Rad Onc Twitter

[jondunn]

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Problem with the idea that you can hire large contingent of low paid radoncs who are not clinically productive (model of many academic centers) is that they can also be be fired when times are tough and they will be totally unemployable. To fill up 40 hours, I have notice a lot of these centers have ever increasing documentation requirements and qa committees etc

numbers say median of 12/doc gets you median 550k. this only works for the big picture i think because more and more docs are hospital outpatient employed

 

[RickyScott]

numbers say median of 12/doc gets you median 550k. this only works for the big picture i think because more and more docs are hospital outpatient employed

12/doc is not based on Medicare rates. This can only be achieved by price gouging systems who can afford this with 3-5x cms rates

 

[Ray D. Ayshun]

I'm getting paid decently based on $/Rvu and would need more like 15-16 on treat to get the median.

 

[jondunn]

12/doc is not based on Medicare rates. This can only be achieved by price gouging systems who can afford this with 3-5x cms rates

Just saying what TheWallnernus numbers say.

I agree this works because of corporate hospital rates

 

[brushbeamscanning]

12/doc is not based on Medicare rates. This can only be achieved by price gouging systems who can afford this with 3-5x cms rates

Just to play devil's advocate, getting paid Medicare rates for the majority of your patients is not sustainable for many specialties and points to a larger systemic issue with healthcare reimbursement beyond just radiation oncology.

 

[deleted1111261]

Yes, this is with a mix of payors. Not just government insurance. And it is just a rough estimate.

 

[deleted1116990]

I'm getting paid decently based on $/Rvu and would need more like 15-16 on treat to get the median.

I agree. From what I've seen to get to about 1M you need about 30 on treat. 15 would obviously get you half of that. I'd think at 12 you'd be struggling to break into the 400s.

 

[OTN]

This discussion needs to be moved to the "Business of Radonc" sub-forum

 

[jondunn]

I agree. From what I've seen to get to about 1M you need about 30 on treat. 15 would obviously get you half of that. I'd think at 12 you'd be struggling to break into the 400s.

The numbers are the numbers based on wallnernus

Assuming wallnernus is correct, average of slightly less than 12 patients on beam per rad onc. I rounded up to 12

The MGMA median is 550k

 

[Chartreuse Wombat]

The numbers are the numbers based on wallnernus

Assuming wallnernus is correct, average of slightly less than 12 patients on beam per rad onc. I rounded up to 12

The MGMA median is 550k

Does MGMA translate to AAMC or FPSC?

 

[thecarbonionangle]

I know 550k is “median” however i know way more people making less than this and a few making more. Is this really median? And does this data include benefits and retirement plans?

 

[jondunn]

I know 550k is “median” however i know way more people making less than this and a few making more. Is this really median? And does this data include benefits and retirement plans?

it's like Dr. Scarborough (accent hit me by surprise!) said on the podcast - people say 'who only treats 12?!' and it seems like everyone says 'im at 25-30!' but the numbers are the numbers..

 

[deleted1111261]

He's from rural Tennessee! Accent like sweet tea on a hot day.

 

[BobbyHeenan]

This discussion needs to be moved to the "Business of Radonc" sub-forum

Agree.

I may have more input there.

 

[jondunn]

It can be discussed in the business forum as well for anyone who wants to.

This is specifically about averages.

 

[TheWallnerus]

I know 550k is “median”

Increasingly fake news the more one digs or checks

 

[deleted1116990]

There are a lot of variables. Just because the average is 12 patients per rad onc and the median comp is 550k doesn't mean most rad oncs are treating 12 patients and earning that much. But if that were true, then 12 patients? Where? Who is doing the billing? What is the payor mix? I have known people who worked in rural centers with < 10 on treat getting paid > 700 by the hospital and the hospital never complained. They could pay that much and still be profitable. If you weren't an employee, you'd probably be lucky to collect half that on your own with so few patients. So there's a unique circumstance where being a hospital employee is hugely in your favor. Other hospitals would never consider you paying you 700+ for any patient volume because they don't have a recruiting problem.

Probably one of the best set-ups is a find a place that will agree to pay you a flat percentage (15-25%) of global collections with some sort of reasonable base guarantee. Far less opportunities for shenanigans in that model. Unfortunately, after interviewing at probably 30 places so far, I've seen this offered exactly once (I regret not taking that job and not appreciating the value of such an offer at that time, as Todd alluded to on the podcast regarding a similar offer he had).

 

[jondunn]

Increasingly fake news the more one digs or checks

Sir - you cannot pick and choose which averages and medians you think are real. One is MGMA and one is your math.

 

[DebtRising]

Mgma is not salary

 

[jondunn]

There are a lot of variables. Just because the average is 12 patients per rad onc and the median comp is 550k doesn't mean most rad oncs are treating 12 patients and earning that much. But if that were true, then 12 patients? Where? Who is doing the billing? What is the payor mix? I have known people who worked in rural centers with < 10 on treat getting paid > 700 by the hospital and the hospital never complained. They could pay that much and still be profitable. If you weren't an employee, you'd probably be lucky to collect half that on your own with so few patients. So there's a unique circumstance where being a hospital employee is hugely in your favor. Other hospitals would never consider you paying you 700+ for any patient volume because they don't have a recruiting problem.

all of this is true. but all of the variables end up making the numbers what they are.....apparently.

and on the bold - I keep saying - we need to stop thinking of this in a freestanding way. I work in a free standing, but most dont, and even less will in the future.

 

[thecarbonionangle]

Mgma is not salary

Then what is it

 

[RO28]

Also linac babysitting across the network and of course academic expectations. All of that added together does not a happy rad onc make. Nobody likes to feel like their time away from their home, family, hobbies, etc. isn't maximally productive and efficient. It was actually a big reason I went to med school because I saw my peers going to work for major corporations where they had to go sit in their cubicles from 8-5 even if they, often, literally had nothing to do other than figure out how to look like they were doing something (fluff publications, anybody?). That looked miserable, albeit easy. I think most of us want to be busy at work and leave when we are done.

If you said, hey we don't have a lot of work for you. You can schedule all your patients in the morning and leave at noon if you want or work M-W or something, then that's fine. That's a part time job. It's a bit of a trick to take that same clinical workload, make the person stay until 5, and call that a 1.0 "FTE." And then you will also call the person who treats 30-40 at a time in clinic 4 days a week with one protected admin day 0.8 FTE. Huh? How is the second person less than? Seems suspicious.

you are so so so spot on.

 

[thecarbonionangle]

Increasingly fake news the more one digs or checks

This is the problem. There doesnt seem to be a real number. Like take out huge fish making 1-2M and what is the most common realistic salary for most people? It seems like many will never sniff over 350 on here by what some posters say yet the median is 550+? Tough to believe

 

[deleted1116990]

Then what is it

Subtract off $20k for value of employee sponsored health plan, 20k for retirement match, subtract off whatever retention bonus or profit sharing employees are lucky enough to get, and I guess you are left with shows on the steady paycheck. I don't know if they factor in PTO as compensation. That would muddy it.
I've always ballparked expected salary+RVU bonus as 50k less when benchmarking against MGMA total comp, but maybe I'm way off.

 

[jondunn]

It seems like many will never sniff over 350 on here by what some posters say

this is total BS.

 

[deleted1116990]

Clearly, we know Medicare reimbursement. That is a highly knowable number. A little less knowable is number of rad oncs.

How is this not knowable? It would be onerous, but technically possible using publicly available data from the ABR, to figure out the number of active board certifications in RO (which provides a pretty good idea). Harder, but also possible, would be to find out the number of active medical licenses of physicians with radiation oncology or therapeutic radiology as their specialty. All public data from each state board. How bored are you?

 

[deleted1111261]

Subtract off $20k for value of employee sponsored health plan, 20k for retirement match, subtract off whatever retention bonus or profit sharing employees are lucky enough to get, and I guess you are left with shows on the steady paycheck. I don't know if they factor in PTO as compensation. That would muddy it.
I've always ballparked expected salary+RVU bonus as 50k less when benchmarking against MGMA total comp, but maybe I'm way off.

The hospital admins I’ve worked with don’t agree (not saying you’re wrong). But 3 I’ve worked with used that number for salary. Not salary + everything

 

[deleted941485]

This is the problem. There doesnt seem to be a real number. Like take out huge fish making 1-2M and what is the most common realistic salary for most people? It seems like many will never sniff over 350 on here by what some posters say yet the median is 550+? Tough to believe

Median is a joke. Even median starting slalaru for new grads is overinflated driven mostly by desperate places out in the BFE that aren’t owned by a major academic center yet. I remember first starting and using first year numbers as a benchmark. They laughed!

 

[deleted1116990]

The hospital admins I’ve worked with don’t agree (not saying you’re wrong). But 3 I’ve worked with used that number for salary. Not salary + everything

Oh, I agree. In my experience this is how I negotiated with the hospital with the goal to view the MGMA number as salary + RVU bonus. But I was saying that my understanding was that it was reported to MGMA as W-2 income plus reported value of benefits paid by employer.

 

[thecarbonionangle]

Subtract off $20k for value of employee sponsored health plan, 20k for retirement match, subtract off whatever retention bonus or profit sharing employees are lucky enough to get, and I guess you are left with shows on the steady paycheck. I don't know if they factor in PTO as compensation. That would muddy it.
I've always ballparked expected salary+RVU bonus as 50k less when benchmarking against MGMA total comp, but maybe I'm way off.

Ok so in that case median is not really 550k. If you have a 401k, health plan substract that. If you have profit sharing add a bit over 30k to ur 401k 20k. Very few people i know even had an opportunity for profit sharing or let alone technical revenue, the kind of jobs Dr. Scarborough talks about.

Median somewhere in 400-500 range?

 

[thecarbonionangle]

Median is a joke. Even median starting slalaru for new grads is overinflated.

It just feels a bit surreal to like hear ya its median yet it seems like anectodally people have all sort of stories of people making these crazy wide ranges of money. The information asymetry alluded to in podcast is enormous even after residency and BC. Many continue to know little.

 

[deleted1111261]

We need better numbers. Ugh

 

[TheWallnerus]

How is this not knowable? It would be onerous, but technically possible using publicly available data from the ABR, to figure out the number of active board certifications in RO (which provides a pretty good idea). Harder, but also possible, would be to find out the number of active medical licenses of physicians with radiation oncology or therapeutic radiology as their specialty. All public data from each state board. How bored are you?

There 8,678 docs with an NPI radiation oncology 2085R0001X taxonomy in the Medicare database.

That's one start.

I like your other ideas too.

Another thought about "median salaries"... I have two acquaintances (was in residency with both) my age right now in rad onc who are not working. They want to work, but have yet to be able to find a job over the last year I think. Do the surveys count their present salary as zero? My survey would. And they would both have active state licenses and active NPIs. When you retire, you are supposed to retire your NPI. I don't know how strict people are about it.

 

[Lamount]

Increasingly fake news the more one digs or checks

Including medical benefits/401k + bonus? It's not that hard to imagine that this is a mid-career total comp for many

 

[jondunn]

 

[jondunn]

 

[jondunn]

Mean income of 563k for rad onc

 

[TheWallnerus]

Mean income of 563k for rad onc

FWIW this is averaged over 2005-17 timeframe, and the devil can be in the details.

The mean income for a Golden State Warrior is $9.4m. But only 4 out of 19 players on the team make above the mean.

 

[jondunn]

Agree median is a better number than mean.

Median we have MGMA and AAMC numbers to rely on, but IRS is king

So the mean is a bit higher than the median, but the story checks out

 

[TheWallnerus]

Agree median is a better number than mean.

Median we have MGMA and AAMC numbers to rely on, but IRS is king

So the mean is a bit higher than the median, but the story checks out

It is excellent data. Limitations are the timeframe and the mean. More contemporary data suggests some decreases, and that story too checks out.

 

[jondunn]

Perhaps I am in a bubble but I don’t know a single person who is midcareer who doesn’t make between 500-600k. Many who make more.

Any non-academic non- new hire person here want to cop to making less than this?

The story totally checks out to me

 

[RO28]

Perhaps I am in a bubble but I don’t know a single person who is midcareer who doesn’t make between 500-600k. Many who make more.

Any non-academic non- new hire person here want to cop to making less than this?

The story totally checks out to me

me. In the midst of a contract nego so we'll see but not hitting that number atm.

 

[TheWallnerus]

Perhaps I am in a bubble but I don’t know a single person who is midcareer who doesn’t make between 500-600k. Many who make more.

Any non-academic non- new hire person here want to cop to making less than this?

The story totally checks out to me

Well OK. Let's think about this critically for a bit. If you are willing to humor me. Give me your guess for the average non-Medicare to Medicare payor mix per RO in terms of total reimbursement (ie if a rad onc got $1.5m from non-Medicare and $0.5m from Medicare each year the ratio would be 3:1), and give me your guess for the average percent of total professional and technical an RO gets (using previous example, if a rad onc were paid a salary of $500K on total $2m reimbursement collections, the percent would be 25%).

I will give you my guesses... 5:1 for non-Medicare to Medicare, and 25% of total collections. Whatever numbers you pick, we can make a very reasonable prediction of what the median RO salary is in the US from just those two numbers. And I don't need any other numbers.

As a hint to what I'm getting at: if 1/3 rad oncs in the US get a total reimbursement from Medicare of $100K a year or less, and 2/3 rad oncs get $200K or less, and 75% get $300K or less... how could the average RO salary be $600K a year. We would need a lot of insurance company lift, and limit Medicare patients in preference of private insurance. And private insurance would need to be paying everyone handsomely, on average. However, of the 1.1m people irradiated each year, 350K are Medicare. So....

 

[jondunn]

Well OK. Let's think about this critically for a bit. If you are willing to humor me. Give me your guess for the average non-Medicare to Medicare payor mix per RO in terms of total reimbursement (ie if a rad onc got $1.5m from non-Medicare and $0.5m from Medicare each year the ratio would be 3:1), and give me your guess for the average percent of total professional and technical an RO gets (using previous example, if a rad onc were paid a salary of $500K on total $2m reimbursement collections, the percent would be 25%).

I will give you my guesses... 5:1 for non-Medicare to Medicare, and 25% of total collections. Whatever numbers you pick, we can make a very reasonable prediction of what the median RO salary is in the US from just those two numbers. And I don't need any other numbers.

As a hint to what I'm getting at: if 1/3 rad oncs in the US get a total reimbursement from Medicare of $100K a year or less, and 2/3 rad oncs get $200K or less, and 75% get $300K or less... how could the average RO salary be $600K a year. We would need a lot of insurance company lift, and limit Medicare patients in preference of private insurance. And private insurance would need to be paying everyone handsomely, on average. However, of the 1.1m people irradiated each year, 350K are Medicare. So....

you're making something excessively complicated with lots of assumptions though. median MGMA numbers are far from perfect but are closer to the truth then trying to use backwards alleys to get there.

 

[OTN]

Well OK. Let's think about this critically for a bit. If you are willing to humor me. Give me your guess for the average non-Medicare to Medicare payor mix per RO in terms of total reimbursement (ie if a rad onc got $1.5m from non-Medicare and $0.5m from Medicare each year the ratio would be 3:1), and give me your guess for the average percent of total professional and technical an RO gets (using previous example, if a rad onc were paid a salary of $500K on total $2m reimbursement collections, the percent would be 25%).

I will give you my guesses... 5:1 for non-Medicare to Medicare, and 25% of total collections. Whatever numbers you pick, we can make a very reasonable prediction of what the median RO salary is in the US from just those two numbers. And I don't need any other numbers.

As a hint to what I'm getting at: if 1/3 rad oncs in the US get a total reimbursement from Medicare of $100K a year or less, and 2/3 rad oncs get $200K or less, and 75% get $300K or less... how could the average RO salary be $600K a year. We would need a lot of insurance company lift, and limit Medicare patients in preference of private insurance. And private insurance would need to be paying everyone handsomely, on average. However, of the 1.1m people irradiated each year, 350K are Medicare. So....

I think you are over-estimating the number of practicing radoncs in the USA. I know of several who still have their NPI but haven't practiced medicine in at least 5 years.

 

[jondunn]

Or as my girl Carbon says -

‘Nobody will ever be able to tell you how the sausage was made,exactly. What you know is you like the sausage so you dont care how it was made.’

 

[TheWallnerus]

you're making something excessively complicated with lots of assumptions though. median MGMA numbers are far from perfect but are closer to the truth then trying to use backwards alleys to get there.

I think you are over-estimating the number of practicing radoncs in the USA. I know of several who still have their NPI but haven't practiced medicine in at least 5 years.

It's not complicated. And I don't need to know the number of rad oncs to make a guess at median rad onc salary. And, yes, one should not use NPIs to estimate rad onc numbers. I think the best we can do on rad onc numbers is use the Bates/Chowdhary 2020 PRO paper which said 5300 in 2017, and estimate an extra 100 ROs per year since then. But be that as it may...

Here are the best data with the highest confidence:
1) The median RO Medicare reimbursement is $150K/year (avg is $335K/RO per year over about 4800 entities... mostly MDs but also centers... for ~1.6B in 2019... this is very granular data).
2) There were 350K Medicare RT patients in 2019 with unique courses of RT tx's, and they comprise on average ~30% of all patients irradiated per year.

SO... we were talking x/y/z way back when. If
M = Medicare reimbursement
X = ratio of non-Medicare insurance reimbursement to Medicare insurance reimbursement per RO
Y = % of total prof&technical reimbursement paid to the RO
Z = RO salary

(X*M + M) * Y = Z

In this case, one of the most knowable stats in rad onc supply/demand is median Medicare reimbursement per RO which is $150K (M=150,000). Let's solve for Y if the non-Medicare to Medicare ratio is 10 to 1...

(10*150000 + 150000)*Y=600000, Y=36%

IOW, the average rad onc would need a 10-to-1 insurance-to-medicare reimbursement ratio, and get paid 36% of the global, to get a median reimbursement of $600K a year. If a rad onc only gets 20% of the global....

(X*150000 + 150000)*0.2=600000, X=19

.... a rad onc on average ALL rad oncs would need to average a 19-to-1(!!!) non-Medicare-to-Medicare ratio to hit $600K a year median. On average 🙂

So what I am saying is to say that there is a $600K median RO salary in the US stretches credulity very, very unbelievably. When you stop to think about it.

 

[medgator]

Perhaps I am in a bubble but I don’t know a single person who is midcareer who doesn’t make between 500-600k. Many who make more.

Any non-academic non- new hire person here want to cop to making less than this?

The story totally checks out to me

I personally know of a few jr faculity BC and 3-4 years out from training making low to mid 3s for a FT clinical schedule, both are based at the motherships of NCI-designated CCs.

It's garbage to making such a low-ball salary when you're working at a place with some of the highest costs in the country

 

[jondunn]

well I dont think its 600 median. If the mean is 560, and the MGMA say the median is 550, the median is likely somwhere between 500-550

keep in mind that these numbers jive with what AAMC and FPSC say for academics as well. the median salary for a professor in academics (mid-career we are talking about) is >500k.

everything that is somewhat reasonably reliable that is also used by hospitals, academic departments as benchmarks says the 50th percentile is 500 or above.

people in real life most of us know also make >500 at mid career.

so why be surpised that would be the median?

 

[jondunn]

I personally know of a few jr faculity BC and 3-4 years out from training making low to mid 3s for a FT clinical schedule, both are based the motherships of NCI-designated CCs

non-academic I said, but yeah assistant professor level making mid 3s checks out.