Typical salary for this situation?

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Before you interview me, I just have two requests... 3 days off per week and a starting salary of 500k. I look forward to working with you soon!
I think you weeded yourself out :laugh:

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It's tough. But really it boils down to how badly people want to be here versus "oh gee whiz, let me apply and see what happens." Surrogates like growing up here, having connections here or otherwise having a compelling reason to be here are all critical in the screening process. We really want a partner, not a physician employee so we are looking for longevity.

Best of luck my friend!

You bring up a good point. I honestly believe it when people say a good job in a decent town gets 100-200 applications so I’d bet you have over 500 but at the same time with online applications once an applicant gets a CV together with 2-3 versions of the cover letter (one true private practice, one hospital based, one academy) I’m guessing it takes them 2-3 minutes to submit an application (I’m pretty sure it’s free or at least not much to submit) so why not apply to every single job?
 
Excellent (and really smart) way to think about it. I can’t remember the last time I heard of a colleague (in Rad onc or otherwise) upon making partner cutting a check for the “buy in” ... rather the “excess” from the first 2 years is used as “sweat equity.” If you’re treating 25 patients and being paid for 8-10 (sounds about right for 4500 RVU) and they are just pocketing the difference vs considering it the “buy in” then they are making a killing (like literally multiple hundreds of thousands of dollars/yr) off of you!

It’s almost impossible to “fire” a partner but it’s relatively easy to let an employee go - just say patient volume, compensation, etc has decreased so we are not renewing your service agreement, sorry! In this market I would definitely take a job that offered partnership (and hope they don’t screw me over)vs one that didn’t but paid a little more.

If they have endless supplies of graduating residents what’s to stop them from just letting everybody go after they get what sounds like small annual pay increases when they can just replace with newer doctors who cost them less?

I was been in exact same situation about 5 years ago. Employed salaries (assuming you're competent) are dictated by local market, not MGMA. You may have to switch jobs to get any pay raise, unfortunately.

In the city I am looking for a job, the rad onc only groups appear to be slowly dying. The place I referenced above is a multi-specialty group. Only one of the rad oncs is partner for a tiny portion of the company. I brought up MGMA and Doximity data for me and they said that's reasonable for someone in their mid career, so hopefully I can get that in writing. Based on that, the compensation seems like it will be fair, so I guess the only thing I am really worried about is job security...

Obviously, being busy will help prevent a rad onc from just being let go. Going beyond that, are there potential things one can do to make themselves "irreplaceable" where the partners might be like - 'damn, we can't let this guy go' and potentially have leverage to renegotiate a contract? Perhaps like honing a particular skill, developing a program (brachy?), etc? Of course it depends on who you are working for, but assuming they are reasonable people. Wishful thinking? I'm going to be a new grad looking to be in a big city so not much to negotiate at the moment, but just thinking of what I can do to bring more to the bargaining table in the future...
 
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Obviously, being busy will help prevent a rad onc from just being let go. Going beyond that, are there potential things one can do to make themselves "irreplaceable" where the partners might be like - 'damn, we can't let this guy go' and potentially have leverage to renegotiate a contract? Perhaps like honing a particular skill, developing a program (brachy?), etc? Of course it depends on who you are working for,

Generate lots of business. The three A's etc.

Harder to let you go when you are keeping the linac full with referrals you've generated
 
Generate lots of business. The three A's etc.

Harder to let you go when you are keeping the linac full with referrals you've generated

Similarly, if you start a new program. Not as easy to do anymore but not that long ago I had friends who trained in high volume SBRT/SRS programs and joined practices that hadn't offered SBRT/SRS so they were hired for that exact purpose. Almost instantly, patient volume skyrocketed and the group had a huge advantage over their competitors who had to refer out for SBRT/SRS (or treat with antiquated techniques), and moral was lifted because before this they knew they weren't providing state of the art care. It's also reasonable to assume that if somebody can start a program like this they are good at planning and this guy was worth his weight in gold now and likely in the future = make him partner!

Not sure what, if anything you can do now . . . maybe HDR brachy for prostate? Breast DIBH?

If nothing else good ol' fashioned three A's and being a team player (without being taken advantage of). If I were a new graduate now the first thing I would do is analyze a practice and see what I could improve. Almost everyplace has SBRT/SRS now so it won't be that huge but anything you can do, preferably better than the existing physicians like SBRT/SRS or IMRT back in the day, will impress. Whatever you do don't talk about your ASTRO poster's or retrospective reviews . . . sorry nobody is really impressed with that (or at least relative to things that increase patient volume and give the practice an advantage over others).
 
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For an employed RadOnc, protecting your job security is no different from any other occupation. The safest way is to maintain close and cordial relationships with your bosses (i.e. practice owners (MedOncs?) in your situation).

In the city I am looking for a job, the rad onc only groups appear to be slowly dying. The place I referenced above is a multi-specialty group. Only one of the rad oncs is partner for a tiny portion of the company. I brought up MGMA and Doximity data for me and they said that's reasonable for someone in their mid career, so hopefully I can get that in writing. Based on that, the compensation seems like it will be fair, so I guess the only thing I am really worried about is job security...

Obviously, being busy will help prevent a rad onc from just being let go. Going beyond that, are there potential things one can do to make themselves "irreplaceable" where the partners might be like - 'damn, we can't let this guy go' and potentially have leverage to renegotiate a contract? Perhaps like honing a particular skill, developing a program (brachy?), etc? Of course it depends on who you are working for, but assuming they are reasonable people. Wishful thinking? I'm going to be a new grad looking to be in a big city so not much to negotiate at the moment, but just thinking of what I can do to bring more to the bargaining table in the future...
 
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COC/NAPBC/APEX/Insert Accreditation is a ton of thankless, unpaid work that no one wants to do. If you want to make yourself indispensable volunteer for that nonsense.
 
For an employed RadOnc, protecting your job security is no different from any other occupation. The safest way is to maintain close and cordial relationships with your bosses (i.e. practice owners (MedOncs?) in your situation).
And the way to do that is keep the linac full ;)
 
COC/NAPBC/APEX/Insert Accreditation is a ton of thankless, unpaid work that no one wants to do. If you want to make yourself indispensable volunteer for that nonsense.

I got duped into being the cancer center CoC chairman. Awful.

I guess this is some silver lining, but I'm a partner, so I think I'm "safe" even if I can find someone to punt this to.
 
That's only one part. Personal experience has demonstrated to me that just because you're working hard and bringing in referrals doesn't mean that they won't find a reason to replace you if they want to.
Yeah... Not always foolproof esp if you're dealing with a non md hospital administrator with a bad personality who is too shortsighted to see the value you may bring to the practice/Dept
 
That's only one part. Personal experience has demonstrated to me that just because you're working hard and bringing in referrals doesn't mean that they won't find a reason to replace you if they want to.
It depends on the group/financial set-up. If you are in an integrated system in a major city, most of the referrals come from within the system and if you leave, they will just go to someone else or the next guy. Increasingly, because of the consolidation and financial arrangements, in general we are quite replaceable.
 
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Show up on time/every time, be nice to patients/staff, don't complain, don't ask for too much but make a good case when something is truly needed, say yes more than no.

There are so many problem physicians out there, that just being the nice person who flies under the radar in the basement is usually a great way to keep your job.
 
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Yeah... Not always foolproof esp if you're dealing with a non md hospital administrator with a bad personality who is too shortsighted to see the value you may bring to the practice/Dept

Even at these "hire and fire" practices I never understood how the senior guys can be so ruthless as to fire/let go somebody whom they have been seeing/working with everyday for 1-2 years (and likely met their families and everything), especially after they have been doing a good or even great job just over a little money, but I guess it's even easier for the random non-MD CEO or administrator to see a person as a number or cog in the wheel.
 
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It depends on the group/financial set-up. If you are in an integrated system in a major city, most of the referrals come from within the system and if you leave, they will just go to someone else or the next guy. Increasingly, because of the consolidation and financial arrangements, in general we are quite replaceable.

This is actually a really good point. In those places I bet they don't have many options and choice to refer to Dr. X (awesome new graduate they really love working with) to discuss RT so much as a referral pattern of no choice just "refer to RT" and whoever is in that position sees the patient so easier to be replaced.
 
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This is actually a really good point. In those places I bet they don't have many options and choice to refer to Dr. X (awesome new graduate they really love working with) to discuss RT so much as a referral pattern of no choice just "refer to RT" and whoever is in that position sees the patient so easier to be replaced.

Sounds about right from my experience. Also works vice versa- Send to x for chemo and y for surgery. We had so much turnover with docs in our system, I literally don't even know where the patient ends up anymore.
 
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This is actually a really good point. In those places I bet they don't have many options and choice to refer to Dr. X (awesome new graduate they really love working with) to discuss RT so much as a referral pattern of no choice just "refer to RT" and whoever is in that position sees the patient so easier to be replaced.
As opposed to the freestanding setting where most of my referrals come with my name on it from networking and relationships that have taken years to build
 
New question from a mostly lurker. I'm going for an academic job this year and have an offer on the table, want to possibly negotiate, but I know salary can be tough to negotiate for academic places, do other people have suggestions in terms of bargaining chips? Loan repayment, educational fund, research money? Just curious to hear some suggestions.
 
New question from a mostly lurker. I'm going for an academic job this year and have an offer on the table, want to possibly negotiate, but I know salary can be tough to negotiate for academic places, do other people have suggestions in terms of bargaining chips? Loan repayment, educational fund, research money? Just curious to hear some suggestions.

Honestly, I think when you're a new grad the only bargaining chips that both work and don't come across pompous are competing offers. Do you have other academic offers that are higher? Do you have any private offers that are in that city and higher?
 
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New question from a mostly lurker. I'm going for an academic job this year and have an offer on the table, want to possibly negotiate, but I know salary can be tough to negotiate for academic places, do other people have suggestions in terms of bargaining chips? Loan repayment, educational fund, research money? Just curious to hear some suggestions.

One question I always ask is: "if you were me, what would you ask/negotiate for?"
In general, if you have a reasonable request, it's always worth asking. I would certainly have the contract et al reviewed by an attorney, they can assist you in coming up with a list of items to negotiate for.
 
Honestly, I think when you're a new grade the only bargaining chips that both work and don't come across pompous are competing offers. Do you have other academic offers that are higher? Do you have any private offers that are in that city and higher?

This is very good advise. The only other thing I can think of is if you have close friends in the program who would be willing to share specifics like that with you (I asked for this they gave it to me or I asked for that and they laughed in my face).

As far as I know academic jobs have always had standard compensation packages (years ago I reviewed one for a friend upon his request and it was less than 2-3 pages total and in one spot it had the previous hires name so I’m pretty sure they just change the name and use the exact same contract for everybody).
 
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Honestly, I think when you're a new grad the only bargaining chips that both work and don't come across pompous are competing offers. Do you have other academic offers that are higher? Do you have any private offers that are in that city and higher?
I have another offer from an "academic" center that is higher (by 100k), though calling it academic may be a stretch and it is in a less desirable location. Not sure how far that will get me, definitely do not want to come off greedy. Any other fringe benefits that I could ask for? Relocation assistance?
 
I have another offer from an "academic" center that is higher (by 100k), though calling it academic may be a stretch and it is in a less desirable location. Not sure how far that will get me, definitely do not want to come off greedy. Any other fringe benefits that I could ask for? Relocation assistance?

Absolutely, relocation is so common I honestly assumed that it was already included. Getting anywhere from 5-15k for relocation is standard and would not look bad at all asking for that. I would get a quote from a full service moving company, and then when you ask you can say, "I was able to get a quote from a moving company and it looks like it will cost me XX dollars to move there."

As for the salary, are you at the median or higher? If you're not at the median, then I'd say something like, "I appreciate your offer and I am very excited to come work there. As for the salary, I have a competing offer for 350k, but I'd much rather work for you. Would it be possible to increase your offer from 250k to the median starting salary of 300k?" Now you're using both the salary survey and the competing offer to get closer to where you'd like to be.

Congrats on having multiple offers!
 
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I thought median salary was 400-450k per my limited research.
 
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Now that's some fake news...
 
According to Terry Wall's talk at ASTRO this year:

PP starting salary: Median 330K, Average: 353K
Academic starting: Median 310K, Average: 300K

So no...400-450k is not the median starting salary. Not to say that you can't be offered 400k+ starting but prob more likely in a rural area, small town, Mid West, etc. Less likely in a bigger city.
 
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All I have to say is “WOW. I’m not sure how things are now but my experience was different in “desirable” areas. I’ll be the first to tell you that I’m no superstar either.
 
All I have to say is “WOW. I’m not sure how things are now but my experience was different in “desirable” areas. I’ll be the first to tell you that I’m no superstar either.

My offers were lower than the Terry Wall data, both academic and private side.

I tried to negotiate my two academic job offers for more research time and resources and was told that the offers were "take it or leave it".
 
In terms of salary, part of the issue is setting a precedent. A decent center should not pay new grad more than existing faculty, unless they want discord, so hands are somewhat tied here, regardless of your other offers. They should have plenty of candidates to take your place if you decline.
 
My offers were lower than the Terry Wall data, both academic and private side.

I tried to negotiate my two academic job offers for more research time and resources and was told that the offers were "take it or leave it".

All I have to say is “WOW. I’m not sure how things are now but my experience was different in “desirable” areas. I’ll be the first to tell you that I’m no superstar either.

How desirable? I think this is really where the difference is. Some employers will view the location by itself as a fringe benefit and use that as justification for holding back more of your collections. This is of course highly unethical and predatory and there are groups that refuse to do it and pay fairly based on payor mix and overhead. Unfortunately I think these groups are becoming less common, especially in competitive markets as you can get away with severely underpaying new hires. The large academic "centers" (machines is probably a better term) will absolutely screw you as there are massive financial incentives for cancer center management to cut costs and maximize profit margin any humanly way possible. You can still find private groups that divide collections up fairly. Why anyone would want to work for the former is beyond me. I guess location really is that important to some people.

Probably half of existing radiation programs are trying to expand and new programs are opening every year. If the machines and number crunchers can get new rad oncs for the price of family med docs, what do you think it's going to be like in 10 years? Med students, are you listening? The gripes of the posters here in exploitative and dead end jobs are fair. In 10 years, the whining about having to do fellowships and retrain in a different field will fall on deaf ears as it's your own fault for not reading the 10,000 point font writing on the wall.
 
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I guess location really is that important to some people.

I don't want to get too personal about things in public. If you ever want to have a beer with me I'll tell you all about it.

Suffice to say, I didn't pick because of location and I didn't have a single offer that paid more than the Wall data just posted.

I applied to positions all over the country (including upper midwest). Still, I didn't have a whole lot of choices. Most of my offers were in the "desirable area" where I trained and had connections.
 
According to Terry Wall's talk at ASTRO this year:

PP starting salary: Median 330K, Average: 353K
Academic starting: Median 310K, Average: 300K

So no...400-450k is not the median starting salary. Not to say that you can't be offered 400k+ starting but prob more likely in a rural area, small town, Mid West, etc. Less likely in a bigger city.

Terry Wall data published:

J Am Coll Radiol. 2019 Jan 2. pii: S1546-1440(18)31473-X. doi: 10.1016/j.jacr.2018.11.021. [Epub ahead of print]

The Employment Experience of Recent Graduates From US Radiation Oncology Training Programs: The Practice Entry Survey Results From 2012 to 2017.

PMID: 30611681

DOI: 10.1016/j.jacr.2018.11.021
 
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Where exactly does one go to purchase or view those MGMA compendiums with the Rad Onc compensations?
 
Where exactly does one go to purchase or view those MGMA compendiums with the Rad Onc compensations?
MGMA and other groups are moving away from individuals being able to purchase the surveys. I think part of the idea is requiring submission by the organizations they sell to. With that being said, surveys are really just one piece and in my experience provide a tool but not a great one. The reason being most organizations do not use one survey and most organizations use proprietary updated data based upon experience. The reason being that in MGMA or other surveys it is all respondents lumped into one. However, if you pull out academic, it basically resets the medians, or if you pull out new physicians, it resets the medians. Just a thought.
 
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MGMA and other groups are moving away from individuals being able to purchase the surveys. I think part of the idea is requiring submission by the organizations they sell to. With that being said, surveys are really just one piece and in my experience provide a tool but not a great one. The reason being most organizations do not use one survey and most organizations use proprietary updated data based upon experience. The reason being that in MGMA or other surveys it is all respondents lumped into one. However, if you pull out academic, it basically resets the medians, or if you pull out new physicians, it resets the medians. Just a thought.

In my experience from job searching a couple years ago hospitals tend to use the surveys with the lowest salaries reported :)
 
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In my experience from job searching a couple years ago hospitals tend to use the surveys with the lowest salaries reported :)

Yeah, I was gonna say from what I've seen hospitals and corporations tend to use the MGMA as a weapon to try to lowball people.
 
approximate total comp numbers:

10%tile: 305k (4700 wRVUs)
25th:450k
Median:525k (8200 wRVUs)
75th:620k
90th:760k (13400 wRVUs)

So keep in mind if you are getting paid 300k, you are getting paid for around 4500 wRVUs. That's like, what 8-10 patients on treatment at most? If you're treating 25 patients, getting paid that much, and not having an opportunity to buy in at all in the future, someone is making a HUGE profit off of your labor.

Would be interesting if they broke the data up by metro area and not just geographic region.
Again, very clear if you want to get a salary that is going to approach anywhere near your actual collections, you need to get out of the big cities.
Sad.

Is there a difference between wRVUs and just regular "RVUs?" The wRVU notation is new to me. And, the above comp numbers are wRVUs per MONTH, right? That's the only way the numbers would add up in my practice...
 
Is there a difference between wRVUs and just regular "RVUs?" The wRVU notation is new to me. And, the above comp numbers are wRVUs per MONTH, right? That's the only way the numbers would add up in my practice...

wrvu = work rvu (professional component)
trvu = total rvu (includes technical component)

wRVUs annually, per provider.
If you yourself are generating 8200 wRVUs per month then you are 10 people and making 8 figures.
Are you looking at the total wRVUs for your practice or per provider? Whole practice numbers are obviously going to be a lot larger.
 
wrvu = work rvu (professional component)
trvu = total rvu (includes technical component)

wRVUs annually, per provider.
If you yourself are generating 8200 wRVUs per month then you are 10 people and making 8 figures.
Are you looking at the total wRVUs for your practice or per provider? Whole practice numbers are obviously going to be a lot larger.


We must be using some other sort of RVU formula then. I'm seeing like 10's of thousands of RVUs listed per month total.
 
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