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Rad Onc - Supply & Demand

Discussion in 'Radiation Oncology' started by Gfunk6, Jan 4, 2017.

  1. Mandelin Rain

    Mandelin Rain 5+ Year Member

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    Not knowing anything past what was posted, I'd be very leery of a 0.6 position that will "increase as needed." What/who defines the need to add more FTE (i.e. pay)? If the need goes the opposite way, does that 0.6 FTE become 0.4 or 0.0?
     
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  3. nkmiami

    nkmiami

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    Part time jobs are typically for mom with children/or semi-retired doc (I am sure there are exceptions). Anyway, 1)what is the chance that someone would move to Harrisburg in this demographic?
     
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  4. DrfluffyMD

    DrfluffyMD

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    I remember how devastated the radiology match became when the job market issue became wide spread. Some of the most brilliant people I know graduated into the worst of times. I've seen credential of incoming residents going from AOA and 250s to brilliant but much less accomplished caribean grads.

    Now days the radiology job market got a bit better and competitiveness is picking up again. I especially like what our field did with the IR/DR residency as we are recruitig some of the best again.

    More over, we used 80 slots from DR to create IR/DR (many of those 80 people will not be practicing DR full time, if at all). Our PGY2 spot went from 982 last year to 932 this year. That's the right approach.

    I hope rad onc doesn't go the way of radiology. I know brilliant MD/PHDs who busted their ass throughout med school and it would be tragic if they are relegated to small town away from their family due to lack of career options, but this could happen and it's so unfair.
     
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  5. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    This is already happening. Rad onc is such a small specialty that location preferences are a chronic problem for us.
     
  6. anonperson

    anonperson Physician 7+ Year Member

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    As a non radiation oncologist, the fact that a group in Harrisburg of all places has the temerity to advertise a part time position and probably feel confident that they can hire someone speaks volumes of the current job market. Either the partners are barely scraping by financially and can only offer a part time gig to minimize their costs or they're being greedy as hell. Either way, not great.

    Should be a warning for all medical students out there in general that although it is important to choose a field of medicine you can tolerate/enjoy, you must be cognizant of what the job situation is like. Not saying the situation is permanent and things to change, but food for thought.
     
  7. radiaterMike

    radiaterMike Junior Member 10+ Year Member

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    You are making a lot of assumptions. As stated above there are people looking for part time jobs. It can simply be that the practice reviewed their volume, RVUs etc and they can expand their group by less than an FTE. Or a partner wants to go half time and they want to add another to make up for that. Just because it is not the job you want doesn't give you license to be judgmental or derisive. Yes there are people who want to live in Harrisburg. Yes there are people who want a part time job.


    Sent from my iPhone using SDN mobile
     
  8. Warderino92

    Warderino92 2+ Year Member

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    As a med student I really appreciate the time everyone further up in the chain is putting in to discuss the issue. I don't have a home rad onc department but during my time in a PP multispecialty office shadowing Rad Oncs I absolutely loved the field. It makes my specialty choice much harder knowing what I do now about the job market from you guys.
     
  9. DrfluffyMD

    DrfluffyMD

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    Job markets are cyclic. You don't want to buy high and sell low. I think I bought fairly high into radiology (was told appearently in 2015 there were less than 50 people nation wide with my step score). Perhaps in a different life I would have trained in my beloved NYC rather than the midwest and maybe settled down.

    Job market is very important. You should not move away from home to do something unless you cannot see yourself doing it for life without any other alternatives.
     
  10. oldking

    oldking Senior Member 10+ Year Member

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    The job market is way worse than I realized ... newest job posting on the Astro career website under physicians. It appears to be in rural Washington state but at least it's a full time position.

    Linen Attendant
     
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  11. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    :laugh::laugh::laugh:

    Come on ASTRO. You can do better than this. Please clean up your career center website so this non-rad onc physician/physicist work isn't included.
     
  12. medgator

    medgator Senior Member Physician 10+ Year Member

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    At first, it was non rad onc MD career positions that ended up there, and then practice manager and RTT/CMD positions and now it's come to this.

    Ridiculous.

    All the more reason for a strong practice in a desirable area to NOT have to pay for the privilege of using the astro career site to post a listing...
     
  13. oldking

    oldking Senior Member 10+ Year Member

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    Somebody forwarded that to me as a joke. It just occurred to me that the hospital actually paid money to ASTRO to post that position (and ASTRO took the money) ... more evidence that ASTRO doesn't care about anything other than taking money from whomever they can.

    This is a bit of an exaggeration/joke of course but I can't imagine being a resident right now freaking out about the job market then going to the career site of the only major organization in radiation oncology only to find that most of the posts are mislabeled or aren't even for physicians.

    After scanning through everything I agree that no reputable, well run organization would post a position there. I can't imagine ASTRO plans to do anything to stop residency expansion when they can't even manage a decent job posting site (that isn't even free!) in the year 2017!
     
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  14. PruritisAni

    PruritisAni

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    Think about it from Prov St Joes perspective. The entire medical community, and in particular healthcare administration, is really enjoying themselves watching RO cannibalize itself. Now they have an opening for a linen attendant. They think to themselves, what area of medicine is so miserably pathetic that even a linen attendant realizes they are on a sinking ship? Oh yeah, rad onc has brachytherapy and people wear scrubs, right? Let's send that poor schmuck a life vest and hire him for pennies on the dollar.

    I'd poach the RO support staff too!
     
  15. Gfunk6

    Gfunk6 And to think . . . I hesitated Physician PhD Faculty Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Well, if you REALLY need to be in the Pacific NW, it's not unreasonable to take a part-time job as a linen attendant. Maybe with time, patience and networking you could parlay to a full time position.

    Then, you could go into the RO department at night, logon to the TPS and "optimize" the attending plans a la Good Will Hunting. Once they recognized your genius, I'm sure you would be offered a full time RO position at Swedish.

    You guys are a bit too "the glass is half empty," look on the bright side!!


    Sent from my iPhone using SDN mobile
     
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  16. DrfluffyMD

    DrfluffyMD

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    I see 123 jobs on astro site, with 200 or so residents. In comparison radiology job site has 500 or so jobs and 1200 residents. Is the job situation super terrible right now?
     
  17. medgator

    medgator Senior Member Physician 10+ Year Member

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    If you're a urologist or endocrinologist, you could probably write your contract, depending on the locale....
     
  18. CaesarRO

    CaesarRO 2+ Year Member

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    Is endocrine really on its way up?

    Sent from my Pixel XL using Tapatalk
     
  19. DrfluffyMD

    DrfluffyMD

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    Yeah, but then urology residency is grueling.

    I truly believe subspecialty surgery have it the best and I hope IR move toward that model.
     
  20. hot sauce

    hot sauce 7+ Year Member

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    I'm not sure that is a good metric. My job was not advertised and I know many residents who got jobs that were never advertised.
     
  21. DrfluffyMD

    DrfluffyMD

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    I think most radiologists also get unadvertised jobs (just a nature of the beast), I think those job sites are a good gauge of job market.

    I was told that when radiology was hot, there were more than 1000 jobs posted at one time. The lowest I heard was around 200.
     
  22. medgator

    medgator Senior Member Physician 10+ Year Member

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    Urology can be benign as far as surgical specialties go once you are out in practice compared to say gen surg or nsg. Uro is in many ways similar to ent, good mix of clinic and OR, not a ton of emergencies
    It's always been in demand per one of my endocrine friends who literally said it's because it's one of the lower paid IM specialties
     
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  23. berag

    berag 10+ Year Member

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    Wife: It's time to buy a new car, and I think we can afford an upgrade.
    Me: Come read these SDN Radiation Oncology threads.
    (later)
    Wife: I think I can get a few more miles out of the Camry.
     
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  24. OTN

    OTN Member 10+ Year Member

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    In my experience the salary difference can be quite dramatic.
     
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  25. medgator

    medgator Senior Member Physician 10+ Year Member

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    Looks like pp version of that job just popped up on the astro job site... rural pp looking for employed cheap labor

    Radiation Oncologist in rural setting
     
  26. radoncopotamus

    radoncopotamus 2+ Year Member

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    $250k for 20-30 hrs/week, single site, no call. Is this supposed to be bad?
     
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  27. oldking

    oldking Senior Member 10+ Year Member

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    My wife and several close friends and relatives work or have worked "part-time" as a physician with varying degrees of success (it can definitely work but it's not as easy as it might seem). If you are going to do it be very careful and have everything carefully written out.

    What often happens is you get the worst of the worst cases and/or you work part-time in the office/hospital but full time when you add in all the extra you do from home. You can easily end up getting paid part time while working full time. It's doesn't help if you are "off" for two days a week but during that time you are constantly covering calls (even if you are not on call for the practice who is covering your patients while you are "off"?) or working on your notes, etc but doing so from home rather than the office so you are essentially doing it for free rather than paid like a full time employee.
     
  28. medgator

    medgator Senior Member Physician 10+ Year Member

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    In a rural setting? Sure. Didn't say 20-30 hrs btw. see oldkings post above
     
  29. oldking

    oldking Senior Member 10+ Year Member

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    I just read the description and I obviously don't know a thing about this particular position but my point is it's not "part-time" if you're there in the clinic from 8-12 (or "sometimes" which might mean "almost all the time" until 2pm) then instead of going to your office like the "full time" employees you go home and just go to your home office and work on notes, volumes, etc until 4pm (or 6-7pm "depending on census") like the full time employees are doing at the work office but your getting paid "part time."

    You also might be seeing all the train wrecks and palliative/low RVU cases while the full time employees get the easiest and highest revenue generating cases (then after a few months when the census consistently builds instead of making you 0.5 to 0.75 FTE or whatever they say you aren't generating enough RVU's even though you are working harder than they are).

    Again, I don't know anything at all about this position and I know more than a few people who are very happy working part-time. If this is really a job where you go in at 8am and leave at noon (or occasionally 2pm) with all work done and nothing to do until 8am the next day for $250,000 I will seriously consider applying. In fact, I'm about to right now!
     
    Last edited: Apr 28, 2017
  30. BobbyHeenan

    BobbyHeenan 2+ Year Member

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    These low(ish) single linac rural places can be very difficult to find the right fit. If you're treating 10-15, and don't have a great payer mix, then it's a pain because like you say you're there daily, at minimum 8-2 PM, but if billing only professional fees it may not be at the income level you'd like. Plus, if it's in a rural location where you don't want to live, when you add in commute time you really are away from home for what feels very much like a full time position for part time pay.

    If you can find a position like this in an area where you want to live, then absolutely this can be a good gig...but when you throw commute in there it becomes less than ideal.

    Some groups (and academic centers) have sent a rad onc out to the clinic 3 days/week, and had a mid level or a med onc serve as the "supervising" doctor on the other days with off line imaging review from a remote location. We've been round and round about the legality/appropriateness of that on this board before, but that kind of thing I know for a fact was going on across a number of places in the southeast, south, and midwest about 3-5 years ago. I don't have a set up like that, but I know people that do that.
     
  31. nkmiami

    nkmiami

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    Irvine CA and Salina KS are hiring again?
     
  32. medgator

    medgator Senior Member Physician 10+ Year Member

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    I think there is a loophole in the supervision guidelines for "CAH" situations or "critical access hospitals" but it had to be pretty rural and I believe Medicare has to define the area as such.

    It's really a tough situation, I'm sure some of these areas really need a linac but just don't provide the enticement as you've alluded to
     
  33. thecarbonionangle

    thecarbonionangle 2+ Year Member

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    What's the deal with the Salina job? it constantly gets dumped on in this board. Is it just the location or location plus predatory practice?
     
  34. medgator

    medgator Senior Member Physician 10+ Year Member

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    Most jobs don't sponsor visas but that one does... Unfortunately those kinds of jobs can be predatory esp if an img takes the position....their visa is tied to keeping that job.

    Plus that job has probably been posted off and on for several years. red flag imo.

    On top of all of that, location may be an issue. Kansas city isn't bad, I've been there it's like any large Midwestern city with plenty to do, but I imagine salina is no KC....
     
    Last edited: Apr 29, 2017
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  35. nkmiami

    nkmiami

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    I consider Irvine, CA one of the best places to live in the world... The job has been posted numerous times over the past 10 years.
     
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  36. medgator

    medgator Senior Member Physician 10+ Year Member

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    Which should then make you wonder about what's wrong with the job.... no partnership or advancement within the practice, they may just want to keep new grads coming in as cheap labor and cut them loose after a couple of years
     
  37. bluebubbles

    bluebubbles 2+ Year Member

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    One question is whether any group of trainees will be immune to the effects of supply/demand issues in the labor market, if it'll just be bad for residents in smaller programs w/o a long history or brand name, or if residents are more or less the same in the eyes of pp hospital managers and academic chairs

    IMO, the nature of physician jobs is such that there isn't much in the way of statistical discrimination in hiring docs 2/2 standardized clinical practices, so it mainly comes down to taste-based discrimination (residency reputation, location-specific ties, "personality", obedience, etc.)
     
    Last edited: Apr 29, 2017
  38. fiji128

    fiji128 Junior Member 10+ Year Member

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    The Salina people actually had a booth as the Astro Refresher this year. I didn't really talk to them but it is a private practice med onc/rad onc group that has multiple sites across rural Kansas with the home base being in Salina, which is probably why they are frequently posting.
     
  39. medgator

    medgator Senior Member Physician 10+ Year Member

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    Current issue of Red Journal....

    Domestic Job Shortage or Job Maldistribution? A Geographic Analysis of the Current Radiation Oncology Job Market


     
  40. Chartreuse Wombat

    Chartreuse Wombat 2+ Year Member

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  41. medgator

    medgator Senior Member Physician 10+ Year Member

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    Agreed. A good follow up study would be a survey showing how people got jobs in the populated metros of TX/FL/CA/northeast etc got their jobs

    Sent from my SAMSUNG-SM-N910A using Tapatalk
     
  42. radiadouken

    radiadouken 5+ Year Member

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    Not only that, the authors missed several jobs that were posted based on my review.
     
  43. nkmiami

    nkmiami

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    Perhaps a resident on this board- maybe one considering a fellowship- would be interested in writing an article: "lack of leadership in radiation oncology, diminished leaders and the rapid decline of ASTRO, including the scientific content of the meeting." There is an oversupply: 1) many patients still get conventional fractionation for prostate /breast /mets and this will decrease over the next 10 years. 2) large regional health care systems consolidate and centralize and require less radiation centers 3) i get the sense that in the rest of the world radoncs dont have 15-20 patients on treat ever! (more like 30+, and they probably work past 3:00 pm 5days/week) 4) physician presence rules artificially inflate the number of radoncs needed and there could be reform in this area- more np s/pa s. 5)Payment reform will never favor an increased need for radoncs - bundled payment/capitation will mean less fractionation/treatments.

    ... and residency slots have almost doubled in the past 10 years. As our professional organization, you would think that this would be something they would tackle. (a lot of resources are invested in educating a medstudent through residency for them to be underemployed/utilized)
    When someone chairs astro, do they have any kind of agenda, or do they see it as a largely professional honor/meeting organizer, and platform to release statements like "technology and safety are important." etc
    Isnt it logical that "Choosing wisely...." is accompanied by an assessment of need for radiation oncologists? Not just because hypofractionation/observation requires less docs, but because an oversupply of docs may result in some becoming desperate for patients and more likely to excessively fractionate/treat.
    I can remember ASTRO taking over 5 years to release a position statement on urorads, and by then it was largely irrelevant. Maybe I am getting old and crotchety but it seemed like in the late 90s, the leaders in the field- Perez, Brady, Liebel etc had more of a presence/impact.
     
    Last edited: Aug 18, 2017
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  44. Neuronix

    Neuronix Total nerd Administrator Physician PhD Faculty SDN Advisor 10+ Year Member

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    Such an article would be a good way to make sure you never work in academics ever again.
     
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  45. seper

    seper 7+ Year Member

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    I think ASTRO meeting diminished just because radiation-containing phase III studies are MedOnc-led, and presented at ASCO.
     
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  46. PruritisAni

    PruritisAni

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    Cool!
     
  47. Mandelin Rain

    Mandelin Rain 5+ Year Member

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    Can't initiate protocols when spending all time acquiring satellites and Varian doesn't fund as well as BMS or Novartis, etc...
     
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  48. bluebubbles

    bluebubbles 2+ Year Member

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    Get BMS or Novartis to fund you. Of course, you'll have to ask questions that they care about.
     
  49. medgator

    medgator Senior Member Physician 10+ Year Member

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    RTOG 0617 asked about erbitux in NSCLC. Turned out to be a dud, but yes you're correct.
     
  50. Mandelin Rain

    Mandelin Rain 5+ Year Member

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    I feel it probably best to ask one question in a Phase III rather than two scientifically unrelated and potentially confounding questions.

    I think every time RTOG has done this it's turned out to be a dud. Like when RTOG had a negative trial in 0129, and despite that, they took the losing arm to be their standard arm in 0522 +/- Erbitux.

    Maybe it's just Erbitux.
     
    Last edited: Aug 25, 2017
  51. MOHS_01

    MOHS_01 audemus jura nostra defendere Physician 10+ Year Member

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    That... or one could be a little more diplomatic in the discussion portion and make a name for themselves whose inertia carries them through their career.

    I remember this one brash, young resident being appointed to a "Dermatology WorkForce TaskForce" (or some similarly named BS) at the AAD who was ultimately silenced but not before angering several balding old jackasses. 15 years later and he was spot on; that's the funny thing about mathematics, equilibrium dynamics, and non-politically (or financially) driven "analysis" or projections. Oops.
     

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