Rad Onc V Big Pharma

[Burt Radnolds]

In halls of science, where knowledge gleams,A battle rages, a doctor's dream,Radiation therapy, a weapon bright,Against the shadows of cancerous night.

Yet, in this struggle, a darker force,Big Pharma's shadow, takes its course,With promises of pills and potions sweet,They lure the world with a false conceit.

Radiation therapy, once held in high regard,Now cast aside, a forgotten card,As profits soar and patients yearn,For treatments costly, yet to discern.

The halls of power, where deals are made,With whispers hushed and fortunes swayed,Radiation therapy, pushed to the side,As big pharma's influence, far and wide.

But hope remains, in pockets deep,Where doctors fight, their patients to keep,With knowledge and skill, they stand as one,To battle the darkness, 'til victory's won.

For radiation therapy, a beacon of light,Can pierce the shadows, and make things right,With focused beams and careful aim,It strikes at cancer, a deadly game.

So let us raise a voice, a clarion call,For radiation therapy, to stand tall,Let's fight for science, for truth, and might,And reclaim our future, with all our might.

-Google Gemini

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[Chartreuse Wombat]

AI hallucinating again

 

[RickyScott]

Big pharma and health insurance companies are not the main villains. Hospital prices are. Big pharma did not ruin this field.

 

[medgator]

Big pharma and health insurance companies are not the main villains. Hospital prices are. Big pharma did not ruin this field.

Leadership ruined this field. Full stop

 

[RickyScott]

Leadership ruined this field. Full stop

Leadership is largely synonomous with large hospital systems.

 

[deleted1180461]

Leadership is largely synonomous with large hospital systems.

Working for independent hospitals and practices is the way to go.

 

[Chartreuse Wombat]

Working for independent hospitals and practices is the way to go.

Sadly in many areas of the US this is not an option.

 

[deleted1180461]

Sadly in many areas of the US this is not an option.

Move to the places where you can. I did. But you’re right. There are entire Midwest states that have been consolidated into total crap.

Rad onc not a field you want to go into if you’re not willing to be constantly moving for the best option.

 

[medgator]

Move to the places where you can. I did. But you’re right. There are entire Midwest states that have been consolidated into total crap.

Rad onc not a field you want to go into if you’re not willing to be constantly moving for the best option.

Hence my repeated ad nauseum posts that in 2020+ I'd rather go into med onc,gu, rads, ENT etc over rad onc. And lo and behold that is exactly what has happened to rad oncs competitiveness in the match the last several years.

Psych and rad onc have essentially switched places in the match, now our specialty attracts weak FMGs with no other options (some of whom can't even match or scramble into pgy1 prelim years when they secure their pgy2 RO spots).

 

[Bequerel]

Move to the places where you can. I did. But you’re right. There are entire Midwest states that have been consolidated into total crap.

Rad onc not a field you want to go into if you’re not willing to be constantly moving for the best option.

Unfortunately independent hospitals keep getting bought up by bigger systems.

 

[drowsy12]

The only difference between now and 25 years from now is instead of all of us working for a Advent, a Providence, a Baptist, a Sloan, or a Kaiser, we’ll be working for Google, Apple, Amazon, Netflix, Tesla or whatever new tech companies ultimately merge with hospital systems and take over.

 

[medgator]

The only difference between now and 25 years from now is instead of all of us working for a Advent, a Providence, a Baptist, a Sloan, or a Kaiser, we’ll be working for Google, Apple, Amazon, Netflix, Tesla or whatever new tech companies ultimately merge with hospital systems and take over.

Don't see big tech buying hospital systems at all. The biggies like UPMC and Adventist are likely too big for them to acquire anyways.

Is there a single example of it happening now?? Just don't see where the synergies are. Amazon and Walmart tried to get into medicine and fell flat on its face

https://www.axios.com/2024/05/01/walmart-walgreens-amazon-health-care-clinics

 

[DrProtonX]

We can blame the big pharma, big corporate hospitals, big techs, big whatever but the reality is we did it to ourselves because we’re selfish individuals. The boomers in our field are greedy af. They offer crap pay with shady 3-4 year ‘partnership’ track just because they can. They rather sell the practice to PE for a quick 7-figure check while their net worth is 8-figure instead of passing it down to the next generation with solid partnership tracks. We can blame the ASTRO for causing this by increasing residency spots and lack of effort to fix it BUT at the end we still have a choice to take advantage of our young generation for our personal benefit or not… unfortunately we all know the answes

 

[Chartreuse Wombat]

The only difference between now and 25 years from now is instead of all of us working for a Advent, a Providence, a Baptist, a Sloan, or a Kaiser, we’ll be working for Google, Apple, Amazon, Netflix, Tesla or whatever new tech companies ultimately merge with hospital systems and take over.

I rather think it will be Optum, Cigna, etc.

"With 90,000 physicians in its portfolio, UnitedHealth Group's Optum is the largest employer of physicians in the U.S. Optum has 2,200 primary and specialty care offices in 16 states."

 

[deleted1180461]

The only difference between now and 25 years from now is instead of all of us working for a Advent, a Providence, a Baptist, a Sloan, or a Kaiser, we’ll be working for Google, Apple, Amazon, Netflix, Tesla or whatever new tech companies ultimately merge with hospital systems and take over.

lol wut

 

[medgator]

We can blame the big pharma, big corporate hospitals, big techs, big whatever but the reality is we did it to ourselves because we’re selfish individuals. The boomers in our field are greedy af. They offer crap pay with shady 3-4 year ‘partnership’ track just because they can. They rather sell the practice to PE for a quick 7-figure check while their net worth is 8-figure instead of passing it down to the next generation with solid partnership tracks. We can blame the ASTRO for causing this by increasing residency spots and lack of effort to fix it BUT at the end we still have a choice to take advantage of our young generation for our personal benefit or not… unfortunately we all know the answes

Those PP boomers didn't create too many residency spots and flood the job market with too many trainees so they could have cheap labor, place the blame squarely on the boomer academic chairs who did this.

It started there along with the leadership at Astro and scarop that was happy to collude on junior faculty salary surveys but threw their hands up in the air and screamed antitrust when it came time to worrying about overtraining in the specialty.

ASTRO finally got its arm twisted to help produce a watered down workforce report that still manages to show we have problems next decade, but you see no one doing anything to address it

 

[deleted1180461]

Can’t we all just agree that blaming any boomer for anything is never the wrong answer?

 

[medgator]

Can’t we all just agree that blaming any boomer for anything is never the wrong answer?

Works when it comes to the government too fo sho

 

[deleted1180461]

Works when it comes to the government too fo sho

Well who do ya think runs the government (and the banks). Oh and the regulatory agencies. Oh and….

 

[DrProtonX]

Those PP boomers didn't create too many residency spots and flood the job market with too many trainees so they could have cheap labor, place the blame squarely on the boomer academic chairs who did this.

It started there along with the leadership at Astro and scarop that was happy to collude on junior faculty salary surveys but threw their hands up in the air and screamed antitrust when it came time to worrying about overtraining in the specialty.

ASTRO finally got its arm twisted to help produce a watered down workforce report that still manages to show we have problems next decade, but you see no one doing anything to address it

Usually when a **** up this big happens, it’s multifactorial so you’re not wrong. However ASTRO isn’t forcing any PP to offer ****ty contracts. They can offer fair pay with solid 1-2 year partnership track, no one is gonna stop them but they choose not to because they’re greedy, they don’t care and they just can. Only the last part is on ASTRO.
Other than aggressively decreasing training spots which we all can agree would never happen, the only way we can change is by taking back the ownership and that requires collective effort.

 

[medgator]

Usually when a **** up this big happens, it’s multifactorial so you’re not wrong. However ASTRO isn’t forcing any PP to offer ****ty contracts. They can offer fair pay with solid 1-2 year partnership track, no one is gonna stop them but they choose not to because they’re greedy, they don’t care and they just can. Only the last part is on ASTRO.
Other than aggressively decreasing training spots which we all can agree would never happen, the only way we can change is by taking back the ownership and that requires collective effort.

They wouldn't be able to offer ****ty partnership contracts if we were graduating 110 a year. It's a lot easier when there are too many grads looking. The same supply and demand issue that lets podunk hospitals get away with offering nonsense contracts and locums rates too @MidwestRadOnc right?

 

[RickyScott]

Usually when a **** up this big happens, it’s multifactorial so you’re not wrong. However ASTRO isn’t forcing any PP to offer ****ty contracts. They can offer fair pay with solid 1-2 year partnership track, no one is gonna stop them but they choose not to because they’re greedy, they don’t care and they just can. Only the last part is on ASTRO.
Other than aggressively decreasing training spots which we all can agree would never happen, the only way we can change is by taking back the ownership and that requires collective effort.

How many “private” practices are out there? (As opposed to academic and community hospitals or multi specialty groups like genesis). My guess would be 10-15% of new jobs. Also, it is not reasonable to suggest that anyone ignore a maket and overpay.

 

[RickyScott]

How many “private” practices are out there? (As opposed to academic and community hospitals or multi specialty groups like genesis). My guess would be 10-15% of new jobs. Also, it is not reasonable to suggest that anyone ignore a maket and overpay.

Probably 5% if “partnership” means ownership in the technical component. Proffesional only “partership” is an oxymoron.

 

[IonsAreOurFuture]

We can blame the big pharma, big corporate hospitals, big techs, big whatever but the reality is we did it to ourselves because we’re selfish individuals. The boomers in our field are greedy af. They offer crap pay with shady 3-4 year ‘partnership’ track just because they can. They rather sell the practice to PE for a quick 7-figure check while their net worth is 8-figure instead of passing it down to the next generation with solid partnership tracks. We can blame the ASTRO for causing this by increasing residency spots and lack of effort to fix it BUT at the end we still have a choice to take advantage of our young generation for our personal benefit or not… unfortunately we all know the answes

Hi DrProtonX. Welcome to the forum! You seem pretty jaded for a newbie, are you a an SDN veteran or just mature for your years?

It sounds like you have recent experience with the rad onc job market and its many vagaries. As someone said to me as a nearly new grad at the onsite ASTRO job fair, "there are a lot of sharks in the water."

 

[deleted1180461]

Probably 5% if “partnership” means ownership in the technical component. Proffesional only “partership” is an oxymoron.

Agreed, better to be employed at high fixed wRVU rate. Juice not worth the squeeze anymore to bill pro only.

 

[BobbyHeenan]

Agreed, better to be employed at high fixed wRVU rate. Juice not worth the squeeze anymore to bill pro only.

Probably true for many people...but in my busy pro only practice there are some things I have that I couldn't have as employed...mainly

- freedom to take vacations when I want and structure my time how I want; if I want to take 6 weeks one year, 10 weeks another year, etc. that's no problem.
- defined benefit cash balance plan on top of 401K.
- some level of independence from admins

 

[deleted1180461]

Probably true for many people...but in my busy pro only practice there are some things I have that I couldn't have as employed...mainly

- freedom to take vacations when I want and structure my time how I want; if I want to take 6 weeks one year, 10 weeks another year, etc. that's no problem.
- defined benefit cash balance plan on top of 401K.
- some level of independence from admins

Yeah but you can negotiate all that as a contractor and let the hospital do the billing and collecting and just pay you per wRVU. I haven’t been convinced this is significantly inferior. And I’m going to attempt to move from full employed to this employer-lite model.

 

[BobbyHeenan]

Yeah but you can negotiate all that as a contractor and let the hospital do the billing and collecting and just pay you per wRVU. I haven’t been convinced this is significantly inferior. And I’m going to attempt to move from full employed to this employer-lite model.

There are definitely pros and cons and each situation is unique. I don't think there's a perfect situation out there or any blanket employed is better than pro only.


Big hospitals in my experience often under bill and miss charges, but there are also plenty of headaches in running a pro only practice.

Also the variability in hospital administrators +/- turnover can have bigger ripple effects on employed vs. pro.

Big it's not all sunshine and rainbows in the pro-only world. Especially when there are staffing issues you are responsible for (and not the hospital), or collections issues/billing hiccups.

 

[DrProtonX]

Hi DrProtonX. Welcome to the forum! You seem pretty jaded for a newbie, are you a an SDN veteran or just mature for your years?

It sounds like you have recent experience with the rad onc job market and its many vagaries. As someone said to me as a nearly new grad at the onsite ASTRO job fair, "there are a lot of sharks in the water."

Thanks! I’ve actually just started the training but i’ve been following the job market since before covid because i’ve always been interested in rad onc and that was the biggest concern. I got pretty close to choosing another specialty when the job market tanked significantly after covid but eventually decided to stick with rad onc because I realized no other specialty would excite and satisfy me as much as rad onc.

 

[deleted1180461]

 

[medgator]

Thanks! I’ve actually just started the training but i’ve been following the job market since before covid because i’ve always been interested in rad onc and that was the biggest concern. I got pretty close to choosing another specialty when the job market tanked significantly after covid but eventually decided to stick with rad onc because I realized no other specialty would excite and satisfy me as much as rad onc.

As long as you didn't mind working in bumble**** for less pay than a medical oncologist and less PTO than a radiologist, you chose just fine

 

[deleted1180461]

As long as you didn't mind working in bumble**** for less pay than a medical oncologist and less PTO than a radiologist, you chose just fine

The mistake most people make when they go into rad onc is they forget to make sure their dad owns a private practice and will make a one off exception to his favorite pastime of screwing over new grads for his own bloodline.

Dad is a chair also works well enough.

 

[thecarbonionangle]

We can blame the big pharma, big corporate hospitals, big techs, big whatever but the reality is we did it to ourselves because we’re selfish individuals. The boomers in our field are greedy af. They offer crap pay with shady 3-4 year ‘partnership’ track just because they can. They rather sell the practice to PE for a quick 7-figure check while their net worth is 8-figure instead of passing it down to the next generation with solid partnership tracks. We can blame the ASTRO for causing this by increasing residency spots and lack of effort to fix it BUT at the end we still have a choice to take advantage of our young generation for our personal benefit or not… unfortunately we all know the answes

Can’t we all just agree that blaming any boomer for anything is never the wrong answer?

It isn’t just boomers. The elder gen X are just as bad. They are younger but very boomer adjacent in their thinking. They are greedy liars and currently control the majority of medicine. Boomers largely are retiring, dying.

 

[thecarbonionangle]

The mistake most people make when they go into rad onc is they forget to make sure their dad owns a private practice and will make a one off exception to his favorite pastime of screwing over new grads for his own bloodline.

Dad is a chair also works well enough.

100% crazy amount of nepotism in our field.

 

[yesmaster]

We can blame the big pharma, big corporate hospitals, big techs, big whatever but the reality is we did it to ourselves because we’re selfish individuals. The boomers in our field are greedy af. They offer crap pay with shady 3-4 year ‘partnership’ track just because they can. They rather sell the practice to PE for a quick 7-figure check while their net worth is 8-figure instead of passing it down to the next generation with solid partnership tracks. We can blame the ASTRO for causing this by increasing residency spots and lack of effort to fix it BUT at the end we still have a choice to take advantage of our young generation for our personal benefit or not… unfortunately we all know the answers

No, I don’t blame the practice owners one bit. They are free to be rational actors in the market, and have no obligation to give one cent of equity to a junior rad onc associate or employee. They don’t run a nonprofit with special tax treatment, they run a business.

I do take issue with shady partnership tracks and broken promises, but at this point, anybody who accepts a handshake deal without contractual power around partnership and equity is dumb or negligent or someone’s son/daughter.

No, the Original Sin is with the academic departments and residency programs. Sure, they were responding to incentives too, but the chairs were dumb enough to sell out their field to enrich the CEO’s of their academic enterprises and fund their empire building agenda. Those technical fees at academic programs usually going towards nothing relevant to rad onc.

Plus these academic departments systemically lied and continue to lie to medical students about the health of the job market.

A rad onc practice owner selling to PE has no bearing on the health of the job market. If the job market were healthy, you could just get a business loan, set up shop, build another practice. But residency overtraining permanently and continuously weakens the job market.

 

[drowsy12]

‘If the job market were healthy, you could just get a business loan, set up shop, build another practice.’

No. This fundamentally ignores the root of the problem which is the policies and economics of modern medicine which favor big consolidation and do not favor a mom and pop shop. To ignore this means you don’t understand what’s really at play here.

Free standing rad onc is dying and that’s never coming back. Hospital systems that can charge more collect more and have the capital to buy you out are
Behemoths that cannot be stopped.

 

[deleted1180461]

‘If the job market were healthy, you could just get a business loan, set up shop, build another practice.’

No. This fundamentally ignores the root of the problem which is the policies and economics of modern medicine which favor big consolidation and do not favor a mom and pop shop. To ignore this means you don’t understand what’s really at play here.

Free standing rad onc is dying and that’s never coming back. Hospital systems that can charge more collect more and have the capital to buy you out are
Behemoths that cannot be stopped.

If you could even get a CON and 5M to build a vault, a small office space, and commission a machine, you then have to somehow get referrals and run lean enough to make a profit. Not sure this is happening anymore without ancillary services. I would want to be partnered with med onc and having imaging, lab, and pharmacy in house, and we are talking a lot more than 5M now. Would love to know where someone is just dumping a linac on their own and having enough patients show up to keep the lights on. I have thought about a niche cyberknife practice with direct marketing, but that's about the best I can come up with.

 

[IonsAreOurFuture]

If you could even get a CON and 5M to build a vault, a small office space, and commission a machine, you then have to somehow get referrals and run lean enough to make a profit. Not sure this is happening anymore without ancillary services. I would want to be partnered with med onc and having imaging, lab, and pharmacy in house, and we are talking a lot more than 5M now. Would love to know where someone is just dumping a linac on their own and having enough patients show up to keep the lights on. I have thought about a niche cyberknife practice with direct marketing, but that's about the best I can come up with.

The CON is a huge con and flies in the face of a free market economy. They aren't even that good of a hedge against overutilization or someone outcompeting you.

Regarding startup costs, I seem to remember that Varian had a 7 year lease agreement that was paid by the month and at the end of year 7 it was your machine for a dollar. Do they still do something like that? Sure beats borrowing 3 million up front.

 

[yesmaster]

we are talking a lot more than 5M now

I know a financing and biz loan guy

I would want to be partnered with med onc and

having enough patients show up to keep the lights on

Med onc partnership plus healthy patient volume both would be much easier if residency programs hadn’t overtrained for 10+ years

 

[yesmaster]

To ignore this means you don’t understand what’s really at play here.

Free standing rad onc is dying and that’s never coming back. Hospital systems that can charge more collect more and have the capital to buy you out.

I partly agree with you.

I’ll revise to: “if the job market were healthy and your senior partner sold to PE, you could just leave and get a great hospital employed job”

 

[Doctorer]

‘If the job market were healthy, you could just get a business loan, set up shop, build another practice.’

No. This fundamentally ignores the root of the problem which is the policies and economics of modern medicine which favor big consolidation and do not favor a mom and pop shop. To ignore this means you don’t understand what’s really at play here.

Free standing rad onc is dying and that’s never coming back. Hospital systems that can charge more collect more and have the capital to buy you out are
Behemoths that cannot be stopped.

I'll push back on this a bit. At the end of the day, it's supply and demand. Take a look at what's happening in the radiology (and anesthesia) market: hospitals are being forced to compete for the business of radiologists/radiology groups. The economics are harder for some free standing imaging centers, but radiologists have leverage in negotiating hospital contracts for their groups.

 

[medgator]

I'll push back on this a bit. At the end of the day, it's supply and demand. Take a look at what's happening in the radiology (and anesthesia) market: hospitals are being forced to compete for the business of radiologists/radiology groups. The economics are harder for some free standing imaging centers, but radiologists have leverage in negotiating hospital contracts for their groups.

It all comes back to supply and demand and the members that make up organizations like ASTRO and SCAROP screwed the pooch for everyone on this very fundamentally important issue.

Rads, GU, derm etc did not

 

[drowsy12]

I'll push back on this a bit. At the end of the day, it's supply and demand. Take a look at what's happening in the radiology (and anesthesia) market: hospitals are being forced to compete for the business of radiologists/radiology groups. The economics are harder for some free standing imaging centers, but radiologists have leverage in negotiating hospital contracts for their groups.

Leverage and negotiation of the deal is a different story.

But I don’t think supply and demand factors can magically bring back free standing rad onc

Not gonna happen

 

[Doctorer]

Leverage and negotiation of the deal is a different story.

But I don’t think supply and demand factors can magically bring back free standing rad onc

Not gonna happen

Free standing doc-in-a-box centers are probably gone, at least in any remotely desirable area.

More bargaining power/better job opportunities? Surely.

 

[OTN]

Free standing doc-in-a-box centers are probably gone, at least in any remotely desirable area.

More bargaining power/better job opportunities? Surely.

There are some freestanding centers in desirable areas which still exist, but I agree it's an endangered species. Once the government chooses winners and losers in a market it's tough to overcome that.

 

[IonsAreOurFuture]

I'll push back on this a bit. At the end of the day, it's supply and demand. Take a look at what's happening in the radiology (and anesthesia) market: hospitals are being forced to compete for the business of radiologists/radiology groups. The economics are harder for some free standing imaging centers, but radiologists have leverage in negotiating hospital contracts for their groups.

For a specialty that has faced down multiple self-proclaimed existential threats like offshoring to India and being replaced by AI, radiologists sure are in high demand right now. Despite everyone in radiology doing at least one fellowship, it seems to have resulted in them doing more of what they enjoy, whether it's a particular body site, modality, or becoming a proceduralist.

Maybe there's hope for us after all?

 

[CurbYourExpectations]

For a specialty that has faced down multiple self-proclaimed existential threats like offshoring to India and being replaced by AI, radiologists sure are in high demand right now. Despite everyone in radiology doing at least one fellowship, it seems to have resulted in them doing more of what they enjoy, whether it's a particular body site, modality, or becoming a proceduralist.

Maybe there's hope for us after all?

No, not necessarily, off shore things are still limited to have to be read by radiologists in the state images were taken by radiologists practicing there.

Radiology reads are often wrong, or at least not 100% accurate, which can change a lot in the treatment of cancer therapy.

Fellowships are becoming less common with an improving workforce. It went from 0 to 2 back to 0-1 mandatory fellowships for most radiologists in a short time span, that is a direct aspect of supply-demand.

Hope for us? Maybe, but most people here don't benefit from the ions you're currently hyping, so it is actually detrimental to them.