Why is rad onc not more competitive?

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UndecidedMS2 said:
I never said that but i’ve seen people here saying “med oncs have it great” “rads have it amazing” “surgeons operating and then going to europe immediately after” all based on the personal observations so I think what I said based on my personal experience wasn’t out line. If it was, I apologize. Once again, MY PERSONAL EXPERIENCE, could be totally opposite for others, but i’ve met surgeons who have regretted picking surgery. I’ve met EM doc who loved EM but felt burnt out after just couple years. Met IM attending and resident who wished they did something else. Met IR residents who told me it wasn’t worth it and one of them is gonna do half IR/half DR… guess what? I have yet to meet a single rad onc who wished they specialized in something else. Then you come into this forum and everyone saying rad onc bad, pick something else! I’m just trying to find out the reason for such huge difference in the sentiment, that’s it.
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Well that’s a different point and I agree for the most part.

What I would say is that the academic rad oncs you’re talking about are doing work outside of work. For sure. Like no question.
 
My future outlook is that there are many reasons to be concerned. But that I truly don’t know what will happen. I think that’s pretty obvious though and most people feel the same way.
 
drowsy12 said:
My future outlook is that there are many reasons to be concerned. But that I truly don’t know what will happen. I think that’s pretty obvious though and most people feel the same way.
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Agree with that sentiment, but almost no other specialty has these quasi existential joys market concerns, do they?
 
elementaryschooleconomics said:
Ah, well...there were many issues very specific to that practice and situation which could not be resolved on a timescale I was willing to tolerate - if they could be resolved at all.

The core of it was really around safety, and I don't mean silly things with no clinical consequences. I mean things like...well, like if I was a manager at a Boeing factory and I had brought a bunch of concerns to the C-suite, and they ignored me, and then doors starting falling off planes mid-flight. That kind of stuff.

But, contributing to that was simply my concerns over the future of the last vestige of private practice Radiation Oncology. The group was on a PSA with a couple of hospitals spread out over a small geographic region. Just like literally everywhere else in the country, consolidation had started to rapidly increase in the years before and after I joined.

The hospitals the group covered did not merge with the same networks. The networks had their own Radiation Oncologists in other hospitals. As I recall, they were all employed in some form or the other.

I strongly suspect that there will come a time in the near future where the group's PSA contract will not be renewed. At that time, the best they can hope for is the network(s) off to keep them on as employees, and the deal isn't wildly different (in terms of compensation) than it is now.

Because: this is Radiation Oncology. The hospitals can offer employment with a 50% pay cut, because they know there's no other linacs in a commuting distance. Or, they could have other RadOncs waiting in the wings, already employed, to take over the positions immediately (also cheaper).

Which just brings us to the most important point in business, or the business of medicine:

Always be prepared to walk away.

That's what I did. I had started the job hunt when it became clear the "doors falling off planes" was not going to be addressed. I made one last big plea at a partners meeting.

It fell on deaf ears.

So my resignation letter fell on them, instead.

They never saw it coming. Because it's RadOnc. They knew there were no linacs in commuting distance. They knew geography was important to me.

Always be prepared to walk away.
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💯

Similar story except I was with a malignant group with a wide non compete. And they never saw it coming either. Had to leave the area or keep getting ****ed

This isn't psych or im or even radiology. Probably one of the worst geographic determinablities in all of medicine
 
medgator said:
💯

Similar story except I was with a malignant group with a wide non compete. And they never saw it coming either. Had to leave the area or keep getting ****ed

This isn't psych or im or even radiology. Probably one of the worst geographic determinablities in all of medicine
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I got f’d by some grifters and then moved across the country and ended up in desirable location. Wouldn’t happen today- would have probably ended up as a roving locums.
 
UndecidedMS2 said:
Obviously i don’t know what they do at home but considering they only had 4-6 consults a week, residents and APPs writing the notes, seeing the f/u and OTVs and doing the contours. They also had at least one academic day. Could they be doing some work/research at home? Sure but if I had to bet the total time they did work, mine would be on under 40 hours
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dude i will say this. I am a junior attending now in PP.
I had no idea what my attendings did when i was a resident. I thought many of my attendings did absolutely nothing while i was faxing poetic on this massive consult notes and stuff.
but now i realize alot of the stuff i did didn't really save attendings that much time. i was a good resident i think so maybe my contours were helpful, but to be honest, now being on the other side i probably would not blindly trust resident contours and would just do them myself. some of my attendings did just that.
I now spend a lot of time writing specific notes (that residents cannot write), supervising procedures (i.e. covering SBRTs that residents cannot do).
I now spend 0 time writing papers and doing stupid research. so thats great.
 
UndecidedMS2 said:
A lot of academic places have the salaries as public record. I think the majority fall in $320-400k starting for assistant professors. However, in my personal experience (n≈30), they barely work 40 hours a week. Obviously those fresh out of residency might not be effiecient yet so the first couple years they might hit 45-50 but after that it’s closer to 36-40hrs. Again, it’s just my personal experience which is limited to attendings that work at main site with multiple residents and APPs.
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I genuinely feel like we don’t work on the same planet.

I do not know a single person at any academic level that genuinely works <40 hours a week.

How many physicians in any field walk in to work at 9am? Do they not attend tumor boards ever?

I am in clinic only 3 days a week and those days alone are probably 30-34 hours.

Even the lab folks with no clinic writing several grants a year, it has to be more.
 
UndecidedMS2 said:
Obviously i don’t know what they do at home but considering they only had 4-6 consults a week, residents and APPs writing the notes, seeing the f/u and OTVs and doing the contours. They also had at least one academic day. Could they be doing some work/research at home? Sure but if I had to bet the total time they did work, mine would be on under 40 hours
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You're more than welcome to your opinion. And maybe that does exist. And I appreciate you admitting you have no idea what these folks do at home. Can I ask where you are in the pathway right now? Resident? Attending?

But to assume that an academic rad onc is doing zero or limited work on their academic day.... somewhat eliminates the point of an academic day.
People coming in at 9-3 or 9-4 each day? No early morning or late afternoon tumor boards? No significant work from home?

Fixing notes and contours is not a trivial matter. Sometimes contours need to be re-done from scratch. Are attendings educating the residents? Many in our field don't take a proactive approach to that, so certainly not a guarantee.

There's a lot of things that residents are shielded from, whether that be because they can't bill (iso checks/SBRTs/CT Sims) or it's felt to not be educational (p2p, behind the scenes patient / procedural coordination).
 
evilbooyaa said:
But to assume that an academic rad onc is doing zero or limited work on their academic day
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I have never been an academic attending (would have liked a shot) and have only been associated with two programs. But in my limited experience, even the attendings that I held in the lowest regard were deeply committed to their careers. They were doing lots of things outside of clinic, including planning presentations, writing grants, writing papers (often not very meaningful, but writing papers is still work), networking (outside of the department), participating in collaborative groups, running tumor boards etc.

Maybe I could critique some attendings commitment to resident education or the details of clinical care, but never their commitment to their careers and the associated work involved.

I'm guessing there are places where this is not the case, but I think most academic docs always have work on their minds. This should kinda be standard for an academic doc. It's a privileged position.
 
evilbooyaa said:
You're more than welcome to your opinion. And maybe that does exist. And I appreciate you admitting you have no idea what these folks do at home. Can I ask where you are in the pathway right now? Resident? Attending?

But to assume that an academic rad onc is doing zero or limited work on their academic day.... somewhat eliminates the point of an academic day.
People coming in at 9-3 or 9-4 each day? No early morning or late afternoon tumor boards? No significant work from home?

Fixing notes and contours is not a trivial matter. Sometimes contours need to be re-done from scratch. Are attendings educating the residents? Many in our field don't take a proactive approach to that, so certainly not a guarantee.

There's a lot of things that residents are shielded from, whether that be because they can't bill (iso checks/SBRTs/CT Sims) or it's felt to not be educational (p2p, behind the scenes patient / procedural coordination).
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i agree whole heartedly.
Most use their academic docs to catch up on clinic, work on research, or both.
Most use their evenings and weekends too.
It was one of the things that pushed me away from academics. I felt like at least where I trained it would be really tough to have a good work-life balance. Only the most senior folks seemed to, but they clearly had to grind to get there.

There is a big difference between resident and attending.
The clinic + treatment-related responsibilities are a major component.
Also the sheer ownership of your patients causes alot of stress sometimes. I try to dis-engage, but its tough when patients die or recur
 
radoncftw said:
i agree whole heartedly.
Most use their academic docs to catch up on clinic, work on research, or both.
Most use their evenings and weekends too.
It was one of the things that pushed me away from academics. I felt like at least where I trained it would be really tough to have a good work-life balance. Only the most senior folks seemed to, but they clearly had to grind to get there.

There is a big difference between resident and attending.
The clinic + treatment-related responsibilities are a major component.
Also the sheer ownership of your patients causes alot of stress sometimes. I try to dis-engage, but its tough when patients die or recur
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Okay I'm getting the sense that y'all all went to way different residencies than I did if you think being an academic attending isn't a completely cush gig. Because as a resident I was responsible for: seeing/documenting all new, follow up, and on treatment patients from start to finish with attending popping their head in the door at the end to ask "any questions," all contouring (rarely reviewed let alone modified), plan approval (we reviewed with dosimetry, attending would often sign prescription without looking), completion notes, peer to peer requests, and educating ourselves. Attendings were on site around 8 and their offices were empty by 4. Oh, and we were required to be at the machine for all SBRTs and new starts. And we were required to be at the sim for every patient because half the time the attending couldn't be there. But at least only one of our rotations required us to do all the IGRT as well.

This was the case for all but the most junior faculty, but last I heard it only took the new faculty about 3-4 years to fall into this pattern as well...
 
HolySmokes said:
Okay I'm getting the sense that y'all all went to way different residencies than I did if you think being an academic attending isn't a completely cush gig. Because as a resident I was responsible for: seeing/documenting all new, follow up, and on treatment patients from start to finish with attending popping their head in the door at the end to ask "any questions," all contouring (rarely reviewed let alone modified), plan approval (we reviewed with dosimetry, attending would often sign prescription without looking), completion notes, peer to peer requests, and educating ourselves. Attendings were on site around 8 and their offices were empty by 4. Oh, and we were required to be at the machine for all SBRTs and new starts. And we were required to be at the sim for every patient because half the time the attending couldn't be there. But at least only one of our rotations required us to do all the IGRT as well.

This was the case for all but the most junior faculty, but last I heard it only took the new faculty about 3-4 years to fall into this pattern as well...
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Is your residency the same now? Does it even fill? It's a buyers market now
 
medgator said:
Is your residency the same now? Does it even fill? It's a buyers market now
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Same attendings are there, so same stuff happens. And no, it doesn't. Not within the regular match at least for the last several years.

I'll give it credit, the transition from resident to attending wasn't as jarring given our experience.
 
HolySmokes said:
Same attendings are there, so same stuff happens. And no, it doesn't. Not within the regular match at least for the last several years.

I'll give it credit, the transition from resident to attending wasn't as jarring given our experience.
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So I guess "hell pits" really do exist.

Were the attendings academically productive?

If not, this is the gig I was born for.
 
HolySmokes said:
Okay I'm getting the sense that y'all all went to way different residencies than I did if you think being an academic attending isn't a completely cush gig. Because as a resident I was responsible for: seeing/documenting all new, follow up, and on treatment patients from start to finish with attending popping their head in the door at the end to ask "any questions," all contouring (rarely reviewed let alone modified), plan approval (we reviewed with dosimetry, attending would often sign prescription without looking), completion notes, peer to peer requests, and educating ourselves. Attendings were on site around 8 and their offices were empty by 4. Oh, and we were required to be at the machine for all SBRTs and new starts. And we were required to be at the sim for every patient because half the time the attending couldn't be there. But at least only one of our rotations required us to do all the IGRT as well.

This was the case for all but the most junior faculty, but last I heard it only took the new faculty about 3-4 years to fall into this pattern as well...
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Exactly!!!

It's all different.

I went to a very big residency program. There were some attendings who...well I'm not sure why they got a paycheck, really.

There were some attendings covering 3 sites with 25+ on beam, mostly head & neck (but also a "generalist" at one of the satellites).

RadOnc is too small of a specialty in too big of a country to make generalizations about lifestyle, salary, etc.

Everything we talk about in RadOnc should be percentile-based, if I had a magic wand.

"He's working 80th percentile hours."

"She's at 50th percentile salary but 90th percentile total comp."

"Those poor residents are at 35th percentile elective time."

"That professional society is at 15th percentile IQ."

And so on.
 
HolySmokes said:
Okay I'm getting the sense that y'all all went to way different residencies than I did if you think being an academic attending isn't a completely cush gig. Because as a resident I was responsible for: seeing/documenting all new, follow up, and on treatment patients from start to finish with attending popping their head in the door at the end to ask "any questions," all contouring (rarely reviewed let alone modified), plan approval (we reviewed with dosimetry, attending would often sign prescription without looking), completion notes, peer to peer requests, and educating ourselves. Attendings were on site around 8 and their offices were empty by 4. Oh, and we were required to be at the machine for all SBRTs and new starts. And we were required to be at the sim for every patient because half the time the attending couldn't be there. But at least only one of our rotations required us to do all the IGRT as well.

This was the case for all but the most junior faculty, but last I heard it only took the new faculty about 3-4 years to fall into this pattern as well...
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i went to a "top 10-15" program
i joke that the thing i learned best in residency was writing notes on time.
i was fortunate that many of my attendings had decent bedside manner and let us see how they examined/talked/consented patients.
i probably sat down to review contours or plans <10 times all of residency.
probably got feedback on 10% of contours, maybe less.
most of my attendings were still pretty busy, but ultimately did not want to do the extra part to teach.
I learned alot studying for oral boards and am still learning as an attending. i actually probably have learned more practical stuff from my partners in practice (and my coresidents in training) than actual attendings while in residency. i guess the expectation was that we were supposed to know everything as a PGY-2. i did match during the golden years...

i cant believe that that program could bill with residents covering SBRTs, new starts, etc.
 
TheWallnerus said:
Jeff Michalski at the ASTRO town hall said residents don’t supervise

Was he wrong, lying, or both
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clearly its happening at certain places.
did not happen where i trained.
it actually sucks because i didn't get much experience supervising stuff until i was an attending.
 
radoncftw said:
i went to a "top 10-15" program
i joke that the thing i learned best in residency was writing notes on time.
i was fortunate that many of my attendings had decent bedside manner and let us see how they examined/talked/consented patients.
i probably sat down to review contours or plans <10 times all of residency.
probably got feedback on 10% of contours, maybe less.
most of my attendings were still pretty busy, but ultimately did not want to do the extra part to teach.
I learned alot studying for oral boards and am still learning as an attending. i actually probably have learned more practical stuff from my partners in practice (and my coresidents in training) than actual attendings while in residency. i guess the expectation was that we were supposed to know everything as a PGY-2. i did match during the golden years...

i cant believe that that program could bill with residents covering SBRTs, new starts, etc.
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Similar experience. After intern year, rad onc residency felt like going back to med student level shadowing and rote memorizing for tests. I didn't really start to understand what the job entailed until my last year and figured out most of it in practice. Went basically the entire 4 years without understanding really anything about what RTTs and dosi do day-to-day.
 
radoncftw said:
i went to a "top 10-15" program
i joke that the thing i learned best in residency was writing notes on time.
i was fortunate that many of my attendings had decent bedside manner and let us see how they examined/talked/consented patients.
i probably sat down to review contours or plans <10 times all of residency.
probably got feedback on 10% of contours, maybe less.
most of my attendings were still pretty busy, but ultimately did not want to do the extra part to teach.
I learned alot studying for oral boards and am still learning as an attending. i actually probably have learned more practical stuff from my partners in practice (and my coresidents in training) than actual attendings while in residency. i guess the expectation was that we were supposed to know everything as a PGY-2. i did match during the golden years...

i cant believe that that program could bill with residents covering SBRTs, new starts, etc.
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Did we...did we go to the same program?

This is exactly how I would describe my "educational experience".

The most confusing thing to me is hearing people talk about how they text/call their old attendings from residency for advice about cases.

I've only talked to my old attendings ~4 times since leaving, and only because I had to (positions they have in journals I publish in etc).

I learned RadOnc from eContour, MedNet, and Google Scholar.

They're who I ask for advice still, to this day!
 
medgator said:
This is exactly where I've seen it. Part of medical staff bylaws indicating where you need to reside
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45 minutes could be pretty far away depending on how fast you drive; Distance equals Rate x Time

Maybe you could get a police escort for a true radiation emergency
 
IonsAreOurFuture said:
45 minutes could be pretty far away depending on how fast you drive; Distance equals Rate x Time

Maybe you could get a police escort for a true radiation emergency
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It's medical staff bylaw theater.

Just get an address that works for initial credentialing and privileging and then do wtf you want. Fwiw I know a med onc who lives over an hour away from one of the main hospitals we are privileged at
 
medgator said:
Different in FS/PP setting but absolutely could see that. Our folks still enjoy coming in when they do
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Same here. Depends on your location, traffic etc. ours also choose to get out of the house several days/week etc. lots of big programs historically paid and treated dosemitry lack crap- Harvard, Yale, duke etc. can see why they would want to stay home.
 
UndecidedMS2 said:
Couple years ago I was convinced that it’s because of job market concern but now i’m starting to think that the lack of exposure and medical students knowledge about the field might be the bigger reason for that. I’m not saying the job market concerns aren’t real but here’s some of the offers right now:
-SOMC Portsmouth OH $668k + $90k SB
-Arnot health Elmira NY $600k
-Trinity Waterloo IA $550k + $75k SB
-Jefferson Healthcare port townstead WA $600-800k
-EOCC Richmond VA $650-750k
-St. Peters Health Albany NY $500-540k
-Jonesboro AK $550k
-Phoenix AZ $525k
Sure the locations might night be the best so if anyone is set to live in a big metro areas, rad onc is not the best choice but those salaries combine with the great lifestyle SHOULD attract way more med students. While I’m 100% in favor of residency spot reduction for long term job market, I think educating med students about the field and the potential it has can go a long way short term in increasing the popularity and competitiveness of rad onc.
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I can tell you that there is a good reason why the top one pays that much money lol!
 
MudPhud20XX said:
I can tell you that there is a good reason why the top one pays that much money lol!
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That Portsmouth OH job has been posted for at least 10 plus years. What is EOCC richmond?
 
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