For all the people who are saying rad onc market is improving

[sam1234567]

2 permanent and 15 locums and some people in twitter saying rad onc future never been brighter yeah right.

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[Fpg1245]

View attachment 368466
2 permanent and 15 locums and some people in twitter saying rad onc future never been brighter yeah right.

Everything is fine if you’re a chair making 750K and underpaying the cogs living in a major coastal city in a nice house.

 

[sam1234567]

Everything is fine if you’re a chair making 750K and underpaying the cogs living in a major coastal city in a nice house.

i just didn’t expect the downfall to be that quick.

 

[Fpg1245]

i just didn’t expect the downfall to be that quick.

It’s been a slow motion train wreck. Don’t worry though no one will fix the issues you can be assured of that.

 

[TheWallnerus]

The amount of hidden jobs in rad onc is large right now. I say this with a salty sprinkle of truth but mostly the salt is being sprinkled on a foul dish. In summary, if you like haggis and difficult job searches rad onc is for you.

 

[elementaryschooleconomics]

The amount of hidden jobs in rad onc is large right now. I say this with a salty sprinkle of truth but mostly the salt is being sprinkled on a foul dish. In summary, if you like haggis and difficult job searches rad onc is for you.

Yeah I wonder how best to communicate this to residents/med students.

There is no "hidden RadOnc job market".

There was a great paper about the "job postings to new grads ratio" published recently. I think it's safe to say that all jobs are posted at some point, usually because of various institutional policies about conducting searches.

However, many jobs are posted after candidates have already been identified or, as I have seen several times, the job is already filled (pending paperwork).

Some jobs aren't even really available until they've already found the "right" person. People thinking about retiring are just waiting to pull the trigger until they feel stuff is lined up - scenarios like that.

Fun!

 

[sam1234567]

I understand that there might be couple of jobs here and there but my point is that rad onc market is in a bad spot right now, keep in mind the massive expansion in residency spots happened in 2019 so we’ll have extra 40-50 new grad entering the workforce each year real soon.

 

[sam1234567]

 

[deleted1111261]

I understand that there might be couple of jobs here and there but my point is that rad onc market is in a bad spot right now, keep in mind the massive expansion in residency spots happened in 2019 so we’ll have extra 40-50 new grad entering the workforce each year real soon.

You don’t say??

Insightful to majority of readers on the forum.

 

[RickyScott]

check out urology. maybe 50% bigger than us

 

[TheWallnerus]

If you did a chi square on rad onc jobs on this site versus rad oncs in America (or total RO residents), versus almost any other specialty on this site versus total MDs in that specialty (or residents in that specialty), you would get a buttload of statistically significant findings.

 

[elementaryschooleconomics]

check out urology. maybe 50% bigger than us

The Urologists tell me size doesn't matter

 

[sam1234567]

If you did a chi square on rad onc jobs on this site versus rad oncs in America (or total RO residents), versus almost any other specialty on this site versus total MDs in that specialty (or residents in that specialty), you would get a buttload of statistically significant findings.

You are absolutely right There is 200+ rad onc graduate a year
600 Hem/onc graduate a year.
I think a good option for future generations is adding a 2 year medical oncology fellowship for rad oncs.
I think the uk implement this hybrid model of oncologist.

 

[Fpg1245]

You are absolutely right There is 200+ rad onc graduate a year
600 Hem/onc graduate a year.
I think a good option for future generations is adding a 2 year medical oncology fellowship for rad oncs.
I think the uk implement this hybrid model of oncologist.

The greedy ****s in this country on the rad onc and the Heme onc side will never get this to passed. It’s too damaging to both of them to even think about. Also who’s gonna certify them?

I’m not saying it’s impossible just be expected to be held to an unrealistic standard for both specialties.

 

[NotMattSpraker]

You are absolutely right There is 200+ rad onc graduate a year
600 Hem/onc graduate a year.
I think a good option for future generations is adding a 2 year medical oncology fellowship for rad oncs.
I think the uk implement this hybrid model of oncologist.

People talk about this a lot, how could that actually be done?

I think you would only need less than 2 years. Maybe 1 or 1.5.

A lot of fellowships are 3 years and include research and hematology. If following the european model (I think?), I dont think wed be the primary treating physician for patients getting only chemotherapy.

 

[TheWallnerus]

People talk about this a lot, how could that actually be done?

I think you would only need less than 2 years. Maybe 1 or 1.5.

A lot of fellowships are 3 years and include research and hematology. If following the european model (I think?), I dont think wed be the primary treating physician for patients getting only chemotherapy.

Rad onc already knows everything about chemo and immuno and hormonal therapy already. Do we really need training?
😎

 

[sam1234567]

Rad onc already knows everything about chemo and immuno and hormonal therapy already. Do we really need training?
😎

check out this link Why a "Board-Certified Cosmetic Surgeon" Isn't a Plastic Surgeon, and What That Means for You
Seems like internists perform surgeries now and surgeons can open urgent care centers now so what’s all the fuzz about an oncologists doing an oncologist job 🤷‍♀️

 

[sam1234567]

People talk about this a lot, how could that actually be done?

I think you would only need less than 2 years. Maybe 1 or 1.5.

A lot of fellowships are 3 years and include research and hematology. If following the european model (I think?), I dont think wed be the primary treating physician for patients getting only chemotherapy.

Hem/onc folks would never accept a 1 yr fellowship for rad oncs.

 

[RadOncDoc21]

Hem/onc folks would never accept a 1 yr fellowship for rad oncs.

Especially when they get to determine when and who to “zap.” I wouldn’t let down the flood gates either. We’re literally the walking dead.

 

[communitydoc13]

We've been told forever in this field that "the good job's aren't posted". This is itself problematic, because it means there is no meritocracy to getting the jobs.....but we all know this.

Job postings data may be limited but they mean something. The ratio of job postings here to number of residency positions is 11x higher for derm than for radiation oncology.

Regarding medonc and a pathway to radoncs meaningfully giving systemic therapy? The last US med school grad that I interviewed by phone for a medonc position (haven't been able to hire a full time US MD grad for forever) was not interested in the job, but was interested in selling me his virtual hemonc service. 3k to 3.5 k per day for an 8 hour work day with 10-14 patient visits (2-3 consults). He reported that most hospitals don't require inpatient interview of the doc who will be providing remote staffing.

Talk about differential value.

 

[RickyScott]

check out this link Why a "Board-Certified Cosmetic Surgeon" Isn't a Plastic Surgeon, and What That Means for You
Seems like internists perform surgeries now and surgeons can open urgent care centers now so what’s all the fuzz about an oncologists doing an oncologist job 🤷‍♀️

in my neck of the woods, a lot of internist do buttock enhancement, fillers, lipos and all sorts of cosmetic procedures

 

[fiji128]

This stuff has been discussed for years upon years in these forums. Part of the purpose of this is so those interested in rad onc are fully aware of the significant job market issues that practicing rad oncs face and what that means for one’s future career. Our job prospects are and have been amongst the worse in all of medicine. “Leadership” has shown an extreme unwillingness to shrink the number of people we are training. I certainly hope this isn’t news to anyone at this point.

 

[pikachu]

People talk about this a lot, how could that actually be done?

I think you would only need less than 2 years. Maybe 1 or 1.5.

A lot of fellowships are 3 years and include research and hematology. If following the european model (I think?), I dont think wed be the primary treating physician for patients getting only chemotherapy.

The sticking point is IM.

Heme/onc fellows have 3 y of medicine under their belt prior to specialty training.

Giving the drugs is fine until you have to manage all the complications, which requires a strong IM background. Everything from neutropenic fever on down. I’m not saying it can’t be done but there needs to be a super strong medicine foundation to underpin your practice. Rad onc training doesn’t provide this at present. Guess could start by requiring IM instead of TY fellowship.

Edit: IM instead of TY PGY1

 

[NotMattSpraker]

The sticking point is IM.

Heme/onc fellows have 3 y of medicine under their belt prior to specialty training.

Giving the drugs is fine until you have to manage all the complications, which requires a strong IM background. Everything from neutropenic fever on down. I’m not saying it can’t be done but there needs to be a super strong medicine foundation to underpin your practice. Rad onc training doesn’t provide this at present. Guess could start by requiring IM instead of TY fellowship.

The training is true, but I am not convinced that medical oncologists have a really strong medicine background nor do I think all manage their complications well. At my first job, the medical oncologists were mostly non-clinical and were often very hard to reach. In fact, a mid-level was the primary clinician on the inpatient side while the attending MO acted more like a consultant (even though they were the attending of record). Mid-levels often carried the outpatient clinics as well.

At my new job, hospitalists manage the inpatients.

Some of course are excellent internists, but Im not sure that's required or even common these days. Their "actual" job is to fill the infusion center like ours is to fill the machine.

Most residencies could be shorter than they are, see conflicts of interests for hospitals surrounding GME and residents. I think any boarded radiation oncologist could learn the clinical care necessary to manage concurrent chemotherapy in 12-18 months assuming there is a medical oncologist, PCP, and/or hospitalist in the system to help with complex cases.

 

[StIGMA]

Could be done if boards would allow subspecialty certification alone ie: integrated training (dual-department sponsored) head and neck oncologist, thoracic oncologist, etc and only certified for that. Wouldnt count on that ever happening.

 

[RadOncDoc21]

I say we focus on supply and demand first. Then maybe more in increasing utilization of radiation.

 

[Lamount]

I would much prefer an abbreviated radiology fellowship than a heme/onc fellowship... but that's just me.

 

[Fpg1245]

I would much prefer an abbreviated radiology fellowship than a heme/onc fellowship... but that's just me.

Diversifying the skill set. Increasing RT indications. That’s the only way you get ahead especially with an adamant refusal to cut spots.

 

[TheWallnerus]

The sticking point is IM.

Heme/onc fellows have 3 y of medicine under their belt prior to specialty training.

Giving the drugs is fine until you have to manage all the complications, which requires a strong IM background. Everything from neutropenic fever on down. I’m not saying it can’t be done but there needs to be a super strong medicine foundation to underpin your practice. Rad onc training doesn’t provide this at present. Guess could start by requiring IM instead of TY fellowship.

Edit: IM instead of TY PGY1

Wait… they taught me all about chemo and DNA intercolation etc etc and nothing about this whole neutropenic fever thing? I’ve been robbed. I would march right up to the inpatient oncology floor right now to express how mad I am—if I could find that part of the hospital. Drats!

 

[pikachu]

Wait… they taught me all about chemo and DNA intercolation etc etc and nothing about this whole neutropenic fever thing? I’ve been robbed. I would march right up to the inpatient oncology floor right now to express how mad I am—if I could find that part of the hospital. Drats!

Precisely. Hope you enjoy rounding for 5 hours on the first nice Saturday of springtime too!

 

[Gfunk6]

Rad Onc in a nutshell - drive it until the wheels fall off

Tyre Revenge! The KIA lost it's SOUL - Video

39 points • 23 comments

9gag.com

 

[taserlaser]

I admitted patients and managed a ward as a resident, and still admit patients and am MRP for my own inpatients. There was cross coverage med onc /rad onc in my neighbouring academic centre but the licensing body said to cut it out for the rad onc residents as they were not general medicine trained (BS in my opinion as it ran well w/o attending input but a big quality of life improvement). Other staff and graduates at other centres in Canada have prescribed concurrent chemo for their patients (TMZ, capecitabine, etc). IMO can be done, but the biggest hurdle I’ve seen has been licensing.

 

[Lamount]

The sticking point is IM.

Heme/onc fellows have 3 y of medicine under their belt prior to specialty training.

Giving the drugs is fine until you have to manage all the complications, which requires a strong IM background. Everything from neutropenic fever on down. I’m not saying it can’t be done but there needs to be a super strong medicine foundation to underpin your practice. Rad onc training doesn’t provide this at present. Guess could start by requiring IM instead of TY fellowship.

Edit: IM instead of TY PGY1

I mean... I don't know if that should be a sticking point (at least not in terms of clinical acumen). Neuro-Onc and Gyn-Onc both can go through non-IM pathways. I would hazard a guess that we all know a bit more about managing neutropenia and chemo tox than a neurologist does.

 

[communitydoc13]

The sticking point is IM.

PAs and NPs don't do an IM residency. They are now managing the infusion suite and the floors. At some point, medoncs are devaluing themselves.

As they are now selling themselves for remote services only, they are minimally more valuable than we could be with a few months effort IMO. We could learn guideline based therapy and dose adjustment pretty easily.

 

[TheWallnerus]

PAs and NPs don't do an IM residency. They are now managing the infusion suite and the floors. At some point, medoncs are devaluing themselves.

As they are now selling themselves for remote services only, they are minimally more valuable than we could be with a few months effort IMO. We could learn guideline based therapy and dose adjustment pretty easily.

Wasn’t there an issue in the Kevorkian case where one of the attorneys was asking “Are you able to assess assisted suicide patients’ emotional state and mental status… are you a psychiatrist” and Kevorkian is like “I did psychiatry training in medical school.” I always liked that answer.

 

[Fpg1245]

Wasn’t there an issue in the Kevorkian case where one of the attorneys was asking “Are you able to assess assisted suicide patients’ emotional state and mental status… are you a psychiatrist” and Kevorkian is like “I did psychiatry training in medical school.” I always liked that answer.

There is certainly a double standard out there.
MOs more than willing to “delegate” responsibilities to a midlevel when in realists they are on their own a lot of the time. But become apoplectic atbthe suggestion that RO could also.

It boils down to control and money. MOs technically control midlevels even when they aren’t directing the type of care they give.

 

[communitydoc13]

I don't want to be managing transfusion reactions, running codes or making inpatient oncology diagnosis. But at this point, medoncs aren't doing these things either.

If what they are now doing is being "strategists" for the systemic management of malignancy. Then, I say, bring it on. We've got some of the best strategic thinkers in medicine.

We can figure out when Abiraterone is appropriate for which very high risk prostate CA patient, who to defer AI in vs partial breast radiation, how to justify adjuvant IO in inoperable esophageal CA, when to biopsy a lung lesion vs. calling it a clinical diagnosis, when to defer concurrent chemo in stage II H&N or in the post-op setting when the surgeon didn't do a radical tonsillectomy, when to refer to hospice in the setting of CNS progression and advanced age.

Care would improve!!!!

 

[RadOncDoc21]

To all my fellow med oncs out there, I love you… you’re great people. Please continue to feed my family and me. I don’t condone this behavior!

 

[sam1234567]

The concept of doing a one year fellowship is definitely doable just not through the typical med onc pathway.
FM physicians practice EM in many parts of the country with a one year fellowship of EM and being certified by the ABPS instead of ABEM.
So the challenge is finding a certifying body who’s willing to do this,I know we are not gonna be able to practice in downtown miami but at least it’s better than nothing .

 

[RickyScott]

The concept of doing a one year fellowship is definitely doable just not through the typical med onc pathway.
FM physicians practice EM in many parts of the country with a one year fellowship of EM and being certified by the ABPS instead of ABEM.
So the challenge is finding a certifying body who’s willing to do this,I know we are not gonna be able to practice in downtown miami but at least it’s better than nothing .

any interest in forming a certifying body/board?

 

[sirspamalot]

CEO asked if "Tele MedOnc" is a good idea.

Abso-f'in-lutely NOT.

Iron deficiency ain't the same as dealing with Stage III lung cancer.

Tele Heme?

 

[RickyScott]

Hi Dr.
I have a new Hematology Oncology Locum Opportunity in Cumberland, MD ($450 per hour). Would you be interested in a short conversation to learn more? If so, please let me know when is best on your calendar, and/or contact me directly. Thank you for your time! Best,

Richard Krakora
Physician Recruiter
[email protected]
602.759.0797

Digital Healthcare Staffing Agency for Locum Jobs | ProLocums

Connect with ProLocums, The Digital Healthcare Staffing Agency, that Helps to Connect the right Locum Jobs with the Relevant Healthcare Organizations Quickly.

www.prolocums.com

 

[TheWallnerus]

Hi Dr.
I have a new Hematology Oncology Locum Opportunity in Cumberland, MD ($450 per hour). Would you be interested in a short conversation to learn more? If so, please let me know when is best on your calendar, and/or contact me directly. Thank you for your time! Best,

Richard Krakora
Physician Recruiter
[email protected]
602.759.0797

Digital Healthcare Staffing Agency for Locum Jobs | ProLocums

Connect with ProLocums, The Digital Healthcare Staffing Agency, that Helps to Connect the right Locum Jobs with the Relevant Healthcare Organizations Quickly.

www.prolocums.com

Even some lawyers would be jealous of this hourly

 

[sam1234567]

any interest in forming a certifying body/board?

Hell yeah i still have 30+ years left to practice medicine.

 

[sirspamalot]

Roll your own, NBPAS did. The question is - will YOUR hospital accept the cert as legit?

 

[Ubba]

Hi Dr.
I have a new Hematology Oncology Locum Opportunity in Cumberland, MD ($450 per hour). Would you be interested in a short conversation to learn more? If so, please let me know when is best on your calendar, and/or contact me directly. Thank you for your time! Best,

Richard Krakora
Physician Recruiter
[email protected]
602.759.0797

Digital Healthcare Staffing Agency for Locum Jobs | ProLocums

Connect with ProLocums, The Digital Healthcare Staffing Agency, that Helps to Connect the right Locum Jobs with the Relevant Healthcare Organizations Quickly.

www.prolocums.com

Does that 450/hr include on-call responsibilities? In a town like Cumberland, wouldn't be surprised if it did. I could easily envision scenarios in which a 450/daytime hour rate would be tolerable at best when the entire context is considered. The number alone doesn't tell us much. And if the point you're making is that no such locums offers exist for RO, bear in mind that MO call can easily be hellish with acute leukemias, septic shock in chemo pts, etc. I get calls at 3am about bloodwork that finally resulted from 5pm draws.

Reminiscent of the idea that every time you buy a stock, remember that there's someone on the other end trying to unload it. if the locums-advertising practices were good, they probably wouldn't need locums in the first place.

 

[medgator]

Does that 450/hr include on-call responsibilities? In a town like Cumberland, wouldn't be surprised if it did. I could easily envision scenarios in which a 450/daytime hour rate would be tolerable at best when the entire context is considered. The number alone doesn't tell us much. And if the point you're making is that no such locums offers exist for RO, bear in mind that MO call can easily be hellish with acute leukemias, septic shock in chemo pts, etc. I get calls at 3am about bloodwork that finally resulted from 5pm draws.

Reminiscent of the idea that every time you buy a stock, remember that there's someone on the other end trying to unload it. if the locums-advertising practices were good, they probably wouldn't need locums in the first place.

Talk to some med onc locums. I know one personally who basically left his near 7 figure hospital employed production job to go do 1099 gigs all year, and basically he will only need to work 60-65% of the year to make what he was making before.

Right now you basically name your rate in some of these places and that hourly is just for outpatient coverage while call is paid extra, plus they pay for incidentals etc

 

[TheWallnerus]

Talk to some med onc locums. I know one personally who basically left his near 7 figure hospital employed production job to go do 1099 gigs all year, and basically he will only need to work 60-65% of the year to make what he was making before.

Right now you basically name your rate in some of these places and that hourly is just for outpatient coverage while call is paid extra, plus they pay for incidentals etc

Anybody know of a rad onc who started doing locums to make more money? I don’t. Never seen it. It’s like the Abscopal of Pay. Even traveling nurses make more than nurses.

 

[medgator]

Anybody know of a rad onc who started doing locums to make more money? I don’t. Never seen it. It’s like the Abscopal of Pay. Even traveling nurses make more than nurses.

@sirspamalot is a damn 🦄

 

[sirspamalot]

But you too can be a unicorn. First, set aside several years to learn how to fly. This will be.. challenging. Don't forget, you'll need to get your instrument rating, buy a plane and learn how to manage it. But hey, you like challenges right?

Second, your learning curve of new EHR's will be, and this is putting it nicely, vertical. The cherry on top is mastering how to walk the line of every place that has obvious problems, otherwise, you wouldn't be there. Fun times. Enjoy learning the intricacies of frequent stay programs from various hotel chains.

Having done all this, Third, you will be away from home 4 days a week. Your family will have to tolerate this. All of this happens until you of course upgrade to the jet, reducing the time and discomfort of traveling longer distance.

Fourth, and this is a gem, you'll have to master dealing with the locums agencies. Negotiate contracts properly, edit language, watch their reimbursement of your expenses like a hawk, and never, ever agree to anything less than 2600 a day, paid as a DAILY rate. Oh, did you say they need you yesterday? 3k/day. 25-30 on treatment routinely? 3.5k. You got this fam. No? "No thank you call me when you're serious."

But but..