Radiation Oncology Is Number 1 In 20 Year Growth

2025 Radiation Oncology Salaries
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radiation said:
On the flipside of this, the specialties that have the least amount of growth (thoracic surgery and nuc meds), are actual dying specialties that have some overlap with rad onc "business". But agree you dont want to be on either extremes of this graph
Click to expand...
Urology having a stellar job market thanks to being on the correct extreme of this graph... Unless you're in a group looking for a urologist to help with call coverage
 
radiation said:
On the flipside of this, the specialties that have the least amount of growth (thoracic surgery and nuc meds), are actual dying specialties that have some overlap with rad onc "business". But agree you dont want to be on either extremes of this graph
Click to expand...
Where I am, thoracic surgery is doing great.Don’t know much abt their overall job market except they will be operating on a lot more stage 3 lungs with neoadjuvant chemo/io.
 
I don't see many surgical candidates for lung around here, but I do view thoracic surgeons as willing to take my SBRT (and other) lung patients whenever a good candidate finally comes along. They seem a bit desperate.

What I do worry about is losing the stage III lung cancer patients (our bread and butter) to this whole neoadjuvant chemo/immuno situation but they never get to surgery or have bad functional outcomes...
 
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metallica81788 said:
I don't see many surgical candidates for lung around here, but I do view thoracic surgeons as willing to take my SBRT (and other) lung patients whenever a good candidate finally comes along. They seem a bit desperate.

What I do worry about is losing the stage III lung cancer patients (our bread and butter) to this whole neoadjuvant chemo/immuno situation but they never get to surgery or have bad functional outcomes...
Click to expand...

Surgeons like that rely on the age old power differential that exists in tumor board to push cases through and keep their volume high.
 
medgator said:
Urology having a stellar job market thanks to being on the correct extreme of this graph... Unless you're in a group looking for a urologist to help with call coverage
Click to expand...

Urology job market is crazy good. There are some "desirable" markets where existing groups cant even hire new docs because their reimbursement isnt high enough to pay what a new doc can get elsewhere these days.
 
Reaganite said:
Urology job market is crazy good. There are some "desirable" markets where existing groups cant even hire new docs because their reimbursement isnt high enough to pay what a new doc can get elsewhere these days.
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The locums GU pay I've seen weekly in the Midwest is downright insane for any specialty
 
TheWallnerus said:
Somewhat surprised this graph hasn't garnered more attention. Or attacks/dissembling.
Click to expand...
It really speaks to sdn posters being characterized as marginal discontents when actually the real outlier and deviants are the programs. They have been totally out of control compared to other specialties.
We saw the same hypocrisy with prices/utilization when Astro academics complained about excesses imrt in the community.
 
Moonbeams said:
This graph should be pinned at the top of the forum. It really explains everything. And every single time a chair claims that job market concerns are B.S. simply point to this and ask how there can be no concern.
Click to expand...
Should definitely be sent to that dean who was the recipient of the scarop letter.
 
Gfunk6 said:
SDN: There are too many Rad Oncs, we need to cut down on training slots

Rad Onc Chairs: Ee Nay Chuck!

View attachment 355703
Click to expand...
I didn't expect to come to SDN and get a wave of nostalgia, thinking about watching Cartoon Network in the early 90s when it first came on the air...
 
It's not just the increase in radonc spots. It's that any additional medonc or urologist or general surgeon is actually a huge asset to the community. I am concerned about my community hospital because the only specialty that it is easy to recruit is radiation oncology. I have to make due with unprofessional physicians in other specialties or exorbitant wait times. Medonc applicants know that they are holding all the cards and don't even pretend to play the traditional interview game. They want an offer that they can play against 5 other offers. The quality of medonc locums is ridiculous, and it is to the point that locums agencies are coming to hospitals with very specific demands regarding their docs.

If you could magically turn 400 radoncs into medoncs tomorrow, it would much better meet the societal oncology needs in the US.

I am frankly worried about the meeting basic community needs in general surgery over the next 20 years.
 
communitydoc13 said:
It's not just the increase in radonc spots. It's that any additional medonc or urologist or general surgeon is actually a huge asset to the community. I am concerned about my community hospital because the only specialty that it is easy to recruit is radiation oncology. I have to make due with unprofessional physicians in other specialties or exorbitant wait times. Medonc applicants know that they are holding all the cards and don't even pretend to play the traditional interview game. They want an offer that they can play against 5 other offers. The quality of medonc locums is ridiculous, and it is to the point that locums agencies are coming to hospitals with very specific demands regarding their docs.

If you could magically turn 400 radoncs into medoncs tomorrow, it would much better meet the societal oncology needs in the US.

I am frankly worried about the meeting basic community needs in general surgery over the next 20 years.
Click to expand...

No need to worry. Sally Surgeon DNP PhD with her 18 month nursing residency, simulator training, and 100 hours of online course work will be repairing your hernia today. There’s an actual surgeon around here somewhere to tap if there’s a problem though…you know collaborative practice and all.
 
fiji128 said:
I’ve been posting about this for like 5 plus years. We are obviously a gutter speciality now. Great, KO says he knows someone that got two job maybe three offers.
Click to expand...
Watching Twitter yesterday:

I suspect there will be a significant uptick in non-anonymous discussion focused on "SDN misanthrope" topics like oversupply.

Why? There's a whole new wave of kids done with residency AND board certification. There is an acknowledgement of, and concern about, the subjectivity of the oral exam. Though paranoid, it's not out of the realm of possibility that the oral exam could be used as an enforcement tool: "hey it's great you've been so active on Twitter, sorry you failed that one section and conditioned, so here's the fee and the process by which you do the repeat exam" blah blah.

What changed to make me think yesterday/last week wasn't a fluke?

Oral exam results were released on Tuesday. The majority of the people taking the exam were from the residency class of 2021. That class:

Applied and interviewed for residency in 2015/2016, arguably at the absolute peak of RadOnc competitiveness.

Started intern year in the summer of 2016. In the fall of 2016, Ben Smith and crew published their updated analysis saying their earlier work was wrong, there will actually be an oversupply given current trends. This was largely ignored. The class of 2021 was already "stuck" and switching residency tracks at that point is very difficult.

Started RadOnc in the summer of 2017, where it was still in the Golden Era Bubble.

Watched the ABR Debacle of 2018 at the start of their PGY3 year. Were told by Kachnic and Wallner that they were actually "lower quality" than the residents from 10 years ago.

Were residents when COVID started and lived through all that meant. Specifically, despite watching job contracts being pulled in RadOnc AS WELL AS other specialties, and virtually all academic institutions enacting some sort of hiring freeze, were STILL told that "the job market was fine".

Applying for jobs and discovering no, the job market was not fine.

Still having to do all 4 board exams in a crazy format and sequence. (Remember when the second wave started canceling people taking written exams in December 2020 like, a week before they were supposed to take it?)

Finished residency and (mostly) started attending jobs, still during COVID. By this point, the specialty had (appropriately) crashed at the medical student level and RadOnc was objectively the least competitive specialty in all of medicine.

There are ~200 kids who lived this timeline. It's not a timeline which breeds happy attending physicians.
 
elementaryschooleconomics said:
Watching Twitter yesterday:

I suspect there will be a significant uptick in non-anonymous discussion focused on "SDN misanthrope" topics like oversupply.

Why? There's a whole new wave of kids done with residency AND board certification. There is an acknowledgement of, and concern about, the subjectivity of the oral exam. Though paranoid, it's not out of the realm of possibility that the oral exam could be used as an enforcement tool: "hey it's great you've been so active on Twitter, sorry you failed that one section and conditioned, so here's the fee and the process by which you do the repeat exam" blah blah.

What changed to make me think yesterday/last week wasn't a fluke?

Oral exam results were released on Tuesday. The majority of the people taking the exam were from the residency class of 2021. That class:

Applied and interviewed for residency in 2015/2016, arguably at the absolute peak of RadOnc competitiveness.

Started intern year in the summer of 2016. In the fall of 2016, Ben Smith and crew published their updated analysis saying their earlier work was wrong, there will actually be an oversupply given current trends. This was largely ignored. The class of 2021 was already "stuck" and switching residency tracks at that point is very difficult.

Started RadOnc in the summer of 2017, where it was still in the Golden Era Bubble.

Watched the ABR Debacle of 2018 at the start of their PGY3 year. Were told by Kachnic and Wallner that they were actually "lower quality" than the residents from 10 years ago.

Were residents when COVID started and lived through all that meant. Specifically, despite watching job contracts being pulled in RadOnc AS WELL AS other specialties, and virtually all academic institutions enacting some sort of hiring freeze, were STILL told that "the job market was fine".

Applying for jobs and discovering no, the job market was not fine.

Still having to do all 4 board exams in a crazy format and sequence. (Remember when the second wave started canceling people taking written exams in December 2020 like, a week before they were supposed to take it?)

Finished residency and (mostly) started attending jobs, still during COVID. By this point, the specialty had (appropriately) crashed at the medical student level and RadOnc was objectively the least competitive specialty in all of medicine.

There are ~200 kids who lived this timeline. It's not a timeline which breeds happy attending physicians.
Click to expand...
A lot of them are probably just thankful to be employed . When the realties about the lack of salary raises, promotions and lateral movement set in, and they compare themselves against colleagues in other specialties, dissatisfaction will set in.
 
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RickyScott said:
A lot of them are probably just thankful to be improved. When the realties about the lack of salary raise, promotion and lateral movement set in, and they compare themselves against colleagues in other specialties, dissatisfaction will set in.
Click to expand...
Future happiness in a rad onc career will almost require not comparing oneself against others in other specialties
 
TheWallnerus said:
Future happiness in a rad onc career will almost require not comparing oneself against others in other specialties
Click to expand...
Honest question to junior faculty and fresh grads out there…

Are you really facing these dismal prospects? No promotion, no raises?

I am not. I have no idea if I am just lucky or if, perhaps, prospects aren’t that grim for my generation. I think we need some real data
 
Lamount said:
Honest question to junior faculty and fresh grads out there…

Are you really facing these dismal prospects? No promotion, no raises?

I am not. I have no idea if I am just lucky or if, perhaps, prospects aren’t that grim for my generation. I think we need some real data
Click to expand...
real word data will never be available, but why should you get a promotion? Is it because you work hard, are productive , and deserve it? In the real world, it’s because, you may leave, and basically need a competing offer.
 
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RickyScott said:
real word data will never be available, but why should you get a promotion? Is it because you work hard, are productive , and deserve it? In the real world, it’s because, you may leave, and basically need a competing offer.
Click to expand...

That’s what these people don’t understand. It has nothing to do with deserving. These corporations that we have been forced to be a part of are not interested in giving you what you think you deserve but they might if they can’t replace you.
 
RickyScott said:
real word data will never be available, but why should you get a promotion? Is it because you work hard, are productive , and deserve it? In the real world, it’s because, you may leave, and basically need a competing offer.
Click to expand...
Where I work, there are certain benchmarks for promotion that I am close to achieving (or already have). I just have to put together a formal dossier. Our base salary is based on prior year’s productivity (maximum increase of X% per year)… plus a sizeable bump when you get promoted.

It’s not perfect, but it seems fair.
 
Lamount said:
Where I work, there are certain benchmarks for promotion that I am close to achieving (or already have). I just have to put together a formal dossier. Our base salary is based on prior year’s productivity (maximum increase of X% per year)… plus a sizeable bump when you get promoted.

It’s not perfect, but it seems fair.
Click to expand...
I am not denying there are still some great jobs out there. I also bet it is very competitive to be offered a position where you are. Top tier jobs exist in every field, and somehow, I doubt the average radonc grad is offered a job at your department.
Given how competitive this field became, it is still a tragedy, if only the bottom quartile ends up in low paying exploitative hellpits thousands of miles from family and friends.
 
Lamount said:
Where I work, there are certain benchmarks for promotion that I am close to achieving (or already have). I just have to put together a formal dossier. Our base salary is based on prior year’s productivity (maximum increase of X% per year)… plus a sizeable bump when you get promoted.

It’s not perfect, but it seems fair.
Click to expand...
I have been at a job for better than half a decade (550 range); it pays well, but there have been zero talks (or offers) for pay raises. I foresee this not changing, ever, given current macroclimate (and given my microclimate: steady but measurable decline in patient on-beam and reimbursement through the years).
 
RickyScott said:
I am not denying there are still some great jobs out there. I also bet it is very competitive to be offered a position where you are. Top tier jobs exist in every field, and somehow, I doubt the average radonc grad is offered a job at your department.
Given how competitive this field became, it is still a tragedy, if only the bottom quartile ends up in low paying exploitative hellpits thousands of miles from family and friends.
Click to expand...
I agree… I think part of the problem is that all of this is so opaque. The only ones who know one if we are being compensated fairly and what other departments are doing are the ones who pay us. This is ripe for a REAL survey
 
Lamount said:
Honest question to junior faculty and fresh grads out there…

Are you really facing these dismal prospects? No promotion, no raises?

I am not. I have no idea if I am just lucky or if, perhaps, prospects aren’t that grim for my generation. I think we need some real data
Click to expand...
It's really hard for us to have any kind of "leverage". As we've seen from "The Great Resignation" stuff over the last year or two, the best way to improve your situation rests in the ability to walk away.

For me: my small group covers the few hospitals for almost an hour in any direction from where I live. Looking at the nearest "competitor" departments, there has been very little turnover. Very typical RadOnc stuff of ~2 person departments with boomers that have been posted up since the 90s.

In the >1 hour range from where I live, I might be able to find something. Probably 1.5-2 hour one-way commute though, which I am not willing to do.

So, I can't "walk away" without moving me and my entire family, again.

In regards to a raise: my group has professional service contracts with our hospitals. Revenue is split equally among partners. Therefore, salary is tied to reimbursement...and we all know how that is going. Smaller reimbursements for fewer fractions.

Interestingly, since I'm the youngest (aka "most modern") person of the group, while I crush RVUs at a disturbing pace, my use of VMAT and hypofrac means I don't generate as much money as the graybeards sneaking in the 3DCRT/conventional patients.

Looking at the long game, if I stay with this group (or any pro-fee group), the best case scenario is that there is never a single reimbursement cut ever again...which seems unlikely. I'm at @OTN-level volume, and I probably can't safely carry more patients than what I'm currently doing. My only other option for a "raise" would be to use 3D where I used to use VMAT, or cut way back on hypofrac in the non-breast patients, which I don't think I can personally handle from a moral injury standpoint.

To your question about "dismal" then...well, if I stay in my current job for the rest of my career (in a location my family is happy in), my fate is the fate of RadOnc in general. I'm sure I could go out and find more money and titles elsewhere, but then I'm rolling the geography dice and risking a "grass is greener" scenario.

"Dismal" seems dramatic...I would go with "stoic acceptance".
 
medgator said:
I've heard this mentioned before but don't see how that would work. An imrt plan generally will bill much higher afaik...
Click to expand...
It defies logic based on EVERYTHING we've heard for the past 20 years, I agree. When I heard this from my senior partner/talked with my billing people/talked with several other people over several weeks:

1) In an absolute (and global) sense, IMRT still reimburses more than 3D.
2) In terms of technical fees, IMRT still reimburses more than 3D.
3) However, the majority of the cuts and changes have been focused on the professional fee side.

Currently, in 2022, professional reimbursement for IMRT and 3D are often roughly equivalent, or 3D generates more, sometimes "a lot" more (in a relative sense). A lot of it has to do with bundling the CTSIM charge and being able to bill complex treatment device for each beam used in 3D, whereas you can only bill once for IMRT even if you use 100 beams.

SUPER ROUGH ESTIMATE/EXAMPLE, but when all is said and done, when I do 60Gy/30 fractions VMAT lung vs when my partner does the same treatment but does it 3D using 4 static fields, the professional reimbursement is ~$1000 for the VMAT and ~$2000 for the 3D.

The change was slow and insidious. But, because many physicians are now W2 employees paid a salary from a mathematical formula, this isn't widely appreciated.

So, any private group on a pro-fee contract is now "choosing wisely" if they choose to use IMRT over 3D.
 
medgator said:
I've heard this mentioned before but don't see how that would work. An imrt plan generally will bill much higher afaik...
Click to expand...
Speaking professional reimbursement only...

77301 will get ~$200 more than 77295

BUT. With 3D... Now you get to throw in $80 for 72290 (and 77280 block verification) and a bunch of sweet $60 77334's per beam (and 77300 per beam, $30). You can boost kind of to your heart's content with more 77295's without rescanning... it's an additional 77295 per plan, plus 77280 setup each time, plus 77334 per beam/77300 per beam. You can, with just a modicum of creativity, make an equal dose 3D plan net a good bunch $more$ than IMRT. IMRT wants to be the villain but fails nowadays. Pound for pound, ****on professional side****, IMRT is the cost effective/high value choice.

TL;DR Hospital rad oncs... do IMRT: you'll make less, the hospital will make more
 
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elementaryschooleconomics said:
It's really hard for us to have any kind of "leverage". As we've seen from "The Great Resignation" stuff over the last year or two, the best way to improve your situation rests in the ability to walk away.

For me: my small group covers the few hospitals for almost an hour in any direction from where I live. Looking at the nearest "competitor" departments, there has been very little turnover. Very typical RadOnc stuff of ~2 person departments with boomers that have been posted up since the 90s.

In the >1 hour range from where I live, I might be able to find something. Probably 1.5-2 hour one-way commute though, which I am not willing to do.

So, I can't "walk away" without moving me and my entire family, again.

In regards to a raise: my group has professional service contracts with our hospitals. Revenue is split equally among partners. Therefore, salary is tied to reimbursement...and we all know how that is going. Smaller reimbursements for fewer fractions.

Interestingly, since I'm the youngest (aka "most modern") person of the group, while I crush RVUs at a disturbing pace, my use of VMAT and hypofrac means I don't generate as much money as the graybeards sneaking in the 3DCRT/conventional patients.

Looking at the long game, if I stay with this group (or any pro-fee group), the best case scenario is that there is never a single reimbursement cut ever again...which seems unlikely. I'm at @OTN-level volume, and I probably can't safely carry more patients than what I'm currently doing. My only other option for a "raise" would be to use 3D where I used to use VMAT, or cut way back on hypofrac in the non-breast patients, which I don't think I can personally handle from a moral injury standpoint.

To your question about "dismal" then...well, if I stay in my current job for the rest of my career (in a location my family is happy in), my fate is the fate of RadOnc in general. I'm sure I could go out and find more money and titles elsewhere, but then I'm rolling the geography dice and risking a "grass is greener" scenario.

"Dismal" seems dramatic...I would go with "stoic acceptance".
Click to expand...

Your options are get over your moral qualms or get out of rad onc entirely. Changing jobs isn’t going to make it any better. None of this will be getting any better at all ever. The only way to maintain any semblance of an income especially in PP is to essentially maximize billing any way you can and maybe get a subsidy.
 
elementaryschooleconomics said:
It defies logic based on EVERYTHING we've heard for the past 20 years, I agree. When I heard this from my senior partner/talked with my billing people/talked with several other people over several weeks:

1) In an absolute (and global) sense, IMRT still reimburses more than 3D.
2) In terms of technical fees, IMRT still reimburses more than 3D.
3) However, the majority of the cuts and changes have been focused on the professional fee side.

Currently, in 2022, professional reimbursement for IMRT and 3D are often roughly equivalent, or 3D generates more, sometimes "a lot" more (in a relative sense). A lot of it has to do with bundling the CTSIM charge and being able to bill complex treatment device for each beam used in 3D, whereas you can only bill once for IMRT even if you use 100 beams.

SUPER ROUGH ESTIMATE/EXAMPLE, but when all is said and done, when I do 60Gy/30 fractions VMAT lung vs when my partner does the same treatment but does it 3D using 4 static fields, the professional reimbursement is ~$1000 for the VMAT and ~$2000 for the 3D.

The change was slow and insidious. But, because many physicians are now W2 employees paid a salary from a mathematical formula, this isn't widely appreciated.

So, any private group on a pro-fee contract is now "choosing wisely" if they choose to use IMRT over 3D.
Click to expand...
It’s odd, but I noticed it pretty close to the same phenomenon. Depending on # of “complex devices” 3D can approach IMRT, from a professional RVU perspective. I treat mostly lung and, if i cared about RVU, i would get much more RVU for treating a lung met with 3D with 15 palliative RT than I would with SBRT.
 
Critical when negotiating service agreement, if you can, to try to not have this tied entirely to pro fees and to allow for a subsidy for practice expenses, including your salary. The hospital would probably make more money subsidizing a practice away from incentives for 3D.

Very few physicians outside of radonc pay for their entire cost with pro fees (most are vanishingly far from this). You might think about the facilities fees or even the imaging revenue that you generate for the hospital.
 
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