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Chartreuse Wombat said:
Performative...the very essence of the bird
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I just lurk on med twitter but my God it is nauseating how performative it is. Feeling virtuous and showing virtue is a hell of a drug/dopamine hit it seems.

There can be some really good discussion (especially at conference time of ASCO/ASTRO)...but wow there are some negatives out there too.
 
Palex80 said:




Calm Down Chill Out GIF
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Is it like this in Europe? Just the excessive enthusiasm over what is probably a very very mediocre applicant pool?
 
The difficulty is scale. We can "instantly" have power over oil/gas issues but healthcare? Insanely complex healthcare?

And, if you lose your job you are SOL with the implication being potentially tens or hundreds of thousands of dollars of risk?

Humans aren't very good at organizing until the pain is so severe, so widespread, it is essentially time to riot.

"The beatings will continue until morale improves."

Carry on.
 
BobbyHeenan said:
I just lurk on med twitter but my God it is nauseating how performative it is. Feeling virtuous and showing virtue is a hell of a drug/dopamine hit it seems.

There can be some really good discussion (especially at conference time of ASCO/ASTRO)...but wow there are some negatives out there too.
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Feeling very similar and I think it is getting worse. There is very little in the way of scientific discussion these days. When I see people try, people become defensive in a very over the top way, acting like any critique is "violence".

It's free so no reason to quit, but very little motivation to put content on there other than jokes, memes, and simple comments unrelated to the science of medicine.

Whoever is SBRT memes, if you are here please keep going, I love your stuff 🙂
 
Revenue tells us nothing. Let's have a look at the profit margin:

Accident & Health Insurance Industry Profitability by quarter, Gross, Operating and Net Margin from Q2 2025

Accident & Health Insurance Industry Gross Margin, Operating, EBITDA, Net and Pre Tax Margin, high, low and average from Q2 2025 - CSIMarket
csimarket.com

Healthcare Services Net Profit Margin 2010-2025 | HCSG

Healthcare Services net profit margin from 2010 to 2025. Net profit margin can be defined as net Income as a portion of total sales revenue.
www.macrotrends.net www.macrotrends.net

Yes, the insurer had record profits. However, those profit margins are still well below those of many industries.
 
OTN said:
Revenue tells us nothing. Let's have a look at the profit margin:

Accident & Health Insurance Industry Profitability by quarter, Gross, Operating and Net Margin from Q2 2025

Accident & Health Insurance Industry Gross Margin, Operating, EBITDA, Net and Pre Tax Margin, high, low and average from Q2 2025 - CSIMarket
csimarket.com

Healthcare Services Net Profit Margin 2010-2025 | HCSG

Healthcare Services net profit margin from 2010 to 2025. Net profit margin can be defined as net Income as a portion of total sales revenue.
www.macrotrends.net www.macrotrends.net

Yes, the insurer had record profits. However, those profit margins are still well below those of many industries.
Click to expand...
Biggest driver of costs in healthcare is hospital prices. 2nd is pharma.
 
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OTN said:
Revenue tells us nothing. Let's have a look at the profit margin:

Accident & Health Insurance Industry Profitability by quarter, Gross, Operating and Net Margin from Q2 2025

Accident & Health Insurance Industry Gross Margin, Operating, EBITDA, Net and Pre Tax Margin, high, low and average from Q2 2025 - CSIMarket
csimarket.com

Healthcare Services Net Profit Margin 2010-2025 | HCSG

Healthcare Services net profit margin from 2010 to 2025. Net profit margin can be defined as net Income as a portion of total sales revenue.
www.macrotrends.net www.macrotrends.net

Yes, the insurer had record profits. However, those profit margins are still well below those of many industries.
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Private insurance is the epitome of regulatory capture. Up there with having exclusive licensure for liquor distribution.

Operating costs are nil, there is minimal contribution to economic growth outside of employment, there is no contribution to real wealth of people (unlike hard tech or big ag or even the oil industry).

It is itself insured by the federal gvt.

It is an industry where profits need to be regulated because they could be almost infinite.

Also, why the crazy disparity between gross profit (20+%!!!!) and EBITDA? Bonuses?
 
Fpg1245 said:
Is it like this in Europe? Just the excessive enthusiasm over what is probably a very very mediocre applicant pool?
Click to expand...

LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

1670371875178.png
 
Palex80 said:
Nope.
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NotMattSpraker said:
LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

View attachment 362938
Click to expand...

I am also opening a fellowship this year for RO graduates for those looking to cross-training in infectious disease. Its a 1-year fellowship in Syphilology. Its unpaid but I'm sure your passion for the subject matter will carry you through
 
NotMattSpraker said:
LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

View attachment 362938
Click to expand...
If only she'd started it with a "good news everyone!"
 
Fpg1245 said:
I am also opening a fellowship this year for RO graduates for those looking to cross-training in infectious disease. Its a 1-year fellowship in Syphilology. Its unpaid but I'm sure your passion for the subject matter will carry you through
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Perhaps something more appealing for the grey-haired boomer senior staff?
 
A_DeMichele said:
True. My local VA no longer offers “full pension after 15 years of service” type of deal. It’s low 300’s + generous 401(k) matching
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Currently considering VA in desirable city. Mid-300’s starting + 40k/year student loan reimbursement (tax free) + no non competes/contracts. All brand new equipment in the department. ~10 on treat per attending. I’m trying to see the downsides…
 
RandomRadOnc12 said:
Currently considering VA in desirable city. Mid-300’s starting + 40k/year student loan reimbursement (tax free) + no non competes/contracts. All brand new equipment in the department. ~10 on treat per attending. I’m trying to see the downsides…
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Don’t forget all the paid holidays, benefits.
 
I saw a non Astro posted VA job for Dayton OH the other day. Here is what was offered. Salary range $325k to $400k depending on credentials, including consideration of annual performance pay bonus up to $15,000. Education Debt Reduction Program Award of up to $200,000 possible and a Recruitment/Relocation Incentive up to 15% of annual salary. 26 Days' Vacation, 13 Days Sick and 11 Federal Holidays with pay. Federal Employees Retirement System and Thrift Savings Plan with 5% government matching.
 
RandomRadOnc12 said:
Currently considering VA in desirable city. Mid-300’s starting + 40k/year student loan reimbursement (tax free) + no non competes/contracts. All brand new equipment in the department. ~10 on treat per attending. I’m trying to see the downsides…
Click to expand...
It's all about opportunity cost. In this environment, I would consider this an excellent deal. If it's where you want to live, it is a no brainer.
 
RandomRadOnc12 said:
Currently considering VA in desirable city. Mid-300’s starting + 40k/year student loan reimbursement (tax free) + no non competes/contracts. All brand new equipment in the department. ~10 on treat per attending. I’m trying to see the downsides…
Click to expand...
Congrats. Have you ever worked in a VA? If you have, and can accept some of the peculiarities that come with it, it sounds like you'll have a terrific work-life balance. Working with the vets is the best.
 
NotMattSpraker said:
LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

View attachment 362938
Click to expand...
This is pretty bad. I guess the winner gets to put MSK on their CV and MSK gets slave labor for a year. After living in NYC for a year at "Fellow" salary you'll be left with 0 if you're lucky.

Pathetic exploitation.
 
NotMattSpraker said:
LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

View attachment 362938
Click to expand...

I'm confused. MSKCC brachy fellowship was already a thing. Are they suggesting they're accepting TWO fellows now for thatyear?
 
RadRadRad said:
To be fair mskcc brachy fellowship has been around a long time
Very busy. Very broad brachy experience. Probably one of the few useful fellowships
(No I didn’t do the fellowship myself)
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Cool. Sounds like a position that would be great for someone who has some brachy experience (as is required to graduate residency) to be hired on as an assistant professor.

Everyone learns some stuff on the job. A "useful fellowship" would be much better if these people were paid appropriately.

Fellowships are exploitive in Radiation Oncology.
 
Radonc Safe Space Seminar Topics Agenda

Todays discussion topic:

Academia: the last safe harbor for the interpersonally challenged?

Tomorrows discussion topic:

Why the VA isn't a dead end for your career, and other fables of the field...
 
RadRadRad said:
To be fair mskcc brachy fellowship has been around a long time
Very busy. Very broad brachy experience. Probably one of the few useful fellowships
(No I didn’t do the fellowship myself)
Click to expand...

It's a useful fellowship which does provide a great training experience, from what I've heard. Can't fault MSKCC for offering it, but I do fault other training programs for not being able to provide enough brachytherapy experience so it has to exist. Those programs should close, as should those which cannot provide enough peds experience.
 
OTN said:
as should those which cannot provide enough peds experience.
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I don't know about close but certainly budget time to send folks to where they can get the relevant experience. I guess the same could be said for brachy. Not training people adequately in specialized subtopics may not be feasibly done onsite for every program; but every program can and should make sure its trainees GET that training somewhere.

Now get off my lawn.
 
I personally looked/interviewed for this back in residency. The big red flag for me was you were basically expected to be the brachytherapy nurse and handle all the scheduling/coordinating stuff the nurse would typically be responsible for. Very busy but mostly all prostate with some few other more exotic things. I was told mskcc does not do a lot of non vag cylinder gyn because they don't allow getting the XRT portion out of the system. Additionally, I was told that pedigree obsessed mskcc has never hired any of their rad onc fellows. Many of the previous fellows seemed to get what I would consider average normal type jobs after completing training. So I would say it was very/exceptionally exploitative in nature and probably viewed internally as a way to save money on salary (fellow would be paid less then a nurse). In exchange you would gain experience, some pedigree and maybe a research project to put on the CV. This was just my own personal impression. I'm sure there are others out there that will sing it's praises.
 
fiji128 said:
I personally looked/interviewed for this back in residency. The big red flag for me was you were basically expected to be the brachytherapy nurse and handle all the scheduling/coordinating stuff the nurse would typically be responsible for. Very busy but mostly all prostate with some few other more exotic things. I was told mskcc does not do a lot of non vag cylinder gyn because they don't allow getting the XRT portion out of the system. Additionally, I was told that pedigree obsessed mskcc has never hired any of their rad onc fellows. Many of the previous fellows seemed to get what I would consider average normal type jobs after completing training. So I would say it was very/exceptionally exploitative in nature and probably viewed internally as a way to save money on salary (fellow would be paid less then a nurse). In exchange you would gain experience, some pedigree and maybe a research project to put on the CV. This was just my own personal impression. I'm sure there are others out there that will sing it's praises.
Click to expand...
Nailed It GIF by MOODMAN
 
fiji128 said:
I personally looked/interviewed for this back in residency. The big red flag for me was you were basically expected to be the brachytherapy nurse and handle all the scheduling/coordinating stuff the nurse would typically be responsible for. Very busy but mostly all prostate with some few other more exotic things. I was told mskcc does not do a lot of non vag cylinder gyn because they don't allow getting the XRT portion out of the system. Additionally, I was told that pedigree obsessed mskcc has never hired any of their rad onc fellows. Many of the previous fellows seemed to get what I would consider average normal type jobs after completing training. So I would say it was very/exceptionally exploitative in nature and probably viewed internally as a way to save money on salary (fellow would be paid less then a nurse). In exchange you would gain experience, some pedigree and maybe a research project to put on the CV. This was just my own personal impression. I'm sure there are others out there that will sing it's praises.
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Are you telling me MSKCC doesn't see a lot of underserved cervix patients?!
 
Yeah, I think 6-8 holidays is about as good as it gets. The more religious places end up on the higher end. The for profit (or non-profit but obviously money grubbing corps) you get on the short end.
 
sirspamalot said:
This is pretty bad. I guess the winner gets to put MSK on their CV and MSK gets slave labor for a year. After living in NYC for a year at "Fellow" salary you'll be left with 0 if you're lucky.

Pathetic exploitation.
Click to expand...
How many of the instructors/professors did a brachy fellowship?

It's just a cost savings measure for MSKCC and because they can. THe old way was you just hired a doc that was interested in brachy and they did it as an attending, maybe over lapping a a hand full of months with the prior doc on their way out.

I have no doubt the fellow will be better at brachy than a regular resident, but this used to be done as an attending.
 
RandomRadOnc12 said:
Currently considering VA in desirable city. Mid-300’s starting + 40k/year student loan reimbursement (tax free) + no non competes/contracts. All brand new equipment in the department. ~10 on treat per attending. I’m trying to see the downsides…
Click to expand...
I posted this on the private forum, but if you do the math, on a per patient basis that is extraordinarily high compensation for your effort. I don't think you will do much better anywhere else even if you are eating into tech. I have heard of very rural places with low census paying 600-700 to manage something like 10. But these are rare now and in sparsely populated areas in the west (think western North Dakota), and the VA will be in a much better location!

The glaring downside would be the work schedule. That is a 9-3 3-day a week job. I wouldn't consider it without a 4 day workweek and ability to leave whenever they are done treating. If you are expected to sit there 8-5 M-F with nothing to do, I think my soul would rot.
 
Moonbeams said:
I posted this on the private forum, but if you do the math, on a per patient basis that is extraordinarily high compensation for your effort. I don't think you will do much better anywhere else even if you are eating into tech. I have heard of very rural places with low census paying 600-700 to manage something like 10. But these are rare now and in sparsely populated areas in the west (think western North Dakota), and the VA will be in a much better location!

The glaring downside would be the work schedule. That is a 9-3 3-day a week job. I wouldn't consider it without a 4 day workweek and ability to leave whenever they are done treating. If you are expected to sit there 8-5 M-F with nothing to do, I think my soul would rot.
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From my experience in residency you are spot on.
The VA had like 30 on treat split between 3 docs.
I probably would have considered it if I couldn't get a PP job. Fresh from training I wanted to try to get a job with a higher ceiling potential. It seems like a good gig and I don't have a non-compete so may consider that if I dont like my job. Would never consider going to the ivory tower in town. They are offering instructor positions to their grads I hear...
 
OTN said:
It's a useful fellowship which does provide a great training experience, from what I've heard. Can't fault MSKCC for offering it, but I do fault other training programs for not being able to provide enough brachytherapy experience so it has to exist. Those programs should close, as should those which cannot provide enough peds experience.
Click to expand...

I talked about this on a podcast and try to be very clear that it does offer a good option for the right person. People should never feel ashamed for taking the job if it makes sense given their priorities.

MSKCC should be very ashamed no matter how good they think the training is at their center. How long do you think it takes for a previously trained low volume brachytherapist to become an expert on a high volume service?

One extremely reasonable alternative is to hire them on as faculty and supervise their cases for a little bit.

I know this is reasonable because I worked at a place that felt the need to "credential" me for a variety of processes and procedures (HA-WBRT, protons, SBRT coverage, MRgRT coverage). All of those required other faculty to teach me and I did learn a lot. This practice might even improve quality. But I still got paid appropriately because I was an independent, BE/BC licensed physician who was billing as such.

Everyone learns on the job, we all talk about it all the time. Why is it that some places decide it's okay to exploit that fact?
 
radoncftw said:
From my experience in residency you are spot on.
The VA had like 30 on treat split between 3 docs.
I probably would have considered it if I couldn't get a PP job. Fresh from training I wanted to try to get a job with a higher ceiling potential. It seems like a good gig and I don't have a non-compete so may consider that if I dont like my job. Would never consider going to the ivory tower in town. They are offering instructor positions to their grads I hear...
Click to expand...

Agree 100%. The base where I trained is just a tiny bit higher than the max salary the VA nextdoor will pay. No brainer. Just have to approach it knowing what you are going into.
 
I hate to be a Cassandra, but the other factor regarding that VA job is security. I am not a VA doc but am very close to one (not a radonc) and there are certain infuriating cultural things about the VA (including the fact that firing someone is essentially impossible). However, there is probably not a more secure radonc job going forward.

We are looking at a demographic cliff in terms of workforce outside of our field. No medonc staffing- no palliative referral, no ENT-no head and neck referral, no GU-no prostate referrals. We are perhaps the specialty most vulnerable to upstream workforce issues. While our colleagues are threatening to leave and negotiating new contracts and moving and working less, we will be the ones with less referrals and even less leverage. Some community cancer centers will close because of physician staffing issues alone.

This is vanishingly unlikely to happen in the VA.

Regarding the hours in the hospital? I'm always amazed at the responses here about this. I take work home every night. I also have a bunch of kids and like to spend time with them, but I would love to have a dedicated 40 hours in the office with not enough clinical work to do. I'd read a book and get paid for it.

NotMattSpraker said:
Why is it that some places decide it's okay to exploit that fact?
Click to expand...
The real way the MSKCC brachy fellowship should work is the same way old brachy away rotations used to work.

It would be the type of thing where you go for 6 months during your residency at another program to get excellent and comprehensive brachy experience.

Per our poster above, it sounds like it might not really fit the bill for an aspiring general brachytherapist anyway. But for the person who wants to be the regional prostate brachy person, this would be a service to the field.
 
In 1997.. Flanigan published a treatise (yellow cover sheet) saying that radiation oncology was dead. Starting salaries were 110k. In 2000 I joined an academic staff and was offered 96k. I left in 2004 and made 2.5x in a month what I earned in a year. The so called doom of our field was actually "the bottom" and IMRT kicked off a 15 year run with lucrative results. At the first ASTRO IMRT meeting (you know, the one with the putting greens around the hotel?) in CA, I met a freestanding owner who told me he needed 3 patients to break even. Oh, and about that new 911..

The dark clouds have descended upon us again however.. and it has become quite ugly.

Once again we find ourselves at the edge of the abyss: declining referrals, reduced revenue pressure from CMS (esp MPFS) and Choosing (un)Wisely, and the mother of all photons.. FLASH radiotherapy.

The smart (lucky?) ones will join the HOPPS or VAMC ARK and wait for the gods to turn their wrath to other specialties. The rest? Glub glub n' Gbye especially to the late comers sliding in the backdoor to the bottom 80% of residencies..

Soon though.. retirees and those fleeing the specialty will result in shortages of radoncs, driving the demand for our specialty once again to glorious heights one hopes. Stay strong, komrade.
 
communitydoc13 said:
I hate to be a Cassandra, but the other factor regarding that VA job is security. I am not a VA doc but am very close to one (not a radonc) and there are certain infuriating cultural things about the VA (including the fact that firing someone is essentially impossible). However, there is probably not a more secure radonc job going forward.
Click to expand...

Bingo. One of the best points considering our current environment. You simply will never be fired or let go.
Languish without any advancement?
Surrounded by lazy, incompetent staff?
You bet!
But not fired....

Local, big university department in town just issued an ultimatum to their attendings. Produce this much... or be cut.

Snag that VA job while you can.
 
NotMattSpraker said:
LOL, now to be fair she is incredibly trainee focused and one of the best (or THE best?) educators in our field. I wish there were way more of her out there in academia.

But have no fear, this thread will never die!

Maybe hiring an attending RO on a fellows salary will reduce the cost of treatment for patients? It's a financial toxicity maneuver, right? #ThisIsExploitation

View attachment 362938
Click to expand...
What percent of rad oncs are now doing >5 brachy cases per year. Assuming 5500-6000 rad oncs nationwide.

10%? 5%?

What percent are doing less than 5 cases a year and should stop?
 
dieABRdie said:
Bingo. One of the best points considering our current environment. You simply will never be fired or let go.
Languish without any advancement?
Surrounded by lazy, incompetent staff?
You bet!
But not fired....

Local, big university department in town just issued an ultimatum to their attendings. Produce this much... or be cut.

Snag that VA job while you can.
Click to expand...
even better than that if you are damaged goods for academics or community practice.... You can get HIRED!

www.usatoday.com

USA TODAY Investigation: VA knowingly hires doctors with past malpractice claims, discipline for poor care

The VA has repeatedly hired doctors with problem pasts in recent years, some of whom went on to harm veteran patients, a USA TODAY investigation found.
www.usatoday.com

www.usatoday.com

Illegal VA policy allows hiring since 2002 of medical workers with revoked licenses

VA officials in Iowa relied on the 15-year-old, illegal guidance to hire a neurosurgeon with multiple malpractice claims and a revoked license.
www.usatoday.com
 
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