Non clinical jobs

[FrostyHammer]

since the job market isn't going to be the best in the future, do any of y'all have ideas of what we can do after residency or a few years of clinical practice if we don't want to be clinicians? haven't really been exposed to the non clinical realm of options so if y'all have any kind of suggestions or resources that'd be great.

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[Neuronix]

There really aren't any. This is a major problem with medical training. You take on massive amounts of debt and train for many years for one thing specifically. It's not like you can go be a different type of physician, dosimetrist, medical physicist, or anything else after all that training without starting over again.

Industry jobs barely exist for rad oncs, those options are rare and often unstable.

You can be an insurance chart reviewer. I personally couldn't live with myself doing that kind of job, but it's increasingly popular to work from home and ride out non-existent job markets or these increasingly ridiculous mandatory non-compete clauses. You can also work part-time if you have a family since part-time options in clinical practice are often unavailable or particularly exploitative.

Locums isn't a bad way to go, though it's still clinical. I'm afraid that market will collapse with the job market as well, but it's been a viable option if you like part-time without putting up with all the problems that the bad full-time positions force upon you.

 

[McConaughey]

Administration...although it could be hard to get a hospital/other docs to accept with Radonc training. MBA would help. I knew a guy in med school who chose IM over Radonc just because he had planned on going into administration to some degree.


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[Neuronix]

You typically have to practice clinically for many years and then often practice clinically concurrently with those administrative positions.

 

[emt409]

There really aren't any. This is a major problem with medical training. You take on massive amounts of debt and train for many years for one thing specifically. It's not like you can go be a different type of physician, dosimetrist, medical physicist, or anything else after all that training without starting over again.

Industry jobs barely exist for rad oncs, those options are rare and often unstable.

You can be an insurance chart reviewer. I personally couldn't live with myself doing that kind of job, but it's increasingly popular to work from home and ride out non-existent job markets or these increasingly ridiculous mandatory non-compete clauses. You can also work part-time if you have a family since part-time options in clinical practice are often unavailable or particularly exploitative.

Locums isn't a bad way to go, though it's still clinical. I'm afraid that market will collapse with the job market as well, but it's been a viable option if you like part-time without putting up with all the problems that the bad full-time positions force upon you.

This is not true at all. There are TONS of jobs in the medical tech and drug industry for non-clinical MD's. The best jobs typically want you to have become boarded in something.

 

[Neuronix]

For rad oncs? Please enlighten me.

 

[medgator]

I imagine there are only so many of those jobs at Varian, mevion, Elekta etc and they probably want significant experience and publications

 

[emt409]

For rad oncs? Please enlighten me.

Most of the drug safety officer positions for drug companies offering oncologic drugs don't care whether MD is med, surg, or rad onc. Lots of biotech companies just want an MD advisor on staff, no requirement for rad onc, but rad oncs do well because of increased technical background.

If you're curious, just send your CV to to a bay area headhunter.

 

[Neuronix]

I used to work in the rad onc device industry. I know exactly four MDs currently in that space, two of whom are half time in industry and half time practicing clinically. There are probably one or two MDs I'm forgetting or haven't met plus there are consultants of varying degrees of effort who are mostly practicing clinically.

I know an MD rad onc who went off to work for a radiopharm company, but last I heard they lost that position and were doing insurance reviews.

If the industry job is looking for "any board certified MD" I'm skeptical of what kind of position it is. But there could be things I'm not aware of. This whole idea of "there are TONS of jobs" outside of clinical medicine has been thrown around in our General Residency Forum for a long time without any real proof of "tons of jobs" and a lot of skeptical users.

 

[nkmiami]

I used to work in the rad onc device industry. I know exactly four MDs currently in that space, two of whom are half time in industry and half time practicing clinically. There are probably one or two MDs I'm forgetting or haven't met plus there are consultants of varying degrees of effort who are mostly practicing clinically.

I know an MD rad onc who went off to work for a radiopharm company, but last I heard they lost that position and were doing insurance reviews.

If the industry job is looking for "any board certified MD" I'm skeptical of what kind of position it is. But there could be things I'm not aware of. This whole idea of "there are TONS of jobs" outside of clinical medicine has been thrown around in our General Residency Forum for a long time without any real proof of "tons of jobs" and a lot of skeptical users.

I am sure Apple and Google are hiring tons of radoncs at 500,000 plus because we tend to be tech minded.... and we could give them input into self driving cars etc. Just like there are tons of unadvertised jobs in well paying private practices in desirable locations for graduating residents.

 

[Gfunk6]

I can tell you that I get contacted by headhunters on LinkedIn frequently for medical director positions in industry. For curiosity sake, I've gone the distance with a few of them. The pay absolutely sucks relative to what you can earn clinically in private practice. So unless you are profoundly dissatisfied with clinical medicine, it is not a good choice. Also, these jobs are not few fresh/new grads as they require MDs with current leadership experience.

 

[deleted18755]

I can tell you that I get contacted by headhunters on LinkedIn frequently for medical director positions in industry. For curiosity sake, I've gone the distance with a few of them. The pay absolutely sucks relative to what you can earn clinically in private practice. So unless you are profoundly dissatisfied with clinical medicine, it is not a good choice. Also, these jobs are not few fresh/new grads as they require MDs with current leadership experience.

In addition they are quite unstable and I’m not sure how easy (especially in this job market) it would be to re-enter clinical medicine after being laid off.

As noted above these jobs are few and far between plus usually done on the side not exclusively.

 

[Haybrant]

It’s important to develop a skill set outside of this career. You begin to realize that the clinical skills we have are simply not that useful beyond the hospital walls. That’s not really a problem but in a lot of ways you have to wonder how long can we continue to get this level of pay? What we are generating is based simply on reimbursement codes. The physician that is terrible, meaning downright horrendous, can make the same or much much more than you. That should raise alarm bells but for decades it has not. I just can’t imagine it is sustainable. Eventually we will be paid as physicians are elsewhere in the world, maybe 3-5 years.

Related to this why can’t I charge a patient separately for the amazing care I provide that patient? Like if they are very satisfied with our interaction and their level of care is there a reason I can’t ask them to pay me for amazing customer service? I’m routinely told by patients how happy they are with their care and yet I get nothing out of that monetarily. The argument is that there would be a conflict of interest - so it’s ok for the hospital system and insurance to engage is egregious conflict of interest but not the physician. We’re being duped

 

[Sheldor]

It’s important to develop a skill set outside of this career. You begin to realize that the clinical skills we have are simply not that useful beyond the hospital walls. That’s not really a problem but in a lot of ways you have to wonder how long can we continue to get this level of pay? What we are generating is based simply on reimbursement codes. The physician that is terrible, meaning downright horrendous, can make the same or much much more than you. That should raise alarm bells but for decades it has not. I just can’t imagine it is sustainable. Eventually we will be paid as physicians are elsewhere in the world, maybe 3-5 years.

Related to this why can’t I charge a patient separately for the amazing care I provide that patient? Like if they are very satisfied with our interaction and their level of care is there a reason I can’t ask them to pay me for amazing customer service? I’m routinely told by patients how happy they are with their care and yet I get nothing out of that monetarily. The argument is that there would be a conflict of interest - so it’s ok for the hospital system and insurance to engage is egregious conflict of interest but not the physician. We’re being duped

What do you mean "paid as physicians are elsewhere in the world"? What makes you say 3-5 years?

I remember when I started down the medicine path a decade ago all I heard about was how physician salaries were all going to go way down, and bundled payments, etc. etc. Obviously, salaries have slowly been dropping, or at the very least not keeping up with inflation, but we have yet to see any massive drops. Have you seen something recently that makes you feel these cuts are more imminent?

 

[Neuronix]

The sky is not falling. I agree with Sheldor. Most of these issues are general long-term trends.

 

[medgator]

The sky is not falling. I agree with Sheldor. Most of these issues are general long-term trends.

I think in places like Canada the salaries are decent but when you go overseas to certain European and Asian countries, that is where these concerns come from

 

[Fpg1245]

What do you mean "paid as physicians are elsewhere in the world"? What makes you say 3-5 years?

I remember when I started down the medicine path a decade ago all I heard about was how physician salaries were all going to go way down, and bundled payments, etc. etc. Obviously, salaries have slowly been dropping, or at the very least not keeping up with inflation, but we have yet to see any massive drops. Have you seen something recently that makes you feel these cuts are more imminent?

But they really are dropping, it’s just not as quickly as physicians predicted but that is the goal of the payors. The older attendings don’t care but the new ones will definitely notice. Since cutting something suddenly would likely get more attention, letting inflation eat away at your real earnings is less inflammatory, but it shouldn’t be. It’s unwarrented devaluation of services.Your housing costs, property taxes, education, and pretty much anything that makes life worth living will cost more. Quite honestly, any one whose been in the field <10years should be considering retraining or getting into administration if that’s an option. Unfortunately, I don’t have the credentials to jump ship today but I am working towards it and in the next few years my goal is to essentially eliminate clinical exposure. For attendings out there who are young enough to care, I think the guiding principle for the next 30 years is this clinicians that manage patients will have more trouble financially and far higher burnout than people who manage the clinicians. Nothing about it is fair considering we have a huge cohort of aging people that require these services but this is likely what’s in store.

The sky really is falling just in slow motion. Prepare accordingly.

 

[nkmiami]

Regarding rest of world- docs dont have huge student debts as college and medical school is free/heavily subsidized, so Canadians actually have a good deal.

 

[Palex80]

Regarding rest of world- docs dont have huge student debts as college and medical school is free/heavily subsidized, so Canadians actually have a good deal.

I have heard this argument often, however:

Your "huge" student debts are generally lower than the additional salary you get in the US.
A radiation oncologist working in the best paying parts of Europe (let's say Switzerland or Germany) will rarely earn more than 250k per year.
I think that many US radiation oncologists earn considerably more than that.
So even if your student debt was a few 100k, you'd be able to pay it back within 5 years or so, right?

 

[medgator]

.Your housing costs, property taxes, education, and pretty much anything that makes life worth living will cost more.

To be fair, the last few years have been an awesome time to get a mortgage from rate perspective and some of us got good deals on houses coming out of the recession. It's all about timing (like everything else with the job situation, obviously) and rates are starting to go back up.

I do agree though, it seems ridiculous that physicians should get paid less as there is more demand for services from an aging population, unfortunately that's what is happening. It will be a sharper drop imo once we see bundles take off with more payors, but that will have a net benefit to PP and freestanding centers imo. The deck has been stacked towards hospital base and academic RO for far too long....

 

[medgator]

I have heard this argument often, however:

Your "huge" student debts are generally lower than the additional salary you get in the US.
A radiation oncologist working in the best paying parts of Europe (let's say Switzerland or Germany) will rarely earn more than 250k per year.
I think that many US radiation oncologists earn considerably more than that.
So even if your student debt was a few 100k, you'd be able to pay it back within 5 years or so, right?

It depends on where undergrad and med school training was done. Institutions in ones state of residence can be cheaper while private for both can easily top $400-500k for some people

 

[OTN]

I'm not nearly as pessimistic as others on this board.

Given the demographics of the population, reimbursements per patient essentially are going to have to drop in order for Medicare to stay even remotely solvent. That isn't necessarily going to translate into decreased income if practitioners can increase efficiency and lower costs, as volume should increase with the increasing Medicare population.

Sure, we're facing reimbursement pressures, because of course we are. Payors are going to do what they can, because they are businesses and that's what they should be doing. I would be incensed if I were a large shareholder in a major insurer and they weren't doing anything to reduce the accounts payable side of their ledger. Anytime a new therapy is introduced (IMRT for example), reimbursements steadily go down over time, no matter the field. I don't know of any medical field that isn't facing reimbursement pressures, so I'm not sure there's a 100% safe place to run to if you still want to do clinical medicine. Our field does give us the ability to ramp up volume much better than others such as surgery, so I think it may be relatively easier for us to maintain income. Finally, If you think hospital administration is going to provide safe haven, be careful- the same reimbursement cuts that you're worried about will effect those jobs as well.

However, currently a busy radonc in a good, strong private practice can still do very well, and some trends are looking good here. Specifically, though we've seen an increased # of academic satellite centers gobbling up business, payors are beginning to notice and push back. Average payments for equivalent outcomes in academic centers vs. strong private practices are 3-5x higher in academic centers for the same services, which really isn't sustainable from a payor standpoint. We've already started to see payors refuse coverage for treatment at academic centers, and I think it's only the beginning. If/When we move to case-based reimbursement, if the payment is the same, academics vs private practice, either rates will be set at levels high enough to allow great profitability in private centers or payments will be low enough to where the academic centers become insolvent. Either way, I think it could rejuvenate PP in the long run, which is long overdue and will save billions nationwide.

On the other hand, salaries for hospital-based jobs will continue to drop due to increased supply of radoncs due to residency overexpansion, no way around it. Shame, but that wound is self-inflicted, so no one to blame but ourselves.

Lots of interesting clinical developments going on as well which gives me hope for the field. I've seen a dramatic uptick in SBRT business since systemic treatment has improved due to oligometastatic disease treatment, and I think this is only going to get better once the academics actually start doing some useful research again on abscopal effects and synergy between XRT and Immunotx. SBRT for VTach is fascinating, and I strongly believe radiocardiology is about to explode.

I'm 9 years out of residency, so I fall within the "10 years out of training" population you mention should think about retraining, and I am completely confident in saying that would be the stupidest financial decision I could possibly make right now.

 

[seper]

"Average payments for equivalent outcomes in academic centers vs. strong private practices are 3-5x higher in academic centers for the same services" - I know some bombastic RadOnc's but man..

 

[medgator]

"Average payments for equivalent outcomes in academic centers vs. strong private practices are 3-5x higher in academic centers for the same services" - I know some bombastic RadOnc's but man..

Prostate Imrt in a freestanding center vs protons in hospital nci center? Maybe not....

 

[OTN]

"Average payments for equivalent outcomes in academic centers vs. strong private practices are 3-5x higher in academic centers for the same services" - I know some bombastic RadOnc's but man..

I'm part of the leadership of the largest private practice in the country, and we contract with a very, very large specialty health organization to provide capital, HR, contracting, purchasing support, etc, etc. As part of this I have met with the largest insurers in the country and leaders in the specialty health organization to talk about payment models and contracting. It was in this meeting they told us about their own robust internal data tracking both pay and outcomes across the country. According to their data- not mine- depending on tumor type the largest academic medical centers and CTCA facilities are 5x more expensive than freestanding private practice facilities with equivalency of outcomes. A second insurer told us the # was 3x.

You can choose to believe it or not, but that came straight from the insurance company.

 

[deleted18755]

To be fair, the last few years have been an awesome time to get a mortgage from rate perspective and some of us got good deals on houses coming out of the recession. It's all about timing (like everything else with the job situation, obviously) and rates are starting to go back up.

I agree the sky isn’t falling in 3-5 years but it sure is a different scenario over the course of a decade or so if you consider the overall peak of 7-8 years ago (when guys like me with slightly above average scores walked into residency and graduated ~15 years ago with minimal student debt at 2.5% interest and high incomes then used the income we made from the previous 4-5 years of working to buy a nice house ... or 2-3 more for rental income like many did ... at rock bottom prices right after the housing bust with a historically low mortgage rate locked in for 30 years) vs 2-3 years from now (rising home prices and mortgage rates, 4-5 times more debt at 6.8%, and rise of cost of everything with stagnant or decreases wages of 2-4%/yr you don’t notice in a paycheck but really add up on their own over the course of years) while fighting for jobs with hordes of brilliant and increasingly desperate new graduates.

If you think I had/have it good imagine the baby boomers before me. That’s why I wish we could suck it up and help the next generation but they just want to juice it more!

 

[seper]

1) You can keep CTCA out of this discussion for obvious reasons. 2) Unless your insurance colleagues show us some of their data, this 3x-5x cost difference between an academic center and a private practice is a lie.

I'm part of the leadership of the largest private practice in the country, and we contract with a very, very large specialty health organization to provide capital, HR, contracting, purchasing support, etc, etc. As part of this I have met with the largest insurers in the country and leaders in the specialty health organization to talk about payment models and contracting. It was in this meeting they told us about their own robust internal data tracking both pay and outcomes across the country. According to their data- not mine- depending on tumor type the largest academic medical centers and CTCA facilities are 5x more expensive than freestanding private practice facilities with equivalency of outcomes. A second insurer told us the # was 3x.

You can choose to believe it or not, but that came straight from the insurance company.

 

[OTN]

The data was/is proprietary and cannot be shown to the public/this forum. That does not make it a lie, and I am not a liar.

Believe me, my response was "we should be shouting this from the rooftops!", but if the payors don't want to share the data, not much we can do.

 

[Gfunk6]

The data was/is proprietary and cannot be shown to the public/this forum. That does not make it a lie, and I am not a liar.

Believe me, my response was "we should be shouting this from the rooftops!", but if the payors don't want to share the data, not much we can do.

I am also in a leadership position of the largest private-practice Oncology group in California and can affirm what OTN is saying for commercial payors. In fact, I would go one step further beyond academic/CTCA and say that large health systems in California can bend over insurance companies and make them pay exorbitant rates. Case in point: California sues Sutter Health, alleging the hospital system unfairly inflated costs for patients

 

[Neuronix]

Meanwhile I'm sitting here wondering when I will get paid 3x - 5x per patient

 

[medgator]

Timely job posting...

Radiation Oncologist Physicians

The Department of Health and Human Services, Center for Drug Evaluation and Research (CDER) at the Food and Drug Administration (FDA), Silver Spring, Maryland, is actively recruiting physicians specialized in Radiation Oncologists and other physicians with expertise in theragnostics and medical countermeasures to serve in a dynamic, highly challenging and innovative atmosphere at the intersection of law, medicine, and science. Medical Officers are the cornerstone of FDA's mission to ensure the safety and efficacy of drug products.

 

[Neuronix]

Timely job posting...

Radiation Oncologist Physicians

I've done some work in this area as well.

Animal Rule Information

"The Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA) added a new section 565(d) of the FD&C Act to require that FDA establish a procedure for a sponsor or applicant developing “a countermeasure for which human efficacy studies are not ethical or practicable"

This has led to a large number of startups proposing products that would be stockpiled by the government for administration to individuals affected by a nuclear incident. The beauty of such a pathway is that the company behind the agent could skip expensive and often unsuccessful clinical trials and try to convince the government to stockpile hundreds of millions of dollars worth of agents per year based on animal studies. So far the stockpiled agents are all things approved in other disease states, i.e. Neupogen. I imagine that the FDA has had a flood of these requests and need more people to critically analyze these agents and guide development.

The job posting notes GS-14 pay. Out of curiosity I pulled that up: GS-14 Pay - 2018 Federal GS Payscale

GS-14 Yearly Pay
$89,370.00 - $116,181.00

Good luck getting a full-time radiation oncologist for that kind of money.

 

[medgator]

GS-14 Yearly Pay
$89,370.00 - $116,181.00

Good luck getting a full-time radiation oncologist for that kind of money.

An IGRT linac babysitter can do far better than that, let alone what one can earn doing a full locums gig.

That being said, it's probably not bad work if it's truly a part time gig and there is just a few hours of work a week

 

[OTN]

If you read the fine print, though, it says that salaries start at GS-14 level but can be increased to account for experience and specialty certification.

 

[Radz08]

An IGRT linac babysitter can do far better than that, let alone what one can earn doing a full locums gig.

That being said, it's probably not bad work if it's truly a part time gig and there is just a few hours of work a week

I haven't heard of many IGRT linac babysitter jobs anymore. Do they still exist (outside of large organizations or groups who internally use older/semi-retired physicians to do it in house)?

 

[medgator]

I haven't heard of many IGRT linac babysitter jobs anymore. Do they still exist (outside of large organizations who internally use older/semi-retired physicians to do it in house)?

Probably not. We use a retired partner for that purpose. Pretty sweet gig for those who can get it

 

[Radz08]

Does anyone know of someone who actually transitioned out to non-clinical medicine from our field ? Successfully?

 

[Gfunk6]

Deepak Khuntia
Deepak “Dee” Khuntia, M.D. | Varian Medical Systems

However, he was clinically accomplished before his transition


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[Neuronix]

Last I heard he was still practicing part-time in addition to his roles at Varian.

You can transition out completely. I know people who have. You'll just take a huge pay cut and it may be very difficult or impossible to ever come back to clinical medicine. Those jobs are also much more unstable than clinical jobs, which could leave you in a bad position some day. The younger people still tend to work part-time clinically (still for a huge pay cut) which keeps them very busy with both jobs. Thus, this all tends to be a semi-retired person's game--if their job goes away and they don't practice again clinically, they have enough money to retire.

 

[seper]

That is the proper way to project intensity on a staff photograph.

Deepak Khuntia
Deepak “Dee” Khuntia, M.D. | Varian Medical Systems

However, he was clinically accomplished before his transition


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[OTN]

I don't know if Nik ever practiced, but he's now involved full-time in his CancerAid app:

https://www.linkedin.com/in/nikhilpooviah/

 

[Neuronix]

I wonder what the student loan debt is like coming from Australia.

 

[Radz08]

Last I heard he was still practicing part-time in addition to his roles at Varian.

You can transition out completely. I know people who have. You'll just take a huge pay cut and it may be very difficult or impossible to ever come back to clinical medicine. Those jobs are also much more unstable than clinical jobs, which could leave you in a bad position some day. The younger people still tend to work part-time clinically (still for a huge pay cut) which keeps them very busy with both jobs. Thus, this all tends to be a semi-retired person's game--if their job goes away and they don't practice again clinically, they have enough money to retire.

So if they are working more for a huge pay cut, why did they decide to make the transition?

 

[Neuronix]

Life is about more than just money. If you want to make the most money go into rural private practice. All of us not there are probably taking pay cuts for one reason or another.

 

[Radz08]

Anyone know which companies (non-clinical) hiring PP rad oncs? In conversation with a colleague this weekend they may be interested in such a position.

 

[Gfunk6]

Anyone know which companies (non-clinical) hiring PP rad oncs? In conversation with a colleague this weekend they may be interested in such a position.

If he really wants to work for corporate (or at least explore opportunities) I would highly recommend using LinkedIn. Create a detailed profile (for free) and watch the job inquiries pour in.

 

[medgator]

No one bit I guess

Radiation Oncologist Physicians

 

[medgator]

Guess they'll have to up the salary or something...

Radiation Oncologist Physicians

 

[Gfunk6]

Guess they'll have to up the salary or something...

Radiation Oncologist Physicians

Well, if a government job which has a base salary in the low $100k range is not your cup of tea, consider an advanced RO fellowship at Columbia - Columbia University Advanced Radiation Oncology Clinical Fellowship

Here you will learn such exotic technologies such as SRS, VMAT, CBCT and IORT. In other words practical and useful techniques which you neglected to pick up while studying the latest irrelevant molecular pathways for your Rad Bio exam.

 

[RadOncDoc21]

Well, if a government job which has a base salary in the low $100k range is not your cup of tea, consider an advanced RO fellowship at Columbia - Columbia University Advanced Radiation Oncology Clinical Fellowship

Here you will learn such exotic technologies such as SRS, VMAT, CBCT and IORT. In other words practical and useful techniques which you neglected to pick up while studying the latest irrelevant molecular pathways for your Rad Bio exam.

I was hoping to hone in on my inpatient palliative RT skills a little more.