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Serious?
was wondering the same, have heard of rad oncs getting referrals for elevated PSAs in GU-aggressive markets to do TRUS biopsies and workups, so I wouldn't rule out anything....
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Dead serious. How many times do you have a follow up patient ask you about a skin spot? I got sick of calling a couple dermatologists in town and begging them to get them in just to see that the spot was poorly radiated at the patient’s next follow up. But like I said, I don’t use it as much as I intended when I hired her a few years back as I’m in a unique situation where I can’t get too busy or admins might make me hire another full time doc and I’m not ready for that. I’ve got skin biopsies and OA in the back pocket for when we lose breast or some other site in the near future with advancement of ctDNA technology lol.
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Woof dude/ette. I'm all for doing reasonable things to expand a practice but I don't love the idea of unilaterally biopsying skin lesions to identify cancer and then irradiating them in a vaccuum without discussing surgical resection. Like yes, if a patient is getting RT for skin cancer I'd prefer it to be with a Rad Onc and not some Derm who stayed in a Holiday Inn express last night. But is RT the correct answer for EVERY skin cancer out there? I don't think so.
Do you know what skin cancer looks like? What will be your number needed to biopsy to find a skin cancer? And does all skin cancer need treatment, especially if they're in f/u for like.... real cancer?
I get that maybe you're just defending your turf or whatever but I'm not really sure that the best way to combat poor medical practices is by.... also performing poor medical practices. A Rad Onc evaluating a skin lesion and biopsying? Did you do a weekend course on identifying skin cancers? A Rad Onc NP biopsying skin lesions? Are you going to go to local nursing homes as well and try to pick up some skin cases?
Lot of assumptions in your post.
I’m going to assume you don’t treat a lot of skin cancer if you don’t know an obvious skin cancer when you see it. I wouldn’t biopsy anything that wasn’t an obvious skin cancer that needs some type of treatment, otherwise I would send to back to derm. My market is different from yours, but might be like others. There’s a shortage of dermatologists in my area and it takes forever to get into them. Also, the main derm group in town loves RT more than surgery.
I would also assume that you would have a balanced discussion when appropriate with your patients about the role of surgery, just as we do with early stage NSCLC, HCC, brain mets seen on follow-up MRIs, etc…
And no I’m not planning on going to any nursing homes. As I said, I’m too busy as it is and rarely biopsy skin cancers, but I am glad that I have the ability to do it in my clinic and I think it might be a good thing for other clinics to consider. I just think our specialty needs to think outside of the box, quit being so passive and not be so afraid to “rock the boat”. Our leaders should have gotten us into the immunotherapy game years ago. Neuro onc, gyn onc are in the systemic therapy game with a lot less oncology knowledge than us, but I digress.
I’m going to assume you don’t treat a lot of skin cancer if you don’t know an obvious skin cancer when you see it. I wouldn’t biopsy anything that wasn’t an obvious skin cancer that needs some type of treatment, otherwise I would send to back to derm. My market is different from yours, but might be like others. There’s a shortage of dermatologists in my area and it takes forever to get into them. Also, the main derm group in town loves RT more than surgery.
I would also assume that you would have a balanced discussion when appropriate with your patients about the role of surgery, just as we do with early stage NSCLC, HCC, brain mets seen on follow-up MRIs, etc…
And no I’m not planning on going to any nursing homes. As I said, I’m too busy as it is and rarely biopsy skin cancers, but I am glad that I have the ability to do it in my clinic and I think it might be a good thing for other clinics to consider. I just think our specialty needs to think outside of the box, quit being so passive and not be so afraid to “rock the boat”. Our leaders should have gotten us into the immunotherapy game years ago. Neuro onc, gyn onc are in the systemic therapy game with a lot less oncology knowledge than us, but I digress.
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I don't see an ethical problem with this if you (or your tech) performs a biopsy and confirms path and the patient declines referral for excision (which I can see in rural areas without a derm). You are providing a service in these settings as we all have seen the 90 year old farmers with 9 cm neglected basal cells because there were no derm or even gen surg to handle it and they weren't going to travel for anything else. Radiation is the patient's only option to treat the cancer.
I don't even have a problem with a rad onc getting adequately trained to perform WLE. I don't exactly know how you would do that to get properly credentialed, but of course you don't need 4 years of derm residency to learn how to do that. PCPs do it. It's theoretically possible and I'm sure some rad onc out there is doing it.
I don't even have a problem with a rad onc getting adequately trained to perform WLE. I don't exactly know how you would do that to get properly credentialed, but of course you don't need 4 years of derm residency to learn how to do that. PCPs do it. It's theoretically possible and I'm sure some rad onc out there is doing it.
Maybe my favorite movie of all time is Albert Brooks’ ‘Defending Your Life’ and the main premise of that movie is that human life on earth is dominated by…
These kinds of deals for rads are common
Someone should do a study of contract-specified vacation days per year radiology vs rad onc
1 week on, 2 weeks off is becoming very common for night hawks working in large hospital groups from what I'm seeing. And you get to work from home
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And if you live in Puerto Rico for 183 days a year, you can pay 4% federal income tax while you read remotely. I have a total unicorn rad onc job, but still... I chose the wrong field. I cannot practice from Puerto Rico, and if I want to take more than 2 days off in a row I have to do a triple backflip to find someone to cover for me and my RVUs vanish into thin air so time away costs serious $$$.
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Can you imagine a similar job description for a rad onc outside of an alternate universe? In Rad onc the typical job is MGMA median W2 with some awful RVU incentive you will never see, 8-5 M-F, 25 days PTO. If you try to negotiate 1099, <5 days a week on site, eat-what-you-kill RVUs, independent billing, even a single day more PTO, alternating weeks via job share, literally anything other than the boilerplate offer, I kill you. I am not even joking, I have had multiple CEOs and chairs verbally berate me, accuse me of being lazy/greedy, and rescind job offers for simply attempting to negotiate job terms.
Bolded are things you will almost never see in rad onc...
Radiology Imaging Associates is a private, exclusively physician-owned practice in Central Florida with divisions in Ocala and Daytona. We are a group of more than 125 radiologists with numerous hospital and free-standing ER contracts from multiple hospital chains, our own outpatient imaging centers and equipment, multiple real estate holdings, and our own IT staff and servers. We also own a private practice in the U.S. Virgin Islands, which includes access to a timeshare at the Ritz-Carlton in St. Thomas. Additionally, we offer a rental townhome on the Big Island of Hawaii, equipped with a workstation, where radiologists can rotate and work remotely. We staff Level I/II Trauma Centers and certified Comprehensive Stroke Centers. Our group is one of the few remaining true private practices, and we intend to capitalize on the dissatisfaction with corporatized/private equity radiology. We have had numerous consecutive years of double-digit growth and are looking to hire sincere, hard-working radiologists to help us to expand further.
Employees and partners are treated equally with equal pay for moonlighting shifts. We strongly value workplace culture and do not support hierarchies, unequal work distribution/productivity, or cherry-picking.
Bolded are things you will almost never see in rad onc...
- Position also available as 1099 for 510k. W2 rads eligible for group cash balance plan in addition to 401k.
- Typical shift is 150 cases - 40% CT, 10% US/MR, and 50% X-ray. RVU bonus for busy nights ($33/RVU above 100, no cap, some productive nights frequently make an additional $1500/shift).
- Candidates must be residency-trained in Diagnostic Radiology and Board-Certified. Prior work experience and any fellowship preferred. Must read from United States, including Puerto Rico.
- Extensive internal moonlighting shifts are available with hourly and per-per-click options.
Radiology Imaging Associates is a private, exclusively physician-owned practice in Central Florida with divisions in Ocala and Daytona. We are a group of more than 125 radiologists with numerous hospital and free-standing ER contracts from multiple hospital chains, our own outpatient imaging centers and equipment, multiple real estate holdings, and our own IT staff and servers. We also own a private practice in the U.S. Virgin Islands, which includes access to a timeshare at the Ritz-Carlton in St. Thomas. Additionally, we offer a rental townhome on the Big Island of Hawaii, equipped with a workstation, where radiologists can rotate and work remotely. We staff Level I/II Trauma Centers and certified Comprehensive Stroke Centers. Our group is one of the few remaining true private practices, and we intend to capitalize on the dissatisfaction with corporatized/private equity radiology. We have had numerous consecutive years of double-digit growth and are looking to hire sincere, hard-working radiologists to help us to expand further.
Employees and partners are treated equally with equal pay for moonlighting shifts. We strongly value workplace culture and do not support hierarchies, unequal work distribution/productivity, or cherry-picking.
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Honestly considering how good the rads job market has become vs how bad it has become in rad onc, the competitiveness switch makes complete sense
Medical students aren't dumb, even if we all love what we do, the lack of multiple competitive job offers, ability to lateral geographically, ability to negotiate etc vs rads is so stark. Still a lot of decent private groups in rads where you can own equipment, much less so in rad onc
Medical students aren't dumb, even if we all love what we do, the lack of multiple competitive job offers, ability to lateral geographically, ability to negotiate etc vs rads is so stark. Still a lot of decent private groups in rads where you can own equipment, much less so in rad onc
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deleted1217978
There are a lot of nasty private practices in rad onc too, which is why I bolded equal partnership and hierarchies. I mentioned the abrasive chairs and CEOs, but the most I have ever been screwed over was by a rad onc peer who obtained ownership through politics (in a practice he did not build) and was determined that no other rad onc besides him would ever do so again.
That being said any smart medical student should enter radiology or many other fields with a healthy caution and understanding that technology, market forces, and government decisions are likely to ensure that their career is going to be different than best case scenarios they hear about
I still think rads > RO for at least the next decade. Surging volume thanks to indications and increasing APPs vs the dumpster fire of omission, consolidation and inept leadership as it relates to reimbursement challenges in RO, even the workforce report they were forced to create and issue didn't paint a pretty picture of our future.
AI can't take liability. Scans will still be signed off by a BC DR
My opinion
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This is absolutely nuts in comparison to what we deal with.
yeah my post was more about medicine in general than comparing to rad onc. just think med students should be very open eyed of realities, regardless, and happiness comes from expectations and would be wise not to have the same expectations for their career.
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There can only be one reason that hasn't filled. MGMA median are pleb wages anywhere near Jackson.
Edit: I think this is in Cody. That's pretty far out there. Some of these frontier towns are kind of like living on a remote island (learned the hard way).
Edit: I think this is in Cody. That's pretty far out there. Some of these frontier towns are kind of like living on a remote island (learned the hard way).
What is the salary?
Dunno, they didn't say. Maybe that's a warning sign?
I hear a lot about how rad onc is screwed in cities but I've seen a number of postings like this, so I wanted to verify if there's some catch here I'm not seeing.
Fortunately you can make very confident decisions about rad onc’s reimbursement future (and thus a rad onc’s salary) since the billing and coding landscape in rad onc is so incredibly stableWhat do ya'll think of this? 550k in LA
I hear a lot about how rad onc is screwed in cities but I've seen a number of postings like this, so I wanted to verify if there's some catch here I'm not seeing.
Very desirable job.What do ya'll think of this? 550k in LA
I hear a lot about how rad onc is screwed in cities but I've seen a number of postings like this, so I wanted to verify if there's some catch here I'm not seeing.
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KP usually a pretty decent option in Cali from what I hear. I'm sure it will be sought afterWhat do ya'll think of this? 550k in LA
I hear a lot about how rad onc is screwed in cities but I've seen a number of postings like this, so I wanted to verify if there's some catch here I'm not seeing.
After medical school, and choosing to become a rad onc (vs anything else), and then doing a 5y residency for same, and then taking a 550K job in LA, I'm thinking of two (paraphrased and not) quotes from Will Rogers and Mark Twain:
* Politics has become so expensive that it takes a lot of money even to be defeated.
* Suppose you were an idiot, and suppose you chose to be a rad onc for 550K in Los Angeles; but I repeat myself.
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Wait why is that an idiotic move? 550k in LA sounds fantastic if someone wants to be in LA.
They’re actively looking. I know for a fact.
Did they just start? Surely this position would be in massive demand. How long has it been open?
KAiser LA used to operate such that the docs did not have their own pts. ie you do everyones sims one day, someone else sees the pt and another docs see the follow ups? not sure if it works like that today. Great job if you want to be in LA, but given over 50% of salary goes to taxes, not sure how anyone without family money could afford a house in a decent area within 20+ miles of this location.
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When I was doing my intern year at a community hospital, I was with a GI doc (he was the only GI in the hospital, so you can guess how busy he was) who was in the middle of a fight with the admin (I think it was about doing notes on time). They threatened to fire him… he laughed at their face and told them he would be at his new job beginning of next week and the only that would change in his life would be his commute would be 10 minutes longer! 1 month later, not only he wasn’t fired, they got him a personal PA who’d do his notes for him!
The rad oncs at the same hospitals might be making the same amount if not more compensation wise, however there is no way they can straight up tell admin to shove it because then they probably have look for jobs in another state!
That’s the issue with rad onc job market.
The rad oncs at the same hospitals might be making the same amount if not more compensation wise, however there is no way they can straight up tell admin to shove it because then they probably have look for jobs in another state!
That’s the issue with rad onc job market.
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Can confirm. I did this once to ultra-toxic admin who was bullying me and not honoring their contract. I thought being in the armpit of America would give me some leverage. Wrong. The response was a smile with "No worries, we fully staffed with locums as soon as you told us you wanted to leave, we have no need or interest in your services here any longer." The CT and ortho surgeons were treated like royalty. Rad oncs were treated as subhuman.
I mean this literally applies to half of doctors. They can do that with IM or Psych or Radiology too. Plus, most of those fields (except radiology) are making noticeably less than rad onc too.
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Rad onc is one of the most profitable service lines in a hospital. The only reason hospitals often treat us like garbage is that the academic centers have produced close to double the number of rad oncs actually needed. As a result, there is a bloated locums pool willing to work for peanuts, and IMGs filling rural positions is not a thing as there are more than enough US MDs to go around. So no we are not like hospitalists or nephrologists in that regard. You will not find many US trained docs in those unprofitable specialties working where I did. Our wound was entirely self-inflicted. There's only one reason we don't have the same leverage and treatment subspecialty surgeons do.
Certainly doesn’t apply to radiology! There is a shortage in psych. For IM, depends on the location. No field in medicine is more oversupplied than radonc, which makes sense given that we had the largest residency expaNsiom
ER bad too
There are good jobs in LA available now, this time period has been well known and predicted. From what I have been told KP is an outlier of an employer too, so you are doing a case report in a sense. Even in a "good" job market you will be competing with the elites in most years to get a job like this, maybe not this year, but some years. It is good of you to observe what is going on now and to question anonymized people based on your current knowledge. These types of jobs may not be the case for you since you will be graduating post analysis in a time that is estimated to be oversupplied again. There was significant oversupply and job problems in the field that is at least a standard deviation above most (maybe all) other currently viable field specialties. That is the reason you observe a higher proportion of jaded people in the field.
If you love the field so much that you would be happy doing it in a fly over state making 300-400k, apply, you will (probably) be happy. If you are thinking you will be making 550k in Manhattan or LA, but you'd prefer to do other specialties all things considered, don't apply. The old trope of "money won't buy you happiness" is true in a sense, it will buy you happiness if you come from a struggling lifestyle (up until a point) or need to provide for sick parents, loved ones, kids, etc. but it has diminishing returns once you get up there, kind of like getting a high score on an arcade game. Do not go into the field because you think it is not very busy and makes a lot of money, because that is the reason for most of the issues in our field, and at some point the house of cards has to fall.
If you love the field so much that you would be happy doing it in a fly over state making 300-400k, apply, you will (probably) be happy. If you are thinking you will be making 550k in Manhattan or LA, but you'd prefer to do other specialties all things considered, don't apply. The old trope of "money won't buy you happiness" is true in a sense, it will buy you happiness if you come from a struggling lifestyle (up until a point) or need to provide for sick parents, loved ones, kids, etc. but it has diminishing returns once you get up there, kind of like getting a high score on an arcade game. Do not go into the field because you think it is not very busy and makes a lot of money, because that is the reason for most of the issues in our field, and at some point the house of cards has to fall.
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Half of the time I talk to a Radiologist they are across the country or maybe further. I don't ask, but I get told I will get transferred and it's usually someone that is not one of our usuals lol.
GI is a field that mirrored RadOnc the most in the last 3 or so decades. GI caused a significant oversupply that they corrected. I think they also have significant existential threats, but I digress. Maybe a good topic for another thread at some point.
Oversupply concerns isn't unique to radiation oncology, I could go into details about this but again digressing. I personally believe in the field somewhat, there has been decrease in the number of doctors being created.
Unfortunately there are new mid levels being created, which is unique to radiation oncology. No other field in the US has ever created a mid level during a time of oversupply. It is an afront to the field as a whole, with no source of need. This is what I would say is the number one reason to not become a RadOnc, despite how much I love the field and all the people in it.
This is why I wish the SDN community here would be consistent. There will be eruptions about stuff that isn't important. But when it comes to stuff that is important like protecting billing (Maybe ROCR (IDK I still don't read that type of stuff)) or mid level encroachment for no reason, stuff like that barely becomes a topic. But if you can argue with a medical student about making 600k in NYC these people are all about legit propaganda case reports lol
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“Hi Dr. XXX, this is Dixon from MBS Oncology and I'm working with a group in western Oregon that is looking for Radiation Oncology help as soon as possible. No call, 20-30 pts per day. EPIC EMR. They are seeking up to full time but will look at any schedule. If you have any availability or know someone who might please let me know! Thank you!”
If any of you are interested, PM me.
If any of you are interested, PM me.
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widespread implementation of one doc for several clinics (especially w/midlevel) and omission of xrt in early stage breast will also hit this field hard within 10-20 years.
What's the salary range?
You’re a med student, right? Don’t sweat about salary too much. Right now focus on finding out if you actually like the field or not. While overall rad onc has a good lifestyle, you have to be comfortable with never being “off”. What I mean is, many physicians once they go home, they won’t have to think about that day’s patients or their next day’s patients. That’s not the same with rad onc. Also, there’s almost zero diagnostic component to rad onc but you should always be vigilant to make sure nothing has been missed. Another thing, your quality of work depends alot on other people so you should be okay to work in a team environment and be able to get what you need from them without causing an issue because again, your work depends on them.
Now let’s say you do in fact like the field, the next question is, should you pursue it? As many people said before, salary itself hasn’t been an issue (an honestly the lifestyle difference between $500k and $700k in much less than what you think), it’s the ability to find a job in your desired location. You’d be surprised how much money other specialties make once you get our of “desirable” locations.
Overall my advice is: first find out what specialties you like and feel fulfilled doing them. Then think about what are the more important aspect of the job for you. Is it just the salary? Location? Time off? No being on-call? Not having to do night? Etc. then talk about people who have been in the field 15-20 years, because there are things that might not matter to right now but it would later in life and vice versa.
I've been seeing a lot of people saying on here that salary tanked, not just location. Job offers have been going down, and grads are making way less. Every post I see doesn't reflect that though, but I still seek in case I'm missing something. I have to decide in a few months, so I'm asking lol
GI docs in rural areas make much more than their rad onc equivalent. Like 2-3 times more.
