Strategies for job search

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Doctorer said:
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?
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Radiation Oncology for the last decade I've been following it has been known for geographic job issues. When I was entering medical school way back when the conventional wisdom was that something like 2/3 of new residents change jobs within the first few years. I have since seen that play out in my friends and ultimately my life!

medgator said:
Keep in touch with folks at practices where you have connections and have an interest in relocating to
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This was key for me, and the people I know. The ultimate path to the dream job in Rad Onc is to make connections with your dream practice(s), then network with them from your PGY-2-PGY-5 year. Then at the beginning of PGY-5, you reach out to see what their needs will be. If they have a job, GREAT. Most likely it will be something like, "We have a partner that is retiring soon, so nothing now but maybe in the next 1-2 years." Or, "We have some expansion opportunities that we are waiting to be finalized, but maybe in the next 1-2 years." So you go about your job hunt and take the best job you can elsewhere. Then, you stay in touch! And lo and behold, in 1-2 years they say, "Guess what! We now have opening you still interested? We'd love to fly you out." Then you go out and then you face the difficult decision as to whether you uproot your life again to move. I've seen some people end up loving their first job so much they stay put, and I've seen others jump on their dream job and ride of into the sunset.

Anyway, the modern (at least the last 10 years) path for getting the dream job is the above. Hope it helps!
 
Sheldor said:
Radiation Oncology for the last decade I've been following it has been known for geographic job issues. When I was entering medical school way back when the conventional wisdom was that something like 2/3 of new residents change jobs within the first few years. I have since seen that play out in my friends and ultimately my life!



This was key for me, and the people I know. The ultimate path to the dream job in Rad Onc is to make connections with your dream practice(s), then network with them from your PGY-2-PGY-5 year. Then at the beginning of PGY-5, you reach out to see what their needs will be. If they have a job, GREAT. Most likely it will be something like, "We have a partner that is retiring soon, so nothing now but maybe in the next 1-2 years." Or, "We have some expansion opportunities that we are waiting to be finalized, but maybe in the next 1-2 years." So you go about your job hunt and take the best job you can elsewhere. Then, you stay in touch! And lo and behold, in 1-2 years they say, "Guess what! We now have opening you still interested? We'd love to fly you out." Then you go out and then you face the difficult decision as to whether you uproot your life again to move. I've seen some people end up loving their first job so much they stay put, and I've seen others jump on their dream job and ride of into the sunset.

Anyway, the modern (at least the last 10 years) path for getting the dream job is the above. Hope it helps!
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not really, the worsening job market will lock most into their first job, Lateral movement is clearly plummeting.
 
RickyScott said:
not really, the worsening job market will lock most into their first job, Lateral movement is clearly plummeting.
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Maybe someday, but not right now. I know many people doing this right now. I did this. And I know people interviewing for lateral job moves getting more interviews than they can attend.

This isn't really a thread to crap on Rad Onc, you may be right, but as of right now this is/was my experience and that of those I know currently.
 
Sheldor said:
Maybe someday, but not right now. I know many people doing this right now. I did this. And I know people interviewing for lateral job moves getting more interviews than they can attend.

This isn't really a thread to crap on Rad Onc, you may be right, but as of right now this is/was my experience and that of those I know currently.
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'
Thank you for posting this.
 
Sheldor said:
Maybe someday, but not right now. I know many people doing this right now. I did this. And I know people interviewing for lateral job moves getting more interviews than they can attend.
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There still is a finite demand for us.

But it goes to show why very few decent jobs make it to the ASTRO site anymore
 
xrthopeful said:
Almost half the people I know made a job change in The first three years
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I've always heard the statistic that half change jobs in their first 2 years, and another half change in the 2 years to follow, but I'm not sure I've seen those statistics play out in my co-residents. We constantly complain about our jobs, but very few have actually moved.
 
Sheldor said:
RickyScott said:
not really, the worsening job market will lock most into their first job, Lateral movement is clearly plummeting.

Maybe someday, but not right now. I know many people doing this right now. I did this. And I know people interviewing for lateral job moves getting more interviews than they can attend.
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“Many people” moving jobs early in career right now is not really more so, or less so, a positive thing vs extreme job movement inflexibility. Speaks to a commoditization which is one classic sign in economics of oversupply. And while not easily taken over by a machine as we have debated here often, one primary “work” of the rad onc is no work at all; namely, just to be present. I believe administrators would argue this is THE primary role of the rad onc: be present when patients are treated. They couldn't care less what we do outside that. This has resulted in further commoditization IMHO. So an increase in job migration can indicate workers trying to find increased value for their labor and hirers unwilling to pay workers more to keep them where they are. I too feel like movement is def on an upswing.
 
scarbrtj said:
“Many people” moving jobs early in career right now is not really more so, or less so, a positive thing vs extreme job movement inflexibility. Speaks to a commoditization which is one classic sign in economics of oversupply. And while not easily taken over by a machine as we have debated here often, one primary “work” of the rad onc is no work at all; namely, just to be present. I believe administrators would argue this is THE primary role of the rad onc: be present when patients are treated. They couldn't care less what we do outside that. This has resulted in further commoditization IMHO. So an increase in job migration can indicate workers trying to find increased value for their labor and hirers unwilling to pay workers more to keep them where they are. I too feel like movement is def on an upswing.
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So how about not droning on about this point endlessly on a public forum where said adminstrators could "find out"?
 
scarbrtj said:
That's one tack to take.
"In the 2013 physician fee schedule, CMS abandoned its traditional reliance on the RUC analysis in favor of online... materials to determine how long it takes to treat patients with radiation therapy."
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Why omit certain words that completely change what you have evidence for?

"CMS abandoned its traditional reliance on the RUC analysis in favor of online patient education materials to determine how long it takes to treat patients with radiation therapy "

SDN is not 'online patient education materials'.

Is the point that data that doesn't support your point can be edited to make it seem like it is?
 
Does anyone think that there has been an improvement in quality of care or any benefit to patients with the advent of the Medicare provision requiring physician presence?

“Online patient education materials” or “online ... materials” ?? Doesn’t really matter when the point is instead they are not looking at the RUC analysis (which pretty much defines every other payment schedule).

Give me a break. Despite his circumlocutory verbosity, Scarb is not wrong. If you think about it, if that ridiculous rule had not occurred, the job shortage would be even more profound. I guess the government could make up more rules to protect jobs. But saving high paying physicians aren’t going to win you MI or PA.
 
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evilbooyaa said:
Why omit certain words that completely change what you have evidence for?

"CMS abandoned its traditional reliance on the RUC analysis in favor of online patient education materials to determine how long it takes to treat patients with radiation therapy "

SDN is not 'online patient education materials'.

Is the point that data that doesn't support your point can be edited to make it seem like it is?
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The point is that online dissemination of information in many various forms can have consequences. And everyone's got a Google nowadays, including administrators. And CMSers. Etc.
 
rad0nccc said:
If this goes away we are all ****ed beyond recognition. Like quit-residency-immediately-even-if-you’re-a PGY-5-level of ****ed.
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Yeah im not sure arguing with rules of physician presence should even be a thing we talk about
 
Doctorer said:
I've always heard the statistic that half change jobs in their first 2 years, and another half change in the 2 years to follow, but I'm not sure I've seen those statistics play out in my co-residents. We constantly complain about our jobs, but very few have actually moved.
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Out of the 10 rad oncs that I know that have graduated between 2 and 6 years ago 3 of 10 have changed jobs after their first position and probably 4 more would if they could find something better.
 
I think I'm weird in that I'm slightly more bullish on job prospects for grads in the short term (barring a recession, which will make it a disaster) than most posters here, but I'm WAY more bearish on the long term prospects of this field as a whole.

Perhaps Scar is in the same boat.
 
I don’t know about being bearish long-term. As systemic treatment continues to improve, the importance of SBRT for oligomets will increase as well. I agree with Bob Timmerman and think it’s going to be an increasingly large percentage of our practices moving forward.

Edit: this is for “the field” as a whole. With respect to employment prospects, obviously only until residency numbers align with MD demand will we see things return to “normal”, whatever that is.
 
OTN said:
I don’t know about being bearish long-term. As systemic treatment continues to improve, the importance of SBRT for oligomets will increase as well. I agree with Bob Timmerman and think it’s going to be an increasingly large percentage of our practices moving forward.

Edit: this is for “the field” as a whole. With respect to employment prospects, obviously only until residency numbers align with MD demand will we see things return to “normal”, whatever that is.
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Agree. I've always posited that we were in a good place last decade at 110-130/year, with increasing aging of the population being counteracted by trends towards sbrt/hypofx and surveillance in some cases.

Increasing use of sbrt for oligometastatic disease would not make me change my assumptions above
 
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The oligomet thing doesn't move the needle for me. You know who else treats oligomets? IR doctors. And they can read CTs and utilize XRays. See spot, treat spot. Very technician sounding.

I think if oligomets become too "large" a part of what we do, it almost becomes one of our largest existential threats.
 
Mandelin Rain said:
The oligomet thing doesn't move the needle for me. You know who else treats oligomets? IR doctors. And they can read CTs and utilize XRays. See spot, treat spot. Very technician sounding.

I think if oligomets become too "large" a part of what we do, it almost becomes one of our largest existential threats.
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Yup.. sbrt for lung > rfa but unscrupulous ir docs don't care. But for liver, there is a lot more data to support tace etc although sbrt has been gaining traction.

Both liver, lung, and even bone mets are going to be IR vs rad onc battlegrounds. Would not be enthused if we are hanging our hats on that. Prostate, breast, h&n and skin are our core and no reason to give up on them
 
Mandelin Rain said:
The oligomet thing doesn't move the needle for me. You know who else treats oligomets? IR doctors. And they can read CTs and utilize XRays. See spot, treat spot. Very technician sounding.

I think if oligomets become too "large" a part of what we do, it almost becomes one of our largest existential threats.
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Hmm. We order tons of pet scans, mri, and cat scans for follow up. At least I do. If rads group not playing fair or offering Rfa for lesions that they seen in scans that I order, all that imaging will go elsewhere
 
medgator said:
Both liver, lung, and even bone mets are going to be IR vs rad onc battlegrounds. Would not be enthused if we are hanging our hats on that. Prostate, breast, h&n and skin are our core and no reason to give up on them
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I know IRs who try to get painful bone met referrals to do RFA and cementing without ever getting rad onc involved. Y90 has been totally taken over by IR in many markets. And then there are posts like this: Why can't a Neurorad/msk(or dual certified in them) do a neurophys/electrodiagnosis/EMG NCS fellowship and why can't INR do gamma knife procedures?
 
My 2 cents.....

1. "You can wait until later in the year because there will be less competition."

I agree with the OP that this is risky... especially if you have a family depending on you or if you have geographic restrictions. 50% of our class accepted positions in geographic areas in which they had no interest in living due to job market. The other 50% held out in hopes of landing a job they actually wanted and graduated without having a contract signed. One resident ended up getting an offer for $450K in a major metro area that the majority would consider "very desirable". This resident actually had some negotiating power because the job needed to be filled and there weren't many other residents competing. I held out because a group I had interviewed with in December of 2018 was expanding and offered me the position once the cancer center was completed... which would not be until Spring of 2020. It was a private group, located in the exact area I wanted to live in and I would have a fully loaded, brand new linac.... but if I wanted the job I would have to find something to do until the position was available (see below).

2. "If you don't find a job, you can do locums."

As someone who is doing this... I can confirm that this is NOT the cake walk some make it out to be. There are very few full time (or close to full time) locums positions available. I managed to find one of them that will last me until my position is available... but that was mostly due to luck. There MAY have been a few other such opportunities in the United States... but if even a handful of residents take this approach there will be none. There are quite a few short (i.e. days) assignments available... but not every assignment is available through every locums company. In order to take advantage of this you will have to be credentialed with multiple locums companies (I am credentialed through 5 different companies). Furthermore, you will need to have a state license in that state in order to practice.... which can take 6-8 weeks in some case (the locums company does pay all fees). So even if something is available you might not be able to take it. I didn't really start looking until the week after boards and ended up going 2.5 months only surviving on savings, credit and 7 days of locums in the state I already had a license. I am single and don't have kids so I could take the risk... but I was one week away from not being able to pay my rent. If you take this route be sure to start looking 8-10 weeks before your last paycheck.

3. "You can easily leave your first job if you don't like it."

The major issue I encountered here was coverage of "tail" malpractice. This is the coverage that is necessary for the patients you treated at that location once you have left. The first contract I reviewed required that if I was to be the one initiating the termination that I would have to pay this myself. Another trick is that they will make the non-compete absurdly extensive. 21C is notorious for this in that they try to include EVERY center they own or are affiliated with in the country. The group I interviewed with had multiple locations throughout the state and tried to include all of them in the non-compete. I was able to convince them to only include the locations I actually practiced at... exclusive of coverage for other physician's absences.
 
RadRadRad said:
Hmm. We order tons of pet scans, mri, and cat scans for follow up. At least I do. If rads group not playing fair or offering Rfa for lesions that they seen in scans that I order, all that imaging will go elsewhere
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I stopped sending biopsies to the unscrupulous IR group in town. Instead of doing the $#&!@ biopsy, they would bring them in for a consult, do the biopsy and then bring them back in for fu to go over path and hardsell RFA.

They would biopsy lung nodules sent in for referral FOR A BIOPSY by myself or someone else, and RFA without so much as getting a pulm or CT surgeon involved, let alone obtain any baseline PFTs.

Personally have zero interest in a combined IR/RO training program, based on the above. Probably need way too much training in oncology (with some ethics thrown in) to make sense
 
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We had IR who was getting referrals for portacaths and instead offering upfront y90 to newly diagnosed breast cancer patients with liver mets who were chemo and hormone blockade naive. He subsequently lost majority of y90 referrals and portacaths to another IR in town.

medgator said:
I stopped sending biopsies to the unscrupulous IR group in town. Instead of doing the $#&!@ biopsy, they would bring them in for a consult, do the biopsy and then bring them back in for fu to go over path and hardsell RFA.

They would biopsy lung nodules sent in for referral FOR A BIOPSY by myself or someone else, and RFA without so much as getting a pulm or CT surgeon involved, let alone obtain any baseline PFTs.

Personally have zero interest in a combined IR/RO training program, based on the above. Probably need way too much training in oncology (with some ethics thrown in) to make sense
Click to expand...
 
medgator said:
I stopped sending biopsies to the unscrupulous IR group in town. Instead of doing the $#&!@ biopsy, they would bring them in for a consult, do the biopsy and then bring them back in for fu to go over path and hardsell RFA.

They would biopsy lung nodules sent in for referral FOR A BIOPSY by myself or someone else, and RFA without so much as getting a pulm or CT surgeon involved, let alone obtain any baseline PFTs.

Personally have zero interest in a combined IR/RO training program, based on the above. Probably need way too much training in oncology (with some ethics thrown in) to make sense
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Happened in our town as well, but referrals to that provider from us dried up instantaneously.

One benefit of a combined IR/RO approach would be that the IR training would actually be oncologic in nature, so rather than "see a lesion and treat it" type IR docs, you could have someone with a better understanding of the entire oncologic course of care.
 
In light of false information about there being >200 positions posted on ASTRO jobs on an yearly basis. I want to clarify:

There was only about ~120 independent new jobs posted on ASTRO jobs when I was a PGY5 resident last year. I know because I wrote down every job advertised on an excel spreadsheet. This is no where close to the >200 residents graduating every year unless there is just tons of unadvertised jobs out there. I don't know. All the grads I know from last year found jobs using ASTRO jobs or another online website.

If you really want to know how many jobs there are out there. We should create a google doc just like the med students.
 
well of course there are a ton of unadvertised jobs, both academic and PP, but more PP.

that's RadOnc 101.
 
SDN has always been the place to share and gain information candidly. It gives voice to the voiceless majority. My hospital MBA admin just asked me this week whether I would consider working part time 3 days a week for ~170K with the new supervision requirement. They would then pay me a daily rate if there were emergency consults or sim/tx needed. I am glad that I signed a three year contract at my current ~250K salary. At least I have a full time job this way.

The next rounds of graduates replacing me though will be looking at ~170K for 3 days/week of work. I guess Ralph's prediction is correct. In radiation oncology you will work for pediatrician pay, internist hours, and have the job stability of a temp worker.

Graduates, sign your contract ASAP.
 
Remember the debate scene of Big Short where Steve Carrell’s character is warning everyone about the coming crisis and how the corruption and greed of those in power have lead to it. Then the academic looking guy is telling everyone everything is fine and now is the time to buy. And while it’s happening Lehman Brothers goes to zero and Carrell just says, “Boom.”

Well... “Boom.”
 
radoncradonc said:
SDN has always been the place to share and gain information candidly. It gives voice to the voiceless majority. My hospital MBA admin just asked me this week whether I would consider working part time 3 days a week for ~170K with the new supervision requirement. They would then pay me a daily rate if there were emergency consults or sim/tx needed. I am glad that I signed a three year contract at my current ~250K salary. At least I have a full time job this way.

The next rounds of graduates replacing me though will be looking at ~170K for 3 days/week of work. I guess Ralph's prediction is correct. In radiation oncology you will work for pediatrician pay, internist hours, and have the job stability of a temp worker.

Graduates, sign your contract ASAP.
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WOW. I guarantee multiple more people on here will share similar stories soon. Havent made partner yet? Guesa what your group may not need you anymore. You ain’t as necessary as you think!
 
Mandelin Rain said:
Remember the debate scene of Big Short where Steve Carrell’s character is warning everyone about the coming crisis and how the corruption and greed of those in power have lead to it. Then the academic looking guy is telling everyone everything is fine and now is the time to buy. And while it’s happening Lehman Brothers goes to zero and Carrell just says, “Boom.”

Well... “Boom.”
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+1

Rad onc. Needed a correction. Sad to say for all of us because we're going to bear the brunt.

I personally know of two bad stories in the past week. Won't elaborate 'cause it's redundant at this point. I will say if MGMA says rad onc salaries are increasing next go 'round they're lying liars.

I am not joking... You know in China how they have the re-education camps. Maybe ACGME can set up something like that for us. I love lamp. I love psych.
 
scarbrtj said:
+1

Rad onc. Needed a correction. Sad to say for all of us because we're going to bear the brunt.

I personally know of two bad stories in the past week. Won't elaborate 'cause it's redundant at this point. I will say if MGMA says rad onc salaries are increasing next go 'round they're lying liars.

I am not joking... You know in China how they have the re-education camps. Maybe ACGME can set up something like that for us. I love lamp. I love psych.
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I’d say tell the stories. The more knowledge we have of what’s happening the more difficult it will be for others to deny.
 
Just tell them I’m very general generalities so people know what to expect.

i.e. offer pulled and contract voided
 
radoncradonc said:
SDN has always been the place to share and gain information candidly. It gives voice to the voiceless majority. My hospital MBA admin just asked me this week whether I would consider working part time 3 days a week for ~170K with the new supervision requirement. They would then pay me a daily rate if there were emergency consults or sim/tx needed. I am glad that I signed a three year contract at my current ~250K salary. At least I have a full time job this way.

The next rounds of graduates replacing me though will be looking at ~170K for 3 days/week of work. I guess Ralph's prediction is correct. In radiation oncology you will work for pediatrician pay, internist hours, and have the job stability of a temp worker.

Graduates, sign your contract ASAP.
Click to expand...

Just got a call from a local hospital I previously declined to staff...they heard about the supervision change and feel my concerns about coverage not being worth my time are now allayed since my group wouldn't have to send a full-timer over. (Location is currently staffed by 2 Rad Oncs).
 
OTN said:
I’d say tell the stories. The more knowledge we have of what’s happening the more difficult it will be for others to deny.
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Two docs hired by previous single doc MDs pressured by admins to hire ~5y ago due to supervision/coverage. In towns that end in "-ville." Now their jobs are superfluous. The two have found out in last week but graciously being given time to find somewhere "where they're needed."
Reaganite said:
Just got a call from a local hospital I previously declined to staff...they heard about the supervision change and feel my concerns about coverage not being worth my time are now allayed since my group wouldn't have to send a full-timer over. (Location is currently staffed by 2 Rad Oncs).
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The supervision thing was always (mostly) a CYA kabuki for the admins. Now they're like cry havoc and let slip the dogs of war.
 
Nobody I know is actively letting physicians go but many are scrapping plans to hire any time soon (and some are even considering delaying retirement because they had planned to go part time or do locums/coverage for supplemental income, which isn’t an option anymore) and literally everybody is figuring out how to capitalize on the change (SBRT and sims every other day, maybe keep an ultra rural center with an old machine open for bone mets, etc). Everything boils down to the need for less physician labor.

I’ve tried to keep optimistic but this is obviously absolute disaster for new graduates. As I’ve stated many times I’d do my job for a 50% pay cut but not a 100% pay cut and 0% job!!!

What in the world are the new graduates supposed to do?
 
Very surprised admins are acting so quickly.

radoncradonc said:
SDN has always been the place to share and gain information candidly. It gives voice to the voiceless majority. My hospital MBA admin just asked me this week whether I would consider working part time 3 days a week for ~170K with the new supervision requirement. They would then pay me a daily rate if there were emergency consults or sim/tx needed. I am glad that I signed a three year contract at my current ~250K salary. At least I have a full time job this way.

The next rounds of graduates replacing me though will be looking at ~170K for 3 days/week of work. I guess Ralph's prediction is correct. In radiation oncology you will work for pediatrician pay, internist hours, and have the job stability of a temp worker.

Graduates, sign your contract ASAP.
Click to expand...
 
medgator said:
I'm not surprised at all. Their bonuses depend on financial metrics (aka saving their system $$$)
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Neither am I. It's why I think if students/residents/faculty are interested in learning more about the impacts of APM and direct-to-general, they should be speaking with the billing department and operations managers, not attending physicians/professors.
 
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