muskie2016

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My spouse is applying to surgical oncology fellowships this year. We're wondering what kind of pay he can expect once he graduates from a fellowship and over the course of his career. My husband thinks it will be low 200s, but I find that hard to believe especially given how competitive it is. His passion and interest lies in surgical onc, but it's depressing to think after 7 stressful residency years he'll be making much lower than other subspecialties.

Does anyone know what a surgical oncologist who graduates from a tier 1 or tier 2 fellowship can expect to make (w/o bonus)? We live in the midwest but are open geographically. I've seen huge ranges from 200s to 350s.
 
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ACSurgeon

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My spouse is applying to surgical oncology fellowships this year. We're wondering what kind of pay he can expect once he graduates from a fellowship and over the course of his career. My husband thinks it will be low 200s, but I find that hard to believe especially given how competitive it is. His passion and interest lies in surgical onc, but it's depressing to think after 7 stressful residency years he'll be making much lower than other subspecialties.

Does anyone know what a surgical oncologist who graduates from a tier 1 or tier 2 fellowship can expect to make (w/o bonus)? We live in the midwest but are open geographically. I've seen huge ranges from 200s to 350s.
Academic jobs will start in the 250k range. He can eventually make 500k+ if he becomes a bigwig. You start out working hard and earning very little, but as you get older you make more without working as hard.

Private: in the Midwest you can start in the 350-450 range. After the first couple of years, your income depends on how hard you work (how many patients you see).
 
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DoctwoB

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My spouse is applying to surgical oncology fellowships this year. We're wondering what kind of pay he can expect once he graduates from a fellowship and over the course of his career. My husband thinks it will be low 200s, but I find that hard to believe especially given how competitive it is. His passion and interest lies in surgical onc, but it's depressing to think after 7 stressful residency years he'll be making much lower than other subspecialties.

Does anyone know what a surgical oncologist who graduates from a tier 1 or tier 2 fellowship can expect to make (w/o bonus)? We live in the midwest but are open geographically. I've seen huge ranges from 200s to 350s.
Surg onc average may be lower then expected due to the fact that it's a self selected population with a lot of people who stay in academics. In PP it should be at least equal to if not higher then PP gensurg.
 
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muskie2016

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Academic jobs will start in the 250k range. He can eventually make 500k+ if he becomes a bigwig. You start out working hard and earning very little, but as you get older you make more without working as hard.

Private: in the Midwest you can start in the 350-450 range. After the first couple of years, your income depends on how hard you work (how many patients you see).
Thanks for your response! He wants to stay academic because he is really interested in continuing his research.

Would you say that the pay and lifestyle is pretty in-line with other specialties i.e. trauma, transplant, gen surg? He's expressed interest in these before.
Also, if surg onc pays lower, what's the big incentive for people to go in to it and why is it so competitive? Is it lifestyle? Difficulty of cases?
 

Trauma Surgeon

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Also, if surg onc pays lower, what's the big incentive for people to go in to it and why is it so competitive? Is it lifestyle? Difficulty of cases?[/QUOTE]
We are a rare breed but still so many so there is a competition; the stubborn and self destructive surgeons whom for some reason want to boost our egos by having the surgical community worship us for all we do for our field and our patients!
Please, don't try to understand us, since we our selfs don't really know why we do it, the lifestyle sucks, the pay is awful (I have offers that pay x3 if I would go to PP or smaller hospital!), and the research and work environment can only be described as malignant and hostile.
 

ACSurgeon

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Thanks for your response! He wants to stay academic because he is really interested in continuing his research.

Would you say that the pay and lifestyle is pretty in-line with other specialties i.e. trauma, transplant, gen surg? He's expressed interest in these before.
Also, if surg onc pays lower, what's the big incentive for people to go in to it and why is it so competitive? Is it lifestyle? Difficulty of cases?
The pay is similar at academic centers. A breast surgeon working normal business hours earns the same as a trauma surgeon who takes in house call and works more nights/weekends/holidays.

You'll find some academic jobs that compensate doctors based on productivity, but true academic jobs pay you based on rank more than how hard you work or the exact nature of your work.
 

OTOSwap

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It depends on the job. I know those in surg onc that make around 350 but the hospital makes them enter the general surgery call pool versus doing strictly surg onc. I think it really varies on region and what other requirements the hospital imposes on the surgeon.
 

vhawk

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Agree with all the above, if you look at the MGMA data or the AAMC data, surgical oncology has the LOWEST median salaries among all the general surgery specialties, including general surgery itself. Basically surgical oncologists are masochists.
 

SouthernSurgeon

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Thanks for your response! He wants to stay academic because he is really interested in continuing his research.

Would you say that the pay and lifestyle is pretty in-line with other specialties i.e. trauma, transplant, gen surg? He's expressed interest in these before.
Also, if surg onc pays lower, what's the big incentive for people to go in to it and why is it so competitive? Is it lifestyle? Difficulty of cases?
One thing about surg onc is that it is one of the most academic specialties out there. This both skews the competitiveness (since research years are a near requirement), and skews the jobs people are looking at afterwards.

More people taking academic jobs --> lower mean salary.

While low 200s isn't something you have to worry about, high 200s is not uncommon for starting assistant professor level jobs in academia. There are often some hidden bonuses/incentives other than the base pay in those contracts depending on the institution.

As for the competitiveness of surg onc? I think it's (a) as I mentioned that it is heavily academic, which is desirable to a certain subset of the surgical community, (b) it is, traditionally, where you go to get trained to do whipples/HPB surgery, which is in many people's mind the be all/end all of general surgery, (c) it offers clinical diversity that you don't get in a lot of other fellowships, and (d) it's just a small field so the competition is to some degree a supply/demand issue.
 

SLUser11

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The pay is similar at academic centers. A breast surgeon working normal business hours earns the same as a trauma surgeon who takes in house call and works more nights/weekends/holidays.

You'll find some academic jobs that compensate doctors based on productivity, but true academic jobs pay you based on rank more than how hard you work or the exact nature of your work.
I said something similar about this in the past, but my experience has been that there is still a disparity in pay between surgical subspecialties in academia. Clinical productivity is more important than it used to be, which has a somewhat negative impact on education, as it's a lot harder to be patient with the resident flopping around when I have 2 more big cases to get done that day.

Surgical oncologists do long surgeries and then follow patients for free for 90 days. It's obviously dependent on their case mix, which can be quite diverse depending on geography and competing subspecialists, but most SOs that I've met generate less RVUs...they see less patients, have long conversations, and ultimately have to say "no" a lot. Therefore, it's not too surprising that they make a little bit less than their busier colleagues. This is, of course, separate from any research funding, etc that they receive.

The hard thing in academics is that everyone is a specialist, so the surgical oncologist's particular set of skills is not seen as more valuable than the vascular/trauma/endocrine/colorectal/bariatric/breast/etc surgeons.

That being said, most surgical oncologists that I know are very happy with their jobs, and none of them are starving. Starting pay is a lot different than what you make in the long-term.
 

vhawk

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Also its been published on a few times but we are a bit overdue for a revamping of the RVU system. There is very poor correlation between the number of RVUs for a given procedure and its likely operative time and risk profile, i.e. its "difficulty." This is bad if the point of the RVU system is to try to approximate the value of a surgeons time and effort, which is more or less the stated goal, and its also bad in the sense that it sets up some (perhaps mild) perverse incentives. In my own practice, it motivates me very strongly to do as many non-anatomic small liver resections as I can do, and to do as few big-ass whipples with vein recon or even worse big sarcoma cases. I'm not in an RVU model so I dont REALLY have to care about that, but even in "not an RVU model" someone is always keeping track, and bonuses and to a lesser degree even advancement are in some small way tied to it. IOW, at the end of the day, I'd still rather have more RVUs than less.

I think its a good point about how in private practice, a surg onc guy who is capable and willing to do all the godawful horrible bigass dangerous cases is a precious commodity and can demand more in salary, but in academics, EVERYONE is a specialist who does godawful horrible bigass cases. The academic vascular guys arent doing veins all day, the academic colorectal guys arent doing scopes all day. Everyone does hard cases that the community doesnt want to do, so there is less appreciation of the guy doing whipples and trisegs. Rightly so.
 
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filter07

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Seems like the RVU model is just fine. You do not want guys in the community doing a bunch of big whacks just because it generates more reimbursement. It is more efficient for the system for the community guys to do cholecystectomies than everyone in the country doing 1 Whipple every few years. Let the income protected surgeons in the academic centers do the big whacks in their salaried model. Let Cameron do his Whipples and write his thousand page textbooks.
 

vhawk

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Seems like the RVU model is just fine. You do not want guys in the community doing a bunch of big whacks just because it generates more reimbursement. It is more efficient for the system for the community guys to do cholecystectomies than everyone in the country doing 1 Whipple every few years. Let the income protected surgeons in the academic centers do the big whacks in their salaried model. Let Cameron do his Whipples and write his thousand page textbooks.
Which makes sense unless it turns out that human beings respond to incentives.
 
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