Objectively, the pay is still pretty awesome. It may not be as awesome as it used to be... but we are WELL above the median salary for most physicians. As you said, it is reasonable to lament how things have changed (and worry how things will be), but it is hard to lament how things are.
For years we were paid based on what we were worth. We were rare, we brought in a lot of money, and so we were paid a lot of money.
Now we are paid based on what others think we are worth. There are many of us, there is less demand for us, and we are easier to replace and thus worth less. This is a shame, because we actually provide high value care and are relative experts in oncology with a better understanding of everyones' role, that is how all the puzzle pieces fit together, than anyone else.
I agree the pay and lifestyle is awesome, but it's awesome until it isn't. How low does the salary need to go before we stop asking "why aren't med students applying" and start asking "why is everyone retiring?" At what point is it no longer worth it to do our job?
As for the SCAROP presentation
I agree that Dan did a very good job of clearly identifying the problem. None of this is new or revolutionary, but it's definitely a nice summary. I think the root causes are spot on, but the result isn't. It should look more like this (sorry its kind of bootleg):
I think it's sometimes forgotten that we are actual radiation oncologists raising these issues and these concerns. It may only be a core group of 50 prominent posters on here raising the concerns, but there are hundreds of radoncs reading the forums and the only ones who disagree are academics who, and I don't mean this perjoratively, live in a parallel universe to us. Their chosen path, their priorities, and their job opportunities are different to ours.
As for the "anti-trust implications" of contraction, stop hiding behind this bullsh*t. If you acknowledge what the problem is and refuse to find a way to fix it, you are complicit and just paying us lip service. We're a smart bunch, find a way to drop numbers that isn't "anti-trust" or you know what? Just risk the anti-trust lawsuit! Nothing says "I'm a sh*thole program" like joining an antitrust lawsuit to not shut down your sh*ithole program.
Also, can we stop it with the geographic maldistribution BS? Consider the general path of a med student:
1)
High School - You are a smart high achieving high school student
2)
Undergrad - You get into the best undergrad school you can get into, likely somewhere on a coast or in a big metro area with other intelligent free thinking colleagues
3)
Med School - You get into one of the many med schools, also concentrated on the coasts or in big cities or liberal smaller cities
4)
Residency - Based on all of the above, there's a good chance you want to get into a residency that is not in the middle of nowhere. In the past, when the specialty was competitive, more of us were willing to sacrifice location for a good training program (UF, Mayo, UAB) but that's not the case now. Even if you're open to less desirable locations, you've probably met a significant other at one of the above places who perhaps isn't as willing.
After spending over a decade in a relatively liberal bubble learning about the scientific method and evidence based medicine, I could think of nothing more intolerable than moving to a town where my neighbors think I'm a baby killing pedophile or wonder why I wasn't at last week's "Stop the Steal" rally.
The cards are simply stacked against rural practice. Opening programs in rural America does nothing to fix this. In the days when we were competitive, people were forced to go there to train because they had no choice. Now that we are not competitive, those programs go unfilled. The only way to get people to practice in these areas is to pay them or to exploit them. If we truly want to increase the quality and coverage of flyover states, then get more creative because opening up programs in West Virginia and Mississippi ain't working.
