Unsolicited Jobs Thread

[Gfunk6]

I will leave this here without further comment

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[RadRadRad]

Lubbock?

 

[medgator]

Definitely would take the $50k paycut to work somewhere closer to civilization

 

[fiji128]

Centennial Bank Stadium. That’s Jonesboro Arkansas. They were recruiting in 2016 and I personally knew someone who interviewed there in my training program. I think the offer was $650k base for 2 years then.

 

[sirspamalot]

Or, add 250k and make it a guarantee. Then, learn how to fly and escape to civilization more easily.

 

[elementaryschooleconomics]

I received this exact same brochure in the summer of 2020.

So if @fiji128 knows this job was available in 2016, I know it was available in 2020, and now we're in 2022...

What a great example of the dreaded "good salary for 2 years then production based in middle of nowhere with sleepy linac that doesn't support the salary in year 3 and beyond".

At what point is this hospital system going to realize they need to just guarantee the salary forever? They've been paying $600k-ish per year for 8 years now, but with the huge added expense of recruiting and onboarding every 2-3 years.

They could save a lot of money by just locking the salary in and keeping a doc around long-term...

 

[A_DeMichele]

I think it’s a fairly common rural compensation setup.the idea is that they give you 2 years of security to “build practice”

 

[elementaryschooleconomics]

I think it’s a fairly common rural compensation setup.the idea is that they give you 2 years of security to “build practice”

Historically this has been true.

However - and I can't tell if this is good or bad - the fact that everyone is becoming a W2 hospital employee seems to have changed things around a bit.

Instead of these "high starting then you're on your own", it's been more of a "here's your salary forever" deal where the number is lower but locked in. Sort of like a "higher floor / lower ceiling" kind of deal.

For people like @OTN, this type of arrangement would be handcuffs. But medicine has changed so much over the last 15 years that the "2 years then production" jobs would smoke most new grads. And I'm saying that not to imply an intrinsic deficit with the new grads, they're just a product of the training pathway we currently have. More that there's a lot of hands grabbing for a piece of the Healthcare pie, and doctors are trained to be cogs.

 

[yesmaster]

I had this discussion with several older rad onc’s when I was looking for jobs, age 50-70. When I was reviewing job offers with them, they said these rural jobs used to pay $1m/year but they don’t anymore. Similarly, the pay bump for rural locations within an academic system or hospital network is currently $50k/year, but it should be closer to $250k/year based on the difficulty of recruiting to those locations and the difference in QOL.

It’s a little secret across all of medicine that the publicly available salary data on Medscape or AAMC reflects salaried, urban coastal locations. It’s always been true that in private practice or in rural/suburban locations, the pay is much higher. It’s still high in other specialties (1.5m for heme onc). It’s lower for rad onc, even in Jonesboro, Arkansas, because of supply/demand/market power, primarily.

 

[yesmaster]

middle of nowhere with sleepy linac that doesn't support the salary

This may be true for tiny places, population 30,000 for example. Jonesboro, AR is 130,000. Depending on their competition and the local air quality, their linac may not be quite so sleepy

 

[medgator]

I think it’s a fairly common rural compensation setup.the idea is that they give you 2 years of security to “build practice”

Building happens to a degree in these podunk places, but in many cases, you are competing with patients leaving town 1 to several hours away, not a Linac across town. My first gig basically involved building a practice where patients were bleeding out 1-1.5 hours away to various tertiary care and an NCI center(s).

Hospital system would be foolish to let someone build that up and then not support them with a competitive compensation backstop. But that's usually what they do, and no one is going to stick around for pro fees on a middle of nowhere Linac in a **** geographical location after the guarantee runs out

 

[seper]

I had this discussion with several older rad onc’s when I was looking for jobs, age 50-70. When I was reviewing job offers with them, they said these rural jobs used to pay $1m/year but they don’t anymore. Similarly, the pay bump for rural locations within an academic system or hospital network is currently $50k/year, but it should be closer to $250k/year based on the difficulty of recruiting to those locations and the difference in QOL.

It’s a little secret across all of medicine that the publicly available salary data on Medscape or AAMC reflects salaried, urban coastal locations. It’s always been true that in private practice or in rural/suburban locations, the pay is much higher. It’s still high in other specialties (1.5m for heme onc). It’s lower for rad onc, even in Jonesboro, Arkansas, because of supply/demand/market power, primarily.

Yes, small rural pay bump is a thing. My network currently pays about $460K at the main center (not a very desirable town anyway) and 520K at the satellites > 2h drive from any airports

 

[CaesarRO]

Yes, small rural pay bump is a thing. My network currently pays about $460K at the main center (not a very desirable town anyway) and 520K at the satellites > 2h drive from any airports

Small bump

 

[medgator]

Yes, small rural pay bump is a thing. My network currently pays about $460K at the main center (not a very desirable town anyway) and 520K at the satellites > 2h drive from any airports

$460K at a main center, likely in a better/bigger MSA, is waaaay better pay than $520k at some podunk satellite without resident support.

As @sirspamalot says #750korFOH

 

[sirspamalot]

You'll keep eating it until enough of you say NO.

What's it gonna be?

#750orGTFO

 

[elementaryschooleconomics]

And again, for anyone who thinks 750k is asking "too much", I can promise you - from firsthand knowledge - there are an awful lot of MedOnc jobs with starting salaries of 800k right now.

 

[Lamount]

I had this discussion with several older rad onc’s when I was looking for jobs, age 50-70. When I was reviewing job offers with them, they said these rural jobs used to pay $1m/year but they don’t anymore. Similarly, the pay bump for rural locations within an academic system or hospital network is currently $50k/year, but it should be closer to $250k/year based on the difficulty of recruiting to those locations and the difference in QOL.

It’s a little secret across all of medicine that the publicly available salary data on Medscape or AAMC reflects salaried, urban coastal locations. It’s always been true that in private practice or in rural/suburban locations, the pay is much higher. It’s still high in other specialties (1.5m for heme onc). It’s lower for rad onc, even in Jonesboro, Arkansas, because of supply/demand/market power, primarily.

I don’t understand how heme/onc bills but it seems like the don’t generate a ton of RVUs -at least not in my academic microcosm. I guess my question is… why would they ever get 1.5M, regardless of the location?

 

[elementaryschooleconomics]

I don’t understand how heme/onc bills but it seems like the don’t generate a ton of RVUs -at least not in my academic microcosm. I guess my question is… why would they ever get 1.5M, regardless of the location?

All wRVUs are not created equal.

RadOnc has zero community residency programs because of our small size, so we all go from med school (zero business of medicine training) to an academic environment (not only zero training, but barely contained disgust regarding business of medicine).

So anyone who goes right from residency into an academic job - and stays in academia - is really insulated from how insanely variable everything is.

But there are a lot of ways to pay a doctor. Sometimes it's a flat salary. Sometimes it's their professional fees. Sometimes it's a dollar amount per RVU. The big MedOnc contracts I've seen have high "dollar per wRVU" reimbursement.

So while a MedOnc and a RadOnc could both generate the same wRVUs in a year, the pay could be drastically different.

 

[sirspamalot]

They are deeply invested in making sure YOU GET LESS. (instagoogle)

Oncology Programs: Take Action Now to Avoid a Massive Increase in Physician Expense in 2021

Explore the anticipated impact of the proposed CMS changes to the MPFS for CY 2021 to avoid possible financial losses for your organization.

www.ecgmc.com

See a guy like Neal (random google) here will try to edumacate your hospital CEO how to cleverly present how to f you right outta those dollars.

Work RVU Compensation Models: Best Rate Determination | HSG

HSG can help health systems determine what dollar rates per work RVU should be used for employed provider work rvu compensation models.

hsgadvisors.com

F guys like Neal and F anyone who says we should take less just to "get along" and be good little compliant doctors. As if taking less makes us worthy of.. Social altruism or some such nonsense.

Lol. Open your eyes or bend over. No lube for you.

 

[RSAOaky]

I don’t understand how heme/onc bills but it seems like the don’t generate a ton of RVUs -at least not in my academic microcosm. I guess my question is… why would they ever get 1.5M, regardless of the location?

RVUs are a way of comparing "productivity" between hospitals within a specialty, but there is no cross specialty comparison. Medoncs bring in the bulk of their money through the delivery of systemic therapy (even though there is no professional component tied to this) much like we bring in the bulk of our money from treatments (70-80% of radonc revenue is technical).

So for medonc, you have your own pharmacy that dispenses medications, the markup on those medications, and the reimbursement for infusion of those medications. With patients living longer, I/O, targeted therapy, etc, there are a lot more infusions being done. Take something simple like the PACIFIC regimen. Locally advanced lung cancer patients went from getting 6 infusions of concurrent chemorads to 6 + Q2W infusion of I/O for 6-12 months (13-26 infusions). Add the fact that these meds are significantly more expensive that conventional/generic chemo and so the standard medicare markup of ~4.3% becomes substantial.

So you now have this perfect storm where you suddenly have a greater need for medoncs (more infusions) and higher overall revenue in a well controlled labor market. Hospitals can't just pay medoncs their professional billings anymore and they have to eat into their "technical" revenue. Contrast this with radonc where we're seeing the complete opposite, resulting in many radoncs earning LESS THAN their professional billings. It all comes down to supply and demand of physicians.

 

[fiji128]

I don’t understand how heme/onc bills but it seems like the don’t generate a ton of RVUs -at least not in my academic microcosm. I guess my question is… why would they ever get 1.5M, regardless of the location?

Just about any hospital of any size needs to offer oncology services that's why. The demand for medical oncologist is currently much greater then the supply. As stated elsewhere, it can now take years to recruit a med onc to non desirable areas so those salaries go ever upward. Also, all med oncs need to go through and complete IM residency so just expanding fellowships and taking low quality grads out of med school isn't as easy as it is with rad onc. It has just about nothing to do with rvu generation.

 

[Gfunk6]

I wonder what "$600K+ PROVEN" actually means? Does that mean it is proven that some people can earn $600,000+, just not you?

 

[RickyScott]

I don’t understand how heme/onc bills but it seems like the don’t generate a ton of RVUs -at least not in my academic microcosm. I guess my question is… why would they ever get 1.5M, regardless of the location?

Our medoncs receive more than double per rvu what I get. It is all supply and demand. If a specialty is in demand, $/rvu are increased. The hospitals start with what they want to pay us, based on supply and demand, and then calculate the $/rvu.

 

[sirspamalot]

Whats a good medonc wRVU? 100? 150? I mean, if 75orGTFO then 150 must be the new new for medonc homies.

 

[Lamount]

RVUs are a way of comparing "productivity" between hospitals within a specialty, but there is no cross specialty comparison. Medoncs bring in the bulk of their money through the delivery of systemic therapy (even though there is no professional component tied to this) much like we bring in the bulk of our money from treatments (70-80% of radonc revenue is technical).

So for medonc, you have your own pharmacy that dispenses medications, the markup on those medications, and the reimbursement for infusion of those medications. With patients living longer, I/O, targeted therapy, etc, there are a lot more infusions being done. Take something simple like the PACIFIC regimen. Locally advanced lung cancer patients went from getting 6 infusions of concurrent chemorads to 6 + Q2W infusion of I/O for 6-12 months (13-26 infusions). Add the fact that these meds are significantly more expensive that conventional/generic chemo and so the standard medicare markup of ~4.3% becomes substantial.

So you now have this perfect storm where you suddenly have a greater need for medoncs (more infusions) and higher overall revenue in a well controlled labor market. Hospitals can't just pay medoncs their professional billings anymore and they have to eat into their "technical" revenue. Contrast this with radonc where we're seeing the complete opposite, resulting in many radoncs earning LESS THAN their professional billings. It all comes down to supply and demand of physicians.

I knew there had to be something unseen. The owning-your-own-pharmacy angle would certainly explains the comp. Thanks!

 

[HemeOncHopeful19]

And again, for anyone who thinks 750k is asking "too much", I can promise you - from firsthand knowledge - there are an awful lot of MedOnc jobs with starting salaries of 800k right now.

Would you mind PMing me locations for these 800k jobs? I know it’s considered a good time to be in Med Onc (although personally I think 10-15 years ago was a better time for pretty much every specialty) but I’ve never heard of anything with an initial base that high.

If it were up to me we’d all be making 800+

 

[medgator]

I knew there had to be something unseen. The owning-your-own-pharmacy angle would certainly explains the comp. Thanks!

Even better is when you own the scanners you send your radiology to and the path lab you send biopsies to

 

[radiation]

And again, for anyone who thinks 750k is asking "too much", I can promise you - from firsthand knowledge - there are an awful lot of MedOnc jobs with starting salaries of 800k right now.

Changes in median heme/onc salary

About how much does the median heme/onc salary increase every year? Like the only MGMA data I have is from 2021 and it was 481K. Anyone know what it was for 2020 or 2019? … or 2022 for that matter? Additionally, if someone is signing a three or four year contract, is it reasonable to request...

forums.studentdoctor.net

what med onc actually makes and what rad onc thinks they make seems to be a fairly large discrepancy

 

[sirspamalot]

Even better is when you own the scanners you send your radiology to and the path lab you send biopsies too

 

[communitydoc13]

Changes in median heme/onc salary

About how much does the median heme/onc salary increase every year? Like the only MGMA data I have is from 2021 and it was 481K. Anyone know what it was for 2020 or 2019? … or 2022 for that matter? Additionally, if someone is signing a three or four year contract, is it reasonable to request...

forums.studentdoctor.net

what med onc actually makes and what rad onc thinks they make seems to be a fairly large discrepancy

I don't know the causes of this discrepancy but I have some ideas.

First, my experience with medonc market is from perspective of community practice hours from a major metro. These places have always been staffed by IMG docs, many of whom did community onc fellowships. You might get an odd DO (no offense meant) or older MD, but most US med school grads coming out of fellowship are rarely taking these jobs.

I do not know what proportion of medoncs are in academics, but I do know that large academic systems employ ungodly numbers of medical oncologists. In my experience a significant proportion of these folks are living the physician scientist life and even the clinical docs at the main center will have what many of us would consider to be a part time clinical schedule. I believe that these folks make significantly less than academic radoncs on average. Many are employed at the institution they trained at. To the extent that these folks are included in salary surveys, they will anchor that number.

The workforce that was staffing community places has cratered for various reasons. The need for hemonc in the community is growing as the boomers age into cancer and blood dyscrasias. So places have had to change their offers for medonc significantly.

The locums market always tells you something. While an academic medonc is not making bank, a locum working 100 days a year in oncology can break 500k on the locums market with many expenses paid. This is basically public knowledge at this point. Many docs have thrown their hat in this ring.

Locums docs provide far less value than a permanent doc in general. They are now serving a role they never should, which is to provide long term staffing. Their crazy pay per day and contract structures only worked when they functioned as "emergency pinch hitters". Centers will close or eventually just say, eff-it, we won't see the heme cases any more.

750K base is high. But a contract where 750K is going to be where you are in terms of total comp with reasonable productivity is not unusual at all in many locations.

The owning-your-own-pharmacy angle would certainly explains the comp.

Not what's going on most places. Most docs still work for hospitals via contract. But, the hospital makes a lot on the drugs prescribed and even more if they have 340b status (that markup is whack!). They need the docs to write for the drugs (still not letting mid-levels do this). The docs are in rare supply, so they are getting paid. Like said above, oncology is lucrative for a hospital. Many service lines are not money makers at all.

 

[sirspamalot]

750 isn't high, its the minimum boys (and girls).

#750orGTFO

 

[elementaryschooleconomics]

Changes in median heme/onc salary

About how much does the median heme/onc salary increase every year? Like the only MGMA data I have is from 2021 and it was 481K. Anyone know what it was for 2020 or 2019? … or 2022 for that matter? Additionally, if someone is signing a three or four year contract, is it reasonable to request...

forums.studentdoctor.net

what med onc actually makes and what rad onc thinks they make seems to be a fairly large discrepancy

I've literally seen the contracts myself, I don't know what else to say.

I guess...the population of my personal circle of Medical Oncologists who have shared details of their contracts with me is underpowered to make a Category A statement?

Therefore, ElementarySchoolEconomics gives the $800k+ salary a Category 2B endorsement.

 

[RickyScott]

I've literally seen the contracts myself, I don't know what else to say.

I guess...the population of my personal circle of Medical Oncologists who have shared details of their contracts with me is underpowered to make a Category A statement?

Therefore, ElementarySchoolEconomics gives the $800k+ salary a Category 2B endorsement.

I have recieved multiple locums offers directed at medoncs for 5k a day. In my metro which is very desirable, they earn around 600k at the university.

 

[TheWallnerus]

I have recieved multiple locums offers for medoncs at 5k a day. In my metro which is very desirable, they earn around 600k at the university.

At some point… money talks

 

[medgator]

I have recieved multiple locums offers directed at medoncs for 5k a day. In my metro which is very desirable, they earn around 600k at the university.

I know one that quit a lucrative FT employed position to make the same 7 figure salary working 60 rather than 100% of the year as a locums. He thinks the 1099 thing will be advantageous for him as well

 

[deleted1116990]

And again, for anyone who thinks 750k is asking "too much", I can promise you - from firsthand knowledge - there are an awful lot of MedOnc jobs with starting salaries of 800k right now.

This is not going to change until we, in meaningful numbers, understand what we are worth (on a PC basis at a minimum) and refuse to take hospital-employed jobs for less, and in undesirable areas as is this ad, at a premium above this. I've certainly done my part on about a half dozen offers over the past 3 years (I had a few places up to 750k, but not 850k as that was what the old guys were making they were trying to save on).

10% of rad oncs practice rural.

Rural rad onc should pay 90th percentile MGMA, which is 800-850k unless it's very low volume and you can negotiate 3 days a week and a lot of PTO.

Anyone who takes a busy rural rad onc job for 500k is a chump.

And this applies to undesirable cities too. I might have considered Laredo, TX 5 years ago. Now? I don't see that position ever filling.

 

[BobbyHeenan]

This is not going to change until we, in meaningful numbers, understand what we are worth (on a PC basis at a minimum) and refuse to take hospital-employed jobs for less, and in undesirable areas as is this ad, at a premium above this. I've certainly done my part on about a half dozen offers over the past 3 years (I had a few places up to 750k, but not 850k as that was what the old guys were making they were trying to save on).

10% of rad oncs practice rural.

Rural rad onc should pay 90th percentile MGMA, which is 800-850k unless it's very low volume and you can negotiate 3 days a week and a lot of PTO.

Anyone who takes a busy rural rad onc job for 500k is a chump.

And this applies to undesirable cities too. I might have considered Laredo, TX 5 years ago. Now? I don't see that position ever filling.

Yes.

People need to understand what a ball park professional fee revenue is. In a rural location, it is unreasonable to expect to work as an employed doc and bringing in less than what your professional fees are (minus some expenses - say around 15% or so to cover billing/admin costs). If your pro fees are generating 900K and they're offering you 600K, they're skimming off your fees on top of technical revenue.

 

[OTN]

This is not going to change until we, in meaningful numbers, understand what we are worth (on a PC basis at a minimum) and refuse to take hospital-employed jobs for less, and in undesirable areas as is this ad, at a premium above this. I've certainly done my part on about a half dozen offers over the past 3 years (I had a few places up to 750k, but not 850k as that was what the old guys were making they were trying to save on).

10% of rad oncs practice rural.

Rural rad onc should pay 90th percentile MGMA, which is 800-850k unless it's very low volume and you can negotiate 3 days a week and a lot of PTO.

Anyone who takes a busy rural rad onc job for 500k is a chump.

And this applies to undesirable cities too. I might have considered Laredo, TX 5 years ago. Now? I don't see that position ever filling.

It's easy for us to call someone a chump for taking a sub 500k job, but what if that's what's available? 750orGTFO sounds great if you've been in the field for awhile and have a nest egg to fall back on, but we really need to put ourselves in the shoes of an average radonc residency grad with a couple hundred grand in debt. They are not in the position to refuse any job.

 

[NotMattSpraker]

I've literally seen the contracts myself, I don't know what else to say.

I guess...the population of my personal circle of Medical Oncologists who have shared details of their contracts with me is underpowered to make a Category A statement?

Therefore, ElementarySchoolEconomics gives the $800k+ salary a Category 2B endorsement.

In Radiation Oncology, you will get wildly different assessments of the job market depending on who is giving the assessment. This is a huge topic on this forum and one of the biggest problems on the topic of jobs in this field.

It's the same for medical oncology. We are interviewing many of them and the SDN conversations have come up a few times. No one I have asked is seeing that kind of money, but all agree it's a "strong" market with a lot of interviews to be had. The one time I did hear of a salary close to 800 for MO was in a very rural job and it came with all the caveats you hear about rural jobs on here, except the guy was complaining about the lack of Mexican food not Indian food. It was like I was in the bizarro world.

 

[deleted1116990]

It's easy for us to call someone a chump for taking a sub 500k job, but what if that's what's available? 750orGTFO sounds great if you've been in the field for awhile and have a nest egg to fall back on, but we really need to put ourselves in the shoes of an average radonc residency grad with a couple hundred grand in debt. They are not in the position to refuse any job.

Well I'm not intentionally trying to make anyone feel bad. But I have literally met people in these positions who chose to do them because they were in a more "desirable" undesirable location (few hours drive to a city, in a neater western state compared to rural Indiana or something, etc) and thought what they were getting paid was fair.

The problem is that the CEOs at these places all think they can offer 10-20k above median MGMA and that's a solid offer above median that makes up for their rural location and just staff with locums for as long as they have to. It's hard to have a productive back and forth for a 800k job when the first number thrown out is 540k. NO. HARD NO. That is what the rad oncs in the metro areas are making at hospitals, if not more. NO. DO NOT TAKE THIS.

Kona, HI for instance is offering a 520k salary. If you've been there and left the resort, you know the big island is extremely rural and isolated, added to that a very high cost of living and stupid state taxes. It will eventually fill if it hasn't already because it's got appeal that Vincinees, IN doesn't. And Vincinees will too if the overtraining problem continues.

 

[sirspamalot]

They are not in the position to refuse any job.

Then they'll get what they deserve for taking a crappy job.

 

[medgator]

Then they'll get what they deserve for taking a crappy job.

@OTN is correct, esp when we start seeing less stellar grads who matched into residency positions #130-195 and start graduating later this decade.

Hospital management will have a field day

 

[sirspamalot]

because it's got appeal that Vincinees, IN doesn't

Lol another wasteland post that still isn't filled, I heard about this one like 2 or 3 years ago. Nobody wants to live in these places, unless they are socially happy in total isolation (and so is their spouse).

Laredo, Carlsbad, fill in the blank OH, IN, KY etc. Makes central florida look like paradise don't it? I heard the gang in Jacksonville was making 800k W2 doing modest levels of work (25).

The golden days are gone boys (are there any girls here?). But I can live with #750orGTFO in a ruralish location as long as its a 3.5 day work week and..

 

[Mandelin Rain]

Oncology Programs: Take Action Now to Avoid a Massive Increase in Physician Expense in 2021

Explore the anticipated impact of the proposed CMS changes to the MPFS for CY 2021 to avoid possible financial losses for your organization.

www.ecgmc.com

People need to understand what a ball park professional fee revenue is.

Footnote from the above link:

2. Assuming that radiation oncology compensation is based on median WRVU production multiplied by a median compensation per WRVU rate (equal to $515,725) and median professional collections ($660,691) are based on an equal-weight blend of 2020 national composite benchmarks from MGMA, AGMA, SullivanCotter, and ECG.

Median skim: $145,000

 

[deleted1116990]

Lol another wasteland post that still isn't filled, I heard about this one like 2 or 3 years ago. Nobody wants to live in these places, unless they are socially happy in total isolation (and so is their spouse).

Laredo, Carlsbad, fill in the blank OH, IN, KY etc. Makes central florida look like paradise don't it? I heard the gang in Jacksonville was making 800k W2 doing modest levels of work (25).

The golden days are gone boys (are there any girls here?). But I can live with #750orGTFO in a ruralish location as long as its a 3.5 day work week and..

Let me know if you can do better than this guy in his Cirrus trying to make it to Kona...
The life of a modern rad onc. How do you empty the pee bag on the long flights?

 

[sirspamalot]

What they really need to understand is economic value.

What is your total economic value? If you're a radonc, its 2-3M net profit. What do you think you deserve to generate this, assuming your pro fees are 'only' lets say 600k.

Now factor in where the job is.. and..

 

[deleted1116990]

Footnote from the above link:

2. Assuming that radiation oncology compensation is based on median WRVU production multiplied by a median compensation per WRVU rate (equal to $515,725) and median professional collections ($660,691) are based on an equal-weight blend of 2020 national composite benchmarks from MGMA, AGMA, SullivanCotter, and ECG.

Median skim: $145,000

90%-tile PC on the MGMA data I have from 2018ish was $1,055k. Total comp $875k

18% skim on the high end if you believe MGMA.

And 75th percentile PC was $790k.
If you are working full time for less than 75th percentile PC numbers in a rural area, you are doing it wrong.

 

[OTN]

What they really need to understand is economic value.

What is your total economic value? If you're a radonc, its 2-3M net profit. What do you think you deserve to generate this, assuming your pro fees are 'only' lets say 600k.

Now factor in where the job is.. and..

Given that you fly yourself, I'm assuming you haven't seen the God-awful Karass negotiation advertisements in airplane magazines in awhile, but they say

"You don't get what you deserve, you get what you NEGOTIATE"

Economic value means nothing if you aren't in a good position to negotiate. New grads are not in a good position to negotiate, given the effective plans of Dr. Dennis Hallahan et al to place them in said position. I'm 100% in agreement with you that the radoncs are the ones who generate value and should be reimbursed for it. However, whether or not we agree on that matters not. Only supply and demand does.

 

[deleted1116990]

Economic value means nothing if you aren't in a good position to negotiate. New grads are not in a good position to negotiate, given the effective plans of Dr. Dennis Hallahan et al to place them in said position. I'm 100% in agreement with you that the radoncs are the ones who generate value and should be reimbursed for it. However, whether or not we agree on that matters not. Only supply and demand does.

In a competitive environment, you negotiate a good deal because you demonstrate added value the way pro athletes do. There's few, if any ways, for doctors and rad oncs especially to do that as admin has literally been trained to view us as robots on an assembly line. Robot broke. Buy new robot. Make deal with robot company to get good price under market value. One way of adding value, in the past, had been ability to go to a place nobody else would.

Still, I would refuse to take these bad offers for as long as possible until I just had to put food on the table.

 

[sirspamalot]

However, whether or not we agree on that matters not. Only supply and demand does.

Supply and Demand are 90% of it, which is of course impacted by location.

That said, quality still matters as some places (finally) get the message after a couple of docs coming and going in a row leave a bad taste in their mouth. Your only chance to negotiate is.. at the beginning.

Geographic arbitrage: the only leverage you may have left soon.