New Doximity Compensation Report is out

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in my experience this would not apply to new grads or early career radoncs looking to get raises. Presently, jobs paying 600k+ are mostly available in undesirable locations in which all the specialties are recieving high salaries. The problem with radonc is location, location, location.
 
If you took every rad onc and averaged their annual incomes, then that would probably be close. But that is a meaningless data point. What does a 0.5 FTE mommy-track salaried rad onc in SoCal have in common with a solo linac owner in rural Louisiana who sees 20 consults a week?
 
The thing I don't understand is, if the field is oversupplied then why isn't the average salary being driven down? If the supply is high then surely the demand decreases? Yet, every year the rad onc average salary remains so high.
 
RickyScott said:
in my experience this would not apply to new grads or early career radoncs looking to get raises. Presently, jobs paying 600k+ are mostly available in undesirable locations in which all the specialties are recieving high salaries. The problem with radonc is location, location, location.
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Is the argument you're making that the reason rad onc average salaries are so high is that a greater percentage of rad oncs are in horrible locations? Interesting.
 
allseasons said:
The thing I don't understand is, if the field is oversupplied then why isn't the average salary being driven down? If the supply is high then surely the demand decreases? Yet, every year the rad onc average salary remains so high.
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The sample size for rad onc in these surveys are always ridiculously low. I’d bet there are less than 30 rad oncs comprising this Doximity salary data. Willing to be proven wrong and hopefully will be, but historically, that’s usually how it goes.
 
TheWallnerus said:
The sample size for rad onc in these surveys are always ridiculously low. I’d bet there are less than 30 rad oncs comprising this Doximity salary data. Willing to be proven wrong and hopefully will be, but historically, that’s usually how it goes.
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I guess I would say that's all well and good but the numbers and the overall picture remains the same year after year in these surveys, MGMA, etc. at some point should just be taken at face value IMO. all the caveats about location limitation etc are baked in and always have been
 
alwaysbeIMRTing said:
If you took every rad onc and averaged their annual incomes, then that would probably be close. But that is a meaningless data point. What does a 0.5 FTE mommy-track salaried rad onc in SoCal have in common with a solo linac owner in rural Louisiana who sees 20 consults a week?
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To be fair, this is also true for a lot of fields. A new urologist in NYC isn't making close to those numbers either, although I imagine they have an easier time finding a job than a radonc in NYC.
 
drowsy12 said:
I guess I would say that's all well and good but the numbers and the overall picture remains the same year after year in these surveys
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Not really.

Doximity's first report came out in 2017. Since then, rad onc is (supposedly) up 32%, neurosurgery up 20%.

And if you believe rad onc is up 32%, cool. ASTRO needs to quit its goshdarn complaining.

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They got 37,000 responses too. That averages to 740 per field. Obviously that’s not evenly split by every field of course, but I’d assume they have a decent sample size of rad onc. Or at least, it shouldn’t be any more skewed than other small specialties.
 
allseasons said:
if the field is oversupplied then why isn't the average salary being driven down?
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I wouldn't put a lot of stock in the Doximity survey. All surveys are dicey...response rate is almost always below 25% and usually much lower.

Still, the order of specialties is roughly correct. If the sky were falling, it would show up in Doximity.

Radonc is still well compensated. Inertia plays a big role (very hard to cut wages), as do the peculiarities of a gradually replaced work force, variance in compensation...all of that. A big booster of salaries over the past 20 years in radonc was the increase in academic salaries relative to say the 1990s. These lag behind private jobs in terms of market forces (young academics in prestige organizations were leaving for very lucrative PP jobs in the 2000's). To be fair, academic salaries were likely increased through advocacy by academic leadership and the fact that academic radonc often gets paid huge amounts per intervention (there really was an IMRT gold rush). (People thought some of these chairs were business geniuses...well maybe Paul Wallner was 😳).

Nearly all docs have lost real earning power over the past many decades. This is the life of the highly paid professional class in today's America, which overwhelmingly favors the ownership class.

But here's the rub IMO. The distribution problem for most docs is real and a big deal. There are many locations in the US where primary care doctors and most specialties are undersupplied and waits are excessive for a PCP appointment, GI, cards, even diagnostic rads. In most places away from major metros, there is close to no snobbery at all for recruiting IMGs or DOs or folks with many prior jobs.

The exception is radiation oncology, where some combination of the field's size, the high capital investment required for treatment tools, the variable regulatory environment and our peculiar compensation model means that where there is a linac, there is likely a doc to be found, and that doc is likely to be profitable for any system in place. (The locums market tells you everything you need to know.). The new payment schedule is unlikely to change any of this.

The leaders who promoted residency expansion are not vulnerable to our tirades about decreased marked value or oversaturation of rad docs. Nor do they care if we make a bit less on average.

They just believe that all other specialties are undersupplied. I don't know that they are wrong.

If I was an aspiring radonc I would not worry too much about compensation. If you are looking to optimize income, do dentistry, ortho away from a major city, entrepreneurial derm or cash services plastics.

What will undoubtedly be true is that your geographic flexibility and your ability to move on from a bad job will be markedly less than pretty much any other doc out there.

You should also consider that you will be continually and gradually marginalized as molecular oncology improves and evidence-based oncology matures. You will always (well foreseeably) have a role. It is just likely to be less in the definitive setting as you move through your career. (It has certainly become less during mine). Radonc is not where the intellectual excitement is (if that is what you care about).

Good luck!
 
allseasons said:
They got 37,000 responses too. That averages to 740 per field. Obviously that’s not evenly split by every field of course, but I’d assume they have a decent sample size of rad onc. Or at least, it shouldn’t be any more skewed than other small specialties.
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drowsy12 said:
You’re making my point.
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More than half of US rad oncs get reimbursed 200K or less per year by Medicare, about a quarter less than 100K per year, and the fraction that do gets larger every year. And Medicare is the biggest payer of rad onc services in America and has decreased reimbursement to rad onc by 20% or more these last twenty or so years.

And yet, average rad onc salary goes up almost more than any other specialty per year… according to the surveys. Even Jesus would be impressed by such miracles.

And yes one year there was a rad onc MGMA with something like 40 respondents. (It’s admittedly gotten lots better, but I’m still skeptical of other surveys… for lots of reasons.)
 
TheWallnerus said:
More than half of US rad oncs get reimbursed 200K or less per year by Medicare, about a quarter less than 100K per year, and the fraction that do gets larger every year.
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Well, if you are at a large, urban academic center, what is your payor mix? We know that a small number of interventions with high pay payors can contribute enormously to the bottom line and in principle you are paid for more than just clinical care.

We are also in an era of massive consolidation.

Not sure if these seemingly exclusive trends (stable to increasing pay with lots of docs collecting a little in terms of medicare) are really so.
 
There are plenty of RadOncs in workforce making >550K total comp; Doximity salary survey though is not the one you should be looking at. Sample
size too small etc. I’ve found AAMC faculty report to be the most valuable
 
A_DeMichele said:
There are plenty of RadOncs in workforce making >550K total comp; Doximity salary survey though is not the one you should be looking at. Sample
size too small etc. I’ve found AAMC faculty report to be the most valuable
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I've only been midwest and east coast, but in both locations, this seems to be a pretty reasonable estimate of what to expect for total compensation after 8-10 years of practice (even in academics). As always when having these conversations, people need to be clear on what compensation means. Its not just salary. Bonus and fringe can easily end up being 25%+ of your base salary.

What I don't know and would love for someone with firsthand knowledge to speak up is what happens with the people taking instructor/non-tenure positions at academic satellite centers? They start low and on paper often don't have much room for advancement. What can they expect after 10 years of practicing? Those positions are becoming a lot more common but feel like a black box in some ways.
 
ramsesthenice said:
I

What I don't know and would love for someone with firsthand knowledge to speak up is what happens with the people taking instructor/non-tenure positions at academic satellite centers? They start low and on paper often don't have much room for advancement. What can they expect after 10 years of practicing? Those positions are becoming a lot more common but feel like a black box in some ways.
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exactly. I have not heard of anyone taking a salary cut, hence the average may still be high, but have anecdotally heard that it is becoming increasingly harder for juniors to get raises. My sense is that the only place right now to be on track to make this kind of money is a less than desirable location, where other specialties are also paying high premiums.
 
RickyScott said:
exactly. I have not heard of anyone taking a salary cut, hence the average may still be high, but have anecdotally heard that it is becoming increasingly harder for juniors to get raises. My sense is that the only place right now to be on track to make this kind of money is a less than desirable location, where other specialties are also paying high premiums.
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Still getting cuts. Places in BFE/meth country that used to pay $800-mil now offering 600-650k
 
medgator said:
Still getting cuts. Places in BFE/meth country that used to pay $800-mil now offering 600-650k
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My sense is that new grads can hope for career salaries of 4-500 k in academic satellites in Kentucky/Kansas, which is the floor for other specialties in those locations. Of course, the radoncs probably wont be very busy.
 
ramsesthenice said:
I've only been midwest and east coast, but in both locations, this seems to be a pretty reasonable estimate of what to expect for total compensation after 8-10 years of practice (even in academics). As always when having these conversations, people need to be clear on what compensation means. Its not just salary. Bonus and fringe can easily end up being 25%+ of your base salary.

What I don't know and would love for someone with firsthand knowledge to speak up is what happens with the people taking instructor/non-tenure positions at academic satellite centers? They start low and on paper often don't have much room for advancement. What can they expect after 10 years of practicing? Those positions are becoming a lot more common but feel like a black box in some ways.
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If you are making <550K total comp, you are probably getting jipped. I agree that you gotta look at all your benefits including health care, 401k match, fsa/hsa, dca etc etc.

I think additional pre tax savings like 457b are non compensation related that could greatly impact your in pocket benefit.
 
Doximity isn't the best source and I don't think employers ever go off of a Doximity report, more often MGMA, other benchmark systems or in some cases data kept by programs in a small field like this (I think you can buy it now?).

In my experiences as a rule of thumb I think for academics expect to make 300-400k starting out, maybe slightly higher in remote satellite positions, and mid high 200s in really popular areas, and then a little bit higher based on professorship which can take a decade to advance in.

Community jobs increase that number by 100k and a lot of PP people I know are around this or a little higher as well. Live in the middle of no where or be in a great PP job and make even higher than that.

I think these surveys aren't supposed to be straight salary, but total compensation, and what I think that means is subtract about 30-50k in most cases.

Once you start making more and more money you get decreasing returns due to taxes and it may not be worth it. I'd rather live somewhere I want to live then to make a 100k higher salary, after taxes that is closer to around 55-65k depending on your state.

I'd personally do this job for less than I am currently making and I fully expect to have to prove that in the upcoming years.

Idk if there is an ARRO survey floating around anywhere these days, but the last one I saw was pretty close to this.
 
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A_DeMichele said:
There are plenty of RadOncs in workforce making >550K total comp; Doximity salary survey though is not the one you should be looking at. Sample
size too small etc. I’ve found AAMC faculty report to be the most valuable
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How do I see the AAMC faculty report averages? Is there anything online or do I have to buy it?
 
medgator said:
Still getting cuts. Places in BFE/meth country that used to pay $800-mil now offering 600-650k
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I still see these offers, but is anyone actually taking them?

FWIW, there are definitely people in desirable areas make more than
CurbYourExpectations said:
Doximity isn't the best source and I don't think employers ever go off of a Doximity report, more often MGMA, other benchmark systems or in some cases data kept by programs in a small field like this (I think you can buy it now?).

In my experiences as a rule of thumb I think for academics expect to make 300-400k starting out, maybe slightly higher in remote satellite positions, and mid high 200s in really popular areas, and then a little bit higher based on professorship which can take a decade to advance in.

Community jobs increase that number by 100k and a lot of PP people I know are around this or a little higher as well. Live in the middle of no where or be in a great PP job and make even higher than that.

I think these surveys aren't supposed to be straight salary, but total compensation, and what I think that means is subtract about 30-50k in most cases.

Once you start making more and more money you get decreasing returns due to taxes and it may not be worth it. I'd rather live somewhere I want to live then to make a 100k higher salary, after taxes that is closer to around 55-65k depending on your state.

I'd personally do this job for less than I am currently making and I fully expect to have to prove that in the upcoming years.

Idk if there is an ARRO survey floating around anywhere these days, but the last one I saw was pretty close to this.
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Are any academic places still offering 200s starting out? I was hoping COVID would have stamped that out.
 
Tangent from some posts on other threads. Why do we cling on to the idea of a place none of us wants to work giving 1mil+ offers? That is the worst argument I see anywhere. Who wants that job? Clearly not you or me or anyone apparently lol. I think the money is the least important aspect, the lack of mobility and difficulty of getting a job in the area you want is the biggest issue.

I think this is the disconnect in RadOnc. RadOncs want to make way more money than they are worth, but also **** on small community hospital centers that are struggling for not giving them money that they can't afford. What growth or help to the hospital are RadOncs bringing that are in and out a few days a week? Leeching them until they die? Oh, heroic work.

Maybe you should also intimidate medstudents anonymously.

No matter what all spots end up filling, might as well have people in the field that like the field.
 
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CurbYourExpectations said:
RadOncs want to make way more money than they are worth, but also **** on small community hospital centers that are struggling for not giving them money that they can't afford.
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If the small community hospital can't afford to staff the linac with the salary that would be required to keep someone there, why should they have a rad onc program at all? Just close it down. That seems like basic supply and demand.
 
HolySmokes said:
If the small community hospital can't afford to staff the linac with the salary that would be required to keep someone there, why should they have a rad onc program at all? Just close it down. That seems like basic supply and demand.
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Oversupply of docs looking for a job. They are hoping to find someone
 
It's unusual (but possible) for a rad onc department to not be a revenue center in a hospital. Two problems with these jobs:

1. It's not a very busy clinic and guaranteeing a 1M salary (either directly to one doc or split between 2 in a workshare arrangement) in order to recruit and retain a full time rad onc to rural North Dakota would actually make it unprofitable.

2. It is a busy clinic, but the hospital administration lacks basic business knowledge and will not allow an eat-what-you-kill unlimited income model. They want to cap the doctor(s) at MGMA median and retain the rest on the professional side in their operating margin. No doctor with a functional prefrontal cortex will sign up for this (i.e., working for free) or at least stay (I regretfully signed up for this in my PGY-6 year after a decade of the academic bubble had turned my common sense to mush. Survival instincts re-emerged rapidly) so the hospital instead pays Comphealth $4000/day to put a different warm body in there every other week and pats themselves on the back.

Either one of these results in an inability to recruit and retain to BFE.

#1 is uncommon. And it's not like the hospital doesn't run any other needed service lines at a loss.
#2 is unfortunately super common and accounts for the majority of these constantly posted crap rural jobs.
 
Doctorer said:
FWIW, there are definitely people in desirable areas make more than that
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Biggest thing for residents to understand is the value of a job is in its volume, not the advertised salary. If your goal is to maximize income (which is a fair goal for a debt-loaded early career rad onc, especially given the persistence of policy leading to high inflation and constant CMS cutting), you should be looking for a location that will allow you to be very busy, not looking for a location that you can geographically arbitrage. The only reason to do this would be if you don't have an interest in working really hard. You might get 75th percentile pay for 25th percentile work in Ogdenville, but you won't get 95th percentile.

Conversations with potential "employers" about compensation should always begin with, "how many cases will I treat per year, what is the case mix, and what is the payor mix?" Then you negotiate how much you get per wRVU and how that is paid out. If they only want to talk about RVUs in terms of a "bonus," run away. Your work should be consistently worth the same. No surgeon would sign up for a model where you perform 20 lobectomies for X amount per each, then after 20 they will pay you 50% of X and call it a "bonus" as your reward for being so productive. It is insane, but this is exactly how so many hospital contracts are structured, and due to the nature of the radiation treatment cycle not having all the charges on the same day, it makes it super easy for admins to shift numbers around so you don't actually get paid for what you do.
 
Hospital admin alway try to screw physicians, it’s not unique to rad onc. However, what’s unique to rad onc is the private practices, the people you’d consider your “mentor” also try to stick it to the younger generation. Somehow, having an 8-figure net worth is not enough to them, they must screw new grads to make few more bucks!
 
DrProtonX said:
Hospital admin alway try to screw physicians, it’s not unique to rad onc. However, what’s unique to rad onc is the private practices, the people you’d consider your “mentor” also try to stick it to the younger generation. Somehow, having an 8-figure net worth is not enough to them, they must screw new grads to make few more bucks!
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You really have to experience the greed first hand to understand it. It's amazing. It's no surprise that boomers act this way, but it's sad when amicable modest residents turn into Gollum once they obtain ownership shares and only want their peers under them at the lowest possible cost. Partnership becomes a dictatorship. Seen it.
 
Yeah it’s not boomers only in my experience. Gen X same thing. Learned from the boomers. Now elder millennials in same position.

I think they would say that they just follow what the market dictates and they can get away with not making people partners in some situations
 
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Some MDs run in crazy circles. When all your friends are medium sized business owners, you don't want to be the one showing up in Aspen on a commercial flight. Sharing partnership is going to cut into your 50k monthly lifestyle spend. To be fair, I've seen this more with radiologists.

There is a urorads named Dr. Lambo. I wonder what he drives?
 
I’ve given up on scarop or academics weaning themselves off masses of cheap labor. The bifurcation or the funnel will be after residency, many will be at mgma median being hospital and health insurer slaves, some will be at arro survey median being academic slaves, and others not many will have ownership and control and autonomy over their professional trajectory.
 
alwaysbeIMRTing said:
Some MDs run in crazy circles. When all your friends are medium sized business owners, you don't want to be the one showing up in Aspen on a commercial flight. Sharing partnership is going to cut into your 50k monthly lifestyle spend. To be fair, I've seen this more with radiologists.

There is a urorads named Dr. Lambo. I wonder what he drives?
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A toyota corolla with a Lamborghini sticker
 
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