Rad Onc Twitter

[RSAOaky]

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If a resident found this advice helpful, they are probably dumb AF.

Hi, I'm KO. Here's a bunch of generic advice about finding a job from someone whose been in the same one for 20 years.

I really love the "use an offer as leverage" bit. There's no such thing as leverage when there's an oversupply of residents and an undersupply of good jobs.

 

[elementaryschooleconomics]

KO is such a goofball.

But he's the only one of the #raraRadonc crowd left standing after the Great Crash and Purge s/p 2018 Debacle. I'll give him credit for that.

(or maybe he's just a frog left in a pot set to boil slowly, who knows)

 

[TheWallnerus]

(or maybe he's just a frog left in a pot set to boil slowly, who knows)

 

[bubbachuck]

There's no such thing as leverage when there's an oversupply of residents and an undersupply of good jobs.

I didn't read his thread but with respect to this specific statement, last year and--from what it sounds like--this year, the tables were shifted in favor of applicants.

 

[jondunn]

 

[medgator]

Hi, I'm KO. Here's a bunch of generic advice about finding a job from someone whose been in the same one for 20 years.

I really love the "use an offer as leverage" bit. There's no such thing as leverage when there's an oversupply of residents and an undersupply of good jobs.

I think he got it in reverse but is too clueless to know that practices owe the job applicant nothing

 

[OTN]

Not my job to do the academics' work for them.

All you have to do is see the dose distribution of a VMAT CSI plan to know it will be tolerated decently well. I don't understand the obtuseness with respect to this.

 

[OTN]

I think he got it in reverse but is too clueless to know that practices owe the job applicant nothing

Just read the whole thread. Would have been great advice in the early/mid 2000s. Irrelevant now.

 

[jondunn]

I think he got it in reverse but is too clueless to know that practices owe the job applicant nothing

everyone knows there are a lot of dinguses out there, doesnt need to be said. guess you just told on yourself?

 

[jondunn]

 

[medgator]

You having a KO fan fest today, huh

 

[elementaryschooleconomics]

So I saw this:

And when I looked at the graph, this was immediately obvious:

You don't need a PhD to Match into a good surgery program, you just need to be willing to endure 120 hour workweeks.

Everyone knows that specialties like Neurology don't have the best pay or lifestyle (on average), and anyone competitive/driven enough to matriculate into an MD-PhD program, willing to endure/finish their PhD, AND THEN go into a specialty like Neurology is really...genuine about their motivations.

AWFULLY SUSPICIOUS that the 3 most competitive non-surgical specialties over the last 20 years are clustered together in such a tight range...hmm...I wonder...I wonder why...

 

[RSAOaky]

I didn't read his thread but with respect to this specific statement, last year and--from what it sounds like--this year, the tables were shifted in favor of applicants.

If you need or want to be in a competitive city, you have no leverage unless you consider leverage to be taking a job somewhere else entirely. It’s part of the issue with consolidation. If the major health system in my region is hiring 5 people, they’re offering them all pretty equivalent salaries. Pre-consolidation that was 5 separate clinics with separate offer sheets and maybe there was some room for negotiations. Now you can pat yourself on the back for the 10-30k extra you negotiate upfront and then at 2 years when you ask about renegotiating your contract, unless you’re a stud get ready to hear “well you already get paid more than the other faculty that are your equivalent level.”

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

 

[deleted941485]

If you need or want to be in a competitive city, you have no leverage unless you consider leverage to be taking a job somewhere else entirely. It’s part of the issue with consolidation. If the major health system in my region is hiring 5 people, they’re offering them all pretty equivalent salaries. Pre-consolidation that was 5 separate clinics with separate offer sheets and maybe there was some room for negotiations. Now you can pat yourself on the back for the 10-30k extra you negotiate upfront and then at 2 years when you ask about renegotiating your contract, unless you’re a stud get ready to hear “well you already get paid more than the other faculty that are your equivalent level.”

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

This is precisely why you can’t listen to anyone in a position of power when it comes to these types of issues. They are too busy trying to shuffle the chips around to deceive you and make you think you’re getting a deal.

 

[elementaryschooleconomics]

If you need or want to be in a competitive city, you have no leverage unless you consider leverage to be taking a job somewhere else entirely. It’s part of the issue with consolidation. If the major health system in my region is hiring 5 people, they’re offering them all pretty equivalent salaries. Pre-consolidation that was 5 separate clinics with separate offer sheets and maybe there was some room for negotiations. Now you can pat yourself on the back for the 10-30k extra you negotiate upfront and then at 2 years when you ask about renegotiating your contract, unless you’re a stud get ready to hear “well you already get paid more than the other faculty that are your equivalent level.”

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

This just needs to be repeated over and over and over because people don't understand.

The thing we know as the "academic medical center model" didn't exist 20 or 30 years ago. Actually, based on the hospitals and institutions where I have personally trained and worked, it seems to have accelerated only 10-15 years ago.

It's not exclusively a RadOnc problem either. It's an everyone problem.

Working in "the network" of an "academic medical center" is basically like working in a restaurant where tips are pooled at the end of the night and the owners tell staff "it's more fair this way", but you're still getting paid the substandard wage because "your tips will make up for the difference".

The only ones who win are the C-suite execs. How many "Vice Presidents" does one hospital need? What do they do? How do the generate revenue for the organization to justify their salary?

So, all you "Clinical Assistant Professors" staffing satellites that were community hospitals in the 1990s and 2000s - I hope you're getting the "friends and family" discount when you choose to eat at the restaurant you wait tables for.

 

[jondunn]

Bolus has been CANCELLED in my clinic for a while as well

 

[jondunn]

This just needs to be repeated over and over and over because people don't understand.

The thing we know as the "academic medical center model" didn't exist 20 or 30 years ago. Actually, based on the hospitals and institutions where I have personally trained and worked, it seems to have accelerated only 10-15 years ago.

It's not exclusively a RadOnc problem either. It's an everyone problem.

Working in "the network" of an "academic medical center" is basically like working in a restaurant where tips are pooled at the end of the night and the owners tell staff "it's more fair this way", but you're still getting paid the substandard wage because "your tips will make up for the difference".

The only ones who win are the C-suite execs. How many "Vice Presidents" does one hospital need? What do they do? How do the generate revenue for the organization to justify their salary?

So, all you "Clinical Assistant Professors" staffing satellites that were community hospitals in the 1990s and 2000s - I hope you're getting the "friends and family" discount when you choose to eat at the restaurant you wait tables for.

perfectly said.

would only add that it's not just academic medical center corporate models that have gobbled up previously independent clinics

 

[Neuronix]

It's not exclusively a RadOnc problem either. It's an everyone problem.

Our institution can't hire faculty on clinical assistant professor model in satellites. Other specialties are hired as staff physicians and paid MGMA level rates competitive with other employed positions. It's the only way they can hire.

 

[Neuronix]

You don't need a PhD to Match into a good surgery program, you just need to be willing to endure 120 hour workweeks.

Everyone knows that specialties like Neurology don't have the best pay or lifestyle (on average), and anyone competitive/driven enough to matriculate into an MD-PhD program, willing to endure/finish their PhD, AND THEN go into a specialty like Neurology is really...genuine about their motivations.

AWFULLY SUSPICIOUS that the 3 most competitive non-surgical specialties over the last 20 years are clustered together in such a tight range...hmm...I wonder...I wonder why...

I think another challenge is that institutions often see radiation oncology as an ancillary or supporting service. We're often viewed as technicians and revenue generators more than leaders in the patient care or research domain. Also, because it is a lucrative specialty, either the rad onc has to accept a large pay cut (fellowship, instructor, etc) to be a physician-scientist, or the institution has to chip in a lot of money to support the rad onc while they could pay less to support startup packages and salaries of less procedural specialties.

 

[medgator]

would only add that it's not just academic medical center corporate models that have gobbled up previously independent clinics

Hospital consolidation is happening everywhere, agree.

Academic centers are probably the biggest driver though, see CCF, Mayo, msk, UPMC etc either becoming the biggest entities in their respective states and/or even "metting" out to other ones...

 

[elementaryschooleconomics]

Our institution can't hire faculty on clinical assistant professor model in satellites. Other specialties are hired as staff physicians and paid MGMA level rates competitive with other employed positions. It's the only way they can hire.

Just to clarify - they can't hire ANYONE on that track in the satellites, or they can't hire other specialties on that track but CAN for RadOnc at satellites?

 

[RickyScott]

Just to clarify - they can't hire ANYONE on that track in the satellites, or they can't hire other specialties on that track but CAN for RadOnc at satellites?

Some places pay sh-t at the main campus because it is highly “academic”. They “shouldn’t” also do this at the satellites, but will try. When I came out 10+years ago, satellites were the worst possible job for this reason.

 

[Doctorer]

If you need or want to be in a competitive city, you have no leverage unless you consider leverage to be taking a job somewhere else entirely. It’s part of the issue with consolidation. If the major health system in my region is hiring 5 people, they’re offering them all pretty equivalent salaries. Pre-consolidation that was 5 separate clinics with separate offer sheets and maybe there was some room for negotiations. Now you can pat yourself on the back for the 10-30k extra you negotiate upfront and then at 2 years when you ask about renegotiating your contract, unless you’re a stud get ready to hear “well you already get paid more than the other faculty that are your equivalent level.”

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

This is a perfect post.

 

[Neuronix]

Just to clarify - they can't hire ANYONE on that track in the satellites, or they can't hire other specialties on that track but CAN for RadOnc at satellites?

It's a little more nuanced, but essentially med onc is hired as staff physicians at MGMA while rad onc is hired as clinical assistant professor at AAMC rates. It all gets negotiated based on supply/demand.

 

[RickyScott]

It's a little more nuanced, but essentially med onc is hired as staff physicians at MGMA while rad onc is hired as clinical assistant professor at AAMC rates. It all gets negotiated based on supply/demand.

It seems so obvious that we should care more about supply and demand than whether cms cuts xrt rates.

 

[RSAOaky]

It's a little more nuanced, but essentially med onc is hired as staff physicians at MGMA while rad onc is hired as clinical assistant professor at AAMC rates. It all gets negotiated based on supply/demand.

All supply and demand. The academic megacorp in my town is a revolving door of junior physicians on both academic and clinical tracks. They pay the worst in the region. They employ ~40 physicians and have to replace 3-5 of them every year. You may look at that and say 10% attrition doesn't seem that bad, but when you break it down it's not the 20 or so senior faculty with their titles, minimal clinical responsibility, and high salaries that are being replaced, it's the young work horses who were so happy 2 years ago to have this job but now realize they're underpaid and overworked and it's a dead end in terms of salary. Suddenly 25% attrition of young faculty doesn't sound as good, but year after year, bright eyed and bushy tailed senior residents are clamoring to be underpaid by the same nationally recognized health system and chirping about how strong the job market is. When early-mid level salaries rise to market rates because it's gotten so tough to replace someone that megacorp has to pay them what they're actually worth, I'll eat crow and accept that the job market's not so bad.

 

[communitydoc13]

Wow, every single poster spot on IMO.

In the throes of peak radonc, leadership forgot what radonc was and how it was viewed by those outside of the field. That is; a cush, technical field driven by physics.

They actually thought that the easy and remarkable available talent would transform the field, sort of like how crypto is going to be transformed by the influx of financial talent. Radonc was going to become the preeminent source of oncologic innovation. I think chairs of high power departments in the early 2010s were really starting to imagine themselves as great men. Some of them do employ great medical oncology researchers pretending to be radiation oncologists.

No MD/PhD having, 70% in the lab working, 225K making medonc is thinking that we are not progressing rapidly enough in oncology because of the lack of radonc research. I'm sure they are happy that all of their radonc colleagues seem bright and reasonable and well versed in the literature.

 

[RickyScott]

I think chairs of high power departments in the early 2010s were really starting to imagine themselves as great men.

Thats when "leadership masterclasses" began to appear at ASTRO.

 

[elementaryschooleconomics]

I think chairs of high power departments in the early 2010s were really starting to imagine themselves as great men.

I don't think it was just the Chairs, I think it was everyone.

We built our own echo chamber before it was cool.

Sure, people "in the know" (read: the people already in the field or interested in joining) were aware of just how competitive RadOnc was, our 4 board exams, our obsession with trivia, etc etc -

But...other than knowing RadOnc exists, how many other types of physicians and healthcare professionals know the ins-and-outs of our insanity? I honestly think less than 5%, and mostly just our friends in MedOnc and Surgery.

In our echo chamber, we forgot that the world doesn't care about us. Not actively, not maliciously. Just...indifferent. Why should they?

The Dermatologists releasing their own radiation guidelines says it all. Didn't even occur to them to talk to us. Why would it?

We're barely a blip on the medical radar.

So you junior residents better get back to memorizing the Mayneord F factor equation and the proteins involved in the NHEJ signaling pathway. It makes sure we are the exclusive users of therapeutic radiation!

Right?

Right?

 

[jondunn]

I don't think it was just the Chairs, I think it was everyone.

it was definitely everyone. I think it also leads to more dissatisfaction as this generation went into rad onc thinking it was the biggest gold mine (in money, respect, impact, whatever domain you pick) and so when reality hit it burned even more.

 

[elementaryschooleconomics]

it was definitely everyone. I think it also leads to more dissatisfaction as this generation went into rad onc thinking it was the biggest gold mine (in money, respect, impact, whatever domain you pick) and so when reality hit it burned even more.

That was definitely a factor for me. I had all these mentors saying a lot of glorious things, and now I get referrals from MedOnc telling me what dose, fractionation, and timeline scheme I'm supposed to do.

I'm glad they do, because I'm too busy trying to keep up with who I'm supposed to omit radiation for while waiting on hold with eviCore because I had the audacity to accidentally generate a DVH while treating a bone met.

[insert pic of monkey hitting keyboard in dingy basement]

 

[RSAOaky]

One thing I would like to add is that there are actually academic institutions or health systems that pay quite well, sometimes uncharacteristically so for their region. This is largely driven by powerful and well respected chairmen/medical directors who have a good relationship with their health system and have been able to continue to make the case for paying radoncs based on the money they bring in rather than based on how difficult they are to replace.

However, eventually these people retire or the health system merges or gets bought out by a bigger system. Maybe the new hospital CEO doesn't have the same relationship/history with your chairman and values people differently. Maybe the new Chairman feels that it's better to have some redundancy and pay two physicians the minimum that they'll accept rather than pay 1 physician what they're actually worth.

These shifts will continue to happen. No one is coming in and saying "whoa whoa whoa, these radonc salaries need to be...twice as big!" Once those salaries drop, they ain't ever comin' back up. There is no demand for radiation oncologists. There is only demand for CHEAP radiation oncologists.

 

[deleted1116990]

One thing I would like to add is that there are actually academic institutions or health systems that pay quite well, sometimes uncharacteristically so for their region. This is largely driven by powerful and well respected chairmen/medical directors who have a good relationship with their health system and have been able to continue to make the case for paying radoncs based on the money they bring in rather than based on how difficult they are to replace.

However, eventually these people retire or the health system merges or gets bought out by a bigger system. Maybe the new hospital CEO doesn't have the same relationship/history with your chairman and values people differently. Maybe the new Chairman feels that it's better to have some redundancy and pay two physicians the minimum that they'll accept rather than pay 1 physician what they're actually worth.

These shifts will continue to happen. No one is coming in and saying "whoa whoa whoa, these radonc salaries need to be...twice as big!" Once those salaries drop, they ain't ever comin' back up. There is no demand for radiation oncologists. There is only demand for CHEAP radiation oncologists.

Academic institution acquires local private practices. PP are brought on initially as faculty and allowed to keep earning high six figures through their high volume practices. Over the next 5-10 years there is a gradual effort to shift that revenue and spread it out elsewhere in the department in the name of fairness. Eventually after years of bickering, the contracts are just slashed and the PP guys are told to take it or leave it, most leave, and they are replaced with multiple early career rad oncs earning much less. Hmm, I wonder how that would go if there weren't a giant willing pool of early career rad oncs desperate to work in metro areas?

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

I have applied to multiple hospital jobs where they advertise 20-30 on treatment. Great, a busy practice and they should offer me a healthy base salary and I should easily be able to tap well into bonus range. Then you find out the hospital already has a doctor employed and they want to add another, so 10-15 per doctor. Very few places will be ok with a rad onc carrying a full patient load (20-30). They want 2 doctors doing the work of 1. I think we know why. Oh, and both doctors have to be there 8-5 M-F, anyway. You're a full-time doctor and expected to "work" full-time after all.

 

[OTN]

Academic institution acquires local private practices. PP are brought on initially as faculty and allowed to keep earning high six figures through their high volume practices. Over the next 5-10 years there is a gradual effort to shift that revenue and spread it out elsewhere in the department in the name of fairness. Eventually after years of bickering, the contracts are just slashed and the PP guys are told to take it or leave it, most leave, and they are replaced with multiple early career rad oncs earning much less. Hmm, I wonder how that would go if there weren't a giant willing pool of early career rad oncs desperate to work in metro areas?



I have applied to multiple hospital jobs where they advertise 20-30 on treatment. Great, a busy practice and they should offer me a healthy base salary and I should easily be able to tap well into bonus range. Then you find out the hospital already has a doctor employed and they want to add another, so 10-15 per doctor. Very few places will be ok with a rad onc carrying a full patient load (20-30). They want 2 doctors doing the work of 1. I think we know why. Oh, and both doctors have to be there 8-5 M-F, anyway. You're a full-time doctor and expected to "work" full-time after all.

My ignorance is showing here, as I honestly don't know why the hospital would want 2 doctors doing the work of 1. What's the difference, financially, for them to have to pay 2 docs $350k each vs 1 doc $700k? Why don't places want a radonc to carry a full patient load?

Having 10-15 patients on treatment and being required to be in the facility from 8-5, 5 days a week, would be absolute hell for me. I love being busy and hate having nothing to do. If I couldn't find any other job than that I would retrain so quickly I would red shift as I ran out of the radonc department.

 

[elementaryschooleconomics]

My ignorance is showing here, as I honestly don't know why the hospital would want 2 doctors doing the work of 1. What's the difference, financially, for them to have to pay 2 docs $350k each vs 1 doc $700k? Why don't places want a radonc to carry a full patient load?

Having 10-15 patients on treatment and being required to be in the facility from 8-5, 5 days a week, would be absolute hell for me. I love being busy and hate having nothing to do. If I couldn't find any other job than that I would retrain so quickly I would red shift as I ran out of the radonc department.

My immediate guess, putting my C-suite MBA hat on:

Leverage. One doc carrying a department with 20-30 patients has more negotiating power than 2 docs carrying half. The single doc knows what they're bringing into the hospital, and if they walk it could be hard to replace them quickly.

Two docs? Knowing physician personalities, some might feel guilty for their salary if they only have 10 on beam. Also, if one walks...boom, built in elasticity. Not a problem in the short term.

 

[OTN]

My immediate guess, putting my C-suite MBA hat on:

Leverage. One doc carrying a department with 20-30 patients has more negotiating power than 2 docs carrying half. The single doc knows what they're bringing into the hospital, and if they walk it could be hard to replace them quickly.

Two docs? Knowing physician personalities, some might feel guilty for their salary if they only have 10 on beam. Also, if one walks...boom, built in elasticity. Not a problem in the short term.

No leverage for radoncs in this market, though. Does each radonc usually get their own nurse, MA, etc, or do they share? If they have their own support staff the cost would add up quickly.

 

[elementaryschooleconomics]

No leverage for radoncs in this market, though. Does each radonc usually get their own nurse, MA, etc, or do they share? If they have their own support staff the cost would add up quickly.

I guess it depends on what hospital we're talking about. Something in Miami or LA yeah, not a problem. Something in Pine Bluff, Arkansas, might be a harder sell.

We haven't hit the wall quite yet where every job everywhere is saturated, as it seems like we're currently in the era of the pie getting smaller overall but being sliced into more pieces. COVID gave us an artificial boost with people either retiring or stepping away from clinical duties.

 

[deleted1116990]

My ignorance is showing here, as I honestly don't know why the hospital would want 2 doctors doing the work of 1. What's the difference, financially, for them to have to pay 2 docs $350k each vs 1 doc $700k? Why don't places want a radonc to carry a full patient load?

Having 10-15 patients on treatment and being required to be in the facility from 8-5, 5 days a week, would be absolute hell for me. I love being busy and hate having nothing to do. If I couldn't find any other job than that I would retrain so quickly I would red shift as I ran out of the radonc department.

Control. Hospitals hate having high paid doctors or independently billing doctors. Treating 30 patients can lead to professional collections over 1M. There is no way a hospital or academic center is going to be comfortable paying a doctor that much even if it is justified from an RVU/collections standpoint because they are working hard. That gives the doctor a lot of leverage being a very high producer. They also get squeamish about the optics of the high number and Stark Law, and honestly I think there is a lot of jealously that gets involved when numbers get that high. So the hospital can either just pay the the high income they have earned or they can stick them with the work but cap their pay, which understandably eventually will lead to the doctor becoming unhappy and asking uncomfortable questions about what the production actually is and where the overage is going.

Alternatively, the hospital can pay 2 doctors a very low salary, not have to worry about vacation coverage, and know that if one becomes unhappy and threatens to leave, they can just point and say your colleague is not complaining and say bye.

I cannot tell you how many times I have run into this situation where they are trying to place 2 doctors in a 25 patient practice. It is extremely frustrating. Suggesting that you can handle that load yourself, which you think would be welcome, seems to suggest you are just greedy and don't take your time with patients to do good work.

 

[bubbachuck]

If you need or want to be in a competitive city, you have no leverage unless you consider leverage to be taking a job somewhere else entirely. It’s part of the issue with consolidation. If the major health system in my region is hiring 5 people, they’re offering them all pretty equivalent salaries. Pre-consolidation that was 5 separate clinics with separate offer sheets and maybe there was some room for negotiations. Now you can pat yourself on the back for the 10-30k extra you negotiate upfront and then at 2 years when you ask about renegotiating your contract, unless you’re a stud get ready to hear “well you already get paid more than the other faculty that are your equivalent level.”

We’re going through this post consolidation period where a single 700k job is getting replaced with multiple 300-350k jobs. THE PIE IS NOT GROWING! It’s just getting cut into smaller pieces and everyone thinks all is well because we’re using our “leverage” to negotiate 20-30k more in crumbs.

Rhetorical question but why would the pie be growing? The only way to grow the pie is to innovate. Let's work on it.

 

[medgator]

Control. Hospitals hate having high paid doctors or independently billing doctors. Treating 30 patients can lead to professional collections over 1M. There is no way a hospital or academic center is going to be comfortable paying a doctor that much even if it is justified from an RVU/collections standpoint because they are working hard. That gives the doctor a lot of leverage being a very high producer. They also get squeamish about the optics of the high number and Stark Law, and honestly I think there is a lot of jealously that gets involved when numbers get that high. So the hospital can either just pay the the high income they have earned or they can stick them with the work but cap their pay, which understandably eventually will lead to the doctor becoming unhappy and asking uncomfortable questions about what the production actually is and where the overage is going.

Alternatively, the hospital can pay 2 doctors a very low salary, not have to worry about vacation coverage, and know that if one becomes unhappy and threatens to leave, they can just point and say your colleague is not complaining and say bye.

I cannot tell you how many times I have run into this situation where they are trying to place 2 doctors in a 25 patient practice. It is extremely frustrating. Suggesting that you can handle that load yourself, which you think would be welcome, seems to suggest you are just greedy and don't take your time with patients to do good work.

This. It's all about control and leverage and the Hallahans, Steinbergs and Potters of rad onc have facilitated it via increased resident supply to the benefit of employers everywhere

 

[RSAOaky]

My ignorance is showing here, as I honestly don't know why the hospital would want 2 doctors doing the work of 1. What's the difference, financially, for them to have to pay 2 docs $350k each vs 1 doc $700k? Why don't places want a radonc to carry a full patient load?

The simplest answer is that you aren't replacing a doc working 40 hours a week with 2 docs working 20 hours a week, but rather with 2 docs working 40 hours a week.

 

[OTN]

Control. Hospitals hate having high paid doctors or independently billing doctors. Treating 30 patients can lead to professional collections over 1M. There is no way a hospital or academic center is going to be comfortable paying a doctor that much even if it is justified from an RVU/collections standpoint because they are working hard. That gives the doctor a lot of leverage being a very high producer. They also get squeamish about the optics of the high number and Stark Law, and honestly I think there is a lot of jealously that gets involved when numbers get that high. So the hospital can either just pay the the high income they have earned or they can stick them with the work but cap their pay, which understandably eventually will lead to the doctor becoming unhappy and asking uncomfortable questions about what the production actually is and where the overage is going.

Alternatively, the hospital can pay 2 doctors a very low salary, not have to worry about vacation coverage, and know that if one becomes unhappy and threatens to leave, they can just point and say your colleague is not complaining and say bye.

I cannot tell you how many times I have run into this situation where they are trying to place 2 doctors in a 25 patient practice. It is extremely frustrating. Suggesting that you can handle that load yourself, which you think would be welcome, seems to suggest you are just greedy and don't take your time with patients to do good work.

Man that sounds terrible. To suggest a radonc cannot take good care of 25 patients is simply untrue.

 

[RO28]

My immediate guess, putting my C-suite MBA hat on:

Leverage. One doc carrying a department with 20-30 patients has more negotiating power than 2 docs carrying half. The single doc knows what they're bringing into the hospital, and if they walk it could be hard to replace them quickly.

Two docs? Knowing physician personalities, some might feel guilty for their salary if they only have 10 on beam. Also, if one walks...boom, built in elasticity. Not a problem in the short term.

hit the nail on the head. also my current situation. there are 4 of us, and only when we are busy is there truly enough work for 4 doctors.

 

[RSAOaky]

Rhetorical question but why would the pie be growing? The only way to grow the pie is to innovate. Let's work on it.

My chosen career path was to treat patients, not to innovate.

 

[deleted941485]

My chosen career path was to treat patients, not to innovate.

Probably won’t be doing much of either very soon.

 

[RickyScott]

My immediate guess, putting my C-suite MBA hat on:

Leverage. One doc carrying a department with 20-30 patients has more negotiating power than 2 docs carrying half. The single doc knows what they're bringing into the hospital, and if they walk it could be hard to replace them quickly.

Two docs? Knowing physician personalities, some might feel guilty for their salary if they only have 10 on beam. Also, if one walks...boom, built in elasticity. Not a problem in the short term.

hungry, bored docs will pull pts out of the woodwork. A chair said something like this to me. Busy doc is not usually going to treat g5 w/alz

 

[OTN]

hungry, bored docs will pull pts out of the woodwork. A chair said something like this to me. Busy doc is not usually going to treat g5 w/alz

Probably better ways to motivate docs to produce than hiring them at a level well below their capacity, but what do I know? I'm not one of those super smart radonc chairs. Why, look at all the good they've done over the last 20 years!

 

[Lamount]

Academic institution acquires local private practices. PP are brought on initially as faculty and allowed to keep earning high six figures through their high volume practices. Over the next 5-10 years there is a gradual effort to shift that revenue and spread it out elsewhere in the department in the name of fairness. Eventually after years of bickering, the contracts are just slashed and the PP guys are told to take it or leave it, most leave, and they are replaced with multiple early career rad oncs earning much less. Hmm, I wonder how that would go if there weren't a giant willing pool of early career rad oncs desperate to work in metro areas?



I have applied to multiple hospital jobs where they advertise 20-30 on treatment. Great, a busy practice and they should offer me a healthy base salary and I should easily be able to tap well into bonus range. Then you find out the hospital already has a doctor employed and they want to add another, so 10-15 per doctor. Very few places will be ok with a rad onc carrying a full patient load (20-30). They want 2 doctors doing the work of 1. I think we know why. Oh, and both doctors have to be there 8-5 M-F, anyway. You're a full-time doctor and expected to "work" full-time after all.

I have been reading this conversation with fascination and envy. 10-15 patients on treatment? Sign me up!

I am in clinic 3 days a week at a major academic center and haven't been able to get below 20 on beam in the past 4 months (not even counting SBRTs).

 

[temujim]

I have been reading this conversation with fascination and envy. 10-15 patients on treatment? Sign me up!

I am in clinic 3 days a week at a major academic center and haven't been able to get below 20 on beam in the past 4 months (not even counting SBRTs).

Say no. Close new patient slots months in advance. Take stupid amounts of vacation. Ain't no one going to protect you.

 

[metallica81788]

hit the nail on the head. also my current situation. there are 4 of us, and only when we are busy is there truly enough work for 4 doctors.

Alternatively, the hospital can pay 2 doctors a very low salary, not have to worry about vacation coverage, and know that if one becomes unhappy and threatens to leave, they can just point and say your colleague is not complaining and say bye.

I cannot tell you how many times I have run into this situation where they are trying to place 2 doctors in a 25 patient practice. It is extremely frustrating. Suggesting that you can handle that load yourself, which you think would be welcome, seems to suggest you are just greedy and don't take your time with patients to do good work.

The simplest answer is that you aren't replacing a doc working 40 hours a week with 2 docs working 20 hours a week, but rather with 2 docs working 40 hours a week.

Man that sounds terrible. To suggest a radonc cannot take good care of 25 patients is simply untrue.

This is me currently. I have a decent setup but still face outward pressure for another doctor when it's not even remotely needed. Only question is how long can I hold out on my own. My guess is <2 years. I was hoping for 5.