Sorry to ask this...

[oncology2020]

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I don't mean to offend anyone by asking this question but I do seem to have this (ir)rational fear of future job security. Rad Onc seems to be so dependent on technology that they essentially don't have a job without extremely expensive technology. Do you guys ever worry about future job security? All that investment and sacrifice in time/money and training and you may then end up having a difficult time finding a job---similar to what radiology/pathology/nuclear med are going through? I can't even imagine how stressful it must be for newly trained radiologists/pathologists. Ever feel like rad onc may be over-training residents which will saturate the job market? Ever feel like dosimetrist or other mid-levels can start taking over similar to what is happening in internal medicine and anesthesiology? Pharmacists and nurse practitioners are also increasingly getting involved in leading patient care for heme/onc at my institution. Many think that rad onc are over-paid, is rad onc on the list to get destroyed by drastic reimbursement cuts? I understand that these issues are not specific to rad onc and are often fluid and difficult to predict and that other fields seem to have it worse right now but I just have a fear of committing due to job security especially with the current economy and state of health care. l feel like Rad Onc is even more susceptible to all these issues because of their increasing dependence on costly technology. Any other procedures or patient care that Rad Onc is trying to expand into to increase their scope of practice (i.e. nuclear medicine or interventional oncology--using minimally invasive catheter-based procedures to deliver targeted therapy/radio-ablation, etc)? Shouldn't Rad Onc consider expanding into these turfs?

I grew up poor, have a lot of loans and worked extremely hard with the hopes of getting out of "poverty" so I live in constant fear of future job security..It seems like surgery and internal medicine may be the safest bets right now (included internal med only because of the variety of specialities that can be done after residency and can always open up a clinic in the middle of no where if it ever comes to that) but I don't have any inclinations towards those fields. I already read FAQs and read some older threads but appreciate any insights especially of others who may have had similar reservations before committing to rad onc. Thanks!

 

[Gfunk6]

I don't mean to offend anyone by asking this question but I do seem to have this (ir)rational fear of future job security. Rad Onc seems to be so dependent on technology that they essentially don't have a job without extremely expensive technology. Do you guys ever worry about future job security?

Honestly? No.

All that investment and sacrifice in time/money and training and you may then end up having a difficult time finding a job---similar to what radiology/pathology/nuclear med are going through?

Well, Pathology has absolutely over-saturated the market. At least that's what I gather from my Pathologist friends and the Pathology forum on SDN. Radiologists have done something similar, but perhaps not to as great an extent. I understand that it is challenging to obtain a job in Radiology without fellowship training.

Nuclear Medicine is a different beast altogether. Their training has been subsumed by Radiology and, thus, there is little need for a 'pure' Nuclear Medicine MD. Their over-saturation of the market also did not help.

I can't even imagine how stressful it must be for newly trained radiologists/pathologists. Ever feel like rad onc may be over-training residents which will saturate the job market?

Honestly? Yes.

Ever feel like dosimetrist or other mid-levels can start taking over similar to what is happening in internal medicine and anesthesiology?

Absolutely not. They fill a very important niche in our specialty but neither dosimetrists, therapists, nor physicists can take the 'captain of the ship' role that we do. They simply do not have the medical training to do so. Radiation Oncology is a LOT more that simply understanding physics and technology, you need a detailed, voluminous understanding of the natural history, staging, and multi-modality treatment of cancer.

Pharmacists and nurse practitioners are also increasingly getting involved in leading patient care for heme/onc at my institution. Many think that rad onc are over-paid, is rad onc on the list to get destroyed by drastic reimbursement cuts?

Well, let's be clear. All specialties are being cut, Radiation Oncology is not in a special category.

I understand that these issues are not specific to rad onc and are often fluid and difficult to predict and that other fields seem to have it worse right now but I just have a fear of committing due to job security especially with the current economy and state of health care.

It is important to be cognizant of such things, but no field of medicine is immune to the 'fear' that you cite. PCPs are being replaced by noctors and specialists are being replaced by advanced practiced noctors and/or getting their reimbursement slashed.

If you are really that afraid then go into concierge medicine or cash-only cosmetic dermatology/surgery. Keep in mind that these areas of medicine are hyper-competitive and subject to a capitalistic culture that few doctors are trained to handle.

l feel like Rad Onc is even more susceptible to all these issues because of their increasing dependence on costly technology. Any other procedures or patient care that Rad Onc is trying to expand into to increase their scope of practice (i.e. nuclear medicine or interventional oncology--using minimally invasive catheter-based procedures to deliver targeted therapy/radio-ablation, etc)? Shouldn't Rad Onc consider expanding into these turfs?

If there were ever a zombie/nuclear/viral holocaust, then Radiation Oncologists would be worthless. There, I said it. In the post-apocalyptic wasteland, survivors would probably best served by PCPs and general surgeons. In other scenarios (e.g. not total societal collapse) I think we will be just fine.

If you want to be a generalist, then be a generalist.

I grew up poor, have a lot of loans and worked extremely hard with the hopes of getting out of "poverty" so I live in constant fear of future job security..It seems like surgery and internal medicine may be the safest bets right now (included internal med only because of the variety of specialities that can be done after residency and can always open up a clinic in the middle of no where if it ever comes to that) but I don't have any inclinations towards those fields. I already read FAQs and read some older threads but appreciate any insights especially of others who may have had similar reservations before committing to rad onc. Thanks!

I don't know what more I can tell you. Either face your fears and go into Rad Onc or suck it up and go into IM.

 

[deleted4401]

Job security is there, and I think there are a few articles that talk about this. Most medical specialties are at least geographically under-represented, so you can work somewhere. There is a projected deficit of rad oncs, about 40% by one publication, if we continue at current pace... I'm not concerned about having a job in the future.

That being said, I think high income security is in jeopardy. This can be a draining job, but the way that RUC/Medicare/Private insurers have valued our services, we are a huge target, basically the equivalent a medical "tramp stamp". I think the average incomes reported in 2012-2013 for a rad onc will drop 30-40% in the next 10-15 years, in terms of "real dollars". You will not be poor. Your kids may have to go to public schools in the suburbs and state university rather than Exeter and Oberlin. Country club may be difficult to get join, but golf weekly is a possibility if you don't have other expensive pursuits. You might have 1-2 custom suits, and the rest rack. So, yes, life will be tough for me in 2023, but I think I have the overall will and temperament to make it.

S

 

[CUBuffsgrad98]

Agree with Simul

I feel I will most likely always have my job, but will my 30 year mortgage hold up (which is easily affordable now), or will it be a drain in the future and I have to move out in 10-20 years does weigh on me.

 

[medgator]

Your kids may have to go to public schools in the suburbs and state university rather than Exeter and Oberlin. Country club may be difficult to get join, but golf weekly is a possibility if you don't have other expensive pursuits. You might have 1-2 custom suits, and the rest rack. So, yes, life will be tough for me in 2023, but I think I have the overall will and temperament to make it.

S

Tesla Model S basic or performance?

I kidd.... SimulD brings up an obvious, but sometimes overlooked point. Rad Onc will continue to be a well reimbursed specialty IMO, particularly in terms of job satisfaction when you look at income. I think I can speak for myself and may others in saying that we'd rather do this and than pretty much any other medical specialty around, income cuts or not.

 

[thesauce]

These concerns are quite normal. Unfortunately, we can't know with any certainty what is to come in any field. People have been predicting the downfall of our specialty since the 70s and those who chose it then have seen the field grow and expand throughout their careers and are either retired now or close to it.

In the end, I believe you have to choose what you enjoy and do your part to make it/keep it a thriving field for years to come. This is particularly important in a small field like ours. We are fortunate to be in the position of drawing some of the best and brightest medical students to radiation oncology and that probably bodes well for us.

As for the overtraining, yes, that is a major concern. Multiple recent threads and publications have addressed it. There is a frustrating disconnect between the leaders of our field and those that are currently entering the work-force in terms of the status of the job market.

Salaries are very likely to drop in this and every other specialty, and probably primary care too with the rapid influx of NPs and PAs who are willing to work for half as much. However, I do think a 30-40% cut to radonc in 10 years is a stretch. My guess would be closer to 20%, which will be counteracted by an increase in volume from the baby boomers and new technologies/procedures, keeping "real dollars" close to stable. Salaries in the boonies will continue to be high. Fewer free-standing centers since CMS appears hell-bent on shutting them down. Again, this is speculation, which is all we have.