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communitydoc13 said:
Definite fair critique. Above groups incredibly elite. I would guess as much emphasis on pedigree as almost any academic place.
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For every inova or SERO, what about those practices that got swallowed up over the years by 21C/Genesis care, oncure (which was swallowed up by 21C), vantage etc. Some of those practices were shut down. In other cases, certain hospital based PP groups essentially were forced out or retired by larger organizations taking over multiple hospitals throughout the years (mskcc, upmc and CCF have definitely done this afaik)
 
any large hospital does what any large company does. outcompetes, buys, destroys.

capitalism, baby!
 
not sure where in those links you point out the 80/20, was wondering if there was some good data.

the best I can find is this: 40% academic/60% non-academic over 4 years of analysis.

let me know if you find something better

 
jondunn said:
not sure where in those links you point out the 80/20, was wondering if there was some good data.

the best I can find is this: 40% academic/60% non-academic over 4 years of analysis.

let me know if you find something better

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My first glance is that this abstract is not telling us anything about *net* job adds over the 2016-2020 time period. It does show that for a ~4 year period in the US, ~40% of (666, yikes) offered jobs were academic and the other 60% PP. But again this is telling me nothing about net job adds over time. To determine net job adds over time, we need to determine/agree upon just three things:
1) start/stop time period
2) beginning/ending job numbers (ie # of practicing physicians)
3) proportion academic/non-academic over time period in #1

If anything, my estimate for #2 is slightly over-estimated for ~25 new PP jobs a year. And we have not factored in the PP->academic job titularity ("satelliting") which has happened last 20 years. Again, very comfortable with a 25-50/year net new PP jobs in the US number. The number of academic ROs has more than doubled last ~20 years; the number of total practicing ROs has not.
 
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i agree that it is a different question, but the 80/20 has to be based on something.

if all new jobs being offered over 4 years are 40 percent academic/60 percent PP, that is probably the more relevant thing for anyone looking for jobs, though your question is a good one. if you come up with a way to come up with a decent guess, im all ears.
 
medgator said:
For every inova or SERO, what about those practices that got swallowed up over the years by 21C/Genesis care, oncure (which was swallowed up by 21C), vantage etc. Some of those practices were shut down. In other cases, certain hospital based PP groups essentially were forced out or retired by larger organizations taking over multiple hospitals throughout the years (mskcc, upmc and CCF have definitely done this afaik)
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When I was looking, the group north of Boston was taking over local hospital contracts and kicking out the docs and replacing them with new grads. Fired a bunch of docs from Lahey, including that year’s astro Gold medal winner. Several members of group like “subatomic doc” are active on twitter.
 
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jondunn said:
i agree that it is a different question, but the 80/20 has to be based on something.

if all new jobs being offered over 4 years are 40 percent academic/60 percent PP, that is probably the more relevant thing for anyone looking for jobs, though your question is a good one. if you come up with a way to come up with a decent guess, im all ears.
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NOT NEW JOBS. Just jobs. There’s a big difference. A job seeker seeks any job. A growing workforce needs new jobs.

EDIT: The 80/20 is based on the fact that anything for PP greater than 50% makes no sense with the academic attending boom that has happened last 20y. 66/33 is feasible (40 new PP jobs a year), 75/25 is feasible (30 new PP jobs a year), etc.
 
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RickyScott said:
When I was looking, the group north of Boston was taking over local hospital practices and kicking out the docs and replacing them with new grads. Fired a bunch of docs from Lahey, including that years Gold medal winner.
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A result of resident oversupply which begets new (low salary) RO oversupply which tends to attrition out older (higher salary) ROs.
 
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TheWallnerus said:
A result of resident oversupply which begets new (low salary) RO oversupply which tends to attrition out older (higher salary) ROs.
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Eventually everyone gets screwed by an oversupply unless you own your own equipment
 
TheWallnerus said:
NOT NEW JOBS. Just jobs. There’s a big difference. A job seeker seeks any job. A growing workforce needs new jobs.

EDIT: The 80/20 is based on the fact that anything for PP greater than 50% makes no sense with the academic attending boom that has happened last 20y. 66/33 is feasible (40 new PP jobs a year), 75/25 is feasible (30 new PP jobs a year), etc.
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I understand that. Im saying your question is a different one in terms of NEW jobs.

the relevant thing to someone looking for jobs is just jobs, not new jobs, but again, your question is an interesting one.

but if its just based on a total guess, I guess the range of possiblity is pretty wide.
 
RickyScott said:
When I was looking, the group north of Boston was taking over local hospital contracts and kicking out the docs and replacing them with new grads. Fired a bunch of docs from Lahey, including that year’s astro Gold medal winner. Several members of group like “subatomic doc” are active on twitter.
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Let's not forget one of their group is first-author on a 2021 paper spinning job market concerns as just the fanciful imagination of anonymous, online misanthropes.

Of course, that article fails to mention that one of their partners was retiring, and they were deep into interviews to replace that person...when APM was (again) announced, and they decided to not hire last year to replace them.

(In all fairness, they did hire this year, but I'm not sure if additional people had to leave the group to make it happen.)
 
jondunn said:
I understand that. Im saying your question is a different one in terms of NEW jobs.

the relevant thing to someone looking for jobs is just jobs, not new jobs, but again, your question is an interesting one
but if its just based on a total guess, I guess the range of possiblity is pretty wide.
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New jobs is relevant because if a job is created by firing someone, now you have 2 people looking for a job/more competition.
 
RickyScott said:
New jobs is relevant because if a job is created by firing someone, now you have 2 people looking for a job/more competition.
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no one is saying that it is not relevant or important to know. it's important to know to understand wtf actually is truly happening with the job market overall, I agree.

just saying that me as John Doe X graduating, what is immediately most relevant to me is how many jobs are available, and what proportion are academic and what proportion PP.

but yes the more REAL data we have on the entire rad onc world, including exactly how many practicing rad oncs are there on Ocrober 18, 2021, is a good thing to know
 
Yeah - I am not sure why new job matters, rather than jobs available, overall.

To echo Dunn, if you're looking for a job, and there are 200 available (hahahahahahahhhahahahaahah!), does it make a difference if 100 are new, 200 are new or 0 are new?
 
I don't know about SERO specifically, but I know for a fact that a few physician-owned RO mega-groups in the country have stopped offering technical partnership for years. The best new grads can get is straight salary with RVU bonuses/incentives.
 
Gfunk6 said:
I don't know about SERO specifically, but I know for a fact that a few physician-owned RO mega-groups in the country have stopped offering technical partnership for years. The best new grads can get is straight salary with RVU bonuses/incentives.
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why did you guys stop
 
jondunn said:
why did you guys stop
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We have not stopped, but I know others who have. I would assume principles are the same for any other large professional corporation. Namely there are "senior" partners who founded the practice who took significant risk and now want to continue to reap the rewards. "Junior" partners are welcomed and nurtured but will always be viewed as employees.
 
Gfunk6 said:
We have not stopped, but I know others who have. I would assume principles are the same for any other large professional corporation. Namely there are "senior" partners who founded the practice who took significant risk and now want to continue to reap the rewards. "Junior" partners are welcomed and nurtured but will always be viewed as employees.
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The best practices do not do this.
 
Gfunk6 said:
We have not stopped, but I know others who have. I would assume principles are the same for any other large professional corporation. Namely there are "senior" partners who founded the practice who took significant risk and now want to continue to reap the rewards. "Junior" partners are welcomed and nurtured but will always be viewed as employees.
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Happened in our neck of the woods, too. And in AZ.

SERO still hiring for partner track. There are a few jobs in their system at specific sites that are always employed.. They come up and then people will say "See - SERO not hiring partners". They never post for partner track jobs, just employed jobs. This has been for decade +
 
RealSimulD said:
Yeah - I am not sure why new job matters, rather than jobs available, overall.

To echo Dunn, if you're looking for a job, and there are 200 available (hahahahahahahhhahahahaahah!), does it make a difference if 100 are new, 200 are new or 0 are new?
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On an individual person or individual year basis I agree. But over time, the rate of production (ie residents per year) of radiation oncologists is increasing; this is highly knowable. And over time, we know the number of practicing ROs in America per year, and this is increasing; this (the number of ROs) is generally knowable. There has been a clear trend in shift from PP to academics (data, and seen-with-own-eyes). If we were at the Bureau of Labor Statistics we would be talking "job creation" vs unemployment (and which sectors are supporting job creation: academic or PP?). If the growth in PP has been anemic and RO job growth has been largely supported by academics—and we see a slowing of academic jobs—we have yet another data point supporting the need to slow RO production (ie decrease resident supply). I am, too, definitely suspicious PP job growth has been anemic vs academic job growth.
 
Everyone always thinks someone else is charging too much or getting too much money lol. My referrings make comments about my money.

That surgeon is going to bring TOPA to its knees if she has her way, for example
 
one of my friends lives in a top 10 population metro. theres a rad onc there that will keep patients on waiting lists for WEEKS, just so that he sees them, eventually. sad ****.
 
thecarbonionangle said:
Nothing more triggering to men’s egos than a brown woman speaking her mind. Live your truth sister!
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Is that the issue? That it's a brown woman speaking her mind? Interesting transition.

How about someone focusing on a local issue in a specialty that isn't hers and endorsing a global solution having more trainees to solve the problem of access in her Texas town?

No one else brought up gender / race ... wonder why you perceive it as that?

I see it as someone who has little data / understanding about something complex, but wants to sound like she's doing something "for the patients". Anyone of any gender / race doing that deserves some push back, right? Even as gentle as mine ...
 
RealSimulD said:
Is that the issue? That it's a brown woman speaking her mind? Interesting transition.

How about someone focusing on a local issue in a specialty that isn't hers and endorsing a global solution having more trainees to solve the problem of access in her Texas town?

No one else brought up gender / race ... wonder why you perceive it as that?

I see it as someone who has little data / understanding about something complex, but wants to sound like she's doing something "for the patients". Anyone of any gender / race doing that deserves some push back, right? Even as gentle as mine ...
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There is no problem with radiation access in the cities in which she has practiced (and currently practices) and never has been. While some may know of large cities which do have XRT access problems, I know with 100% certainty the cities in Texas which she references and which have been discussed do not.

Her race and sex have nothing to do with the issue. Shameful and anti-intellectual that they were brought into the discussion, but unfortunately not surprising.
 
RealSimulD said:
Is that the issue? That it's a brown woman speaking her mind? Interesting transition.

How about someone focusing on a local issue in a specialty that isn't hers and endorsing a global solution having more trainees to solve the problem of access in her Texas town?

No one else brought up gender / race ... wonder why you perceive it as that?

I see it as someone who has little data / understanding about something complex, but wants to sound like she's doing something "for the patients". Anyone of any gender / race doing that deserves some push back, right? Even as gentle as mine ...
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Surgeons are very "what have you done for me lately" and the flipside of that is "how have you pissed me off lately." Like Dr. Phil says, it takes a thousand "Atta boy!"'s to make up for one "you're stupid." You piss a surgeon off once, woe unto you. They're elephants, they never forget. And if you delayed care once, then you get the label of A Care Delay-er. 60% of American centers start RT on 2 or less breast cancer patients a week (hard data; and therefore >60% of individual ROs start RT on 2 or less breast cancer pts per week), and 99% of American RT centers have breast cancer as their main service line. Access to care along the lines of a general surgeon not getting timely RO consults shouldn't be a problem in general for American radiation oncology. That said, outliers happen; and it sounds like 2 ROs for 40 med oncs (if that ratio is real) is a significant outlier. And sometimes fake problems seem very real from the outside.
 
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I did hear that Bill Taylor bought his plane to improve patient access!

Damn I’m really falling behind in my neck of the woods. Got to buy a plane
 
jondunn said:
I did hear that Bill Taylor bought his plane to improve patient access!

Damn I’m really falling behind in my neck of the woods. Got to buy a plane
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The number of ROs who owned their own chopper or plane was pretty high late 80's into the 90's. 21st Century definitely bought a lot of private jet flights, saw that first-hand several times.
 
thecarbonionangle said:
all of medicine has the issue of the same people who sit at the top gobbling all opportunities for others. In our small field, this dynamic is highly amplified. Same crew gobbles up all NRG, ASTRO, ACRO,ACR, ABR, ABS, ARRO opportunities. They also sit at the top in cities and refuse to bring anybody in because it would hurt their bottom line. The best thing that could happen to this field is to have most people over 55 start winding down to retirement. How many more lines do you need on your resume? How many more senior authorships must you gobble up at NRG preventing others from benefitting? How much money do you need?

Greed!
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so per you, this guy, and many others in the practice, should be sent out to pasture?

 
jondunn said:
so per you, this guy, and many others in the practice, should be sent out to pasture?

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I think it depends on how he practices. If he treats as if it is 1989, take him out back. If he stays up to date and treats with appropriate levels of competence, then he can practice until he is deemed incompetent.

The problem is that a lot of these older docs are grandfathered in. How does one person on the outside able to assess his competence and knowledge base? Is MOC appropriate enough?

A quick search on ABR's verification page shows that this particular doc has a lifetime certificate:
1634600077111.png


Unfortunately, for these people grandfathered in, maintenance of certification is only voluntary:
1634600123965.png


Is he good or is he bad? I don't know, but given the pace advances, especially in the everchanging treatment paradigm and advent of IMRT, I would imagine that one would have to work hard to stay on top of things. I think I read something some time ago that showed that rad oncs now spend more time contouring and planning than ever before.
 
back when the wallnernus first started practicing and others here who got to work in the glory days of the early 2000s, it took 5 minutes to plan, 1 minute to say hi at the otv, and 23 hours to count cash!

man you have it made.
 
jondunn said:
back when the wallnernus first started practicing and others here who got to work in the glory days of the early 2000s, it took 5 minutes to plan, 1 minute to say hi at the otv, and 23 hours to count cash!

man you have it made.
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I got hosed!
 
jondunn said:
back when the wallnernus first started practicing and others here who got to work in the glory days of the early 2000s, it took 5 minutes to plan, 1 minute to say hi at the otv, and 23 hours to count cash!

man you have it made.
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I treated prostate mostly. We hosted all the on-treats at Ruth's Chris for appetizers and wine and a talk every Wednesday night. Drinks, snacks, shake everyone's hand, 77427s in one fell swoop. And it was all tax deductible. The dessert was "Enticement Lava Cake."
 
jondunn said:
back when the wallnernus first started practicing and others here who got to work in the glory days of the early 2000s, it took 5 minutes to plan, 1 minute to say hi at the otv, and 23 hours to count cash!

man you have it made.
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Apparently the real glory days were the early 80s when CT planning first started and Medicare hadn't squeezed anything quite yet. Before my time, but knew a guy who practiced then -- rad onc was his hobby when I met him -- hobby because he was raking it in as owner of a bank.
 
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