Quantifying Job Market Difficulties and predicting ahead

eggeggeggegg

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I'm a current medical student and have been lurking here for a while now. I was reading the ACR webinar thread and am hoping to get a realistic outlook if I were to take the plunge. I realize these are all just guesses but, I figured it would be better than nothing. It seems like fewer people on twitter are disputing the job market is difficult, but it'd be helpful for medical students to quantify what sacrifices they would be making if they were to go this route. My partner has a relatively mobile job, and is open to the option of not working if need be/life changes. Ignoring COVID, it sounds like it would take minimum of a few years to find a desirable location, even back when the job market was better. To add to that, if this year is the first year with a small absolute reduction in the number of residents, than the number of graduating residents won't even peak for another 5 years... (+whatever impact hypofractionation, CMS billing changes etc would have)

So for a medical student entering the 2021 match and is say an average resident, middle of the pack of the 190 incoming residents, and average at networking...
Does anyone have guesses to how long it takes a graduating rad onc to find a "good" job in a medium sized area? For example not Chicago, but not super rurally either say either a place with ~100,000 people or say 25,000 but within an hour drive of a large centre. Making the assumption then that: any state would be fine, okay with academic or private practice as long as it isn't super exploitative.

I know people joke about breadlines on here sometimes, and after a year of reading posts, makes me wonder if there is more truth to it than i thought.
 
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I'm a current medical student and have been lurking here for a while now. I was reading the ACR webinar thread and am hoping to get a realistic outlook if I were to take the plunge. I realize these are all just guesses but, I figured it would be better than nothing. It seems like fewer people on twitter are disputing the job market is difficult, but it'd be helpful for medical students to quantify what sacrifices they would be making if they were to go this route. My partner has a relatively mobile job, and is open to the option of not working if need be/life changes. Ignoring COVID, it sounds like it would take minimum of a few years to find a desirable location, even back when the job market was better. To add to that, if this year is the first year with a small absolute reduction in the number of residents, than the number of graduating residents won't even peak for another 5 years... (+whatever impact hypofractionation, CMS billing changes etc would have)

So for a medical student entering the 2021 match and is say an average resident, middle of the pack of the 190 incoming residents, and average at networking...
Does anyone have guesses to how long it takes a graduating rad onc to find a "good" job in a medium sized area? For example not Chicago, but not super rurally either say either a place with ~100,000 people or say 25,000 but within an hour drive of a large centre. Making the assumption then that: any state would be fine, okay with academic or private practice as long as it isn't super exploitative.

I know people joke about breadlines on here sometimes, and after a year of reading posts, makes me wonder if there is more truth to it than i thought.

Get out now while you can and don’t even look back...

Even if there is a 5% match rate, if all remaining spots continue to be filled in SOAP then you’ll still be competing with ~190-200 ppl for a job

This is after 5 years of 200 ppl per year in front of you

Pts getting RT going down

Reimbursement going down

Academic attendings and PP attendings on ACR webinar just making shi* up to gaslight

They can’t go on a national platform and say oh everything sucks but they don’t have to be overly rosy either.
 
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medgator

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Rad Onc has had a highly cyclical job market over the decades.... the early to mid 90s was a terrible time leading to closure of some programs, adding an extra year of training, and then of course, IMRT saved the day.


Don't see any such thing on the horizon, either technologically, or from the standpoint of programs that are willing to contract for the greater good.

Anyone who tells you that we are not heading back to that time is ignoring the fact that there has been a significant increase in fellowships in RO, all of which are un-accredited and which more and more US grads are taking when they can't find a job in their preferred geographic locale.
 
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scarbrtj

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Does anyone have guesses to how long it takes a graduating rad onc to find a "good" job in a medium sized area?
5-10y, if you got out of residency today.
But if you got into a residency today, there will be ~15+% more rad oncs in 5y when you get out; there's already oversupply.
It's a crap shoot mixed in with musical chairs—according to the recent job market experts, 90% of you will change jobs first two years anyways (you won't change your job 'cause you love your good job in a medium sized area!)—two games I hate.
To some extent your question is: how likely am I to win a heads-up poker match.
You may win. You may lose.
I think this is the honest answer even a few of the higher-ups are now begrudgingly making.
 
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elementaryschooleconomics

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Oh man, the million dollar question. As you correctly observe, we can only give you guesses. It also seems like you have read many of the posts here and can hypothesize what our answers are going to be. I'll try to take two novel avenues for you to consider:

1) My partner was/is "open to anything" in terms of working, location, staying at home etc. DO NOT underestimate the emotional toll this puts on your relationship, especially if you've been together a long time. Your partner had to share the stress of medical school - residency is worse (I'm typing this next to my partner - "RESIDENCY SUCKS FAR WORSE THAN MED SCHOOL"). You're asking another adult human (+/- children) to continue to put their life in some sort of weird limbo because you picked a career with some extreme limitations.

2) COVID is going to have some far-reaching downstream effects, WHICH IS TRUE FOR ALL OF MEDICINE. However, RadOnc was/is starting from a weaker position. The resident classes of 2020 and 2021 are potentially going to be forced into unfavorable jobs that they're going to want to get out of as soon as the opportunity arises. This will have a domino effect for years. Do you, coming out in 2026, want to be faced with competition from not only your class but 5-6 years of classes before you?

Again, obviously, COVID will have downstream effects on everyone. However, in other specialties with more elasticity, the limitations might not be as pronounced. You don't want to ever find yourself on a sinking ship, but if you do - it's better to be stuck on the mast instead of the boiler room.
 
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thecarbonionangle

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Nobody call tell you what is going to happen. There is no free lunch in medicine. Every field has pluses and minuses. Covid has exposed some vulnerabilities in other fields. If all you do or most of the stuff you do is “elective” maybe you are not as safe as you think? Fortunately for us cancer does not sleep.
 
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I definitely worry about the job market for future residents, but it's hard to predict. Only data I can provide is from recent grads from my program. I graduated 2019. In my program, only 1 of 12 graduates in the last 6 years (including this year) ended up in a place that did not meet your criteria. 8 ended up in a large metro or suburb of large metro (~30 min from city). This year and last year - two to mid-size city, two to large city.
 

ramsesthenice

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Nobody call tell you what is going to happen. There is no free lunch in medicine. Every field has pluses and minuses. Covid has exposed some vulnerabilities in other fields. If all you do or most of the stuff you do is “elective” maybe you are not as safe as you think? Fortunately for us cancer does not sleep.

I am fairly certain that a tempered response about the rad onc job market by carbon is a sign of the end times :joyful:

This is a loaded question but I, the eternal optimist, think things are going to be rough. W00ts is right, most residents in the last few years have met your criteria but this COVID stuff is scary. 2 months of this stuff triggered across the board cuts and mandatory hiring freezes at huge centers. God knows what it did to small ones. If the worst of it is over the long term effects may not be catastrophic but if there really is a second wave later this year and health systems are stressed like that again there could be a horrific hiring crunch for the 2021 graduating class. If you add some market contraction on to that it could take years to get back to where we are now.

Yes, the field is a little more protected than some because cancer doesn’t stop. But we were a small market with over saturation to start. I am not saying don’t go into rad onc yet but if there is a significant economic down turn you really might want to consider a larger field with more of a buffer.
 
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I am fairly certain that a tempered response about the rad onc job market by carbon is a sign of the end times :joyful:

This is a loaded question but I, the eternal optimist, think things are going to be rough. W00ts is right, most residents in the last few years have met your criteria but this COVID stuff is scary. 2 months of this stuff triggered across the board cuts and mandatory hiring freezes at huge centers. God knows what it did to small ones. If the worst of it is over the long term effects may not be catastrophic but if there really is a second wave later this year and health systems are stressed like that again there could be a horrific hiring crunch for the 2021 graduating class. If you add some market contraction on to that it could take years to get back to where we are now.

Yes, the field is a little more protected than some because cancer doesn’t stop. But we were a small market with over saturation to start. I am not saying don’t go into rad onc yet but if there is a significant economic down turn you really might want to consider a larger field with more of a buffer.
Pretty well thought out assessment imo. The spectre of APM/bundling on the horizon won't help either and i do think that will be another shoe to drop regarding the job market if and when it is finally implemented
 

thecarbonionangle

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I am fairly certain that a tempered response about the rad onc job market by carbon is a sign of the end times :joyful:

This is a loaded question but I, the eternal optimist, think things are going to be rough. W00ts is right, most residents in the last few years have met your criteria but this COVID stuff is scary. 2 months of this stuff triggered across the board cuts and mandatory hiring freezes at huge centers. God knows what it did to small ones. If the worst of it is over the long term effects may not be catastrophic but if there really is a second wave later this year and health systems are stressed like that again there could be a horrific hiring crunch for the 2021 graduating class. If you add some market contraction on to that it could take years to get back to where we are now.

Yes, the field is a little more protected than some because cancer doesn’t stop. But we were a small market with over saturation to start. I am not saying don’t go into rad onc yet but if there is a significant economic down turn you really might want to consider a larger field with more of a buffer.

you’re welcome sir
 

DukeNukem

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Here is how physician recruiting works in most other specialties. You entice the doc with two out of three of location, pay, and lifestyle. It is hard to get all three in one job.

In rad onc you can pick one of those. Maybe. Pay anywhere near MGMA median for our specialty, lifestyle (let's say less than 50-60 hours/week), or not in a rural or other lower tier location.

Super competitive locations (big NE city, coastal California, Florida, etc) you may not get any job at all, but most locations are accessible if you are willing to take any job. This becomes a bigger problem if you quit or get fired and have a huge non-compete or the closest job afterwards is 100+ miles away. Then I guess you go work for Evicore and deny everyone in your area to give radiation with a big FU smile on your face.

But I'm sick of SDN focusing on this idea that only location matters. What if you get a fellowship in your desired location or an "instructor" job at a satellite that pays $180k/year? Is that a success?

There are plenty of jobs in desirable locations (urban or suburban) that are toxic and miserable. Rad oncs working 60+ hours a week, making AAMC 25th percentile assistant professor level salaries or less OR getting 10th percentile $/wRVU incentives, with little respect from the group (i.e. little support, no desire to fix anything that does not work correctly for your practice, admins or senior docs who just laugh at you and treat you like crap). There are also plenty of people stuck in those types of jobs trying to get out. These types of jobs used to be "churn and burn" -- that is nobody would last in them more than a year or two or they would fix things to keep you around when you got a good offer elsewhere, but now there are no jobs to go to and no incentive to give you anything.

So sure, TODAY you can have your choice as a new grad.
Do you want to work in a big city and get mistreated and ground down for pay way less than "average" for this specialty?
Do you want to work in a rural area and either work your butt off to get to MGMA median OR have a decent lifestyle and never make what you thought a rad onc would?
Sure good jobs still exist. I know people who have gotten them. They are few and far between. There are not 200/year and I don't think there ever will be in the next decade or two.

The problem I see is that the job market just gets worse every year. In the future when every job is taken and nobody has anywhere to go, then what? The entrenched groups/hospitals and academic departments that are expanding into every "satellite" location are licking their lips to make a ton of money off your hard work while paying you as little as possible. That is a business decision--simple supply and demand--and we docs are the dramatically oversupplied. We're not at a place yet where there are no jobs. It's just that most jobs today suck compared to 10 years ago and are getting worse every year. If you're graduating this year or next year, you can expect a job like I described above. If you're graduating in five years, good freaking luck. You're gonna need it. I advise any medical student to pick a specialty with a future like med onc or radiology.
 
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thecarbonionangle

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folks, our best years are yet to come! The time will come when the word “radiation oncology” will bring a smile to your face, instead of a tear to your eye. Chin up folks!

yes the field has some bad people who just “laugh at you” and your misery. There are bad people everywhere. You will not catch me ever defending any chairmen. There are good people, however, and we need to begin rewarding good people and elevating them to leadership and give the bad no good “leaders” the cold shoulder at the cook off. They can eat at the kid’s table next time. We need to stop rewarding bad no good “leaders”. The squeaky wheel needs to get the grease, instead of getting pushed aside for lack of sycophantry or boot licking. Current “leaders” will disappoint you EVERYTIME. Not one single person will save field, WE all will!
 
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RickyScott

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To some extent your question is: how likely am I to win a heads-up poker match.
You may win. You may lose.
Agree with your analogy, and would add that how many medical students willing to take this risk given work they have put into career and fact that there are plenty of great specialties out there? Have hard time conceptualizing how 99% of medstudents would roll the dice. Personally am quasi asperger type who enjoys reading about radonc In free time and love speciality and absolutely would not take on this type of risk if were medstudent today.
 
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The best to you can say is that you are flying blind because data is so poor.

But indications for radiation, number of treatments, reimbursement, and willing patients are all decreasing. The latter may be due to Covid and reverse over time in some small way but not the overall trend. Cancer is not going away, but many areas of active research are at shrinking the role of radiation. We do significantly less in prostate and breast than we did 5 years ago, despite new shiny tools, and may do even less in breast with neoadjuvant chemotherapy. Prostate and breast are the most common cancers, so less radiation there is a great thing for society and costs of done safely, but definitely means less need from society for radiation oncologists.

Also, we seemed to be pretty hard hit by Covid. The Astro letter noted clinical volumes and revenue down by 20-30% I believe. Someone can correct me as I deleted it. In private practice, that hit your take home (unevenly depending on region). In the large academic centers, not all, but the majority “socialized” the losses. Ie retirements cut, salaries cut, raises held due to the financial impact on the institution. Which means you could have been working full time and carrying a decent service, but had the same pay cut as someone who had maybe 1 workday a week for the last 2 months. So yes, cancer does not stop, but neither has administration at many of the largest centers from cutting salary and benefits regardless if you were out treating or not.

All of that combined points to a likely prediction of poor employment outcomes as we continue to produce record or near record levels of new graduates.
 

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Rad onc is the best field in medicine (not even a debate), which also happens to have the 2nd worst job market and leadership in all of medicine (second to pathology). The biggest issue is that many of the people in leadership positions do not think we have a problem. How can we even fix a problem if people don't think we have one? It's gonna be a rough. I say this as a pgy2. Only apply if you can't see yourself doing anything else and are fine with doing a fellowship and then taking a job in a random small to mid-size city in any part of the US, making around 300k. Honestly, i think fellowships are going to be required in a few yrs and especially for those who come from mid-tier (not top 10 or not big name) or lower programs.
 
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Grubbe-a-dub-dub

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I'm a recent grad with a decent job in a rural area. I'd ideally like to be closer to my family but I don't see that playing out.

I second @elementaryschooleconomics what he said about your spouse and family. It's very true (although med school is far worse than residency IMO).

Does anyone have any suggestions on how to pivot to another specialty? I love rad onc and what we do, but I don't want to spend my life away from friends and family.
 
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Mandelin Rain

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I'm generally a pessimist regarding our future job prospects but...

For example not Chicago, but not super rurally either say either a place with ~100,000 people or say 25,000 but within an hour drive of a large centre. Making the assumption then that: any state would be fine, okay with academic or private practice as long as it isn't super exploitative.

If that's all true. I'd say you'll find A job somewhere even if the market declines further.

There are a lot of cities between 25-100k within and hour or two of larger cities across America. If you're willing to go to any that isn't "super" exploitative, my guess is there will be SOMETHING waiting.
 

thecarbonionangle

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I'm a recent grad with a decent job in a rural area. I'd ideally like to be closer to my family but I don't see that playing out.

I second @elementaryschooleconomics what he said about your spouse and family. It's very true (although med school is far worse than residency IMO).

Does anyone have any suggestions on how to pivot to another specialty? I love rad onc and what we do, but I don't want to spend my life away from friends and family.

options are go back and finish medicine if you did a prelim. This will be Hard but you would get through it. You can also do something else but this would also be hard and cost you money. There are some neuroonc fellowships which list rad onc as a potential residency they would take. You would be able to give some chemo. Ive never understood if we can train neurologists, obgyns to give chemo why our specialty does not create a pathways for those who want to like clinical oncologist in UK!

other option is palliative care, ABR pathway. Get boarded in it and do palliative care and pain medicine
 
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Mandelin Rain

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NeuroOnc is interesting and they always seem in demand. If you could be the chemo and radiation guy, I bet you'd find a decent job. Hell, I bet you could find a neurosurgery group to go in on a linac with you somewhere.
 
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thecarbonionangle

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NeuroOnc is interesting and they always seem in demand. If you could be the chemo and radiation guy, I bet you'd find a decent job. Hell, I bet you could find a neurosurgery group to go in on a linac with you somewhere.

stanford neuro-onc fellowship lists rad onc as a specialty they consider. Idk if anybody has ever done it but it is an option.

i think like Zeitman said, our issue is we are married to a modality. And this makes it really difficult to increase our spectrum and pivot to a broader practice. At some point a medical specialty was only specialized on syphilis. We know how that turned out!
 
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seper

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Not a whole lot of options to re-train. I'm 42 yo and just shudder of the idea of going back to IM PGY-2. Not to mention, it is very hard to find a decent PGY-2 spot for people like us.
 

KHE88

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Pick a different field unless your parents have a private practice in your hometown for you to take over (not uncommon).

The question of geography is interesting. When most people are deciding what specialty to apply to, they are in their mid 20s. Basically still in a college mindset. Wanting to live in a big city with lots of other young people, probably single, wanting to go out and meet a lot of people, party, etc. The reality is that by the time you get your first job you'll be early-mid 30s. Priorities totally different then. Geography still matters for a lot, but for totally different reasons. Maybe wanting to be closer to family, maybe having a spouse who is not open-minded to certain areas (common). The change is mindset throughtout residency is gradual but dramatic compared from MS3 to first year as attending even though it doesn't seem like a lot of time!

Yes, you'll probably be able to find a job in a 100k city somewhere in the country. What will your circumstances be? Will you have to get a divorce to stay there (common). Who knows!

Don't risk it. Just pick something safer. Diagnostic rads, Anesthesia, ER, basically anything else not super specialized and you can go anywhere easily. Hell even the general surgeons here have great lifestyles. They are usually drunk on the golf course by 4PM most days.
 
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KHE88

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I'm a recent grad with a decent job in a rural area. I'd ideally like to be closer to my family but I don't see that playing out.

I second @elementaryschooleconomics what he said about your spouse and family. It's very true (although med school is far worse than residency IMO).

Does anyone have any suggestions on how to pivot to another specialty? I love rad onc and what we do, but I don't want to spend my life away from friends and family.

I am in the same boat. Unless you are very young and single, like 28-30, I would just dig in. You could consider a PGY-2 spot in diagnostic rads in a location you want to be in. You'll be trading quality of life for a better location and 4-5 more years of training. I've slowly been coming to this conclusion to just accept it. Focus on the positives. You're getting paid well and have a great quality of life. You can afford fantastic vacations. You can afford to fly your family out to visit if you want. It's all about attitude. Others like Duke are in awful locations, getting paid terribly, and have awful quality of life. Try and make some local friends. It's hard and I feel you. Small towns hate outsiders. But if you can get a small group of friends, it can make it more tolerable. Especially couples if you are married (watch out for swingers though unless you are into that -- they are literally everywhere in small towns. You think they just want to be your friends then comes their "idea." I guess people get bored?).
 
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I'm a current medical student and have been lurking here for a while now. I was reading the ACR webinar thread and am hoping to get a realistic outlook if I were to take the plunge. I realize these are all just guesses but, I figured it would be better than nothing. It seems like fewer people on twitter are disputing the job market is difficult, but it'd be helpful for medical students to quantify what sacrifices they would be making if they were to go this route. My partner has a relatively mobile job, and is open to the option of not working if need be/life changes. Ignoring COVID, it sounds like it would take minimum of a few years to find a desirable location, even back when the job market was better. To add to that, if this year is the first year with a small absolute reduction in the number of residents, than the number of graduating residents won't even peak for another 5 years... (+whatever impact hypofractionation, CMS billing changes etc would have)

So for a medical student entering the 2021 match and is say an average resident, middle of the pack of the 190 incoming residents, and average at networking...
Does anyone have guesses to how long it takes a graduating rad onc to find a "good" job in a medium sized area? For example not Chicago, but not super rurally either say either a place with ~100,000 people or say 25,000 but within an hour drive of a large centre. Making the assumption then that: any state would be fine, okay with academic or private practice as long as it isn't super exploitative.

I know people joke about breadlines on here sometimes, and after a year of reading posts, makes me wonder if there is more truth to it than i thought.
You have one opportunity to walk back!! Take it, and forget about radonc!! Mark my words, you will regret if you decide to pursue #radonc!!
A jobseeker radonc.
 
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RadOncMegatron

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Not a whole lot of options to re-train. I'm 42 yo and just shudder of the idea of going back to IM PGY-2. Not to mention, it is very hard to find a decent PGY-2 spot for people like us.

I'd rather work at Starbucks or Gamespot hahaha.

Is it true that your residency spot wouldn't be paid for (by the government) if you went back since you already went through a residency? This is something I heard about, but never confirmed...
 
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scarbrtj

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I'd rather work at Starbucks or Gamespot hahaha.

Is it true that your residency spot wouldn't be paid for (by the government) if you went back since you already went through a residency? This is something I heard about, but never confirmed...
I believe this was true in the past; specifically there was a 5 year watch period where the govt would look at residency slots in a hospital and fund based on that. So in theory no resident training past 5 years was funded. It's a tad complicated. Now some first-year slots technically already unfunded; can argue it multiple ways depending on how you want to account for the money. But federal residency cash, coupled with low-priced resident labor, is a cash cow. On the other hand residency training in the U.S. would likely be a dysfunctional mishmash without govt funding, and residents would be more taken advantage of than they already are.

 
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radmonckey

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Once you match, your # years of govt funding is frozen at the length of your program. For example, if you match into a 3 year medicine program but switch to a 7 year neurosurgery program, you will have at least 4 unfunded years. This ends up not mattering at most places as many institutions have a combination of funded and unfunded positions, so the money can be fudged. There is still some chance though that your lack of attached funding could rule you out of a spot at certain places.
 
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medgator

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Thought this was a good thread to post this in... Job has been posted for a few years now iirc with no one biting, guess flint isn't that desirable?? Anyways interesting how they mentioned PP salary potential this time to spruce up the listing.

Even with 190+/year coming out, no one wants to practice in a place with a questionable water supply. Go figure

 

taserlaser

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Thought this was a good thread to post this in... Job has been posted for a few years now iirc with no one biting, guess flint isn't that desirable?? Anyways interesting how they mentioned PP salary potential this time to spruce up the listing.

Even with 190+/year coming out, no one wants to practice in a place with a questionable water supply. Go figure

How much is a year’s supply of bottled water? Really that’s the question. I feel so bad for Flint’s community :(
 
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elementaryschooleconomics

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Thought this was a good thread to post this in... Job has been posted for a few years now iirc with no one biting, guess flint isn't that desirable?? Anyways interesting how they mentioned PP salary potential this time to spruce up the listing.

Even with 190+/year coming out, no one wants to practice in a place with a questionable water supply. Go figure

While I didn't personally inquire about this particular job, I did reach out to some of the locations which I see are still being reposted on other job sites. What gives? Are these real jobs? Is someone posting things to fill a quota somewhere?

Like, I get when an academic job gets posted that isn't "real" (they already have interviewed a handful of folks before the job is even advertised), but some of these jobs are just straight radio-silence (although perhaps I'm not worth even a return email).
 
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medgator

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While I didn't personally inquire about this particular job, I did reach out to some of the locations which I see are still being reposted on other job sites. What gives? Are these real jobs? Is someone posting things to fill a quota somewhere?

Like, I get when an academic job gets posted that isn't "real" (they already have interviewed a handful of folks before the job is even advertised), but some of these jobs are just straight radio-silence (although perhaps I'm not worth even a return email).
Could be looking for someone with more experience? Not sure why they would be picky about though if they have to keep reposting the job every so often
 
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elementaryschooleconomics

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Could be looking for someone with more experience? Not sure why they would be picky about though if they have to keep reposting the job every so often
That was my thought as well. A couple times I went out of my way to track down and email the HR person/recruiter who posted the job, in addition to applying through the online portals. Not even a "sorry kid, come back in 5 years with board certification".

C'est la vie.
 

RadOncDoc21

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That was my thought as well. A couple times I went out of my way to track down and email the HR person/recruiter who posted the job, in addition to applying through the online portals. Not even a "sorry kid, come back in 5 years with board certification".

C'est la vie.
I honestly think some of the admins are that bad. I’ve seen job postings with the wrong contact info, names, etc. Sometimes they go out their way to make sure the docs are not involved in the recruiting process which doesn’t make sense. If you are able to contact the docs directly somehow that’s usually the best bet because if it’s a hospital or VA setup, I’m almost certain it’s not being followed as routinely as it should.
 
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deleted969641

Virtually all of these jobs that are posted by recruiters in middle of nowhere locations are hospital-employed positions offered by recruiters/admins/CEOs who have no idea what they are doing and are attempting to try and lock in someone desperate for < 50th percentile pay in Victoria, TX; Kearney, NE, Marshfield, WI, Eau Claire, WI, Poplar Bluff, MO, etc. These places should all be paying 90+ percentile, and anybody is foolish for accepting anything less than 80th percentile (700k+) to go to such places. It's important to note, that even at a salary like this, you are still making the hospital money -- LOTS of money. Anybody with half a brain would work out a deal to contract independently in such places and bill for their own professional services and let the hospital be plenty fat off the technical. If the hospital says no, then you know they are only interested in their bottom line. Not a good place to practice for many reasons.

Legitimate jobs in undesirable locations WILL fill (albeit not immediately, but within a reasonable amount of time) as a good health system is more interested in getting good physicians, especially hard-to-recruit specialists, to provide greatly needed services for their patients/community and are willing to make a fair deal to ensure a long term arrangement with quality providers vs. trying to bargain hunt for years and end up with a medical staff of incompetent schmucks.

The Marshfield, WI posting is particularly egregious. I just checked my email. This job has been spammed to me for over 3 years. THREE YEARS. What kind of insanely crap offer are they trying to get away with there? Anyone actually talk to them? Very curious as to what absurdity is being thrown out there. I'm going to take a wild guess and say $350k salary, crap production bonus, crap benefits, PTO you can't use, and some crap signing bonus/loan repayment deal that you only get it you somehow make it 5 years without killing yourself. Am I close?
 
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deleted969641

That was my thought as well. A couple times I went out of my way to track down and email the HR person/recruiter who posted the job, in addition to applying through the online portals. Not even a "sorry kid, come back in 5 years with board certification".

C'est la vie.

You seriously, seriously underestimate how incompetent management and recruitment is at some of these places.

The in-house recruiter at my current crap gig probably does at most 15 minutes of actual work a day The rest of his job consists of figuring out how to put off to tomorrow what should be done today, convincing suckers who already work there not to quit, getting paid 6 figures, and going out to lunch on the company dime for "recruiting." As long as they have locums keeping the beam on, which is the department manager's problem, it's not a pressing issue. I'd guess they read maybe 25% of their emails. When the CEO eventually talks to them about it, they will say hey I put an ad out 6 months ago, maybe you need to send me on a paid vacation to Astro to try and recruit.

Send Marshfield, WI an email every day and tell them your mother lives in Marshfield and it's been your life long dream to come back there but you have an amazing offer offer on the table for $250k in Eau Claire and wanted to see if there's any chance you could be lucky enough to get an interview before you take it. Maybe you'll get a call back in a few months.
 
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fiji128

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About three or so years ago I spoke with the Victoria TX people, they were hiring at about $450,000 for a new grad. The department had two old docs ready to retire and old tech. I think they got a new grad from Miami, who by the looks of it, didn't last.

I agree with the above post regarding the in-house recruiters and some of these rural places. Many of them are just lazy/incompetent. Like they won't even return phone calls or emails even though a MD is directly reaching out to them for a position that they are recruiting for and yet you see the posting month after month. This is probably an indication of how the whole hospital is run so beware of such places.
 
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evilbooyaa

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That was my thought as well. A couple times I went out of my way to track down and email the HR person/recruiter who posted the job, in addition to applying through the online portals. Not even a "sorry kid, come back in 5 years with board certification".

C'est la vie.

Many recruiters are really, really bad at their jobs. Doubly so for the places that continue to re-post on a yearly basis.
 
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deleted969641

About three or so years ago I spoke with the Victoria TX people, they were hiring at about $450,000 for a new grad. The department had two old docs ready to retire and old tech. I think they got a new grad from Miami, who by the looks of it, didn't last.

I agree with the above post regarding the in-house recruiters and some of these rural places. Many of them are just lazy/incompetent. Like they won't even return phone calls or emails even though a MD is directly reaching out to them for a position that they are recruiting for and yet you see the posting month after month. This is probably an indication of how the whole hospital is run so beware of such places.

The old docs at the place were likely independent and making 1M+ or accepted some buy out at the end of their career to establish rad onc services as an employed. This is a common occurrence as the MBAs at these places all operate from the same playbook. Their objective is to get as much of the professional pie as they can (because the technical is not enough), so when the old guy retires, they specifically hunt out a new grad who doesn't understand billing and pay them a salary that's about half of what they would collect independently. The new grad either figures the scam out or is run out by the toxic culture of the place, or (most likely) decides Victoria, TX isn't where they want to build their career and leaves. They repeat the cycle and wait another 2-3 years for the next victim. The job market has really engendered a lot of this, and I think it's why we're seeing this incredible shift to hospital employment over the past 10 years. Long term locums are plentiful and cheap, and new grads who can't get a job where they want to be are common place.

This is a really good teaching point for new grads:
1. Do not take an employed job in a rural area. Hospitals get away with this in desirable locations because the location is worth it (or it's an academic institution or something). But if you must...
2. Do not accept a salary < 700k at a place like this. Please, stop setting this precedent. They only get away with offering 450k because they can. Analyze the payor mix, the charges, and the number treated to understand what your professional services are worth. If the hospital tells you they are constrained by fair market value law and can't pay you greater than >75th percentile, they are lying to you. Their reason doesn't matter. It's a crap offer in a crap location, pass on it and keep looking into you find a non crap offer in a crap location. Don't go down the rabbit hole of trying to see what the highest amount their "lawyer will agree to" is.
3. Do whatever you can to attempt to establish independent, non-employed practice.
4. Do not be enticed by 100k sign on bonuses or student loan repayment. You will most likely have to pay it back because you won't last long enough.
5. Do not buy an expensive house in these areas. Rent or buy some dump at the mean listing price (150k or so) you can unload quickly.
6. Understand that the exploitative fellowship might actually be a better option than some of these.

Oh, and most important, make sure the department manager isn't a complete sociopath who thinks he is god of radiation oncology because he's been running his department in Victoria, TX for 30 years (Good luck).
 
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RadRadRad

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Completely agree with above rec to establish your own practice especially at rural areas where you should have that leverage. So many benefits to not being employed both in terms of tax avoidance and autonomy. Lot of work too, but worth it IMO
 
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deleted969641

Completely agree with above rec to establish your own practice especially at rural areas where you should have that leverage. So many benefits to not being employed both in terms of tax avoidance and autonomy. Lot of work too, but worth it IMO

It's really shocking once you run the numbers and understand what the professional charges and collections would be for an average amount on beam (20). If you're treating 40, it's wild. Nobody teaches you this in residency because the junior faculty don't know and it's not in the chair's interest for residents to fully understand the business.

There is now a generation of young rad oncs who have been gaslit into believing what fair compensation is. The older rad oncs know better, and many of them have an interest in keeping this a secret. It's not like the discount on your compensation is being passed on to the patients. If you have your own practice, you can decide to do charity care if you want. Good luck even getting a patient through a door at these "non-profit" hospitals without ability to pay guaranteed up front.

Some of these rural centers can break even with 8-10 patients on treatment. And that's despite a 700k rad onc salary "expense." Food for thought.
I'm beating a dead horse here, but if you are going to take a hospital employed job, do it in a decent sized city. An extra 100k or even 200k isn't worth it (you'll lose half to taxes at that point as a W2 employee). The only thing that makes those locations acceptable is independent practice.

And if you're an older rad onc with a service contract at a hospital, please for the love of God and the sake of the field, please do not make a deal with the hospital to become an employee before you retire. Pay it forward and find a new grad to take over your practice, teach him/her the business and how to continue independent practice with the hospital. Once hospitals get a taste of employing rad oncs, they will never go back.
 
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RickyScott

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It's really shocking once you run the numbers and understand what the professional charges and collections would be for an average amount on beam (20). If you're treating 40, it's wild. Nobody teaches you this in residency because the junior faculty don't know and it's not in the chair's interest for residents to fully understand the business.

There is now a generation of young rad oncs who have been gaslit into believing what fair compensation is. The older rad oncs know better, and many of them have an interest in keeping this a secret. It's not like the discount on your compensation is being passed on to the patients. If you have your own practice, you can decide to do charity care if you want. Good luck even getting a patient through a door at these "non-profit" hospitals without ability to pay guaranteed up front.

Some of these rural centers can break even with 8-10 patients on treatment. And that's despite a 700k rad onc salary "expense." Food for thought.
I'm beating a dead horse here, but if you are going to take a hospital employed job, do it in a decent sized city. An extra 100k or even 200k isn't worth it (you'll lose half to taxes at that point as a W2 employee). The only thing that makes those locations acceptable is independent practice.

And if you're an older rad onc with a service contract at a hospital, please for the love of God and the sake of the field, please do not make a deal with the hospital to become an employee before you retire. Pay it forward and find a new grad to take over your practice, teach him/her the business and how to continue independent practice with the hospital. Once hospitals get a taste of employing rad oncs, they will never go back.
Pathologists apparently bill high technical and proffessional fees. Means nothing.
 
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deleted969641

Pathologists apparently bill high technical and proffessional fees. Means nothing.

The field that allowed themselves to be taken over by a few mega corporations?
I'm not super familiar with path but besides that mass employment of their physicians, I believe there is also a much wider discrepancy in charges and collections compared to rad onc. Back of the napkin calc for 40 patients on beam still puts global collections at 8.8M/year. Are my rules of thumb that outdated/far off? Maybe a little, but I don't think so. (The problem is really where do you come up with 40 patients these days without giving everybody 6-8 weeks of RT with 180s). But, sure, the demise of pathology should be a model of what not to do for the field of rad onc. The boomer generation seems fine going that way though. They got theirs.
 
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DoctwoB

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Pathologists apparently bill high technical and proffessional fees. Means nothing.
This is the sad truth. There are two factors that determine salary and jobs for physicians at the end of the referral chain (Path, EM, Rads, Rad onc, etc). How much $ they can generate (RVUs), and supply and demand of docs. Being able to generate 5-10 mil in professional fees doesn’t mean anything if no one will send you the patients or if there are so many docs willing to do the work they’ll accept a lower salary and let the practice/hospital keep the profits.

Even the whole idea of Urorads which this forum loved to hate is a supply demand issue. If a Urologist comes to you and says I’ll pay you a good salary and send you patients but I’ll own the linac and collect the fees, you would say F off unless the market is saturated enough that the referral stream is worth the trade off.
 
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