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at least they were honest.
lot of practitoners in the states love to dance around the fact
Thoughts from a PGY-5
Started by 20181121
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at least they were honest.
lot of practitoners in the states love to dance around the fact
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deleted18755
Just curious, are the prices for radiation therapy, or medicine in general, relatively standard in wherever you are in Europe. If not, are they at least transparent?
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radoncradonc
Full Member
I know private practice partners who have a full time NP working 1:1 with them and sees only prostate/breast while making the new grad see all the difficult H&N, Gyn, GI, and palliative cases w/o any nurse/NP/PA support. The partners of course work 9-3 three days a week while the new grad works 5 days a week usually 12 hours/day. This practice has gone through multiple new grads w/o offering them partnership btw. When the job market is bad, this is the type of job that's available. At least this job pays more than $250K.
radoncradonc
Full Member
Med students,
The radiologists at my hospital have double my vacation time, 2/3 of my work hours, and make $200K more than I. Most of the radiology new hires are also either FMG or Caribbean grads.
If you want to take care of cancer patients, become a med onc. You will make twice the salary and have location flexibility.
If you are after the lifestyle or money, go into radiology
If you want respect, become a surgical oncologist
The jobs market in rad onc is bad and going to crash soon. There's 1000 new grads waiting for a job in front of you. My hospital already told me that they are looking to hire FMGs who need visa sponsorship and is thus willing to accept very low salaries. I was told that FMGs can work in a rural area for several years to get a green card so they accept very low salaries. This is the future of rad onc. Be aware!
The radiologists at my hospital have double my vacation time, 2/3 of my work hours, and make $200K more than I. Most of the radiology new hires are also either FMG or Caribbean grads.
If you want to take care of cancer patients, become a med onc. You will make twice the salary and have location flexibility.
If you are after the lifestyle or money, go into radiology
If you want respect, become a surgical oncologist
The jobs market in rad onc is bad and going to crash soon. There's 1000 new grads waiting for a job in front of you. My hospital already told me that they are looking to hire FMGs who need visa sponsorship and is thus willing to accept very low salaries. I was told that FMGs can work in a rural area for several years to get a green card so they accept very low salaries. This is the future of rad onc. Be aware!
You ain't kiddin'. Do a job search for "generous vacation package" and "radiation oncology." Goes together like cocaine and waffles. Here's a radiology job that pays 375K a year with 26 weeks annual vacation 😉
I know some folks will wail at the comparison but I don’t know of a rad onc job anywhere in US where you get 26 weeks off. Closest analog would be working 20 hrs/week at someplace like Evicore (offering 2 weeks of vacation a year to start). And they will pay about 120K a year for that.
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Crack waffles sounds really good... is that being served at IHOP now?
When people started arguing against my claim above, I genuinely was not sure if people were joking or trolling. The subsequent posts led me to believe that people were posting serious responses. I don't even know what to say to that!
For what it's worth, I confirmed against my own case logs, and other residents even thought I was underestimating.
My point is that I am now having an even tougher time accepting people's anecdotes and calculations when they are just so far out of line with reality.
"My point is that I am now having an even tougher time accepting
fixed 😉
Are we talking about 50 early stage lung or are we including oligomets?
Average of 4 per rad onc does seem low (and 50 seems high), but some things that may attribute to the low average number of cases:
- Some rad oncs in the community do no have the equipment to do SBRT or are unfamiliar with the technique
- Not a good referral base from pulm or cardiothoracic surgeons.
- Academics that treat breast, prostate, GI, etc - I mean these rad oncs wouldn't treat any early stage lungs with SBRT, right?
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This is exactly what I'm saying. There's only so many ways you can divvy up the care of just ~50,000 Stage I NSCLC patients per year in the U.S., and the surgeons have historically--and still do--dealt with the majority of that ~50,000. Idk what the contribution of the "oligomet bucket" adds to early NSCLC SBRT work. This is unknown to me; I've looked for the data but can't find any reliable data to report. I'd be surprised to find out rad oncs are doing more oligomet SABRing than NSCLC SABRing, but it's possible. Let's say it's
* edited. Still doesn't sound like a ton 🙂
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I'm doing far more oligomet SABRing than stage I NSCLC SABRing.
Between my partner and I we did ~750 SBRT treatments last year.
Scar's anecdotes and calculations were literally just to illustrate a point - for the calculations to be actually "correct" (or close to reality), you have to assume that every SBRT-able lung cancer case is evenly distributed across the country and those patients are evenly distributed among practicing RadOncs.
In practice, this obviously isn't the case. @20181121, I think you and I are probably in similar environments.
Here's the situation for me and my system:
I am at a sprawling academic center with multiple satellites and a giant urban population. My department is large with many attendings and residents. However, only a few of the attendings (2-4 perhaps) do lung SBRT. The majority of our crew do not do lung SBRT. Considering my personal experience (and those dreaded case logs), I think we probably treat 20-40 lung SBRTs a month across our entire system? This is a crude ballpark, but I feel like each of those 2-4 attendings do 0-3 cases a week? Sometimes we get demolished and it's much higher, sometimes the universe says "no patients for you" and it's much lower.
Radiation Oncology is a sprawling, complex enterprise which can make gross generalizations difficult. I can't speak for Scar, but I read his post as just a way to put into perspective lung SBRT in America as a function of the population of patients and Radiation Oncologists.
I completely believe your number of "50 cases in a matter of weeks-to-months". However, I believe you are making that claim based on a large academic medical center, probably a tertiary care center, and not all of your attendings are doing SBRT. Does that sound correct? If you're claiming every attending at your institution is cranking out 50 lung SBRT cases in 4-8 weeks consistently...I find that unlikely, unless you have a very small department.
That is for stage I NSCLC only. I do SBRT far more for stage IV disease than I do for Stage I NSCLC. Like if I've done 100 SBRT cases over the years, I'd be surprised if more than 10 of them were stage I NSCLCs.
Same here, I was actually surprised that my SBRT early stage lung numbers were so low because we do about 3-4 a week and 90% are oligomets.
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This is where relying on oligomets to save the field becomes a VERY dangerous game. If a Phase III trial shows no change in OS and worse toxicity, those current treatments may just *poof* into nothing. At least the ones with private insurance. And... you better be able to defend each Medicare case if audited.
Quite dangerous. I wanted to say this a couple days ago lol but afraid I'd be wah-wah'd. I have been very reticent to dive into the Stage IV spot welding pool. I mean I see a fair number of patients but ain't no way I'm ready to pull the trigger on 750 SABRs a year (to each his own!). The data have been lackluster IMHO. SABR-COMET was a study which to me said don't be SABRing all the mets. And to get a bunch of Stage IV SABR met work, I guess you need med oncs who buy into it. I don't think those people (SABR met patients) are walking in off the street nor are they being plumbed from the depths of our followup visits. So when the referrers (our lord and master med oncs) become uninfatuated with met SABRing, which is a distinct possibility...
So my math work is still intact 😉
Case logs bro.
Full of arguably palliative, not robustly EBM-based care evidently.
Nope. 50 stage I lung patients per month on my service.
750 was between my partner and I at least.
I believe the oligomets data- all the studies seem to point in the direction of an OS benefit, and if I were a patient, I'd want it.
You're right in that getting medonc buy-in is the key.
I mean, I hope it does pan out. Not just for us, but for our patients.
But.... if it doesn't... it seems like a large chunk of your existing practice dries up rather than expanding.
That's a big risk if you're relying on that growth to push the specialty forward. I think it's roughly a 50/50 shot that a Phase III trial could have the exact opposite impact.
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deleted774703
Well damn....
Numbers just depressing. I wonder how hiring practices change when these disease site reimbursement drops dramatically
Let's all give a great big round of applause to #radonctwitter #radoncrocks for leading students off a cliff last 2 years...
www.sciencedirect.com
Numbers just depressing. I wonder how hiring practices change when these disease site reimbursement drops dramatically
Let's all give a great big round of applause to #radonctwitter #radoncrocks for leading students off a cliff last 2 years...
Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM)
The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) r…
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deleted941485
If it’s a fixed payment then why the resistantance to hypofrac?
Well damn....
Numbers just depressing. I wonder how hiring practices change when these disease site reimbursement drops dramatically
Let's all give a great big round of applause to #radonctwitter #radoncrocks for leading students off a cliff last 2 years...
Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM)
The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) r…
Ah, published data in support of the "SDN miscreant narrative".
Nothing to see here, Twiteratti. Move along.
Not all of them have the bundles, yet.
Mayo worrying about the underserved; now that is rich.Well damn....
Numbers just depressing. I wonder how hiring practices change when these disease site reimbursement drops dramatically
Let's all give a great big round of applause to #radonctwitter #radoncrocks for leading students off a cliff last 2 years...
Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM)
The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) r…
They don’t want all the surrounding Rural practices to go belly up, because then they’d have to treat those folks.
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deleted941485
As much as I hate these academic corporate practices, you’re community hospital probably is gonna face a similar fate. I mean a 22 percent reduction in reimbursement for Head and Neck patients seriously? Probably some of the more challenging and sicker patients I take care of on a daily basis. What do they think is gonna happen in an APM? Think I’m gonna put up with the endless mucositis and dehydration and talking about PEG tubes? No I’m punting that nonsense.
Hospitals will start firing therapist to save $$ then fire attendings.
I heard that hospitals have really soured on the bundling of joints and I’m pretty sure the orthopods have as well.
But oh no I’m rad onc where we embrace whatever the govt proposes!
Worst specialty advocacy on the planet.
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deleted774703
its a chicken and egg situation
not enough ppl donate to ASTRO but at same time ASTRO hasn’t shown themselves recently to deserve donations...
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deleted941485
Because all we ever look at is oh they must be smart they went to Yale or MSK and chair an academic Dept they’ll make a great advocate for the rest of the specialty! Newsflash they don’t, they want people to like them more than they want to do well by the specialty.
Honestly had these dynamics been more clear to me 10 years ago I would have told a certain the Arrogant pricks at my home institution to go screw.
The APM is going to lead to big cuts, no matter what formula ends up being published- that's the point. As a result, we will need to make up for reductions in reimbursement per case with increased volume. I'll take ALL those head and neck cases that no one wants.
Our group has 7 radoncs in our city/region, and we met two weeks ago to discuss future plans/strategy/etc. We were unanimous in agreeing that:
a. When one of our older partners retires, we will not be hiring for his replacement and will instead cover his volume ourselves (pending any change in coverage requirements, of course)
b. Any new centers built will be covered by the existing radoncs
c. None of us (other than the single older partner) are going to retire in the next 10-15 years. (Increased residency complement over the last decade means many of us out there practicing are still relatively young.)
In our practice, then, we are anticipating a reduction in our local radonc workforce over the next decade, with zero new hiring to occur. I'm sure this conversation is happening at pp groups all across the country.
Our group has 7 radoncs in our city/region, and we met two weeks ago to discuss future plans/strategy/etc. We were unanimous in agreeing that:
a. When one of our older partners retires, we will not be hiring for his replacement and will instead cover his volume ourselves (pending any change in coverage requirements, of course)
b. Any new centers built will be covered by the existing radoncs
c. None of us (other than the single older partner) are going to retire in the next 10-15 years. (Increased residency complement over the last decade means many of us out there practicing are still relatively young.)
In our practice, then, we are anticipating a reduction in our local radonc workforce over the next decade, with zero new hiring to occur. I'm sure this conversation is happening at pp groups all across the country.
?? What does Vanderbilt have to do with this? I'm not aware of Vanderbilt playing a negative role in this.
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deleted774703
read Vandy radonc attending, dept, and residency twitter and you’ll see
biggest cheerleaders of nothing is wrong and SDN just big mad
This is (a) good news for OTN's group and they should see stable income despite pay cuts and (b) yet another warning to future (and current) rad oncs that the job market isn't going to get better any time soon.
Similarly, my group is looking toward being 'lean and mean' with our future staffing needs. We have 5 retirements within the next 3 years, and I'd be surprised if we replaced more than 1-2 of these guys/gals. However, if you know a good rad onc NP who wants to see easy follow ups and prep notes, I'll happily pay him/her to >average NP salary, and I can focus on running a busy clinic as the only doc.
The future is looking bright indeed!*
*Offer applies only to physicians who have an ownership stake in a stable practice in an economically viable location. Outcomes may vary.
when did that program start? cant be more than 10-15 years old
Can you provide some links supporting this? I can't navigate twitter anymore as I can see what people tweet out and the official account doesn't seem to say anything too outrageous, just cheerleading their own department....
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deleted774703
Def not going to go back for this lol
I will screenshot the next times though and send it out to you.
Update from the front lines:
People I know are seeing more job offers coming in, academic and private (not fellowships).
Would reiterate what I and others have said, that most interviews and offers are coming through word of mouth and that positions are often posted online after they have already been filled, to satisfy HR requirements.
People I know are seeing more job offers coming in, academic and private (not fellowships).
Would reiterate what I and others have said, that most interviews and offers are coming through word of mouth and that positions are often posted online after they have already been filled, to satisfy HR requirements.
xrt jobs are more likely to be posted online than other specialties because radoncs are more likely to be employed by large institutions/academics who have policies that all jobs must be posted. The fact that some of the few jobs online were pre-filled is an even bigger disaster! Divide the number of radonc current jobs by total graduating residents (200) and compare to radiology/IR/neuro/urology/ neurosurgery other specialties and see for yourself we are an order of magnitude off. scarb has done this. Again, those specialties are more likely to have word of mouth jobs than radiation since employers are less dominated by huge instituitions that are required to post jobs, so probably reality is even worse.
That OP is appealing to his self created urban myth of hidden job bank for the well connected is very telling.
Its really hard for OP to get around the basic fact that graduating resident class is double what it was in 2007 just as hypofractionation becomes wide spread, APM on horizon, and declining prostates
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deleted1002574
Always fun to go through current ASTRO job postings
Cook County Hospital / Chicago - "Where the life you save may one day take your own"
3 Fellowships, a few from UF and one from INOVA (it's funny to met that UF has posted more fellowships than actual jobs in the last 3 years)
CCF Mansfield - "Our Meth Is Clinic Approved"
Omaha - probably not a bad gig, actually
"Southern Rad Onc" - has been discussed, something does not feel right about this
Plano, TX - nice suburb of Dallas, but this job has been posted in the last few years, curious to see why they can't keep someone
Locums in The Bay Area - probably the best available job in CA right now
A Hem-Onc Job in VA - for those willing to re-train, VA wine country is gorgeous
Shreveport, LA - "Like if the worst parts of Louisiana and Texas had a child"
Normal, IL - "We are only like 3 hours from Chicago"
Allegheny Network - probably okay, depending on location
Good lord, going through the rest makes me feel sad for those applying ...
Cook County Hospital / Chicago - "Where the life you save may one day take your own"
3 Fellowships, a few from UF and one from INOVA (it's funny to met that UF has posted more fellowships than actual jobs in the last 3 years)
CCF Mansfield - "Our Meth Is Clinic Approved"
Omaha - probably not a bad gig, actually
"Southern Rad Onc" - has been discussed, something does not feel right about this
Plano, TX - nice suburb of Dallas, but this job has been posted in the last few years, curious to see why they can't keep someone
Locums in The Bay Area - probably the best available job in CA right now
A Hem-Onc Job in VA - for those willing to re-train, VA wine country is gorgeous
Shreveport, LA - "Like if the worst parts of Louisiana and Texas had a child"
Normal, IL - "We are only like 3 hours from Chicago"
Allegheny Network - probably okay, depending on location
Good lord, going through the rest makes me feel sad for those applying ...
“Most offers coming through word of mouth”
If you’re deaf and dumb, won’t get a job or pass boards. Just deaf: at least you’ll pass boards.
And the huge drop in incidence of cancer in that little gland is a story that’s currently writing itself in rad onc, the final chapter of which must... MUST... result in a downturn. And need for less rad oncs. And also going to be calamitous for proton centers. The number one dx in many rad onc depts 10y ago was CaP. The incidence is about half today what it was 10y ago.
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This is comparing against peak prostate cancer diagnoses thanks to the advent of PSA testing. Our center and other centers have recently been seeing increasing demand for prostate cancer RT.
Other estimates from better-regarded sources, as I’ve discussed before, actually predict an increase in cancer incidence overall. Other estimates posted here have struck me as surprisingly inaccurate - e.g., current residents would agree with me that someone’s prior claim that MGH treats something like 8 lung SBRTs per year reflects a shockingly low number.
All of my fellow PGY-5s I have talked with - including those at my program and other programs - received offers for jobs that were not publicly advertised or posted. This is of course anecdotal, but nonetheless a large n. Again, we all have jobs, not fellowships, in highly desirable cities.
Just trying to introduce a dose of reality!
Other estimates from better-regarded sources, as I’ve discussed before, actually predict an increase in cancer incidence overall. Other estimates posted here have struck me as surprisingly inaccurate - e.g., current residents would agree with me that someone’s prior claim that MGH treats something like 8 lung SBRTs per year reflects a shockingly low number.
All of my fellow PGY-5s I have talked with - including those at my program and other programs - received offers for jobs that were not publicly advertised or posted. This is of course anecdotal, but nonetheless a large n. Again, we all have jobs, not fellowships, in highly desirable cities.
Just trying to introduce a dose of reality!
The claim was MGH treats 8 SBRT lung patients referred specifically from their lung nodule program. I believe this was in context of an argument that lung screening will greatly increase the demand for XRT as a downstream effect.
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deleted774703
How many PGY5 specifically did you talk to?
5? 10? 20? 100? 150?
Without being more specific, I would urge you to not minimize the issues that are occurring
I think there is benefit here from remembering that "weather" is different than "climate". Just because Michigan still has brutal snowstorms doesn't mean that global warming is a lie. While jobs are currently available (and, honestly, there will always be some level of jobs available), the true impact of oversupply has yet to be felt.
To remind everyone, in the 2016 analysis of supply and demand in RadOnc, by 2025 (5 years from now) "the demand for radiation therapy is expected to increase by 19%".
However, "the supply of radiation oncologist FTEs is expected to increase by 27%".
This study was performed and published before the APM proposal was introduced.
It was also before general supervision was introduced. I think it's safe to say those two factors apply additional downward pressure on the economic calculus.
I am also aware of several PGY5s signing contracts for favorable jobs at my institution as well as outside my institution. However, this is still <10 people because RadOnc is a small field.
Similarly, I have also heard from several people that massage therapy cured their herniated discs. Do I think massage therapy is the best modality for herniated discs...
...wait till I publish my survey analysis with <25% response rate in the Red Journal to hear that answer!
The only reason I'm replying is to make sure to stamp out the fake news.
... incidence may flatline or decrease.*
*even the CDC's 2015 modeling was off. They predicted ~1.9 million cases for 2020 in 2015. But now that we are five years in the future from 2015, and actually in 2020, we can better see the actual 2020 number will be about ~1.8 million for 2020. About 5% less than what the CDC predicted just 5y ago.
So how do you think this is possible. Prostate cancer is, as you know, the most common cancer in men. Number of new cases per year has dropped by ~33% over the last 10y, and we are about 25y out from the advent of PSA testing. The incidence held steady as you can see for many years after this advent (1990-95 time frame).
"Better-regarded sources" is weasel wording and a logical fallacy. Who's predicting this increased incidence in the U.S.? Smoking is on the downswing thus lung CA decreasing, prostate CA trends as noted above. You have previously cited one source which says the number of incident cases will increase in America by <1 million over the next 20 years and this will thus equal a ~1% rise in incidence per year. Surely you can realize that if this one single source's modeling is even mildly off... and follows the recent trend...
... incidence may flatline or decrease.*
I will call you out for weasel wording again ("would agree with me"... that's nice!), and that "someone" is me. And it wasn't a claim. I was simply citing a source which revealed that at a lung nodule clinic at MGH they saw about 140 patients/year which yielded about 8 lung SBRTs a year. Draw conclusions from that as you will. But I have also cited national data showing that over a 10y period about 30,000 (out of ~150,000) patients at most got lung SBRT which translates to about 3,000 cases per year. We can be very confident that no more than ~15,000 patients per year are getting lung ca SBRT in the U.S. This number is where I get the ~3 lung SBRTs for every rad onc in America (on average) metric.
Back to your "better-regarded sources" and my "claims." Hopefully I have not made any "claims" per se. And my sources here were SEER, the CDC, The Oncologist, the JNCI, and the Red Journal. And a few random internet links for fun. However you have made claims which are, from my end, impossible to falsify. This does give you the virtue of never being provably wrong.
*even the CDC's 2015 modeling was off. They predicted ~1.9 million cases for 2020 in 2015. But now that we are five years in the future from 2015, and actually in 2020, we can better see the actual 2020 number will be about ~1.8 million for 2020. About 5% less than what the CDC predicted just 5y ago.
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