Charting Outcomes 2022 - Rad Onc

[RadOncDoc21]

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?

Yea, agree… not sure why we need to keep seeing pay cuts all the time.

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[deleted1111261]

I make 2x our hospitalists

 

[metallica81788]

Apologies if driving this more off track, but hospitalists, ER, etc, can take extra call/shifts to increase income. Discuss burnout all you want, but we can't do that. Radonc is 99% reliant on others for our income we rarely drive our own volumes.

I'd love to able to pick up some extra shifts for spending $$$ in far-flung biryani destinations; or at least have the option to do so

 

[Ray D. Ayshun]

If you are going to pick and choose starting salary for an academic Rad Onc vs a rural community hospitalist and stand by that as a fair comparison, than you should accept when a urologist cherry picks data and suggests that surgery is better than RT for prostate cancer.

Growth and trajectory are different topics altogether. You want to quickly move to that, fine, but it's a very weak argument to suggest that hospitalists out earn us. Pick one setting - for example an academic center or a private community hospital. Compare what the mid career hospitalist is making vs the RadOnc. I suspect it will be 1.8-2.x in favor of the radiation oncologist.

Don't use "1.8" in a sentence with this crowd. You're gonna trigger someone...

 

[Mandelin Rain]

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.

While I think it's likely true, I'm not "sure" that most mid-career rad oncs make >500k at this point. But you talk to way more people than me so I believe it. Assuming it's true, I'd guess that most fall in a fairly narrow range between 475-550k. I don't think that salary is atypical or especially high for 5-year residency/fellowship trained specialists. Why we'd compare to hospitalists or Family Med is beyond me.

I think the main issue is that there aren't too many paths to those BIG salaries anymore. There are some, but getting tougher by the year for new grads.

 

[yesmaster]

If the hospitalist ever had or has an interest in oncology, they can do a med onc fellowship. Their GME training time becomes equivalent to rad onc, the 2x pay gap disappears and if anything is in favor of med onc.

Why are we being compared to peds and hospital medicine? Of course, there’s a pay gap, per aamc mgma social media etc.

We work daily with med oncs and surgical specialists, they are the most relevant peer group that do similar things as what we do.

 

[deleted1111261]

If the hospitalist ever had or has an interest in oncology, they can do a med onc fellowship. Their GME training time becomes equivalent to rad onc, the 2x pay gap disappears and if anything is in favor of med onc.

Why are we being compared to peds and hospital medicine? Of course, there’s a pay gap, per aamc mgma social media etc.

We work daily with med oncs and surgical specialists, they are the most relevant peer group that do similar things as what we do.

Agree. Compare with specialists. We are falling way behind compared to specialists.

 

[yesmaster]

The worry that med students are going to choose rad onc over peds/IM (or the hope, if you’re a rad onc chair or PD), is overblown IMO. The folks choosing those fields have a totally different set of life priorities than the folks choosing a specialty field. They value being close to family, or keeping their options open, or choosing something that feels like “real medicine”, or being able to follow their orthopedics/dermatology/FAANG spouse.

The unholy alliance between rad onc residencies and cash-hungry academic health systems, with hyperaggressive marketing and a few bribes/gifts, might peel a couple med students from other specialty choices. More likely, to fill spots, we will only get those with significant sunk cost, or med students who are looking for a backdoor, that is SOAP or immigration to the US. That is my observation from NRMP data.

 

[jondunn]

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.

Yes. Thank you.

 

[deleted1116990]

There is another piece to this that is not usually, and should always be, discussed.
Which is what the volume is for the income you are making, and to a much lesser extent location to try and determine market value through bargaining power.

You are making 500k? That tells me nothing. That could be horrible or great or more likely somewhere in between.

Do you have a 500k salary and have 10 on beam, get 8 weeks of PTO, and are only in the office 25-30 hours a week? We know there are people in these setups. Is anybody going to look at that and say you are underpaid? Perhaps you would like to make more, but you could supplement that with locums on your vacation if you really wanted to (and why would you?).

Or do you have some tiny base comp with a complicated RVU or split-collections "bonus" structure where you have 30 on beam, are frequently in on Saturdays getting caught up or seeing inpatients with shared call and no outside vacation coverage, making it difficult to get away and having you manage double loads sometimes when your partners leave? This is a 1 million dollar job, but of course we also all know people doing work like this where at the end of the year their gross is 500k or in some cases significantly less (not uncommon to see exploitative stuff like this dished our to early career rad oncs in the 300s).

You can do this at any income level. Maybe you are jealous of the guy making 750k until you realize he is seeing 500 consults a year and his partners/hospital overlords are taking half of his pro collections. Add in a high COL area and high tax "desirable" state and it becomes pretty clear the low volume 500k guy in a small midwest town is living a much more comfortable life.

 

[deleted1116990]

Yes. Thank you.

No, JD. Lots of underpaid people out there. My group recently acquired a (extremely) rural facility and offered it to me for mid 500s if I wanted to be less busy (20ish). I declined, and they kept the late career rad onc on, who didn't want to move, with a deal in the 300s.

 

[jondunn]

No, JD. Lots of underpaid people out there. My group recently acquired a (extremely) rural facility and offered it to me for mid 500s if I wanted to be less busy (20ish). I declined, and they kept the late career rad onc on, who didn't want to move, with a deal in the 300s.

Not sure how your anectode negates simul post. No one is disputing you.

I’m sorry this is happening to you.

 

[deleted1116990]

Not sure how your anectode negates simul post. No one is disputing you.

I’m sorry this is happening to you.

There is a narrative that it is unusual to make sub 500k as a rad onc. It's not. Happens a lot. I was offered 400k in west virginia. Had a high volume low 400s employed offer in Kansas. Somebody eventually takes these offers.

 

[jondunn]

There is a narrative that it is unusual to make sub 500k as a rad onc. It's not. Happens a lot.

sorry this is happening to you

 

[Mandelin Rain]

Agree. Compare with specialists. We are falling way behind compared to specialists.

And hence, med students interested in specialty medicine are picking other specialty medicine fields.

This isn't rocket science.

If you (not you, but anyone) don't think that matters more than what two dozen of us whiners type on a message board, I don't think we're going to find too much common ground on this topic. High pay. Good lifestyle. Why the "Golden Age" of rad onc residents ever happened.

 

[deleted1116990]

And hence, med students interested in specialty medicine are picking other specialty medicine fields.

This isn't rocket science.

If you (not you, but anyone) don't think that matters more than what two dozen of us whiners type on a message board, I don't think we're going to find too much common ground on this topic. High pay. Good lifestyle. Why the "Golden Age" of rad onc residents ever happened.

Probably. The high pay crowd will go for the surgical subspecialties where 7 figure incomes are common and expected. The lifestyle crowd will go for rads and anesthesia where you get a week for vacation every month. The MD PhD crowd, well, really? Who's left? Caribbean grads who reallllly don't want to do primary care?

 

[deleted1111261]

And hence, med students interested in specialty medicine are picking other specialty medicine fields.

This isn't rocket science.

If you (not you, but anyone) don't think that matters more than what two dozen of us whiners type on a message board, I don't think we're going to find too much common ground on this topic. High pay. Good lifestyle. Why the "Golden Age" of rad onc residents ever happened.

The absolute numbers today in 2022 are not terrible. My CV is not as good as most of yours and I still do fine. I also am not as picky as a lot of people in terms of city I would live in, these days. I don't need 50 biryani joints within 5 miles. 5 within 50 miles will do.

It's the change compared to other similar specialties. It is the speed of the change. It is the uncertainty of the future. It is the raging fire that ASTRO cares nothing about. It is the lack of respect shown by the board towards its members. It is the poorly treated scientists in our departments. It is the department and hospital extracting, leeching from the revenue we bring.

It is utter BS that PSA is considered good. It should be global. The machine can't beam on without us. Give us a ****ing cut. Everyone will be better off.

 

[jondunn]

And hence, med students interested in specialty medicine are picking other specialty medicine fields.

This isn't rocket science.

If you (not you, but anyone) don't think that matters more than what two dozen of us whiners type on a message board, I don't think we're going to find too much common ground on this topic. High pay. Good lifestyle. Why the "Golden Age" of rad onc residents ever happened.

Again - where do you think Med students are seeing tbis dara? Because if one googles - the ‘average’ numbers that are published look pretty good!

They don’t tell the whole story of course - which is why what’s discussed here matters

It’s mind boggling that you don’t understand this

 

[deleted1116990]

It is utter BS that PSA is considered good. It should be global. The machine can't beam on without us. Give us a ****ing cut. Everyone will be better off.

I was ***this*** close to getting a rural hospital to let me buy half of a new linac and split expenses and revenue on it. They talked about it for about a month and ultimately said no and hired permalocums instead. It's unfortunate for us that we have been looped into the RVU reimbursement system with everyone else as that doesn't make sense for our specialty as our "procedure" involves the linac. As long as we are oversupplied, our chances of machine ownership are slim. The hospitals have no incentive to offer it, and to buy your own involves enormous risk due to competition from the oversupply and a business environment that favors large systems.

 

[Mandelin Rain]

Again - where do you think Med students are seeing tbis dara? Because if one googles - the ‘average’ numbers that are published look pretty good!

They don’t tell the whole story of course - which is why what’s discussed here matters

It’s mind boggling that you don’t understand this

The point is, what they are seeing IRL matches what they read here.

If they saw rad oncs driving Lambos and rocking Patek watches like neurosurgeons or went to ASTRO, and attended lavish parties with bubbly handed out by scantily clad beautiful people, or heard the term "buck a rad" all the time by openly jealous colleagues, none of what is written on this forum would matter.

My guess is you missed real peak rad onc. There was a vibe. No message board needed. Unfortunately, that vibe changed quickly. Also, no message board needed.

 

[deleted1111261]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

 

[FindMeOnTheLinks]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

You’ve been relegated to second class status. Can’t sit at the table with the real high earners anymore

 

[medgator]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

Nuc med Shah and path Gupta are in the cards for your next table

 

[TheWallnerus]

they saw rad oncs driving Lambos and rocking Patek watches like neurosurgeons

Love the Pateks but Dr Strange (neurosurgeon) wore a gorgeous Jaeger LeCoultre on his wrist in the first movie. He severely damaged it in the wreck in his car which *was* a Lambo. He still puts it on his wrist though, cracked and all. Tony Stark wore AMVOXes in the first couple movies.

 

[dieABRdie]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

I get put at the table with the sandwich tray.

 

[Ray D. Ayshun]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

Endocrine Reddy? Lucky you. Everyone I know has to wait 6 months at least to see Endocrine Reddy.

 

[medgator]

Endocrine Reddy? Lucky you. Everyone I know has to wait 6 months at least to see Endocrine Reddy.

He's been making extra hay post covid as Tele-Reddy

 

[communitydoc13]

Going to an Indian wedding. They used to seat me next to ENT Patel and Moh’s Reddy. Now, I’m with Podiatry Patel and Endocrine Reddy. Different vibe for sure.

Let's be honest, You were never really in ENT Patel's league.

 

[Neuronix]

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?

My experience has been that many experienced clinical non-procedural positions (FM, IM, EM, etc) make same or similar to first 1-2 year rad onc in my competitive metro (academic or not).

Mid career rad onc will typically make more than those non-procedural docs. After a few years rad onc pay should increase, though in competitive metro this requires hard renegotiation or a move out to greener pastures elsewhere in the country, rarely in area. Some rad oncs are unable to successfully renegotiate or move, and they get exploited. Other specialties much easier to stay in area and jump across employers if there are difficulties. Your mileage/pay my vary in academics... What even is academics anymore. It's such a spread from very research oriented to basically an employed clinician. Very academic positions may continue to pay mid-career non-procedural rates.

This is excluding the very low rad onc pay you hear about from places like Harvard, Stanford, Hopkins, Penn, etc... First year family practice at a public community health center makes more than instructors at these places to my knowledge.

 

[medgator]

My experience has been that many experienced clinical non-procedural positions (FM, IM, EM, etc) make same or similar to first 1-2 year rad onc in my competitive metro (academic or not).

Mid career rad onc will typically make more than those non-procedural docs. After a few years rad onc pay should increase, though in competitive metro this requires hard renegotiation or a move out to greener pastures elsewhere in the country, rarely in area. Some rad oncs are unable to successfully renegotiate or move, and they get exploited. Other specialties much easier to stay in area and jump across employers if there are difficulties. Your mileage/pay my vary in academics... What even is academics anymore. It's such a spread from very research oriented to basically an employed clinician. Very academic positions may continue to pay mid-career non-procedural rates.

This is excluding the very low rad onc pay you hear about from places like Harvard, Stanford, Hopkins, Penn, etc... First year family practice at a public community health center makes more than instructors at these places to my knowledge.

Very accurate.. good point regarding those other specialties in terms of being able to lateral to better jobs in a region if things start heading south, which just isn't an option for most of us, more of a take it or leave it

 

[jondunn]

Agree neuronix

do want to point out that it can be hard these days because of non competes - even in other specialties, thanks to consolidation.

If you’re a urologist in the Pittsburgh area and want to leave UPMC…..good luck. You’re pretty much going to find that the vast majority of urology jobs are owned by UPMC or Allegheny, and non competes are a bitch.

This is a major problem with continued consolidation, and is not going away anytime soon

 

[deleted1111261]

Very accurate.. good point regarding those other specialties in terms of being able to lateral to better jobs in a region if things start heading south, which just isn't an option for most of us, more of a take it or leave it

Yeah I don’t get it

I am less pedigreed than most everyone here. No research. No PhD. No parents in medicine. I’ve not found this lateral difficulty. Anecdote, as well. But, have had 3 local opportunities, since I got here. I’ve worked in 4 settings and I’m not one does a RO with 5 years experience make less than a hospitalist. Midwest. DC suburbs, Phoenix, Tacoma. Always about double. We live in parallel worlds.

 

[jondunn]

Yeah I don’t get it

I am less pedigreed than most everyone here. No research. No PhD. No parents in medicine. I’ve not found this lateral difficulty. Anecdote, as well. But, have had 3 local opportunities, since I got here. I’ve worked in 4 settings and I’m not one does a RO with 5 years experience make less than a hospitalist. Midwest. DC suburbs, Phoenix, Tacoma. Always about double. We live in parallel worlds.

not easy to go against the grain on this forum - give you credit for always being true to your experience and the experiences of those you know.

 

[Neuronix]

Yeah I don’t get it

I am less pedigreed than most everyone here. No research. No PhD. No parents in medicine. I’ve not found this lateral difficulty. Anecdote, as well. But, have had 3 local opportunities, since I got here. I’ve worked in 4 settings and I’m not one does a RO with 5 years experience make less than a hospitalist. Midwest. DC suburbs, Phoenix, Tacoma. Always about double. We live in parallel worlds.

Pedigree is limiting.

Private practices and many other employed positions see an academic CV and wonder why the heck that person would even apply and whether they would be happy working outside academics.

Meanwhile academic jobs are hard to come by and often pay less. This is even worse if you have a niche. You need the stars to align to find a better job hiring in whatever your niche area is.

If you want to make the most money, I always say have the best personality, business sense and be competent. Don't build a very academic CV.

There's an old adage about medical students. The A students go into academics and the B students end up with all the money.

 

[Lamount]

My experience has been that many experienced clinical non-procedural positions (FM, IM, EM, etc) make same or similar to first 1-2 year rad onc in my competitive metro (academic or not).

Mid career rad onc will typically make more than those non-procedural docs. After a few years rad onc pay should increase, though in competitive metro this requires hard renegotiation or a move out to greener pastures elsewhere in the country, rarely in area. Some rad oncs are unable to successfully renegotiate or move, and they get exploited. Other specialties much easier to stay in area and jump across employers if there are difficulties. Your mileage/pay my vary in academics... What even is academics anymore. It's such a spread from very research oriented to basically an employed clinician. Very academic positions may continue to pay mid-career non-procedural rates.

This is excluding the very low rad onc pay you hear about from places like Harvard, Stanford, Hopkins, Penn, etc... First year family practice at a public community health center makes more than instructors at these places to my knowledge.

Will not argue with any of this. “Elite” academic institutions pay awfully and promote slowly. I know a few instructors as one-such institution who have been there >10 years. On the other hand, there are a few decent programs who are always hiring and have reasonable comp plans.

 

[medgator]

Will not argue with any of this. “Elite” academic institutions pay awfully and promote slowly. I know a few instructors as one-such institution who have been there >10 years. On the other hand, there are a few decent programs who are always hiring and have reasonable comp plans.

It's been my experience that some of the big names outside of Anderson pay pretty ****ty for whatever reason, esp if NCI/PPS exempt.

Have heard Anderson actually pays really well despite the crazy number of attendings that they have.. maybe it's a Sunbelt vs Northeast thing

 

[medgator]

Yeah I don’t get it

I am less pedigreed than most everyone here. No research. No PhD. No parents in medicine. I’ve not found this lateral difficulty. Anecdote, as well. But, have had 3 local opportunities, since I got here. I’ve worked in 4 settings and I’m not one does a RO with 5 years experience make less than a hospitalist. Midwest. DC suburbs, Phoenix, Tacoma. Always about double. We live in parallel worlds.

3 local? No non-compete at current job?

Only states that are going to happen in are those that have made non competes illegal and there's enough competition/lack of consolidation to have multiple places in the area to switch jobs to

 

[Mandelin Rain]

Simul, for whatever reason, I’d posit the hospitalists you’ve encountered make way less than those I’ve spoken to if you’re talking double.

350-400 seems pretty normal to me. Maybe the dudes I know are picking up extra shifts or something.

 

[jondunn]

I feel like hospitalist is just a hard comparison because I feel like for many they shift into something else after a few years

 

[DoctwoB]

I feel like hospitalist is just a hard comparison because I feel like for many they shift into something else after a few years

Very mixed bag. Some deliberately do it as a way to take a break and make some money before fellowship. Some go into it intending for it to be a career and burn out. Some stick with it for the long haul.

It depends a lot on the job which is highly variable, as well as the person. E.g. 12hour shift of non stop fast paced work vs 6-8 hours of reasonably paced work and then holding a pager at home. 7 on/ 7 off also Is a great schedule for the childless or maybe those with a non-working spouse; but it means a lot of missed weekend kids activities and solo spouse on the weekend, so some find it less lifestyle friendly with young kids.

 

[CurbYourExpectations]

350-400k is around 90th percentile for hospitalists, and they probably are picking up some extra shifts

 

[medgator]

I feel like hospitalist is just a hard comparison because I feel like for many they shift into something else after a few years

The ones around here have been doing it for years and like the flexibility for scheduling... Most are 7/7 and pick up extra shifts here and there to supplement income. Some were doing it prn and have now closed their own practice and have become straight up hospitalists

While RO is great and fulfilling as a career, it can be a ball and chain in terms of continuity of care if you want to take a long vacation somewhere, hospitalist/rads/gas etc are great for that. EM as well but that job market is rough like ours

 

[LostResident1]

Sometimes I get envious of my hospitalist friends but then I have to remember what their day looks like. Can't imaging rounding on 10-20 pts, admissions, orders, notes, follow up on tests, discharge, etc. Can you really make a 30 year career out of that? Same with EM.

 

[medgator]

twitter since almost none of them are defending the oversupply anymore.

Really? Still seeing plenty of RadOncRocks bs outreach over there and chairs sucking up to rotating MS's.

Not sure that's the same as not defending... Maybe they are just ignoring and moving on?

 

[medgator]

Sometimes I get envious of my hospitalist friends but then I have to remember what their day looks like. Can't imaging rounding on 10-20 pts, admissions, orders, notes, follow up on tests, discharge, etc. Can you really make a 30 year career out of that? Same with EM.

Couldn't do either, esp EM.... Id probably have just done gu or ent looking back, great specialties, good income, nice mix of office and procedures and widespread demand. Rads probably fine too but couldn't just look at film all day, personally and IR still seems like it has an identity crisis

Even med onc isn't safe at this point imo if you are looking for autonomy in PP environment. Seeing a lot more extenders/APPs being hired.

 

[CurbYourExpectations]

Really? Still seeing plenty of RadOncRocks bs outreach over there and chairs sucking up to rotating MS's.

Not sure that's the same as not defending... Maybe they are just ignoring and moving on?

I can see that point too, maybe I'm being too optimistic lately. Hoping it's just a realization that they should care more about their applicants and not just expect to get top tier prospects no matter what they do.

 

[communitydoc13]

Midwest. DC suburbs, Phoenix, Tacoma.

That's the rub. You also probably work, present and network very well. You have been willing to move thousands of miles across the country on multiple occasions.

If priority is staying close to parents or extended family (within a weekend drive) this dynamic changes rapidly.

A very American phenomenon for many fields. Part of our cultural weakness if you ask me. Even among the professional/academic class, most people should be living close to family.

In the US, immigrants do better than people born here. When you normalize for people being willing to move far away from where they grow up, this disparity disappears.

 

[ramsesthenice]

Can I posit we should acknowledge one psychological aspect of what is going on here. Rad Onc was sexy in just about every regard. Simply being a Rad Onc told people you were highly accomplished and one of the best in medicine. We didn’t have to brag about anything ourselves. The title on our badge did it for us. It was like stepping out of a Diablo and skipping everyone waiting in line at a posh club. People envied us. And now that party is over. We feel like Ray Liota at the end of Goodfellas waiting in line like everyone else for noodles and ketchup. It’s true, life now for most of us in 2022 is not bad. But it’s hard to get booted from the in crowd.

As a field, we blew it (and I use the term “we” very loosely). We were not inherently exceptional and we squandered what made us exceptional and there are a lot of dumb f!@$s who still don’t get it. Med students shunning us is not a disease, it’s a symptom.

 

[medgator]

.

As a field, we blew it (and I use the term “we” very loosely). We were not inherently exceptional and we squandered what made us exceptional and there are a lot of dumb f!@$s who still don’t get it. Med students shunning us is not a disease, it’s a symptom.

Great post. And it's not like we haven't been here before (1970s, 1990s - bottom of barrel amongst specialties). Those who forget the past are doomed to repeat it

 

[ramsesthenice]

Great post. And it's not like we haven't been here before (1970s, 1990s - bottom of barrel amongst specialties). Those who forget the past are doomed to repeat it

That’s part of the rub. The folks who got us here this time by and large never would have come close to even matching in our recent heyday. If anyone should have known better…