Rad onc vs. Med onc salaries

[sallyhasanidea]

What salaries are graduating rad oncs getting vs. graduating med oncs? I understand there were cuts to drug reimbursement for chemo, has this cut down medical oncology's reimbursement significantly?

In which field is small group practice and partnership more feasible?

What can I expect to make in either field 10 years in?

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[RickyScott]

Salaries set by supply and demand not drug prices. Average medonc generates half RVus as radonc but out of training will have many more offers in desirable locations at substantially higher starting salaries.

 

[ramsesthenice]

What can I expect to make in either field 10 years in?

10 years ago we all would have given you a different answer, so I am not sure how to even give you anything meaningful to this. At this very moment most everyone in oncology is still relatively well paid, but neither field is moving in the right direction. Rad onc has definitely taken bigger hits in recent years but thats not to say a few major changes in legislation couldn't put a major damper in salaries for oncology (or any other field really). Its really hard to look much more than 3-5 years down the road for some things.

 

[Haybrant]

10 years ago we all would have given you a different answer, so I am not sure how to even give you anything meaningful to this. At this very moment most everyone in oncology is still relatively well paid, but neither field is moving in the right direction. Rad onc has definitely taken bigger hits in recent years but thats not to say a few major changes in legislation couldn't put a major damper in salaries for oncology (or any other field really). Its really hard to look much more than 3-5 years down the road for some things.

saw a merit Hawkins in gerogia for a med onc starting at 550k private practice. Maybe it’s a headache And high volume place but you hardly ever saw salary on med oncs advertisements and always on rad oncs. Now it’s the opposite for obvious reasons

 

[elementaryschooleconomics]

10 years ago we all would have given you a different answer, so I am not sure how to even give you anything meaningful to this. At this very moment most everyone in oncology is still relatively well paid, but neither field is moving in the right direction. Rad onc has definitely taken bigger hits in recent years but thats not to say a few major changes in legislation couldn't put a major damper in salaries for oncology (or any other field really). Its really hard to look much more than 3-5 years down the road for some things.

This is an impossible question to answer. We could guess based on current trends - RadOnc bad, MedOnc good. But I imagine the government will eventually crack down on the price of some of these fancy MedOnc drugs, and maybe RadOnc gets its head out of the sand and steers away from the cliff. Regardless, we need to get through COVID before anyone can start forecasting that far out. Perhaps the United States collapses?

 

[sallyhasanidea]

Salaries set by supply and demand not drug prices. Average medonc generates half RVus as radonc but out of training will have many more offers in desirable locations at substantially higher starting salaries.

Do you mean supply and demand of physicians, or of drugs? Could you elaborate on this? How is it that medonc generates half of the RVUs as rad onc but gets paid more? Are rad onc jobs no longer production based?

10 years ago we all would have given you a different answer, so I am not sure how to even give you anything meaningful to this. At this very moment most everyone in oncology is still relatively well paid, but neither field is moving in the right direction. Rad onc has definitely taken bigger hits in recent years but thats not to say a few major changes in legislation couldn't put a major damper in salaries for oncology (or any other field really). Its really hard to look much more than 3-5 years down the road for some things.

What do you mean neither field is moving in the right direction, could you please elaborate on how med onc is moving in a bad direction?

 

[Neuronix]

Do you mean supply and demand of physicians

Yes. In my state starting private salaries in med onc are about double the starting private salaries in rad onc, and you can pick your location in med onc while in rad onc you're lucky to find a job at all (in this state).

How is it that medonc generates half of the RVUs as rad onc but gets paid more? Are rad onc jobs no longer production based?

$/RVU is based on the job. Median MGMA for rad onc is supposedly $61/wRVU per MGMA, but I've never been offered anywhere near that. Median for med onc is $100/wRVU.

 

[Mandelin Rain]

If you are still in college, just do yourself a favor and avoid medicine altogether. Overall, the practice of medicine in 2020 is of dubious professional and financial reward and the trend for each is down sloping for almost all doctors (see burnout rates). If you enjoy endless bureaucracy, paperwork, pointless meetings, massive debt, and a sprinkle of helping sick people then medicine is still a way to earn a very good but far from grandiose living (almost regardless of specialty).

If you really want to help people, use your passion to start a business or non-profit or run for office.

I'm someone who really likes my job and really think of it as my ideal fit, but.... I like the practice of medicine in America a little bit less each year. Knowing what I know, I'm not sure I would even consider it if my horizon was 40 years.

 

[sallyhasanidea]

Median MGMA for rad onc is supposedly $61/wRVU per MGMA, but I've never been offered anywhere near that. Median for med onc is $100/wRVU.

Thanks I didn't know that. Would you happen to know where I can find $/wRVU spreadsheet from MGMA? Having trouble finding it from google.

If you are still in college, just do yourself a favor and avoid medicine altogether. Overall, the practice of medicine in 2020 is of dubious professional and financial reward and the trend for each is down sloping for almost all doctors (see burnout rates). If you enjoy endless bureaucracy, paperwork, pointless meetings, massive debt, and a sprinkle of helping sick people then medicine is still a way to earn a very good but far from grandiose living (almost regardless of specialty).

If you really want to help people, use your passion to start a business or non-profit or run for office.

I'm someone who really likes my job and really think of it as my ideal fit, but.... I like the practice of medicine in America a little bit less each year. Knowing what I know, I'm not sure I would even consider it if my horizon was 40 years.

I'm a 4th year medical student. To be honest I don't mind staying in the hospital or seeing patients, I'm just asking these questions because I want to be compensated fairly and get more reimbursement for my time investment

 

[RickyScott]

Thanks I didn't know that. Would you happen to know where I can find $/wRVU spreadsheet from MGMA? Having trouble finding it from google.



I'm a 4th year medical student. To be honest I don't mind staying in the hospital or seeing patients, I'm just asking these questions because I want to be compensated fairly and get more reimbursement for my time investment

I think your approach is misguided but rvu in xrt 45-55 and in medonc around 85-95 more or less. Again, Supply and demand set salary and dollars/RVus are subsequently increased or decreased. More important than your salary is having a job and in place that you desire, neither of which you are likely to achieve with xrt (on top of a low salary) in 6 years.

 

[OTN]

In our large private practice, staring salaries for medonc and radonc are the same. Once partner, the average radonc makes more than the average medonc, but there is considerable variability and overlap, depending on how busy the partner is.

However, in my Top-15 city we have hired five (5) medical oncologists in the past two years and no (0) radoncs. Our small group of radoncs in the city has decided we will NOT hire someone to replace our oldest radonc when he retires. We don't expect to hire another radonc for 10+ years, while we will continue to expand our cadre of medical oncologists.

 

[medgator]

In our large private practice, staring salaries for medonc and radonc are the same. Once partner, the average radonc makes more than the average medonc, but there is considerable variability and overlap, depending on how busy the partner is.

However, in my Top-15 city we have hired five (5) medical oncologists in the past two years and no (0) radoncs. Our small group of radoncs in the city has decided we will NOT hire someone to replace our oldest radonc when he retires. We don't expect to hire another radonc for 10+ years, while we will continue to expand our cadre of medical oncologists.

Similar situation in our group however i have noticed a trend towards existing med oncs hiring more extenders rather than bring on new partners so i do think a squeeze is coming in MO as well

 

[scarbrtj]

In our large private practice, staring salaries for medonc and radonc are the same. Once partner, the average radonc makes more than the average medonc, but there is considerable variability and overlap, depending on how busy the partner is.

However, in my Top-15 city we have hired five (5) medical oncologists in the past two years and no (0) radoncs. Our small group of radoncs in the city has decided we will NOT hire someone to replace our oldest radonc when he retires. We don't expect to hire another radonc for 10+ years, while we will continue to expand our cadre of medical oncologists.

I have made arguments about a falling cancer incidence meaning that the radiation oncology workforce shouldn't be rapidly growing. Why wouldn't I make the same arguments about med onc? Because they have much higher rates of repeat business... ongoing infusions, chronicity of problems, etc. Rad onc doesn't come close, and we are decreasing the frequency of visits if anything; certainly we are decreasing in comparison to med onc. So we can see cancer incidence decreasing, and prevalence just barely increasing, but the need for med oncs increasing significantly because their practice patterns are evolving (in their favor IMHO). Another thing I see med oncs doing is setting up their own in-house mini-pharmacies. The med oncs I know doing this are substantially increasing their profit. Some of these drugs in their pharmacies have 200% or more profit margins, and they might cost $1000-$2000+ each refill. They can do this and profit from it just like they can hire a rad onc and put in a linac and refer to their own in-house linac. It's all thanks to the Stark loophole.

 

[medgator]

I have made arguments about a falling cancer incidence meaning that the radiation oncology workforce shouldn't be rapidly growing. Why wouldn't I make the same arguments about med onc? Because they have much higher rates of repeat business... ongoing infusions, chronicity of problems, etc. Rad onc doesn't come close, and we are decreasing the frequency of visits if anything; certainly we are decreasing in comparison to med onc. So we can see cancer incidence decreasing, and prevalence just barely increasing, but the need for med oncs increasing significantly because their practice patterns are evolving (in their favor IMHO). Another thing I see med oncs doing is setting up their own in-house mini-pharmacies. The med oncs I know doing this are substantially increasing their profit. Some of these drugs in their pharmacies have 200% or more profit margins, and they might cost $1000-$2000+ each refill. They can do this and profit from it just like they can hire a rad onc and put in a linac and refer to their own in-house linac. It's all thanks to the Stark loophole.

Oral oncolytics can be very profitable for MO if they have in house dispensing. Just write a script and fill. No infusion nurse/chair needed

 

[thecarbonionangle]

Are you a woman? Well it doesn’t matter but lets assume you are. Say in five years you are graduating. Maybe you are single, maybe you are not. Lets discuss single. You look for a job anywhere and end up in a rural position because the job market is so poor. Most on your patients come in MAGA hats still because they are still that nostalgic about those four years. You open up your online dating app and instantly run out of people in your area after a few swipes. Most potential suiters are missing teeth. You go shopping at walmart if you are lucky and maybe eat at cracker barrel on a good night. Does this sound appealing? Then by all means apply.

ok say youre married got a SO. Similar scenario. In 5 yrs you look for a job. You cant find a job anywhere they can get a job so you take a middle of nowhere job. They lose their job. Your family does not understand why you moved so far and what you did wrong that you could not find a job in a better location. Your SO low key resents you for ruining their career and secretly thinks about choking you with a pillow in your sleep. You loved your SO but your marriage is done after a few years. You have no way out of your job because of a noncompete, zero jobs in the area so your choices are leave clinical medicine, take an equally remote terrible job, locum in rural TN, do a “fellowship” or work for evilcore and deny people treatment.

above sounds good and “good living”? Apply to RO.

above is not for you? Run for your life and never look back. You cheated death. Be happy. The killer bunny did not get you. You looked down at that bottomless pit and you saw your life flash across your eyes. You escaped. Good for you. God bless America!

 

[scarbrtj]

The killer bunny did not get you.

are you the living receiver???

 

[sallyhasanidea]

but the need for med oncs increasing significantly because their practice patterns are evolving (in their favor IMHO).

How are med onc practice patterns evolving, could you give me any examples?

Are you a woman? Well it doesn’t matter but lets assume you are. Say in five years you are graduating. Maybe you are single, maybe you are not. Lets discuss single. You look for a job anywhere and end up in a rural position because the job market is so poor. Most on your patients come in MAGA hats still because they are still that nostalgic about those four years. You open up your online dating app and instantly run out of people in your area after a few swipes. Most potential suiters are missing teeth. You go shopping at walmart if you are lucky and maybe eat at cracker barrel on a good night. Does this sound appealing? Then by all means apply.

ok say youre married got a SO. Similar scenario. In 5 yrs you look for a job. You cant find a job anywhere they can get a job so you take a middle of nowhere job. They lose their job. Your family does not understand why you moved so far and what you did wrong that you could not find a job in a better location. Your SO low key resents you for ruining their career and secretly thinks about choking you with a pillow in your sleep. You loved your SO but your marriage is done after a few years. You have no way out of your job because of a noncompete, zero jobs in the area so your choices are leave clinical medicine, take an equally remote terrible job, locum in rural TN, do a “fellowship” or work for evilcore and deny people treatment.

above sounds good and “good living”? Apply to RO.

above is not for you? Run for your life and never look back. You cheated death. Be happy. The killer bunny did not get you. You looked down at that bottomless pit and you saw your life flash across your eyes. You escaped. Good for you. God bless America!

I'm a female, but wondering, what if I were a male, how does this change?

 

[scarbrtj]

How are med onc practice patterns evolving, could you give me any examples?

Multi-month, multi-year, or lifelong/time indefinite immunotherapies with patients surviving longer.

 

[medgator]

Multi-month, multi-year, or lifelong/time indefinite immunotherapies with patients surviving longer.

The really big groups have all kind of ancillary opportunities.... In house radiology, pathology, pharmacy/dispensing etc.

 

[thecarbonionangle]

How are med onc practice patterns evolving, could you give me any examples?




I'm a female, but wondering, what if I were a male, how does this change?

save yourself sister. Dont worry about the males. They had a good run.

 

[Mandelin Rain]

save yourself sister. Dont worry about the males. They had a good run.

LOL. To answer the question, though.... Women MAY have a more difficult time with the geographic restrictions because they TEND (based on studies) to marry spouses with education levels similar to their own and USUALLY these spouses are men who are LESS likely to give up their job for family. None of that may be your situation. But the implication is that the male spouses of female docs are less portable to rural areas for the reasons above. Additionally, it becomes harder to find spouses of similar education level for unwed female docs when living in a rural area because the pool is small. Again, YMMV on all this.

 

[scarbrtj]

The really big groups have all kind of ancillary opportunities.... In house radiology, pathology, pharmacy/dispensing etc.

When you control referrals/refer out a lot, and are prescribing a ton, makes sense. And of course these are two things that apply ~zero to rad onc unfortunately.

 

[OTN]

When you control referrals/refer out a lot, and are prescribing a ton, makes sense. And of course these are two things that apply ~zero to rad onc unfortunately.

Generally true, but some larger private practices share technical revenue from ancillary services between specialists, including lab, pharmacy, imaging, etc. Amount of sharing depends on the particular physician reimbursement contract in the practice.

 

[scarbrtj]

Generally true, but some larger private practices share technical revenue from ancillary services between specialists, including lab, pharmacy, imaging, etc. Amount of sharing depends on the particular physician reimbursement contract in the practice.

In one practice I was in, the rad oncs and radiologists got 20% (of their global). All other MDs (pulm, surgery, etc) got 50% of their collections. After all expenses, what was left over everyone shared equally including profit from the other ancillaries like lab (lab's usually minimal... but pharmacy can be OK'ish). That is to say: the highly reimbursed technical specialties are usually the sharers in such setups and provide the profit margin, others the beneficiaries of the sharing.

 

[medgator]

In one practice I was in, the rad oncs and radiologists got 20% (of their global). All other MDs (pulm, surgery, etc) got 50% of their collections. After all expenses, what was left over everyone shared equally including profit from the other ancillaries like lab (lab's usually minimal... but pharmacy can be OK'ish). That is to say: the highly reimbursed technical specialties are usually the sharers in such setups and provide the profit margin, others the beneficiaries of the sharing.

At the same time, the pulms, surgeons etc are feeding the imaging and radiation.... Volume business where the ROI can do significantly much better with higher referrals. It's why most of us in PP believe multi specialty groups are the only way to survive going forward

 

[scarbrtj]

At the same time, the pulms, surgeons etc are feeding the imaging and radiation.... Volume business where the ROI can do significantly much better with higher referrals. It's why most of us in PP believe multi specialty groups are the only way to survive going forward

and when large and successful they must refuse lucrative buyouts from hospitals

 

[BobbyHeenan]

and when large and successful they must refuse lucrative buyouts from hospitals

Do the hospitals ever then get heavy handed with admitting privileges for med onc or surgery when these sorts of things are going on? ie if you don't accept this buy out we may limit your OR time(s) or priviledges?

 

[TheIllusionist]

Women will start to marry down educationally for looks like men have forever. This will help alleviate suffering. Just have to mentally overcome hypergamy

 

[Mandelin Rain]

Do the hospitals ever then get heavy handed with admitting privileges for med onc or surgery when these sorts of things are going on? ie if you don't accept this buy out we may limit your OR time(s) or priviledges?

Always.

 

[medgator]

Do the hospitals ever then get heavy handed with admitting privileges for med onc or surgery when these sorts of things are going on? ie if you don't accept this buy out we may limit your OR time(s) or priviledges?

Wouldn't surprise me. Also love it when the hospital tries to violate CMS rules and steer people to their own imaging and treatment centers without providing patients options elsewhere

 

[scarbrtj]

How are med onc practice patterns evolving, could you give me any examples?

Quincy Medical Group cancer institute expands to offer radiation oncology

 

[sallyhasanidea]

Women will start to marry down educationally for looks like men have forever. This will help alleviate suffering. Just have to mentally overcome hypergamy

What does this mean and what is it in response to?

 

[ramses99]

OP I'm in your same boat as a fourth year interested in these two fields and I ended up going IM -> hem/onc. I feel good about the decision at this point and am working on my IM app for ERAS. PM me if you have any questions or anything, good luck with the decision

 

[TheIllusionist]

PM me

I did rad onc aways. But I still did IM, at a solid place now. Plan on doing heme onc

 

[fiji128]

Quincy Medical Group cancer institute expands to offer radiation oncology

This describes my first job set up. I was basically a radiation oncology tech, MD. No need to share in patient management or decision making. Just irradiate what and when the med oncs tell you to. When the supply of available BC/BE rad oncs exceeds demand it allows for these type of employment situations.

 

[OTN]

This describes my first job set up. I was basically a radiation oncology tech, MD. No need to share in patient management or decision making. Just irradiate what and when the med oncs tell you to. When the supply of available BC/BE rad oncs exceeds demand it allows for these type of employment situations.

That might not be fair to this job. They may work really well together as a team for all we know.

 

[fiji128]

That might not be fair to this job. They may work really well together as a team for all we know.

Fair, I know nothing about that position and its set up except for whats in that article. To me it sounds like a successful med onc practice decided to buy a linac to capture the revenue. Its easy to get a compliant rad onc to oversee the whole thing these day in a place like Quincy IL with no chance at real revenue sharing. Basically like Urorads except this is MedOncRads.

I don't want to get into too much speculation about things I have no specific knowledge of but a quick google search shows the Rad Onc was previously at a place that google list as being permanently closed. He has now relocated 1,000 miles away for his next job. I have no idea about his motivations but I would imagine I would have to do the same thing if my place closed down as well. This is how over supply of MDs, decreased utilzation and a job market in near grid lock plays out in real life outs side the #radoncrocks echo chamber.

 

[thecarbonionangle]

Can someone please explain the “stark loophole”? How are places able to refer to their own pharmacies, pet, xrt, etc etc?

 

[OTN]

Can someone please explain the “stark loophole”? How are places able to refer to their own pharmacies, pet, xrt, etc etc?

The thought when the loophole was intentionally created was that it would be easier for patients to get ancillary services (pharmacy, labs, radiology) at their MDs office, rather than having to run around to lots of different places to get it done. Reasonable, actually.

Edit: Re: MedOncRads, it would still be much smarter for a group of medical oncologists to bring in a radonc as a true partner and treat them well with proper incentives, rather than simply exploit them. We should SUPPORT private practices expanding to offer radiation services. This group is capturing patients who likely would have been traveling to academic centers in St. Louis or their satellite affiliates.

 

[medgator]

Can someone please explain the “stark loophole”? How are places able to refer to their own pharmacies, pet, xrt, etc etc?

The thought when the loophole was intentionally created was that it would be easier for patients to get ancillary services (pharmacy, labs, radiology) at their MDs office, rather than having to run around to lots of different places to get it done. Reasonable, actually.


.

That is the loophole, basically allows a multi specialty group to offer these services. They have to be under the same tax ID however.

Competition is a good thing when a lot of markets have 1-2 hospital system monopolies/oligopolies using their clout to charge usurious rates to insurers and the general public at large

 

[medgator]

Edit: Re: MedOncRads, it would still be much smarter for a group of medical oncologists to bring in a radonc as a true partner and treat them well with proper incentives, rather than simply exploit them. We should SUPPORT private practices expanding to offer radiation services. This group is capturing patients who likely would have been traveling to academic centers in St. Louis or their satellite affiliates.

Yup.... A lot of direct referrals come to rad onc outside of MO... Prostate, skin, h&n, benign stuff etc

 

[sallyhasanidea]

Yup.... A lot of direct referrals come to rad onc outside of MO... Prostate, skin, h&n, benign stuff etc

You mean med oncs are referring to rad onc? What do you mean by this?

 

[medgator]

You mean med oncs are referring to rad onc? What do you mean by this?

Exactly what i said.. many rad onc referrals can come from outside medical oncology

 

[evilbooyaa]

That's

You mean med oncs are referring to rad onc? What do you mean by this?

That's the standard. Most referrals to rad onc come from med onc.

However, in certain disease sites, patients are referred to rad onc from non med onc services. This makes the model of a med onc and rad onc multispecialty group more favorable if they treat the rad onc as an equal partner, not just as a subordinate. To motivate the rad onc to practice build beyond just the in-house med oncs to capture outside sources of referrals.

 

[Neuronix]

90% of my referrals come from surgery.

 

[medgator]

90% of my referrals come from surgery.

Brain mets? Probably do get a fair amount of those from MO myself and imagine that's the case in a lot places

 

[Neuronix]

Brain met, glioma, meningioma, spine, etc

 

[evilbooyaa]

Interesting on brain meet for sure. Gbm I can see coming from surgery at same time as med onc

 

[udrag14]

Fair, I know nothing about that position and its set up except for whats in that article. To me it sounds like a successful med onc practice decided to buy a linac to capture the revenue. Its easy to get a compliant rad onc to oversee the whole thing these day in a place like Quincy IL with no chance at real revenue sharing. Basically like Urorads except this is MedOncRads.

I don't want to get into too much speculation about things I have no specific knowledge of but a quick google search shows the Rad Onc was previously at a place that google list as being permanently closed. He has now relocated 1,000 miles away for his next job. I have no idea about his motivations but I would imagine I would have to do the same thing if my place closed down as well. This is how over supply of MDs, decreased utilzation and a job market in near grid lock plays out in real life outs side the #radoncrocks echo chamber.

He sold his practice to the local hospital and then left town.

The hospital is still running his practice.

 

[DoctwoB]

Can someone please explain the “stark loophole”? How are places able to refer to their own pharmacies, pet, xrt, etc etc?

As mentioned there is an exemption for any services offered in office. For my field (urology) that means in office path, urorads, maybe pharmacy. The law is basically a farce these days, where most doctors work for some mega group/academic center/hospital, where your referrals are strongly suggested to be in house. Basically outside of the exemption it’s illegal to profit on your referral to ancillary service. However it’s perfectly legal for the giant medical center that employs you (likely in part supporting your salary through the ancillary revenue you generate) and suggests you refer in house to profit from your referrals.