the last 20 years. Then, we’d have comfortable workloads (if we ignore hypofrac and getting squeezed out of gastric, esophageal adeno, RPS, melanoma), and we could take an intellectually honest look at general supervision. Instead, we have this proliferation of low clinical volume positions (academic clinical faculty, sleepy rural facilities, etc.). There’s no good way to reverse the excess 1500-2000 practicing rad onc’s in US, and our field is still decent, sure, I’m glad I’m not a PCP getting confused with a midlevel, but it’s literally half the job it should be.

 

[Mandelin Rain]

What would the % break down look like if you asked every rad onc in the country the following options (compared to their current situation):

1. Stay equally busy and receive the same pay.
2. See 25% more patients and receive 20% more pay.
3. See 50% more patients and receive 30% more pay.
4. See 100% more patients and receive 50% more pay.

I'd go with:
2% (basically OTN)
20%
50%
28%

Which is to say that almost all rad oncs would feel that they have excess capacity in their current roles.

 

[DrProtonX]

What would the % break down look like if you asked every rad onc in the country the following options (compared to their current situation):

1. Stay equally busy and receive the same pay.
2. See 25% more patients and receive 20% more pay.
3. See 50% more patients and receive 30% more pay.
4. See 100% more patients and receive 50% more pay.

I'd go with:
2% (basically OTN)
20%
50%
28%

Which is to say that almost all rad oncs would feel that they have excess capacity in their current roles.

Why would anyone pick 3 or 4? I’m assuming most rad oncs make $400k+ which means 40% of the those extra income would go to tax so why would anyone double up their load for 30% increase income?

 

[TheWallnerus]

Why would anyone pick 3 or 4? I’m assuming most rad oncs make $400k+ which means 40% of the those extra income would go to tax so why would anyone double up their load for 30% increase income?

If your workload was 4 new patients a week on average.

 

[deleted1180461]

What would the % break down look like if you asked every rad onc in the country the following options (compared to their current situation):

1. Stay equally busy and receive the same pay.
2. See 25% more patients and receive 20% more pay.
3. See 50% more patients and receive 30% more pay.
4. See 100% more patients and receive 50% more pay.

I'd go with:
2% (basically OTN)
20%
50%
28%

Which is to say that almost all rad oncs would feel that they have excess capacity in their current roles.

50% more pay here. I would anticipate a p<0.0001 signal on male vs. female and urban vs. rural rad onc on this question.

 

[Neuronix]

I choose option 1.

Lab is humming along, and adjusted for grant protected research effort I'm usually 98-99th percentile on academic professional work RVUs.

 

[RickyScott]

If your workload was 4 new patients a week on average.

exactly- if you have to be present until 4:00 in an employed hospital setting anyway and your baseline is 4-5 pts, no extra time committment

 

[deleted1180461]

Why would anyone pick 3 or 4? I’m assuming most rad oncs make $400k+ which means 40% of the those extra income would go to tax so why would anyone double up their load for 30% increase income?

Because there are some of us (not a lot it seems sometimes) out there who didn’t grow up with family money and appreciate the opportunity to earn an extra of what is multiples of the average American income EVEN after tax. We also tend to save nearly all of our income and keep gold and cash at home because of generational fears of depression and poverty that haven’t fully shaken out. Would I double my patient load for an extra 100k per year? Absolutely as long as I’m below my FI number. It’s perhaps my biggest gripe about this field. An inability to hustle and moonlight. 99% of job openings are for M-F full time, bankers hours.

 

[communitydoc13]

Saw nine consults this week...treating four. At least my clinic values my input!

Not every week like this...but in the old days there were never weeks like this.

 

[pikachu]

Why would anyone pick 3 or 4? I’m assuming most rad oncs make $400k+ which means 40% of the those extra income would go to tax so why would anyone double up their load for 30% increase income?

Double the work, double the money. There's no other way that would make sense.

 

[yesmaster]

What would the % break down look like if you asked every rad onc in the country the following options (compared to their current situation):

1. Stay equally busy and receive the same pay.
2. See 25% more patients and receive 20% more pay.
3. See 50% more patients and receive 30% more pay.
4. See 100% more patients and receive 50% more pay.

I'd go with:
2% (basically OTN)
20%
50%
28%

Which is to say that almost all rad oncs would feel that they have excess capacity in their current roles.

Totally agree with you about underemployment and this is just hypothetical, but the fact that pay doesn’t scale linearly with workload in this scenario, it might be subconscious way hospitals have made us believe there should be a cap. Can’t make more than local hospital ceo or you’re a bad doctor.

 

[deleted1180461]

Saw nine consults this week...treating four. At least my clinic values my input!

Not every week like this...but in the old days there were never weeks like this.

I thought it was just me. My conversion rate is typically low 90s right now I think it’s about 75%.

 

[deleted1180461]

Totally agree with you about underemployment and this is just hypothetical, but the fact that pay doesn’t scale linearly with workload in this scenario, it might be subconscious way hospitals have made us believe there should be a cap. Can’t make more than local hospital ceo or you’re a bad doctor.

I will repeat this ad nauseum on this board. DO. NOT. TAKE. A. CONTRACT. WITH. A. SLIDING. SCALE. WRVU. PAYOUT.

You are scabbing the profession when you agree to this absurdity. In a FFS model, your work is measured per RVU, and those RVUs have equal value INDEFINITELY. They don’t suddenly become worth less after October until dec 31 or something.

Get paid as you produce. Arbitrary timeframes are just that. It doesn’t matter how many RVUs you produce in a year any more than it does in a fortnight.

The above response about doubling workload for less than double pay assumes a scenario of declining reimbursements.

 

[medgator]

I will repeat this ad nauseum on this board. DO. NOT. TAKE. A. CONTRACT. WITH. A. SLIDING. SCALE. WRVU. PAYOUT.

You are scabbing the profession when you agree to this absurdity. In a FFS model, your work is measured per RVU, and those RVUs have equal value INDEFINITELY. They don’t suddenly become worth less after October until dec 31 or something.

Get paid as you produce. Arbitrary timeframes are just that. It doesn’t matter how many RVUs you produce in a year any more than it does in a fortnight.

The above response about doubling workload for less than double pay assumes a scenario of declining reimbursements.

No different than PP where you are paid per CPT code. 💯

Unfortunately when you have an oversupply, this kind of crap happens and is accepted by someone eventually