Charting Outcomes 2022 - Rad Onc

[Fpg1245]

Unless they come out with an inverse radiation ETF/ETN

I sink my life savings into that one. The Astro smart money is already on this boat. Why do you think they fraction shame? All part of the plan

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[Mandelin Rain]

Not the hugest fan of the SDN RO narrative being that people aren't making 500k in major metros and not making 1 mil in the outskirts.

I don't think that this has to be taboo.

Scarb has posted the data multiple times that we have been subject to the largest decrease in reimbursement in medicine over the past couple decades. That sucks. That's a problem for us as radiation oncologists. Still, there is an imminent threat in the form of APM to further, dramatically reduce reimbursement while fundamentally changing the way we bill for services. ASTRO has been impotent to stop any of it.

If most people here are being honest with themselves, they choose this specialty based on these three things with varying degrees of importance:
1. It's a pretty cool job.
2. High salary when applied (500k-1 million the norm when I applied)
3. Great lifestyle for above salary

Now, the salary is dropping or the lifestyle is worsening to maintain salary. Personally, I also think that the "coolness" of the job (as defined by me) has dropped as we become closer and closer to 1-5 fraction technicians. Though, I can see how others think that's even more cool.

Regardless, 1 of the main draws of this specialty is plunging. I have no doubt that this has impacted med student decisions much more than the misanthropes here.

 

[jondunn]

Regardless, 1 of the main draws of this specialty is plunging. I have no doubt that this has impacted med student decisions much more than the misanthropes here.

agree with most of your post - but I think this part is untrue.

SDN IS the source of the opinion shift. We can be aloof and think that students have ways of finding out info about this stuff but how would they? SDN is the ground truth. Back when we applied, we looked at SDN and it was all positive so it added to the desire that rad onc was the secret grift and would be all that and a can of whipped cream.

there is no point denying it - the goal of the discussion here IS to inform anyone reading what we feel. This of course, and by design, has had the major impact on medical student opinion of the field.

 

[Mandelin Rain]

I bet if new grads were still being offered 850k in Chilicothe, med students would look past the musings on this website.

 

[jondunn]

I bet if new grads were still being offered 850k in Chilicothe, med students would look past the musings on this website.

.... there wouldnt be postings on this page if everything was great.

also - there absolutely are 800k jobs to new grads in the boonies available. you know this.

most importantly - how the F would med studeents know about specific salaries for specific jobs?

not sure why there is this weird sentiment to deny the CLEAR role SDN plays?

 

[TheWallnerus]

there absolutely are 800k jobs to new grads in the boonies available. you know this.

I don't know it! Is this provable. Keep in mind we are saying jobs, plural.

 

[medgator]

also - there absolutely are 800k jobs to new grads in the boonies available. you know this.

Post 'em

 

[medgator]

DEFINE_MESDN IS the source of the opinion shift. We can be aloof and think that students have ways of finding out info about this stuff but how would they? SDN is the ground truth.

You probably called it the SDN (rather than Reddit) spreadsheet too in your op-ed, JD

 

[medgator]

I don't think that this has to be taboo.

Scarb has posted the data multiple times that we have been subject to the largest decrease in reimbursement in medicine over the past couple decades. That sucks. That's a problem for us as radiation oncologists. Still, there is an imminent threat in the form of APM to further, dramatically reduce reimbursement further while fundamentally changing the way we bill for services. ASTRO has been impotent to stop any of it.

If most people here are being honest with themselves, they choose this specialty based on these three things with varying degrees of importance:
1. It's a pretty cool job.
2. High salary when applied (500k-1 million the norm when I applied)
3. Great lifestyle for above salary

Now, the salary is dropping or the lifestyle is worsening to maintain salary. Personally, I also think that the "coolness" of the job (as defined by me) has dropped as we become closer and closer to 1-5 fraction technicians. Though, I can see how others think that's even more cool.

Regardless, 1 of the main draws of this specialty is plunging. I have no doubt that this has impacted med student decisions much more than the misanthropes here.

Your post didn't mention geography/job type on top of it... Used to be a lot more pp/ownership opportunities in general and in more places around the country 10-20 years ago. Geography matters to more to a lot of people than just the compensation

 

[dieABRdie]

.... there wouldnt be postings on this page if everything was great.

also - there absolutely are 800k jobs to new grads in the boonies available. you know this.

most importantly - how the F would med studeents know about specific salaries for specific jobs?

not sure why there is this weird sentiment to deny the CLEAR role SDN plays?

As a single, white, anglo-saxon male who hates the city and held out for a job like that (800K in the boonies); I hate to report that I did not even hear about one of these when I was looking.

Maybe they had some diversity initiative and weren't considering white males.?

Or maybe you "have to network."

Something opened up near my family... at median MGMA. So I snagged that and never looked back.

IMO.... that saving grace for rad onc is gone.

 

[medgator]

I bet if new grads were still being offered 850k in Chilicothe, med students would look past the musings on this website.

Have not seen the Chillicothe posting in at least 8-10 years easy and that's probably the last i can recall that an advertisement threw out a number like that.

Now they are all coy and none of them ever give you the number, even after you call, sometimes

 

[RickyScott]

agree with most of your post - but I think this part is untrue.

SDN IS the source of the opinion shift. We can be aloof and think that students have ways of finding out info about this stuff but how would they? SDN is the ground truth. Back when we applied, we looked at SDN and it was all positive so it added to the desire that rad onc was the secret grift and would be all that and a can of whipped cream.

there is no point denying it - the goal of the discussion here IS to inform anyone reading what we feel. This of course, and by design, has had the major impact on medical student opinion of the field.

So increasing residency spots more than any other specialty has nothing to do with it? The specialty can be a total/extreme/ outlier, and medstudents only care because of SDN? ER had a similar increase in residency numbers (but no decrease in utilization), and guess what, they have joined radiation at the bottom of the match. Did SDN trash ER as well?

 

[jondunn]

So increasing residency spots more than any other specialty has nothing to do with it? The specialty can be a total/extreme/ outlier, and medstudents wouldnt care? ER had a similar increase in residency numbers (but no decrease in utilization), and guess what, they have joined radiation at the bottom of the match.

What?

 

[deleted1116990]

JD:

July 20, 2022: $2500/day is way too much for a locums because rad onc coverage is easy
July 21, 2022: Lots of $800k/year jobs out there

Have not seen the Chillicothe posting in at least 8-10 years easy and that's probably the last i can recall that an advertisement threw out a number like that.

A recruiter for Spencer, IA was throwing out $850k salary and 10 weeks of vacation. Guess what? That wasn't real.

 

[Neuronix]

A recruiter for Spencer, IA was throwing out $850k salary and 10 weeks of vacation. Guess what? That wasn't real.

Was it meant for radiology or med onc?

 

[deleted1116990]

As a single, white, anglo-saxon male who hates the city and held out for a job like that (800K in the boonies); I hate to report that I did not even hear about one of these when I was looking.

Lots of these places with bean counters calling the shots viewing all rad onc labor as replaceable and will bottom feed trying to get people who need visa sponsors vs. pay well for good recruits and would actually like to be in the location (these places exist, but they are rare). The sad thing is, in 3-4 years these permalocums places are going to be able to hire full-time at their price targets with all the people hitting the market that will be DOA at anything near a semi-major metro.

 

[TheWallnerus]

Have not seen the Chillicothe posting in at least 8-10 years easy and that's probably the last i can recall that an advertisement threw out a number like that.

Now they are all coy and none of them ever give you the number, even after you call, sometimes

The people going into rad onc right now... some prob have questionable judgment.

People paying a rad onc 800K nowadays when you can "buy" one off the street for cheap? Well, they're just plain stupid.

 

[Mandelin Rain]

also - there absolutely are 800k jobs to new grads in the boonies available. you know this.

[citation needed]

 

[Mandelin Rain]

What ASTRO felt like in 2008

What ASTRO felt like in 2018

Med students who may have a poster to present can definitely sense the difference.

 

[TheWallnerus]

What ASTRO felt like in 2008

What ASTRO felt like in 2018

Med students who may have a poster to present can definitely sense the difference.

ASTRO in 1998

 

[thecarbonionangle]

Where are the gifs with the barely clothed women walking around giving finger food? Don’t act like you guys didn’t play ball back then!

 

[Fpg1245]

What ASTRO felt like in 2008

What ASTRO felt like in 2018

Med students who may have a poster to present can definitely sense the difference.

The conference sucks. I’ve been to 3 in the last 10 years. Accurate portrayal really. The meeting sucks. There’s nothing to discuss that I won’t find out about in a few weeks anyway. Maybe that’s why they charge for you to see the whole job bank now. Just needlessly commoditizing something.

 

[Mandelin Rain]

Where are the gifs with the barely clothed women walking around giving finger food? Don’t act like you guys didn’t play ball back then!

That was what the Gatsby gif was referencing. What a time to be alive.

ASTRO 2028 will be Gangs of New York Big Rad Onc vs Little Rad Onc battle.

ASTRO 2038 likely Djangoumab killing the entire profession singlehandedly.

 

[Ray D. Ayshun]

Wish I coulda been there. I haven't been to astro in 2 or 3 years but I remember being disappointed I had to buy my own coke.

 

[Mandelin Rain]

Live look at ASCO calling ASTRO

 

[deleted1111261]

Wish I coulda been there. I haven't been to astro in 2 or 3 years but I remember being disappointed I had to buy my own coke.

Shrooms booth coming soon!

 

[communitydoc13]

SDN IS the source of the opinion shift.

SDN reflects the experiences of the posters, which in turn reflect their real experience.

Medstuds sense the whole vibe on rotations, the presence or absence of apathy, the enthusiasm for upcoming jobs, the opportunities residents are getting. It's clear as mud without SDN.

Whatever happened to the luxury car threads?

Those departmental X-mas/graduation parties circa 2008 were something. That was peak X-mas party and before peak meritocracy. Being a young radonc attending then must have been like being an above average white dude in the Mad Men era.

The winners of the academic job search (good institution in good location with good chair and good time allotment for research) are still gonna feel like winners. They will notice any economic down turn less and will notice fewer/lower quality residents more. Lots of folks in decent academic departments looking for opportunities elsewhere however. Makes you wonder.

 

[jondunn]

SDN reflects the experiences of the posters, which in turn reflect their real experience.

exactly.

this is my point. SDN posters post their real stories here - and that has had clear impact.

 

[deleted1116990]

Whatever happened to the luxury car threads?

Those departmental X-mas/graduation parties circa 2008 were something. That was peak X-mas party and before peak meritocracy. Being a young radonc attending then must have been like being an above average white dude in the Mad Men era.

I know someone who practiced independently in the 2000s. Covered multiple hospitals and was pulling in well over 2M a year. Told me dealers would harass him constantly and leave Mercedes keys with his nurse for him to test drive.

Those days are over. Must have been nice. I know others that lived through those years and maxed out their lifestyle on the income assuming it would continue forever. I think young rad oncs these days are approaching it differently now, at least I am. Aggressively saving assuming this is as good as it's ever going to get. Kind of the way a pro athlete has to stretch income from a 10 year career over the rest of his life.

 

[jondunn]

Also - ‘Med students sense the vibe on rotations’ - of course I agree. But many of them most of them - most of US if we were applying now- wouldn’t even get to the state where we are rotating because of the impact that a public forum has had on medical student opinion.

There still is a lag of course- I had a colorectal surgeon friend ask me about rad onc for his brother as if it is still quite competitive - but younger people know - but SDN started that avalanche

What I don’t get is why peope are acting like this is not true ?

 

[jondunn]

I know someone who practiced independently in the 2000s. Covered multiple hospitals and was pulling in well over 2M a year. Told me dealers would harass him constantly and leave Mercedes keys with his nurse for him to test drive.

Those days are over. Must have been nice. I know others that lived through those years and maxed out their lifestyle on the income assuming it would continue forever. I think young rad oncs these days are approaching it differently now, at least I am. Aggressively saving assuming this is as good as it's ever going to get. Kind of the way a pro athlete has to stretch income from a 10 year career over the rest of his life.

Yes they are over. Long gone.

 

[RickyScott]

Also - ‘Med students sense the vibe on rotations’ - of course I agree. But many of them most of them - most of US if we were applying now- wouldn’t even get to the state where we are rotating because of the impact that a public forum has had on medical student opinion.

There still is a lag of course- I had a colorectal surgeon friend ask me about rad onc for his brother as if it is still quite competitive - but younger people know - but SDN started that avalanche

What I don’t get is why peope are acting like this is not true ?

A member of sdn didn’t create this. The programs did. Btw Medstudents also avoiding er.

 

[Lamount]

I bet if new grads were still being offered 850k in Chilicothe, med students would look past the musings on this website.

The thing that I think is a little bit of a disconnect here…

I would bet that >50% of posters here make >500k total comp, and >80% make more than 400k total comp.

That’s far better than most med students will make as an attending in most specialties.

What is being discussed here is a relative change in compensation compared to a few years ago, but from an absolute perspective, it is still hard to beat the comp for the lifestyle (maybe derm, rads but not many others)

 

[RadOncDoc21]

Live look at ASCO calling ASTRO

This is what’s left of rad onc

 

[RickyScott]

The thing that I think is a little bit of a disconnect here…

I would bet that >50% of posters here make >500k total comp, and >80% make more than 400k total comp.

That’s far better than most med students will make as an attending in most specialties.

What is being discussed here is a relative change in compensation compared to a few years ago, but from an absolute perspective, it is still hard to beat the comp for the lifestyle (maybe derm, rads but not many others)

In many of the locations where radonc jobs are available, salary is close to that of primary care. Geography, in any case is more important than pay for most docs. Also, markets are forward looking, and the match is probably the worlds smartest market.

 

[deleted1111261]

The thing that I think is a little bit of a disconnect here…

I would bet that >50% of posters here make >500k total comp, and >80% make more than 400k total comp.

That’s far better than most med students will make as an attending in most specialties.

What is being discussed here is a relative change in compensation compared to a few years ago, but from an absolute perspective, it is still hard to beat the comp for the lifestyle (maybe derm, rads but not many others)

At this point with all the data we have, no one is convincing the other side

There is no additional data that will make La Mount say “you know what, those guys are right.” Or for me to say, “La Mount is right.”

No one’s priors are adjustable at this point.

Which is fine.

 

[Lamount]

In many of the locations where radonc jobs are available, salary is close to that of primary care. Geography, in any case is more important than pay for most docs. Also, markets are forward looking, and the match is probably the worlds smartest market.

Primary care makes 200-250 most places. I wouldn’t think it is impossible for a rad onc attending (assistant prof+) to be making that… but I would hazard a guess that 90% are making more.

 

[jondunn]

At this point with all the data we have, no one is convincing the other side

There is no additional data that will make La Mount say “you know what, those guys are right.” Or for me to say, “La Mount is right.”

No one’s priors are adjustable at this point.

Which is fine.

what part do you disagree with him on though? that 50 percent of posters here make over 500k or more?

 

[Mandelin Rain]

The thing that I think is a little bit of a disconnect here…

I would bet that >50% of posters here make >500k total comp, and >80% make more than 400k total comp.

That’s far better than most med students will make as an attending in most specialties.

What is being discussed here is a relative change in compensation compared to a few years ago, but from an absolute perspective, it is still hard to beat the comp for the lifestyle (maybe derm, rads but not many others)

So years ago, rad oncs made more and there was more interest in the specialty? Color me shocked!


Anyway, part of the issue is also that the ceiling has come WAY down. I agree with your guesstimates. However, I’d also guess that <2% of this forum makes over a million and probably <10% makes over 750k. In 2022 dollars. This way not in any way uncommon 15 years ago in 2007 dollars. If you were a polite person going into PP at that time, you were asking for the sky and getting it. If you were an academic type, you weren’t getting paid, but you were treating 8-10 patients and taking 3 academic days.

It’s sooooo drastically different now than it was when even early career docs started down this path. And the trend ain’t up. I’m not comparing myself to other fields. I’m comparing to my expectations when I applied to this field. “Not met” is an understatement.

I know you’re optimistic and I respect that. I’m not trying to convince you not to be. But, I hope we can acknowledge that all the above is real and at least highly problematic. Also, it is 100% the reason med students aren’t interested. The upside vs downside has done a complete 180.

 

[jondunn]

Agree with all - The difference is you think Med students figured out salary stuff without reading the internet, chiefly SDN.

It is also true that IF salaries stay where they are and don’t have more falls in income potential - expectations will adjust accordingly and future students will evaluate the field for what it is now in comparison to other options rather than what it used to be.

 

[Mandelin Rain]

Primary care makes 200-250 most places. I wouldn’t think it is impossible for a rad onc attending (assistant prof+) to be making that… but I would hazard a guess that 90% are making more.

But what does this matter? They should be getting more too.

But let’s acknowledge there are trade offs. Like extra years of training. Onerous board process. Not being able to work literally anywhere you want at anytime. Etc…

On the whole, we probably deserve to get paid more that primaries, even acknowledging they deserve much more.

 

[Mandelin Rain]

It is also true that IF salaries stay where they are and don’t have more falls in income potential - expectations will adjust accordingly and future students will evaluate the field for what it is now in comparison to other options rather than what it used to be.

The future is now.

Med students have adjusted their expectations for rad onc salaries and are saying, “No thanks.”

 

[jondunn]

The future is now.

Med students have adjusted their expectations for rad onc salaries and are saying, “No thanks.”

If the dust settles and rad onc is a median 500-550k job where most are employed and there is a low ceiling - you really think people won’t apply.

I think the bigger issue is the worry there won’t be jobs - not that salary. That would be attractive to many MDs or DOs who go into other more intensive fields for sometimes less mone

 

[RickyScott]

If the dust settles and rad onc is a median 500-550k job where most are employed and there is a low ceiling - you really think people won’t apply.

I think the bigger issue is the worry there won’t be jobs - not that salary. That would be attractive to many MDs or DOs who go into other more intensive fields for sometimes less mone

Why is location/geography de emphasized in every back and forth. It is more important than salary to most medical students.

 

[yesmaster]

Future students will evaluate the field for what it is now in comparison to other options rather than what it used to be.

So, rad onc used to be a 9 or a 10, but then the years set in, wrinkles started to show from too much booze, rad onc’s metabolism slows down. Some periodontal disease here, some puffy love handles there. Six pack gets buried. Instead of getting a gym membership and sticking to a modestly calorie-restricted Mediterranean diet, rad onc looks in the mirror every night, says “you still got it babe.” Cheat day is every day, at least during the SOAP week before Match Day. Treat yo self becomes rad onc’s favorite self-affirmation. Fast forward several years, rad onc wanders onto the med school campus and wonders “why aren’t the med students interested in me anymore?”

Rad onc meets a couple long time buddies, pathology and derm.

Path says, “no worries, you ain’t a 9 or 10 anymore, but you’re still a solid 4, maybe a 5 or 6 in good lighting. Let me tell you, some students on this side of campus, they still dig you. You don’t need to change a damn thing.”

Derm says, “what happened to you? You used to be so cool. Tell you what, let’s train for this year’s triathlon, it won’t be easy but we’ll get you back to your prime.”

Who does rad onc listen to, pathology or derm?

 

[Lamount]

But what does this matter? They should be getting more too.

But let’s acknowledge there are trade offs. Like extra years of training. Onerous board process. Not being able to work literally anywhere you want at anytime. Etc…

On the whole, we probably deserve to get paid more that primaries, even acknowledging they deserve much more.

I Was responding to a specific assertion that in many desirable locations, rad onc comp is the same as PCP… do you think this is true?

 

[Mandelin Rain]

I Was responding to a specific assertion that in many desirable locations, rad onc comp is the same as PCP… do you think this is true?

I do not.

I think it may be true in certain situations. For example, new hires at Stanford or something.

I mean we had that Iowa (!) job listing that just MUST have been wrong (based on nothing). The salary wasn’t too far off from what they were offering IM primary iirc.

Edit: 239k for full time in Clinton, Iowa. That is indeed PCP money.

https://forums.studentdoctor.net/attachments/1652128026678-png.354492/

 

[medgator]

Primary care makes 200-250 most places. I wouldn’t think it is impossible for a rad onc attending (assistant prof+) to be making that… but I would hazard a guess that 90% are making more.

Hospitalists making closer to 3 in many nice metro areas, including places where you won't find a rad onc job at all.

Quite frankly was shocked that psych is seeing the 3s at all considering what they were getting paid 10-15 years ago

 

[medgator]

I Was responding to a specific assertion that in many desirable locations, rad onc comp is the same as PCP… do you think this is true?

In certain academic centers? It ain't that far off

 

[medgator]

Bad argument

Cannot compare highest hospitalist to lowest RO.

This looks hysterical. Most mid career employed ROs are making 500k. Almost no hospitalists are.

I do not complain about the money to my pcp or hospitalist friends. Yes we can’t move easily. Yes we are going to earn less. Yes the leadership is a joke. Yes we have zero indication things will improve. But, we out earn them. Saying otherwise - come on.

Agree.... But starting? Not really far off at all in some places. And if you stay in academics in certain places it still isn't far off 5 years later.

We shouldn't be having this conversation to begin with... Hospitalists and psychiatrists have had steady growth in their salaries the last 5-10 years and demand growth in every market, have we?