Would you guys still consider rad onc to be a lifestyle specialty?

[Swaggy109010]

I know that rad onc was long considered one of the best specialties for lifestyle with decent, stable hours and little call. Is that still the case? I would imagine hours are going up as reimbursements and job opportunities go down. Could you stillget away with a M-F 40-50 hour work week anymore?

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[Fpg1245]

I haven't noticed the hours changing but payment reform will probably drop salaries substantially and affect the job market as rad oncs grab more patients to compensate. The field has already sustained cuts over the last few years and it likely won't get better. The problem is not being overworked it's finding work. If you're exploring specialties right now I would suggest looking elsewhere before settling.

 

[evilbooyaa]

I know that rad onc was long considered one of the best specialties for lifestyle with decent, stable hours and little call. Is that still the case? I would imagine hours are going up as reimbursements and job opportunities go down. Could you stillget away with a M-F 40-50 hour work week anymore?

As an attending, if you were OK taking a hit to your potential pay, then yes, you certainly can.

 

[Swaggy109010]

I haven't noticed the hours changing but payment reform will probably drop salaries substantially and affect the job market as rad oncs grab more patients to compensate. The field has already sustained cuts over the last few years and it likely won't get better. The problem is not being overworked it's finding work. If you're exploring specialties right now I would suggest looking elsewhere before settling.

I'm not really tied down to any region in particular, wife is from one side of the country, I'm from the exact opposite lol, so no matter where we are 1 or both of us will be far from family. I was under the impression that it's not like people aren't finding jobs, it's more that they aren't finding jobs in the state/region they want, or in a major city. Has it now gotten worse than that?

 

[medgator]

I'm not really tied down to any region in particular, wife is from one side of the country, I'm from the exact opposite lol, so no matter where we are 1 or both of us will be far from family. I was under the impression that it's not like people aren't finding jobs, it's more that they aren't finding jobs in the state/region they want, or in a major city. Has it now gotten worse than that?

It is worse in the fact that more desirable areas are saturated and it's difficult to guarantee a specific city/location where you can land a job in any given year.

If you and your spouse are cool with the Midwest or less populated areas away from the coasts, you should be ok. Again,, it's going to come down to location and pay. Your lifestyle in pp will be better if you see/treat less patients but obviously lower $$$ with that

 

[BobbyHeenan]

There are so many factors that go into hours worked it's very hard to predict. Among my friends in the field whom I all consider good, hard working docs, it varies wildly. So many variables like solo practice vs. group, hospital employed vs. not, number of sites covered, technical ownership or not, number and location of tumor boards, private vs. academic, involvement in clinical trials, involvement in committees, competitiveness of your market or not et al.

Will you need to sleep in the hospital or go in a ton on the weekends? No. Will you get caught in 8 hour surgeries? No. Will the ER wake you up to ask you to see a patient? Very rarely.

Could you find yourself in a busy practice treating 30-35 under treatment patients and coming in at 6-7 AM daily and leaving at 6-7 PM some weeks on end when volume gets high and you have sick and/or complex cases? Absolutely. You're going to make very good money doing this, but it can burn you out quickly. It's very hard to find that "perfect balance" in my experience of busy enough but not too busy versus pretty slow where you're not busy enough and income suffers.

It's possible to get that 40 hour week, but the colleagues I know that get that are working 4 days/week. The ideal set up in my mind is multiple people (ie 3+) working in one large center - that way you have lots of clinic/machine coverage. I don't have that set up but it can be a really nice one if you have a good group to work with.

===

Personally, we have seen hours go up. We had a senior partner cut back (basically retire) and decided not to re hire so we could just absorb his volume to keep our salaries up. This phenomenon, a long with practices hiring mid levels to help out some of the work flow, is becoming more common and is further adding to the concerns about job shortages/competitiveness.

 

[Neuronix]

The traditional mantra for physician recruiting is pick 2 of location, salary, and lifestyle.

I say that currently in rad onc you get to pick one of those. You've apparently made your choice.

Who knows what it'll be like in another 5-10 years. Hopefully not worse, though all indications are that it'll continue to get worse.

 

[Dare2Dream]

The traditional mantra for physician recruiting is pick 2 of location, salary, and lifestyle.

I say that currently in rad onc you get to pick one of those. You've apparently made your choice.

Who knows what it'll be like in another 5-10 years. Hopefully not worse, though all indications are that it'll continue to get worse.

Even if it is pick one, it isn't bad at all compared to most other specialties. Sounds like one could pick location, still get paid same or more than Med Onc while working reasonable hours without calls/weekends. Perhaps RO just had it too good which makes it feel like a big downgrade but even with the downgrade, it is still better than many other specialties.

 

[Neuronix]

Even if it is pick one, it isn't bad at all compared to most other specialties. Sounds like one could pick location, still get paid same or more than Med Onc while working reasonable hours without calls/weekends. Perhaps RO just had it too good which makes it feel like a big downgrade but even with the downgrade, it is still better than many other specialties.

Keep dreaming.

In my area the rad oncs work 60+ hours and make less than the med oncs. This isn't the only area. I know junior PP med oncs in the area making about double what I make.

 

[medgator]

Keep dreaming.

In my area the rad oncs work 60+ hours and make less than the med oncs. This isn't the only area. I know junior PP med oncs in the area making about double what I make.

Depends on the setup.

Some of the large med onc groups have in house oral pharmacies dispensing big dollar drugs, in house imaging, in house pathology etc.... So essentially they are making "technical" revenue on their ancillaries not just on the iv chemo, and yes they can easily push high six figures (or more) with all that. I heard stories back in the early 90s when chemo paid margins in the thousands per dose

Then I know of others with bloated overhead, poor billing, poor insurance contracts etc that are just getting by... med oncs have the risk of their drug not getting paid after they front the $$$. Lucky for us, our drug comes from the power plant

 

[PruritisAni]

I know junior PP med oncs in the area making about double what I make.

Shouldn't have gone into academics?

 

[Neuronix]

No need to make this personal. I had multiple private interviews paying less than academics. The pay is not much different anymore anymore between private and academics. The downside is that everyone is working hard in academics too. I interviewed at a big name academic place and told them I wanted to write a K08 grant. They laughed in my face and told me that was not allowed. Clinical faculty only, no protected time.

Sure, if you get technicals as a partner you'll make more than academics. I don't know anyone offering that anymore. New grads get scraps and no pathway to anything better.

Exception is working hard in nowheresville. Which comes back to my original post. Race to the bottom here. Good luck future rad oncs.

 

[medgator]

Sure, if you get technicals as a partner you'll make more than academics. I don't know anyone offering that anymore. New grads get scraps and no pathway to anything better.

Exception is working hard in nowheresville. Which comes back to my original post. Race to the bottom here. Good luck future rad oncs.

A PP rad onc collecting full professional revenue can still make a chunk of change in a busy practice on par with what an academic chair might make. Again, comes down to finding those practices, but they do exist, albeit in less and less desirable areas these days.

 

[Neuronix]

If you say so. What I was quoted was on par with associate professor in academics.

 

[PruritisAni]

No need to make this personal. I had multiple private interviews paying less than academics. The pay is not much different anymore anymore between private and academics. The downside is that everyone is working hard in academics too. I interviewed at a big name academic place and told them I wanted to write a K08 grant. They laughed in my face and told me that was not allowed. Clinical faculty only, no protected time.

Sure, if you get technicals as a partner you'll make more than academics. I don't know anyone offering that anymore. New grads get scraps and no pathway to anything better.

Exception is working hard in nowheresville. Which comes back to my original post. Race to the bottom here. Good luck future rad oncs.

Wasn't making it personal. At least that certainly wasn't the intent. However, what you outline is the general sense of the present environment of rad once in that the current state of academics is effectively functioning similar to PP models (of old?) without the compensation.

 

[medgator]

If you say so. What I was quoted was on par with associate professor in academics.

The entry level year 1/2 salary in a pp group is pretty low, worse than what I saw in academics or hospital-based employment.

Assuming you make it through the gauntlet and partner in, full professional fees are still nothing to sneeze at imo.

There's a posting at the astro job site right now at a rural place in NV where it sounds like they give you a share in the technical rev, I think if you are wanted enough, you will still find the money.

 

[Gfunk6]

I will give all of you two relevant quotes from a recent white paper I read. It tells you everything you need to know:

#1

Hospital systems with dominant market positions have used those positions to generate extraordinary earnings (see Exhibit II). Hospitals are using the cash flow generated by near-monopoly status to acquire the practices of independent physicians in their communities. The American Hospital Association estimated in 2010 that hospitals employed 212 thousand physicians directly, a 32 percent increase from 2003.4 That number is certainly higher now.Not only do these acquisitions result in sharply higher prices for physician services.5 But hospitals also exert pressure on the acquired physicians to redirect their imaging and surgical referrals from lower cost, freestanding providers to the hospital, which can charge as much as two to five times higher rates than freestanding providers for the same services.

And #2

At present, physician payments account for only about 14 percent of total Medicare spending. The proposed increases should be funded by a compensating reduction in Medicare HOPPS (hospital) outpatient rates and in imaging and surgical technical fees from Medicare’s physician fee schedule – as well as through eliminating the “site of service” differential which enables hospitals to charge as much as 80 percent more for their employed physicians who provide the same service as a physician in private, office- based practice.Presently, technical fees for imaging and other complex care can exceed fees for physicians exercising their professional judgment by as much as four or five-fold. This imbalance has encouraged an excess of facility investment at the expense of adequate professional compensation, and has encouraged physicians to rely excessively on owning and controlling capital and facilities for their income generating potential. Physicians should earn much more than they presently do for exercising their professional judgment, and less from facility related profits.

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Source: http://www.physiciansfoundation.org/uploads/default/PF_Blueprint_Report_-_May_2013.pdf

All this bull**** and playing the "let's see who makes the most bank and works the least" entirely misses the point.

There are only two fates for a non-academic Rad Onc. Bow your head in subservience to your RN, MBA overlords, generate money for THEM and if you are lucky they will pay you enough to pay off your loans and drive your 1984 Nissan Maxima to the hospital every day.

Or, you can join like minded physicians of different specialities, from your own mega group, show you can get get equivalent outcomes at far cheaper cost. Maybe you will eventually fail and get "eaten" but you will be happier in the long run; physician autonomy is a precious commodity.

 

[thesauce]

I have been out for 2 years. I have an amazing lifestyle with a great salary in a place that I love. I thank God for every day that I chose this field.

 

[RadOncDoc21]

I have been out for 2 years. I have an amazing lifestyle with a great salary in a place that I love. I thank God for every day that I chose this field.

you suck!

 

[Neuronix]

you suck!

Haha, the correct response here is: are you hiring?!

I love hearing from senior rad oncs how great their group/practice is. You ask if they're hiring and the answer is no or not for the same track they had.

I'm not here to make it sound like I'd do anything else in life. This is exactly what I wanted to do and I have no regrets. But, the oversaturation in the market is very real and the job opportunities both in private and academics are not what they were. Things are worsening by the year.

I am very grateful for my job. No other offer even came close for me, so it was easy to choose. I had to market myself very aggressively for it and I worked very hard as a resident to build my CV. But please don't pretend like I have it easy or make a ton of money. I picked location.

 

[RadOncDoc21]

Haha, the correct response here is: are you hiring?!

I love hearing from senior rad oncs how great their group/practice is. You ask if they're hiring and the answer is no or not for the same track they had.

I'm not here to make it sound like I'd do anything else in life. This is exactly what I wanted to do and I have no regrets. But, the oversaturation in the market is very real and the job opportunities both in private and academics are not what they were. Things are worsening by the year.

I am very grateful for my job. No other offer even came close for me, so it was easy to choose. I had to market myself very aggressively for it and I worked very hard as a resident to build my CV. But please don't pretend like I have it easy or make a ton of money. I picked location.

I chose job, a somewhat decent location (no beaches but large metropolitan area east coast) and ended up making "good" money.

At the end of the day (some longer than others). I'm glad I chose this field, however I do enjoy having time off!

 

[berag]

I'm just glad I'm not a medical oncologist.


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[CyberKnife19]

I have been out for 2 years. I have an amazing lifestyle with a great salary in a place that I love. I thank God for every day that I chose this field.

I am also blessed to have the triumvirate of job/location/salary and absolutely love my job. I would rather be a Radiation Oncologist and have only one of the three then have to practice a different specialty and have all three.

We almost never get called on nights/weekends, have very good and predictable hours and make a great salary. Is it as much of a lifestyle specialty as it once was? No, but that goes for all of medicine and it's still phenomenal.

We have the opportunity to have a profoundly positive impact in people's lives, have an intellectually stimulating speciality that is continually evolving and get to work with incredible technology. It's all perspective.

 

[Reaganite]

I am also blessed to have the triumvirate of job/location/salary and absolutely love my job. I would rather be a Radiation Oncologist and have only one of the three then have to practice a different specialty and have all three.

We almost never get called on nights/weekends, have very good and predictable hours and make a great salary. Is it as much of a lifestyle specialty as it once was? No, but that goes for all of medicine and it's still phenomenal.

We have the opportunity to have a profoundly positive impact in people's lives, have an intellectually stimulating speciality that is continually evolving and get to work with incredible technology. It's all perspective.

Have also been profoundly blessed with job/location/salary, but I busted my balls to get it! Honestly, making serious money in this field is a combination of a lot of things, not just technical ownership. Owning a radiation facility doesn't bring as much income as you'd think. The start up costs are very high and monthly overhead just to keep the lights on is 100k+. If you're splitting ownership among 5+ people, the profit gets diluted fast especially in areas where heavy competition has driven reimbursement into the toilet (e.g. IMRT prostate reimbursing $8000). A good professional contract with a freestanding facility will still generate most of your income because it's guaranteed money off the top.

I will tell you it is pretty much impossible to be a baller and have a good lifestyle in this field. Yeah, the work is easy, but you gotta continuously hustle and stress to bring in business, keep contracts, etc. I put in as much time worrying about that stuff as I do patient care. Edit: But, yes, to Medgator's point--when you bust your ass and serious cash is coming in, it makes it all worth it

 

[medgator]

I will tell you it is pretty much impossible to be a baller and have a good lifestyle in this field. Yeah, the work is easy, but you gotta continuously hustle and stress to bring in business, keep contracts, etc. I put in as much time worrying about that stuff as I do patient care.

Pretty much, if you're in pp in a semi-desirable/desirable market....but with pain comes gain

 

[Dare2Dream]

Keep dreaming.

In my area the rad oncs work 60+ hours and make less than the med oncs. This isn't the only area. I know junior PP med oncs in the area making about double what I make.

How much are those med oncs making? $300K-$400K or more?

If you were starting out today and if med oncs were making more than rad onc, as is the case in your area, would you still go into RO? Would you still consider RO to provide better lifestyle than medonc, even for the ROs doing 60 hour weeks?

 

[medgator]

How much are those med oncs making? $300K-$400K or more?

If you were starting out today and if med oncs were making more than rad onc, as is the case in your area, would you still go into RO? Would you still consider RO to provide better lifestyle than medonc, even for the ROs doing 60 hour weeks?

Two words....No rounding

 

[Neuronix]

How much are those med oncs making? $300K-$400K or more?

Yes, more. I'm friends with some med oncs where I trained. The med oncs in academics make less of course but they work less clinically.

If you were starting out today and if med oncs were making more than rad onc, as is the case in your area, would you still go into RO? Would you still consider RO to provide better lifestyle than medonc, even for the ROs doing 60 hour weeks?

I already answered this question. I have a PhD in physics. I love what I do. There is nothing else I'd rather do except more research. Lifestyle wise as an attending I think rad onc is pretty similar to med onc.

 

[medgator]

Lifestyle wise as an attending I think rad onc is pretty similar to med onc.

Working in a med onc/rad onc pp myself, I would disagree, at least for pp. Reference my post above... med oncs have a coverage schedule for the weekends but they still need to round on their own inpts during the week. Rad onc is outpatient with inpatient consult duties only (in most situations)

 

[hot sauce]

The question of lifestyle specialty is relative. For example, reading this thread I wonder what people consider good income. I understand that most of us do not feel comfortable posting our incomes. I will say of the recent graduates I know most are starting between $300k-$400k but none of them are in the areas that are considered highly desirable (not all in the boonies but no NYC, SF, etc). To me that seems pretty decent but my sample size is small (~10) and I don't know what others consider decent. Same thing for lifestyle. If you compare us to neurosurgery we have a good lifestyle but some fields are probably better.

I would argue today we are still a lifestyle specialty but future is unclear. Unfortunately, we are running into an oversupply situation. If uncorrected this will likely drive down compensation and make great jobs rare.

Of course I am limited to my perspective and I the job market seems quite heterogeneous. My personal situation is a compromise that I am happy with at the moment but it isn't perfect. My location is fair but was not my first choice. My current income is also fair right now (seems like a lot coming from residency); I anticipate becoming a partner and having a great income. Of course, I could get screwed and not end up becoming a partner. I attempted to vet my job as best I could but I have yet to find a position that has no risk of bait & switch (private, academic, or hospital). I am busy at work but generally work 7-4 for 4.5 days per week. I have a generous amount of vacation. I think my schedule is better than my medical oncology friends. I am very happy that I am a radiation oncologist and couldn't imagine doing anything else (and not just for the lifestyle).

 

[Dare2Dream]

Yes, more. I'm friends with some med oncs where I trained. The med oncs in academics make less of course but they work less clinically.

I already answered this question. I have a PhD in physics. I love what I do. There is nothing else I'd rather do except more research. Lifestyle wise as an attending I think rad onc is pretty similar to med onc.

Working in a med onc/rad onc pp myself, I would disagree, at least for pp. Reference my post above... med oncs have a coverage schedule for the weekends but they still need to round on their own inpts during the week. Rad onc is outpatient with inpatient consult duties only (in most situations)

Thanks for sharing your perspectives and experiences, it is difficult to assess things looking in from the outside at a time of uncertainty.

 

[nih15hopeful]

@hot sauce @medgator @Neuronix and any/all others who may have any idea: would you predict this trend in the job market will continue to worsen even 9 years out from now, or is there a chance things might improve by then?

 

[Fpg1245]

@hot sauce @medgator @Neuronix and any/all others who may have any idea: would you predict this trend in the job market will continue to worsen even 9 years out from now, or is there a chance things might improve by then?

It probably won't be good. Surpluses like the one we have will be with us for the better part of the decade. And you can do this job into your 70s. If you want a rough sketch of how bad things can get take a look at the pathology forum or their career website. The lights are flashing yellow here. I'd look at other much more vibrant fields with equally good lifestyles.

 

[medgator]

@hot sauce @medgator @Neuronix and any/all others who may have any idea: would you predict this trend in the job market will continue to worsen even 9 years out from now, or is there a chance things might improve by then?

This is my feelings, from another thread:

I don't see the parallels to radiology unfortunately. The last time the rad onc job market was in the toilet in the early to mid 90s, that's when they shut down a bunch of programs and lengthened the training from 3 to 4 years which was in part to help the job crunch (so I hear). There seems to be no interest from the academic elites this time around, and programs seem to be forming and expanding even now, along with the proliferation of (sometimes questionable) fellowships which taking advantage of the situation.

Radiology is in much more of a growth mode imo, while rad onc has trends working both for (think more sbrt for medically-inoperable lung cancer being caught on low dose CT) and against (think less treatment of older patients with breast and prostate ca, increasing use of hypo fractionation in many disease sites etc) increased demand for our services.

As has been posted already on this thread, if you can see yourself practicing away from the coasts, I do believe there will be jobs, even down the road. There may be jobs even in the desirable areas but it's no guarantee, and the job that may show up may not be the one you want in terms of hours/pay/lifestyle.....

 

[Neuronix]

@hot sauce @medgator @Neuronix and any/all others who may have any idea: would you predict this trend in the job market will continue to worsen even 9 years out from now, or is there a chance things might improve by then?

You're asking two separate questions, the answer to which I think are both yes.

1. Yes I think things will get worse in the next 10 years because of everything medgator already posted.

2. Yes there's a chance things might improve in 10 years.

Predicting the future has always been a tricky job.

 

[JPSmyth]

It probably won't be good. Surpluses like the one we have will be with us for the better part of the decade. And you can do this job into your 70s. If you want a rough sketch of how bad things can get take a look at the pathology forum or their career website. The lights are flashing yellow here. I'd look at other much more vibrant fields with equally good lifestyles.

What would these other fields be? Outside of derm. It seems like every speciality forum on here seems to be saying similar things ... "this field is doomed, lower reimbursements longer hours less job opportunities, go into another field!" But where are these golden fields that med students should be going into? This is a genuine question, not being sarcastic. It seems to me like its a grass is always greener effect but maybe it's just the bias on these forums

 

[medgator]

What would these other fields be? Outside of derm. It seems like every speciality forum on here seems to be saying similar things ... "this field is doomed, lower reimbursements longer hours less job opportunities, go into another field!" But where are these golden fields that med students should be going into? This is a genuine question, not being sarcastic. It seems to me like its a grass is always greener effect but maybe it's just the bias on these forums

Tech and AI development

Seriously, medicine will still be good compared to many other occupations imo, as will rad onc if you are willing to be flexible on things. There are great-paying jobs in rad onc right now, if they are advertised, they are probably in the boonies, and if they aren't.... well you've got to do the legwork to find them.

 

[Fpg1245]

What would these other fields be? Outside of derm. It seems like every speciality forum on here seems to be saying similar things ... "this field is doomed, lower reimbursements longer hours less job opportunities, go into another field!" But where are these golden fields that med students should be going into? This is a genuine question, not being sarcastic. It seems to me like its a grass is always greener effect but maybe it's just the bias on these forums

I should probably correct my prior statement. I don't think there is a golden field of medicine. They are all pretty crappy especially these days. I really haven't spoken to one physician in any specialty that's like: "you know what? I'm doing great! The hours are reasonable and the paperwork is light and the pay is wonderful!" RO is especially frustrating. The way you pick a job in this field is you take out a map and if your finger lands somewhere that you may have heard of then sorry try again. Literally one of the few fields of medicine that doesn't have robust demand for services. People on this forum talk about networking and connections etc as a key to landing a good gig but then again they tell the pathology residents that too and yet I don't believe that those resident's are doing 2 and 3 fellowships because of poor networking skills. For them, quite literally there is nothing out there. There are no sure things in medicine and this field has got its own existential threats from outside and within. It's quite difficult to take your training seriously when your program doesnt care if you ever become an attending and the field in general sees no problem with expanding training positions for jobs that won't exist.

If I was born truly intelligent (no not just memorizing large volumes of crap) had the right connections and could redo my life, I'd probably just try to get into a top business school try to break into consulting or finance. If You want to talk about going places with the right networking landing a spot at Harvard or stanford bussiness school probably takes the cake. But alas, I lack those qualities.

 

[Reaganite]

I should probably correct my prior statement. I don't think there is a golden field of medicine. They are all pretty crappy especially these days. I really haven't spoken to one physician in any specialty that's like: "you know what? I'm doing great! The hours are reasonable and the paperwork is light and the pay is wonderful!" RO is especially frustrating. The way you pick a job in this field is you take out a map and if your finger lands somewhere that you may have heard of then sorry try again. Literally one of the few fields of medicine that doesn't have robust demand for services. People on this forum talk about networking and connections etc as a key to landing a good gig but then again they tell the pathology residents that too and yet I don't believe that those resident's are doing 2 and 3 fellowships because of poor networking skills. For them, quite literally there is nothing out there. There are no sure things in medicine and this field has got its own existential threats from outside and within. It's quite difficult to take your training seriously when your program doesnt care if you ever become an attending and the field in general sees no problem with expanding training positions for jobs that won't exist.

If I was born truly intelligent (no not just memorizing large volumes of crap) had the right connections and could redo my life, I'd probably just try to get into a top business school try to break into consulting or finance. If You want to talk about going places with the right networking landing a spot at Harvard or stanford bussiness school probably takes the cake. But alas, I lack those qualities.

I'm not sure there ever was a "golden field" of medicine for most doctors depending on your definition of "golden." Most docs lack the business sense and personality it takes to make big money. But don't kid yourself--there are plenty of doctors pulling in millions in every specialty. For all the doom and gloom I read on these boards, I'm amazed at the number of colleagues I know personally making serious cash. These guys all share the same traits, though...very personable, good marketers, good business sense, constantly thinking of ways to expand their practices/monopolize areas, etc. (and, yeah, sadly, they aren't up on the latest journal articles and they probably won't waste 2 hours of their day in a tumor board). I almost never see these traits in rad oncs. You don't get rich arguing about the results of RTOG XYZ or catching up on the latest Red Journal issue. And, btw, I'm not saying it's a bad thing to be a good, up-to-date doc! Just pointing out the really successful guys use their time developing their practices.

 

[Phantom1]

I'm not sure there ever was a "golden field" of medicine for most doctors depending on your definition of "golden." Most docs lack the business sense and personality it takes to make big money. But don't kid yourself--there are plenty of doctors pulling in millions in every specialty. For all the doom and gloom I read on these boards, I'm amazed at the number of colleagues I know personally making serious cash. These guys all share the same traits, though...very personable, good marketers, good business sense, constantly thinking of ways to expand their practices/monopolize areas, etc. (and, yeah, sadly, they aren't up on the latest journal articles and they probably won't waste 2 hours of their day in a tumor board). I almost never see these traits in rad oncs. You don't get rich arguing about the results of RTOG XYZ or catching up on the latest Red Journal issue. And, btw, I'm not saying it's a bad thing to be a good, up-to-date doc! Just pointing out the really successful guys use their time developing their practices.

For all the complaining Rad Onc is still very high on the "lifestyle" scale. Its not like you have to rush at any second to do an emergent procedure, or take care of some drug fiend in the ER or ICU, or work over night in the hospital, etc.. Call is light, you can have control over your time, and pay is well above average. At the same time you are administering an important therapy which can help to improve lives.

As far as academics versus privates, don't put down people who spend time in tumor boards. Some of the most complex and advanced cases get referred to academic centers because they have the resources to manage them. I personally don't enjoy academic jousting over trial X versus Y, but I have great respect for the people who take the time and effort to design and conduct clinical trials. If it weren't for RTOG, SWOG, EORTC, NSABP, and the many other groups running studies confirming the benefits of radiation our field would not be what it is today. If it weren't for researchers pushing the limits to develop IMRT, SBRT and SRS, our field would not be what it is today. I'm very happy I chose rad onc and would do it again today.

 

[JPSmyth]

Thanks for sharing some positives about the field.

Just from a medical student perspective, rad onc is one of the most competitive specialties to match into, and any time I see that a field is highly competitive I usually find that it correlates with compensation, lifestyle, or both (others would be derm, plastics, ortho, ENT, neurosurg for example)

I am defining "competitiveness" based off the publication Charting outcomes in the match from last year

 

[medgator]

I'm not sure there ever was a "golden field" of medicine for most doctors depending on your definition of "golden." Most docs lack the business sense and personality it takes to make big money. But don't kid yourself--there are plenty of doctors pulling in millions in every specialty. For all the doom and gloom I read on these boards, I'm amazed at the number of colleagues I know personally making serious cash. These guys all share the same traits, though...very personable, good marketers, good business sense, constantly thinking of ways to expand their practices/monopolize areas, etc. (and, yeah, sadly, they aren't up on the latest journal articles and they probably won't waste 2 hours of their day in a tumor board). I almost never see these traits in rad oncs. You don't get rich arguing about the results of RTOG XYZ or catching up on the latest Red Journal issue. And, btw, I'm not saying it's a bad thing to be a good, up-to-date doc! Just pointing out the really successful guys use their time developing their practices.

Some of those dual threats exist though...good at pp and up to date on everything.

In pp, you sometimes HAVE to go to tumor boards to maintain visibility with potential referring physicians

 

[fiji128]

I should probably correct my prior statement. I don't think there is a golden field of medicine. They are all pretty crappy especially these days. I really haven't spoken to one physician in any specialty that's like: "you know what? I'm doing great! The hours are reasonable and the paperwork is light and the pay is wonderful!" RO is especially frustrating. .

There is nothing wrong with working hard and putting up with some crap especially given the amount of salary we can make. But the issue with Rad Onc is that there is sooooo much excess capacity and now it is nearly impossible to find a reasonable employment situation in a location you actually want to live in or is even adjacent to a place you would want to live in. No way this will be getting any better in the near future as every academic seems hell bent on finding ways to hypofractionate everything or even looking for ways to get RT out the equation entirely. If you maintain contacts with people you went to med school with and ask about their job prospects we are easily at the bottom or near the bottom of the pile in regards to this. The fact that the largest provider of RT services in world needs bankruptcy protection because they cannot service the debt they took on to buy or start up RT centers should be a huge red flag that we are not in a bull market for our services anymore.

 

[OTN]

I'm not sure where the "pp docs don't go to tumor boards" idea comes from, but at least in my market good tumor board attendance has been critical to growth of my practice. Most weeks I attend 5-6 hours of tumor boards and even run my own H+N tumor board "sponsored" by our private practice. I'm also not sure why we get to slander pp docs as not keeping up with the latest and greatest. In order to properly market your services in my market it's also vital to prove to your referring docs (medoncs especially) that you're on top of the latest research, techniques, etc.

 

[deleted18755]

I'm not sure where the "pp docs don't go to tumor boards" idea comes from, but at least in my market good tumor board attendance has been critical to growth of my practice. Most weeks I attend 5-6 hours of tumor boards and even run my own H+N tumor board "sponsored" by our private practice. I'm also not sure why we get to slander pp docs as not keeping up with the latest and greatest. In order to properly market your services in my market it's also vital to prove to your referring docs (medoncs especially) that you're on top of the latest research, techniques, etc.

"PP docs don't go to tumor boards" is just one of those ridiculous things that many in academics tend to say to make themselves feel better and sway residents to stay in academics and be their juniors rather than go into PP. It's similar to the idea that those of us in PP went into PP for money while those in academics did it for the love of knowledge and advancement of the field or some other altruistic reason or the most ridiculous of all "if you go into PP you can never go back to academics but if you go into academics you can always go in PP . . . I would love to see somebody from any academic center who specializes in GU or something who carries less than 20 patients under treatment with a brilliant resident try to switch to PP with 30-35+ patients and try to manage day to day let alone contour a nasopharynx, then anal case, then 3 other volumes by himself in between patients but I'm pretty sure I could show up to an academic center tomorrow on the breast service or something and within a few months handle the clinical load no problem while pumping out nonsense restrospective reviews (with the resident/medical student doing the dirty work of course). No way I could/would obtain grant funding or lead phase III RTC's or anything but honestly how many in academics are producing level I evidence?

Anyway, I definitely don't go to 5-6+ hours worth of tumor boards a week.

OTN: I'm curious . . . can you briefly describe these tumor boards. How many are general vs site specific, do different practices attend, do you live in a large metro area or something? 5-6+ tumor boards a week sounds like too much unless you live in a huge area or discuss every case but I've always practiced in small cities/rural areas. I assume you have to drive to at least some of them so 5-6 hours + drive time is almost a full days worth of work per week in tumor boards!

 

[OTN]

I do live in a larger metropolitan area, which certainly plays a big part of it. The busiest weeks look like this:

Monday
7:30 am general hospital tumor board
12:30 pm hospital general tumor board
5:15 pm my H+N tumor board

Tuesday
7 am GI tumor board
12:30 pm Colorectal tumor board

Wednesday
7 am breast tumor board
7 am lung tumor board

Thursday
6:45 am neuroonc tumor board (6:45, ugh)
7 am lung tumor board
12:30 pm montly breast tumor board

Friday
7 am neuro-onc tumor board

Not every tumor board meets every week- most are every other week. We have two major hospital systems in town which explains the duplicates- they each want/need to have their own for accreditation. Different practices do attend from all over the city, and I have no doubt that my attending as many of these as possible has really helped me build my practice. Pain in the butt, sure, but a really easy way to get in front of referring MDs, and obviously helps patient care as well.

EDIT: Some of these are very easy to attend virtually (mine is ONLY virtual, which has been great), which helps with driving, attendance, etc.

 

[Reaganite]

haha, man my response obviously came across the wrong way!!! I totally respect those of us in private practice going to tumor boards, keeping up with current data, etc. I HATE the hospital machine and the snooty BS that comes out of academics. I was trying to relay the point (obviously ineffectively!) that the guys making serious cash (I'm not talking 500k or 800k, but MILLIONS a year) are mostly business men first, clinicians second. They are good at what they do, but they make their money through joint business ventures, equipment ownership, etc. In my experience, these guys are not reading the latest journal articles in their fields, and in my experience, our field does not in general accept docs with the kind of personality capable of doing that. Going to tumor boards is great and you will get more referrals for sure. But you don't ball being a physician first and getting more patients from tumor boards. That was the point I was trying to make. Love you guys on SDN and respect everyone here to death. Sorry it came across like it did.

 

[neoevolution]

What would these other fields be? Outside of derm. It seems like every speciality forum on here seems to be saying similar things ... "this field is doomed, lower reimbursements longer hours less job opportunities, go into another field!" But where are these golden fields that med students should be going into? This is a genuine question, not being sarcastic. It seems to me like its a grass is always greener effect but maybe it's just the bias on these forums

Job market only seems this bad for path and rad onc. Paperwork, hours, income, lifestyle, etc. I think everyone says have worsened.

I know my school's FM director said they had a job opening in our city for every graduate last year if they wanted it, and half of the class did take it. Our city is pretty desirable and hard for even top tier residency graduates to get hired, but primary care has insanely high demand.

 

[Krukenberg]

Job market only seems this bad for path and rad onc. Paperwork, hours, income, lifestyle, etc. I think everyone says have worsened.

I know my school's FM director said they had a job opening in our city for every graduate last year if they wanted it, and half of the class did take it. Our city is pretty desirable and hard for even top tier residency graduates to get hired, but primary care has insanely high demand.

Psych is a good gig too. High demand and low cost to open a practice. Just hang a shingle and can start a cash-only practice if you're in the right market. In some cities only taking cash would be seen as a plus from high income patients.