Quantifying Job Market Difficulties and predicting ahead

[Reaganite]

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 Are my rules of thumb that outdated/far off?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.

There's really no "back of the napkin" calc for radiation. It's highly geographically and site dependent. The range is probably 3 million (yes) to tens of millions. Say you had a practice that had 40 IMRT prostates on treatment at all times, all getting 9 weeks of treatment. Lets be generous and say 100% Medicare reimbursement is 30k. 52wks/9wks x 40 x 30k=6.9 million global...And what practice outside a urorads is going to have 40 IMRT patients on beam at all times? Don't get me wrong, I agree with your statements-- people should be as aggressive as possible in trying to obtain independent contracts, but y'all are gonna be disappointed when the nuances of all of this hit you square in the face in the real world. The hospital in the middle of nowhere may not give 2 ****s about how they staff their rad onc clinic if they own all the referring physicians in town. They'll locum in perpetuity before they give you an independent contract because where else are the referrals gonna go? They can just tell all the referring docs they own they're waiting for the "right fit." Alternatively, it may just be the hospital doesn't want to set the precedent of independent contracts when every other doc is employed (I've personally run into this scenario).

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[deleted969641]

Don't get me wrong, I agree with your statements-- people should be as aggressive as possible in trying to obtain independent contracts, but y'all are gonna be disappointed when the nuances of all of this hit you square in the face in the real world.

And I agree with all of the above as well. Estimates are just that. Of course there's a lot that plays into actual collections. I have seen practices treating well above 8-10 patients actually lose money. But in general, the delivery of radiotherapy is very profitable for hospitals and employing rad oncs is done because it's greatly in the hospital's interest financially, period.

The issue is not the RVU system, it's the way that hospitals attempt to pay you with a fixed $/wRVU that are well below what the actual physician work component of the service actually reimburses. Somebody please explain why the hospital should be permitted to keep the entire facility fee plus half of the physician work component of the RVU reimbursements? The physician work component should go to the physician. Not half of it. All of it.

I fully understand that if you attempt to actually get paid for all of the work you do, many places will tell you to take a hike. It's just funny that we allow this to happen in Victoria, TX. I have yet to hear an explanation from a hospital of why they feel entitled to 30-50%+ of your professional collections other than it is "illegal" to pay you that much with no good explanation why. Knowing our value is important.

I'm not telling people they should expect to be able to negotiate full professional collections from an HCA hospital in Miami. But when Victoria, TX can get away with paying a full time rad onc 450k without some catastrophic plunge in reimbursement rates, we know our field is in the toilet.

I've actually wondered why some of these places just don't do locums forever and stop wasting their time with lowball recruiting. They have no competition. The patients will come there regardless. I don't understand why the bean counters haven't figured out that they can pay Weatherby 3k/day (the docs are only getting about $1500 of that these days). This gets them 252 days of coverage for about $750k/year, which is what a full-time rad onc would be getting (but they don't have to pay for benefits and PTO for the locums) until eventually they find a semi-decent locums who will agree to long term and contract directly for $2500/day or less cutting out Weatherby. That's rad onc coverage for $630k/year. Not too shabby! Used to be hard to line up locums like that, but the way things are going I think we'll see a lot more of this crap.

VIctoria, TX is probably paying out 600-700k/year for locums coverage. When you come to them as a new young, hard-working, up-to-date board certified rad onc and offer to provide long term quality care of their patients and improve their practice and ask for 800k, they say, hey no thanks we'll keep paying our non-BC boomer rad onc who practices like he did 30 years ago until one of you guys agrees to work for 450k. We know someone will take it eventually and we're making of plenty of money right now. Or if you say, hey you don't have to pay me anything I'll send the bills on my own, they say nah, we'd like to keep paying Weatherby 3k/day for sketch coverage indefinitely. That's sad. And that's what I was hoping every new grad understands.

 

[Reaganite]

And I agree with all of the above as well. Estimates are just that. Of course there's a lot that plays into actual collections. I have seen practices treating well above 8-10 patients actually lose money. But in general, the delivery of radiotherapy is very profitable for hospitals and employing rad oncs is done because it's greatly in the hospital's interest financially, period.

The issue is not the RVU system, it's the way that hospitals attempt to pay you with a fixed $/wRVU that are well below what the actual physician work component of the service actually reimburses. Somebody please explain why the hospital should be permitted to keep the entire facility fee plus half of the physician work component of the RVU reimbursements? The physician work component should go to the physician. Not half of it. All of it.

I fully understand that if you attempt to actually get paid for all of the work you do, many places will tell you to take a hike. It's just funny that we allow this to happen in Victoria, TX. I have yet to hear an explanation from a hospital of why they feel entitled to 30-50%+ of your professional collections other than it is "illegal" to pay you that much with no good explanation why. Knowing our value is important.

I'm not telling people they should expect to be able to negotiate full professional collections from an HCA hospital in Miami. But when Victoria, TX can get away with paying a full time rad onc 450k without some catastrophic plunge in reimbursement rates, we know our field is in the toilet.

I've actually wondered why some of these places just don't do locums forever and stop wasting their time with lowball recruiting. They have no competition. The patients will come there regardless. I don't understand why the bean counters haven't figured out that they can pay Weatherby 3k/day (the docs are only getting about $1500 of that these days). This gets them 252 days of coverage for about $750k/year, which is what a full-time rad onc would be getting (but they don't have to pay for benefits and PTO for the locums) until eventually they find a semi-decent locums who will agree to long term and contract directly for $2500/day or less cutting out Weatherby. That's rad onc coverage for $630k/year. Not too shabby! Used to be hard to line up locums like that, but the way things are going I think we'll see a lot more of this crap.

VIctoria, TX is probably paying out 600-700k/year for locums coverage. When you come to them as a new young, hard-working, up-to-date board certified rad onc and offer to provide long term quality care of their patients and improve their practice and ask for 800k, they say, hey no thanks we'll keep paying our non-BC boomer rad onc who practices like he did 30 years ago until one of you guys agrees to work for 450k. We know someone will take it eventually and we're making of plenty of money right now. Or if you say, hey you don't have to pay me anything I'll send the bills on my own, they say nah, we'd like to keep paying Weatherby 3k/day for sketch coverage indefinitely. That's sad. And that's what I was hoping every new grad understands.

You're completely correct. We should be able to negotiate like this, but our field is in the dumps for all the reasons we've gone into on this board, namely residency overexpansion and a healthcare system that seemingly encourages high cost, monopolistic systems.

 

[Grubbe-a-dub-dub]

And I agree with all of the above as well. Estimates are just that. Of course there's a lot that plays into actual collections. I have seen practices treating well above 8-10 patients actually lose money. But in general, the delivery of radiotherapy is very profitable for hospitals and employing rad oncs is done because it's greatly in the hospital's interest financially, period.

The issue is not the RVU system, it's the way that hospitals attempt to pay you with a fixed $/wRVU that are well below what the actual physician work component of the service actually reimburses. Somebody please explain why the hospital should be permitted to keep the entire facility fee plus half of the physician work component of the RVU reimbursements? The physician work component should go to the physician. Not half of it. All of it.

I fully understand that if you attempt to actually get paid for all of the work you do, many places will tell you to take a hike. It's just funny that we allow this to happen in Victoria, TX. I have yet to hear an explanation from a hospital of why they feel entitled to 30-50%+ of your professional collections other than it is "illegal" to pay you that much with no good explanation why. Knowing our value is important.

I'm not telling people they should expect to be able to negotiate full professional collections from an HCA hospital in Miami. But when Victoria, TX can get away with paying a full time rad onc 450k without some catastrophic plunge in reimbursement rates, we know our field is in the toilet.

I've actually wondered why some of these places just don't do locums forever and stop wasting their time with lowball recruiting. They have no competition. The patients will come there regardless. I don't understand why the bean counters haven't figured out that they can pay Weatherby 3k/day (the docs are only getting about $1500 of that these days). This gets them 252 days of coverage for about $750k/year, which is what a full-time rad onc would be getting (but they don't have to pay for benefits and PTO for the locums) until eventually they find a semi-decent locums who will agree to long term and contract directly for $2500/day or less cutting out Weatherby. That's rad onc coverage for $630k/year. Not too shabby! Used to be hard to line up locums like that, but the way things are going I think we'll see a lot more of this crap.

VIctoria, TX is probably paying out 600-700k/year for locums coverage. When you come to them as a new young, hard-working, up-to-date board certified rad onc and offer to provide long term quality care of their patients and improve their practice and ask for 800k, they say, hey no thanks we'll keep paying our non-BC boomer rad onc who practices like he did 30 years ago until one of you guys agrees to work for 450k. We know someone will take it eventually and we're making of plenty of money right now. Or if you say, hey you don't have to pay me anything I'll send the bills on my own, they say nah, we'd like to keep paying Weatherby 3k/day for sketch coverage indefinitely. That's sad. And that's what I was hoping every new grad understands.

I like your thoughtful description of what is going on in these employed practices. I've witnessed firsthand that this is not only happening in extremely remote places but even places 1 hour outside major metropolitan cities that most nowadays wouldn't consider remote.

Prior older docs with nice professional agreements left after those agreements dissolved and the hospital wanted to employ their own rad oncs, and then they were left with locums for years. YEARS!

Nowhere else for patients to go so the lincas still ran and the hospital system still got to collect. They could care less that patients got very substandard care and the patients aren't privy to the inner dynamics of the practice - they simply go to the doctors they are referred to.

All the while the hospital systems sit and wait for someone to take their crummy deals with below-average pay, below-average vacation time (while they boast about "physician wellness" programs), heck below-average health care coverage as part of some borderline illegal healthcare plan that is owned by the system itself.

I ask though - what is the alternative? What are graduates and folks looking to exit their crummy deals to do?

Stay unemployed? Play the locum gamble? Establish side gigs and hobbies?

I say the whole healthcare system in America is corrupt. We're simply maneuvering through it the best we can.

 

[fiji128]

The bottom line is if you practice in a specialty with an oversupply of BC/BE MD's you will have no negotiation power with any potential employer. That's just a market reality. What you bill for is largely irrelevant and the question becomes how cheap can we get someone to work for us.

 

[RickyScott]

The bottom line is if you practice in a specialty with an oversupply of BC/BE MD's you will have no negotiation power with any potential employer. That's just a market reality. What you bill for is largely irrelevant and the question becomes how cheap can we get someone to work for us.

nailed it. And, In fact, given 10-15 years of AOA types who went into this specialty, the next guy is also highly likely to be competent.

 

[thecarbonionangle]

Most going rates for jobs out there is 350-500k. Some make more. Some make less. Some will never sniff near it. i understand the argument that they should be paying more but that is just not where the market is at because there will always be a sucker to take the job. If you pass, you end up unemployed as they all laugh at your requests for 800k in whatever hell pit place you looking at (KHE, RIP, posted about this multiple times describing his experience). The only way to fix long term to this is a dramatic reduction of rad oncs, including forcing retirements of old timers and dramatic cuts in residencies. The damage is already done. There is no short term fix.

 

[Grubbe-a-dub-dub]

The bottom line is if you practice in a specialty with an oversupply of BC/BE MD's you will have no negotiation power with any potential employer. That's just a market reality. What you bill for is largely irrelevant and the question becomes how cheap can we get someone to work for us.

Agreed. Supply and demand.

I also think that with this level of dissatisfaction with the types of employment these grads receive, there will be a pool of employed doctors looking for that next employed position. A "semi-locum state" - if I can coin a phrase

I have heard arguments that your CV starts to look like a red flag once you start leaving jobs after 2-3 years, but once again, WHAT IS THE ALTERNATIVE?

Swallow it and keep moving? That's fine for most but a good portion of those AOA grads can't stand being taken advantage of, after years of slaving away to get to where they are.

 

[dieABRdie]

Most going rates for jobs out there is 350-500k. Some make more. Some make less. Some will never sniff near it. i understand the argument that they should be paying more but that is just not where the market is at because there will always be a sucker to take the job. If you pass, you end up unemployed as they all laugh at your requests for 800k in whatever hell pit place you looking at (KHE, RIP, posted about this multiple times describing his experience). The only way to fix long term to this is a dramatic reduction of rad oncs, including forcing retirements of old timers and dramatic cuts in residencies. The damage is already done. There is no short term fix.

Just as a data point from my 2 years interviewing exclusively rural for the sake of currently interviewing residents:

Highest offers were $650K range.... quickly dropped to $550K with CMS changes... and then to no longer hiring shortly thereafter.

So $700-800K not going to happen. If you can get $550K you might want to consider taking it. Anything less I would keep looking.

 

[elementaryschooleconomics]

Just as a data point from my 2 years interviewing exclusively rural for the sake of currently interviewing residents:

Highest offers were $650K range.... quickly dropped to $550K with CMS changes... and then to no longer hiring shortly thereafter.

So $700-800K not going to happen. If you can get $550K you might want to consider taking it. Anything less I would keep looking.

$550k-ish is also the highest I've heard for new grads (not true rural but not coastal).

If the state touches an ocean, I've mostly seen $290k-360k.

The only time I've heard $700k+ is the answer to the question "what do full/senior partners make"...or I Googled the MD Anderson salaries.

 

[yesmaster]

Current PGY-5, from my job search.

$450-650k base salary for new grads in rural communities or smaller cities, city populations 250,000 and under, metro populations 450,000 and under, with some opportunity for partnership or productivity bonus in 2 years.

I observed that many rural hospitals bought up a senior rad onc(s) practice in the last 5 years or so. Some of the dodgy hospitals overuse locums, that is as less qualified, less invested staff members, rather than as vacation coverage.

$700k+ is definitely doable for at least 5-6 of the physician owned practices that I interviewed at, after partnership. I personally wouldn’t accept anything less for a job outside of a major, desirable metro area.

Physician pay is, unfortunately, one of the factors driving cannibalization of community practices by academic centers. Somehow, chairs and some hospital administrators have gaslighted graduating residents into accepting much lower base salaries, for jobs that are essentially community practice. When the bar for a healthy job market is merely having a job, chairs have near-infinite slack, as they can just pay graduating residents less and less. For graduating residents in 2026, an annual salary of $225k is still 15 times greater than the minimum wage.

It is certainly news to me that 40 patients under beam generates almost $8-9 million in fees. I would've guessed half of that.

 

[Neuronix]

I have never been offered more than $450k at full productivity or "partnership". I was open to a lot of different locations and practice settings. I was laughed out of several interviews for asking about partnership tracks. In the end, I have made significantly less than $450k/year in my 5 years of practice.

I went the academic route in part because pay was basically the same between academic and non-academic for me. Stability in academics tends to be pretty high of course. Best argument I could ever get not to stay in academics was so that I could get away from administrators. Is that a good reason? Anyway, I doubled down on academics as a result.

I always "heard" about other positions with higher pay, but applications to those positions were always returned with radio silence or "we're not hiring". I don't know where you all are finding $700k+. Luckier than I am I guess.

 

[RadOncDoc21]

I have never been offered more than $450k at full productivity or "partnership". I was open to a lot of different locations and practice settings. I was laughed out of several interviews for asking about partnership tracks. In the end, I have made significantly less than $450k/year in my 5 years of practice.

I went the academic route in part because pay was basically the same between academic and non-academic for me. Stability in academics tends to be pretty high of course. Best argument I could ever get not to stay in academics was so that I could get away from administrators. Is that a good reason? Anyway, I doubled down on academics as a result.

I always "heard" about other positions with higher pay, but applications to those positions were always returned with radio silence or "we're not hiring". I don't know where you all are finding $700k+. Luckier than I am I guess.

I agree there are not many 700k gigs out there and are usually the few remote places we see from time to time but I’m pretty sure if you tried to get interviews now, 5 yrs out, you should be able to crack 450k almost anywhere that’s not in a “competitive” area.

Of course those opportunities are dwindling but 3-5 yrs post residency is the Golden era for employers to hire.

 

[imhopeful432]

I have never been offered more than $450k at full productivity or "partnership". I was open to a lot of different locations and practice settings. I was laughed out of several interviews for asking about partnership tracks. In the end, I have made significantly less than $450k/year in my 5 years of practice.

I went the academic route in part because pay was basically the same between academic and non-academic for me. Stability in academics tends to be pretty high of course. Best argument I could ever get not to stay in academics was so that I could get away from administrators. Is that a good reason? Anyway, I doubled down on academics as a result.

I always "heard" about other positions with higher pay, but applications to those positions were always returned with radio silence or "we're not hiring". I don't know where you all are finding $700k+. Luckier than I am I guess.

I know several graduting residents (5 personally, several more that I've heard 2nd hand) who signed jobs this year with PP partnership salaries (in 2-4 years) of $600k+
But yes, mostly (although not all) outside of major metro areas.

They do exist but yes true PP jobs are getting more rare as majority are now academic, academic affilates, etc per most recent ASTRO numbers

 

[Grubbe-a-dub-dub]

I know several graduting residents (5 personally, several more that I've heard 2nd hand) who signed jobs this year with PP partnership salaries (in 2-4 years) of $600k+
But yes, mostly (although not all) outside of major metro areas.

They do exist but yes true PP jobs are getting more rare as majority are now academic, academic affilates, etc per most recent ASTRO numbers

I'm sure these offers exist - but remember, those employed salary guarantees disappear after 2 years. And those PP salary expectations at partnership (if that's offered) are based on collections 2-4 years from now.

Most hospital systems are not pricing in hypofractionation and declining utilization of radiation. And PPs are still trying to use every means imaginable to squeeze out as much as they can in their collections. This will NOT be the case 2-3 years from now.

We are headed towards a scenario of decreasing pay regardless of the practice set up.

Graduates - get as much guaranteed money now and do not expect to be rolling in it like your old fat cat partners. Those days are over.

Make sure there are exit clauses in your contracts and make sure there is a tail insurance arrangement.

 

[imhopeful432]

I'm sure these offers exist - but remember, those employed salary guarantees disappear after 2 years. And those PP salary expectations at partnership (if that's offered) are based on collections 2-4 years from now.

Most hospital systems are not pricing in hypofractionation and declining utilization of radiation. And PPs are still trying to use every means imaginable to squeeze out as much as they can in their collections. This will NOT be the case 2-3 years from now.

We are headed towards a scenario of decreasing pay regardless of the practice set up.

Graduates - get as much guaranteed money now and do not expect to be rolling in it like your old fat cat partners. Those days are over.

Make sure there are exit clauses in your contracts and make sure there is a tail insurance arrangement.

Definitely something current graduates are exploring. I.e. had a friend with 2 offers - employed hospital contract, 500k right out of residency vs. PP partnership track with better set up after 2-3 years of grinding. Obviously not just a $$$ question, also depends on location, stability, etc etc but I don't think the answer on which one to choose between the 2 (if you're otherwise equally happy with the 2) is clear

 

[dieABRdie]

I'm sure these offers exist - but remember, those employed salary guarantees disappear after 2 years. And those PP salary expectations at partnership (if that's offered) are based on collections 2-4 years from now.

Most hospital systems are not pricing in hypofractionation and declining utilization of radiation. And PPs are still trying to use every means imaginable to squeeze out as much as they can in their collections. This will NOT be the case 2-3 years from now.

We are headed towards a scenario of decreasing pay regardless of the practice set up.

Graduates - get as much guaranteed money now and do not expect to be rolling in it like your old fat cat partners. Those days are over.

Make sure there are exit clauses in your contracts and make sure there is a tail insurance arrangement.

And DO. NOT. BUY. A. F***ING. HOUSE!

 

[kimplera]

make sure there is a tail insurance arrangement.

This!

 

[medgator]

This!

2nd! Tail can be five figures, easily.

 

[yesmaster]

What if your employer offers an occurrence policy? That obviates the need for tail insurance, right?

 

[scarbrtj]

t is certainly news to me that 40 patients under beam generates almost $8-9 million in fees. I would've guessed half of that.

Look at or google some of the current Varian reimbursement data they provide. It depends on mix and types of patients. But there are still patients that have 35K global price tags for their RT. If you see 250 of these a year that’s about 8.5m global.

 

[evilbooyaa]

What if your employer offers an occurrence policy? That obviates the need for tail insurance, right?

Correct

 

[deleted941485]

The mathematical case against blaming people for their misfortune | Psyche Ideas

Complexity science reveals the hard limits of our predictive abilities, and makes a mathematical case for compassion

psyche.co

"The problem is that much of economic and social life in affluent countries is structured to require individuals to commit most of their resources towards one strategy for pursuing a flourishing life. Taking out a student loan or mortgage, or buying a taxi medallion, are all strategies that require a large, if not total, commitment of a person’s financial resources. Here, real hedging would require us to start from a place of considerable wealth, and so it isn’t a viable strategy for many. Most of us remain consigned to placing big bets in a casino where it’s effectively impossible to know the underlying odds."

You invested so much time and money and put it all on RO. We are no different than those who paid $1M for a taxi medallion pre-ride share.

 

[medgator]

The mathematical case against blaming people for their misfortune | Psyche Ideas

Complexity science reveals the hard limits of our predictive abilities, and makes a mathematical case for compassion

psyche.co

"The problem is that much of economic and social life in affluent countries is structured to require individuals to commit most of their resources towards one strategy for pursuing a flourishing life. Taking out a student loan or mortgage, or buying a taxi medallion, are all strategies that require a large, if not total, commitment of a person’s financial resources. Here, real hedging would require us to start from a place of considerable wealth, and so it isn’t a viable strategy for many. Most of us remain consigned to placing big bets in a casino where it’s effectively impossible to know the underlying odds."

You invested so much time and money and put it all on RO. We are no different than those who paid $1M for a taxi medallion pre-ride share.

Except halfway through that medallion process, you have the option to go in a different line of work

 

[deleted941485]

Except halfway through that medallion process, you have the option to go in a different line of work

lol exactly. We are medallion holders that are locked in.

 

[radsisrad]

lol exactly. We are medallion holders that are locked in.

"Locked in" for offers of 500-600k? 700k+ for partners?

I thought the market was trash. These numbers are fantastic for any physician but a neurosurgeon or high-call-load ortho.

 

[thecarbonionangle]

Soon enough the field will look no different than taxi drivers who can barely speak english with a criminal record. No uber/lyft to filter who gets in. who cares! Potters gets paid.

 

[elementaryschooleconomics]

The mathematical case against blaming people for their misfortune | Psyche Ideas

Complexity science reveals the hard limits of our predictive abilities, and makes a mathematical case for compassion

psyche.co

"The problem is that much of economic and social life in affluent countries is structured to require individuals to commit most of their resources towards one strategy for pursuing a flourishing life. Taking out a student loan or mortgage, or buying a taxi medallion, are all strategies that require a large, if not total, commitment of a person’s financial resources. Here, real hedging would require us to start from a place of considerable wealth, and so it isn’t a viable strategy for many. Most of us remain consigned to placing big bets in a casino where it’s effectively impossible to know the underlying odds."

You invested so much time and money and put it all on RO. We are no different than those who paid $1M for a taxi medallion pre-ride share.

We aren't any different...but any med students from the class of 2021 or later going into RadOnc are essentially looking at Uber and saying - "I just feel a calling! I can't see myself doing anything else than buying this million dollar medallion! It's what I'm meant to do. I can beat the odds and turn a profit."

 

[medgator]

"Locked in" for offers of 500-600k? 700k+ for partners?

I thought the market was trash. These numbers are fantastic for any physician but a neurosurgeon or high-call-load ortho.

Are you trolling?

 

[deleted941485]

Are you trolling?

They banged their head getting out of their time machine from 2005

 

[elementaryschooleconomics]

"Locked in" for offers of 500-600k? 700k+ for partners?

I thought the market was trash. These numbers are fantastic for any physician but a neurosurgeon or high-call-load ortho.

Are you trolling?

They banged their head getting out of their time machine from 2005

People make weird conclusions after they see salary reports like the one Doximity just put out, or read SDN anecdotes.

It took me many years (until I was deep into residency) to learn that I shouldn't put a lot of stock in the "average salary" number. I personally know a Family Medicine doc who pulls down >500k/year. I personally know a hospice/palliative medicine guy who pulled down 350k last year. I haven't checked recently, but I believe those numbers are far above what we're told Family Med/Palliative Care should be making.

So yeah, while I know RadOnc partners who made >700k last year, 1) that's not a guarantee they'll make that next year and 2) that doesn't mean some Family Med doc hasn't figured out a business model where he can make >700k next year, too.

 

[Neuronix]

"Locked in" for offers of 500-600k? 700k+ for partners?

I thought the market was trash. These numbers are fantastic for any physician but a neurosurgeon or high-call-load ortho.

Like hitting the lottery. I assume it happens, but not very often.

What was the average first year salary last year? 300-350k? That honestly isn't bad as long as you're open to going anywhere and having little mobility.

What things will look like in 5-10 years, nobody knows.

 

[RadOncG]

"Locked in" for offers of 500-600k? 700k+ for partners?

I thought the market was trash. These numbers are fantastic for any physician but a neurosurgeon or high-call-load ortho.

I think you might be forgetting about location.

An academic doctor on the beach as @Neuronix has described himself might be lucky to get half of a private practice doc in rural midwest.

That doesn't mean one is doing better than the other but that people prioritize different things in life.

The problem with radiation oncology is that desirable location use to mean SF bay and Manhattan. Now it means within one hour of any place you have heard of before.

 

[Neuronix]

When I graduated from residency, I applied all over the country and all practice settings. I got two offers, both "academic", both similar pay, and in two wildly different parts of the country. I took the one on the beach because... Why not?

I could have negotiated into probably 2-3 more offers inside and outside academics, but the pay was pretty similar both at hire and full production, and this was in several parts of the country including upper midwest.

Several years into attendinghood and I would say that nothing has changed. I get the occasional discussion even 3-5 years in that sounds exactly like what I was discussing when I graduated (the $300k discussions are particularly insulting now). I stopped looking though, it's a huge distraction from moving forward and was just getting me nowhere.

N=1 I know, but this is the reality on the ground.

 

[RickyScott]

I would put it this way: todays mid tier resident would have job offers in non coastal locations 250-325. None of these guys will get 5–600 k in 5 years. Need to compare salary to other specialties like IM in these same locations. I get the sense that psych or neurology would make more in same locations coming out of residency.

 

[hal9k]

I’m a current PGY5 mostly looking in the southeast. Starting salary for either PP/hospital employment is about 400k here, however in locations 1-2 hours from major cities. The puzzling part for me is the potential after partnership is almost the same as full professor in academics, ~600k. PP is mostly 5 days now. Very rare to find 4-day week. Overall, academics gets a higher hourly rate, better location, and better lifestyle I would think since pay is pretty much the same now.

 

[Neuronix]

Overall, academics gets a higher hourly rate, better location, and better lifestyle I would think since pay is pretty much the same now.

Don't bet on the better lifestyle in academics. I think lifestyle is very specific to the practice and hard to generalize. E.g. I was here till 8:15 PM two days ago (in at 8 AM), we had a meeting until 7:30 PM last night (in at 7:30 AM), and I've got a meeting until 6 PM today (Friday).

Not trying to argue one side or the other, but just pointing out that full professor will take you at least 10 years to achieve, whereas partner will be much shorter assuming it happens.

 

[hal9k]

Don't bet on the better lifestyle in academics. I think lifestyle is very specific to the practice and hard to generalize. E.g. I was here till 8:15 PM two days ago, we had a meeting until 7:30 PM last night, and I've got a meeting until 6 PM today (Friday).

Not trying to argue one side or the other, but just pointing out that full professor will take you at least 10 years to achieve, whereas partner will be much shorter assuming it happens.

I didn’t realize academic ppl have meetings that late. I guess academics gets higher potential too if you make it to medical director/chairman?

 

[Neuronix]

I didn’t realize academic ppl have meetings that late. I guess academics gets higher potential too if you make it to medical director/chairman?

Sometimes it's meetings, sometimes it's treatments. Our machines often run into the evening with SBRT/SRS. I have been here doing Gamma Knife until very late many times.

But sure, sky is the limit with chair salaries. The chair where I trained made $1 million per year. Wally Curran was making $1.5 million per year. it's a pyramid scheme though. It's not easy to get to full professor, and past that is very uncommon.

 

[hal9k]

The other thing I noticed during my job interviews is lack of patient volume. In other specialities, if you want to work harder and make more you are welcome to. In rad onc, you simply can’t because there’s a limit on patient volume so it’s almost impossible to meet production bonus.

 

[scarbrtj]

The other thing I noticed during my job interviews is lack of patient volume. In other specialities, if you want to work harder and make more you are welcome to. In rad onc, you simply can’t because there’s a limit on patient volume so it’s almost impossible to meet production bonus.

I have thought of setting up a Free Skin Cancer Screening Booth, or "Free PSA and Digital Rectal Exams!" booth, in Wal-Marts.

 

[RickyScott]

The other thing I noticed during my job interviews is lack of patient volume. In other specialities, if you want to work harder and make more you are welcome to. In rad onc, you simply can’t because there’s a limit on patient volume so it’s almost impossible to meet production bonus.

This is so important!
btw- only way you get raises in academics is with competing offers and threatening to leave- that is not happening over the next 15-20 years.
BTW used to make millions as partners in the 80s, has nothing to do with what they can expect today (although still better than us)

 

[hal9k]

Also it’s really depressing to see ppl who used to score 250+ On step1, AOA type, multiple pubs with great social and clinical skills work in the middle of nowhere for 450-500k. This is really not what I signed up for. Simply depressing

 

[Neuronix]

This is so important!
btw- only way you get raises in academics is with competing offers and threatening to leave- that is not happening over the next 15-20 years.
BTW used to make millions as partners in the 80s, has nothing to do with what they can expect today (although still better than us)

You can get raises in academics. The problem is that you're kind of at your institution's mercy now.

If you aren't getting promoted when you should be, an offer from a place willing to promote you (or a good offer from a private group nearby) can often get you promoted. If your salary isn't being raised annually or upon promotion to be competitive, a competing offer can often get your salary bumped up. If you're otherwise being mistreated, you can tell them "fix this or I'm out". There were always limits here and they always had the option to tell you to leave in the past, though they're much less likely to if they're short staffed and don't know when they'll be able to fill your vacancy.

Nowadays, I haven't seen anyone willing to promote on hire like they used to. Competing offers are hard or impossible to get, especially with huge area non-competes.

So sure, if the academic place is doing things well (listening to faculty feedback, treating people fairly, promoting faculty and raising salaries appropriately), it's not really an issue. But if they're not, you can very easily get trapped in an unhappy, underpaid position, generating tons of revenue for the institution while you remain an underpaid academic. It's definitely happening out there.

PS: I'm probably getting promoted, and I didn't threaten to leave (where would I go? LOL). My H-index and other productivity is very high for an assistant prof though.

 

[hal9k]

This is so important!
btw- only way you get raises in academics is with competing offers and threatening to leave- that is not happening over the next 15-20 years.
BTW used to make millions as partners in the 80s, has nothing to do with what they can expect today (although still better than us)

I heard the same thing. In order to get promoted in academics, you need to threaten to leave with competing offers..but it doesn’t always work lol and can really burn you

 

[OTN]

I’m a current PGY5 mostly looking in the southeast. Starting salary for either PP/hospital employment is about 400k here, however in locations 1-2 hours from major cities. The puzzling part for me is the potential after partnership is almost the same as full professor in academics, ~600k. PP is mostly 5 days now. Very rare to find 4-day week. Overall, academics gets a higher hourly rate, better location, and better lifestyle I would think since pay is pretty much the same now.

Depends very, very highly on the private practice. There are still some private practices out there in which you can do very well, just not many of them.

 

[hal9k]

Depends very, very highly on the private practice. There are still some private practices out there in which you can do very well, just not many of them.

I agree. Those jobs are usually not posted and do not often have openings. It usually takes 3+ years to make partners. In current climate, who knows what’s gonna happen when you make partner

 

[OTN]

I agree. Those jobs are usually not posted and do not often have openings. It usually takes 3+ years to make partners. In current climate, who knows what’s gonna happen when you make partner

18 months in our practice, but I agree most partnerships are 2-3 years to make. Edit: It's also important to ask about the buy-in and what you exactly get for that buy-in.

 

[Bequerel]

Would anyone buy into a technical opportunity in today’s environment? Even if perfect situation (CON state and no competition), couldn’t decline in reimbursements crush you while you’re on the hook for millions in buy-in?

 

[Neuronix]

18 months in our practice, but I agree most partnerships are 2-3 years to make. Edit: It's also important to ask about the buy-in and what you exactly get for that buy-in.