Private practice "rankings"

[Radiator20]

Threads on this forum about rankings of academic residency programs have gotten a lot of attention over the years.

I think it is only fair to recognize that there are likewise some particularly strong private groups across the country.

I wonder: what do people see as some of the "strongest" or "top" private groups across the country? Obviously definition is an issue, but I am thinking along the lines of high-quality clinical care, well positioned in their market, good environment within the group.

I'll start with a few large groups I frequently hear mentioned along these lines, in no particular order. Apologies in advance for the limitations of my knowledge (especially in the West), and no offense intended to those not listed.

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)

How do others feel? And I propose a ground rule: no nominating your own group! 🙂

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[medgator]

TOPA (Texas oncology)

 

[KHE88]

A more useful thread would be "private practices to avoid."

But we don't do that in our field because we're all a bunch of chickens. It's a way to take the power back, just like discussing our salaries openly.

I mean, we won't even name bad residencies or call out the recall/cheating programs even after we've left.

 

[Haybrant]

A more useful thread would be "private practices to avoid."

But we don't do that in our field because we're all a bunch of chickens. It's a way to take the power back, just like discussing our salaries openly.

I mean, we won't even name bad residencies or call out the recall/cheating programs even after we've left.

Talking a big game, Go ahead and do it then

 

[Radiator20]

A more useful thread would be "private practices to avoid."

You are certainly welcome to start a separate thread on that question, if you wish. But I am hoping this thread can be for the question originally asked.

 

[OTN]

Tennessee Oncology

 

[Mandelin Rain]

I named Kansas City in another thread. Is the Toledo group still strong?

 

[KHE88]

Talking a big game, Go ahead and do it then

I went to a great residency program and have a great job. I have nothing negative to report.
I have heard a number of extremely disturbing things regarding a handful of programs regarding malignancy and recall use/cheating.
I am hesitant to post second hand accounts, which I have no reason not to believe, but am not prepared to do so at this time.
What is sad that the people with first hand knowledge of the bad things going on keep silent and continue to keep silent.

 

[deleted941485]

Threads on this forum about rankings of academic residency programs have gotten a lot of attention over the years.

I think it is only fair to recognize that there are likewise some particularly strong private groups across the country.

I wonder: what do people see as some of the "strongest" or "top" private groups across the country? Obviously definition is an issue, but I am thinking along the lines of high-quality clinical care, well positioned in their market, good environment within the group.

I'll start with a few large groups I frequently hear mentioned along these lines, in no particular order. Apologies in advance for the limitations of my knowledge (especially in the West), and no offense intended to those not listed.

PROG (NJ)
ROA (MA/NH)
SERO (NC)
MRO (MN)

How do others feel? And I propose a ground rule: no nominating your own group! 🙂

PROG has recently merged with RCCA and is no longer a single specialty RO group. Unless someone knows different or has additional details.

 

[OTN]

I don't think there are very many single-specialty RO groups left. TOPA and Tennessee Oncology are not, for example. I would be very hesitant to join a single-specialty RO group at this point, no matter the deal/practice.

 

[deleted941485]

PROG has recently merged with RCCA and is no longer a single specialty RO group. Unless someone knows different or has additional details.

Also PROG as well as these other premier groups only really take from top programs or if there’s a residency sort of embedded in the area. Otherwise you’re pretty SOL. This is (was) the case with PROG and Likely the case with the others as well.

 

[deleted941485]

I don't think there are very many single-specialty RO groups left. TOPA and Tennessee Oncology are not, for example. I would be very hesitant to join a single-specialty RO group at this point, no matter the deal/practice.

Well if your in NJ, that will no longer be a concern!

I’d be very hesistant to join any multi specialty oncology group that didn’t at least service like 5 or 6 different hospitals or centers. There’s just wayy too much risk being even in that scenario. Hospital decides it wants an in-house oncology...boom you work for them now.

I’ve seen a great PP med Onc group get completely decimated by big hospital Corp when they refused to sell practice. They opened up one next door. Bought out their referring. In 2 years the practice was worth nothing and they all left the state. Best part of course is they get way better drug reimbursement.

Hospital employee or academic pretty much the only thing I’m seeing around civilization. unless you go out to the sticks, PP just ain’t hiring.

 

[metview]

How likely is it to join one of these groups? Im betting you need some serious connections?

 

[deleted941485]

How likely is it to join one of these groups? Im betting you need some serious connections?

About as likely as getting into Harvard and becoming a managing director at goldman sachs and making $3M a year is before you are 30. No one you know is getting these jobs. Which was kind of the point I was making with my previous post about PROG.

 

[Radiator20]

I would be very hesitant to join a single-specialty RO group at this point, no matter the deal/practice.

Why so? Same concerns as RadsWFA outlines for a multi-specialty group, or do you have other specific concerns about the single-specialty group model?

 

[medgator]

Why so?

Where are your referrals going to come from?

 

[OTN]

I work for a large private practice oncology organization. Several reasons why I like the multi-specialty model:

You have a “built-in” referral base as mentioned. 40% of my referrals are still external, however.

As long as you’re getting paid fairly as a radonc (not all groups are the same), if at least some of the overall practice revenue is spread around, it protects you a bit from “specialty-specific” problems like urorads taking all your prostate business, etc.

I really, really have enjoyed building relationships with and learning from our medoncs, surgical oncologists, neuro-oncologists, pharmacists, etc. In building those relationships in multispecialty groups, in ours at least, it has eliminated any sort of adversarial relationship between specialities, allowing me to be able to help advocate more strongly for radiation therapy.

Large groups have an advantage: If the hospitals and academic centers have to start competing on cost, they are in trouble. We’ve been told by insurers that our outcomes are equal to those of the closest prominent academic medical center, while our costs are 20% of theirs. We are cheaper by five fold. The local hospital is reimbursed 3X what we would be for SRS. Getting to this level of efficiency, though, requires a larger physician organization, to secure a larger revenue base to fund everything you will need to be able to run such an organization. The insurers know about all this and are starting to look at their patterns of coverage.

As I thought we all knew (but some over the last decade some conveniently forgot), you don’t need a lot of radiation oncologists to treat a large population, so the size of a radonc group is naturally limited, which limits both your buying power for new equipment and your bargaining power with payers. By combining with a local/regional/national (ideally all three) organization, you gain stability of contracting and a great deal of negotiating power that goes a long way towards being profitable.

Larger groups have very good administrators and leaders who are not physicians. In my opinion physicians are good at being physicians but may or may not be good at “business”, for lack of a better term. Businesspeople are good at business. That’s their job. I like to have them do the business stuff so I can do the doctor stuff. Larger multispecialty organizations attract better candidates than smaller practices due to the possibility of promotion throughout the levels of the organization.

It’s true, though, that there are not many jobs available in these groups. Two reasons: 1. They’re great jobs, so not many people leave the practice. 2. The businesspeople referenced before help limit over-exuberant MD expansion efforts, which aren’t uncommon. Growth will be steady but not explosive. They’re not owned by a VC firm trying to get bought out.

So, if the larger groups have 50-75 radoncs and the average physician practices for 20-30 years, each group just won’t need that many people each year. The groups know how good the jobs are and look for very strong candidates who will fit in with the practice and get up and running right away. Experience and comfort with SRS/SBRT/HDR for skin/breast/gyn, multiple IGRT systems, 4D sim, etc would be considered a given for a newer grad. Pedigree helps but is one factor among many.

 

[deleted941485]

I work for a large private practice oncology organization. Several reasons why I like the multi-specialty model:

You have a “built-in” referral base as mentioned. 40% of my referrals are still external, however.

As long as you’re getting paid fairly as a radonc (not all groups are the same), if at least some of the overall practice revenue is spread around, it protects you a bit from “specialty-specific” problems like urorads taking all your prostate business, etc.

I really, really have enjoyed building relationships with and learning from our medoncs, surgical oncologists, neuro-oncologists, pharmacists, etc. In building those relationships in multispecialty groups, in ours at least, it has eliminated any sort of adversarial relationship between specialities, allowing me to be able to help advocate more strongly for radiation therapy.

Large groups have an advantage: If the hospitals and academic centers have to start competing on cost, they are in trouble. We’ve been told by insurers that our outcomes are equal to those of the closest prominent academic medical center, while our costs are 20% of theirs. We are cheaper by five fold. The local hospital is reimbursed 3X what we would be for SRS. Getting to this level of efficiency, though, requires a larger physician organization, to secure a larger revenue base to fund everything you will need to be able to run such an organization. The insurers know about all this and are starting to look at their patterns of coverage.

As I thought we all knew (but some over the last decade some conveniently forgot), you don’t need a lot of radiation oncologists to treat a large population, so the size of a radonc group is naturally limited, which limits both your buying power for new equipment and your bargaining power with payers. By combining with a local/regional/national (ideally all three) organization, you gain stability of contracting and a great deal of negotiating power that goes a long way towards being profitable.

Larger groups have very good administrators and leaders who are not physicians. In my opinion physicians are good at being physicians but may or may not be good at “business”, for lack of a better term. Businesspeople are good at business. That’s their job. I like to have them do the business stuff so I can do the doctor stuff. Larger multispecialty organizations attract better candidates than smaller practices due to the possibility of promotion throughout the levels of the organization.

It’s true, though, that there are not many jobs available in these groups. Two reasons: 1. They’re great jobs, so not many people leave the practice. 2. The businesspeople referenced before help limit over-exuberant MD expansion efforts, which aren’t uncommon. Growth will be steady but not explosive. They’re not owned by a VC firm trying to get bought out.

So, if the larger groups have 50-75 radoncs and the average physician practices for 20-30 years, each group just won’t need that many people each year. The groups know how good the jobs are and look for very strong candidates who will fit in with the practice and get up and running right away. Experience and comfort with SRS/SBRT/HDR for skin/breast/gyn, multiple IGRT systems, 4D sim, etc would be considered a given for a newer grad. Pedigree helps but is one factor among many.

At the expense of sounding presumptuous. So which one do you work for?

US Oncology
21C
Vantage Oncology

 

[medgator]

At the expense of sounding presumptuous. So which one do you work for?

US Oncology
21C
Vantage Oncology

Vantage got bought out by US oncology/McKesson a few years ago

Vantage Oncology Announces Successful Completion Of Acquisition By McKesson

/PRNewswire/ -- Vantage Oncology, LLC is pleased to announce the successful completion of the company's acquisition by McKesson Corporation, which was...

www.prnewswire.com

 

[OTN]

I’m a partner in a practice that contracts with USON, but we’re not a USON-owned network.

 

[thecarbonionangle]

Are the middle of nowhere jobs really that highly paid? How much are Wausau, WI and Salina, KS offering that nobody will take those jobs for whatever money they offer?

 

[deleted941485]

Are the middle of nowhere jobs really that highly paid? How much are Wausau, WI and Salina, KS offering that nobody will take those jobs for whatever money they offer?

I have actually explored these options myself and through recruiters. Even these places that are literally 2,3,4 hours from metro area, I have not been impressed with their offerings at all. They starting are like 390-440 ("faculty positions" offering 320-350 for 80% clinical 20% research covering multiple satellites) and these are mostly employed postitions with hospitals that have bought far flung hospitals for whatever reasons. the private practices start slightly lower but even their upside with partnership they are now stretching it out over 5 years or more. Sure you make "partner" over the 2-3 years so it doesnt raise any red flags with the person but if you delve into the structure you basically have no say in the organization for 2 years and do not share in the profits of the enterprise to any appreciable extent until around 5-7 years after you make partner anyway. Not really alot of leeway or chance for advancement. Remember for most people who are training in major metros across the country they are giving up family ties, convieniance, and civilzation to practice in these areas, I do not think these salaries compensate for the loss of these things and therefore do not think they are worth pursuing unless you happen to love the outdoors or are from the area *Most are not*.

 

[Mandelin Rain]

My guess is for the rural sites, you need to give them your number. If you walked into Salina and said, I'll sign a 5 year contract with a 2000 mile non-compete for 850k per year, you'd probably get it on the spot.

 

[KHE88]

My guess is for the rural sites, you need to give them your number. If you walked into Salina and said, I'll sign a 5 year contract with a 2000 mile non-compete for 850k per year, you'd probably get it on the spot.

My understanding of the Salina practice, which basically operates sites throughout all of rural Kansas, is that they pay you well, but not great (and I took this to be around the 500k range vs. the 750k range rural Kansas would typically be at), and require you to cover these very rural/frontier sites and also heavily push reimbursement-heavy treatment practices. Note that I did not interview there and know noone personally who did, so it's all basically third-hand reports, but multiple ones.

Bottom line, I'd be shocked if they paid you 850k/year and kept you in one place and were cool with you hypofracing all breast and prostate and doing 8 gy x 1 for bone mets.

 

[KHE88]

I have actually explored these options myself and through recruiters. Even these places that are literally 2,3,4 hours from metro area, I have not been impressed with their offerings at all. They starting are like 390-440 ("faculty positions" offering 320-350 for 80% clinical 20% research covering multiple satellites) and these are mostly employed postitions with hospitals that have bought far flung hospitals for whatever reasons. the private practices start slightly lower but even their upside with partnership they are now stretching it out over 5 years or more. Sure you make "partner" over the 2-3 years so it doesnt raise any red flags with the person but if you delve into the structure you basically have no say in the organization for 2 years and do not share in the profits of the enterprise to any appreciable extent until around 5-7 years after you make partner anyway. Not really alot of leeway or chance for advancement. Remember for most people who are training in major metros across the country they are giving up family ties, convieniance, and civilzation to practice in these areas, I do not think these salaries compensate for the loss of these things and therefore do not think they are worth pursuing unless you happen to love the outdoors or are from the area *Most are not*.

It's unreasonable to expect more than 400k as an associate in a partnership track practice, no matter where it is. This is sweat equity.

Hospital employeed. If you are true rural, you should be looking at/demanding 600k+ guarantee with bonus potential for 800k+

 

[deleted18755]

My guess is for the rural sites, you need to give them your number. If you walked into Salina and said, I'll sign a 5 year contract with a 2000 mile non-compete for 850k per year, you'd probably get it on the spot.

There has to be more to it than that. So many people in medicine do more than 5 years of grueling residency training while living like college kids. I just can't imagine that in the entire country there isn't one random 30 year old single new graduate (or young or older couple married couple with out without small children . . . or somebody, anybody) who thinks "f it I'm going to get the nicest place in all of Salina, Kansas or wherever and live there for 3-5 years easily saving 90% of my 0.1%er post-tax income while providing care to people who really need my help then leave still only 1-3 years older than my neurosurgery and other friends from medical school (but I'll literally be millions of dollars richer)."

It's not like they don't have internet there and I'm sure you get at 4-5 weeks vacation so drive 3 or 4 or even 6 hours or whatever to the airport and go on VIP vacations every 2-3 months.

If it really pays that much for a normal radiation oncology job is there really not one graduate who would do it for 4-5 years and save a ton of money while helping out the people of Kansas. Just work 40 hour weeks and spend your evenings on Netflix binges (fine if the internet connection is crappy grab dvds), getting in the best shape of your life in your home gym (don't forget you'll be hanging out VIP on the beach for a week every few months), writing that novel you always thought about, or who care straight up drinking every night or even crying yourself to sleep at 8pm (you can do anything for a few years!) then leave having provided a valuable service to the community while making a fortune before the age of 35 (in a field and job market that is somewhere between declining and crashing)!

Am I missing something?

PS: sorry for derailing the thread a bit

 

[KHE88]

There has to be more to it than that. So many people in medicine do more than 5 years of grueling residency training while living like college kids. I just can't imagine that in the entire country there isn't one random 30 year old single new graduate (or young or older couple married couple with out without small children . . . or somebody, anybody) who thinks "f it I'm going to get the nicest place in all of Salina, Kansas or wherever and live there for 3-5 years easily saving 90% of my 0.1%er post-tax income while providing care to people who really need my help then leave still only 1-3 years older than my neurosurgery and other friends from medical school (but I'll literally be millions of dollars richer)."

It's not like they don't have internet there and I'm sure you get at 4-5 weeks vacation so drive 3 or 4 or even 6 hours or whatever to the airport and go on VIP vacations every 2-3 months.

If it really pays that much for a normal radiation oncology job is there really not one graduate who would do it for 4-5 years and save a ton of money while helping out the people of Kansas. Just work 40 hour weeks and spend your evenings on Netflix binges (fine if the internet connection is crappy grab dvds), getting in the best shape of your life in your home gym (don't forget you'll be hanging out VIP on the beach for a week every few months), writing that novel you always thought about, or who care straight up drinking every night or even crying yourself to sleep at 8pm (you can do anything for a few years!) then leave having provided a valuable service to the community while making a fortune before the age of 35 (in a field and job market that is somewhere between declining and crashing)!

Am I missing something?

PS: sorry for derailing the thread a bit

There's a couple of us but not many. <10% I would guess. But I intend on staying rural for my whole career. And it's not just because of the money. A single white male. The last kind of person the field wants to recruit. Into the area that needs it the most that no one wants to talk about. Lets talk about recruiting people who are going to gravitate to oversaturated areas instead because the optics are better...

 

[deleted941485]

It's unreasonable to expect more than 400k as an associate in a partnership track practice, no matter where it is. This is sweat equity.

Hospital employeed. If you are true rural, you should be looking at/demanding 600k+ guarantee with bonus potential for 800k+

With these crazy convoluted newly structured partnerships out there and the almost near continuous threat of going under due to changes in CMS payment policy which freestanding places have borne the brunt of or the local hospital system deciding they’d like to have they’re own cancer program in house and under control. Plus all the other things I mentioned earlier. I don’t even think the sub 400 base salary at a PP out in the sticks is really gonna cover the most obvious high risk which is that your sweat equity is really for nothing. It does not adequately capture the risk being assumed by the junior members.

I watched this play itself out with a friend of mine 3 hours outside metro. 3yr Partnership track paying him well below market. Sounds reasonable. He did a lot of the low value RVU work for them and They treated him like the second coming until the final year. Then all of sudden they had a problem with the way he did things, they were losing money, he wasn’t coding right, and blah blah blah. Long story short no partnership and he left. Practice was sold the following year. He decided to go hospital employed and not do PP again. It will take years for him to recoup that.

 

[deleted947887]

There's a couple of us but not many. <10% I would guess. But I intend on staying rural for my whole career. And it's not just because of the money. A single white male. The last kind of person the field wants to recruit. Into the area that needs it the most that no one wants to talk about. Lets talk about recruiting people who are going to gravitate to oversaturated areas instead because the optics are better...

Graduated a year ago. Haven't come remotely close to seeing offers like this. I'm a white Male and with go anywhere.

 

[KHE88]

Graduated a year ago. Haven't come remotely close to seeing offers like this. I'm a white Male and with go anywhere.

I don't understand this because I saw them everywhere for truly "rural" areas (Not Kansas City or Cleveland, real "rural" areas).

 

[KHE88]

With these crazy convoluted newly structured partnerships out there and the almost near continuous threat of going under due to changes in CMS payment policy which freestanding places have borne the brunt of or the local hospital system deciding they’d like to have they’re own cancer program in house and under control. Plus all the other things I mentioned earlier. I don’t even think the sub 400 base salary at a PP out in the sticks is really gonna cover the most obvious high risk which is that your sweat equity is really for nothing. It does not adequately capture the risk being assumed by the junior members.

I watched this play itself out with a friend of mine 3 hours outside metro. 3yr Partnership track paying him well below market. Sounds reasonable. He did a lot of the low value RVU work for them and They treated him like the second coming until the final year. Then all of sudden they had a problem with the way he did things, they were losing money, he wasn’t coding right, and blah blah blah. Long story short no partnership and he left. Practice was sold the following year. He decided to go hospital employed and not do PP again. It will take years for him to recoup that.

This is one of the reasons I decided to go hospital employed in a rural area off the bat.

 

[medgator]

I don't understand this because I saw them everywhere for truly "rural" areas (Not Kansas City or Cleveland, real "rural" areas).

In the last 5 years off the top of my head.... Chillicothe OH, Minot ND, Walla Walla WA etc I've heard all pay $600k+. I remember the Chillicothe email I actually saw stating $750k+.

Those are true rural practices, not KC or Cleveland lol

 

[KHE88]

In the last 5 years off the top of my head.... Chillicothe OH, Minot ND, Walla Walla WA etc I've heard all pay $600k+. I remember the Chillicothe email I actually saw stating $750k+.

Those are true rural practices, not KC or Cleveland lol

Exactly.

This forum has been eye-opening in regards as to what the silver spoon coastal elite regard as rural.
I literally got an email today about a practice in TX offering "over 600k + bonus."
I have a feeling it wasn't Austin.

 

[medgator]

Exactly.

This forum has been eye-opening in regards as to what the silver spoon coastal elite regard as rural.
I literally got an email today about a practice in TX offering "over 600k + bonus."
I have a feeling it wasn't Austin.

Technically Austin isn't on the coast 😉

 

[deleted18755]

In the last 5 years off the top of my head.... Chillicothe OH, Minot ND, Walla Walla WA etc I've heard all pay $600k+. I remember the Chillicothe email I actually saw stating $750k+.

Those are true rural practices, not KC or Cleveland lol

We all did. So what’s the explanation?

Are those salaries fake or jobs extreme? The fact that nobody would take a job that pays that much even just for 3-5 years implies that the its a bait and switch but I honestly don’t know.

Can one of the posters who keeps saying they would go anyplace but can’t find a job that pays really well (forget $850k let’s say $600,000) please let us know why they didn’t take any of those multiple jobs that said they pay that much and that were posted all over the place for a very long time (during the exact time when they say they couldn’t mind exactly that type of job?)

 

[thecarbonionangle]

Yeah thats my point. With all these talk of these jobs paying so so much money, surprised nobody takes them. Wausau has been there for a while...

 

[deleted947887]

We all did. So what’s the explanation?

Are those salaries fake or jobs extreme? The fact that nobody would take a job that pays that much even just for 3-5 years implies that the its a bait and switch but I honestly don’t know.

Can one of the posters who keeps saying they would go anyplace but can’t find a job that pays really well (forget $850k let’s say $600,000) please let us know why they didn’t take any of those multiple jobs that said they pay that much and that were posted all over the place for a very long time (during the exact time when they say they couldn’t mind exactly that type of job?)

I can tell you I called ND for that 600 job and got no interview. That's the thing. What's advertised and what's real are different. Haven't heard of anyone making more than 450 in the boons. That is, no firsthand knowledge if someone in the boons making more.

 

[deleted18755]

I can tell you I called ND for that 600 job and got no interview. That's the thing. What's advertised and what's real are different. Haven't heard of anyone making more than 450 in the boons. That is, no firsthand knowledge if someone in the boons making more.

As I mention above the fact that not one single young person would take a job that pays an astronomical sum even for a few years to pay off debt and build up an impressive savings while working Rad Onc hours leads me to believe at least some of the positions are not as advertised but I honestly don’t know.

 

[medgator]

As I mention above the fact that not one single young person would take a job that pays an astronomical sum even for a few years to pay off debt and build up an impressive savings while working Rad Onc hours leads me to believe at least some of the positions are not as advertised but I honestly don’t know.

Maybe they really are holding out for someone who will do a multi year commitment and settle in the area

 

[deleted947887]

Maybe they really are holding out for someone who will do a multi year commitment and settle in the area

I would've signed a 5 year contract for that kind of money.

 

[taserlaser]

Canadian grad here. Looking for work up north, but if I'm considering rural Canada, I really should consider making the hike down south and save up some dough, and avoid the snow. The market difference at the 49 parallel is still crazy.

FYI for comparison - say low 20s canuck graduates. Of people in my class that I know of (and my knowledge is certainly not all encompassing), 2 are hired straight out at home institution, 2 going to US, some small number of French speaking residents have contracts to stay in Quebec (different market really due to the language barrier), leaving around 15-20 residents doing fellowships and hunting for jobs. This does not include the amount of fellows finishing this year that are still looking for permanent work. Locum places are having difficulty filling, but there is still a paucity of full time jobs. For the past few years it takes 2 years for the graduating class to find full time work which has held stable, but less graduates leaving for the US in general. And note that most positions will be academic and hired on that merit...

Compare with the ASTRO job board - Career Opportunities • Canadian Association of Radiation Oncology
And arguably, this has been the best that I've seen that list. Yup.

 

[medgator]

Canadian grad here. Looking for work up north, but if I'm considering rural Canada, I really should consider making the hike down south and save up some dough, and avoid the snow. The market difference at the 49 parallel is still crazy.

FYI for comparison - say low 20s canuck graduates. Of people in my class that I know of (and my knowledge is certainly not all encompassing), 2 are hired straight out at home institution, 2 going to US, some small number of French speaking residents have contracts to stay in Quebec (different market really due to the language barrier), leaving around 15-20 residents doing fellowships and hunting for jobs. This does not include the amount of fellows finishing this year that are still looking for permanent work. Locum places are having difficulty filling, but there is still a paucity of full time jobs. For the past few years it takes 2 years for the graduating class to find full time work which has held stable, but less graduates leaving for the US in general. And note that most positions will be academic and hired on that merit...

Compare with the ASTRO job board - Career Opportunities • Canadian Association of Radiation Oncology
And arguably, this has been the best that I've seen that list. Yup.

Why do Canadians still go into the specialty with such an abysmal job market there? Most of them planned on moving to the US for full time work?

 

[taserlaser]

Why do Canadians still go into the specialty with such an abysmal job market there? Most of them planned on moving to the US for full time work?

Well the market right now is on an anticipated ‘upswing’. I think there were 3 posted jobs for the whole year when I was in my last year of med school. Can debate about the opportunity cost of multiple fellowships, Locum, etc which was once the norm, (hoping to limit it to one year myself...), But once you land a job, I think we still agree it’s a great intersection of patient care, technical skill, and research. Still better than average remuneration for a specialty with predictable hours and minimal call requirements. Hard to beat, really.

 

[medgator]

Well the market right now is on an anticipated ‘upswing’. I think there were 3 posted jobs for the whole year when I was in my last year of med school. Can debate about the opportunity cost of multiple fellowships, Locum, etc which was once the norm, (hoping to limit it to one year myself...), But once you land a job, I think we still agree it’s a great intersection of patient care, technical skill, and research. Still better than average remuneration for a specialty with predictable hours and minimal call requirements. Hard to beat, really.

Agree. Plus I imagine the rural Midwest isn't that different from a lot of Canada's weather, save Vancouver

 

[taserlaser]

I don’t know if the information asymmetry up North is quite as bad as one might think. Residents were pretty honest with me (with one limited exception) when I applied, and I am with them. Rad onc has had a bad rap if people even knew about it in Canada for years because of the job market. Prior to the crash, it was somewhat more competitive, and its hovered around internal medicine competitiveness although with some bigger variations the past few years.

 

[medgator]

I don’t know if the information asymmetry up North is quite as bad as one might think. Residents were pretty honest with me (with one limited exception) when I applied, and I am with them. Rad onc has had a bad rap if people even knew about it in Canada for years because of the job market. Prior to the crash, it was somewhat more competitive, and its hovered around internal medicine competitiveness although with some bigger variations the past few years.

IM is competitive in Canada?

 

[deleted947887]

IM is competitive in Canada?

IM is "competitive" in America.

 

[taserlaser]

No, but to give an idea of where things stand. CaRMS has gotten increasingly competitive in Canada last few years, with at one point I think English speaking residency spots approx equal to graduating English speaking residents, so not a whole lot of flexibility and more unmatched students.

RO has more or less consistently hung out around the 0.8 applicants for first round residency spot (same as IM - hence my wording), with two years ago about double the amount of unfilled spots first round (7/~20!), to completely filled this past year. Small numbers means high variance, but it’s been around those numbers for what it’s worth.

 

[medgator]

IM is "competitive" in America.

I guess I've been out of it for awhile but always thought it was middle of the road in competitiveness

 

[fiji128]

In the last 5 years off the top of my head.... Chillicothe OH, Minot ND, Walla Walla WA etc I've heard all pay $600k+. I remember the Chillicothe email I actually saw stating $750k+.

Those are true rural practices, not KC or Cleveland lol

The Chilicothe, OH, (which is about an hours drive from Columbus, OH) job filled like 5 years ago with someone who is still there I believe. There is not as many of these very high paying and quality rural jobs out there these days as there were in the recent past. I can't say that I even recall seeing the Minot ND job posted in quite sometime either. Some of the these same high paying rural jobs do seem to pop up every 2 or 3 years and I'm guessing that is because its not all $500K+ working 40 hours a week with a good infrastructure that advertisements make them seem to be.