If not rad onc, where else would you suggest med students look?

[von Matterhorn]

I'm facing the unfortunate reality of not really enjoying any of my core rotations or electives outside of radiation oncology, and I'm getting to a point where I need to start making decisions. I entered medical school intent on becoming an oncologist, but I have come to find that I really do not enjoy the endless rounding associated with IM/subspecialties. I kind of fell into a rad onc rotation while doing some research and really, really enjoyed it. But, I have read the doom and gloom and I don't think I can, in good conscience, doom my wife and kids to a lifetime of never having a say in where we live.

Is there any other specialty out there that even somewhat attempts to match what makes rad onc seem so unique? The patient interactions, the science, the day to day in general just all felt very different from any of my other rotations. Worth noting that I'm a DO with relatively good board scores (650 COMLEX and ~245 step 1) and a decent amount of research, but all cancer-based, so things like derm/ENT/surgery/etc. are all likely off of the table. Appreciate any advice. Thanks

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[OTN]

MedOnc doesn’t have to involve tons of rounding if you utilize hospitalists.

 

[medgator]

MedOnc doesn’t have to involve tons of rounding if you utilize hospitalists.

In larger groups, you also can have a rotation system where you essentially do inpatient 2-8 weeks a year and that's it.

 

[maruchan]

I would probably do med onc, especially if your main reason against it is rounding. In my experience rounding was unbearable as a med student, but perfectly fine as an intern, and as a resident it's probably even better. As an attending you're unlikely to do much rounding at all as others have mentioned.

 

[deleted947887]

But, I have read the doom and gloom and I don't think I can, in good conscience, doom my wife and kids to a lifetime of never having a say in where we live.

I think the geographic problem is only the tip of the iceberg. I sincerely believe salaries are taking a hit (in unmeasured ways), will continue to do so, and jobs in general will be scarce. I don't think we are far from pathology and I do believe we are in walking distance of nuclear medicine.

 

[PointA]

First, congrats on your success in medical school with strong step scores and research productivity. I'm not sure why you say derm, ENT, surgery are off the table. You can do a MOHS fellowship or a surgical oncology fellowship and take care of cancer patients all day. There are many roads to becoming a cancer doctor.

Keep in mind, your previous research accomplishments do not have to directly match the field you're going into. It's great if they do, but most program directors are just looking for a prior track record of productivity.

Another good field to consider is interventional radiology. It combines cool imaging with patient care and procedures. You can biopsy and radioembolize tumors. In academics, you could develop a focus on oncology but you may need a more diverse practice in the community setting. I have no idea what their job market is like though.

As a DO applicant, some of these competitive fields will be difficult to match into and you will need to cast a very wide net for your residency applications. You will likely need to be OK with matching anywhere in the country. One option would be to rank internal medicine programs as a back up on your list if you choose one of the more competitive fields.

I think you will have the most geographic flexibility for both residency match and your career by going through IM then med onc. Rad onc is a great field and I love what I do, but you should really be comfortable going anywhere in the country after residency. Pretty much every resident I know applied for jobs all over the country. A few land in their desired location but many do not.

 

[evilbooyaa]

Agree with med onc if the focus is oncology and the only complaint of it is rounding. Fair number of mostly or nearly all outpatient jobs in med onc AFAIK.

 

[deleted941485]

I think the geographic problem is only the tip of the iceberg. I sincerely believe salaries are taking a hit (in unmeasured ways), will continue to do so, and jobs in general will be scarce. I don't think we are far from pathology and I do believe we are in walking distance of nuclear medicine.

Just spoke with our graduating class. They’re getting about 10% less this year than the year before (300K down to 265K). These are academic satellite jobs. No signing bonuses. No CME and they are expected to “teach” and do research with no protected time. They were quibbling over 4 vs 5 weeks vacation.

The non academic sites aren’t much better. One dude who was out is getting 310K this year to work at main clinical site of hospital last year. This year they took another one of our grads because one of the attendings decided to finally hang it up. They offered him 280K. But hey at least they didn’t make him teach or do research.

Anyway, for the OP I was in the same boat. I hated everything I rotated in and thought Rad Onc was just so above all this ****. Well it isn’t and it’s a waste of a medical degree. It’s a sinking boat.

Med Onc is totally doable as a DO. Yeah IM sucks but I mean there’s flexibility and a loft at the end of the tunnel. I know many that went this path and now their out in jobs they like in places they want to be. I mean DO is a pretty expensive degree and I mean probably should think about ROI.

 

[radoncradonc]

The above numbers are absolutely correct. Expect a salary in the mid to high 200s. If you try to negotiate higher, the job will just get taken by someone else in a week or two. Grads are getting more desperate each year as the market tightens considerably.

 

[fiji128]

I would not base any decision based on the medical school style rounding for IM specialites. I would guess 90% plus of what a medical oncologist does is through an outpatient clinic and not inpatient based.

These are some of the offers I've been given, $265K respectable large city private practice on partnership track after 3 years with partners making about $340's, pure academics at a med school main hospital site but with no rad onc residents in a great city $250K, very rural location hospital employed $490K.

The future of oncology will be in medical oncology over the next decades in terms of inovation and pushing the needle forward. Part of that is that med onc gets massive amounts of research funding through the pharmaceutical industry. Just this morning on my way into work the general network news was covering what was going on at ASCO, that type of press and excitement is not going to ever happen with anything going on at ASTRO.

 

[DukeNukem]

Just spoke with our graduating class. They’re getting about 10% less this year than the year before (300K down to 265K). These are academic satellite jobs. No signing bonuses. No CME and they are expected to “teach” and do research with no protected time. They were quibbling over 4 vs 5 weeks vacation.

Here's how that game works. You will be hired as "clinical assistant professor" or some other meaningless title. Teaching and publications are required for promotion in the track. The chair will tell you about opportunities to participate in academics towards promotion, but it's a lie. You will be given no time, money, or access to do any academics, and you will be far busier clinically than the chair claimed.

Since you will be busy clinically with essentially no ability to do research and a promotion pathway dependent on academics, they will just keep you as clinical assistant professor for the rest of your life. Maybe you will get a pay raise eventually, but probably not anything significant. You will have a large non-compete so you cannot build a local name for yourself and transition to private in your area. These jobs will be happy to keep you at 200k-300k for the rest of your life unless you can negotiate with a better job offer elsewhere. Since every other academic satellite job is doing the same thing, you will never get out of this cycle.

The non academic sites aren’t much better. One dude who was out is getting 310K this year to work at main clinical site of hospital last year. This year they took another one of our grads because one of the attendings decided to finally hang it up. They offered him 280K. But hey at least they didn’t make him teach or do research.

I saw the same thing applying to many private jobs. They pay what they can get away with, and not what you are worth. It doesn't matter if the owner is a rad onc or a hospital corporation. They are happy to replace you and talk bad about you "not a good fit" "troublemaker" (reality: not happy and smiling with the exploitation) and pocket all the money you generated for them. Even the rural market pay is dropping because there are so many desperate new grads willing to take any job, anywhere. If you go to the middle of nowhere, be careful they don't just drop your salary in the future to 300k. What are you going to do about it? You will have nowhere to go.

How long until the MGMA and other salary surveys reflect the current reality? I doubt I will make current MGMA numbers in my entire career, and it's not for lack of trying.

 

[BobbyHeenan]

IF those numbers are accurate and the clinical volume really isn't low (as in you're treating in the high teens or twenties), then these places are making money on the backs of their docs.

I bill professional only fees, the hospitals we cover bill technical. I can tell you that unless you're treating the worst payer mix ever or very few patients that the professional fees would very likely be significantly (upwards of six figures) above these upper 200K/lower 300K jobs.

If you're going to be paid below your professional revenue, then it better have other perks like great support staff, protected research time, or some other benefit(s).

 

[seper]

Are these number really that far off? 15 patients under beam -- 150 completions per year X $ 2,000 in professional fees, subtract physician's benefits.

IF those numbers are accurate and the clinical volume really isn't low (as in you're treating in the high teens or twenties), then these places are making money on the backs of their docs.

I bill professional only fees, the hospitals we cover bill technical. I can tell you that unless you're treating the worst payer mix ever or very few patients that the professional fees would very likely be significantly (upwards of six figures) above these upper 200K/lower 300K jobs.

If you're going to be paid below your professional revenue, then it better have other perks like great support staff, protected research time, or some other benefit(s).

 

[scarbrtj]

Are these number really that far off? 15 patients under beam -- 150 completions per year X $ 2,000 in professional fees, subtract physician's benefits.

Professional fees should in general average more than 2K per patient. (For example, one gets about $300 per weekly tx management visit.) Of course will depend on diagnosis mix, insurance mix, and yes(!), how much of a hypofractionator one desires to be. EDIT: Before I generate the standard kerfuffle, keep in mind, for example, one could tx all early stage breast CA patients with either 5 or 13 or 16 fractions today based on available good data; all low-risk prostate in 5 or 20 or 28 fractions. Yet the latter is FAR more predominant than the formers.

 

[OTN]

IF those numbers are accurate and the clinical volume really isn't low (as in you're treating in the high teens or twenties), then these places are making money on the backs of their docs.

I bill professional only fees, the hospitals we cover bill technical. I can tell you that unless you're treating the worst payer mix ever or very few patients that the professional fees would very likely be significantly (upwards of six figures) above these upper 200K/lower 300K jobs.

If you're going to be paid below your professional revenue, then it better have other perks like great support staff, protected research time, or some other benefit(s).

"It better have other perks like..."

Or what? What are new grads supposed to do, not accept the job? Be unemployed after residency? What options would they realistically have? "Frontier medicine" doesn't count.

 

[Mandelin Rain]

Professional fees should in general average more than 2K per patient. (For example, one gets about $300 per weekly tx management visit.) Of course will depend on diagnosis mix, insurance mix, and yes(!), how much of a hypofractionator one desires to be.

For sure.

Between consult, sim, treatment planning, special treatment, OTVs, etc... it should be well more than 2k per patient unless you're single fractioning everyone. That also discounts that follow ups exist (they don't pay much, but they pay more than nothin).

 

[seper]

Reimbursement also depends on the payor mix.. I know of a place where <15% patients are privately insured and >70% are in some state of being uninsured (e.g. Medicaid pending). Surely, they get <2K per case.

For sure.

Between consult, sim, treatment planning, special treatment, OTVs, etc... it should be well more than 2k per patient unless you're single fractioning everyone. That also discounts that follow ups exist (they don't pay much, but they pay more than nothin).

 

[nkmiami]

IF those numbers are accurate and the clinical volume really isn't low (as in you're treating in the high teens or twenties), then these places are making money on the backs of their docs.

I bill professional only fees, the hospitals we cover bill technical. I can tell you that unless you're treating the worst payer mix ever or very few patients that the professional fees would very likely be significantly (upwards of six figures) above these upper 200K/lower 300K jobs.

If you're going to be paid below your professional revenue, then it better have other perks like great support staff, protected research time, or some other benefit(s).

Salaries are set by supply and demand, not whats reasonable or right. Someone will almost always take a job at a large hospital system in a decent sized metero.

 

[BobbyHeenan]

"It better have other perks like..."

Or what? What are new grads supposed to do, not accept the job? Be unemployed after residency? What options would they realistically have? "Frontier medicine" doesn't count.

I understand; That's the current problem - due to over supply there are no bargaining chips to keep this from happening.

 

[BobbyHeenan]

Are these number really that far off? 15 patients under beam -- 150 completions per year X $ 2,000 in professional fees, subtract physician's benefits.

I consider 15 patients a pretty light clinical volume though.

I was more saying if you were running a busier service but still in that 200/300 range then there is a disconnect there.

 

[scarbrtj]

I consider 15 patients a pretty light clinical volume though.

I was more saying if you were running a busier service but still in that 200/300 range then there is a disconnect there.

Rad onc is weird on what is "light" and what is "busy."
I agree; 15 is light. However, 20 is still light. But it's 33% more patients. And WAY more collection$.
The professional on 15/day will be ~400-500K a year; 33% more than that is a big lifestyle/retirement/etc difference.
Gedankenexperiment:
MD runs an all early-stage breast CA service. He sees 4 new patients/week, consistently... NEVER changes.
(One can easily show that number of patients on beam = number of new patients per week * avg tx length in weeks.)
In 2005, this fellow treats breast cancer with average 6 week course; number of patients on tx = 24.
In 2015, this fellow treats breast cancer with average three week course; number of patients on tx = 12.
In 2025, this fellow treats breast cancer with a one week course; number of patients on tx =4.
What a difference decisions re: fraction number make! This guy lowered his professional salary from ~$1 million to less than $200K over a 20 year period.
Of course this is "only" a gedankenexperiment

 

[seper]

In my experience (large metros in Midwest, saturated markets), 15 on-treatment is more of average number. RadOncs with > 20 and compensated accordingly consider themselves lucky.

I consider 15 patients a pretty light clinical volume though.

I was more saying if you were running a busier service but still in that 200/300 range then there is a disconnect there.

 

[KHE88]

IF those numbers are accurate and the clinical volume really isn't low (as in you're treating in the high teens or twenties), then these places are making money on the backs of their docs.

I bill professional only fees, the hospitals we cover bill technical. I can tell you that unless you're treating the worst payer mix ever or very few patients that the professional fees would very likely be significantly (upwards of six figures) above these upper 200K/lower 300K jobs.

If you're going to be paid below your professional revenue, then it better have other perks like great support staff, protected research time, or some other benefit(s).

A couple of comments to this post and the post above it.

You are most likely not going to get to keep your professional fees anywhere near a major metro due to competition. You are getting paid in the sunshine of SoCal or the culture of NYC. A full time rad onc should bringing in around 500k even in bad payor mixes in pro fees alone, but the reality is you could end up with half of this in these markets.

The message is overwhelmingly clear that if you want to make decent money in this field, you have to go to the middle of nowhere. And if you do, you can make very, very decent money. This tends to top out around 1 mil/year without a technical cut. I know people doing this. With technical cuts/ownership, I know of people making > 2mil.

Remarkably, nobody wants to work in these areas for any price. The posters who are experiencing frustration all, as far as I know, are geographically limiting themselves to being near major metros.

And by middle of nowhere, I mean > 3-4 hours from a decent airport let alone a major city.

Starting salaries for hospital employed jobs in decent-sized midwestern cities (100-200k) are still in the 450-500 range + bonus. I was offered 525 + production bonus off the bat in a midwestern city with metro area of 400k and this was before negotiating.
Rural, you can push that to 650-700. With bonus structures paying top dollar RVUs, that is how you end up getting to 1 mil without ownership. Of note, the hospital is still making a lot of money off your services.

Coastal/desirable area or anywhere even close, try more like 300k. on the top end and 200k on the bottom. Employers will hold back pro fees and partnerships will churn and burn associates because they can. There are legit opportunities in desirable areas but they are few and far between.

The difference is dramatic, and I'd be curious if any other specialty has such a huge disconnect.

I don't think any of this is news at this point as every med student knows this is baked into the cake with rad onc.
You have to be willing to literally go anywhere in the US or else be ok with family medicine level pay or worse without the benefit of family medicine job flexibility/demand.

 

[KHE88]

In 2005, this fellow treats breast cancer with average 6 week course; number of patients on tx = 24.
In 2015, this fellow treats breast cancer with average three week course; number of patients on tx = 12.
In 2025, this fellow treats breast cancer with a one week course; number of patients on tx =4.

Just to be clear, are you talking about UK FAST or APBI?

I don't think 5 day breast radiation is going to become standard, nor is IORT, and I think that is very clear to anyone paying attention to what's coming out. APBI is basically dead. IORT is a surgeon's gimmick. And we are getting that benefit of mild hypofractionation with 267s.
Call me crazy, but I think we found we were overtreating and the Canadians hit the sweet spot, and that's where we'll stay, so this is a bit of fear mongering IMO.

Now if you wanna talk about ultrahypofrac in prostate that's a different story. I think SBRT is poised to become a slam dunk there, both in definitive intermediate and low risk and for boost in high risk, and I don't think that's a bad thing for us at all. Ultrahypofrac in breast? Get outta here...

 

[scarbrtj]

Just to be clear, are you talking about UK FAST or APBI?

I don't think 5 day breast radiation is going to become standard, nor is IORT, and I think that is very clear to anyone paying attention to what's coming out. APBI is basically dead. IORT is a surgeon's gimmick. And we are getting that benefit of mild hypofractionation with 267s.
Call me crazy, but I think we found we were overtreating and the Canadians hit the sweet spot, and that's where we'll stay, so this is a bit of fear mongering IMO.

Now if you wanna talk about ultrahypofrac in prostate that's a different story. I think SBRT is poised to become a slam dunk there, both in definitive intermediate and low risk and for boost in high risk, and I don't think that's a bad thing for us at all. Ultrahypofrac in breast? Get outta here...

Talking ‘bout

https://cancer.osu.edu/news-and-media/news/partial-breast-irradiation-effective-convenient-treatment-option-for-low-risk-breast-cancer

Modern rad onc like Moore’s law in reverse. The chips get faster and faster; the RT schedules get shorter and shorter.

 

[KHE88]

Talking ‘bout

https://cancer.osu.edu/news-and-media/news/partial-breast-irradiation-effective-convenient-treatment-option-for-low-risk-breast-cancer

Modern rad onc like Moore’s law in reverse. The chips get faster and faster; the RT schedules get shorter and shorter.

Did ya miss the b-39 presentation or am I missing something???

" while partial breast irradiation does not produce equivalent cancer control for all breast cancer patients with stage 0, 1 and 2 disease, it should still be considered as an alternative for women with DCIS (ductal carcinoma in situ) and early stage breast cancers deemed “low risk” based on other tumor characteristics."

I'm sorry, but when I'm practicing on my own in one month from now, I am not going to offer my patients substandard radiation unless they have a major insurmountable difficulty for making 10 extra trips for a 20 minute non-invasive treatment. I can't imagine this being a problem for more than 2-3% of patients but I guess time will tell.

 

[evilbooyaa]

Remember that the conclusions of a study and the conclusions of the article writing about the study are often not the same thing. One (the article writing about the study) definitely has an agenda, while the study itself may or may not have an agenda.

 

[scarbrtj]

Did ya miss the b-39 presentation or am I missing something???

" while partial breast irradiation does not produce equivalent cancer control for all breast cancer patients with stage 0, 1 and 2 disease, it should still be considered as an alternative for women with DCIS (ductal carcinoma in situ) and early stage breast cancers deemed “low risk” based on other tumor characteristics."

I'm sorry, but when I'm practicing on my own in one month from now, I am not going to offer my patients substandard radiation unless they have a major insurmountable difficulty for making 10 extra trips for a 20 minute non-invasive treatment. I can't imagine this being a problem for more than 2-3% of patients but I guess time will tell.

10-year recurrence of 2.3% with whole breast vs 5-day APBI 2.7% doesn't make APBI "substandard" any more than prostate hypofx's higher rectal/urinary toxicity makes it "substandard."
By modern lines of thought, it makes APBI superior. Cheaper. Quicker.
At least, one must countenance rather than APBI being "dead," as you said, it will be within the realm of possibility that one day we will hear things like "I don't see why you subject these low-risk women to multiple weeks of treatment." Here's what Dr. Anderson thought: "PBI appears to be more convenient than WBI in patients not treated with [chemo]; there is less associated fatigue and slightly poorer cosmesis. Cosmetic outcomes are similar for PBI and WBI in patients treated with[chemo]."

And again, while you feel it "substandard," Julia White (no slouch) feels "A significant portion of the breast cancer patient population nationally – about 25,000 to 30,000 women – would qualify for partial breast irradiation."

 

[Irradi8or]

Rad Onc is dead as a competitive field. Hard to believe just 3-4 years ago very competitive applicants with 250+ scores were worried about matching.

Sad part is it’s a great field in general. Now ruined by greedy academics with no vision or regard for their trainees - each just trying to get theirs.

To a certain extent, there was irrational exuberance (from many Rad Onc stakeholders) over the last decade or so that created a bubble like environment. Reminds me of some of the tech sector/dotcom problems of the late 90's. Competitive applicants went into Rad Onc because of what they had heard about the field and because the competitive crowd over the previous few years had also gone into it. Less competitive applicants also went along as it seemed to make sense to desire Rad Onc, and with the number of spots surging (for many reasons we've all discussed ad nauseum), most felt lucky to match at all. However, med students in general have limited experience in doing due diligence about the current health and future viability of the field (there's a lot of information asymmetry when you're a 4th year student who's just trying to get a good residency spot in a solid field while looking forward to finishing med school, and you have limited exposure to economic principles). That becomes even less so when most other competitive applicants they know are bullish on Rad Onc. Bursting that bubble hurts those who bought high - many of those of us on this forum and certainly the current/future residency classes. Impossible to predict the future, but most of us would feel that there's a higher probability that future growth in oncology will be in the medical oncology sector as compared to rad onc, surg onc. Like one of my investment banker friends told me when I ask him how he's OK with charging superfluous fees for very subpar or even negative returns: "Caveat emptor."

 

[DukeNukem]

Salaries are set by supply and demand, not whats reasonable or right. Someone will almost always take a job at a large hospital system in a decent sized metero.

Exactly.

The salaries I quoted are for 20s-30s on beam with good payor mix. My academic satellite is so picky about insurance. We turn away so many patients due to non-contracted insurance (1/3? 1/2?), it's insane.

KHE you are a trip. I would move anywhere for over $1 million a year. I looked for a year and couldn't even get a new job interview at all, let alone for that kind of money.

 

[Spikebd]

I'm facing the unfortunate reality of not really enjoying any of my core rotations or electives outside of radiation oncology, and I'm getting to a point where I need to start making decisions. I entered medical school intent on becoming an oncologist, but I have come to find that I really do not enjoy the endless rounding associated with IM/subspecialties. I kind of fell into a rad onc rotation while doing some research and really, really enjoyed it. But, I have read the doom and gloom and I don't think I can, in good conscience, doom my wife and kids to a lifetime of never having a say in where we live.

Is there any other specialty out there that even somewhat attempts to match what makes rad onc seem so unique? The patient interactions, the science, the day to day in general just all felt very different from any of my other rotations. Worth noting that I'm a DO with relatively good board scores (650 COMLEX and ~245 step 1) and a decent amount of research, but all cancer-based, so things like derm/ENT/surgery/etc. are all likely off of the table. Appreciate any advice. Thanks

I’m in pathology and I’ve gotta say it’s bizarre reading this stuff going on in rad onc. Welcome to the club of “worst job market in medicine.” If its any consolation, most of us seem pretty happy. The big difference is pathology didn’t fall from the top like rad onc is now experiencing. Hopefully you guys can get through this downturn.

Commoditization sucks.

 

[Reaganite]

Reimbursement also depends on the payor mix.. I know of a place where <15% patients are privately insured and >70% are in some state of being uninsured (e.g. Medicaid pending). Surely, they get <2K per case.

This is the most sane thing I've read about reimbursement on this thread . There is no consistent average per patient. There are geographies where the reimbursement can be significantly below 2K per patient on average. Reimbursement is heavily dependent upon payer mix, patient type, contracted rates, and random **** that will make you claw your eyes out as a practice owner. In some coastal areas, prof fees on a 45 fraction prostate could be low 1000's. You also never get what you think you're going to get. Oops, your staff forgot to get precert for IGRT and IMRT planning. There goes most of your prof fees on that patient. Insurance company told you no precert necessary, then you find out 2 months later pre cert for all the high paying codes was required. Biller didn't submit half the prof charges because the fax machine f'd up, and you didn't find out until after timely filing deadlines had passed. (I once did an audit on a practice and found the biller was missing 20% of the charges we submitted to her). Staff submitted an unspecified ICD10 code for which IMRT isn't covered. Patient lost insurance mid-treatment and your staff didn't catch on. Patient never had insurance to begin with, but somehow that fell through the cracks. Patient can't afford any of the copays and half your prof reimbursement comes from the co-pay. Local medical group in town controls half the radiation volume and caps prof reimbursement at $1,500 per case. Local medical group owes you 100k and then goes out of business. I do think there are exploitative practices, but there are definitely geographies where the profit margin on prof only business for a practice owner is slim.

 

[Schoolboy2018]

It’s tough now but stick it out bro Onc is pretty solid. If you wanna talk more just inbox me, trust me it get better

 

[xrthopeful]

offers that I and many people I know had graduating this year were decently higher than the ones listed in this thread. Mid 300s starting in both academic and PP places with some PP places easily going into the 500-600k range in 2-3 years with sure thing partnership.

as always - talk to real people in real life about this stuff.

 

[medgator]

offers that I and many people I know had graduating this year were decently higher than the ones listed in this thread. Mid 300s starting in both academic and PP places with some PP places easily going into the 500-600k range in 2-3 years with sure thing partnership.

as always - talk to real people in real life about this stuff.

Location? (Region, metro size etc)

 

[Sheldor]

offers that I and many people I know had graduating this year were decently higher than the ones listed in this thread. Mid 300s starting in both academic and PP places with some PP places easily going into the 500-600k range in 2-3 years with sure thing partnership.

as always - talk to real people in real life about this stuff.

Thanks for saying this, I feel like a few people on this board are making it sound worse than it is. In real life the 10+ PGY-5's I know all got jobs starting over 300, all around the median per Terry Wall. I also know one person under 300, and 2 people over 400. Rad Onc certainly has issues, and we need to cut back on residency spots etc, but a lot of these posts just don't match with what I've heard. ( I get the irony of countering anecdote with anecdote, but since anecdotes are all we have on this particular thread figured they should at least be balanced.)

 

[deleted947887]

It’s tough now but stick it out bro Onc is pretty solid. If you wanna talk more just inbox me, trust me it get better

Yes "stick it out," because it's "solid." Despite the 10ish (?) articles written in the last two years saying the market is dead and getting buried deeper in academic incest. Stick it out, and you too will find yourself like the graduates this year without jobs after 9 years of schooling and training (unless you accept a garbage position). All for what? So academics can use you for cheap labor. Yes, stick it out. Real solid and respectable. Like brain mets being discussed at tumor board.

Assembling the brain trust: the multidisciplinary imperative in neuro-oncology - Nature Reviews Clinical Oncology

www.nature.com

"[...]On the challenges and future approaches to curing patients with primary brain tumours. We congratulate Cancer Research UK (CRUK) on convening this group of expert clinicians and scientists, and we applaud the authors’ elegant synthesis of multiple complex issues. However, we note that among the disciplines represented by the 26 authors of this article, expertise in radiation oncology is conspicuously absent. "

 

[winstonfoot5]

can you provide these?

10ish (?) articles written in the last two years saying the market is dead

 

[von Matterhorn]

Certainly some interesting discussion here, haha. I thank you all for the feedback.

I suppose I'm less concerned about salary and more concerned about location. From what I've experienced so far, I can truthfully say earning 260k/year in rad onc sounds highly preferable to earning a comparable salary in FM/IM, even at the expense of additional residency training. At least I could go home at night having enjoyed my day as best as one can when it comes to work. I'm sure it sounds naive but my rad onc rotation has been the only one I have actually *enjoyed* vs. actively disliking or being neutral at best with everything else.

But, location is definitely a sticking point for me. My wife/family followed me to nowhere-land for medical school and will probably do the same for residency. At some point I owe it to my family to live in a respectable city and I'm not sure I can commit to a specialty if it really means taking a job anywhere in the country. I'm not restricted to SF or anything, but I know my wife also doesn't want to be forced into Cleveland, OH or Kansas City forever.

I'll look into med onc some more. I suppose I initially wrote it off because I've done research with two of them and they were both often on call/rounding despite being outpatient PP. Seeing rad onc not being a slave to the pager was such a selling point to me.

First, congrats on your success in medical school with strong step scores and research productivity. I'm not sure why you say derm, ENT, surgery are off the table. You can do a MOHS fellowship or a surgical oncology fellowship and take care of cancer patients all day. There are many roads to becoming a cancer doctor.

Keep in mind, your previous research accomplishments do not have to directly match the field you're going into. It's great if they do, but most program directors are just looking for a prior track record of productivity.

Another good field to consider is interventional radiology. It combines cool imaging with patient care and procedures. You can biopsy and radioembolize tumors. In academics, you could develop a focus on oncology but you may need a more diverse practice in the community setting. I have no idea what their job market is like though.

As a DO applicant, some of these competitive fields will be difficult to match into and you will need to cast a very wide net for your residency applications. You will likely need to be OK with matching anywhere in the country. One option would be to rank internal medicine programs as a back up on your list if you choose one of the more competitive fields.

I think you will have the most geographic flexibility for both residency match and your career by going through IM then med onc. Rad onc is a great field and I love what I do, but you should really be comfortable going anywhere in the country after residency. Pretty much every resident I know applied for jobs all over the country. A few land in their desired location but many do not.

Appreciate the feedback. I suppose I say these things are off limits because my class of ~400 graduates maybe 3 or so people in each of those fields each year, and I'm probably on the low end of competitiveness relative to them. I have some decent research but nothing that will make anyone's eyes pop out. I also have little interest in surgery or derm, so there's that as well.

 

[scarbrtj]

offers that I and many people I know had graduating this year were decently higher than the ones listed in this thread. Mid 300s starting in both academic and PP places with some PP places easily going into the 500-600k range in 2-3 years with sure thing partnership.

as always - talk to real people in real life about this stuff.

Thanks for saying this, I feel like a few people on this board are making it sound worse than it is. In real life the 10+ PGY-5's I know all got jobs starting over 300, all around the median per Terry Wall. I also know one person under 300, and 2 people over 400. Rad Onc certainly has issues, and we need to cut back on residency spots etc, but a lot of these posts just don't match with what I've heard. ( I get the irony of countering anecdote with anecdote, but since anecdotes are all we have on this particular thread figured they should at least be balanced.)

This is good. Good numbers. If you like your numbers, you can keep your numbers. It's good. Good.
I'll see your anecdotes and raise you a few more anecdotes, some completely unverifiable so toss it in the mental wastebin, probably. That said, here goes. 10 years ago, these would have been dismal, hair-on-fire numbers. And even if you think the numbers are OK, there are other hidden draconian and depressing aspects of the rad onc job these days... For example. Vacation. 4 weeks of vacation is AWFUL and that's what most folks are getting. Even guys who are employed for years are maxing out at 6 weeks vacation. And forget working 4 days a week like most med oncs do. We are "married to the machine." Med oncs are taking 10-12 weeks of vacation a year, getting $100,000 loan repayments and $50,000 sign-on bonuses... I just don't think that's happening in rad onc guys. On the other hand, we all have a job we love, yada yada yada.

 

[randomname2018]

I would urge caution when stating, "I'm less concerned about salary and more concerned about location".

Salary and effort have been largely decoupled, particularly in highly desirable geographies. $260k/yr in a desirable location may sound moderately appealing but employment details may be onerous (high patient load, long hours, decreased vacation, etc). On this board, salary arguments are a misnomer. The point being argued more often represents the total employment package and career trajectories rather than salary alone.

 

[Neuronix]

Seeing rad onc not being a slave to the pager was such a selling point to me.

I know med oncs who do no inpatient work, and I know rad oncs with significant inpatient commitments. This is not cut and dry.

 

[scarbrtj]

"Seeing rad onc not being a slave to the pager was such a selling point to me. "
I know med oncs who do no inpatient work, and I know rad oncs with significant inpatient commitments. This is not cut and dry.

Paucity of pager servitude perhaps a pernicious Achilles' heel for the MD. To paraphrase Anne Murray, "You paged me."

 

[medgator]

I know med oncs who do no inpatient work, and I know rad oncs with significant inpatient commitments. This is not cut and dry.

Wasn't Columbia trying to hawk an inpatient palliative radiation fellowship last year?

 

[Neuronix]

Paucity of pager servitude perhaps a pernicious Achilles' heel for the MD. To paraphrase Anne Murray, "You paged me."

Do you talk like this in real life?

 

[seper]

I would imagine they wound up hiring.
All large, and especially "charity" hospitals require inpatient RadOnc service. I was on staff at a 700+ bed hospital like that for a few years. It was not uncommon to have 6-8 inpatients under the beam at a given time, and for me to have 3 emergent inpatient consults per day. I had to do rounds daily just to check on sick people. Inpatient work was so onerous, the RadOnc was interviewing a dedicated PA for that. In the end, the Chairwoman found it to be easier to use newly graduating attendings instead.

Wasn't Columbia trying to hawk an inpatient palliative radiation fellowship last year?

 

[scarbrtj]

Do you talk like this in real life?

I talk just like Ed Halperin, always trying to choose the right verb.

 

[RadOnc37]

Location? (Region, metro size etc)

Same as xrthopeful. Rounded numbers to answer your question while attempting to provide some anonymity to the specific practices:

Spot 1: Just under 1 mil population in the metro border, ~ 2 mil including immediately surrounding area: starting in the low 300s while employed, increasing ~10% each year during employment until partnership with current partners making 500-900+.
Spot 2: Just under 1 mil population in the metro border, ~ 2 mil including immediately surrounding area: starting in the low 300s while employed, increasing ~10% each year during employment until partnership with current partners making 600-900+.
Spot 3: multi mil area population: starting in the low 300s while employed, increasing each year during employment until partnership with current partners making 500+.
Spot 4: multi mil area population: starting in the low 300s while employed, increasing each year during employment until partnership with current partners making 700-1M+
Spot 5: multi mil area population: starting in the low 400s while employed, increasing each year during employment until partnership with current partners making 500-600+
Spot 6: mid-sized kinda remote town with few hundred thou population: hospital employed 600+ starting then potential for 800+

To be fair, I agree that MedOnc is infinitely more flexible in your ultimate job location. You will struggle to get a job in an elite radonc group if you haven't gone to a decent radonc program and networked heavily. Even if you "do everything right," you may not land in a desirable city (whatever that is to you personally) because of other factors working against you (e.g. at one spot, I was up against a lineage candidate and had no chance). That's not your fault. It is a risk with any small sub-specialty. If geographic uncertainty bothers you, you absolutely should not do radonc.

Yes, the above spots were with pretty elite practices. Yes, there weren't more than a couple jobs this year in radonc in any of the above cities and those numbers do not mean all other variables are equal. The above descriptions are not meant to imply that quality of life is equal in the above scenarios or that the stability of the job is the same. Please contact my lawyer for further fine print.

To current and future residents: remember that the money has to come from somewhere. You can't expect to have 10-15 on-treatment and make a ton of money unless you're somewhere like Alaska. You can't expect 10 weeks of vacation and a salary close to a mil. The above spots varied in the income of partners primarily because of differences in (1) ownership of the technical, (2) volume of patients and (3) payer mix. Even if somehow the sky falls and even the strongest of practices start making 300k per doc per year, I'd argue you can maintain a very good quality of life on 300k a year in most areas in this country. If you are responsible with your money, your discretionary income, house, cars, etc will not keep up with your corporate exec friends, but if you thought you'd go into medicine to make the big bucks, you were fooling yourself. You have to love your job. I love radonc and am mentally okay with the unknowns (location, salary) because I love the job and the lifestyle is good for my family. I totally understand if not everyone feels that way. A bit of a tangent, but again to the current and future residents: the most important thing for you to protect yourself financially (and perhaps mentally in your future) is to invest as much as you can early into your retirement accounts - this can be as simple as "passively investing" by putting money in index funds. If you are lucky enough to land a job in a desirable area, you can become financially stable and make the money work even if it's not 500k+ per year, and if you're losing your mind in your first job, you can move. Most people move in the first few years. If you invest well and you're losing your mind after a decade, you can think about alternative options. I hear there's a recent red journal paper that offered some interesting alternative job ideas (kidding)

 

[medgator]

. Inpatient work was so onerous, the RadOnc was interviewing a dedicated PA for that. In the end, the Chairwoman found it to be easier to use newly graduating attendings instead.

And unsurprisingly, the least financially renumerative. I'm sure they were thrilled to have the excess supply of grads trying to find something in NYC

 

[seper]

This was a Department with a set personnel budget. New grad got started at around 280K (in 2015) and PA wanted about half of that.

And unsurprisingly, the least financially renumerative. I'm sure they were thrilled to have the excess supply of grads trying to find something in NYC