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I wrote off radiology for this reason as well, until someone told me that watching someone be a radiologist is like watching someone else play video games.
I think about that a lot.
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I think about that a lot.
That's all the rage these days with kids... Watching other people play video games
It's like trying to time the market, but man Rads seems to be really taking off over the past few years....
Seeing high 6 or 7-figures to Rads in telerads or major metros....
Allseasons - I appreciate your optimism, I do.
And the future may not be *as* doom and gloom as the bulk of SDN regulars will post. Crotchety old men (and women) will generally be crotchety, and all that.
If you still want to do Rad Onc, then go for it.
However, I think all the people who state "don't trust anything SDN says" probably have some sort of issue with something we are saying, that likely affects them in some way, whether it be lifestyle, prestige, etc.
Seeing high 6 or 7-figures to Rads in telerads or major metros....
Allseasons - I appreciate your optimism, I do.
And the future may not be *as* doom and gloom as the bulk of SDN regulars will post. Crotchety old men (and women) will generally be crotchety, and all that.
If you still want to do Rad Onc, then go for it.
However, I think all the people who state "don't trust anything SDN says" probably have some sort of issue with something we are saying, that likely affects them in some way, whether it be lifestyle, prestige, etc.
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When I was in med school, radiology was doomed. This paper isn't even 10 years old.
Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets - PubMed
The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is...
pubmed.ncbi.nlm.nih.gov
Radiology is a much bigger field, but they seem to have much more healthy discussion about workforce and economics than radiation oncology.
15,000 rvus and no other responsibilities, is a
They also don't have leadership actively trying to reduce their role in medicine.... Quite the contrary actually when you look at what's been happening to their workloadWhen I was in med school, radiology was doomed. This paper isn't even 10 years old.
Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets - PubMed
The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is...
Radiology is a much bigger field, but they seem to have much more healthy discussion about workforce and economics than radiation oncology.
ASTRO does seem to be actively trying to expand radiation use, based on the theme of ASTRO this year at any rate. And from what we're treating at my institution, non-oncologic indications for radiation haven't had a larger portion of our share for decades (obviously it was higher back before the field even became radiation oncology) and it's expected to continue growing.
No clue if it will pan out, but we have higher demand and more patients than ever despite hypofractionation right now.
I totally disagree that there are more total patients nationwide. Certainly new pts per doc is significantly decreased per acr data. The average radonc in academics sees less than 4 new pts per week, less than 10-15 years ago, and frankly pathetic.
accreditationsupport.acr.org
Personnel: Radiation Oncology (Revised 7-22-2026)
Revision History Role Personnel Requirements/Recommendations Medical Director Each program must have a medical director who is a radiation oncologist as described below. He/she is responsible for oversight of the department, includi...
accreditationsupport.acr.org
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When I trained, not long ago, these indications you cite that academic centers are now treating were considered spurious at best, and money grabs at worst. I would argue this is not a sign of health. It's like transitioning from eating king salmon to carp. When there aren't enough fish in the river you cast your line next to the nuclear plant.
It was my understanding that some of the larger (patient wise) benign resurgence discussions were propagated on SDN and within the community and not academic centers. I would have preferred expansion into oncology such as clinical oncology rather than or in addition to adding ablation and LDRT. The number of patients per RadOnc currently seems too low when you think about how much a lot of our computer facing work will be automated within the next 5-10 years. It is already faster with EMR improvements/AI tools, autocontouring, and the likes.
I think about the "timing the market" about RadOnc sometimes. RadOnc job market died in the 90s, but if you went in to it at that time of no competition you had one of the best careers medicine could offer, then around the 2010s everyone was being told the gravy train was never going to end, but then the oversupply concerns and the big fall off happened.
That is why I don't think @allseasons should be looking at it from a "job market is great right now", because these things will wax and wane, might as well be doing a job that makes you happy if you're making 500k or 300k. I think a mistake a lot of people make is they think that making 500k instead of 400k is going to make a big difference in their life. Having more/better options to transition jobs, live where you want to live, and things of that nature will have more impact on your happiness down the road.
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I think the real issue for medstudents is the non zero chance of a black swan/total collapse of the job market. It is on the table in a 20-30 year timeframe. No reason to think that we won’t be able to omit radiation in the vast majority of breast and prostate cancers at some point.
I'm just tired of seeing more, and more complicated, patients for the same or less money over time
No matter how efficient I am it gets worse - AI can't help too much at my particular job; it's not a social worker
It's a different kind of rat race and just wears on you
No matter how efficient I am it gets worse - AI can't help too much at my particular job; it's not a social worker
It's a different kind of rat race and just wears on you
IMRT igrt changed the game curb. Going from light boxes and China markers to contouring the F out of everything and using image guidance that paid well.
No one saw that coming in the 90s
I do not forsee a similar white knight technology coming to save the specialty now esp when you look at what Medicare and hypofx has been doing for years
I agree, hard to predict the future and people got extremely lucky with the advances in technology, idk if there will ever be a technology advance that helps us that much again. They are trying to do it with adaptive therapy or flash! Maybe?
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Not ASTRO. I launched a program in my network. This started before Sameer decided to take on "benign" as his pet topic. Everyone that has helped me is not affiliated with ASTRO. It's nice they have joined the party making it the theme this year, but they've hopped on a bandwagon that started without them.
The other thing is that "benign indications" are unlikely to fix the economic problems described by many here. It takes several courses of arthritis treatment to generate the same income as one course of breast or prostate treatment.
Agreed. I was taught that these indications are bad. Only scammers do it. Weirdly, during these journal clubs, we never once discussed any of the literature around treating these indications. We just talked about practice websites and why LDRT is "dangerous".
I saw a resident get berated rather vociferously for presenting a benign case at a morning case conference. If you were MattSpraker I'm sure you could guess the institution, conference, and attendings involved.
The future of academic rad onc is seeing 1 new consult per week with 1 new start per week. Artisan small-batch radiation will be the marketing angle. Except if the academic practice serves a safety net hospital, then treatment volumes will still be reasonable.
LDRT in no way comes close to making up for the drop off in esophagus, pancreas, stomach, stage 3 lung, lymphoma, myeloma over the past 10 years.
It's fine if you're already being underpaid at an academic center
And don’t forget balls. We’ve lost balls. Literally and metaphorically.
I will say this about rad onc. I should be waaaay more depressed about it than I am, especially if were somehow able to give a report to my 2005 self. So I do give thanks for that. I would attribute this to the frog in a boiling pot analogy and the power of positive thinking.
Radiopharmaceuticals, ldrt, sbrt oligomets etc
Great examples of pissing on people and calling it rain
A back and forth on radiopharmaceuticals that nicely reflects the culture of this field. They are both good editorials, it's just funny that the professional services argument came from the junior leadership of RPT development in RO.
Initial: https://www.practicalradonc.org/article/S1879-8500(23)00168-6/fulltext
Response: https://www.practicalradonc.org/article/S1879-8500(23)00228-X/fulltext
That i’m not sure.. i’m currently in residency and see 6-10 consults a week. And i’m in a super small program!
The vast vast majority of radiation oncologists are either making $/RVU or collecting professional codes.
On both of those metrics/formulations...the reimbursement for the amount of time/effort expended on doing a good job at managing radiopharm is abysmal. You are enriching your cancer center and pharma, but pro reimbursement is so so bad.
I wish there was more urgency on the doc side of things for this - and it parallels the whole IGRT change as well.
what are you smoking
All of the ASTRO Presidential Symposium this year is focused on alternative indications including: Dupuytren's, OA, functional SRS beyond AVMs and TGN (movement disorders and psych), and cardiac ablation.
They have to establish and expand use before embarking on omission studies.
What do ya'll think could be the future of rad onc in Alzheimers? Part of the talk focuses on that too.
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How? What can we do?
If you are on base + bonus and working below threshold, developing an RPT program: helps patients, demonstrates your value to the cancer program, and gives the best opportunity for RO-industry collaboration (assuming you have a trials program). Plenty of upside.
I get that very busy ROs need to be choosy with time spent, but a lot of ROs are not busy.
The number one indication, by far, for XRT in America is breast. And if America was using one week breast RT at the level England is, American rad onc would be full meltdown mode. So thank god we aren’t following evidence based treatments!
The evidence shows that 15- or 16-fraction regimens lead to better cosmetic outcomes than 1 week whole breast RT. The UK docs did a really good job of burying it in the addenda to pretend like it doesn't exist, but it does.
Having said that, I try to push for external beam 5-fraction partial breast as much as possible and have moved the needle on getting my breast surgeons to stop doing oncoplastic lumpectomies for patients older than 70.
I'm optimistic about breast for the first time in awhile, because the data is also finally showing what we've known all along: for older patients, adjuvant RT, especially with partial breast RT (Europa trial) is better tolerated than hormone therapy, and omission of HT in these patients doesn't meaningfully increase recurrence. I've gotten zero pushback from my medoncs or surgeons when I counsel patients that I would recommend adjuvant RT and not HT for their early-stage breast ca.
I agree the value for patients is there and maybe demonstrating value to your cancer program helps with goodwill, but the gap between pro and facility fees for these drugs are insane. The cancer centers cannot administer this drug without you. I think there is room for negotiation for employed or PSA docs to figure out a way the facility can reimburse them on top of the paltry pro fees generated (basically how med oncs are paid....their pro fees don't cover their salaires in employed med oncs. A huge chunk of their salaries comes siphoned off of chemo drug reimbursement).
Those PRO editorials basically suggest this as I recall.
Maybe it's a pipe dream but I would like to see some new CPT codes and/or some push/literature that has $/wRVU closer to med onc for RVU procedures that mimic chemo (like radiopharm administration/management).
EDIT
A lot of the perspective here is what you're alluding too as well. I come from a very busy practice, where with all the billing turmoil upcoming we are reluctant to hire...yet we're all very busy. The amount of work to get our radiopharm running as a quality program has been a good amount of time, and looking at those pro fees is frustrating for docs working 50-60 hours/week right now.
Sure, if you've got the bandwith, getting up and running is a really important thing.
In other news
Extreme geographic restriction is a real bonus for their husbands. A lot of these women are married to stay at home partners who can’t wait to move out to BFE.
And then, somewhat ironically, BF is really frowned upon in BFE.
I agree with everything you said. If an employed Rad Onc's base is not covered by pro fees, they kind of already have the "med onc" deal going on. I would have no problem sitting in front of a hospital administrator and telling them that this is a no brainer for value to the hospital in 2025, especially if 340B.
Presumably, as a medical student who knows Rad Onc residents, you are at an academic medical center. Consolidation is a very big deal and most academic centers are seeing volumes increase despite hypofrac, at the expense of community centers.
Not all places are seeing volume expansion.
Sure, patients living longer is giving more opportunities to do a 5th+ course of radiation. So you are going to get repeat customers.
D
deleted1217978
Don't forget 25% inflation from 2020-2025 because of you-know-what.
My 650k BFE salary in 2019 would now have to be 832k. Show me a new grad anywhere making that as a base. Or anybody anywhere.
You would need about 20 knees a month to make up the difference.
A new grad from a nearby program this past June that went to the rural midwest signed an offer for 850k, 5 days a week. A new grad at my friend's program signed an offer for 750k, 4.5 days a week in the southwest in a city with over half a mil. Another new grad from a program in the southeast signed a semi-rural(?) "city" offer for 650k at 4 days a week.
I mean, even in major cities right now there's offers going for 500k+. I posted one in LA earlier, but there's others too. As others said, I have no clue how long this will last, and totally possible it's a dead cat bounce. But this year, at least, it's not looking too bad.
yea this is a very fair point. I think long story short, I like rad onc, but I wouldn't say I love it. It's not like I feel a deep compulsion to do it and I can't see myself doing anything else. However, there's little else I like in medicine more. There's only one other field I liked as much and that's psychiatry, which I also liked, but again, didn't really have a deep compulsion to do it or anything.
It was between psych and this for me. I sometimes wish I'd done psych for the flexibility and autonomy.
Or ability to go cash only...
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You should ask those folks if those salaries are guaranteed regardless of production and if so how long. Might give you a more complete picture of what those contracts are really like.
How long ago did you make that decision?
I'm curious to know wtf 4.5 days a week means...
I saw the job postings for two of them and there wasn't any length restriction. I remember seeing things like that even last year, where the high salary was only guaranteed for the first year or two. This year, most offers don't seem to be like that. I do not know if there are productivity requirements.
Is that not common? I've seen multiple postings like that. 35 hours a week, typically friday afternoons off.
