Medicare plans to cut RO reimbursement by 14%

[Tedebear]

I think the salaries have always been around 200k for one. For two, I think they have risen about 10% + recently due to the dire need of PCPs that is out there. Nevertheless, they are still not starting in the 300's + for the most part, like many other specialties and while the PCP/hospitalist thing may be hot right now, I think this is a trend that will likely go back to what it was before. Like everything, it's cyclical. Why are their salaries still in the 200's vs what theya re for other specialties? Also there isn't anywhere to go for the most part salary wise with these positions, so you won't see the higher salaries you'll see for other specialties mid career.

If you read the above article it specified that the purpose of the CMS cut is to equalize the specialists salary to the primary care salary.

CMS cuts are not a one year phenomenon. The goal is to take money from the specialists and give to the primary care physicians. If you talk to most cardiologists, radiologists, and surgeons at your hospital they feel that this will happen under the umbrella of bundle payments and hospital employment.

No where does it say that a hospital must pay a radiologist or anesthesiologist $300,000 plus out of residency. In fact, since jobs are so few in these specialties there are radiologists and anesthesiologists taking academic jobs for less than $200,000 in these specialties right now.

Also, politicians do not care or know it takes 5-6 years to become a specialist and 3 years to become a PCP. All they know is that the primary care physicians are on the politicians side to cut specialists salary to fund PCP's salary. Read the CMS report and notice that internal medicine, pediatric, and family medicince actually have an increase in %. Every other specialty has decrease in %. Was that by accident?

Regardless, by the time you are done with residency, if you truly believe that the salary will be the same in this era of Hospital employment, Obamacare, and PCPs working hand in hand with politicians to cut subspecialty salary is a huge leap of faith on your part.

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[Tedebear]

I think the salaries have always been around 200k for one. For two, I think they have risen about 10% + recently due to the dire need of PCPs that is out there. Nevertheless, they are still not starting in the 300's + for the most part, like many other specialties and while the PCP/hospitalist thing may be hot right now, I think this is a trend that will likely go back to what it was before. Like everything, it's cyclical. Why are their salaries still in the 200's vs what theya re for other specialties? Also there isn't anywhere to go for the most part salary wise with these positions, so you won't see the higher salaries you'll see for other specialties mid career.

One more thing. Obamacare is NOT cyclical. This is the first time in history such a healthcare policy passed. Hillarycare did not pass. Also, the rise in hospitalists is also not cyclical because PCPs won't go back to seeing patients in their clinic and admitting patients in the hospital. Hospitals give credentials for PCPs to admit patients. Currently, they are cutting back PCP's credentials to Hospitalists because Hospitalists are hospital employees. We can't just be simplistic and say "everything in medicine" is cyclical.

 

[DrAwsome]

If you read the above article it specified that the purpose of the CMS cut is to equalize the specialists salary to the primary care salary.

CMS cuts are not a one year phenomenon. The goal is to take money from the specialists and give to the primary care physicians. If you talk to most cardiologists, radiologists, and surgeons at your hospital they feel that this will happen under the umbrella of bundle payments and hospital employment.

No where does it say that a hospital must pay a radiologist or anesthesiologist $300,000 plus out of residency. In fact, since jobs are so few in these specialties there are radiologists and anesthesiologists taking academic jobs for less than $200,000 in these specialties right now.

Also, politicians do not care or know it takes 5-6 years to become a specialist and 3 years to become a PCP. All they know is that the primary care physicians are on the politicians side to cut specialists salary to fund PCP's salary. Read the CMS report and notice that internal medicine, pediatric, and family medicince actually have an increase in %. Every other specialty has decrease in %. Was that by accident?

Regardless, by the time you are done with residency, if you truly believe that the salary will be the same in this era of Hospital employment, Obamacare, and PCPs working hand in hand with politicians to cut subspecialty salary is a huge leap of faith on your part.

I think that like with everything, it's a cyclical thing. Do you think people will continue to go into rads, rad onc, and other lengthy specialties when they are making the same as PCPs? No, not really, and then there will be a shortage of specialists, which will drive up payments to specialists once again. This is what's happening even in other countries-look at Canada, Australia, etc-they are offering their rads and rad oncs in the 1/2 million + because there is such a shortage of those professions there (same way that rads for example were making mid 6 figs in the 2005-2008 era).

No, I do not think highly of Obama or politicians, but I do think that there is a reason why specialists get paid more, here and everywehre else. Is it because specialists are some magical identify that intrinsically deserve more $$? No, in part it is because few people will go into these specialties (double the training +) if the pay sucks. No one will train for 3, 4 or more years to be a specialist, with higher liability, if they get paid the same as primary care docs. The reason hospitals/private practices pay more for specialists is because that's the "market price" for these specialists, and what's required to attract people into the field. Now there is a huge need for PCPs, so there is some higher payment to PCPs.

Do you honestly think people will put in double the amount of work to get paid the same? Rads is already seeing this, with a huge # of open positions in the last year's match.
Do you think that rad oncs are really going to be working for 200k? Go see what happens with the competitiveness of rad onc if wages drop. Rad onc used to be very uncompetitive in the past, now with increased wages, it's one of the most competitive specialties.

And primary care docs are being naive to think that they won't be targets in the future.

 

[DrAwsome]

One more thing. Obamacare is NOT cyclical. This is the first time in history such a healthcare policy passed. Hillarycare did not pass. Also, the rise in hospitalists is also not cyclical because PCPs won't go back to seeing patients in their clinic and admitting patients in the hospital. Hospitals give credentials for PCPs to admit patients. Currently, they are cutting back PCP's credentials to Hospitalists because Hospitalists are hospital employees. We can't just be simplistic and say "everything in medicine" is cyclical.

The new hospitalist gig is rather attractive for many people. I am personally getting offers constantly even though I'm not in primary care, with offers of up to 250kish, 7 on/7 off. If i was a new grad, I don't see why I wouldn't take it, and avoid the hassles of dealing with a private practice.

So you think all PCPs/hospitalits will be making 300k from now on, and that specialists will be making in the 200's? Again I ask-how do you think that would work? Because few people would be going into specialties then.

 

[napoleondynamite]

Do you think people will continue to go into rads, rad onc, and other lengthy specialties when they are making the same as PCPs?

The answer to this question is YES. Most people do not make their decision based solely on how long a residency is. If radonc and family med paid the same, would I do two additional years of training to not have to see 40 patients a day with runny noses?? Um, yes! People love to ask me about how depressing oncology must be. Well, I think that spending my life managing diabetes, hypertension and viral URI's after all these years of sacrifice, schooling and debt, well..I find that depressing. I happen to love radonc and think it is bar none the coolest specialty in medicine, regardless of what we make at the end of the day. That's my honest opinion, not speaking from a high horse I promise.

I don't know where exactly you guys are getting these figures from. But as with everything, it depends on many variables including geography, academic vs private, benefits, etc. There are radonc jobs I interviewed for where I could start at double what I am going to start at. I'm sure for every 200k starting family med job there are ten that start at 140 or 150 taking into account other variables. But it's not all about money. The money is nice and, don't get me wrong, it sucks that our specialty is on the horizon to make less and less money. I love money, I want to make a lot of it and get very rich some day. That is my plan. Nothing wrong with that either. But, money ain't everything and you can bet that people would still choose specialties other than primary care even if the pay was equal. Just sayin'

 

[DrAwsome]

The answer to this question is YES. Most people do not make their decision based solely on how long a residency is. If radonc and family med paid the same, would I do two additional years of training to not have to see 40 patients a day with runny noses. Um, yes! People love to ask me about how depressing oncology must be. Well, I think that spending my life managing diabetes, hypertension and viral URI's after all these years of sacrifice, schooling and debt, well..I find that depressing. I happen to love radonc and think it is bar none the coolest specialty in medicine, regardless of what we make at the end of the day. That's my honest opinion, not speaking from a high horse I promise.

I don't know where exactly you guys are getting these figures from. But as with everything, it depends on many variables including geography, academic vs private, benefits, etc. There are radonc jobs I interviewed for where I could start at double what I am going to start at. I'm sure for every 200k starting family med job there are ten that start at 140 or 150 taking into account other variables. But it's not all about money. The money is nice and, don't get me wrong, it sucks that our specialty is on the horizon to make less and less money. I love money, I want to make a lot of it and get very rich some day. That is my plan. Nothing wrong with that either. But, money ain't everything and you can bet that people would still choose specialties other than primary care even if the pay was equal. Just sayin'

Well I absolutely agree with you that money is not everything, and changing from derm I'll likely make less in rad onc than derm but find rad onc so much more worthwhile so we are on the same page there. However the reason many specialties are competitive is because of the $$ they make. If derm and rad onc made the same as IM/FM, then they would be far more competitive and while you may decide that you would 100% do rad onc, I think many others would not choose to complete lengthy residencies.

While most people do not make their decision solely on how long residency is, financial compensation certainly is factored into this. And let's face it-a lot of the specialties that are so competitive are that way because of finances. If you look at other countries you will find that derm and rad onc are not nearly as competitive. In places like India, peds is rather competitive, and derm is in the dumps. In many South American countries, psych and Ob are at the top of the game.

So if we reduce all specialties to the same $ financially speaking, you will see a lot more people choosing to say hey I'll deal with URIs and diarrhea for a 3 year residency vs. doing 6+ in rads or 5 in rad onc or whatever for same pay.

 

[Tedebear]

The new hospitalist gig is rather attractive for many people. I am personally getting offers constantly even though I'm not in primary care, with offers of up to 250kish, 7 on/7 off. If i was a new grad, I don't see why I wouldn't take it, and avoid the hassles of dealing with a private practice.

So you think all PCPs/hospitalits will be making 300k from now on, and that specialists will be making in the 200's? Again I ask-how do you think that would work? Because few people would be going into specialties then.

Actually I think subspecialists and PCPs will meet somewhere in the middle. Would PCPs make more than subspecialists probably not. The trend right now is that subspecialists are employed by hospitals. A radiologist cannot tell the hospital administrator that he should be paid more than a hospitalist because he trained for 4 more years. It doesn't work that way. Also, if you look up medicare physician payment codes. A hospitalist is considered a "subspecialist".

Lastly, it doesn't matter if there are fewer people going into a specialty because there is always a greater supply than demand.

How?

FMGs and IMGs will fill in the spots. Theres is a huge excess here. If the trend continues I expect radiology and anesthesiology to be like pathology. More and more FMGs and IMGs will be radiology residents. The end result will be the same amount of radiologists and anesthesiologists finish residency every year. Albeit less U.S. Medical graduates in these programs.

 

[Tedebear]

The government and CMS does not owe medical students squat.

If they want to (and will) cut reimbursement of radiology, dermatology, and anesthesiology to PCP salaries. That is the way it goes.

No politician is going to say, "Hey this means less medical students are going to be specialists". It doesn't work that way.

Primary Care Physicians interest groups and PACS is much bigger than radiology, anesthesiology, dermatology, and rad onc combined. Plus, politically speaking it doesn't make logical sense to maintain a two tier physician payment plan for the politician.

Most physicians will agree that PCPs are underpaid. And most subspecialists are overpaid. The problem is that subspecialists do not want a pay cut.

The politicians have shrewely pitted PCP vs Subspecialists and are sideing with the PCPs for increased pay (at the expense of the subspecialists).

 

[napoleondynamite]

FMGs and IMGs will fill in the spots. Theres is a huge excess here. If the trend continues I expect radiology and anesthesiology to be like pathology. More and more FMGs and IMGs will be radiology residents. The end result will be the same amount of radiologists and anesthesiologists finish residency every year. Albeit less U.S. Medical graduates in these programs.

I don't know about that. Last year, for the first time in history, there were more US graduating seniors from medical schools than there were residency positions available. This means there are US seniors who in the future will not be able to get a residency position in even the least competetive specialties. There has been a virtual explosion of D.O. medical schools and this is the result (no disrespect intended toward D.O.'s, it's just the truth).

Anyway, I think the trend of filling less-competetive specialties with FMG's will be on the decline.

 

[DrAwsome]

Actually I think subspecialists and PCPs will meet somewhere in the middle. Would PCPs make more than subspecialists probably not. The trend right now is that subspecialists are employed by hospitals. A radiologist cannot tell the hospital administrator that he should be paid more than a hospitalist because he trained for 4 more years. It doesn't work that way. Also, if you look up medicare physician payment codes. A hospitalist is considered a "subspecialist".

Lastly, it doesn't matter if there are fewer people going into a specialty because there is always a greater supply than demand.

How?

FMGs and IMGs will fill in the spots. Theres is a huge excess here. If the trend continues I expect radiology and anesthesiology to be like pathology. More and more FMGs and IMGs will be radiology residents. The end result will be the same amount of radiologists and anesthesiologists finish residency every year. Albeit less U.S. Medical graduates in these programs.

I think that trend will be with all specialists if that happens, not just rads and anesthesia, and rad-onc certainly is not immune. Rad onc was filled with IMG/FMGs in the past precisely because of compensation issues-look at rosters of programs, and you will see that countless chairs/older attendings are foreign and have studied abroad. With the increase in payment has come an increase in AMG interest in the specialty-like I said, pendulum. If payments drop, then there will be a wave of primary care interest and lower interest in specialty training that will hit across the board.

 

[Tedebear]

I don't know about that. Last year, for the first time in history, there were more US graduating seniors from medical schools than there were residency positions available. This means there are US seniors who in the future will not be able to get a residency position in even the least competetive specialties. There has been a virtual explosion of D.O. medical schools and this is the result (no disrespect intended toward D.O.'s, it's just the truth).

Anyway, I think the trend of filling less-competetive specialties with FMG's will be on the decline.

Did not know that. Makes sense. Thanks.

Regardless, I think the caliber of students going into subspecialty of radiology and anesthesiology will go down. Since the best students will shy away from specialties that essentially require a fellowship to be employable.

One good news about rad onc is that it doesn't require a fellowship to get a job like rads and gas.

 

[DrAwsome]

The government and CMS does not owe medical students squat.

If they want to (and will) cut reimbursement of radiology, dermatology, and anesthesiology to PCP salaries. That is the way it goes.

No politician is going to say, "Hey this means less medical students are going to be specialists". It doesn't work that way.

Primary Care Physicians interest groups and PACS is much bigger than radiology, anesthesiology, dermatology, and rad onc combined. Plus, politically speaking it doesn't make logical sense to maintain a two tier physician payment plan for the politician.

Most physicians will agree that PCPs are underpaid. And most subspecialists are overpaid. The problem is that subspecialists do not want a pay cut.

The politicians have shrewely pitted PCP vs Subspecialists and are sideing with the PCPs for increased pay (at the expense of the subspecialists).

Are you even in the medical field? It doesn't seem so.

There is a market price for everything, just like actors are paid millions for movies, because that's what the market pays, not because they are special.

Same with specialists. More training/expertise, etc = more pay. Has been that way and will likely always be, here and everywhere else. Just like CRNAs and NPs get paid more than regular nurses. And part of the reason specialist pay has been so high is because that has been what has been the amount of $$ that is sufficiently high to attract people to committ themselves to such levels of training, liability, etc.

It's ridiculous to believe that neurosurgery, rads, rad onc, anesthesia, etc should make the same as FM. Why not pay doctors the same as nurses too then? Then we could save a bundle!

 

[Tedebear]

Agreed!

That is why it is absolutely stupid for anyone to pick a specialty unless they are genuinely interested in that specialty.

 

[DrAwsome]

Did not know that. Makes sense. Thanks.

Regardless, I think the caliber of students going into subspecialty of radiology and anesthesiology will go down. Since the best students will shy away from specialties that essentially require a fellowship to be employable.

One good news about rad onc is that it doesn't require a fellowship to get a job like rads and gas.

"Gas" does not require a fellowship for one, and for two, there is a tremendous amount of needs for anesthesiologists, reason why CRNAs have been developed. Further, gas training is 3-4 years, rad onc is 5, so rad onc is an out of itself is longer. Rad onc got hit extremely hard in the CMS fee reduction proposition, and given the low # representation in PACs, it is very vulnerable. So I would be careful about being so happy and content with other specialties getting cut, because if it happens there, it will continue to happen in rad onc as well. We should all unite, not put down other fields.

 

[Tedebear]

Medicine is not a true open market system. Like NBA basketball players like Jeremy Lin going to different teams to gauge market value.

Payments are dictated by CMS reimbursements. If the CMS decided to cut radiology MRI reimbursement 50% they can do it. A radiologist does not go around to different hospitals to try to get a higher reimbursement for MRI images.

Medicine is not a free market system.

Are you even in the medical field? It doesn't seem so.

There is a market price for everything, just like actors are paid millions for movies, because that's what the market pays, not because they are special.

Same with specialists. More training/expertise, etc = more pay. Has been that way and will likely always be, here and everywhere else. Just like CRNAs and NPs get paid more than regular nurses. And part of the reason specialist pay has been so high is because that has been what has been the amount of $$ that is sufficiently high to attract people to committ themselves to such levels of training, liability, etc.

It's ridiculous to believe that neurosurgery, rads, rad onc, anesthesia, etc should make the same as FM. Why not pay doctors the same as nurses too then? Then we could save a bundle!

 

[DrAwsome]

Agreed!

That is why it is absolutely stupid for anyone to pick a specialty unless they are genuinely interested in that specialty.

Ridiculous. Why not double medical school education too, pay congress 3 times what they make now, and we can work for free too? That's a grand idea!

Ok, I will stop responding now.

 

[Tedebear]

"Gas" does not require a fellowship for one, and for two, there is a tremendous amount of needs for anesthesiologists, reason why CRNAs have been developed. Further, gas training is 3-4 years, rad onc is 5, so rad onc is an out of itself is longer. Rad onc got hit extremely hard in the CMS fee reduction proposition, and given the low # representation in PACs, it is very vulnerable. So I would be careful about being so happy and content with other specialties getting cut, because if it happens there, it will continue to happen in rad onc as well. We should all unite, not put down other fields.

Buddy, go to the GAS forum. Jobs have dried up. More than 20 states have said CRNAs are equivalent to Anesthesiologists.

And yes. Anesthesiology residents have to get a Critical Care Fellowship or Pain Medicine Fellowship to get a job in this market. Gas is 1 year internship like rad onc and 3 years training. It is only 1 less year than Rad-Onc.

 

[Sheldor]

Curious, now that these have been out for a couple weeks, has anybody heard how these will effect salaries for the next few years?

 

[radninja]

Curious, now that these have been out for a couple weeks, has anybody heard how these will effect salaries for the next few years?

Still not certain its going to go into effect. Its only the proposed rule. My guess is ASTRO and other groups are going to lobby to have the decision reversed during the comment period before they come out with the final rule.

 

[Neuronix]

They all had offers in the low 200's for a 5 day work week with complete loan forgiveness.

Where are you rotating, Montana? My girlfriend is a new FP attending and her offers were in the low to mid 100s with those sorts of hours.

 

[DrAwsome]

Where are you rotating, Montana? My girlfriend is a new FP attending and her offers were in the low to mid 100s with those sorts of hours.

I think your gf did not get good financial offers. I mean I even posted some offers that I've seen recently for hospitalists, which can be either FM/IM, and they go from 220 for the lowest up to 270k.

 

[smq123]

I think your gf did not get good financial offers. I mean I even posted some offers that I've seen recently for hospitalists, which can be either FM/IM, and they go from 220 for the lowest up to 270k.

As someone in FM, I've seen a lot of the job offers that you're referring to.

As always, with ALL job offers (in all fields!), job offers that you can readily see only tell half the story.

Some hospitals, particularly those in big cities in the Northeast (i.e. NYC, Philadelphia, DC) will not hire FM hospitalists. They require that all hospitalists be IM trained. They MAY hire someone in FM who has completed a hospitalist fellowship....but then that's an extra year or two tacked on after residency.

Other hospitals that pay that much for an FM hospitalist will not tell you up front that it's an open ICU - i.e. that you're required to follow your patients in and out of the ICU. Some people (FM or IM) are not cool with that.

Finally, again, salaries are extremely region dependent (again, for all fields). As someone who did residency in Philadelphia, there is almost no way that you'd see a job offer for that much, even for a hospitalist job. In parts of central Pennsylvania (which we not-so-affectionately call "Pennsyltucky"), you MIGHT see salaries that high....might. But the Northeastern part of the US does not reimburse well, whether you're a surgeon or a cardiologist or a pediatrician. Or a radiation oncologist, for that matter.

So, again, just because you've "seen" job offers for a certain number, that doesn't mean that you understand the whole story behind it. I mean, it's not unheard of to get paid $250K for outpatient primary care only....but I'm not willing to do OB call every other night for eternity, and live in Texarkana on top of that. But they certainly don't tell you that in the pretty little job flier that they send out. They'll just highlight the $250K and hope that you don't ask too many questions.

For the record, I actually am happy with the salary that I got. It's not huge, but it's more than enough for me and the lifestyle that I currently want to live. That being said, I realize fully that I say that because I don't have loans, and I genuinely, honestly, enjoy primary care. So...my opinion might be different from the average FM grad who has a lot more loans, has children, has a mortgage, etc.

 

[Pointless]

As someone in FM, I've seen a lot of the job offers that you're referring to.

As always, with ALL job offers (in all fields!), job offers that you can readily see only tell half the story.

Some hospitals, particularly those in big cities in the Northeast (i.e. NYC, Philadelphia, DC) will not hire FM hospitalists. They require that all hospitalists be IM trained. They MAY hire someone in FM who has completed a hospitalist fellowship....but then that's an extra year or two tacked on after residency.

Other hospitals that pay that much for an FM hospitalist will not tell you up front that it's an open ICU - i.e. that you're required to follow your patients in and out of the ICU. Some people (FM or IM) are not cool with that.

Finally, again, salaries are extremely region dependent (again, for all fields). As someone who did residency in Philadelphia, there is almost no way that you'd see a job offer for that much, even for a hospitalist job. In parts of central Pennsylvania (which we not-so-affectionately call "Pennsyltucky"), you MIGHT see salaries that high....might. But the Northeastern part of the US does not reimburse well, whether you're a surgeon or a cardiologist or a pediatrician. Or a radiation oncologist, for that matter.

So, again, just because you've "seen" job offers for a certain number, that doesn't mean that you understand the whole story behind it. I mean, it's not unheard of to get paid $250K for outpatient primary care only....but I'm not willing to do OB call every other night for eternity, and live in Texarkana on top of that. But they certainly don't tell you that in the pretty little job flier that they send out. They'll just highlight the $250K and hope that you don't ask too many questions.

For the record, I actually am happy with the salary that I got. It's not huge, but it's more than enough for me and the lifestyle that I currently want to live. That being said, I realize fully that I say that because I don't have loans, and I genuinely, honestly, enjoy primary care. So...my opinion might be different from the average FM grad who has a lot more loans, has children, has a mortgage, etc.

to that post.

 

[DrAwsome]

As someone in FM, I've seen a lot of the job offers that you're referring to.

As always, with ALL job offers (in all fields!), job offers that you can readily see only tell half the story.

Some hospitals, particularly those in big cities in the Northeast (i.e. NYC, Philadelphia, DC) will not hire FM hospitalists. They require that all hospitalists be IM trained. They MAY hire someone in FM who has completed a hospitalist fellowship....but then that's an extra year or two tacked on after residency.

Other hospitals that pay that much for an FM hospitalist will not tell you up front that it's an open ICU - i.e. that you're required to follow your patients in and out of the ICU. Some people (FM or IM) are not cool with that.

Finally, again, salaries are extremely region dependent (again, for all fields). As someone who did residency in Philadelphia, there is almost no way that you'd see a job offer for that much, even for a hospitalist job. In parts of central Pennsylvania (which we not-so-affectionately call "Pennsyltucky"), you MIGHT see salaries that high....might. But the Northeastern part of the US does not reimburse well, whether you're a surgeon or a cardiologist or a pediatrician. Or a radiation oncologist, for that matter.

So, again, just because you've "seen" job offers for a certain number, that doesn't mean that you understand the whole story behind it. I mean, it's not unheard of to get paid $250K for outpatient primary care only....but I'm not willing to do OB call every other night for eternity, and live in Texarkana on top of that. But they certainly don't tell you that in the pretty little job flier that they send out. They'll just highlight the $250K and hope that you don't ask too many questions.

For the record, I actually am happy with the salary that I got. It's not huge, but it's more than enough for me and the lifestyle that I currently want to live. That being said, I realize fully that I say that because I don't have loans, and I genuinely, honestly, enjoy primary care. So...my opinion might be different from the average FM grad who has a lot more loans, has children, has a mortgage, etc.

I am sorry you disagree. Maybe I live in an area of the country where salaries are high for some reason (and I live in a pretty major city, not in the middle of Idaho), but I actually have 2 friends who actually signed on to hospitalist positions this past week-one is FM and one is IM. Both were hired as hospitalists, neither one of them has an extra year completed-both with 3 year residencies, and one was hired for 290k, one for 310k. Neither one is doing OB call every other day, both have call one in 7, from home. I have a gas buddy who signed on for 315k, and who actually is fellowship trained. So while that may not be your experience and I can respect that, it is hardly true that high salaries for primary care are not out there, not to mention plentiful jobs anywhere and everywhere you want to work, which is not true for most specialties. Personally also doing moonlighting/urgent care where I am at, pay is close to $150 an hour, and I'd be looking at close to 280k if I worked full time during the year until residency. Fellow colleagues I believe are making the same if not more. All of them either IM/FP, some foreign, some AMG mix, and none of them fellowship trained.

Lastly, you saw the postings I made regarding the high salaries for the primary care positions. Clearly these are not salaries/positions I just made up out of nowhere. Are you saying they are not real, or that they are being deceptive? Not quite understanding.

 

[Cancerdancer]

DrAwsome

There is data available on the reimbursement patterns for physicians. Find it, post it, and then argue that PCPs are making major coin. Quit with the anecdotes.

 

[smq123]

I am sorry you disagree. Maybe I live in an area of the country where salaries are high for some reason (and I live in a pretty major city, not in the middle of Idaho), but I actually have 2 friends who actually signed on to hospitalist positions this past week-one is FM and one is IM. Both were hired as hospitalists, neither one of them has an extra year completed-both with 3 year residencies, and one was hired for 290k, one for 310k. Neither one is doing OB call every other day, both have call one in 7, from home. I have a gas buddy who signed on for 315k, and who actually is fellowship trained. So while that may not be your experience and I can respect that, it is hardly true that high salaries for primary care are not out there, not to mention plentiful jobs anywhere and everywhere you want to work, which is not true for most specialties.

Lastly, you saw the postings I made regarding the high salaries for the primary care positions. Clearly these are not salaries/positions I just made up out of nowhere. Are you saying they are not real, or that they are being deceptive? Not quite understanding.

Your friends are hospitalists and yet still have 1-in-7 call?

I thought that was the reason a lot of people became hospitalists....no call.

And yes, it is extremely region dependent. Even a major city in the midwest or the northwest will pay much better than a major city in the northeast.

To give you an example, I did my residency at a community hospital outside Philadelphia. The hospitalists there were being offered $180K. They did not hire FM for hospitalist positions.

In the same health system, the outpatient primary care guys were being offered $130K. You get a productivity bonus only once you start bringing in over $260K....but only 10% of anything over $260K.

This health system barely bothers recruiting and posting job offers. Because of its location, they know that they will be inundated with CVs by people who would love to live near Philadelphia. So you never hear about these types of places unless you're looking to get a job in that area (which I'm assuming that you are not).

And, if you haven't learned this yet, you should learn it before you start looking for jobs: all job offers are too good to be true until proven otherwise. That place in Atlanta that pays $170K? Oh, by the way, they want you to take care of a minimum of 30 suboxone patients. No worries, they'll give you a crash 8 hour online course on suboxone management. (This was a real requirement that was told to me at the tail end of a job interview!) That job in Ohio that offers a $25K signing bonus and loan forgiveness? What they don't tell you, until the interview, is that you'll be covering 5 different hospitals that are an hour drive apart from each other. Oops! No big deal, right? That job in California that offers $160K a year? They want you to see 50 patients a day...it's ok if they include that in your contract, right?

So yes, there ARE jobs for primary care that pay well out there. But until you're the one sitting down going over the contract and the job responsibilities in painstaking detail, you can't say that these are feasible jobs or if they're being deceptive - no matter what your friends may be saying. Remember, 40% of all physicians leave their first job within the first 3 years out of residency. At some point, the money just isn't worth it.

 

[Pointless]

I am sorry you disagree. Maybe I live in an area of the country where salaries are high for some reason (and I live in a pretty major city, not in the middle of Idaho), but I actually have 2 friends who actually signed on to hospitalist positions this past week-one is FM and one is IM. Both were hired as hospitalists, neither one of them has an extra year completed-both with 3 year residencies, and one was hired for 290k, one for 310k. Neither one is doing OB call every other day, both have call one in 7, from home. I have a gas buddy who signed on for 315k, and who actually is fellowship trained. So while that may not be your experience and I can respect that, it is hardly true that high salaries for primary care are not out there, not to mention plentiful jobs anywhere and everywhere you want to work, which is not true for most specialties. Personally also doing moonlighting/urgent care where I am at, pay is close to $150 an hour, and I'd be looking at close to 280k if I worked full time during the year until residency. Fellow colleagues I believe are making the same if not more. All of them either IM/FP, some foreign, some AMG mix, and none of them fellowship trained.

Lastly, you saw the postings I made regarding the high salaries for the primary care positions. Clearly these are not salaries/positions I just made up out of nowhere. Are you saying they are not real, or that they are being deceptive? Not quite understanding.

Alright, the medical student has been indulged enough. Time to move on.

 

[DrAwsome]

Alright, the medical student has been indulged enough. Time to move on.

Not a med student, sorry I dont know how to change the status.

 

[DrAwsome]

Your friends are hospitalists and yet still have 1-in-7 call?

I thought that was the reason a lot of people became hospitalists....no call.

And yes, it is extremely region dependent. Even a major city in the midwest or the northwest will pay much better than a major city in the northeast.

To give you an example, I did my residency at a community hospital outside Philadelphia. The hospitalists there were being offered $180K. They did not hire FM for hospitalist positions.

In the same health system, the outpatient primary care guys were being offered $130K. You get a productivity bonus only once you start bringing in over $260K....but only 10% of anything over $260K.

This health system barely bothers recruiting and posting job offers. Because of its location, they know that they will be inundated with CVs by people who would love to live near Philadelphia. So you never hear about these types of places unless you're looking to get a job in that area (which I'm assuming that you are not).

And, if you haven't learned this yet, you should learn it before you start looking for jobs: all job offers are too good to be true until proven otherwise. That place in Atlanta that pays $170K? Oh, by the way, they want you to take care of a minimum of 30 suboxone patients. No worries, they'll give you a crash 8 hour online course on suboxone management. (This was a real requirement that was told to me at the tail end of a job interview!) That job in Ohio that offers a $25K signing bonus and loan forgiveness? What they don't tell you, until the interview, is that you'll be covering 5 different hospitals that are an hour drive apart from each other. Oops! No big deal, right? That job in California that offers $160K a year? They want you to see 50 patients a day...it's ok if they include that in your contract, right?

So yes, there ARE jobs for primary care that pay well out there. But until you're the one sitting down going over the contract and the job responsibilities in painstaking detail, you can't say that these are feasible jobs or if they're being deceptive - no matter what your friends may be saying. Remember, 40% of all physicians leave their first job within the first 3 years out of residency. At some point, the money just isn't worth it.

I guess I won't say anything further on this matter since you seem to get very upset. I certainly don't want to upset you/offend you but I think that there is another side of the story to this. Good luck with your new job is all.

 

[deleted4401]

Seriously gotta end the topic... It was marginally relevant, but has devolved into PCP salaries and other nonsense none of us care about...

Interesting, though, how open PCP/ER are about their salaries, while we really tiptoe around the numbers. It's like they have a benefit in telling people how high their salaries are, while we minimize it...

 

[Gfunk6]

To steer this back to a related Rad Onc topic . . .

I was offered $410,000/year for a Rad Onc position in a semi-rural/suburban area. However I would be the ONLY Rad Onc in the area and would soley be responsible for all radiation-related care. Even if I wanted to take a trip on weekends or holidays, I had to set up a locums Rad Onc guy.

Like Spiderman said: "With great power [$$$] comes great responsibility." Though I was nearly seduced by the stratospheric salary (+ RVU bonuses!) I did not feel ready for that level of responsibility coming out of residency. Also, I wasn't crazy about the quality of life in a semi-rural area.

Moral: Salary isn't everything and doesn't tell the whole story.

 

[DrAwsome]

To steer this back to a related Rad Onc topic . . .

I was offered $410,000/year for a Rad Onc position in a semi-rural/suburban area. However I would be the ONLY Rad Onc in the area and would soley be responsible for all radiation-related care. Even if I wanted to take a trip on weekends or holidays, I had to set up a locums Rad Onc guy.

Like Spiderman said: "With great power [$$$] comes great responsibility." Though I was nearly seduced by the stratospheric salary (+ RVU bonuses!) I did not feel ready for that level of responsibility coming out of residency. Also, I wasn't crazy about the quality of life in a semi-rural area.

Moral: Salary isn't everything and doesn't tell the whole story.

That is a ton of responsibility to be the only one of your kind. I have heard of those types of salaries and more in rural areas due to the great need though. I also heard that there will be a huge shortage of rad oncs by 2020. What are your thoughts on increasing residency spots? yay or nay?

 

[Gfunk6]

That is a ton of responsibility to be the only one of your kind. I have heard of those types of salaries and more in rural areas due to the great need though. I also heard that there will be a huge shortage of rad oncs by 2020. What are your thoughts on increasing residency spots? yay or nay?

Absolutely no idea.

 

[deleted4401]

Yeah, but we are all not the famous and mighty G-Funk getting baseball player money offers. I got one for $350-400 in a city 40 miles outside Charlotte with about 12-15 on treatment...

To steer this back to a related Rad Onc topic . . .

I was offered $410,000/year for a Rad Onc position in a semi-rural/suburban area. However I would be the ONLY Rad Onc in the area and would soley be responsible for all radiation-related care. Even if I wanted to take a trip on weekends or holidays, I had to set up a locums Rad Onc guy.

Like Spiderman said: "With great power [$$$] comes great responsibility." Though I was nearly seduced by the stratospheric salary (+ RVU bonuses!) I did not feel ready for that level of responsibility coming out of residency. Also, I wasn't crazy about the quality of life in a semi-rural area.

Moral: Salary isn't everything and doesn't tell the whole story.

 

[medgator]

Yeah, but we are all not the famous and mighty G-Funk getting baseball player money offers. I got one for $350-400 in a city 40 miles outside Charlotte with about 12-15 on treatment...

Not shabby at all, but I'm sure it probably doesn't top out a whole lot above that. It seems like the hospital-employed positions will start you off higher, but your ceiling is lower compared to a pure rad onc or multi-specialty private practice. The reverse seems to be true in partnership/PP models (lower starting salary, higher overall potential down the road).

 

[BraggPeak]

I put a note in my cover letter saying, don't contact me unless you're willing to pay me a minimum of $350,000 + 12 weeks vacation.

Still waiting for interview offers...

 

[Palex80]

I finished my radiation oncology training 1,5 years ago and I am currently an attending in a clinic with 8 other radiation oncologists (1 of them in training).

I make roughly $ 145.000 per year, before taxes and insurance.
My vacation is 5 weeks / year.

I have about 15 patients on treatment.

How does that sound to you guys?

 

[deleted4401]

It sounds like we don't want to work in Europe

 

[Gfunk6]

I finished my radiation oncology training 1,5 years ago and I am currently an attending in a clinic with 8 other radiation oncologists (1 of them in training).

I make roughly $ 145.000 per year, before taxes and insurance.
My vacation is 5 weeks / year.

I have about 15 patients on treatment.

How does that sound to you guys?

Well, I assume that your education was very low-cost, possibly free. Also, I'm pretty sure that you don't have to deal with the level of medical malpractice and litigiousness that we do in the US. Also, I'm sure your health insurance premiums are far cheaper.

Plus you get all the chocolates, cheese and watches you want, right?

 

[napoleondynamite]

I finished my radiation oncology training 1,5 years ago and I am currently an attending in a clinic with 8 other radiation oncologists (1 of them in training).

I make roughly $ 145.000 per year, before taxes and insurance.
My vacation is 5 weeks / year.

I have about 15 patients on treatment.

How does that sound to you guys?

I'd take 145k in Euros

 

[medgator]

I'd take 145k in Euros

Yeah, maybe 3 years ago. Have you seen the euro lately?

 

[Palex80]

Well, I assume that your education was very low-cost, possibly free.

I did not pay for any tuition.

Also, I'm pretty sure that you don't have to deal with the level of medical malpractice and litigiousness that we do in the US.

Indeed. Probaly 1 case every 5 years or so with a patient actually going that way.

Also, I'm sure your health insurance premiums are far cheaper.

I pay around $600/month for health insurance. It covers only myself, but it covers everything.

Plus you get all the chocolates, cheese and watches you want, right?

True, true, I get lots of chocolate and cheese. I am not that much into watches though.

Anyways, I just wanted to point out the fact, that we are in a whole different situation concerning earnings in Europe. If you reach the level of head or vice-head of a department however, you can make over $500.000/year in some cases here too.

 

[Gfunk6]

The Euro (1 euro = 1.2260 US dollars) is doing a bit better than the Swiss Franc (1 Swiss franc = 1.0208 US dollars).

Still, $145k/year for no tuition, universal health insurance, and low malpractice rates is not a bad deal.

 

[Tedebear]

Especially when you consider being below the heavily taxed tax bracket.

Making more than $250k on paper sounds good until you see your first paycheck with top tier tax bracket.

 

[medgator]

Especially when you consider being below the heavily taxed tax bracket.

Making more than $250k on paper sounds good until you see your first paycheck with top tier tax bracket.

It's about to get worse next year with the possible double whammy of increased income tax rates along with new surcharges on investment and interest income on those people making $200-250K and up

 

[Pointless]

Especially when you consider being below the heavily taxed tax bracket.

Making more than $250k on paper sounds good until you see your first paycheck with top tier tax bracket.

Just want to clarify this, as it is a widely held misconception: the US federal tax system is progressive, meaning that you only pay the rate per dollar above each given tax tier. So, in the example above, somebody who makes 251,000 would only pay the increased tax rate on the $1000 that exceeds $250,000.

The moral: don't renegotiate your contract from 260k to 249k and pat yourself on the back for avoiding the long reach of Uncle Sam....

 

[ToasterThief]

Just want to clarify this, as it is a widely held misconception: the US federal tax system is progressive, meaning that you only pay the rate per dollar above each given tax tier. So, in the example above, somebody who makes 251,000 would only pay the increased tax rate on the $1000 that exceeds $250,000.

The moral: don't renegotiate your contract from 260k to 249k and pat yourself on the back for avoiding the long reach of Uncle Sam....

The amount of people in this country who believe it's possible to lose money by going from say, a tax bracket at $250,000 to $250,001 is staggering. And I bet it includes a huge number of physicians.

 

[Gfunk6]

Here is a letter drafted by US Senators Debbie Stabenow (D-Mich.) and Richard Burr (R-N.C.) which is being circulated to help gather support against Rad Onc cuts.

 

[deleted4401]

By the way, DrAwesome does not seem to know history of radiation salaries. We have ALWAYS been paid well, even when it was non-competitive. In the 80s and early 90s, radoncs did well. What happened was that in the 90s computers got awesome and rad onc became cool. The hours and workload became worse. Compare planning a head and neck treatment now versus drawing a lateral field and matching to a low neck. Talking about 2-3 hours versus 7 minutes.

But, my point #1 is that I don't equate years of training directly with salary. That's dumb. It's so dumb I won't even go into why it's so dumb.

Point #2 is that I'd take less money to do this over FP even if money was equal and training was more, as long as hours are equal. I take more pleasure in therapeutics than prevention, I love palliative care, and the desperation/gravity of the situation feels more worth my while.

Point #3 is that I will fight to do the death to not let #2 happen

S

P.S. - I love the word "holistic" at the end of Debbie's letter. Really makes us sound in line with the PCPs. Nice touch. It's a good letter... Might be time to finally send to ASTROPac

 

[DoctwoB]

It also seems odd to me that CMS expects cutting reimbursements will cut healthcare spending costs. They've tried this before. It hasn't worked. Why? Because people are (understandably) resistant to having their salary cut, and will take actions to maintain their pay.

Say CMS cuts SBRT professional fees by 20%. What will a rad-onc that is accustomed to a certain income level do?
Option 1 = take it and accept lower income

Option 2 = irradiate more patients, which increases both professional fees AND technical fees paid by CMS, net result = increased healthcare utilization, increased costs.

Option 3 = shunt more patients into fancy new higher paying treatment du jour. Right now thats IMRT and protons. I have no doubt soon there will be new toys with high costs and debatable benefit. Once again, but professional and technical costs go up and overall costs go up.

My money is on most people pursuing options 2 and 3.