What is the problem...can one define it? Let your voice be heard...

[RickyScott]

In other words: “Cutting spots is not enough to fix the entire problem in one single move so we shouldn’t do it.”

Do you realize how weird that sounds? It is like saying we shouldn’t treat cancer because we can’t cure everyone who has it.

I understand your point, but I am just trying to bring awareness that we will still be left with a lot of under/un employed radoncs no matter what happens with the spots.

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[TheWallnerus]

MD/PhDs didn't fail [rad onc]; [rad onc] failed us.

Absolutely. I don't think we have hard, definitive numbers, but there was a recent Red Journal article (The Holman Research Pathway in Radiation Oncology: 2010 to 2019) looking at the outcomes of those who did Holman (although I am sure there are non-Holman people focused on research).

Nonetheless, in this select group of people from 2010 to 2019, this is what the abstract highlights: Of the 75 HRP graduates currently employed in an academic position, 39 (52.0%) have their own laboratories. Twenty-three of the 96 HRP residents (24.0%) who secured employment in full-time clinical positions after residency switched jobs over the study period.

Back of the envelope calculation, across 10 years, 39 have a laboratory, with nearly a quarter switching jobs during this time, leaving about 3 laboratory positions per year.

I am an MD/PhD, like many of us, who is now primarily clinical in an academic shop. The experience I saw on the job search, data like this, and decreased federal funding, I think I would be hard pressed to find a reason to persuade an MD/PhD student, who wants a physician-scientist career, to look at our field. There seems to me more opportunity elsewhere and ask them to look at those fields before coming back to rad onc.

MD–PhD Program Graduates’ Engagement in Research: Results of a National Study
"Participation in ≥ 1 year of GME research (beta [β] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (β: −28.70), diagnostic radiology (β: −32.92), or surgery (β: −29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine)."

 

[thesauce]

I understand your point, but I am just trying to bring awareness that we will still be left with a lot of under/un employed radoncs no matter what happens with the spots.

Sure. That is entirely possible, but it will help tremendously. Other ideas have been floated to help the situation, but none of them are going to put much of a dent into it unless training spots are cut first.

 

[RickyScott]

Sure. That is entirely possible, but it will help tremendously. Other ideas have been floated to help the situation, but none of them are going to put much of a dent into it unless training spots are cut first.

My worry is that to misinformed the specialty may appear viable. Unless we broaden utilization - clinical oncology etc, we are dead in the long run for most newbies. Being a One trick pony was good while it lasted but the sooner it ends, the less pain.

 

[medgator]

My worry is that to misinformed the specialty may appear viable. Unless we broaden utilization - clinical oncology etc, we are dead in the long run for most newbies. Being a One trick pony was good while it lasted but the sooner it ends, the less pain.

Market specific... Some of us are perfectly fine with our ebrt and occasional brachy workload. Current number of grads is not sustainable for the amount of that work though

 

[jondunn]

Market specific... Some of us are perfectly fine with our ebrt and occasional brachy workload. Current number of grads is not sustainable for the amount of that work though

Will CMS one day force @OTN to hire partners?

 

[Ray D. Ayshun]

One trick pony? We use energy to kill cancer. Nobody's clamoring for surgeons to start using forks

 

[thesauce]

My worry is that to misinformed the specialty may appear viable. Unless we broaden utilization - clinical oncology etc, we are dead in the long run for most newbies. Being a One trick pony was good while it lasted but the sooner it ends, the less pain.

Perhaps but the first step is to stop digging

 

[RickyScott]

One trick pony? We use energy to kill cancer. Nobody's clamoring for surgeons to start using forks

Giving substances to treat disease and cutting have been around for 5000 years and will be around for the next 5000. Essence of medicine.

 

[deleted941485]

Giving substances to treat disease and cutting have been around for 5000 years and will be around for the next 5000. Essence of medicine.

Who or what will be giving them to patients

 

[radiation]

MD–PhD Program Graduates’ Engagement in Research: Results of a National Study
"Participation in ≥ 1 year of GME research (beta [β] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (β: −28.70), diagnostic radiology (β: −32.92), or surgery (β: −29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine)."

there are more total residents in the Holman pathway than ever before and the vast majority of them will be MD only. Will be interesting how much different their research output will be vs. the "golden years" of md/phds

 

[Dan Spratt]

@Dan Spratt
It would be very decent of you to share your conclusions/presentation publicly for the education of all, even if the official meeting is behind closed doors. Since you are including our thoughts in the discussion, I'd love to know what your take away is

Happy to

 

[communitydoc13]

there are more total residents in the Holman pathway than ever before and the vast majority of them will be MD only. Will be interesting how much different their research output will be vs. the "golden years" of md/phds

In our field, if clinician/scientists were really doing fairly late stage, translational radio-pharm stuff or actual radiation/physics stuff, this makes sense to me. But, what I have seen in the past 10-15 years is a lot of molecular biology/immunology type researchers who support their salary through some clinical time while doing very unrelated wet lab work that could easily be supported in other departments. The possibility of these type of jobs was undoubtedly an appeal to the great MD/PhDs we were getting during peak radonc. The ones that have been successful often had tremendous research career momentum going into residency.

The paradigm changing stuff is almost always done by dedicated researchers (either PhDs or physician/scientists who have abdicated clinical duties). This stuff takes decades (often 3 or more decades with occasional 2 decade flyers) to impact clinical care.

I'm sure that many of these molecular oncology researchers who are hidden in radonc departments support the understood "academic mission" of the department. It's just that this mission has almost no relatability to clinical radiation oncology.

Keep in mind that medical oncology is not only supported by physician scientists, but whole immunology departments, pathology departments, biochemistry departments, evolutionary biology departments and even embryology research. Medical oncology is in general the terminus for application of new biological knowledge to cancer care.

 

[deleted941485]

The paradigm changing stuff is almost always done by dedicated researchers (either PhDs or physician/scientists who have abdicated clinical duties). This Keep in mind that medical oncology is not only supported by physician scientists, but whole immunology departments, pathology departments, biochemistry departments, evolutionary biology departments and even embryology research. Medical oncology is in general the terminus for application of new biological knowledge to cancer care.

Which is why the boundaries between Rad Onc and Med Onc should be dismantled. Especially when rad onc claims they are the true oncologists…at least until recently. Or at least that was the propoganda being pushed at the time I was an idiot medical student

It would be a shame to have all the supposed clinical knowledge of cancer become nothing more than a encyclopedia of bygone therapies.

 

[RickyScott]

Which is why the boundaries between Rad Onc and Med Onc should be dismantled. Especially when rad onc claims they are the true oncologists…at least until recently. Or at least that was the propoganda being pushed at the time I was an idiot medical student

It would be a shame to have all the supposed clinical knowledge of cancer become nothing more than a encyclopedia of bygone therapies.

With you 💯. Not to mention the huge industry support in medical oncology research.

 

[Baws]

The future of radiation oncology

 

[radoncftw]

View attachment 354492
The future of radiation oncology

yikes this is not stanford or harvard. this is iowa.

 

[jondunn]

not to be that guy - but we really doing that thing where we believe that's really the pay? hasn't this conversation been had like a hundred times here?

 

[medgator]

not to be that guy - but we really doing that thing where we believe that's really the pay? hasn't this conversation been had like a hundred times here?

Here comes JD from his academic satellite, ready to defend the exploitative mothership practices. Hallahan would be proud, brah

 

[thecarbonionangle]

Nobody seems to know what the median salary for rad onc is!

 

[RadOncDoc21]

Nobody seems to know what the median salary for rad onc is!

That can’t be it!

 

[grenz]

Here comes JD from his academic satellite, ready to defend the exploitative mothership practices. Hallahan would be proud, brah

He’s not wrong though. Most of the comp at public universities is not in the advertised salary

 

[deleted1116990]

View attachment 354492
The future of radiation oncology

Even if that's base salary before RVU bonus, IIRC per MGMA base is on average 85% of total comp which means, reasonably if we are being generous this is a 275k position in a place that should be paying 800k.

You can make double that doing locums.

Someone from Iowa needs to come on here and splain themselves. Is this part time? Do you routinely pay 400-500k bonuses beyond base? Did they create an instructor position for a graduating resident who needed a job and were required by law to post it? WTF. Why would you advertise this?

This makes the 850k-year-1-then-we'll-figure-out-later-thereafter salary and if you leave you owe us one year of salary in cash deal in Spencer seem benevolent.

 

[jondunn]

this is a 275k position in a place that should be paying 800k.

am i missing something? do you have access to how many RVUs this satellite is producing? what?

 

[deleted1116990]

am i missing something?

Yes -- where I asked for someone from Iowa to explain.

A busy full time rad onc in Iowa should be making 700+. Maybe that's not what this is.

 

[radoncftw]

Yes -- where I asked for someone from Iowa to explain.

A busy full time rad onc in Iowa should be making 700+. Maybe that's not what this is.

key word "should". I don't think academic practices pay based on what a rad onc "should" make.

 

[TheWallnerus]

View attachment 354492
The future of radiation oncology

This is a fake post. Because this salary is so far below MGMA median for rad onc of $550K. And no rad onc makes below MGMA median. JK.

New grads starting out at instructor level theoretically have a 25-30% chance (@Chartreuse Wombat) of being in this "salary bin."

BTW, anyone who thinks MGMA rad onc salary data is that reliable, you clearly aren't paying attention. Again... 1.1m new RT patients per year at 3.5w average duration of treatment means ~74K Americans per day get RT. If there are ~6000 rad oncs, this is ~12/day per RO in America, on average. Thus, it is almost mathematically impossible that the *average* salary in the US is $550K. Twenty years ago, this math (1.2m new RT pts/yr, 5 weeks RT duration, 3500 rad oncs) worked out to **33/day** per RO under beam on average. A $550K median MGMA was FAR more feasible back then!

 

[jondunn]

Nobody seems to know what the median salary for rad onc is!

TheWallnernus is pretty confident he does know.

He does not believe MGMA.

He does not believe @RealSimulD

 

[Baws]

I work at a satellite. It’s an 8am to 5pm job.

My base is less than 300. Including all the extras, my take home is 310-325. (Closer to 310 in the past few years; below that actually one year) .

This iowa posting is not as much of a zebra as its being made here.

 

[TheWallnerus]

TheWallnernus is pretty confident he does know.

He does not believe MGMA.

He does not believe @RealSimulD

How many sub-median-MGMA data points do we need to see (and almost never getting a supra-median point) before we can be confident MGMA does not know the true median? "Oh those higher values are for the busy guys, the established guys." Who gets busy and who gets "established" nowadays???

 

[jondunn]

I work at a satellite. It’s an 8am to 5pm job.

My base is less than 300. Including all the extras, my take home is 310-325. (Closer to 310 in the past few years; below that actually one year) .

This iowa posting is not as much of a zebra as its being made here.

310 or 325 is a lot diff from 239.

we are talking about a 25 percent difference.

310 or 325 i believe all day.

 

[deleted1116990]

I work at a satellite. It’s an 8am to 5pm job.

My base is less than 300. Including all the extras, my take home is 310-325. (Closer to 310 in the past few years; below that actually one year) .

This iowa posting is not as much of a zebra as its being made here.

In the midwest? Brutal.

Dan, this is the short answer to your question you were looking for. Med students can make more with a 3 year family medicine residency and get a job anywhere in the country.

 

[Lamount]

He’s not wrong though. Most of the comp at public universities is not in the advertised salary

Agree. Some academic places will have a "clinical" salary and a "faculty" salary... perhaps this is just the clinical component (or perhaps not).

 

[RickyScott]

In the midwest? Brutal.

Dan, this is the short answer to your question you were looking for. Med students can make more with a 3 year family medicine residency and get a job anywhere in the country.

Family med/primary care in some of these rural locations can pay very well.

 

[deleted1116990]

310 or 325 is a lot diff from 239.

we are talking about a 25 percent difference.

310 or 325 i believe all day.

The difference in standard of living, saving etc from a 239k vs. a 310k gross income is not that big. For all intents and purposes these will give you the same life. The difference between a 239k income and a 600k income is enormous.

I don't think that if it turns out that this job is not actually 239k but is actually low 300s we can all breathe a sigh of relief that all is well after all.

It's kind of messed up that there are some of us that do the exact same and amount of work as others are able to lead totally different lives because a middleman takes a cut from the fee-for-service from one but not the other? Don't you think?

 

[jondunn]

It's kind of messed up that there are some of us that do the exact same and amount of work as others are able to lead totally different lives because a middleman takes a cut from the fee-for-service from one but not the other? Don't you think?

welcome to America!

in all seriousness, I have talked about this here ad nauseum - the corporatization of medicine is the root of all evil.

I agree with you on QOL differences, but numbers matter - and 239 is different than 325. same way 410 is diff than 325.

 

[Chartreuse Wombat]

This is a fake post. Because this salary is so far below MGMA median for rad onc of $550K. And no rad onc makes below MGMA median. JK.

New grads starting out at instructor level theoretically have a 25-30% chance (@Chartreuse Wombat) of being in this "salary bin."

BTW, anyone who thinks MGMA rad onc salary data is that reliable, you clearly aren't paying attention. Again... 1.1m new RT patients per year at 3.5w average duration of treatment means ~74K Americans per day get RT. If there are ~6000 rad oncs, this is ~12/day per RO in America, on average. Thus, it is almost mathematically impossible that the *average* salary in the US is $550K. Twenty years ago, this math (1.2m new RT pts/yr, 5 weeks RT duration, 3500 rad oncs) worked out to **33/day** per RO under beam on average. A $550K median MGMA was FAR more feasible back then!

TW-

I don't know the appropriate syntax for this sort of conversation.

"New grads starting out at instructor level theoretically have a 25-30% chance (@Chartreuse Wombat) of being in this "salary bin."

is this responding to a previous statement from me? I am not on Twitter so I don't know what you mean by "salary bin"

Would you be so kind as to translate this statement?

Not sure if I am supposed to respond with a rebuttal or whether you are agreeing with me.

Serious question I am old.

My starting salary as assistant professor was $175K; 25 patients on treatment. In clinic 4 days a week. Early 1990's

 

[TheWallnerus]

TW-

I don't know the appropriate syntax for this sort of conversation.

"New grads starting out at instructor level theoretically have a 25-30% chance (@Chartreuse Wombat) of being in this "salary bin."

is this responding to a previous statement from me? I am not on Twitter so I don't know what you mean by "salary bin"

Would you be so kind as to translate this statement?

Not sure if I am supposed to respond with a rebuttal or whether you are agreeing with me.

Serious question I am old.

My starting salary as assistant professor was $175K; 25 patients on treatment. In clinic 4 days a week. Early 1990's

Ah no I am quoting your data from an old post you made ... see link above

The 25%ile is $261K for an instructor, thus the Iowa job of $239K would be a ~20-25% chance of a grad falling in this "bin" or range... if this is an instructorship.

(25-30% chance was a mistake; I went the wrong way; brain fart etc etc)

 

[radiation]

The root of many of these salary arguments is what you believe to be the "ground truth" of what radiation oncology salary should be. Is it peak rad onc of 2000's? Or are we regressing to the mean of the 70, 80s, and pre-IMRT 90s.

 

[RickyScott]

The root of many of these salary arguments is what you believe to be the "ground truth" of what radiation oncology salary should be. Is it peak rad onc of 2000's? Or are we regressing to the mean of the 70, 80s, and pre-IMRT 90s.

At the very least, a radonc in Iowa should make the same as primary care in Iowa, provably a bit more to account for extra 2 yrs of trainging an extreme geographic inflexibility. Decreased salary joined at hip to geographic limitation as both are result of oversupply. And geography matters much more to most docs per surveys.

 

[medgator]

310 or 325 is a lot diff from 239.

we are talking about a 25 percent difference.

310 or 325 i believe all day.

In Iowa? That's terrible pay any way you slice considering that's what NE coastal pps exempt places with plenty of biryani options around are paying. $310k or $239k... Trash salary in a trash location

 

[fiji128]

View attachment 354492
The future of radiation oncology

U of Iowa posted a job about 6+ months ago for a satellite rad onc clinic in Clinton Iowa with a pay listed at $240k with no further salary specifics given.

 

[RadOncDoc21]

When did Iowa become a place?

 

[medgator]

In the midwest? Brutal.

Dan, this is the short answer to your question you were looking for. Med students can make more with a 3 year family medicine residency and get a job anywhere in the country.

@Dan Spratt this in a nutshell is the kind of stuff that will keep medical students far far away from this dumpster fire of a specialty. I know for a fact that psych is paying $300k+ in better locations than Iowa

 

[TheWallnerus]

When did Iowa become a place?

 

[RadOncDoc21]

You think they have good biryani?

 

[deleted1111261]

I don’t know… $240k is very low. KU is paying way more than that for first year / entry level with tons of vacation and I am pretty sure a 4 day work week. I use that as an example, because it’s a neighboring breadbasket state, and KC is more metropolitans than any city in Iowa. I don’t know anything about working w/ Hotboy Ronald and the gang, but they appear to be paying well.

If we found out it’s real, not shocked. If it’s $240k and there is some component that makes it close to $300k, not shocked. If it is actually $400k+, then I would be shocked.

 

[RickyScott]

I don’t know… $240k is very low. KU is paying way more than that for first year / entry level with tons of vacation and I am pretty sure a 4 day work week. I use that as an example, because it’s a neighboring breadbasket state, and KC is more metropolitans than any city in Iowa. I don’t know anything about working w/ Hotboy Ronald and the gang, but they appear to be paying well.

If we found out it’s real, not shocked. If it’s $240k and there is some component that makes it close to $300k, not shocked. If it is actually $400k+, then I would be shocked.

Within 2 years, grads of Iowa’s program will be begging for the job

 

[medgator]

not to be that guy - but we really doing that thing where we believe that's really the pay? hasn't this conversation been had like a hundred times here?

I work at a satellite. It’s an 8am to 5pm job.

My base is less than 300. Including all the extras, my take home is 310-325. (Closer to 310 in the past few years; below that actually one year) .

This iowa posting is not as much of a zebra as its being made here.

Within 2 years, grads of Iowa’s program will be begging for the job

/Thread

 

[seper]

University-based nerworks pay closer to AAMC salary data than MGMA. 240 is low, anyway