Charting Outcomes 2022 - Rad Onc

[deleted1111261]

I envy you. Clearly you are somewhere, doing something that challenges you intellectually and feels progressive and important.

I have a good community job. I like seeing patients and there is some thought there. But for the last 10 years and for the foreseeable future, when someone asks me "What's new at work?", my reply has been and will be, "nothing". Sometimes I talk to them about advances in medical oncology.

We have gotten some new machines that make RTT's lives better. We hypofractionate more and SBRT a little more. We PCI less and treat post-op lung way less. Our hippocampal sparing plans (rarely used) are better now than 5 years ago. I read the big radonc papers (there are not many) and some medonc papers (these are innumerable).

We are in a field where progress is largely technical and hard to scale. In fact, given our single modality and diminishing indications, it is in the interest of larger centers to leverage anything incremental they have (protons, MRI_linac... and yes, I view these as incremental) to try to expand market share. I am also not a believer in the great value of ions or even marginal improvements in conformality at this point (happy to be proven wrong). To me, it is just not that stimulating a field to be in intellectually unless you are actively doing some sort of hard cancer research. (retrospective reviews, cost analysis and equity research would just not do the job for me). That the MDACC grads almost uniformly chose community careers makes me wonder if this is a common sentiment.

That we share cancer centers with docs that can't keep up with the standard of care (because the change is so dizzying) doesn't help. I was briefly excited that our role in metastatic disease was about to blossom, but the oligo trials have been tiny and the results spotty (less breast oligo SBRT than a year ago). Every new advance in systemic therapy re-contextualizes our role in ways that are largely out of our control and not immediately clear in terms of evidence based medicine. Usually it means less or deferred XRT and typically medoncs are making this decision.

The stats and numbers of applicants now are fine and leadership should just take what they get. By my reasoning, the following people should still be applying to radonc.

1. Real physics nerd types (may be you) who believe in ion therapy or flash and are really pretty facile with physics and can at least push the physics work forward some from a position of being a physician. (Probably 10-20 folks like this per year).

2. Truly elite wet lab folks with a strong track record of onc research preceding residency. (The Tim Chan model). Probably 10 folks like this per year. We were recruiting a lot of folks who looked like aspirants to this model ten years ago and many are underemployed now.

3. Average med students who like onc and hate inpatient call and can't stand the thought of doing a medicine residency. They are fine being third of three in importance regarding oncology and are fine not driving global clinical decision making. They are fine with declining reimbursement and limited geographic flexibility.

About 80 US grads applying sounds right.

This should be written up

I love this

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[RickyScott]

I dont understand the premise that these are not good jobs? What. Based on what?

I went to a sht program and 10 years ago would not have been happy with any of these jobs, save the one in San Diego. Titusville/health first not a great job.
In past, mdacc either went into academics, private practices like the Princeton group, or 1 million dollar yr spot in the Midwest. No way they would consider a community affiliate in Indiana.

 

[fiji128]

For comparison, where did the same year MDACC heme onc fellows end up?

 

[medgator]

I went to a sht program and 10 years ago would not have been happy with any of these jobs, save the one in San Diego. Titusville/health first not a great job.
In past, mdacc either went into academics, private practices like the Princeton group, or 1 million dollar yr spot in the Midwest. No way they would consider a community affiliate in Indiana.

It's all about reset expectations, esp coming off a rough pandemic year job wise for the last class. They are happy with what they got and i think that's @RealSimulD s point. Good for them.

Still doesn't mean it was as good of a market as it was when many of us graduated after the turn of the century, but that doesn't affect them now.

Will be interesting to see what the next decade brings job wise to the folks that still want to gamble on this specialty

 

[hal9k]

The MDA graduates in 2021 did very well, in my opinion, relative to radiation oncology graduates from other programs.

Boulder, CO is better than metro area Denver, CO. Its desirability is reflected in its high cost of living. It’s gorgeous. Rocky Mountain Cancer Centers is also a desirable USO practice, I believe.

San Diego Scripps MDA is an awesome, gorgeous metro coastal location.

Indy is a good metro location with Lilly, Roche, and Salesforce offices. Good brunch places. Kokomo, IN is a 45 min commute from the affluent northern suburbs of Indy. That practice is also a desirable MDA affiliate.

Titusville, FL is a 45 min commute from Orlando. It’s on the beach. Watch out for Burmese pythons in the Everglades. Be very careful with your small animals and children.

As for Corvallis, OR and Cedar City, UT, I hope they’re being paid well.

Please keep in mind that the vast majority of 2021 graduates did not have the options, alumni/institutional network, or job placement quality of the MDA graduates.

It is a very different world from other specialties (medical oncology, radiology) where an average graduate from an average program can choose to go to a specific desirable metro.

2021 was a very tough year. Even extremely rural jobs were taken very quickly. I think they did really well compared to the rest of us. I am sure their class of 2022 job placement list looks better/more impressive if anyone has it

 

[RickyScott]

It's all about reset expectations, esp coming off a rough pandemic year job wise for the last class. They are happy with what they got and i think that's @RealSimulD s point. Good for them.

Still doesn't mean it was as good of a market as it was when many of us graduated after the turn of the century, but that doesn't affect them now.

Will be interesting to see what the next decade brings job wise to the folks that still want to gamble on this specialty

Medstudents don’t need to reset their expectations. They have options- can just match into medonc, urology etc.

 

[medgator]

Medstudents don’t need to reset their expectations. They have options- can just match into medonc, urology etc.

Bingo. I think that's the overriding point here

 

[jondunn]

No way they would consider a community affiliate in Indiana.

you don't know anything about the community affiliate. It's a fantastic job.

also your post is just ....... wrong - about past MDACC placement.


this is SDN at its worst/most useless

 

[deleted1111261]

Bingo. I think that's the overriding point here

What I’m sensing is that you think these people should have OUR values of what a good job should be. I agree with you about the past.

If you are graduating now, and you can have an 8-4 with 6-7 weeks of vaca and make the current MGMA median, at least about 80 or so US MDs a year seem to be happy with that. I talk to my FP friend and he’s like “what’s the problem again?” (Everyone is different - he always wanted to live in MI and he thinks that I “won” by coming home and getting a reasonable good job)

 

[deleted1116990]

1 million dollar yr spot in the Midwest

The doctors who landed in these hospital-based practices with independent PSAs have subsequently all been fired and replaced by new grads earning half as much as direct hospital employees even in the rural Midwest. I wonder what happens to all these people? 15 years of 1M+ income should surely be enough to retire on, and I wonder if these people are just exiting the workface mid-career instead of taking a 70% income hit to work for an academic satellite somewhere.

 

[thecarbonionangle]

The doctors who landed in these hospital-based practices with independent PSAs have subsequently all been fired and replaced by new grads earning half as much as direct hospital employees. I wonder what happens to all these people? 15 years of 1M+ income should surely be enough to retire on, and I wonder if these people are just exiting the workface mid-career instead of taking a 70% income hit to work for an academic satellite somewhere.

A lot of doctors dont save as much as they should. This is very documented. If you are making 1M and spent most of it, you still broke like AI and we ain’t talking about practice here son!

 

[deleted1116990]

you don't know anything about the community affiliate. It's a fantastic job.

also your post is just ....... wrong - about past MDACC placement.


this is SDN at its worse/most useless

Can you post the specifics you have about the community affiliate? Base and bonus structure? PTO? Schedule? Coverage?

 

[jondunn]

A lot of doctors dont save as much as they should. This is very documented. If you are making 1M and spent most of it, you still broke like AI and we ain’t talking about practice here son!

Scottie Pippen Earned Nearly $110 Million in the NBA but Lost It All at a Yard Sale

Chicago Bulls legend Scottie Pippen earned over $100 million in the NBA but still had to sell many of his belongings at a yard sale.

www.sportscasting.com

 

[deleted1116990]

A lot of doctors dont save as much as they should. This is very documented. If you are making 1M and spent most of it, you still broke like AI and we ain’t talking about practice here son!

I would love to meet the person making over 1M for the past 15 years who failed to become FI while living in a low COL midwest area and living through the longest bull market in history. Did this person charter a private jet to Vegas every weekend? I mean, I believe you, but I presently live a lower standard of living than I did as a resident so kinda blows my mind what some of our colleagues do.

The only rad onc I know who did this, worth well over 8 figures by age 50, who is in this boat of not being able to retire yet has only one reason for it: Divorce.

 

[deleted1111261]

The doctors who landed in these hospital-based practices with independent PSAs have subsequently all been fired and replaced by new grads earning half as much as direct hospital employees even in the rural Midwest. I wonder what happens to all these people? 15 years of 1M+ income should surely be enough to retire on, and I wonder if these people are just exiting the workface mid-career instead of taking a 70% income hit to work for an academic satellite somewhere.

All?

 

[thecarbonionangle]

I would love to meet the person making over 1M for the past 15 years who failed to become FI while living in a low COL midwest area and living through the longest bull market in history. Did this person charter a private jet to Vegas every weekend? I mean, I believe you, but I presently live a lower standard of living than I did as a resident so kinda blows my mind what some of our colleagues do.

The only rad onc I know who did this, worth well over 8 figures by age 50, who is in this boat of not being able to retire yet has only one reason for it: Divorce.

I was just generally speaking about physicians. We are notoriously terrible at finance. Many books on this in WCI world and why the FAs pray on us because they kmow many docs are financially illiterate. I recently heard about a totally broke plastic surgeon, ex wife took everything plus zero savings, high salary. Divorce and lack of savings absolutely wrecks many.

 

[deleted1111261]

Can you post the specifics you have about the community affiliate? Base and bonus structure? PTO? Schedule? Coverage?

They are all about the same, very similar structures for all. Very good QOL. Very relaxed environment.

My experience there: It was one of the "easiest" places to work and hardly ever went past 4pm. Tumor boards were at good times of day. There is an admin day. The RVU expectations very manageable. A now usual "Base Plus" model where you get a good salary and more if busier. I hate RVUs, but that's what they do there. PTO was fine, especially since the admin day turned into WFH. No coverage responsibilities outside of my two sites. Made amazing friendships and maintain them. I'm not giving numbers out, because I don't think that's my place to do so. I'm fair minded, so I think that anyone that knows me would say that if I say it's pretty good, it's pretty good.

Again, not everyone wants this. But, for people that trained in the MDACC system, this feels like home.

 

[Ray D. Ayshun]

If i did 44 fx to my prostates and 30-33 to my breasts and 10-15 to all palliative I'd break a mil.

 

[deleted1116990]

All?

I have interviewed at many hospital based practices throughout the midwest. It's the same story at every one. Either the old guy finally retired or the previous mid-career physician was not renewed for supposedly doing sloppy work and being disagreeable (and just by coincidence had an independent contract). In either case, the 25 person practice is offered up to an early career rad onc at a 500-ish employed salary with minimal bonus potential. Discussion of a PSA is off the table.

 

[deleted1111261]

I have interviewed at many hospital based practices throughout the midwest. It's the same story at every one. Either the old guy finally retired or the previous mid-career physician was not renewed for supposedly doing sloppy work and being disagreeable (and just by coincidence had an independent contract). In either case, the 25 person practice is offered up to an early career rad onc at a 500-ish employed salary with minimal bonus potential. Discussion of a PSA is off the table.

My friend was over my house this weekend. Younger guy (younger than me, at least!). Switched from salaried job in midwest to a new place an hour away few years ago and got a PSA for him and a buddy. Has an amazing set up. So, should we continue with anecdote game?

 

[deleted1116990]

They are all about the same, very similar structures for all. Very good QOL. Very relaxed environment.

My experience there: It was one of the "easiest" places to work and hardly ever went past 4pm. Tumor boards were at good times of day. There is an admin day. The RVU expectations very manageable. A now usual "Base Plus" model where you get a good salary and more if busier. I hate RVUs, but that's what they do there. PTO was fine, especially since the admin day turned into WFH. No coverage responsibilities outside of my two sites. Made amazing friendships and maintain them. I'm not giving numbers out, because I don't think that's my place to do so. I'm fair minded, so I think that anyone that knows me would say that if I say it's pretty good, it's pretty good.

Again, not everyone wants this. But, for people that trained in the MDACC system, this feels like home.

That's great and certainly explains a lot. Some academic systems do pay well and allow busy rad oncs to bonus well into the upper 6 figures as they should. The key is not having to deal with the bs that often comes with it, such as the meetings, early AM late PM tumor boards, mutli-site coverage, system wide chart rounds that lasts for hours, etc. If they only require 4 days in clinic and don't make you come in on your admin day, that's huge. Why systems are so reluctant to embrace this model baffles me. Everyone is so much happier with 4 day weeks.

My friend was over my house this weekend. Younger guy (younger than me, at least!). Switched from salaried job in midwest to a new place an hour away few years ago and got a PSA for him and a buddy. Has an amazing set up. So, should we continue with anecdote game?

Your friend's experience is not typical, and I agree sounds amazing. If I were him, I would save aggressively and constantly be worried about management turnover followed by the hospital cutting my contract to employ directly as the marketplace gets flooded with new grads. No, I don't have data to prove to you just how untypical this is, but why would a hospital CEO agree to a PSA if they have the option of skimming 25-50% of the pro fees by employing at median MGMA or even going permalocums?

 

[CurbYourExpectations]

Ironically, the negativity probably lowered as many top med students coming into the field, but in turn now people who are entering it probably now have lower expectations, so will likely be happier to be making less money. "Everyone said I would be unemployed, I am now making 400k living next door to MedGator!"

 

[deleted1111261]

Ironically, the negativity probably lowered as many top med students coming into the field, but in turn now people who are entering it probably now have lower expectations, so will likely be happier to be making less money. "Everyone said I would be unemployed, I am now making 400k living next door to MedGator!"

Not gonna be able to live next door to gator on 400k a year unless your partner makes us much or more, amirite @medgator ??

 

[jondunn]

Not gonna be able to live next door to gator on 400k a year unless your partner makes us much or more, amirite @medgator ??

the only 8/1 medgator knows is his 8 bed/1 bath guest house in the back.

 

[deleted1111261]

That's great and certainly explains a lot. Some academic systems do pay well and allow busy rad oncs to bonus well into the upper 6 figures as they should. The key is not having to deal with the bs that often comes with it, such as the meetings, early AM late PM tumor boards, mutli-site coverage, system wide chart rounds that lasts for hours, etc. If they only require 4 days in clinic and don't make you come in on your admin day, that's huge. Why systems are so reluctant to embrace this model baffles me. Everyone is so much happier with 4 day weeks.


Your friend's experience is not typical, and I agree sounds amazing. If I were him, I would save aggressively and constantly be worried about management turnover followed by the hospital cutting my contract to employ directly as the marketplace gets flooded with new grads. No, I don't have data to prove to you just how untypical this is, but why would a hospital CEO agree to a PSA if they have the option of skimming 25-50% of the pro fees by employing at median MGMA or even going permalocums?

Well, those seven grads all read this forum. It just confirms to many people that aren't supporters that so much is made up here. And it happens a lot. Sure, Twitter is GasLight city. But time after time, incorrect or misleading things about real people are posted here and it weakens all the work done by the community here. (The Work: Explaining reality of the destruction rad-onc to the so-called experts). When we reveal all the **** that happens, when we give real insight into how the specialty has changed, when we explain what is good and what is bad, we do so much.

When we engage in this - guesses about why people took what jobs, saying that people's jobs are terrible without knowing about the job or the person, it is just gossip. Did you know that in my parent's language the literal translation of gossip is "slinging lies"?

Why not just ask people? I don't get it. I know as much as anyone that it is going to be terrible out there in 10 years if nothing changes. Some people are already experiencing the badness. But, if we just stay on message and tell the truth and not be hysterical, we can hopefully change hearts and minds. But, basically 7 people from one of the largest cancer centers in the country and their huge network of friends will pretty much discount much of everything said here. And that's too bad, because most of them are on the right side (there is a right side and a wrong side, that much I'm sure of).

 

[TheWallnerus]

I envy you. Clearly you are somewhere, doing something that challenges you intellectually and feels progressive and important.

I have a good community job. I like seeing patients and there is some thought there. But for the last 10 years and for the foreseeable future, when someone asks me "What's new at work?", my reply has been and will be, "nothing". Sometimes I talk to them about advances in medical oncology.

We have gotten some new machines that make RTT's lives better. We hypofractionate more and SBRT a little more. We PCI less and treat post-op lung way less. Our hippocampal sparing plans (rarely used) are better now than 5 years ago. I read the big radonc papers (there are not many) and some medonc papers (these are innumerable).

We are in a field where progress is largely technical and hard to scale. In fact, given our single modality and diminishing indications, it is in the interest of larger centers to leverage anything incremental they have (protons, MRI_linac... and yes, I view these as incremental) to try to expand market share. I am also not a believer in the great value of ions or even marginal improvements in conformality at this point (happy to be proven wrong). To me, it is just not that stimulating a field to be in intellectually unless you are actively doing some sort of hard cancer research. (retrospective reviews, cost analysis and equity research would just not do the job for me). That the MDACC grads almost uniformly chose community careers makes me wonder if this is a common sentiment.

That we share cancer centers with docs that can't keep up with the standard of care (because the change is so dizzying) doesn't help. I was briefly excited that our role in metastatic disease was about to blossom, but the oligo trials have been tiny and the results spotty (less breast oligo SBRT than a year ago). Every new advance in systemic therapy re-contextualizes our role in ways that are largely out of our control and not immediately clear in terms of evidence based medicine. Usually it means less or deferred XRT and typically medoncs are making this decision.

The stats and numbers of applicants now are fine and leadership should just take what they get. By my reasoning, the following people should still be applying to radonc.

1. Real physics nerd types (may be you) who believe in ion therapy or flash and are really pretty facile with physics and can at least push the physics work forward some from a position of being a physician. (Probably 10-20 folks like this per year).

2. Truly elite wet lab folks with a strong track record of onc research preceding residency. (The Tim Chan model). Probably 10 folks like this per year. We were recruiting a lot of folks who looked like aspirants to this model ten years ago and many are underemployed now.

3. Average med students who like onc and hate inpatient call and can't stand the thought of doing a medicine residency. They are fine being third of three in importance regarding oncology and are fine not driving global clinical decision making. They are fine with declining reimbursement and limited geographic flexibility.

About 80 US grads applying sounds right.

 

[jondunn]

Well, those seven grads all read this forum. It just confirms to many people that aren't supporters that so much is made up here. And it happens a lot. Sure, Twitter is GasLight city. But time after time, incorrect or misleading things about real people are posted here and it weakens all the work done by the community here. (The Work: Explaining reality of the destruction rad-onc to the so-called experts). When we reveal all the **** that happens, when we give real insight into how the specialty has changed, when we explain what is good and what is bad, we do so much.

When we engage in this - guesses about why people took what jobs, saying that people's jobs are terrible without knowing about the job or the person, it is just gossip. Did you know that in my parent's language the literal translation of gossip is "slinging lies"?

Why not just ask people? I don't get it. I know as much as anyone that it is going to be terrible out there in 10 years if nothing changes. Some people are already experiencing the badness. But, if we just stay on message and tell the truth and not be hysterical, we can hopefully change hearts and minds. But, basically 7 people from one of the largest cancer centers in the country and their huge network of friends will pretty much discount much of everything said here. And that's too bad, because most of them are on the right side (there is a right side and a wrong side, that much I'm sure of).

yes.

you said it much more elegantly than I

 

[CurbYourExpectations]

Hyperbole and gossip muddies the waters, there is already enough truth that things are heading in a bad direction.

 

[deleted1116990]

Well, those seven grads all read this forum. It just confirms to many people that aren't supporters that so much is made up here. And it happens a lot. Sure, Twitter is GasLight city. But time after time, incorrect or misleading things about real people are posted here and it weakens all the work done by the community here. (The Work: Explaining reality of the destruction rad-onc to the so-called experts). When we reveal all the **** that happens, when we give real insight into how the specialty has changed, when we explain what is good and what is bad, we do so much.

When we engage in this - guesses about why people took what jobs, saying that people's jobs are terrible without knowing about the job or the person, it is just gossip. Did you know that in my parent's language the literal translation of gossip is "slinging lies"?

Why not just ask people? I don't get it. I know as much as anyone that it is going to be terrible out there in 10 years if nothing changes. Some people are already experiencing the badness. But, if we just stay on message and tell the truth and not be hysterical, we can hopefully change hearts and minds. But, basically 7 people from one of the largest cancer centers in the country and their huge network of friends will pretty much discount much of everything said here. And that's too bad, because most of them are on the right side (there is a right side and a wrong side, that much I'm sure of).

This is why I was (genuinely) asking what the specifics on these positions were rather than just assuming they were junk because of the location. You can rip on anecdotes for being outliers, but enough of them and you have a trend. I know my experience from interviewing at over a dozen hospitals in not-so-great locations before and after graduation in terms of what's common and what's not. But then again, I am not an MDACC grad. I expect they will always do well regardless of how saturated the market becomes.

 

[deleted1111261]

This is why I was (genuinely) asking what the specifics on these positions were rather than just assuming they were junk because of the location. You can rip on anecdotes for being outliers, but enough of them and you have a trend. I know my experience from interviewing at over a dozen hospitals in not-so-great locations before and after graduation in terms of what's common and what's not. But then again, I am not an MDACC grad. I expect they will always do well regardless of how saturated the market becomes.

Sure, I am not talking about you (even though I guess you were one quoted). You asked questions ...

I think they can't be a bellweather for that very reason - they will always do well. In fact, when times are bad, it isn't right to hang them up as an example when all 7 get amazing jobs in amazing cities, either. They will likely be fine no matter what.

 

[medgator]

all 7 get amazing jobs in amazing cities, either. .

Maybe we will find out in a longitudinal survey at some point how amazing they really were... As for whether the cities themselves are amazing, that's really quite subjective. Seems like many are just nondescript places that 1-2 hours outside of major metro areas.

But compared to kearney or Rhinelander or Salina, you're probably right, they are amazing and it's ideal to be no further than an hour or so outside of a major metro for many

 

[Ray D. Ayshun]

Well, those seven grads all read this forum. It just confirms to many people that aren't supporters that so much is made up here. And it happens a lot. Sure, Twitter is GasLight city. But time after time, incorrect or misleading things about real people are posted here and it weakens all the work done by the community here. (The Work: Explaining reality of the destruction rad-onc to the so-called experts). When we reveal all the **** that happens, when we give real insight into how the specialty has changed, when we explain what is good and what is bad, we do so much.

When we engage in this - guesses about why people took what jobs, saying that people's jobs are terrible without knowing about the job or the person, it is just gossip. Did you know that in my parent's language the literal translation of gossip is "slinging lies"?

Why not just ask people? I don't get it. I know as much as anyone that it is going to be terrible out there in 10 years if nothing changes. Some people are already experiencing the badness. But, if we just stay on message and tell the truth and not be hysterical, we can hopefully change hearts and minds. But, basically 7 people from one of the largest cancer centers in the country and their huge network of friends will pretty much discount much of everything said here. And that's too bad, because most of them are on the right side (there is a right side and a wrong side, that much I'm sure of).

TBH, I had a similar presumption about me given the seeming incongruence between where I ended up and from where I came. It's hard to fully understand the sweetness of a gig without seeing things in person. In any case, if I were to use myself as the only metric for the market I'd wonder what all the worry is. Ultimately, it's the math and tech. Fewer fractions, fewer indications and easier planning means same ole is gonna be a problem sooner than later.

 

[salubalu]

When we engage in this - guesses about why people took what jobs, saying that people's jobs are terrible without knowing about the job or the person, it is just gossip. Did you know that in my parent's language the literal translation of gossip is "slinging lies"?

Some languages also means eating flesh...

 

[RSAOaky]

Impressive to me is …

Do these jobs align with the resident’s preferences ?

It appears they do, based on knowing most of them.

“Armchair” critiquing of someone else’s job - especially while many of them read this forum and typically appreciate it - not particularly kind. But, anonymity has its drawbacks. You can be quite mean (and wrong!) with no repercussions.

Sorry I should have been more specific. I meant they don't look impressive from a location standpoint as in they're not all the kinds of places you look at and go "oh wow that's a great location." The point I was trying to make was exactly the one you're making here.

 

[Fpg1245]

Sorry I should have been more specific. I meant they don't look impressive from a location standpoint as in they're not all the kinds of places you look at and go "oh wow that's a great location." The point I was trying to make was exactly the one you're making here.

I really don’t understand why this point escapes people. Is it willful ignorance? Are their preferences really all that different from say Ortho or anesthesia or med onc?

 

[deleted1111261]

Sometimes the job is the draw.

I got a partnership offer from SERO.
And I was super stoked.

But I don’t care for Charlotte - like at all. It’s great for many people, I guess. It just seems if SERO didn’t exist, who’s rushing past Nashville, Austin, Denver, whatever for Charlotte

 

[RickyScott]

For most docs, location is everything.

 

[jondunn]

A great way to help the job market is to keep Simul happy at his current job - and off the job hunt competing with you!

every time simul rejects a job offer, an angel gets its wings

 

[medgator]

Sometimes the job is the draw.

Rad onc will never have the same geographic determinabilty as the other ROAD specialties. It never has, it's just that for a time, it had improved post IMRT.

Now i would say it's much worse

 

[RickyScott]

Rad onc will never have the same geographic determinabilty as the other ROAD specialties. It never has

When I left residency, there were jobs (not always good ones) available everywhere, which is why it had become so competitive.

 

[jondunn]

When I left residency, there were jobs (not always good ones) available everywhere, which is why it had become so competitive.

im sure this was true for you - but rad onc has always had a location limitation issue. even in the gloriest of glory days, it was only so many jobs in any given city.

look at old threads or the FAQs - always interesting to see themes that persist whether it is 2003, 2013, or 2023.

 

[RickyScott]

im sure this was true for you - but rad onc has always had a location limitation issue. even in the gloriest of glory days, it was only so many jobs in any given city.

look at old threads or the FAQs - always interesting to see themes that persist whether it is 2003, 2013, or 2023.

I came from a hellpit and don’t interview well. Plenty of exploitative jobs in places like Los Angeles, San Diego, nyc at the time. (Lewinsky was always hiring). Lots of low paying satellite jobs and urorads as well.

 

[jondunn]

Lewinsky had a good grift going

 

[Fpg1245]

why have they had turnover of their rad oncs if it’s a good gig? they wanted to go elsewhere so they could hypofrac more?

Knowing the head cases doing RO, that would not surprise me. Self destruction is part of the enterprise.

 

[deleted1111261]

why have they had turnover of their rad oncs if it’s a good gig? they wanted to go elsewhere so they could hypofrac more?

Maybe think about that sentence? If there is that much turnover, is it a good gig?

 

[deleted1111261]

Knowing the head cases doing RO, that would not surprise me. Self destruction is part of the enterprise.

Just saying something doesn’t make it true.

In what scenario does a person who has free will to treat how we they want leave a job to earn less and hypofractionate more, when they are allowed to do that a job they already have. Please play this out for me and since you know so many head cases, maybe give a similar example?

 

[deleted1111261]

Just saying something doesn’t make it true.

In what scenario does a person who has free will to treat how we they want leave a job to earn less and hypofractionate more, when they are allowed to do that a job they already have. Please play this out for me and since you know so many head cases, maybe give a similar example?

Doctor: “I’m earning too much and practicing in a way I don’t like. I’m going to treat differently.”

Leadership: “Makes sense, it does seem like things are changing.”

Doctor: “And, I’m earning way too much. We need to fix this.”

Leadership: “Well.. maybe. But that’s the contract. At this time we can’t lower your salary unless your production decreases - at least the way we measure it. But next year, sure!”

Doctor: “THIS IS BULL ****! IM ****IN OUTTA HERE!”

 

[medgator]

Just saying something doesn’t make it true.

In what scenario does a person who has free will to treat how we they want leave a job to earn less and hypofractionate more, when they are allowed to do that a job they already have. Please play this out for me and since you know so many head cases, maybe give a similar example?

Medicare investigation of the dept?

Otherwise it's nonsensical... Just hypofx and take the lower salary that results from it regardless of if you are PP or rvu based

 

[Neuronix]

in my last job in washington state, this is definitely true. the guy before me was making >$1.5m

In my neck of the woods many of the guys pulling high 6 figures or $1m plus got bought out, and their new employers are actively trying to bust down their salaries and/or replace them. This is enforced with large area 2 year non-competes and consolidation to try to ensure that they have no options to retreat to.

Contracts are basically "We'll do whatever we want to you and fire you whenever we want with little notice. Here's your starting expectations and salary. We can change it on an annual basis and enforce non-compete on you no matter what we decide to do." Non-negotiable. No severance and tail is often also not included. Contract still applies no matter who they sell out to or merge with.

Unexperienced or naive docs don't realize the peril here. Also, these contracts are often not presented until the last minute, with employers holding out as long as possible, then with huge pressure to sign immediately when it's presented. I'd like to tell job seekers and new grads to pay attention to this stuff and/or negotiate it. But then again how many options do job seekers even have?

 

[Mandelin Rain]

Not responding to anyone in particular but I don’t love seeing my colleagues trying to convince themselves that decreasing salaries in a moment of record inflation as anything but a horrifying problem.

Sure, we have food on the table. Sure, others in the world have it far worse. But if we can’t even admit it’s a problem to each other, who else is going to care?

If you can’t think of what you’d do with an extra 100k that may make you happier, feel free to Venmo me. I have a vivid imagination. I’ll have enough fun for the both of us.