rad onc job market specifics

[asdf13]

hi everyone, i'm currently deciding between rads vs rad onc. i know they are very different fields, but after looking at many of the issues head-to-head, one thing i've noticed is that on physician job sites, there seem to be hundreds of jobs all over the country for radiologists (all seem attractive, >$600K salary, 12 wks vacation, light call, etc); however, for rad onc there are not nearly as many openings, and most seem to be in places that are less desirable for me (rural areas). rad onc definately seems more interesting to me, but in the end of the day based on what i see online, it seems that the radiology job market is better in terms of job location, salary, and vacation - plus there are an abundance of jobs so i won't have to worry about settling for a lesser job in a less desirable location. in the end of the day i think this information is important because the last thing any of us wants is having worked very hard for years, and then not being able to have a job that is more or less of choice..do any of the current attendings or residents applying for jobs have opinions about this? also, the radiation onc jobs (private pract) that are posted do not entail many specifics regarding salary, vacation, call schedule - i know it varies, but any general idea would be great. i find it interesting that the rads posts have no problem posting titles "Big Money Opportunity in ___" stating that ">$700 can be expected with beaches all around and >12wks off, etc, etc". maybe it's just an inherent difference in the personalities of the two fields...anyways, thanks in advance for your honesty and advice, i think these are important issues to tease out - in any other field outside medicine it would be extremely transparent.

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[radiaterMike]

You need to decide if you want to treat patients with cancer, read films or do interventional procedures. You can get a job doing either radiology or radiation oncology anywhere in the country. If $$ and vacation are the primary reasons for deciding what field to enter, leave medicine now while you have the chance.

 

[cyron]

Rad Onc is a much smaller field, so the number of posted opportunities is going to appear smaller. That does not mean that job opportunities are limited. Rads and rad onc both pay very well and will allow you to enjoy life outside of work. As radiatermike said, focus on what interests you. Waking up to a job you look forward to makes a huge difference.

 

[kimsuki]

I absolutely agree with the above answers to the question regarding job market for rad onc and rad. Unfortunately, people in this country think about money only! Does money own people?

 

[Tanner]

asdf13,

I think you already know what field you want to go into but seem to just want more assurances than it is necessary. Have fun earning your >$700K on the beach with 12 weeks off for the rest of your life. And don't look back; I'm sure you'll be fine.

 

[Dade212]

I absolutely agree with the above answers to the question regarding job market for rad onc and rad. Unfortunately, people in this country think about money only! Does money own people?

I'm not sure why anytime someone has a question about money everyone reacts. Part of the decision making process of any career choice is considering what options are open, what is the lifestyle, etc... Whether or not you realize it, after residency, "real world" issues become "reality". It's easy to say "money doesn't matter", but when you have a mortgage, 3 kids, etc... you want to know ahead of time what you'll be able to provide, and how much time you'll be able to spend with your kids. For those of you who never think about money or lifestyle, I applaud you. But for the rest of us, it's certainly an issue that needs to be considered - perhaps not the sole issue, but definitely AN issue that goes into our decision making process. Most of us do not live in a bubble where nothing but the enjoyment of medicine keeps us alive.

just my 2 cents

 

[asdf13]

I was afraid of this sort of response...I think it's a problem that even though we all obviously have chosen to enter this profession for good (no one is stupid to just blindly enter medicine thinking it's some sort of cash cow), that there is still no trust and no way to actually find out real information. The ultimate problem is that most of the answers (from physicians of all people no doubt!) impose some sort of judgment that I must be in some a malaligned person with only material intents: the bottom line is that one shouldn't assume without the facts, there may also be familial/social issues that underlie why more money and time off are important - is it so wrong to know some specifics (see title of this post!) for what I may be doing for the next 40 yrs. Moreover, here is a real mind-blowing concept, what if I actually did a great job at work with my patients and loved what I did, and also enjoyed something else in life with the well-deserved (after over $500K in education and hard work) income/time off! In reality, there are many other professions that do not contribute much to society, but they are highly compensated - why is it so wrong to actually contribute, make a difference, and be compensated?

I love the field of rad onc as a clinical profession, but really have no idea what the specifics are. It would be like a new cancer drug coming out that had "good outcomes" and "low side effects" without actual numbers...Meaningless information, you would be a fool to publish that paper or be a patient who took that drug. Let's be a little scientific/objective here without subjective comments.

Sorry to get off topic, but I think it's warranted; however, getting back to the original post, does anyone have any numerical answers to the original question? Thanks.

 

[radiaterMike]

Again- you really need to decide what you like to do. Making $700k a year with 12 weeks of vacation is nice, but if you are miserable at work for the other 40 weeks, it is simply not worth it. It is unwise to make life decisions solely on money and vacation, since this is negotiable in any field. Obviously more radiologists are making 7 figures than neurologists, but insurance reimbursements can change over the course of decades, which obviously can impact salary. There are busy rad. oncs. making >700k a year and not so busy radiologists making <200k a year. There is a lot that goes into the equation of salary/vacation.

 

[clintpark]

Sorry to get off topic, but I think it's warranted; however, getting back to the original post, does anyone have any numerical answers to the original question? Thanks.

I haven't started my job search in earnest yet. What I'm telling you is second-hand info from an ARRO talk on this issue.

I don't think a graduating resident would have a hard time find a job. Since rad onc is a small field, job availability in the specific city you want to live in may be sporadic. For example, there was no job in Dallas/Fort Worth area two years ago for a graduating resident who wanted to stay in the area, but he had no problem getting multiple offers elsewhere.

For starters, the salary ranges from 220 to 250K, with variations based on the desirability of the city. (For example, those who are going to So Cal may get considerably less) The gap between academic and private jobs is small (?20K), but as you make a partnership in private practice (which takes ~ 3 yrs from what I gather), the gap may grow significantly. The days of pulling down 500K+ may be over for someone coming into the field now, especially given the inevitable adjustment for IMRT reimbursement. If the offer looks significantly better, I would be suspicious and look very carefully.

I myself am guilty of looking at lifestyle issues when I chose this specialty. I love what I will be doing for next 30+ years; and that includes being able to enjoy time with my family. Just don't say that on your interview trail...

Hope this helped.

 

[PimpMyRad]

I agree with radiaterMike. Reimbursement can change overnight, and that will have immediate implications on income and lifestyle. I guarantee you that if dx radiology gets a 50% cut in reimbursement you won't be seeing many offers of big bucks and 12 weeks vacation for very long. Ditto for rad onc. Also, keep in mind that the services provided by diagnostic radiologists can be out-sourced to well trained radiologists abroad thanks to broadband connections that allow instantaneous review thousands of miles away. This is being done by radiology groups now to cover ER needs at night in many hospitals. If I were a dx radiologist I'd be getting a bit nervous about that. inconvenient truth. I seriously doubt that the gravy train is going to be around for much longer for either field, so you should chose your field based on what you think you'll enjoy doing for the next few decades. What you make is largely out of your control, but choosing to do what you love is up to you. Other than lifestyle, the two fields have very little in common except for their shared heritage and the use of xrays, and I have never encountered anyone that was torn between the two. Sort of like trying to decide between Pediatrics and Pathology if you ask me, but it takes all types I guess.

As a side point, the reason you see so few rad onc positions compared with dx rad is that there are far fewer rad oncs than diagnostic radiologists in practice, and thus fewer positions open. But there are also far fewer newly trained rad oncs looking for jobs at any given time. But your point is valid in that you do have a better chance of getting a job in a location you are intent on, but if it's a highly desirable locale, you will not get the plum offers available in less desirable locations. Supply and demand, pure and simple. Hope this helps.

 

[Tanner]

The ultimate problem is that most of the answers (from physicians of all people no doubt!) impose some sort of judgment that I must be in some a malaligned person with only material intents: the bottom line is that one shouldn't assume without the facts,
.

I'm not judging you. I'm only giving you advice based on what you've told us- you seemed comfortable, from a clinical perspective, knowing what these two fields entail, since you did not voice any concerns about that aspect in your post. It seems to me that you'd be happy and content with either field, professionally. And as you said, although rad onc is more interesting, "in the end" there are other factors that affect your ultimate decision- and it is obvious that they are financial and lifestyle autonomy. Rads simply offers more autonomy than rad onc. The reason there aren't as abundant rad onc job listings with superfluous location and benefits is not because "it's just an inherent difference in the personalities of the two fields" but because of exactly what Pimpmyrads stated- simple supply and demand. You need less rad oncs per population than rads, so you won't find as many positions out there. Though incidence of cancer has increased, they have not changed as dramatically as the increased use of high end diagnostic imaging, so there won't be a big jump in demand anytime soon. Rad oncs at prime locations (unless Sioux Falls, SD is considered prime locale for you) are so entrenched that not even Don Corleone can muscle them out. Now, I'm not saying that you can't find a job you want at a place you desire with similar compensation as rads, but they are definitely harder to find.

You've done your research very thoroughly. Trust it. That's the fact. Now have fun earning your >$700K on the beach with 12 weeks off for the rest of your life. I'm still not being judgemental, I'm just being empathic.

 

[asdf13]

thanks for the honesty and helpful posts regarding this discussion...

 

[amherstguy]

i think the OP makes a valid point, though money shouldnt be such a huge factor, the ability to quickly get a job after residency is important. what good is it going through 5 years of a residency if you have a real tough time landing a job?? the radiologist residents have 10 job offers b4 they are even out of residency- the jobs find them, while the radonc residents have to search for jobs themselves??

 

[Zap]

While jobs in diagnostic radiology are still good, reimbursement is headed south rapidly. Since implementation of cuts to the technical component of many high profit-margin diagnostic procedures (e.g. MRI, PET/CT, etc.) in Jan '07 due to the DRA (https://www.register123.com/event/a...hcwebinars/Medicare_Imaging_Policy_Issues.pdf), many radiology practices have been seeing big decreases in reimbursement. Many practices are shelving plans for expansion and the job market is already starting to get somewhat tighter for recent grads. While ACR, RSNA, etc. are lobbying hard to get these cuts reversed, this has proven very difficult, since the money would have to come from cuts elsewhere. Given current budget issues, the aging population, and fears about rising health care costs, it’s unlikely they will be reversed and much more likely that there will be further cuts.

Given these realities, go into the field you think you will enjoy. If sitting in a dark room interpreting imaging studies with minimal patient contact excites you, then go into rads. If patient contact, multidisciplinary care, oncologic issues, and treatment planning excite you, then choose rad onc. The lifestyle and reimbursement are good in both specialties. If making lots of money gets you up in the morning, think about going into business (maybe medically related given your background and interests).

 

[Permonicek]

As somebody mentioned above, right now it's fairly easy to find jobs in rad onc. Of our 3 graduating seniors, 1 is going to private practice in SoCal, 1 in Connecticut, and 1 academic North Carolina. The places they ended up were their top picks, with multiple other offers. It seems you can expect 4-5 weeks of vacation to start, with a number of private practices working 4 days/week. The number of residency spots increased by 50% over the last 5 years, and it's not clear to me how that will affect supply/demand in the long terms. But, the US population is aging, which means more demand. An ASCO study recently showed a significant projected shortage of medical oncologists (>25%); I would guess the picture for us would be similar. As for radiology, I find it mind-numbingly boring

 

[Gravi69]

While jobs in diagnostic radiology are still good, reimbursement is headed south rapidly. Since implementation of cuts to the technical component of many high profit-margin diagnostic procedures (e.g. MRI, PET/CT, etc.) in Jan '07 due to the DRA (https://www.register123.com/event/a...hcwebinars/Medicare_Imaging_Policy_Issues.pdf), many radiology practices have been seeing big decreases in reimbursement. Many practices are shelving plans for expansion and the job market is already starting to get somewhat tighter for recent grads. While ACR, RSNA, etc. are lobbying hard to get these cuts reversed, this has proven very difficult, since the money would have to come from cuts elsewhere. Given current budget issues, the aging population, and fears about rising health care costs, it’s unlikely they will be reversed and much more likely that there will be further cuts.

Given these realities, go into the field you think you will enjoy. If sitting in a dark room interpreting imaging studies with minimal patient contact excites you, then go into rads. If patient contact, multidisciplinary care, oncologic issues, and treatment planning excite you, then choose rad onc. The lifestyle and reimbursement are good in both specialties. If making lots of money gets you up in the morning, think about going into business (maybe medically related given your background and interests).

So rads has reimbursement cuts on the horizon?

Anything in a similar vein for the field of radonc? Any bad news? Or maybe any upcoming good news?

 

[stephew]

folks, there is nothing wrong with considering the practical issue of income. Im sure the field of medicine would be much smaller if reimbursement was not substantial. please dont come here to scold people for queries in reimbursement per se. Thanks.

 

[deleted4401]

It's the only career that people look down on you for asking how much money you make, can make, and will make in the future ... 'cept probably the clergy. Nothing wrong about knowing about how much scratch you are entitled to at the end of the road.
S

 

[Gravi69]

folks, there is nothing wrong with considering the practical issue of income. Im sure the field of medicine would be much smaller if reimbursement was not substantial. please dont come here to scold people for queries in reimbursement per se. Thanks.

So from a reimbursement standpoint, what do you think of the future for radonc?

 

[stephew]

So from a reimbursement standpoint, what do you think of the future for radonc?

i dont think you'll ever starve.

 

[koolaidkid]

you won't starve, but the stories of people getting paid extravagantly will be less common. rad onc and rads will both likely be targeted for funding cuts, but rad onc can not be outsourced overseas / telemedicine. however, pay is prob comparable but in current market jobs in rads are easier to come by, esp in desirable locations b/c of numbers and demand of diagnostic CTs etc. if you do interventional radiology, pay is really good and job mkt is great (active recruitment, great vacation, great hrs, prob better pay than rad onc, vacation frequently better in pvt). academic opportunities are comparable in both fields. if you want great hours, have time to be a great mother, and not worry about insurance reimbursement, consider derm (private practice). if interest between the fields was all the same and the only consideration was great vacation, hours, location, and pay (esp. future) I would choose derm, rads, then rad onc. if money is more important, probably consider plastics (out of pocket) or spine (possible funding cuts but less likely given lobby). business will prob give you best pay. money, hrs, location prob better on avg for rads. future prospects prob more stable for derm (out of pocket). I find rad onc more gratifying. but if interest is equal and coming out of average residency program in both, job prospects prob better for rads. if couples matching, rads will be easier too. however, reimbursement not tied to insurance prob has the most stable future if u stay in medicine. look at what happened to ophtho and ENT in past 15-20 years. similarly, look at cardiac surgery. a change in tech/mgmt dramatically changed that field. also, in pvt practice shady things/conflicts do occur (cyberknife for bone mets, problems with urology buying equipment and hiring rad oncs to do unnecessary things). short answer: avg pay, locn, and hrs prob better for rads vs rad onc. max/best for both fields prob comparable. do a derm rotation to see if u like it. question is, what do you find more satisfying?

 

[koolaidkid]

there is a book that our esteemed moderator is an author for. it tells you about the different fields. forgot the name...

money and lifestyle are factors but hopefully not the deciding ones. if rad onc paid worse than peds, I doubt there would be as many people applying and the choice to do rads would be easier. similarly, people also have the misperception rad onc makes $500k easy. as a partner, maybe, but probably closer to $400k in pvt on avg w/o owning equipment. if you do rad onc and have absolutely no interest in academics, please be honest (or at least don't say you are 100 percent committed to being the next Hoppe/ Leibel/ Harris).

ultimately, if you can live with doing rad onc and getting paid $200-250k per year starting but find it to be really satisfying, do it. but the balance sheet in this current market is probably better for rads. I would suggest you do another rad onc away rotation and also another rads one (such as interventional) and see what you like more (you will get two good letters of rec also). the work-life balance is hard, and being a mother/father makes things even more difficult. however looking forward to what you do everyday really makes a difference. again, if these two fields are equally rewarding work-wise for you, and the deciding factor is pay/hrs/location, I would choose radiology. who could beat reading films from your laptop on the beach (and getting paid for it)? however, if you prefer therapy vs. diagnosis, rad onc may be more up your alley.

I think we all aspire to be altruistic (otherwise we would not be in medicine) and money/lifestyle cloud this issue. that's probably why 21st century gets a bad reputation and academics does not. however, each academic dept also looks out for the bottom line also. I think the unease ppl have is when they think money is the primary motivator, and to obtain more of it patient care is / may be compromised (e.g. unnecessary tx).

 

[stephew]

http://www.amazon.com/Ultimate-Guid...=sr_1_1?ie=UTF8&s=books&qid=1205012109&sr=8-1

 

[xraydude]

I would say rads will continue to take big hits with reimbursement over the next few years - CMS has already demonstrated this, and there is severe competition on the ownership side of equipment from orthopods, neuro ect.

Rad onc is still pretty protected - no one else can really do what we do, but the urorads is starting to be a threat.

The reality is that no one knows what jobs or income will be in 5 years, let alone 10 years - which is more likely when you may even just become a partner - given that you haven't even done a residency. Certainly medicare can't sustain at this rate, and it will depend on who wins the election in '08.

Your best bet is to do what you enjoy - what are you passionate about. The money will still be good, but probably not what it has been - that's the unfortunate reality, and you'd be best to at least spend the rest of your life enjoying what you do, knowing you will still be better off than not.
my 2 cents

 

[asdf13]

thanks koolaidkid and xraydude, those are extremely helpful posts.