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If they REALLY want to focus on de-escalating the role of radiation, how about some outcome studies on the efficacy of "urgent" weekend treatments so they can keep us technicians only employed 5 days a week
 
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Radiation (like all treatments) should be de-escalated where appropriate. But since we are so small, all the de-escalation efforts are focused on us only. Even removing radiation from elderly breast cancer patients had significant local recurrence risks that increased over time.

And just like other fields prey on us, our senior leadership preys on all the young physicians by pumping up spots while simultaneously cutting indications and use. Same story for the last 10 years with the only change being those of us caught in it posting here. What a field.
 
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Everyone who is telling med students to go into med onc 7-8 years from now because of how rosy job prospects are in 2021 are probably not thinking about the unstainable costs
 
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Everyone who is telling med students to go into med onc 7-8 years from now because of how rosy job prospects are in 2021 are probably not thinking about the unstainable costs

Med oncs aren't actively trying to find ways to reduce or eliminate giving systemic therapy however
 
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Med oncs aren't actively trying to find ways to reduce or eliminate giving systemic therapy however

Yeah still waiting for those non inferiority trials on shortening the length of Maintenence therapy for some of the immuno drugs...I’m sure BMS and Merck will be funding those
 
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Everyone who is telling med students to go into med onc 7-8 years from now because of how rosy job prospects are in 2021 are probably not thinking about the unstainable costs

Cutting drug prices in half not going to affect their job market much. Supply and demand is what affects the job market, not the price of drugs- are you implying they would give less chemo if drug prices were 50% less or there would be less visits to the medical oncologist? Job market, like prices of candy bars and gasoline is based on scarcity.
 
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Price of drugs not really related to medonc job market. Cutting drug prices in half not going to really affect their market.
But cutting the number of fxs for us most certainly will.

Med onc won’t be hurt nearly as much if they found out they could get away with 6 vs 12 months of Herceptin. They have a billion and one other drugs they can push
 
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Yeah still waiting for those non inferiority trials on shortening the length of Maintenence therapy for some of the immuno drugs...I’m sure BMS and Merck will be funding those
But cutting the number of fxs for us most certainly will.

Med onc won’t be hurt nearly as much if they found out they could get away with 6 vs 12 months of Herceptin. They have a billion and one other drugs they can push
Hospital employed medoncs generate their proffesional bills/rvu almost entirely through e and m visits. They will still be seeing the patient frequently even if not delivering maintenance therapy. The fact that they can attain 90-100$ per rvu even in great locations, is based on scarcity of job seekers, not the price of chemo.
 
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Everyone who is telling med students to go into med onc 7-8 years from now because of how rosy job prospects are in 2021 are probably not thinking about the unstainable costs



New way to sell our field...

Radiation: it's like systemic therapy, except it's affordable and curative
 
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Once they fix the Gamestop fiasco, "Chemotherapy" will split into chemotherapy, immunotherapy, and targeted agents, each a different color on the bar graph, thus solving this issue.
 
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Cutting drug prices in half not going to affect their job market much. Supply and demand is what affects the job market, not the price of drugs- are you implying they would give less chemo if drug prices were 50% less or there would be less visits to the medical oncologist? Job market, like prices of candy bars and gasoline is based on scarcity.

 
Once they fix the Gamestop fiasco, "Chemotherapy" will split into chemotherapy, immunotherapy, and targeted agents, each a different color on the bar graph, thus solving this issue.
If they split then maybe we can get immunotherapy or targeted agent certified and leave chemotherapy to Med onc.
 
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I have been doing this a while. Most medoncs today are employed by hospitals and unable to profit from the drugs. A few very large organizations like FCS still can with economies of scale. Epo and rebates were a big deal 10+ years ago. You could post similar outdated info abt urologists (when they used to give to Gleason 6 etc) and hormones from 16 years ago that is also no longer relevant.
 
I have been doing this a while. Most medoncs today are employed by hospitals and unable to profit from the drugs. A few very large organizations like FCS still can with economies of scale. Epo and rebates were a big deal 10+ years ago. You could post similar outdated info abt urologists (when they used to give to Gleason 6 etc) and hormones from 16 years ago that is also no longer relevant.

This is in the same vein as my point - telling med students to go into med onc 7+ years from now based on current market/economic conditions is not useful. Things that drive reimbursement for med onc (like EPO) quickly change, and its very unlikely that their reimbursement is going to continue to go up. Economic forces are unpredictable and there is no compelling reason to say that med onc will be a better job than any of the other dozen specialties that are doing well right now
 
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This is in the same vein as my point - telling med students to go into med onc 7+ years from now based on current market/economic conditions is not useful. Things that drive reimbursement for med onc (like EPO) quickly change, and its very unlikely that their reimbursement is going to continue to go up. Economic forces are unpredictable and there is no compelling reason to say that med onc will be a better job than any of the other dozen specialties that are doing well right now
Except systemic therapy drugs and indications keep growing, more than fractions/indications for XRT are. Plus out IRL, they have to do heme also, plus there's always IM to fall back on when SRHTF.
 
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This is in the same vein as my point - telling med students to go into med onc 7+ years from now based on current market/economic conditions is not useful. Things that drive reimbursement for med onc (like EPO) quickly change, and its very unlikely that their reimbursement is going to continue to go up. Economic forces are unpredictable and there is no compelling reason to say that med onc will be a better job than any of the other dozen specialties that are doing well right now
I just don’t think drug prices drive the employment market. I have no idea if the number of heme onc fellows is increasing as that would be a concern, or a meaningful expansion of npp s. Otherwise, overall number of pt visits to medoncs should increase in future as more long term survivors and pts see more lines of therapy, or older sicker pts are able to tolerate newer less toxic agents and defer hospice. Ex: up to 20% of stage 4 nsclc and over 25% of melanomas (who 7 years ago would be dead) are now seeing their medical oncologists regularly for at least 5 years after their diagnosis.
 
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Except systemic therapy drugs and indications keep growing, more than fractions/indications for XRT are. Plus out IRL, they have to do heme also, plus there's always IM to fall back on when SRHTF.
Yes, good luck if you want to recruit a hematologist for your hospital- there are virtually none.
while we may live in a block universe, none of us know the future, but some things are more likely to happen than others-ie medonc is likely to have better employment prospects than radonc.
 
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Yes, good luck if you want to recruit a hematologist for your hospital- there are virtually none.
Had the 'heme consult attending" consult for a heme issue once in a pregnant patient (who practiced mostly as med-onc but was very close to completion of heme/onc fellowship)... who promptly called a real heme attending for advice.
 
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This is in the same vein as my point - telling med students to go into med onc 7+ years from now based on current market/economic conditions is not useful. Things that drive reimbursement for med onc (like EPO) quickly change, and its very unlikely that their reimbursement is going to continue to go up. Economic forces are unpredictable and there is no compelling reason to say that med onc will be a better job than any of the other dozen specialties that are doing well right now
I would have went into surg onc before med onc (nearly applied to surgery). I think we should be encouraging more people interested in our field to IR and surg onc (in addition to med onc).
 
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I just don’t think drug prices drive the employment market. I have no idea if the number of heme onc fellows is increasing as that would be a concern, or a meaningful expansion of npp s. Otherwise, overall number of pt visits to medoncs should increase in future as more long term survivors and pts see more lines of therapy, or older sicker pts are able to tolerate newer less toxic agents and defer hospice. Ex: up to 20% of stage 4 nsclc and over 25% of melanomas (who 7 years ago would be dead) are now seeing their medical oncologists regularly for at least 5 years after their diagnosis.
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the number of fellows are definitely increasing, partially due to current increased salary, job placement, etc that is talked about here repeatedly as if there is some guarantee that those market conditions will likely be there 7 years from now . Its up 128 spots in 10 years

 
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the number of fellows are definitely increasing, partially due to current increased salary, job placement, etc that is talked about here repeatedly as if there is some guarantee that those market conditions will likely be there 7 years from now . Its up 128 spots in 10 years

Disingenuous to compare gross numbers. Rad onc slots have nearly doubled since the turn of the century. Meanwhile systemic tx options have only expanded. Think immunotherapy in stage 3 lung. We're still giving 60-66 with chemo, no change (and no reduced fractions, yet!)
 
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I just don’t think drug prices drive the employment market. I have no idea if the number of heme onc fellows is increasing as that would be a concern, or a meaningful expansion of npp s. Otherwise, overall number of pt visits to medoncs should increase in future as more long term survivors and pts see more lines of therapy, or older sicker pts are able to tolerate newer less toxic agents and defer hospice. Ex: up to 20% of stage 4 nsclc and over 25% of melanomas (who 7 years ago would be dead) are now seeing their medical oncologists regularly for at least 5 years after their diagnosis.
Drug prices are not driving the hemeonc employment market, but number of RT fractions is impacting the radonc market...not sure I follow the logic there.
 
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When I talk to students and encourage them to pursue MedOnc over RadOnc, it's never about the salary or drug reimbursement. It's simply about the opportunity - they're not tied to a machine. Even if drug reimbursements are slashed, MedOnc has a significantly more elastic job market. There will always be a need to cover inpatient services. You can always fall back on the IM training/board certification. It's a much safer/more stable choice.

There's all these kids on the Google Spreadsheet talking about how "they'd take a lower salary to practice RadOnc" because they "love it so much" or whatever, but that's not going to be a choice. There's generally either a job available for a RadOnc, or there isn't. I can count on one hand the number of times I heard about someone being able to take a pay cut to practice at a certain place - it's twice. Twice I've personally heard that. And neither times did it actually happen, so the offers might not have been sincere.
 
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Drug prices are not driving the hemeonc employment market, but number of RT fractions is impacting the radonc market...not sure I follow the logic there.
because our reimbursement is tied to the number of fractions and hospital employed medoncs are tied to e/m visits. They dont get more or less salary based on the price of the drug, while our rvus increase if we deliver more fractions. In fact, there is less work for radoncs if we treated all pts in five fractions, while if drug prices are slashed, total visits to the medical oncologist dont decrease.
 
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Hospital employed medoncs generate their proffesional bills/rvu almost entirely through e and m visits. They will still be seeing the patient frequently even if not delivering maintenance therapy. The fact that they can attain 90-100$ per rvu even in great locations, is based on scarcity of job seekers, not the price of chemo.

I largely agree, but it's not always so cut and dry.

The employed ones find creative ways to keep those $/RVU up, because many times their salaries come no where close to being covered by E/M charges alone. Creative ways to pay them as "clinical trials director" or "clinical director" or other titles to bump salary...bc the hospital is making bank on those drug costs and downstream med onc money. If that dries up that could definitely impact their salaries.
 
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I largely agree, but it's not always so cut and dry.

The employed ones find creative ways to keep those $/RVU up, because many times their salaries come no where close to being covered by E/M charges alone. Creative ways to pay them as "clinical trials director" or "clinical director" or other titles to bump salary...bc the hospital is making bank on those drug costs and downstream med onc money. If that dries up that could definitely impact their salaries.
Titles are given to boost salaries in tight markets. Medoncs routinely get 90-100 per rvu in good locations. If salary is an SD above average $/RVUs. , this needs to be justified with a title/additional role to avoid being accused of inducement.

E/m charges are not close to covering salary. Medoncs would be making around 200k at 6000 RVUs if salary was based on e/m Billings. No medical oncologist earns this amount because their salary is based on RVUs! As long as hospital is paying within one to two SD of salary/ $ per rvu they are ok legally. (If you are paying someone in the 99%, you better be prepared to justify this ie they are in 90+% RVU priduction or with title )

Basically, with each specialy having its own $/RVUs, supply and demand sets salaries, not professional billings.
 
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When I talk to students and encourage them to pursue MedOnc over RadOnc, it's never about the salary or drug reimbursement. It's simply about the opportunity - they're not tied to a machine. Even if drug reimbursements are slashed, MedOnc has a significantly more elastic job market. There will always be a need to cover inpatient services. You can always fall back on the IM training/board certification. It's a much safer/more stable choice.

There's all these kids on the Google Spreadsheet talking about how "they'd take a lower salary to practice RadOnc" because they "love it so much" or whatever, but that's not going to be a choice. There's generally either a job available for a RadOnc, or there isn't. I can count on one hand the number of times I heard about someone being able to take a pay cut to practice at a certain place - it's twice. Twice I've personally heard that. And neither times did it actually happen, so the offers might not have been sincere.
You do get a sense of naivety from those that post on the Reddit spread sheet. This is what academic rad oncs trying to fill programs are currently praying on. But with so much info out there right now, folks entering the match will have literally no one to blame but themselves as the scope of the specialty and the opportunities it can offer continues to shrink.
 
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You do get a sense of naivety from those that post on the Reddit spread sheet. This is what academic rad oncs trying to fill programs are currently praying on. But with so much info out there right now, folks entering the match will have literally no one to blame but themselves as the scope of the specialty and the opportunities it can offer continues to shrink.
Totally agree. There's a lot of naivety in general about the economics of RadOnc, even from residents and faculty. I think it comes from the ethos of medical training that thinking about money and jobs and whatnot is bad, you should only focus on the healing of the people! So then you get LEGIONS of folks not only just ignorant about this, but that feel active disgust whenever it's brought up (see: the Twitterati who claim that when someone says "hypofrac is bad for jobs" they interpret that as "you hate patients").

I had to go and teach myself all about the business of RadOnc on my own time. Which I guess isn't any different from how I learned the clinical side of RadOnc...
 
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Totally agree. There's a lot of naivety in general about the economics of RadOnc, even from residents and faculty. I think it comes from the ethos of medical training that thinking about money and jobs and whatnot is bad, you should only focus on the healing of the people! So then you get LEGIONS of folks not only just ignorant about this, but that feel active disgust whenever it's brought up (see: the Twitterati who claim that when someone says "hypofrac is bad for jobs" they interpret that as "you hate patients").

I had to go and teach myself all about the business of RadOnc on my own time. Which I guess isn't any different from how I learned the clinical side of RadOnc...

Love how the legions of radoncs that routinely gave 40/20 for bone mets, etc, and made millions during the heyday now have the audacity to shame others for the whole "hypofrac jobs patients money" situation
 
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There's all these kids on the Google Spreadsheet talking about how "they'd take a lower salary to practice RadOnc" because they "love it so much" or whatever, but that's not going to be a choice. There's generally either a job available for a RadOnc, or there isn't. I can count on one hand the number of times I heard about someone being able to take a pay cut to practice at a certain place - it's twice.
Thats a key point that is lost on a lot of idiots. Its not like a job will be created for you in Los Angeles because you are willing to work for 200k. Thats just not how supply and demand work. (its not that liquid that you can go to a large employer and say hire me, fire your present docs, and I will only take
150k).

EDIT: It is a type of magical thinking that reflects a low IQ. Not that dissimilar from- if a lot of docs, go into radonc, they will create new indications for XRT.
 
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because our reimbursement is tied to the number of fractions and hospital employed medoncs are tied to e/m visits. They dont get more or less salary based on the price of the drug, while our rvus increase if we deliver more fractions. In fact, there is less work for radoncs if we treated all pts in five fractions, while if drug prices are slashed, total visits to the medical oncologist dont decrease.
I got that part, but I was under the impression that the drug prices impact the money the hospital gets which then drives med onc employment that way...
 
I got that part, but I was under the impression that the drug prices impact the money the hospital gets which then drives med onc employment that way...
thats true, but If technical billings for radiation doubled tomorrow, I can promise you we would not get a raise. In terms of drug costs, it is mixed blessing, because they can only make a few percent per drug and when payment is denied or delayed, it is painful. 340 B pricing which drove medical oncologists into the hospital setting is now only permitted at the 11 PPI exempt NCCN centers, making drugs a lot less profitable for hospitals over the past 4-5 years, precisely coinciding with medical oncology salaries skyrocketing! (due to low supply)
 
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Disingenuous to compare gross numbers. Rad onc slots have nearly doubled since the turn of the century. Meanwhile systemic tx options have only expanded. Think immunotherapy in stage 3 lung. We're still giving 60-66 with chemo, no change (and no reduced fractions, yet!)
Are the indications for systemic therapy really increasing (honestly asking)? It’s either chemorads, neoadjuvant, adjuvant, or metastatic... and it has been that way for a while.
Consider than “outback” chemo was widely used following CRT for stage III lung.


The only things that have changed are that the drugs are more expensive and people are living longer with metastatic disease. The latter benefits us as well
 
Are the indications for systemic therapy really increasing (honestly asking)? It’s either chemorads, neoadjuvant, adjuvant, or metastatic... and it has been that way for a while.
Consider than “outback” chemo was widely used following CRT for stage III lung.


The only things that have changed are that the drugs are more expensive and people are living longer with metastatic disease. The latter benefits us as well
If the latter benefits is the raw number of new XRT starts nationally should be noticeably increasing but it’s not.
 
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I would have went into surg onc before med onc (nearly applied to surgery). I think we should be encouraging more people interested in our field to IR and surg onc (in addition to med onc).
I second this. Surgeons can buy into surgical hospital and rake in technical along with professional. Local surg onc makes 1.5M++
 
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I second this. Surgeons can buy into surgical hospital and rake in technical along with professional. Local surg onc makes 1.5M++
I have a good friend who just graduated from his surg onc fellowship. Jobs were not plentiful.
 
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I have a good friend who just graduated from his surg onc fellowship. Jobs were not plentiful.
Same - a friend told me he pretty much told me he had to stick to an academic center (even though he didn't really want to) and jobs were limited geographically.

He told me breast surgery would have gave him more options.

Grass is always greener on the other side...
 
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I second this. Surgeons can buy into surgical hospital and rake in technical along with professional. Local surg onc makes 1.5M++
Hospital?? I've heard of ASC buy-in, but hospital... Wow.

Seems too niche job wise unless you're doing academics or working at a large tertiary care center
 
As someone who went through joint radonc - medonc job search this year...

Med Onc Market is much much better than RO

We are very happy with how it turned out for both of us, but it was very interesting seeing some of the differences

Willing to discuss more in the private forum
 
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Yeah the field may be in trouble

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Last week gave us the meme stock. Is rad onc now the meme speciality?
 
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