Med student trying to understand the field

[NotMattSpraker]

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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.

Right, this is my point. Layer on AI, why hire?

Look at be proposed poll, same argument. It is cheaper to have the same person work more than hire another person.

I’d choose same work same pay but only because I have a lucky job with leadership that aggressively protects time off but still pays well.

The last guy I worked for and his buddies are perfectly happy with a junior working 90 hours a week and 280.

Burn out is no issue when there is an endless supply of new grads to hire.

 

[Mandelin Rain]

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.

That’s the premise of the question I’m asking.

Nearly 100% of rad oncs would want to be busier as long as salary increase is linear. But how much more busy would you be willing to be if your salary still increased, but at a diminishing rate of increase.

I think many of us would still do it because we feel 1.badly underutilized currently 2.have seen our salary cut over past decade and 3.it’s not that hard to be busy in rad onc if you’re in a supportive ecosystem.

 

[deleted1180461]

That’s the premise of the question I’m asking.

Nearly 100% of rad oncs would want to be busier as long as salary increase is linear. But how much more busy would you be willing to be if your salary still increased, but at a diminishing rate of increase.

I think many of us would still do it because we feel 1.badly underutilized currently 2.have seen our salary cut over past decade and 3.it’s not that hard to be busy in rad onc if you’re in a supportive ecosystem.

It's hard to imagine how this hypothetical would play out. I initially interpreted it as the common "reimbursements are declining so we need to see more patients to make the same or slightly more money."

But in this case, it would be like admin approaching you and saying hey we've got these secret patients we are losing to another system. We will let you treat them but only if you do it at a reduced rate.

Or possibly, "hey, we just acquired a satellite, we need you to drive out there 2 days a week to cover. But we're not going to pay you $70/wRVU for those patients.... we're thinking more like $50 becase, well, fŭck you. You can say no, but this is our only offer." Would I do it? Probably, but only because I'm hungry and stupid like that. I'd never agree to this contract on the front end.

 

[proverbial_soup]

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?

This is the med student again. I appreciate hearing this opinion. It sounds like the concern for rad onc's decline derives from 1) developments in xrt, and 2) rise in resident training. I was wondering if anyone could expound upon these concerns with empiric data/evidence. It's not that I don't believe you all, I just want to make sure I'm making informed career choices based on data, rather than speculation about what is happening or is going to happen to the market. Rad onc is such a small field that it is sensitive to small changes in market forces. I am trying to discern whether the pessimism about rad onc is a long-term trend or just a temporary downswing, akin to what radiology experienced in the early 2010s and has since made a complete rebound. Thanks everyone for the input. It means a lot to me.

 

[Mandelin Rain]

It's hard to imagine how this hypothetical would play out. I initially interpreted it as the common "reimbursements are declining so we need to see more patients to make the same or slightly more money."

But in this case, it would be like admin approaching you and saying hey we've got these secret patients we are losing to another system. We will let you treat them but only if you do it at a reduced rate.

Or possibly, "hey, we just acquired a satellite, we need you to drive out there 2 days a week to cover. But we're not going to pay you $70/wRVU for those patients.... we're thinking more like $50 becase, well, fŭck you. You can say no, but this is our only offer." Would I do it? Probably, but only because I'm hungry and stupid like that. I'd never agree to this contract on the front end.

It was just a hypothetical to see what extent people would go to make more money/be less bored, but of course that’s the other problem. There’s no mechanism to make it happen.

We’re underutilized currently. Pay has been dropping, in part because of it. Most have a lot of excess capacity that could used to support their previous level of income. But there’s no demand to fill it.

It’s a bad problem to have.

 

[medgator]

This is the med student again. I appreciate hearing this opinion. It sounds like the concern for rad onc's decline derives from 1) developments in xrt, and 2) rise in resident training. I was wondering if anyone could expound upon these concerns with empiric data/evidence. It's not that I don't believe you all, I just want to make sure I'm making informed career choices based on data, rather than speculation about what is happening or is going to happen to the market. Rad onc is such a small field that it is sensitive to small changes in market forces. I am trying to discern whether the pessimism about rad onc is a long-term trend or just a temporary downswing, akin to what radiology experienced in the early 2010s and has since made a complete rebound. Thanks everyone for the input. It means a lot to me.

Astro workforce study which was done after much hand wringing and was watered down... Still shows an eventual oversupply.

Or perhaps ask yourself where the "evidence" came for residencies to expand as much as they did since the turn of the century? Especially during an era of less treatment of prostate and breast cancer, increased uptake of hypofrac etc. Intuitively taken together, it makes zero sense

Numerically, someone posted before that rad onc has expanded more on a percentage basis than any other specialty in medicine over the last two decades.

We are a very niche specialty.

Do you want to take that kind of risk?

 

[drowsy12]

One of the reasons I think rad onc market has stayed mostly stable/afloat despite decrease in fractionations and classic indications is because of the move to employment. many rad oncs employed at median salary, but perhaps less busy than they may have been in the past. Agree that the ability to just hustle harder to make more is not as readily available in rad onc.

a move to diagnosis based reimbursement is likely to extend stabilization in my view.

my honest opinion is that rad onc will likely stay mostly the same as now, for at least the next decade. Past that I am unsure.

 

[proverbial_soup]

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.

Just want to reply because I see several posts like this. I recognize that palliative care is an entirely different field than radiation oncology. The fields draw from separate interests/skill sets that are both big parts of my life, in the same way that, say, a college student who double majored in Spanish and engineering might enjoy careers at the UN or at NASA, despite the numerous differences between the two. Many of you are correct that palliative care has a multitude of drawbacks (e.g. significantly lower salary, harsher hours). I'm trying to weigh whether the drawbacks of radiation oncology should significantly outweigh palliative care or my other specialty considerations.

Either way, appreciate the feedback that everyone has provided.

 

[RickyScott]

This is the med student again. I appreciate hearing this opinion. It sounds like the concern for rad onc's decline derives from 1) developments in xrt, and 2) rise in resident training. I was wondering if anyone could expound upon these concerns with empiric data/evidence. It's not that I don't believe you all, I just want to make sure I'm making informed career choices based on data, rather than speculation about what is happening or is going to happen to the market. Rad onc is such a small field that it is sensitive to small changes in market forces. I am trying to discern whether the pessimism about rad onc is a long-term trend or just a temporary downswing, akin to what radiology experienced in the early 2010s and has since made a complete rebound. Thanks everyone for the input. It means a lot to me.

Every ASCO, the overall footprint of radiation in oncology seems to decrease. If radiation were to loose favorable breast ca, this would be a black swan type event for the job market. I routinely loose definitive cases in lung and esophagus to chemo in lung and gi that I would have treated just several years ago. In lymphoma and myeloma we seem have been eliminated. I hardly palliate them either.

 

[NotMattSpraker]

This is the med student again. I appreciate hearing this opinion. It sounds like the concern for rad onc's decline derives from 1) developments in xrt, and 2) rise in resident training. I was wondering if anyone could expound upon these concerns with empiric data/evidence. It's not that I don't believe you all, I just want to make sure I'm making informed career choices based on data, rather than speculation about what is happening or is going to happen to the market. Rad onc is such a small field that it is sensitive to small changes in market forces. I am trying to discern whether the pessimism about rad onc is a long-term trend or just a temporary downswing, akin to what radiology experienced in the early 2010s and has since made a complete rebound. Thanks everyone for the input. It means a lot to me.

You should read this paper and maybe stay away from the related blog posts.

The American Society for Radiation Oncology Workforce Taskforce Review of the United States Radiation Oncology Workforce Analysis - PubMed

Over the past decade, concerns have arisen in radiation oncology regarding potential workforce supply and demand imbalance. The American Society for Radiation Oncology commissioned an independent analysis in 2022, looking at supply and demand in the United States radiation oncology workforce and...

pubmed.ncbi.nlm.nih.gov

This is really good in my opinion. The limitation is that it is hard to model the future and they only modeled to 2030, before you would graduate training.

There is just a lot of uncertainty in the future of RO, could be stability, exploding, or crashing. I think it is more uncertain that the other fields you mentioned.

Uncertainty is different than pessimism.

I matched in 2013 and remember the radiology doom and gloom. No one then predicted a rebound. Personally I don’t think you can rely on an explosion of therapy the way there was an explosion of diagnostics but of course anything is possible.

My interpretation of the linked model is that there is more likely to be oversupply than under by 2030.

 

[StIGMA]

Talked to pharma regarding how radiation is discussed at trial design phase where chemoRT and chemo alone are standard of care options (+/- investigational therapy). “Chemotherapy is done everywhere but radiation isnt, so we use chemotherapy alone on the trials.”

You can project how this has been and will continue to affect standard of care treatments moving forward. They wont run a 4 arm trial if they can justify 2 arm.

Eg: https://www.astrazeneca.com/media-c...on-cancers-in-matterhorn-phase-iii-trial.html

 

[SneakyBooger]

 

[deleted1180461]

View attachment 387806

Good luck with that. I’ve been trying to get someone to send me an arthritis patient for years and still have yet to treat one.

 

[deleted1180461]

Talked to pharma regarding how radiation is discussed at trial design phase where chemoRT and chemo alone are standard of care options (+/- investigational therapy). “Chemotherapy is done everywhere but radiation isnt, so we use chemotherapy alone on the trials.”

You can project how this will affect standard of care treatments moving forward.

Eg: https://www.astrazeneca.com/media-c...on-cancers-in-matterhorn-phase-iii-trial.html

This is the fault of US training in oncology. Radiation should be a sub specialization after med onc. Med onc should be standalone after an intern year in medicine, not a fellowship.

 

[SneakyBooger]

Good luck with that. I’ve been trying to get someone to send me an arthritis patient for years and still have yet to treat one.

I'm booked out for 4 months with arthritis but I only see 3-4 arthritis consults a week otherwise I couldn't see any cancer patients. Unless you are doing only peds, you already have the patients coming in - start with your cancer patients who have arthritis and it will grow from there.

 

[RickyScott]

I'm booked out for 4 months with arthritis but I only see 3-4 arthritis consults a week otherwise I couldn't see any cancer patients. Unless you are doing only peds, you already have the patients coming in - start with your cancer patients who have arthritis and it will grow from there.

In a large academic multi hospital system, arthritis is still a no go. Much more effort is spent eliminating xrt indications or reducing xrt fractions than towards expanding indications.

 

[DrProtonX]

If you wanna know state of job market. Here’s a job post. It’s $450k for 7700 wRVU which is about $60/wRVU (so far okay) but then you see the messed up part. Somehow anything over that your pay drops to $38/wRVU!!! Also that place has 7k population and 2 hour drive to Seattle. Can’t imagine Rads or Med Onc job there below 600-700k plus much much better incentives!

 

[deleted1180461]

If you wanna know state of job market. Here’s a job post. It’s $450k for 7700 wRVU which is about $60/wRVU (so far okay) but then you see the messed up part. Somehow anything over that your pay drops to $38/wRVU!!! Also that place has 7k population and 2 hour drive to Seattle. Can’t imagine Rads or Med Onc job there below 600-700k plus much much better incentives!

Utter dogs**t
This garbage isn't uncommon, but what's new is they are advertising this on the front-end, like it's some kind of perk of the job. Imagine any other job: You can get overtime here! Oh sweet, time-and-a-half! Oh it's just regular pay? Oh, you're going to pay me only half my regular rate for overtime? LOL. Excuse me while I call the employment commission.

 

[Ray D. Ayshun]

Just saw this

 

[DrProtonX]

Utter dogs**t
This garbage isn't uncommon, but what's new is they are advertising this on the front-end, like it's some kind of perk of the job. Imagine any other job: You can get overtime here! Oh sweet, time-and-a-half! Oh it's just regular pay? Oh, you're going to pay me only half my regular rate for overtime? LOL. Excuse me while I call the employment commission.

Now if you’re a grad who’s in 300k debt and has been living off a 60k/year resident salary for the past 5 years, ofcourse you feel “satisfied” when you sign a $450k job! That’s why I think the survey that said 90% of the grads were satisfied with their job placement doesn’t mean anything. They should do a 3-5 year follow up, my guess is that 90% isn’t gonna hold up!

 

[NotMattSpraker]

Now if you’re a grad who’s in 300k debt and has been living off a 60k/year resident salary for the past 5 years, ofcourse you feel “satisfied” when you sign a $450k job! That’s why I think the survey that said 90% of the grads were satisfied with their job placement doesn’t mean anything. They should do a 3-5 year follow up, my guess is that 90% isn’t gonna hold up!

People have been talking about this for years, no one really wants the answer.

A 6000 RVU job in Sequim for $450,000 could be great for the right person, but Im guessing probably not for a lot new grads.

 

[RickyScott]

Utter dogs**t
This garbage isn't uncommon, but what's new is they are advertising this on the front-end, like it's some kind of perk of the job. Imagine any other job: You can get overtime here! Oh sweet, time-and-a-half! Oh it's just regular pay? Oh, you're going to pay me only half my regular rate for overtime? LOL. Excuse me while I call the employment commission.

What would primary care or psych get in this location?

 

[Ray D. Ayshun]

People have been talking about this for years, no one really wants the answer.

A 6000 RVU job in Sequim for $450,000 could be great for the right person, but Im guessing probably not for a lot new grads.

The Olympic Peninsula is a pretty spectacular place, but not for everyone...

 

[deleted1180461]

Looks like they have 2 rad oncs, presumably someone gave 90 days notice last week, and they are going to fill through Weatherby (costs what, $3500-4000/day to the agency?) rather than let the other rad onc absorb the wRVUs at their bs reduced rate? LOL. This is literally the exact question Mandelin Rain was asking the other day that I was struggling to come up with a real-life scenario for (doubling your work for 50% more pay).

These 2 person-employed gigs are some of the worst out there. All they have to do it get one person to agree to a trash contract, and it locks whoever else takes the other spot into. Will never let one person have it all. Solo or group gigs are way better.

 

[Mandelin Rain]

Looks like they have 2 rad oncs, presumably someone gave 90 days notice last week, and they are going to fill through Weatherby (costs what, $3500-4000/day to the agency?) rather than let the other rad onc absorb the wRVUs at their bs reduced rate? LOL. This is literally the exact question Mandelin Rain was asking the other day that I was struggling to come up with a real-life scenario for (doubling your work for 50% more pay).

These 2 person-employed gigs are some of the worst out there. All they have to do it get one person to agree to a trash contract, and it locks whoever else takes the other spot into. Will never let one person have it all. Solo or group gigs are way better.

And my guess is the other doc there would gladly to do it if they'd hire locums to cover their vacation.

 

[Mandelin Rain]

Wonder what happens when you don't meet that 7700 RVU annual threshold after the first 1 or 2 years...? Sorry, we can no longer support that base salary. The most we can possibly pay is 300k.

Don't buy a home if you're considering this job.

 

[deleted1180461]

Wonder what happens when you don't meet that 7700 RVU annual threshold after the first 1 or 2...? Sorry, we can no longer support that base salary. The most we can possibly pay is 300k.

Don't buy a home if you're considering this job.

I'm not even sure you can rent something with more than 2 bedrooms at that point.
I'm sure they will be willing to prove to you what they are able to pay by showing you their accounts quoting their fair market value consultant.