Strategies for job search

[radoncradonc]

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I have been reading on this forum some people giving out bad job search advice, and I want to use my own example to illustrate why they are bad advice:

1. You can wait until later in the year because there will be less competition. While you might think that your odds of landing a better job improves as your PGY5 years goes on because most of the graduates have signed contracts hence less competition, this was absolutely not true in my case. I was stupid enough to decline job offers in the first part of my PGY5 year, and I could not find another job afterwards. At the end, I ended up signing a contract where my salary was $150K less than what I had been offered in the first place. This was in a similar sized rural town. Some practices might be posting and reposting later in the academic year, but if they haven't interviewed you early on, they will not interview you later. I know some practices that was hiring last year, and they are still hiring this year...they are probably in no hurry and just waiting for the perfect match. Whereas in your case, if you don't have a job by July, you won't have an income and you will default on your student loans.

2. If you don't find a job, you can do locums. Not true. Locum jobs are sporadic and not enough to sustain a family and pay back my loans. I contacted several locum companies when I still couldn't find jobs and was about to graduate. The most work I could get out of them was about ~10 days each month. This would also require me to travel to multiple cities to get those 10 days and they don't pay for time when flying and driving. Locum jobs are very sporadic and they do not provide health insurance, which my family needs. It sucks to be away from my wife and kids.

3. You can easily leave your first job if you don't like it. False again. Employers are smart, and exploitative employers are even smarter. In my case, they have punitive clauses written into my contract saying that if I don't fulfill the 3 year contract, I would have to pay them >150K in damages. That's almost as much as my post tax salary. When you sign a contract, you are stuck with the job for the duration.

I personally found the job market to be bad. Experiences from other friends were the same.

Do your self a favor, find a job that doesn't overwork or exploit you and sign the contract ASAP. Don't care about location because you won't have a choice. Things won't get better later in the year.

 

[Gfunk6]

#radon crock

Fixed it for you 😀

 

[deleted18755]

I have been reading on this forum some people giving out bad job search advice, and I want to use my own example to illustrate why they are bad advice:

1. You can wait until later in the year because there will be less competition. While you might think that your odds of landing a better job improves as your PGY5 years goes on because most of the graduates have signed contracts hence less competition, this was absolutely not true in my case. I was stupid enough to decline job offers in the first part of my PGY5 year, and I could not find another job afterwards. At the end, I ended up signing a contract where my salary was $150K less than what I had been offered in the first place. This was in a similar sized rural town. Some practices might be posting and reposting later in the academic year, but if they haven't interviewed you early on, they will not interview you later. I know some practices that was hiring last year, and they are still hiring this year...they are probably in no hurry and just waiting for the perfect match. Whereas in your case, if you don't have a job by July, you won't have an income and you will default on your student loans.

2. If you don't find a job, you can do locums. Not true. Locum jobs are sporadic and not enough to sustain a family and pay back my loans. I contacted several locum companies when I still couldn't find jobs and was about to graduate. The most work I could get out of them was about ~10 days each month. This would also require me to travel to multiple cities to get those 10 days and they don't pay for time when flying and driving. Locum jobs are very sporadic and they do not provide health insurance, which my family needs. It sucks to be away from my wife and kids.

3. You can easily leave your first job if you don't like it. False again. Employers are smart, and exploitative employers are even smarter. In my case, they have punitive clauses written into my contract saying that if I don't fulfill the 3 year contract, I would have to pay them >150K in damages. That's almost as much as my post tax salary. When you sign a contract, you are stuck with the job for the duration.

I personally found the job market to be bad. Experiences from other friends were the same.

Do your self a favor, find a job that doesn't overwork or exploit you and sign the contract ASAP. Don't care about location because you won't have a choice. Things won't get better later in the year.

Sorry to hear my friend...

Can you elaborate on #3? I don’t think I’ve ever heard of an employer requiring a three year commitment but I’ve definitely never heard of a penalty just for leaving (in any field of medicine)

 

[RadRadRad]

Sorry to hear my friend...

Can you elaborate on #3? I don’t think I’ve ever heard of an employer requiring a three year commitment but I’ve definitely never heard of a penalty just for leaving (in any field of medicine)

My first contract had a financially punitive clause for leaving early (before 2 years) but nothing like 150k. It was less than the initial signing bonus.

Is that clause for leaving in general or only applicable if you go to a nearby competitor?

 

[Lnsean]

Damn. I have really liked and enjoyed my time in the radonc department too. I think radonc has a very good mix of patient interaction and the interesting medicine/physics stuff.

Does one choose passion over practicality?

 

[deleted941485]

I see med students grappling with this all the time. Let me drop some truth on you: your job is never going to love you back. If you’re forced to live in the middle of nowhere away from friends and family, as radonc will force on you, you will regret it.

Choose a job that lets you live your life the way you want to.

The only people who would advise you to choose career over family have neglected their own families. Always remember: you can easily assess someone’s professional success, but how much do you know about your attendings’ home lives? Are their spouses happy? Are their kids happy? Are they in marriage counseling and five years away from a divorce? Put strain on that part of your life for your career and you will be miserable.

The only question medical students should ask before they embark on any long training program:

How much are you willing to sacrifice on the alter of medicine? Family? Location? Money? Leisure? What do you want to burn because medicine will take every bit of it if you allow it.

 

[PleaseRemainCalm]

The only question medical students should ask before they embark on any long training program:

How much are you willing to sacrifice on the alter of medicine? Family? Location? Money? Leisure? What do you want to burn because medicine will take every bit of it if you allow it.

Yes like most jobs, with rad onc, at least in the short to medium term, you cannot have it all even if you are the best of the best--and of course by definition most of us are not the best of the best and will never have it all. You have to decide what your non negotiables are and then choose the specialty you enjoy that has the best chance of protecting that.

 

[radoncradonc]

Yes. You read point #3 correctly. The only way out is if they terminated me without cause. Not even for cause termination.

 

[DoctwoB]

Yes. You read point #3 correctly. The only way out is if they terminated me without cause. Not even for cause termination.

I’m curious as to the contract structure. It is pretty commonplace that things like signing bonuses, loan repayment, covered moving expenses etc must be paid back if the doctor doesn’t stay the pre specified amount of time, but I’ve never heard of straight salary being demanded back, and would question the legality of that provision.

My guess is somewhere in the contract it says that your base is X with signing bonus Y paid out over Z period of time and if you leave early they can take Y back.

 

[Haybrant]

this is a tough situation. Keep looking something will come up, it takes time and persistence and connections really help. These situations are and will continue to be commonplace, we’ve been telling everyone for the last 2-3 years here for a reason. For people still considering rad onc, just remember to do it if you love it this much bc it may come at a major sacrifice, our society which is in the hands of academics has done little to nothing help alleviate the issues, only to make it much worse. There are some really terrible people in practice out there that will never have to face these issues simply won’t retire and will be the ones trying to take advantage of you, it’s deeply unfair.

 

[seper]

I've been on 2-year contracts with two different hospitals (East Coast metro, Midwest). Both had punitive clauses against physicians leaving early on the tune of 150K as well. Having said that, I know a few docs who left the said hospitals early by "mutual agreement" and I'm pretty sure they were released from having to pay the penalty.

 

[Mandelin Rain]

Never heard of a punitive clause. Yikes man. I understand recruiting is a pain and all but that's some rough stuff. Do you really want to keep someone who really doesn't want to be there?

That said, you could maybe negotiate something like that into your deal for a higher base. If you were agreeable to living in Rhinelander for 5 years, I'm sure they'd back up the Brinks truck if they knew you weren't going to leave at the first hint of something better.

 

[medgator]

Never heard of a punitive clause. Yikes man. I understand recruiting is a pain and all but that's some rough stuff. Do you really want to keep someone who really doesn't want to be there?

That said, you could maybe negotiate something like that into your deal for a higher base. If you were agreeable to living in Rhinelander for 5 years, I'm sure they'd back up the Brinks truck if they knew you weren't going to leave at the first hint of something better.

No way in hell I'd sign a clause like that unless the base was significantly above MGMA median.... then again, it sounds pretty bad out there now if hospitals outside major metros are throwing that kind of garbage into contracts these days.

 

[Mandelin Rain]

This is what I've said a couple times. I feel really lucky in the job I landed 10 years ago. Love it. I'm not sure many of those jobs exist today, let alone 5 years in the future. Certainly, there were no six figure punitive clauses in any of the contracts I, nor my buddies reviewed a decade ago (I reviewed 6).

 

[xrthopeful]

I mean, none of us have really ever heard of anything like that, whether you graduated 10 years ago or 1 year ago.

If true, I don't know why you signed that.

That is so outside the reasonable standard.

 

[medgator]

If true, I don't know why you signed that.

That is so outside the reasonable standard.

Just read the op again and look at #1.

If a hospital got wind of the expansion problem and noted a lot more applications the last year or two, why wouldn't they put that in there? Someone might be desperate enough to sign it.

 

[Mandelin Rain]

I mean, we just heard about 4 contracts that included a punitive clause. 3 of which were an oddly coincident 150k.

I was willing to blow off the first mention as completely anamolous, because it seems so lunatic, but maybe it's now a thing.

 

[Lamount]

That's bananas. Would that sort of thing hold up in court? -not asking anyone to try, just curious.

 

[seper]

Why did I sign both? The first contract (c. 2013) was for a downtown job in one the most desirable cities in U.S. I had a lawyer and we tried to negotiate down the punitive sum, but the reply was "take it or leave". As a recent graduate at the time, I did not have the self-assurance to continue the job search and I just took it.
The second contract, just like I've posted above, also has a punitive cause and is "binding". however, I knew for a fact that rather fighting it out with attorneys, this hospital system and physicians have ended contracts agreements early in the past, so I knew that I could do it. I went ahead and signed it. I agree, a risky thing to sign.

 

[DoctwoB]

Did some googling. These clauses are referred to as Liquidated damages provisions. Their enforceability will vary by state but in general it seems they are in fact enforceable if it is found that the amount put forth can be argued to be the damages caused to the employer by you leaving early and not a punitive value.

My guess is that they could reasonably argue that 150k is the cost to recruit and onboard a new radonc plus the lost productivity from the the time it takes to hire someone new.

 

[medgator]

Did some googling. These clauses are referred to as Liquidated damages provisions. Their enforceability will vary by state

I've only seen those with respect to non competes. That's it. But I guess lawyers have figured everything out

 

[Mandelin Rain]

Did some googling. These clauses are referred to as Liquidated damages provisions. Their enforceability will vary by state but in general it seems they are in fact enforceable if it is found that the amount put forth can be argued to be the damages caused to the employer by you leaving early and not a punitive value.

My guess is that they could reasonably argue that 150k is the cost to recruit and onboard a new radonc plus the lost productivity from the the time it takes to hire someone new.

Interesting. My guess is 150k is a significant number in some way. Likely the maximum number that has ever been upheld or something.

 

[thecarbonionangle]

Just off the top of my head there are places in rural NM, rural WI, rural IL, rural TN, advertising 600+, even 700+ salaries. You will be like 4 hours away from anything but at least get paid brotha. Quit this nonsense job and take the high paying job, pay them back and move on. How much is your life worth?

 

[scarbrtj]

One of the first hosp contracts I signed was income guarantee type thing; did my own billing as a PC but hospital guaranteed a set amount per month on front end before things ramped up. Was a three year contract. If I left before the three years, I had to repay the TOTALITY of what they had paid me. Which woulda been >150K.

 

[RickyScott]

One of the first hosp contracts I signed was income guarantee type thing; did my own billing as a PC but hospital guaranteed a set amount per month on front end before things ramped up. Was a three year contract. If I left before the three years, I had to repay the TOTALITY of what they had paid me. Which woulda been >150K.

I think it is reasonable if you are recruited at a high MGMA to put this in contract. Obviously the supply and demand for radiation oncologists dictates if they can get away with this. I would hate to end up with a primary care level salary (250-300k) in the middle of nowhere, locked down for 3 years. (Then in 3 years you have another short window to find a job in a crappy job market or they lock you down again?) I dont know how common this is presently, but 5-7 years from now for present medical students?

 

[deleted1002574]

Anyone try to do calcs based on current volumes and potential APM rates? It seems like it’s even hard to try to make an estimate because of the complexity / multipliers / discounts.

 

[deleted941485]

Anyone try to do calcs based on current volumes and potential APM rates? It seems like it’s even hard to try to make an estimate because of the complexity / multipliers / discounts.

Like most things it’s opaque no one knows what the rates will be so the calls are futile. Hypo frac is already killing small PC groups not really sure APM will help

 

[xrthopeful]

Like most things it’s opaque no one knows what the rates will be so the calls are futile. Hypo frac is already killing small PC groups not really sure APM will help

if it's killing PC groups, sounds like their business plan was pure trash.

better luck next time.

 

[RickyScott]

if it's killing PC groups, sounds like their business plan was pure trash.

better luck next time.

Very well may be true, but still lost jobs and worsening of labor issue. APM will worsen this, by making unprofitable practices that are sustained by overutilization.

 

[xrthopeful]

Very well may be true, but still lost jobs and worsening of labor issue. APM will worsen this, by making unprofitable practices that are sustained by overutilization.

I don't disagree I'm just saying that if its true that hypofrac (of breast patients, because anyone close to being financially 'killed' because of hypofrac surely isn't doing prostate hypofrac) is killing any current practices, then they have their financials all ****ed up.

 

[Mandelin Rain]

I mean that's not really fair. At all. 15 patients can become 10 pretty quick if you're choosing wisely. One is barely sustainable for a PC group to staff. One is not.

 

[deleted1002574]

The point is fair- if your practice hasn’t changed to 15-20 fx for breast, 1-5 or at least 10 or less for bone mets, and consideration of hypofx for selected prostate patients in 2019 then you’re getting what you deserve.

We took over a private group’s contract recently and everything, and I mean EVERYTHING had been done in 1.8s.

 

[Mandelin Rain]

The point is fair- if your practice hasn’t changed to 15-20 fx for breast, 1-5 or at least 10 or less for bone mets, and consideration of hypofx for selected prostate patients in 2019 then you’re getting what you deserve.

We took over a private group’s contract recently and everything, and I mean EVERYTHING had been done in 1.8s.

The point was moving to hypofractionated XRT from where we were 10 years ago is killing some PC groups currently. And it is. You base projections on X, not 0.7X, which is what it's become over the past decade. That's not anyone's fault, poor planning, or screwed up financials. It's the reality of choosing wisely in a FFS model. Contrary to widely held beliefs, most of us want to do right by our patients and do so even when it impacts our bottom line.

Decreasing reimbursement by 8% further and punishing groups that were choosing wisely all along won't be anyone's fault either.

 

[medgator]

if it's killing PC groups, sounds like their business plan was pure trash.

better luck next time.

Yup, they should have known hypofx and academic satellites were coming!

 

[Mandelin Rain]

Our group has taken on small clinic contracts just because they couldn't recruit their own guy and we understood that their patients deserved to be treated too. Taking on some rural site an hour away treating 12-15 patients sometimes isn't bad planning or screwed up financials. Sometimes it's just service. But there's a point where it's just not feasible anymore despite feeling charitable.

 

[scarbrtj]

if it's killing PC groups, sounds like their business plan was pure trash.

better luck next time.

In a few years when most breast/prostate will go from 3-4 weeks/5-6 weeks... to five fractions...

 

[deleted1002574]

The point was moving to hypofractionated XRT from where we were 10 years ago is killing some PC groups currently. And it is. You base projections on X, not 0.7X, which is what it's become over the past decade. That's not anyone's fault, poor planning, or screwed up financials. It's the reality of choosing wisely in a FFS model. Contrary to widely held beliefs, most of us want to do right by our patients and do so even when it impacts our bottom line.

Decreasing reimbursement by 8% further and punishing groups that were choosing wisely all along won't be anyone's fault either.

No, no, I agree. I’m just saying, if you’re getting killed with the transition to APM because you weren’t already “choosing wisely” (what Orwell-ian freaking word choice), then that’s your problem.

Everyone is going to get crushed, but some harder than others.

 

[thecarbonionangle]

Our field will be a wasteland of unemployed physicians.

What’s the difference between a radonc and a large pizza? The pizza can feed a family.

...but also pizza production is driven by supply and demand and we don’t make twice as many pizzas as we need

Whats the difference between a rad onc and a plumber?

 

[RickyScott]

15 patients can become 10 pretty quick if you're choosing wisely..

so true

 

[deleted941485]

I don't disagree I'm just saying that if its true that hypofrac (of breast patients, because anyone close to being financially 'killed' because of hypofrac surely isn't doing prostate hypofrac) is killing any current practices, then they have their financials all ****ed up.

In what way were their financials ****ed up? If you dont own the machines and you’re paid per treatment I’d say the reimbursement structure is what’s screwed up. The group is structured so they can get paid for the work.

 

[SneakyBooger]

Many nonurban cancer centers will likely close.

We might become Canada where many pts drive hours for treatment, if they choose RT. Many won't choose RT.

More breast pts may wisely choose mastectomy. More prostate pts may wisely choose prostatectomy. Many pts in general may wisely choose to forego RT. The rich may choose RT but the poor won't be able to afford the travel/lodging.

So maybe more urban cancer centers will close also.

Time will tell.

 

[RickyScott]

Many nonurban cancer centers will likely close.

We might become Canada where many pts drive hours for treatment, if they choose RT. Many won't choose RT.

More breast pts may wisely choose mastectomy. More prostate pts may wisely choose prostatectomy. Many pts in general may wisely choose to forego RT. The rich may choose RT but the poor won't be able to afford the travel/lodging.

So maybe more urban cancer centers will close also.

Time will tell.

I think this is really unlikely. There is a huge overcapacity of machines in this country, so there is plenty of room for consolidation. A linac can easily have 30-35 pts. ( 4 pts an hour) In many suburban hospitals/centers, because of neighboring competition, they are far below that. Yes, there are places with 50 on a machine, but in my experience, because of competition, in the community of many large cities, the low 20s is common. For a long time, this field needed high 20s to sustain linac, IMRT changed that. Job market implications are obvious. This was posted before, but article is very relevant today. Instead of 21C it is the universities.

Beams and Schemes

Daniel Dosoretz's chain of radiation oncology treatment centers has gotten big fast. How exactly did that happen?

www.forbes.com

"Many communities have five radiation centers that should have one or two," says Kevin Gross, president of Universal Health Services , a national hospital chain that also provides radiation therapy." and this was 2006!

"Last year he bought a radiation center in Santa Monica, Calif. run by Michael Steinberg, a member of an influential trade group that advises Medicare on how to set rates for the latest technologies."

 

[deleted1002574]

Many nonurban cancer centers will likely close.

We might become Canada where many pts drive hours for treatment, if they choose RT. Many won't choose RT.

More breast pts may wisely choose mastectomy. More prostate pts may wisely choose prostatectomy. Many pts in general may wisely choose to forego RT. The rich may choose RT but the poor won't be able to afford the travel/lodging.

So maybe more urban cancer centers will close also.

Time will tell.

This is what happens when you have urban/rural maldistribution issues.

Notable: "Increased distance to radiotherapy ... associated with poorer cancer outcomes."

 

[Mandelin Rain]

FWIW, we have a locums therapist who works at an academic satellite part time. Before she got to our clinic, he/she had never heard of hypofractionation. Like looked at us like we had two heads each when we said breast patients get 3 weeks and prostates get 4 weeks. Literally, all the satellite's breast/prostate patients get full course. In 2019, mind you. Some big names staff said clinic.

My guess is that if they "choose wisely" the clinic wouldn't be worth the hassle to staff.

Things like this are always interesting to me.

 

[medgator]

I mean that's not really fair. At all. 15 patients can become 10 pretty quick if you're choosing wisely. One is barely sustainable for a PC group to staff. One is not.

Cmon, don't expect certain posters to have real world knowledge of these things.

FWIW, we have a locums therapist who works at an academic satellite part time. Before she got to our clinic, he/she had never heard of hypofractionation. Like looked at us like we had two heads each when we said breast patients get 3 weeks and prostates get 4 weeks. Literally, all the satellite's breast/prostate patients get full course. In 2019, mind you. Some big names staff said clinic.

My guess is that if they "choose wisely" the clinic wouldn't be worth the hassle to staff.

Things like this are always interesting to me.

Do as I say, not as I do.

 

[evilbooyaa]

Play nice in the sandbox, kiddos. Respect your fellow SDN member, even if you disagree with them. Multiple posts deleted.

 

[Doctorer]

For those of you that made a jump a few years in, what was that process like? Did you end up feeling a few people out at ASTRO? Go to some on-site interviews? Take the first offer available?

 

[medgator]

For those of you that made a jump a few years in, what was that process like? Did you end up feeling a few people out at ASTRO? Go to some on-site interviews? Take the first offer available?

Keep in touch with folks at practices where you have connections and have an interest in relocating to

 

[xrthopeful]

Almost half the people I know made a job change in The first three years

 

[deleted941485]

Almost half the people I know made a job change in The first three years

I believe my good from who did Derm holds the record. Changed jobs after 6 months. Boss was a douche and the patients were train wrecks. Been at his new place 2 years now.