Rad Onc Twitter

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jondunn said:
Why is radiology salary so down?

Can’t help that they’re mostly employed like us
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Radiologist salary? Are we at the VA? I'm not sure where you are getting your information.

I know multiple radiologists in PP. They are not paid salaries and do quite well. Again, I'm struggling to follow to pre-occupation with average reported "salaries." As noted above, MGMA is not salary.

You're talking about salary a lot. And this was my point above that I was trying to make that went over like a lead balloon. Grooming rad oncs to expect to be paid a salary plays into the model that the hospitals want where physicians are separated from payors and the financials are obfuscated. A $350k "salary" is multiple standard deviations above the national average. It's pretty unreasonable to object to that, don't you think? The physicists all have doctorates too, get paid $100k less, and don't expect to collect a separate commission for every patient treated. Why do you think you're the only one who gets to collect a commission on the patient? The professional fee really covers the professional service provided by the whole team - doctor, nurse, physicist, administrator, etc. The hospital will collect all the fees and split them fairly as salaries. (OTN, don't murder me please).


Edit: I guess it wasn't clear that I was being sarcastic.
 
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Moonbeams stop rambling. Why are you surprised that doctors want to talk about salary. Everyone else talks about salary. Not sure what your point is.

Anyways I was talking about the trends posted in the tweet. Rad onc is down 1 percent, accounting for inflation. Was surprised to see that radiology was down as well.
 
Moonbeams said:
? The physicists all have doctorates too, get paid $100k less, and don't expect to collect a separate commission for every patient treated. Why do you think you're the only one who gets to collect a commission on the patient?
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Physicists don't receive referrals at our practice, radiation oncologists do. There are no physics or technical charges without RO pro charges
 
jondunn said:
Moonbeams stop rambling. Why are you surprised that doctors want to talk about salary. Everyone else talks about salary. Not sure what your point is.

Anyways I was talking about the trends posted in the tweet. Rad onc is down 1 percent, accounting for inflation. Was surprised to see that radiology was down as well.
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They had a weaker job market several years ago.. Not that surprising. They cut slots however and demand has continued to grow
 
data is quite interesting the more I look at it. Derm is down more than anyone else, at -4.59%. Biggest rises are FM (1.45) and Psych (2.06)
 
jondunn said:
data is quite interesting the more I look at it. Derm is down more than anyone else, at -4.59%. Biggest rises are FM (1.45) and Psych (2.06)
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Psych has essentially switched places with rad Onc in terms of competitiveness of their respective specialties over the last few years. One of my close med school buddies is PD at an ivy league program, essentially was matching a lot of fmgs a decade ago now all AMGs are matching with stronger stats. Meanwhile RO programs lately at the lower end are matching people that aren't even competitive enough for surgery prelim years and have failed step 1/2 and even med school years etc

Psych has a very open job market and salaries have been going up. That being said, i couldn't do that job myself
 
medgator said:
Physicists don't receive referrals at our practice, radiation oncologists do. There are no physics or technical charges without RO pro charges
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You are preaching to the choir. I was just pointing out how the MBAs approach these things (I guess I wasn't over the top enough). I have had little success convincing them why I am solely entitled to the professional charge. Jondunn, my point is these numbers have a lot of nuance to them and if you want to focus on compensation in form of salary, then ok, we can just forget about all this and the MBAs can figure out what to pay us regardless of what is actually paid for our services. That's the situation that leads to. In some situations where there is a limited supply of available physicians it works out favorably. In most cases it does not. I think you're missing the forest for the trees, in other words.
 
You’re talking about different things.

We can care about salary AND care about what’s behind the salary. One is tangible, one is what we can get upset about and why we deserve more (if we are employed)
 
jondunn said:
One is what we can get upset about and why we deserve more (if we are employed)
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You can think you deserve the world but at the end of the day you're beholden to people like DH at wash U and the supply they create irrespective of market demand.

Dennis was just stupid enough to actually put it in writing
 
jondunn said:
Why is radiology salary so down?

Can’t help that they’re mostly employed like us
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We got slapped multiple times by CMS.

We also got hurt by the changes in rvu weighting for EM codes since we rarely bill those. All our other codes got a 10% cut when the rvu conversion went down 37->34.

The problem for us as a field are predatory practices selling out to PE.
 
maxxor said:
.

The problem for us as a field are predatory practices selling out to PE.
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Bigger problem is that the table is titled towards hospital based and PPS exempt places when it comes to reimbursement. Why wouldn't those practices sell out when they are getting paid less than everyone else?
 
maxxor said:
We got slapped multiple times by CMS.

We also got hurt by the changes in rvu weighting for EM codes since we rarely bill those. All our other codes got a 10% cut when the rvu conversion went down 37->34.

The problem for us as a field are predatory practices selling out to PE.
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thanks. thought something along those lines.
 
medgator said:
Bigger problem is that the table is titled towards hospital based and PPS exempt places when it comes to reimbursement. Why wouldn't those practices sell out when they are getting paid less than everyone else?
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they will sell and will be more and more and more.

all of medicine.

the future is employment. they should teach it in med school. May as knock out HR modules in MS4.
 
I’ve tried really hard to get a bump in salary from my hospital employer. Making about MGMA mean but I’m at a not great location. Seeing about 200 consults/year. Hospital making millions off me at my single physician site but I can’t get a raise. Seriously considering leaving and they can take their chances with whomever they get. Im sure they will be willing to coast by with locums for years as the consult numbers dwindle down.
 
thecarbonionangle said:
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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Yes, it is, to some extent. On the flip side, the system is screwing most doctors (let alone most people) a whole lot more.
 
fiji128 said:
I’ve tried really hard to get a bump in salary from my hospital employer. Making about MGMA mean but I’m at a not great location. Seeing about 200 consults/year. Hospital making millions off me at my single physician site but I can’t get a raise. Seriously considering leaving and they can take their chances with whomever they get. Im sure they will be willing to coast by with locums for years as the consult numbers dwindle down.
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Locums market definitely stronger this year... Would dump them like a bad habit if you have no ties to the area.

Have even some repeated postings of places looking for technical partnership track ROs, undesirable areas obviously. Most recent email i got was for a freestanding practice in Huntington wv.... Meth country
 
medgator said:
Bigger problem is that the table is titled towards hospital based and PPS exempt places when it comes to reimbursement. Why wouldn't those practices sell out when they are getting paid less than everyone else?
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PPS exempt doesn’t really matter when there isn’t one in most states for us. They also largely don’t have big imaging operations surprisingly, my guess is because many patients will get scanned locally and then have the images second interpreted at the flagship, which is really trivial revenue for them.

In radiology it’s a bit more complicated. The facility and OPPS payments can in certain circumstances actually pay less for hospital based equipment vs IDTF or physician practice owned scanners. An example off the top of my head is PETCT. I believe Medicare reimburses $500 less for hospital owned scanners vs IDTF/physician office.

OPPS payments are very convoluted and can reimburse less for more complex exams because of the way the 5 complexity levels work.

Big networks are another problem because they will require their physicians to refer to their owned scanners. That’s where we are cut out of technical revenue. If you want to play in technical these days, you have to target the cash / hdhp market which is cutthroat.
 
maxxor said:
.

In radiology it’s a bit more complicated. The facility and OPPS payments can in certain circumstances actually pay less for hospital based equipment vs IDTF or physician practice owned scanners. An example off the top of my head is PETCT. I believe Medicare reimburses $500 less for hospital owned scanners vs IDTF/physician office.
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That's completely the opposite of what I've seen... One of the more ruralish hospitals in our area got written up in the local paper for charging the most for an MRI in the whole state.... Well into the 4 figures while the nearby freestanding facility was charging a fraction of that
 
medgator said:
That's completely the opposite of what I've seen... One of the more ruralish hospitals in our area got written for charging the most for an MRI in the whole state.... Well into the 4 figures while the nearby freestanding facility was charging a fraction of that
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What they charge is not what they get paid. Medicare is Medicare. Again, that freestanding has to compete and unfortunately the market for them is cash pay and hdhp. They have to charge less because why else would you go to a random place that isn’t connected etc.

It’s really trivial to look up the rates for your specific MAC and how OPPS pay vs PFS is for imaging. Sometimes hospitals get paid more. Sometimes they don’t.

PET is one of those where it’s better to be IDTF.
 
While RadOnc has its own "unique" (to medical specialties, at least) problems, the PE/MBA/CMS cuts/etc problems affect all of medicine.

Simultaneously, the cost to attend college and medical school continues to increase. Obviously, people find "other" ways to pay - family wealth, military, MD-PhD programs, that sort of thing.

However, there is still a large percentage of kids shouldering the cost through loans alone. 10 years ago, I knew people graduating with $300k+ in student loan debt. The most I remember hearing about - 10 years ago - was around $400k.

Thinking about children born today, and using one of the college cost projection calculators for 18 years in the future, the estimate is staggering.

What's the "canary in the coal mine" for the American medicine enterprise? $600k in student loans? $700k?
 
elementaryschooleconomics said:
While RadOnc has its own "unique" (to medical specialties, at least) problems, the PE/MBA/CMS cuts/etc problems affect all of medicine.

Simultaneously, the cost to attend college and medical school continues to increase. Obviously, people find "other" ways to pay - family wealth, military, MD-PhD programs, that sort of thing.

However, there is still a large percentage of kids shouldering the cost through loans alone. 10 years ago, I knew people graduating with $300k+ in student loan debt. The most I remember hearing about - 10 years ago - was around $400k.

Thinking about children born today, and using one of the college cost projection calculators for 18 years in the future, the estimate is staggering.

What's the "canary in the coal mine" for the American medicine enterprise? $600k in student loans? $700k?
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Look at dental grads who do their paid for residency’s. That’s probably where we are headed. It’s disgusting.
 
Perhaps we move this convo back to business forums, lest we come across like a bunch of MDs sobbing about driving an Audi rather than a Maserati
 
It’s not a smart move to take on more education debt then what your yearly salary will be. This information is everywhere these days. I would hope that maybe this might keep a lid on the med school tuition but wouldn’t bet on it.
 
elementaryschooleconomics said:
While RadOnc has its own "unique" (to medical specialties, at least) problems, the PE/MBA/CMS cuts/etc problems affect all of medicine.

Simultaneously, the cost to attend college and medical school continues to increase. Obviously, people find "other" ways to pay - family wealth, military, MD-PhD programs, that sort of thing.

However, there is still a large percentage of kids shouldering the cost through loans alone. 10 years ago, I knew people graduating with $300k+ in student loan debt. The most I remember hearing about - 10 years ago - was around $400k.

Thinking about children born today, and using one of the college cost projection calculators for 18 years in the future, the estimate is staggering.

What's the "canary in the coal mine" for the American medicine enterprise? $600k in student loans? $700k?
Click to expand...
For the majority of docs who work for a hospital that is a 501c3, PSLF will kick in long before you pay off the loan. In reality, for many of us… the balance doesn’t matter. You just need to endure paying 10% of your salary for 10 years (under one of the income driven repayment deals), and all of the remainder is forgiven. The pause in repayments has been helpful because each month that it remains paused still counts toward the ten years of PSLF
 
Lamount said:
For the majority of docs who work for a hospital that is a 501c3, PSLF will kick in long before you pay off the loan. In reality, for many of us… the balance doesn’t matter. You just need to endure paying 10% of your salary for 10 years (under one of the income driven repayment deals), and all of the remainder is forgiven. The pause in repayments has been helpful because each month that it remains paused still counts toward the ten years of PSLF
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Do a large # of ROs work at a eligible hospital?
 
RealSimulD said:
Do a large # of ROs work at a eligible hospital?
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I’m at one and well into the PSLF program. Everyone should get 5 of the 10 years required just by doing rad onc residency. If 55% of rad onc’s are at “academic” places then at least that many should be technically eligible assuming loans and payment plan are properly structured.
 
RealSimulD said:
Do a large # of ROs work at a eligible hospital?
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I imagine so, but don’t know for sure. I think most hospitals are, technically, not-for-profit (501c3). There are a handful of for profit health systems but I don’t think it is a large fraction. Would defer to others you have more knowledge about the numbers.
 
Lamount said:
I imagine so, but don’t know for sure. I think most hospitals are, technically, not-for-profit (501c3). There are a handful of for profit health systems but I don’t think it is a large fraction. Would defer to others you have more knowledge about the numbers.
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So, if you work for any non-profit, you are eligible ? This is fantastic. I didn’t know it was any non profit.
 
Everyplace with a rad onc residency is either going to be government or 501c entity and would qualify for PSLF. I know HCA hospitals are for profit and any private practice physician group would also be considered the same and thus ineligible. Private practice groups hired for coverage of non for profit hospitals also ineligible.

I’m at about 100 of 120 needed officially counted qualifying payments into PSLF for $350k in debt forgiveness and so follow all rules and news closely.
 
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There’s a lot of devils in the details for non profits. For example you may work at the non profit academic center, but your employer is technically the physician group which provides physician services to the academic center and is not a not for profit. This is true at most academic centers I’ve seen.
 
DoctwoB said:
There’s a lot of devils in the details for non profits. For example you may work at the non profit academic center, but your employer is technically the physician group which provides physician services to the academic center and is not a not for profit. This is true at most academic centers I’ve seen.
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Absolutely.

This is like the "surprise out-of-network" bill in reverse.

Among many other real-world classes I wish were mandatory in med school, "employment and contract structure of American physicians" would be high on my list.
 
elementaryschooleconomics said:
Absolutely.

This is like the "surprise out-of-network" bill in reverse.

Among many other real-world classes I wish were mandatory in med school, "employment and contract structure of American physicians" would be high on my list.
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I have heard about this but haven’t seen it. I think this information is publicly available and should be of keen interest to every resident who is looking for a job. FWIW, this is not the case where I trained or where I work now.
 
jondunn said:
would be interesting to see a mean/median metric for this consult/year number. I'm def above 200.
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It’s very easy to compute.

1646883838362.gif
 
elementaryschooleconomics said:
Absolutely.

This is like the "surprise out-of-network" bill in reverse.

Among many other real-world classes I wish were mandatory in med school, "employment and contract structure of American physicians" would be high on my list.
Click to expand...
If someone offered me such a class prior to med school, no way I would’ve chosen med school. It’s too uncertain and too much of a rigged game. I would’ve rather taken my chances elsewhere in a different game. Just saying what a young 22yo me would’ve thought. I guess if I got the class in med school I would be like “Jeez that’s scary. When are midterms?” They could’ve given a class on Thursdays in med school and I would have stuck it out.
 
Lamount said:
I have heard about this but haven’t seen it. I think this information is publicly available and should be of keen interest to every resident who is looking for a job. FWIW, this is not the case where I trained or where I work now.
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I also think it's public information - I just don't know how many residents even know to ask the question!
 
jondunn said:
I mean it was sort of a batcall for you. Give it to us

More interested in median than mean given all the rad oncs who don’t see many patients either because of admin positions or senior level in academics/large networks
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1.1m XRT patients per year. 5500 ROs.

∴Avg=200 pts/RO/yr.
Median will be in neighborhood 3/4 that.

Avg was 300 plus more than 20y ago.

If trends continue, the avg RO will be out of patients before end of century.
 
TheWallnerus said:
1.1m XRT patients per year. 5500 ROs.

∴Avg=200 pts/RO/yr.
Median will be in neighborhood 3/4 that.

Avg was 300 plus more than 20y ago.

If trends continue, the avg RO will be out of patients before end of century.
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C'mon now you're ignoring all those new oligomet and Radiopharm/Lu patients that are going to rain down and save the specialty!!






/s
 
jondunn said:
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I like how all the Twitter replies say it's not true, but then offer no (zero) data to back up that claim. Hypofractionation is more toxic. Period. Whether or not that toxicity is worth the shortened tx course is a discussion to have with your patients.

Me, I offer either SBRT or standard fractionation. Standard for high risk. SBRT for all else.
 
Moonbeams said:
Radiologist salary? Are we at the VA? I'm not sure where you are getting your information.

I know multiple radiologists in PP. They are not paid salaries and do quite well. Again, I'm struggling to follow to pre-occupation with average reported "salaries." As noted above, MGMA is not salary.

You're talking about salary a lot. And this was my point above that I was trying to make that went over like a lead balloon. Grooming rad oncs to expect to be paid a salary plays into the model that the hospitals want where physicians are separated from payors and the financials are obfuscated. A $350k "salary" is multiple standard deviations above the national average. It's pretty unreasonable to object to that, don't you think? The physicists all have doctorates too, get paid $100k less, and don't expect to collect a separate commission for every patient treated. Why do you think you're the only one who gets to collect a commission on the patient? The professional fee really covers the professional service provided by the whole team - doctor, nurse, physicist, administrator, etc. The hospital will collect all the fees and split them fairly as salaries. (OTN, don't murder me please).
Click to expand...

This is Capitalism 101.

I get to collect a "commission" (I assume you mean global billing) because I am the part owner of the practice in which the patient was treated. As the owner of the enterprise, I assume the financial risk of the practice and invested $$ to help build and grow the practice. Naturally, one would expect to get a return on this investment, which getting the global billing accomplishes.

You're suggesting our nurses, physicists (ours don't have doctorates), administrators should have a right to this global billing as well. Why should they? They don't own the practice, haven't taken on any financial risk, and aren't nearly as medicolegally responsible for the patients as we as physicians are. However, that doesn't even matter.

Our economic structure in this country is capitalism. You have to own the capital to get the ism. I, along with our other physician partners, own the capital. Our employees do not. "Deserve" ain't got nothing to do with it.

You could argue that larger institutions have larger philanthropic and research missions, blah blah blah, but then I would point out that we put more patients on clinical trials than any other institution in the country, deliver an enormous amount of charity care, and do it all at a cost 1/5th that of major academic medical centers. However, again, that doesn't matter. We own the practice, so we get to collect global billing. Doesn't have to be more complicated than that.
 
OTN said:
This is Capitalism 101.

I get to collect a "commission" (I assume you mean global billing) because I am the part owner of the practice in which the patient was treated. As the owner of the enterprise, I assume the financial risk of the practice and invested $$ to help build and grow the practice. Naturally, one would expect to get a return on this investment, which getting the global billing accomplishes.

You're suggesting our nurses, physicists (ours don't have doctorates), administrators should have a right to this global billing as well. Why should they? They don't own the practice, haven't taken on any financial risk, and aren't nearly as medicolegally responsible for the patients as we as physicians are. However, that doesn't even matter.

Our economic structure in this country is capitalism. You have to own the capital to get the ism. I, along with our other physician partners, own the capital. Our employees do not. "Deserve" ain't got nothing to do with it.

You could argue that larger institutions have larger philanthropic and research missions, blah blah blah, but then I would point out that we put more patients on clinical trials than any other institution in the country, deliver an enormous amount of charity care, and do it all at a cost 1/5th that of major academic medical centers. However, again, that doesn't matter. We own the practice, so we get to collect global billing. Doesn't have to be more complicated than that.
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I understand all of that, especially with regards to those who take the financial risk to build a new practice vs. buying into an established healthy practice. My beef is specifically with organizations and how they view the professional billing and the idea that it is unreasonable for a physician to expect to be paid most of whatever is collected on the pro side. The reasoning has devolved down to a level that this reimbursement should be spread among all team members, not just physician, and there is really no shame in saying this anymore. The shame is on the physician for assuming the professional collections should be his/her income.

This is why I think focusing on things like average "salaries" does a disservice. Then you end up with job ads, like the one in Colorado where in order to submit the application you have to input an integer for your "pay expectation." No. My pay expectation depends on the mix of patients I will be seeing and their payors. You need to give me that number, not the other way around.
 
Moonbeams said:
I understand all of that, especially with regards to those who take the financial risk to build a new practice vs. buying into an established healthy practice. My beef is specifically with organizations and how they view the professional billing and the idea that it is unreasonable for a physician to expect to be paid most of whatever is collected on the pro side. The reasoning has devolved down to a level that this reimbursement should be spread among all team members, not just physician, and there is really no shame in saying this anymore. The shame is on the physician for assuming the professional collections should be his/her income.

This is why I think focusing on things like average "salaries" does a disservice. Then you end up with job ads, like the one in Colorado where in order to submit the application you have to input an integer for your "pay expectation." No. My pay expectation depends on the mix of patients I will be seeing and their payors. You need to give me that number, not the other way around.
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Gotcha. I'm certainly in agreement with all that. I also agree that "salary" suggests employment rather than "income", so I see what you're getting at.

The problem is that it really comes down to supply and demand. They're not paying you more because they don't have to. If they had a harder time replacing radoncs they would pay you more. They can try to justify it any way they want and try to create a culture where that justification is accepted by everyone, but it's all smoke and mirrors.

However, ESPECIALLY when it comes to the pro side, suggesting you don't deserve each and every penny of that $$ is complete and total horsesh__. The technical collections are where the facility/hospital gets theirs. The professional collections are supposed to be where you get yours.
 
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