Rad Oncs in Academics. Bummer.

[scarbrtj]

Ed's got a really good (he's one of the smartest people in the US, and a great writer) editorial in the Red Journal. Anyone thinking about academics should read it. A sobering confessional. People talk about being woke and anti-bullying and #MeToo (which in France is known as "#OutYourPig) and on and on and on... which is great and good. But prejudice and bias has many other forms and ways of being expressed. Bias and prejudice against radiation oncology? Get ready for it if you're going into academics (and probably even non-academics). A few excerpts:

If there is substance to the accusation that radiation oncologists are neither perceived as "members of the club" in academic medicine nor viewed as candidates to be dean because they have walled themselves off from the rest of medicine, do not make rounds, do not admit patients to the hospital, and have become "button pushers in the basement," then the paucity of radiation oncologists as deans matters greatly.

...little or no radiation oncology is taught as part of the core basic biomedical sciences in the first 2 years of medical school, nor is it considered a core third-year medical school clerkship, it is to be expected that radiation oncologists are not viewed as part of the mainstream of the school of medicine and will be less likely to seek or be offered school-wide leadership positions.

It is my experience that when a radiation oncologist applies for and is interviewed for a job as medical school dean or college/university president/chancellor, he or she better be ready for a cross examination and critique characterized by the following questions or comments I have heard during my career:

• From someone in internal medicine: “Radiation oncology is a 4-year residency? Gee, I would have thought it only took a year to learn how to do that.”
• When I first became the chairman of a Department of Radiation Oncology, the chairman of surgery referred to radiation oncology as a “clinical catfish: the bottom-feeding garbage-eater at the end of the clinical referral chain.”
• From a search committee: “You have years of experience as a radiation oncology department chair? Well, it's not as if you've been chairman of medicine or pediatrics where you have been running a large and diverse department.”
• From an interviewer: “Pediatric radiation oncology? That's your specialty? Such a small specialty, isn't it? Small. Very small.” (To which I replied, “What's small? The patients?”)
• From a university president interviewing me for a dean's job: “Are you really prepared to make the really, really tough decisions? I'm not sure your experience puts you in the position to make really tough decisions. Can you really make hard decisions about promotion and tenure?” (I replied, “With all due respect, deciding whether or not to irradiate the brain of an 8- year-old with pontine glioma is a tough decision. Deciding who gets promoted to associate professor hardly seems in the same league.” I did not get the job.)

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[RO2019]

This has to do with Rad Onc as a whole and not academics. Everyone has experience with someone else in medicine not understanding what we do nor our value.

I always laugh to myself in response. Usually it’s some poor sucker in some field with some poor lifestyle that hasn’t no clue how cool our field is.

 

[medgator]

This has to do with Rad Onc as a whole and not academics. Everyone has experience with someone else in medicine not understanding what we do nor our value.

I always laugh to myself in response. Usually it’s some poor sucker in some field with some poor lifestyle that hasn’t no clue how cool our field is.

Totally different experience where I practice. I'm not in academics, but generally get my referrals directly from ent/surg/pulm who understand exactly what it is we bring to the table. In borderline chemo cases for lung and head and neck, I'm usually making the referral to MO.

My guess is that weak RO depts in academia likely suffer from weak leadership

 

[medgator]

• From someone in internal medicine: “Radiation oncology is a 4-year residency? Gee, I would have thought it only took a year to learn how to do that.”

They are biased by the length of heme/onc fellowship which is only 3 years and half of that is hematology.

Certainly not enough time to feel comfortable staging every cancer and looking at imaging from an oncologic perspective. But then again, ask any surgeon how often internists look at imaging rather than reports.

 

[seper]

While it is true that almost all U.S. RadOncs are placid bottom-feeders, it is not an absolute job requirement. Cervical brachytherapists are usually on equal standing with GynOncs within the hospital hierarchy. Some smooth operators have independent referral chains bypassing surgeons and MedOncs altogether (think Pulm -- > lung SBRT pathway).

Totally different experience where I practice. I'm not in academics, but generally get my referrals directly from ent/surg/pulm who understand exactly what it is we bring to the table. In borderline chemo cases for lung and head and neck, I'm usually making the referral to MO.

My guess is that weak RO depts in academia likely suffer from weak leadership

 

[medgator]

While it is true that almost all U.S. RadOncs are placid bottom-feeders, it is not an absolute job requirement. Cervical brachytherapists are usually on equal standing with GynOncs within the hospital hierarchy. Some smooth operators have independent referral chains bypassing surgeons and MedOncs altogether (think Pulm -- > lung SBRT pathway).

I get direct referrals for sbrt from pulmonary. Thoracic surgeons use the same pathway. Imo it's part of having a successful practice, not being a "smooth operator"

If the pulm gets the pfts back with an Fev1 of 0.7L for a central lesion why should he waste everyone's time sending it to a surgeon for evaluation? And what's the med onc going to do?

Astute GIs have even sent me a gastric MALT once in awhile. I still will get MO involved to bless the w/u and decision to (not) get a BMBx.

 

[DukeNukem]

Can you really make hard decisions about promotion and tenure?”

What are the really hard decisions, exactly? Lie to people about the P&T pathway when you hire them, then string them along forever while they spin a hampster wheel trying to buff the CV only to have every attempt undermined to help keep down the budget?

 

[PhotonBomb]

What are the really hard decisions, exactly? Lie to people about the P&T pathway when you hire them, then string them along forever while they spin a hampster wheel trying to buff the CV only to have every attempt undermined to help keep down the budget?

Look, clearly you are in a horrible, horrible department, based on everything you've posted.

I understand the realities of having a foundation/base set up with a network of family/friends, but honestly, you're probably what - 5 years in? You've got a long time left. Get out.

If what you are saying is true, and you are that miserable, you're in the bottom 1% of rad onc job situations. GET OUT. That should be your number 1 priority in life right now.

the details don't matter - get out.

don't make excuses, just get out.

 

[Mandelin Rain]

Gotta agree. If you hate it that much, take some time to clear your head. Sign on with a locums company. Cover in some cities you always wanted to visit. If a setup clicks, see if they'll consider a permanent position.

But you seem to be trending in a really bad way. Sorry.

 

[seper]

Well, unless you have good personal connections, locum jobs are hard to come by nowadays. If you call Mission Search and alike, they mostly offer Christmas, New Years, and ASTRO week locum jobs. In rural areas.

 

[thecarbonionangle]

Gotta agree. If you hate it that much, take some time to clear your head. Sign on with a locums company. Cover in some cities you always wanted to visit. If a setup clicks, see if they'll consider a permanent position.

But you seem to be trending in a really bad way. Sorry.

We dont know their situation. They have an SO. Can they afford the paycut? Sometimes things are harder than they sound and to say hey just get out, is not possible for some as easy as it may sound. I do feel sadness to read things are that bad. Ive followed their posts for years and have def taken a negative turn to reflect their situation. That sucks and hope it improves

 

[Mandelin Rain]

We dont know their situation. They have an SO. Can they afford the paycut? Sometimes things are harder than they sound and to say hey just get out, is not possible for some as easy as it may sound. I do feel sadness to read things are that bad. Ive followed their posts for years and have def taken a negative turn to reflect their situation. That sucks and hope it improves

No doubt true. At some point though, none of that stuff matters. If you're truly miserable, you gotta get out. Your SO will have to understand. You might have to sell a bunch of crap you don't need anyway. It requires a leap of faith. But no amount of possessions/proximity to in-laws/whatever other excuse... is worth giving away years of your life in abject misery.

 

[ramsesthenice]

We dont know their situation. They have an SO. Can they afford the paycut? Sometimes things are harder than they sound and to say hey just get out, is not possible for some as easy as it may sound. I do feel sadness to read things are that bad. Ive followed their posts for years and have def taken a negative turn to reflect their situation. That sucks and hope it improves

No doubt true. At some point though, none of that stuff matters. If you're truly miserable, you gotta get out. Your SO will have to understand. You might have to sell a bunch of crap you don't need anyway. It requires a leap of faith. But no amount of possessions/proximity to in-laws/whatever other excuse... is worth giving away years of your life in abject misery.

Lets not turn this into another debate about peoples priorities. Carbon is right that we don't know their situation and they may have pretty compelling complications that are keeping them tied to their current job. Everyone has to be the judge of their own priorities.

At the same time, Rain brings up a super important point. Anyone who gets to the point that they genuinely believe that they are miserable should probably do some serious soul searching and evaluate their priorities. A lot of research has gone into the associations between income and personal happiness and consistently the association is bell-shaped. Having enough money to take care of your family and not have to worry about making money clearly improves peoples happiness. At some point though, it consistently starts to go down above a certain income. The leading hypothesis is that as we get used to a certain standard of living (or whatever the money allowed us to do) we start to worry about maintaining that position and accepting psychological costs we otherwise would not.

The point of this analogy is not money. But it is a friendly reminder that if you think you are in hell its probably worth checking if the door is really locked or not. Like most of us, I have had to do this several times and Im sure I'll have to do it again.

 

[KHE88]

What are the really hard decisions, exactly? Lie to people about the P&T pathway when you hire them, then string them along forever while they spin a hampster wheel trying to buff the CV only to have every attempt undermined to help keep down the budget?

Friend, I really feel for you, but I've gotta say that I don't think you are giving us the full story. You are clearly being exploited, and they are doing this because they know they can get away with it because they know you don't have any other options, which apparently you don't because you have stated that you would be literally willing to go anywhere and you have been unsuccessful.

If you are literally willing to go anywhere, you should be able to find some very decent jobs because the vast majority of people in this field are NOT willing to go literally anywhere (yet our PC leadership continues to curiously make statements that we need to redouble our focus on preferentially recruiting certain "underrepresented" groups that statistically gravitate to saturated coastal urban areas but I digress...).

So what don't we know that is allowing them to exploit you?

Are you here on a visa? Interpersonal problems? Appearance/disability? Criminal record/license issues?

I honestly don't get it. You have got to get out of your current situation, and you should be able to if you're willing to go anywhere. They've got their claws in you somehow, and I just wonder how. If we knew what your red flag was maybe we could provide some less generic advice other than keep on looking and keep looking everywhere. But seriously hang in there -- you will get out and land in a better situation.

 

[xrthopeful]

ding ding ding.

clearly there's a red flag at play here.

I do wish the best for you Duke, and hope you are able to improve your current situation.

 

[thecarbonionangle]

Friend, I really feel for you, but I've gotta say that I don't think you are giving us the full story. You are clearly being exploited, and they are doing this because they know they can get away with it because they know you don't have any other options, which apparently you don't because you have stated that you would be literally willing to go anywhere and you have been unsuccessful.

If you are literally willing to go anywhere, you should be able to find some very decent jobs because the vast majority of people in this field are NOT willing to go literally anywhere (yet our PC leadership continues to curiously make statements that we need to redouble our focus on preferentially recruiting certain "underrepresented" groups that statistically gravitate to saturated coastal urban areas but I digress...).

So what don't we know that is allowing them to exploit you?

Are you here on a visa? Interpersonal problems? Appearance/disability? Criminal record/license issues?

I honestly don't get it. You have got to get out of your current situation, and you should be able to if you're willing to go anywhere. They've got their claws in you somehow, and I just wonder how. If we knew what your red flag was maybe we could provide some less generic advice other than keep on looking and keep looking everywhere. But seriously hang in there -- you will get out and land in a better situation.

Why would a department big enough to have a “vice chair” hire someone as unemployable as you suggest and just keep them in an exploited situation. They have said they went to a top program and got an academic job which they thought was great then are clearly unhappy and want out now. Your theory does not fit for me either. I also wouldnt speculate that cause they sharing a story

 

[xrthopeful]

Why would a department big enough to have a “vice chair” hire someone as unemployable as you suggest and just keep them in an exploited situation. They have said they went to a top program and got an academic job which they thought was great then are clearly unhappy and want out now. Your theory does not fit for me either. I also wouldnt speculate that cause they sharing a story

lol okay then - right back at you - why would someone who went to a top program who got a job they initially thought was great then stay in a job where they are being 'exploited' rather than jump ship?

something is off in this.

 

[DukeNukem]

I'm not miserable, I just hate my employer. Academic satellites are the devil. To clarify what I was posting about initially, there is no promotion track at academic satellites. You have to do "academics" to get promoted in academics, but there is no way to be academically productive working as a busy private practicioner in a satellite. When you get hired to the satellite, they won't tell you this or they'll straight up lie about it.

Ok since you all got personal about this... Fine. You got me on three counts SDN detectives.

I wanted to like my job initially. Doesn't everyone? It took me a little while to realize the job I took was not what I signed up for and really wrap my head around it. I had no choices when I graduated. So to not feel or look miserable, I put the best spin on it. That only lasts for so long.

I have cold feet about moving to solo practice in the middle of nowhere. Also, there are some bad private jobs out there. There's a reason some places can never seem to fill or are always hiring.

I have a red flag. It's called an academic looking CV. It takes a lot to convince people that you hate academics and want out. People don't even believe my story and situation, so some just think there's something wrong with me. Just another "failed academic"

Anyway, you guys don't have to believe me. If I can tell people the truth about this specialty, that's fine for me. Attack me all you want. I'm surprised there aren't more like me out there. I know over a dozen people who left radonc entirely or are forced to stay in some really bad situations.

Anyway, I have a spouse and children. I can't just pick up and start doing locums. How many people stay in a job they hate for their family? I don't think I'm going to be fired since I've decided to roll over and accept my exploitation without complaint until I find something else.

People are hired and quit or are forced out all the time here. It's a revolving door. Most leave without another job lined up because they just hate it here and "get out". Over half of them are no longer practicing radiation oncology. That doesn't apply to me. I need the money for my family.

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

 

[deleted18755]

I'm not miserable, I just hate my employer. Academic satellites are the devil. To clarify what I was posting about initially, there is no promotion track at academic satellites. You have to do "academics" to get promoted in academics, but there is no way to be academically productive working as a busy private practicioner in a satellite. When you get hired to the satellite, they won't tell you this or they'll straight up lie about it.

Ok since you all got personal about this... Fine. You got me on three counts SDN detectives.

I wanted to like my job initially. Doesn't everyone? It took me a little while to realize the job I took was not what I signed up for and really wrap my head around it. I had no choices when I graduated. So to not feel or look miserable, I put the best spin on it. That only lasts for so long.

I have cold feet about moving to solo practice in the middle of nowhere. Also, there are some bad private jobs out there. There's a reason some places can never seem to fill or are always hiring.

I have a red flag. It's called an academic looking CV. It takes a lot to convince people that you hate academics and want out. People don't even believe my story and situation, so some just think there's something wrong with me. Just another "failed academic"

Anyway, you guys don't have to believe me. If I can tell people the truth about this specialty, that's fine for me. Attack me all you want. I'm surprised there aren't more like me out there. I know over a dozen people who left radonc entirely or are forced to stay in some really bad situations.

Anyway, I have a spouse and children. I can't just pick up and start doing locums. How many people stay in a job they hate for their family? I don't think I'm going to be fired since I've decided to roll over and accept my exploitation without complaint until I find something else.

People are hired and quit or are forced out all the time here. It's a revolving door. Most leave without another job lined up because they just hate it here and "get out". Over half of them are no longer practicing radiation oncology. That doesn't apply to me. I need the money for my family.

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

I think the part that didn’t make sense was that you said (I thought at least) that you’d move anywhere for a job

Not sure how long this will last, but it’s clear that if one casts a large net and is literally willing to move anywhere (easier said then done, especially if one has a family and apparently is female and/or a minority) that good jobs still exist.

On an unrelated note what do you mean by your red flag? You have an MD/PhD and/or a million publishications from a top East Coast school or something and feel as though it’s viewed as bizarre or negatively when you apply to a private practice job in the rural Midwest or Deep South?

 

[ramsesthenice]

I'm not miserable, I just hate my employer. Academic satellites are the devil. To clarify what I was posting about initially, there is no promotion track at academic satellites. You have to do "academics" to get promoted in academics, but there is no way to be academically productive working as a busy private practicioner in a satellite. When you get hired to the satellite, they won't tell you this or they'll straight up lie about it.

Ok since you all got personal about this... Fine. You got me on three counts SDN detectives.

I wanted to like my job initially. Doesn't everyone? It took me a little while to realize the job I took was not what I signed up for and really wrap my head around it. I had no choices when I graduated. So to not feel or look miserable, I put the best spin on it. That only lasts for so long.

I have cold feet about moving to solo practice in the middle of nowhere. Also, there are some bad private jobs out there. There's a reason some places can never seem to fill or are always hiring.

I have a red flag. It's called an academic looking CV. It takes a lot to convince people that you hate academics and want out. People don't even believe my story and situation, so some just think there's something wrong with me. Just another "failed academic"

Anyway, you guys don't have to believe me. If I can tell people the truth about this specialty, that's fine for me. Attack me all you want. I'm surprised there aren't more like me out there. I know over a dozen people who left radonc entirely or are forced to stay in some really bad situations.

Anyway, I have a spouse and children. I can't just pick up and start doing locums. How many people stay in a job they hate for their family? I don't think I'm going to be fired since I've decided to roll over and accept my exploitation without complaint until I find something else.

People are hired and quit or are forced out all the time here. It's a revolving door. Most leave without another job lined up because they just hate it here and "get out". Over half of them are no longer practicing radiation oncology. That doesn't apply to me. I need the money for my family.

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

So basically your chairman gave you deceptive advertising and if the place is a revolving door is ok with fostering a hostile work environment. I can very easily see how that could happen to a graduating resident. Sorry to hear that and I would be very pissed if I were in your situation. Places like yours absolutely exist. But academic satellites can be great places to work as long as you know what your signing up for.

No matter where you work, your highest priority is to generate revenue. Even in academics. Even the most supportive and altruistic chairs have a limited ability to support academic activities that either interfere with or fail to generate revenue. Doesn’t matter if you are at main or a satellite. This is reality and why promotion is set up the way it is (at least at most places).

Academic satellites exist for one reason: to make money. There is nothing academic about them. I have yet to meet anyone who does anything more than enroll on cooperative group trials and maybe publish some bulls*** retrospective studies at academic satellites. If research is important to you do not take one of these jobs.

That being said, I know a lot of people who are very happy in these positions. They are salaried workers that can benefit from the built in referral network of their home institution. They generally don’t have to worry about much of the business side of things. They just see patients and manage their clinical care. If that is all you want to do these can be great jobs.

Downsides: your generally not going to be getting promoted. At most places I’m familiar with there is no expectation you do (they are not tenure track). You have no control over your income. When times are lean it can be sweet that your not personally losing money but the flip side is if you absolutely kill it and grow the business the best you can expect is a thanks and maybe a nice bonus. You are also probably not going to get a lot of exciting cases. Most of those will end up getting treated at the mothership so plan on subsisting mostly on bread and butter stuff.

If you know what you are signing up for these can be great jobs. Duke pointed out the biggest red flag of them all: any place that is a revolving door should be avoided at all costs. There is a reason people don’t stay and a high likelihood you won’t want to either. No matter what they say to try to convince you otherwise. Doesn’t matter if the place is academic or PP.

 

[xrthopeful]

agreed 1000% with ramses on the potential pros and nice aspects of working in satellites.

it all depends on where you are.

sounds like you need to move, Duke.

 

[thecarbonionangle]

I'm not miserable, I just hate my employer. Academic satellites are the devil. To clarify what I was posting about initially, there is no promotion track at academic satellites. You have to do "academics" to get promoted in academics, but there is no way to be academically productive working as a busy private practicioner in a satellite. When you get hired to the satellite, they won't tell you this or they'll straight up lie about it.

Ok since you all got personal about this... Fine. You got me on three counts SDN detectives.

I wanted to like my job initially. Doesn't everyone? It took me a little while to realize the job I took was not what I signed up for and really wrap my head around it. I had no choices when I graduated. So to not feel or look miserable, I put the best spin on it. That only lasts for so long.

I have cold feet about moving to solo practice in the middle of nowhere. Also, there are some bad private jobs out there. There's a reason some places can never seem to fill or are always hiring.

I have a red flag. It's called an academic looking CV. It takes a lot to convince people that you hate academics and want out. People don't even believe my story and situation, so some just think there's something wrong with me. Just another "failed academic"

Anyway, you guys don't have to believe me. If I can tell people the truth about this specialty, that's fine for me. Attack me all you want. I'm surprised there aren't more like me out there. I know over a dozen people who left radonc entirely or are forced to stay in some really bad situations.

Anyway, I have a spouse and children. I can't just pick up and start doing locums. How many people stay in a job they hate for their family? I don't think I'm going to be fired since I've decided to roll over and accept my exploitation without complaint until I find something else.

People are hired and quit or are forced out all the time here. It's a revolving door. Most leave without another job lined up because they just hate it here and "get out". Over half of them are no longer practicing radiation oncology. That doesn't apply to me. I need the money for my family.

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

I dont’t think implying that the poster is some VISA IMG with a criminal record “red flag” is constructive. If you want people to share their personal stories you have to be open that people have different experiences and situations. I know i would stay in a bad job for my family anyday as well.

 

[KHE88]

I dont’t think implying that the poster is some VISA IMG with a criminal record “red flag” is constructive. If you want people to share their personal stories you have to be open that people have different experiences and situations. I know i would stay in a bad job for my family anyday as well.

Since when is asking questions implying anything? That wasn't what I was doing at all. I was simply stating that something didn't add up. Duke said he was willing to go anywhere, and there are jobs in highly undesirable places that are desperate for rad oncs and pay very, very well and will treat you great because they don't want to lose you. So I was wondering what the red flag was, and it came out that he

(1) is not actually willing to go anywhere.
(2) may not be applying with an appropriate C.V. (maybe leave off some publications rather than send 4 pages of basic science publications to a private practice)

So that explains that.

There is certainly nothing wrong with limiting yourself to a certain area because of your family. But he was saying he was willing to go anywhere and couldn't find anything. This didn't make any sense to me, and I simply was asking why.

I will still contend that if you honestly are willing to go anywhere, you will do very well (for now) in rad onc.

 

[KHE88]

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

*in certain markets.

I completely believe you that exploitative academic satellites are most of what's available in your market.

However there are some markets that have decent satellite jobs, and others that still have private practice and hospital employed jobs where you are still valued and have bargaining power.

The trend is absolutely towards more exploitative academic jobs, and if I were looking into going into rad onc right now, I would do my research and see that there are some markets where it's virtually impossible to get a good job and there is high competition for even the exploitative jobs, and that there may be even more markets affected by this kind of administrative greed in the future.

Can you give us an idea if you are coastal or mid-America and how far from a major metro you are? If you're experiencing this in a mid-America away from a major city, I would be shocked, but I could be wrong.

 

[2014XRT]

What's happening with the consolidation of practices into big umbrella systems is happening in every single field. Hospitals keeps buying up practices - whether you're an ENT, a IM doc, or a rad onc.

 

[scarbrtj]

hospital employed jobs where you are still valued and have bargaining power.

Oxymoronic.

Hospitals keeps buying up practices - whether you're an ENT, a IM doc, or a rad onc.

I owe my soul to the company sto'.

 

[yeasterbunny]

...

TL;DR: Academic satellites are private practice work for academic pay. They're also almost the only jobs left out there.

To state the obvious, it's hard to generalize with so many different practices and players out there. I'm in an academic satellite that treats 12-15 patients a day, I typically leave by 4 every day, but in a rural area where they understand they have to sweeten salary to attract recruits. I enjoy being the only rad onc on site to avoid the day-to-day politics of a large department, but still have the academic capital of the mothership when I get unusual cases and for peer review. The main drawback is 5 day weeks and having to find locums for vacation. I love the people I work with. I love the area where I live even if the nearest middle-sized city is an hour away. Don't get me wrong, the market appears sour for many people, but keep your eyes open.

 

[ramsesthenice]

and having to find locums for vacation.

Our satellite providers don't even have to do that. The department does it for them. And the sites that are fully integrated get resident coverage for call too. These can be pretty sweet setups for the right people. There are bad ones out there but it is a gross mischaracterization to assume they are all abusive sweatshops.

 

[scarbrtj]

To state the obvious, it's hard to generalize with so many different practices and players out there. I'm in an academic satellite that treats 12-15 patients a day, I typically leave by 4 every day, but in a rural area where they understand they have to sweeten salary to attract recruits. I enjoy being the only rad onc on site to avoid the day-to-day politics of a large department, but still have the academic capital of the mothership when I get unusual cases and for peer review. The main drawback is 5 day weeks and having to find locums for vacation. I love the people I work with. I love the area where I live even if the nearest middle-sized city is an hour away. Don't get me wrong, the market appears sour for many people, but keep your eyes open.

Our satellite providers don't even have to do that. The department does it for them. And the sites that are fully integrated get resident coverage for call too. These can be pretty sweet setups for the right people. There are bad ones out there but it is a gross mischaracterization to assume they are all abusive sweatshops.

Not sweatshops and not necessarily abusive. Two ways to view this. On one hand, super cush and low-stress; and a chance for that big fish in a little pond phenomenon. On the other hand, at just 12-15 patients a day (ie about 3-5 consults a week) and being "forced" to be there 8-4 every day, after 20 years there's an enormous amount of wasted life-hours just sitting idly in an office doing absolutely nothing. For some the latter is a feature not a bug. For others a kind of slow, depressing torture.

 

[xrthopeful]

With only 12-15 on treat, very unlikely that the poster is having to stay until 4 because of treatment times. Probably staying getting work or notes done (or just being available to referrings I would guess).

With one machine, being conservative and only treating 4 per hour, even with 16 on treat, if you start at 8 am, that’s finishing by noon.

Don’t think poster is forcibly staying bored out of his mind. Sounds like a nice job.

 

[OTN]

With only 12-15 on treat, very unlikely that the poster is having to stay until 4 because of treatment times. Probably staying getting work or notes done (or just being available to referrings I would guess).

With one machine, being conservative and only treating 4 per hour, even with 16 on treat, if you start at 8 am, that’s finishing by noon.

Don’t think poster is forcibly staying bored out of his mind. Sounds like a nice job.

Not a job for everyone. If I were in a small town an hour away from a mid-sized city, only working 8-noon, I'd go stark raving mad. Would probably be able to bump my iracing rating up a decent amount, though.

 

[xrthopeful]

Not a job for everyone. If I were in a small town an hour away from a mid-sized city, only working 8-noon, I'd go stark raving mad. Would probably be able to bump my iracing rating up a decent amount, though.

Oh agree not for everyone. Nice gig for someone who wants to spend less amount of time at work. I wouldn’t be able to do week on/week off hospitalist type jobs either but some people love that setup where they get to not work a lot

 

[Burt Radnolds]

With only 12-15 on treat, very unlikely that the poster is having to stay until 4 because of treatment times. Probably staying getting work or notes done (or just being available to referrings I would guess).

With one machine, being conservative and only treating 4 per hour, even with 16 on treat, if you start at 8 am, that’s finishing by noon.

Don’t think poster is forcibly staying bored out of his mind. Sounds like a nice job.

There is a good chance that the hospital administration is requiring them to stay open the full day, despite the fact that those patients could be treated in 3-4 hours on a decent machine.

 

[xrthopeful]

There is a good chance that the hospital administration is requiring them to stay open the full day, despite the fact that those patients could be treated in 3-4 hours on a decent machine.

That would be surprising as it would increase the cost of operations in terms of paying the therapists to stay etc.

 

[yeasterbunny]

With only 12-15 on treat, very unlikely that the poster is having to stay until 4 because of treatment times. Probably staying getting work or notes done (or just being available to referrings I would guess).

With one machine, being conservative and only treating 4 per hour, even with 16 on treat, if you start at 8 am, that’s finishing by noon.

Don’t think poster is forcibly staying bored out of his mind. Sounds like a nice job.

OK let's just be honest, it isn't usually 4, it's usually 2:30 🙂
But yes, there is a decent amount of downtime, but it gives me the luxury to spend more time with clinic patients when they need it, plenty of time to read. Some admin responsibility. We don't start til 8:30 because I'm a single dad and have to get the kids dropped off.

 

[Burt Radnolds]

That would be surprising as it would increase the cost of operations in terms of paying the therapists to stay etc.

Its hard/sometimes impossible to hire therapists in a rural area and pay them part time. Also, administration often likes the idea of offering a wide array of treatment time slots to patients instead of forcing them into a small window. I hear you, makes sense from a cost/resource standpoint to knock them out in a small window, but from multiple experiences in the real world, it often doesn't go down like that.

 

[yeasterbunny]

Its hard/sometimes impossible to hire therapists in a rural area and pay them part time. Also, administration often likes the idea of offering a wide array of treatment time slots to patients instead of forcing them into a small window. I hear you, makes sense from a cost/resource standpoint to knock them out in a small window, but from multiple experiences in the real world, it often doesn't go down like that.

That's certainly true; the therapists had their FTEs docked a few years back from 1.0 to 0.9, which lets them retain benefits, but any further and we'd have a real retention problem. It is definitely nice to give patients a bit more leeway in scheduling their time slots and have more flexibility if the machine has a hiccup or someone is late, rather than packing the schedule into just a few hours.

 

[randomname2018]

I'm not miserable, I just hate my employer. Academic satellites are the devil. To clarify what I was posting about initially, there is no promotion track at academic satellites. You have to do "academics" to get promoted in academics, but there is no way to be academically productive working as a busy private practicioner in a satellite. When you get hired to the satellite, they won't tell you this or they'll straight up lie about it.

I have seen this on several occasions. A number of job postings appear academic and only after applying or visiting is the true job revealed. For those that have signed on to these positions, I have seen a number of people promised opportunities to return to main site which never materialize. Its possible to move from a satellite to the main institution but it is often through both luck and significant personal effort.

I have a red flag. It's called an academic looking CV. It takes a lot to convince people that you hate academics and want out. People don't even believe my story and situation, so some just think there's something wrong with me. Just another "failed academic"

This is a tough situation. Other academic employers look at satellite docs like they're private, and private employers look at satellite docs like they're academic. The success I've seen here is if the private group is former academics who left for the same reasons you're interested in leaving.

Anyway, I have a spouse and children. I can't just pick up and start doing locums. How many people stay in a job they hate for their family? I don't think I'm going to be fired since I've decided to roll over and accept my exploitation without complaint until I find something else.

Locums work is not easy in practicality, particularly for someone with a family. You're generally a 1099, so you're on the hook managing your taxes and health insurance. It also is not easy stringing a long several opportunities to have consistent work. Locums companies also have causes that make it tough to hire someone without paying fines / fees.

I think you have a few exit strategies. First, live lean and save as much as possible. Keep your eyes open on job board listings as you've been doing. Lastly, leverage everything you can that costs you little. Review your institutions HR website and employee programs. Degree programs, training in other avenues, etc. It sounds like doubling down but if you aren't doing anything you aren't going anywhere.