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jondunn said:
non-academic I said, but yeah assistant professor level making mid 3s checks out.
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Mods can move this to private forum if they wish.

Below if the information I received as part of my semi-annual review last month

1646777223226.png
 
jondunn said:
non-academic I said, but yeah assistant professor level making mid 3s checks out.
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~55% of all rad oncs in America are now academic... and I bet there are a lot of asst profs in America. Thus, again, median $500K+ (much less $600K) for all US ROs is very unlikely.

Chartreuse Wombat said:
Mods can move this to private forum if they wish.

Below if the information I received as part of my semi-annual review last month

View attachment 351503
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Certainly mathematically reasonable at least. This "average median" is $430K. I think this would be a lot more in line with known salary dilution by rad onc over-supply, combined with stagnant reimbursement, combined with stagnant patient loads, combined with declining fraction numbers, combined with the ever-present Pareto distribution.

jondunn said:
assuming all assumptions are correct in your analysis, we have roughly 12/beam for roughly MGMA median (havent looked in a while) of 550-600k.
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Some of you guys are not quite grasping the big differences between a $600K median, and, say, a $430K median. It's not just "oh well it's $170K less I can live on $430K." For *a large group* there are BIG differences between a median of $600K and median of $430K when it is Pareto. There are gonna be winners and horror stories. I know the human brain is not very well equipped to deal with this. E.g., I once saw huge criticism in a fetal alcohol syndrome study that showed the *mean* IQ of FAS children decreased 5 points from 105 to 100 (and it was p<0.000001 or so) and people made fun like "a 5 point decrease is nothing in terms of IQ points" or "The IQ test is subject to too much bias, you can't measure 5 points, too much error" etc etc. No, you have to think about the group data and the implications of a 105 vs 100 mean. In relative terms, only a ~5% drop. But still it can mean twice as many kids in the ultra-genius group vs the other.

If rad onc median used to be $600K 10 years ago and it is $430K now this is big as hell news folks. These are the types of things I'm trying to get at. It is becoming increasingly obvious from the real world, and it seems to be becoming a shared agreed-upon reality thankfully, that the rad onc workforce is getting progressively over-supplied. We need some attempts at staying on top of this because I think we are moving into a time phase where the changes are going to come more rapidly. Declining means *and* medians are helped along downwards by those with salary of $0/year; I do not know if the unemployed (or fellows!) go into the salary data databases.
 
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a lot of words to say that for some reason you have a horse in this game to say that real world experience and also data saying salaries are > 500 on average in non academic sites is simply not believable to you.

Im not sure what horse you have in this race to stick to your guns so tightly. Are you an admin trying to hire someone on the cheap? Are you not liking what this says about your own salary? Don’t get it.
 
jondunn said:
a lot of words to say that for some reason you have a horse in this game to say that real world experience and also data saying salaries are > 500 on average in non academic sites is simply not believable to you.

Im not sure what horse you have in this race to stick to your guns so tightly. Are you an admin trying to hire someone on the cheap? Are you not liking what this says about your own salary? Don’t get it.
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What's your horse, bro?
 
jondunn said:
Im not sure what horse you have in this race to stick to your guns so tightly
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Because no one changes unless they are at a precipice. “Common sense” for now is that the precipice is distant. Hazy. “Complicated.”

Somewhere previous and recent you said you only care about two things: jobs and salaries. You first started out thinking that MGMA median salary was 550-600K. And it could have been years ago; Agarwal’s reference gave a mean $560k over 2005-17. But Do you still think the median is $550K plus now after the numerous countering examples using published data and inferred/extrapolated data?
Just trying to get people to open their eyes. See the precipice. Common sense or the common narrative can mislead.
 
I see no reason to believe the median is not lower than 500-550 when that number comes up again and again and again…..and again.

I’m sorry that your machinations of guesses of Medicare payouts per practice don’t jive!
 
jondunn said:
I see no reason to believe the median is not lower than 500-550 when that number comes up again and again and again…..and again.

I’m sorry that your machinations of guesses of Medicare payouts per practice don’t jive!
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How about a mean of $486k? Did you argue with emt409 in 2019? A mean of 486k a year implies a much lower median by NUMEROUS lines of data I already showed…

These numbers in truth are all over the map. You can’t just pick the highest one you’ve ever seen from a decade ago and say that’s truth now.

EDIT: and they’re not “guesses”

forums.studentdoctor.net

2019 Doximity Physician Compensation Report - Rad Onc Still True Ballin'

This just in, the sky has not fallen. Rad onc only trails neurosurg, CT surg, and ortho. Also, gender wage gap among the lowest of all specialties. Still a great field. https://s3.amazonaws.com/s3.doximity.com/press/doximity_third_annual_physician_compensation_report_round3.pdf
forums.studentdoctor.net forums.studentdoctor.net


D70D270F-9BDC-4094-AFF2-2C67B8601273.png
 
TheWallnerus said:
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.
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When I saw those Medicare data saying the median was $150k, something seemed very odd. THAT strains credulity. What assumptions are made to calculate this median? Did every doc counted have at least one charge every year? Are these including part time docs? Docs who left medicine? NPs/PAs who aren’t generating technical revenue?

I feel like if there were a massive number of docs with such low yearly compensation, we would be hearing from a bunch of them here.

Like I said, something is odd with those numbers.
 
TheWallnerus said:
~55% of all rad oncs in America are now academic... and I bet there are a lot of asst profs in America. Thus, again, median $500K+ (much less $600K) for all US ROs is very unlikely.


Certainly mathematically reasonable at least. This "average median" is $430K. I think this would be a lot more in line with known salary dilution by rad onc over-supply, combined with stagnant reimbursement, combined with stagnant patient loads, combined with declining fraction numbers, combined with the ever-present Pareto distribution.



Some of you guys are not quite grasping the big differences between a $600K median, and, say, a $430K median. It's not just "oh well it's $170K less I can live on $430K." For *a large group* there are BIG differences between a median of $600K and median of $430K when it is Pareto. There are gonna be winners and horror stories. I know the human brain is not very well equipped to deal with this. E.g., I once saw huge criticism in a fetal alcohol syndrome study that showed the *mean* IQ of FAS children decreased 5 points from 105 to 100 (and it was p<0.000001 or so) and people made fun like "a 5 point decrease is nothing in terms of IQ points" or "The IQ test is subject to too much bias, you can't measure 5 points, too much error" etc etc. No, you have to think about the group data and the implications of a 105 vs 100 mean. In relative terms, only a ~5% drop. But still it can mean twice as many kids in the ultra-genius group vs the other.

If rad onc median used to be $600K 10 years ago and it is $430K now this is big as hell news folks. These are the types of things I'm trying to get at. It is becoming increasingly obvious from the real world, and it seems to be becoming a shared agreed-upon reality thankfully, that the rad onc workforce is getting progressively over-supplied. We need some attempts at staying on top of this because I think we are moving into a time phase where the changes are going to come more rapidly. Declining means *and* medians are helped along downwards by those with salary of $0/year; I do not know if the unemployed (or fellows!) go into the salary data databases.
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If there really is a substantial decrease in the past ten years (and there may be), my first question would be, what’s the cause? Is it fewer patients, fewer fractions (both scary for our field), or is it that fewer docs are getting a piece of the technical (which is less concerning)?

When I was training, it seemed like PP earned SUBSTANTIALLY more than academic, and overwhelming majority of docs were PP. Neither seems to be the case anymore.
 
Lamount said:
When I saw those Medicare data saying the median was $150k, something seemed very odd. THAT strains credulity.
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1) Do you believe that Medicare spends ~$1.6B a year on Rad Onc? (see here)
2) Do you believe that there are about 5000 rad oncs? (see here; 2015 data)
3) Do you believe that 1.6E9/5000 = 320000? (see here)
4) Do you believe that if #1, #2, and #3 are consecutively true that the average rad onc Medicare reimbursement is $320,000?
5) Do you believe that the Medicare reimbursement distribution per rad onc is shaped like this (see here, see here, data... requires Excel etc. and a good stats package)
6) Do you believe that medians are always less than means in Pareto distributions?

Again... the mean salary of the Golden State Warriors is $9.4m and the median is $2.4m.
 
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TheWallnerus said:
1) Do you believe that Medicare spends ~$1.6B a year on Rad Onc? (see here)
2) Do you believe that there are about 5000 rad oncs? (see here; 2015 data)
3) Do you believe that 1.6E9/5000 = 320000? (see here)
4) Do you believe that if #1, #2, and #3 are consecutively true that the average rad onc Medicare reimbursement is $320,000?
5) Do you believe that the Medicare reimbursement distribution per rad onc is shaped like this (see here, see here, data... requires Excel etc. and a good stats package)
6) Do you believe that medians are always less than means in Pareto distributions?
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TheWallnerus said:
1) Do you believe that Medicare spends ~$1.6B a year on Rad Onc? (see here)
2) Do you believe that there are about 5000 rad oncs? (see here; 2015 data)
3) Do you believe that 1.6E9/5000 = 320000? (see here)
4) Do you believe that if #1, #2, and #3 are consecutively true that the average rad onc Medicare reimbursement is $320,000?
5) Do you believe that the Medicare reimbursement distribution per rad onc is shaped like this (see here, see here, data... requires Excel etc. and a good stats package)
6) Do you believe that medians are always less than means in Pareto distributions?
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It’s #5 that seems odd to me. That data that was posted be scarbt seems skewed by some confounder. That first column! I mean, maybe it’s true, but I wonder if there aren’t a few NPs and retirees in there.
 
Lamount said:
It’s #5 that seems odd to me. That data that was posted be scarbt seems skewed by some confounder. That first column! I mean, maybe it’s true, but I wonder if there aren’t a few NPs and retirees in there.
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I mean it's skewed but it's not skewed in the way you're seeming to say it's skewed. A beneficiary received a Medicare radiation service that year, and beneficiary/service always has to be attached to a provider; there were ~4800 providers in the database. They were all MDs or named centers/facilities (many facilities ie "21ST CENTURY NAPLES" etc obviously contain more than one provider). Not *all* were rad oncs... some were surgeons, derms, and very rare others. But you couldn't have a retiree in that first column, unless it's a "retiree" who had a Medicare RT service billed out under his/her NPI. In the first column (ie the 0-$100K bin), there were about 1400 rad oncs.

But back to the skewness... 1% of physicians (ie about 50 rad oncs) account for 44% of all rad onc spending. That's the skew.
 
TheWallnerus said:
I mean it's skewed but it's not skewed in the way you're seeming to say it's skewed. A beneficiary received a Medicare radiation service that year, and beneficiary/service always has to be attached to a provider; there were ~4800 providers in the database. They were all MDs or named centers/facilities (many facilities ie "21ST CENTURY NAPLES" etc obviously contain more than one provider). Not *all* were rad oncs... some were surgeons, derms, and very rare others. But you couldn't have a retiree in that first column, unless it's a "retiree" who had a Medicare RT service billed out under his/her NPI. In the first column (ie the 0-$100K bin), there were about 1400 rad oncs.

But back to the skewness... 1% of physicians (ie about 50 rad oncs) account for 44% of all rad onc spending. That's the skew.
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Bill Gates walks into a bar….median income doesn’t change much but mean increases exponentially
 
TheWallnerus said:
I mean it's skewed but it's not skewed in the way you're seeming to say it's skewed. A beneficiary received a Medicare radiation service that year, and beneficiary/service always has to be attached to a provider; there were ~4800 providers in the database. They were all MDs or named centers/facilities (many facilities ie "21ST CENTURY NAPLES" etc obviously contain more than one provider). Not *all* were rad oncs... some were surgeons, derms, and very rare others. But you couldn't have a retiree in that first column, unless it's a "retiree" who had a Medicare RT service billed out under his/her NPI. In the first column (ie the 0-$100K bin), there were about 1400 rad oncs.

But back to the skewness... 1% of physicians (ie about 50 rad oncs) account for 44% of all rad onc spending. That's the skew.
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How many on beam do you think to bill 50k a year? How many for 4 mil?
Neither seem very plausible.

I once knew a PP PCP attending in internship who was in the Medicare database for billing millions… but he didn’t really. He just was the medical director for a nursing home and they billed everything under his NPI (god knows why).

Some of that may be protons… but our system doesn’t feel THAT unequal.

Lets find out the old fashioned way.

Who here, on this forum, bills Medicare <100k? It should be… about 10-15% of us?
 
Lamount said:
When I saw those Medicare data saying the median was $150k, something seemed very odd. THAT strains credulity. What assumptions are made to calculate this median? Did every doc counted have at least one charge every year? Are these including part time docs? Docs who left medicine? NPs/PAs who aren’t generating technical revenue?

I feel like if there were a massive number of docs with such low yearly compensation, we would be hearing from a bunch of them here.

Like I said, something is odd with those numbers.
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TheWallnerus said:
1) Do you believe that Medicare spends ~$1.6B a year on Rad Onc? (see here)
2) Do you believe that there are about 5000 rad oncs? (see here; 2015 data)
3) Do you believe that 1.6E9/5000 = 320000? (see here)
4) Do you believe that if #1, #2, and #3 are consecutively true that the average rad onc Medicare reimbursement is $320,000?
5) Do you believe that the Medicare reimbursement distribution per rad onc is shaped like this (see here, see here, data... requires Excel etc. and a good stats package)
6) Do you believe that medians are always less than means in Pareto distributions?

Again... the mean salary of the Golden State Warriors is $9.4m and the median is $2.4m.
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It makes perfect sense to me... No one truly has a pure Medicare practice. It's the same issue with trying to look at the medicare billing data to figure out what someone is making. It's literally half the story or less for many of us.

What's the median salary from all the commercial insurers put together, probably $150-200k.... Add that up with the 150 from Medicare and the answer starts to make more sense. The Medicare data doesn't include commercial ins or even MA afaik
 
medgator said:
It makes perfect sense to me... No one truly has a pure Medicare practice. It's the same issue with trying to look at the medicare billing data to figure out what someone is making. It's literally half the story or less for many of us.

What's the median salary from all the commercial insurers put together, probably $150-200k.... Add that up with the 150 from Medicare and the answer starts to make more sense. The Medicare data doesn't include commercial ins or even MA afaik
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This is helpful. More to it than Medicare. The non-Medicare rates are sometimes >2x-3x. So if your practice is 50% MC and 50% commercial, maybe $150k from MC and $300 from commercial. Starts getting us closer to reality.
 
There are about 8 mid career RadOncs I talk to regularly. I’d say that MGMA number seems accurate (or maybe a touch low).
 
Lamount said:
How many on beam do you think to bill 50k a year? How many for 4 mil?
Neither seem very plausible.

I once knew a PP PCP attending in internship who was in the Medicare database for billing millions… but he didn’t really. He just was the medical director for a nursing home and they billed everything under his NPI (god knows why).

Some of that may be protons… but our system doesn’t feel THAT unequal.

Lets find out the old fashioned way.

Who here, on this forum, bills Medicare <100k? It should be… about 10-15% of us?
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And keep in mind we aren’t talking “billing” this is reimbursement.
 
Of course Medicare reimbursement is not the whole story in physician reimbursement. But it can serve as a base truth because it’s such internally consistent and trackable data. When I look my name up on the Mcr database it’s about $900K for last available year. I do a lot of lung (and replan etc) and my per patient Medicare reimbursement can be close to $20k per patient evidently so again this tracks as this is about 45 to 50 Medicare patients per year. And I seem to be in a reasonably good reimbursing locale. And all This tracks with my individual salary because I know I do about $2.5 mil a year from other payors. I have anywhere from 180 to 200 new starts a year. My salary and benefits is a low double digit percentage of those two gross figures above combined, a little less than eighteen percent.

From Medicare data though I am near the upper first percentile in reimbursement. But according to what everyone seems to think on the board here I am “just” 50 percentile in salary. Well something doesn’t jive, right. Either the Medicare data is wrong, or the salary data we have is wrong. The Medicare data is voluminous and granular and as I said internally consistent. It’s an orgy of data!!! The “salary data” is a number some third party posts on the internet once a year and I don’t have a spreadsheet or any data about it to analyze. I saw one year where the N for the MGMA data was 33 rad oncs (way way back when… they do much better now).

So think about it guys.

Again a “poll of polls” below for 2021.

d8NyrAn.png
 
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TheWallnerus said:
But according to what everyone seems to think on the board here I am “just” 50 percentile in salary.
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using your math of 0.18 x your combined billing, you are a good amount over either 500 or 550, putting you above the 50th percentile ?
 
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all that being said, I fully agree that accounting for inflation, salary is stagnant to down over the last decade plus. so you can argue 550k median doesnt mean what it used to and I would agree.

 
jondunn said:
we have roughly 12/beam for roughly MGMA median (havent looked in a while) of 550-600k.
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jondunn said:
using your math of 0.18 x your combined billing, you are a good amount over either 500 or 550, putting you above the 50th percentile ?
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I'm going to call you out for dissembling a bit (citation bolded above), but at least you're doing some math now 😉 See... it isn't complicated.

jondunn said:
all that being said, I fully agree that accounting for inflation, salary is stagnant to down over the last decade plus. so you can argue 550k median doesnt mean what it used to and I would agree.

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Not "stagnant to down" (still dissembling). Rad onc has had the biggest salary dip over 2011-19 than any other specialty. Again, I know 1.35% yr down doesn't sound like much, but I see our curve as linear quadratic and 2011-19 has been the linear phase.

Nm4jKvO.jpg
 
TheWallnerus said:
I'm going to call you out for dissembling a bit (citation bolded above), but at least you're doing some math now 😉 See... it isn't complicated.
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to be clear - I said 550-600 in that first post, qualified that i havent looked in a while, checked with people who HAVE looked at it, who say it is 550, and have dropped 500-550 in my posts about it since then, to be conservative.

you're using funny, circuitous math to say it cant be anywhere near that (when you're not bringing up evan thomas posts from 3 years ago)

just to be clear.
 
jondunn said:
The admins all use this stuff, in academics or non academics. It’s the docs that don’t always have access to it!
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This needs to be repeated -

These numbers: all the non-MD admins already have them. They know them by memory. The physicians are the ones who don't.

Very few of us have any control of any financial aspect of our practices. The MBAs figured this out long ago. But we can keep rattling sabers about choosing wisely and financial toxicity as if we have any major control over that.

Me doing 28 instead of 44 fractions for a prostate while the PPS-exempt centers charge whatever they want is the same as someone going out of their way to recycle glass bottles while DuPont dumps factory waste into the sea.
 
jondunn said:
to be clear - I said 550-600 in that first post, qualified that i havent looked in a while, checked with people who HAVE looked at it, who say it is 550, and have dropped 500-550 in my posts about it since then, to be conservative.

you're using funny, circuitous math to say it cant be anywhere near that (when you're not bringing up evan thomas posts from 3 years ago)

just to be clear.
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Which "people" did you check with? Are you sure they have done what you would consider robust research into the question you're asking? And if you "dropped [it to] 500-550 in my posts about it since then, to be conservative," why 500-500? Not a single data point I have seen posted here since you "dropped" suggests it's in that range in the most recent 1 or 2 years. And on top of that, there is loose use of the terms median and mean/average by the entities who post rad onc salary data. There is an enormity of data IMHO that this looseness gives unclear and inconsistent pictures of the situation.
 
TheWallnerus said:
Which "people" did you check with? Are you sure they have done what you would consider robust research into the question you're asking? And if you "dropped [it to] 500-550 in my posts about it since then, to be conservative," why 500-500? Not a single data point I have seen posted here since you "dropped" suggests it's in that range in the most recent 1 or 2 years. And on top of that, there is loose use of the terms median and mean/average by the entities who post rad onc salary data. There is an enormity of data IMHO that this looseness gives unclear and inconsistent pictures of the situation.
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The median MGMA is what it is. It is not perfect but it is a concrete, knowable number. The biggest problem with it is that admins have more access to it than docs.

I asked a reputable poster here who looks at the MGMA closely and recently
 
theradiator said:
Working my way through this lengthy document. Page 9, physician income accounts for only 9% of healthcare spending. So let's please stop talking about physician income as a way to "reduce inequality" and move onto something that will actually move the needle.
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Something we can all agree on
 


I wouldn’t let my dog get radiated in Florida without a careful look
 
theradiator said:
Working my way through this lengthy document. Page 9, physician income accounts for only 9% of healthcare spending. So let's please stop talking about physician income as a way to "reduce inequality" and move onto something that will actually move the needle.
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I strongly agree. I can see no (zero) good for us coming out of this discussion on Twitter. You're always going to have barriers to getting accurate numbers, as people like me will never share our income voluntarily.
 
OTN said:
I strongly agree. I can see no (zero) good for us coming out of this discussion on Twitter. You're always going to have barriers to getting accurate numbers, as people like me will never share our income voluntarily.
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There seems to be this hang up on the MGMA median "salary" that is making this discussion hard to follow. You can't really interpret that without also taking into context collections and RVU numbers. This idea that providing more service should result in more income while at the same time a market dynamic of supply and demand in terms of how you are paid if you are not collecting on your own.

I would guess you don't want to share your income because you are very busy under a fee-for-service model. If the goal is to get us all thinking in terms of what "salaries" we should be earning regardless of where we work or how much work we do, then you would be sharing that you are collecting a bunch of fees that you really aren't entitled to that should really be going to the hospitals and chairs to redistribute as they see fit to better serve their missions.
 
well I guess it is better if we have people too shy to say their true salary because they make too much rather than because they make too little.....
 
Moonbeams said:
There seems to be this hang up on the MGMA median "salary" that is making this discussion hard to follow. You can't really interpret that without also taking into context collections and RVU numbers. This idea that providing more service should result in more income while at the same time a market dynamic of supply and demand in terms of how you are paid if you are not collecting on your own.

I would guess you don't want to share your income because you are very busy under a fee-for-service model. If the goal is to get us all thinking in terms of what "salaries" we should be earning regardless of where we work or how much work we do, then you would be sharing that you are collecting a bunch of fees that you really aren't entitled to that should really be going to the hospitals and chairs to redistribute as they see fit to better serve their missions.
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"...that you really aren't entitled to that should really be going to the hospitals and chairs to redistribute as they see fit to better serve their missions."

- are you effing kidding me?
 
Moonbeams said:
. If the goal is to get us all thinking in terms of what "salaries" we should be earning regardless of where we work or how much work we do, then you would be sharing that you are collecting a bunch of fees that you really aren't entitled to that should really be going to the hospitals and chairs to redistribute as they see fit to better serve their missions.
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Wow... Just wow
 
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OTN said:
"...that you really aren't entitled to that should really be going to the hospitals and chairs to redistribute as they see fit to better serve their missions."

- are you effing kidding me?
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Don't shoot the messenger, but this is how they think. Every attempt I've ever made to negotiate an eat-what-you-kill arrangement with a hospital has been immediately struck down. That requires transparency that is simply unacceptable. Thinking of you as a salaried employee the same way physics is rather than someone who generates a separate fee for service is preferable to this end.
 
Moonbeams said:
Don't shoot the messenger, but this is how they think. Every attempt I've ever made to negotiate an eat-what-you-kill arrangement with a hospital has been immediately struck down. That requires transparency that is simply unacceptable. Thinking of you as a salaried employee the same way physics is rather than someone who generates a separate fee for service is preferable to this end.
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Go tell them to pound sand if the location sucks
 
Moonbeams said:
Don't shoot the messenger, but this is how they think. Every attempt I've ever made to negotiate an eat-what-you-kill arrangement with a hospital has been immediately struck down. That requires transparency that is simply unacceptable. Thinking of you as a salaried employee the same way physics is rather than someone who generates a separate fee for service is preferable to this end.
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You're not a messenger telling us something we don't already know. Of course that's how they think. Why would you expect them to behave any differently? Why on Earth would an administrator voluntarily do anything which would end up in you being paid more? You are labor. They are capital.

And, currently, we have an oversupply of radoncs, which was specifically designed to reduce the bargaining power of labor (as described by Dr. Dennis Hallahan in the Red Journal), as you are now seeing. Your inability to negotiate for a better pay package is all part of the plan.
 
People need to realize as they are being screwed that the system aint broken but in fact working just as designed to work. The system is rawdogging/drewdogging you purposefully,methodically,mercilessly. You are welcome sir.
 
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