Interesting WaPo article on physician pay

[Rad Onc SK]

The study authors took a unique approach, linking Medicare's registry of physicians (the National Plan and Provider Enumeration System, or NPPES) to physicians' tax information with their NPIs and specialties. They analyzed more than 10 million tax records from 965,000 physicians over 13 years. They focused on “peak earning years”, ages 40-55.

Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis.

The WaPo article did acknowledge high student debt and the relative lack of doctors in the US as compared to other countries. Most importantly, IMO, they did acknowledge that doctor pay consumes only 8.6% of overall health spending.

From the article: “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Links to both the WaPo article and the actual NBER article are below.

https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/

Who Values Human Capitalists' Human Capital? The Earnings and Labor Supply of U.S. Physicians

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

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[Chartreuse Wombat]

Averages mean very little in a distribution that is know to be Pareto(ish).

The most interesting graphic was the one below

The highest earners have "ownership" and rely less on wages. Nothing new here. Same old story

 

[Doctorer]

Man I can’t wait to turn 40!

 

[elementaryschooleconomics]

Man I can’t wait to turn 40!

Weird, because I can't wait to invent a time machine:

Cool, more data reinforcing it was better before CMS took aim and ASTRO decided they would fight back by...reminding Urologists about Stark Law? Or something?

 

[thecarbonionangle]

Weird, because I can't wait to invent a time machine:

View attachment 375284

Cool, more data reinforcing it was better before CMS took aim and ASTRO decided they would fight back by...reminding Urologists about Stark Law? Or something?

How many of you guys know “many” people making 700? I know a few. I know a few 1M+ and they all own the machines. The vast majority will never come close to 700s. Most jobs i see offer 400-500s flat these days with little ways to make more. The boomers and gen Xers want to tell us we should be happy with these salaries while they raked it in back in day. They sit at the top and block any opportunities for the younger generation. It disgusts me so much.

 

[elementaryschooleconomics]

Averages mean very little in a distribution that is know to be Pareto(ish).

The highest earners have "ownership" and rely less on wages. Nothing new here. Same old story

Bingo.

From the actual paper:

This data is borderline irrelevant now. 2005-2017 is not only pre-CMS crackdown, it's also from the pre-consolidation era (capturing just the dawn of the acceleration). The majority of doctors are W2 employees now.

Table 2:

Hilarious.

This is neat too:

So here's what I take from this:

What a time to be alive, if you managed to have your peak career years in Radiation Oncology from 2005-2017, and you were private practice with technical revenue (owned the linac) in the Midwest.

If you're a med student in 2023:

RUN. GOOD LORD RUN.

 

[TheWallnerus]

The study authors took a unique approach, linking Medicare's registry of physicians (the National Plan and Provider Enumeration System, or NPPES) to physicians' tax information with their NPIs and specialties. They analyzed more than 10 million tax records from 965,000 physicians over 13 years. They focused on “peak earning years”, ages 40-55.

Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis.

The WaPo article did acknowledge high student debt and the relative lack of doctors in the US as compared to other countries. Most importantly, IMO, they did acknowledge that doctor pay consumes only 8.6% of overall health spending.

From the article: “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Links to both the WaPo article and the actual NBER article are below.

https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/

Who Values Human Capitalists' Human Capital? The Earnings and Labor Supply of U.S. Physicians

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

It is not really an interesting article. Least not in the ways one might think. It is a depressing article for rad onc.

Mostly, for the reason @elementaryschooleconomics mentions: we are talking about an aeon ago when we talk about rad onc pay over the 2005-2017 timeframe. If you think as a rad onc today you can get into rad onc and make what those guys were making back then, GOOD LUCK. You might as well think "If I get into boating I can build as big of a house as George Vanderbilt." That was the gilded age of rad onc. I lived it. I made ~$2m a year from 2003-10 in a rural-ish location on the basis of getting paid 20% of my global collections.

Second, we need to keep fulsome views. A single retrospective analysis doesn't establish a new standard of care. Looking at the same sort of data this WaPo article was looking at (tax info), radiation oncologists were found to have the greatest relative decrease in pay of any specialty over the 2010-19 time frame:

Lastly, to think rad onc is doing well now is just going to meet even more hard math (and data). Connie Mantz did a ROCR presentation last week where he said, in total, Medicare is handing out $4B a year to America's rad oncs. That's about $700K per rad onc. This would include all technical and professional, so it's feasible. If Medicare is ~1/3 of a person's practice, which is a reasonable assumption, then the average rad onc is getting about $2.1m a year global, and a further reasonable number to pay a rad onc based on $2.1m a year in collections would be $400-$450K a year.

However, we still do know the average Medicare reimbursement per rad onc is falling (this is part B only), very much "regressing to the mean":

Other people, like Red Journal people e.g., also find that reimbursement is significantly shrinking per rad onc over time:

And, keep in mind, that ~58% of America's rad oncs/centers only have access to the lowest quartile of patient volume:

In summary, you should believe the rad onc salary data in this WaPo article like you should believe ASTRO's recent workforce summary.

 

[fiji128]

As cited in the above, I would love to have a shot at an average salary, in an average location in an averagely decent practice set up. Somehow, despite just wanting average, I don’t think this will be doable in my career.

I just plugged in my salary data for my current job to an inflation calculator and I’m actually down 10% in real terms compared to five years ago, despite turning a barely profitable single MD center into a cash cow over that same time frame.

 

[medgator]

As cited in the above, I would love to have a shot at an average salary, in an average location in an averagely decent practice set up. Somehow, despite just wanting average, I don’t think this will be doable in my career.

I just plugged in my salary data for my current job to an inflation calculator and I’m actually down 10% in real terms compared to five years ago, despite turning a barely profitable single MD center into a cash cow over that same time frame.

It's all about supply and demand @Rad Onc SK why do you think Dr Hallahan at WUSTL wanted to train more residents per his red journal op-ed response to Dr C Shah in 2013?

It's one of the biggest issues facing the specialty and ASTRO has been complicit through silence for several years imo until they were shamed into doing the workforce study

 

[DebtRising]

Can I ask you an honest question SK. Why would you post 6 year outdated salary data, that conflicts with AAMC and MGMA survey data pretty significantly?

That world, the one as a business owner in rad onc, no longer exists for us. Not only have cuts decimated the field and lead to the risk-reward of investing and buying a machine in the few places possible cost prohibitive, consolidation has slashed the opportunities and locations to even attempt to start your own practice. Employment position surveys consistently show more and more of us are employed to back up my assertions.

If this is representative of current salaries, can you share how many people in the SCAROP survey make more than that “average” salary? And how many of them are chairs? My understanding is that ASTRO has access to this data.

I am in the prime earning years of my career with a salary half that average, going down relative to inflation, and no flexibility. Recent medscape, doximity, and AAMC updates all put rad onc salaries way down the list of specialities. So why highlight this when contemporary data says this is not true? What is your goal?

 

[communitydoc13]

Why would you post 6 year outdated salary data

Agree. Actually salary data here represents, by and large, much more than 6 years ago.

So we have wistful ruminations on a 2018 test and outdated information with a one line narrative that radonc is paid better per work performed than any other specialty.

The pertinent points of the articles are:

1. The boomers had it good (Like perhaps the most privileged population of college educated folks ever. This is peak return on college generation).
2. Peak radonc was begat by peak compensation
3. There has historically been a very wealthy physician ownership class. This is a dwindling population (largely boomers) and many have benefited from sale to PE or larger systems in recent years. Pareto gets more pareto. Late stage capitalism has less room for rich professionals.
4. Physician compensation has never been the main driver of health care expenditures

A narrative that is no longer pertinent: That radoncs are compensated better per hour worked than any other specialty. This may have been true at one point in time.

In the absence of physician ownership and overwhelming employment or PSA arrangements, Supply/demand is king.

Listen to the stories of the persons on this board. They represent reality. Some of the PP owners here are honest about how much they made in the former era. How good are young faculty feeling relative to the whims of their institutions/departments. How good are a lot of younger radoncs feeling about their career choice. Don't ask 2nd year faculty BTW, they are completely aspirational, ask docs 5-10 years into their career (at that point, they are getting a sense of whether or not they are building something meaningful).

 

[NotMattSpraker]

Second year was about when I started to realize that we aren’t all in this together.

 

[deleted1111261]

Just a thought experiment.

Say RadOnc was the same training, we hadn’t oversupplied and jobs are reasonably attainable. But, the reimbursement had never been great. Median salary is about 400 and 95% make between 300-500 for a 40 hour work week, 6 weeks off, regular benefits.

Would you do it?

I would .. with the caveat that I probably would not have done it in 2004 - I really did want to earn more money than that. But, now, I would. Most of medicine pretty much sucks.

 

[elementaryschooleconomics]

Just a thought experiment.

Say RadOnc was the same training, we hadn’t oversupplied and jobs are reasonably attainable. But, the reimbursement had never been great. Median salary is about 400 and 95% make between 300-500 for a 40 hour work week, 6 weeks off, regular benefits.

Would you do it?

I would .. with the caveat that I probably would not have done it in 2004 - I really did want to earn more money than that. But, now, I would. Most of medicine pretty much sucks.

In this scenario, I likely would have still chosen RadOnc - because you're positing a situation where "jobs are reasonably attainable".

BUT, and this is the part that's hard to understand for non-legacy med students, heck even some legacy students, heck even the majority of residents and attendings:

There is a HARD ceiling on RadOnc earnings which doesn't exist in other specialties.

We're a specialty based around a type of treatment, NOT an organ system or spectrum of disease.

That's virtually unique, save for Radiology and Pathology. At least for Radiology, not only is demand skyrocketing, they can have multiple types of diagnostic tech to interpret, beyond radiation.

Pathology...well. Yeah. They're in the garbage boat with us.

I know Family Med docs making more than me (both today and when I started in medicine 20 years ago). How? They bring in little additional services like Botox.

While technically we could do the same (we're still doctors, after all) - if you're in a hospital outpatient department as a W2 employee, how easy do you think it would be?

RadOnc: higher floor, lower hard ceiling, no geographic mobility.

Do you hate yourself? Join today!

 

[medgator]

I would .. with the caveat that I probably would not have done it in 2004 - I really did want to earn more money than that. But, now, I would. Most of medicine pretty much sucks.

Would still be open to med onc or GU, much better job and locums market, pay and geographic determinability. Anyone open to rads should feel this way too.

Recent rads group let their nighthawk guys go from 7/7 to 7 nights/14 off, so essentially only working 33% of the time to get FT salary and benefits. All because of supply/demand, where the job market is and what other groups are doing.

@Rad Onc SK do you get this?

 

[TheWallnerus]

Just a thought experiment.

Say RadOnc was the same training, we hadn’t oversupplied and jobs are reasonably attainable. But, the reimbursement had never been great. Median salary is about 400 and 95% make between 300-500 for a 40 hour work week, 6 weeks off, regular benefits.

Would you do it?

I would .. with the caveat that I probably would not have done it in 2004 - I really did want to earn more money than that. But, now, I would. Most of medicine pretty much sucks.

Would you do it knowing that a 25 to 50 percent pay shave would be coming over the next three decades of your career.

If that were “guaranteed” fortune telling, I bet nobody would choose rad onc.

Picking a career is very much trying to predict the future. You’ve gotta predict what your mindset will be through the years, what will make you happy or not happy, and how much in demand you will be. There are literally large geographic swaths of America where there is zero demand for a radiation oncologist (because the market is already full or over-full with rad oncs). Plus, I think a lot of the fancy molecular and targeted teachin’ them med students get these days plants, subconsciously, a side-eyed view of how needed rad onc is going to be in the future. Knowledge is also out there, now versus 20y ago (thanks SDN), as to what a potential career in rad onc is going to look like… and for many the main per-minute activity of radiation oncology is babysitting a linac with one’s physical presence. This sounds innocuous, at first; in practice, it can be an oppressive albatross.

Rad onc attractiveness as a career choice… it’s got some headwinds. Hoo boy.

EDIT
What did I mis-predict as a med student re rad onc…
1) I didn’t predict rad onc demand. The fraction decrease coupled with falling utilization was a big swing and miss. That stings tbh. And rock bottom has not yet been hit.
2) Falling reimbursement. Look up an article in press in PRO right now by Baumann. Medicare rad onc reimbursement down about 25% between 2010 and 2020. CMS was to IMRT what Tyson was to Holyfield’s ear. Ouch! If you told me this as a med student I wouldn’t have believed you.
3) I chose rad onc because it was niche. Because it was secret and undiscovered. Always best to be big fish in a little pond. Suddenly programs increased and residency slots increased and rad onc was America’s Hottest Destination. I like being on the down low. I predicted rad onc always would be, but no. I had to choose the specialty that wound up getting the most scrutiny from the press and CMS ever. “Good old days” mentality, but yes the old days were good in rad onc.
4) I predicted new cool things like nanoparticles or different molecules for radiation enhancement or radiation protectants would appear. They did not. All the super nerds we matriculated into rad onc did not help us there.
5) I predicted procedures like brachy and going to the OR every so often would be key to being a great rad onc. I got into practice and realized that was romanticism.

I could go on. But I’ll stop.

 

[elementaryschooleconomics]

My favorite feature of SDN that no one talks about is the "Similar Threads" feed at the bottom of the page.

It is now suggesting to me, and probably everyone else, this 5-year-old thread by @Chartreuse Wombat where WaPo talks about protons.

The end of the article:

The manuscript the WaPo article is based on is from an eternity ago, 2018, but feels more relevant than ever:

I don't want to ROCR the boat or anything, but med students should Choose Wisely and not incorporate outdated salary data into their career choice.

 

[TheWallnerus]

My favorite feature of SDN that no one talks about is the "Similar Threads" feed at the bottom of the page.

It is now suggesting to me, and probably everyone else, this 5-year-old thread by @Chartreuse Wombat where WaPo talks about protons.

The end of the article:

View attachment 375302

The manuscript the WaPo article is based on is from an eternity ago, 2018, but feels more relevant than ever:

View attachment 375303


I don't want to ROCR the boat or anything, but med students should Choose Wisely and not incorporate outdated salary data into their career choice.

If we could have asked questions verbally during the ROCR presentation I gave myself 50/50 odds of saying “Connie, so I’d like to know where you got the notion… to ROCR the boat. Don’t ROCR the boat baby. Don’t tip the boat over.” Would’ve taken a lot of self control.

 

[deleted1168505]

The study authors took a unique approach, linking Medicare's registry of physicians (the National Plan and Provider Enumeration System, or NPPES) to physicians' tax information with their NPIs and specialties. They analyzed more than 10 million tax records from 965,000 physicians over 13 years. They focused on “peak earning years”, ages 40-55.

Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis.

The WaPo article did acknowledge high student debt and the relative lack of doctors in the US as compared to other countries. Most importantly, IMO, they did acknowledge that doctor pay consumes only 8.6% of overall health spending.

From the article: “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Links to both the WaPo article and the actual NBER article are below.

https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/

Who Values Human Capitalists' Human Capital? The Earnings and Labor Supply of U.S. Physicians

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

45 posts and not a single one addressing or even acknowledging the overwhelming message that was presented to you: workforce oversupply concerns. I appreciate you engaging in seemingly good faith, but the deliberate avoidance of this is glaring and not unsurprising.

I am somewhat suspicious of what motivated this post and the other commentary is all good.

Very few rad oncs are earning $709k/year. I do but I produce nearly 20k wRVU/year currently. You can ask Wallrus what this was worth 20 years ago.

The median MGMA pay is presently around $572k total compensation (not just salary). Hospitals typically only compensate higher than this in very hard to recruit areas, and then not a lot more. 75th percentile max, and volume isn't compensated for appropriately in most places, so even 20k wRVU probably isn't going to crack past the 90th percentile (~864k/year) even though it should.

The caveat is that MGMA, the highest reporting salary survey, doesn't give a true cross-section of the market as the most profitable practices most likely will not fill out MGMA surveys as they do not want this information (that they are unusually profitable) to be discoverable for obvious reasons.

One last thought for some perspective. When I graduated I took the highest paying job possible in some god-forsaken place. Adjusted for inflation, the salary I had there is presently worth $742k/year. My colleagues all took jobs inflation-adjusted that are equivalent to about $450k/year. Hospitals will still cry Stark at basically the same upper limits. So good luck trying to find a hospital literally anywhere willing to guarantee $742k/year now. Inflation over the last 4 years has absolutely wrecked the financial standing of physicians, and especially rad oncs. The idea that seems to be permeating is that it's not morally acceptable to become wealthy as a radiation oncologist, perhaps even that we are still overpaid and our complaints are unworthy of any sympathy. Perhaps this is a cultural shift from a time when people expected and preferred for their doctors to be rich, the rewards of sacrificing a decade of their life in low income study and intense training.

Late stage capitalism has less room for rich professionals.

This phrase sounds like something conjured up by an ignorant Marxist faculty member in the academic bubble (not saying this is you). It's annoying because the problem is not capitalism. Capitalism is the greatest system for prosperity and lifting people out of poverty. History is replete with examples of the destitution and despair brought on by other systems. The problem is that the American healthcare industry is far from true capitalism. You have the second most regulated industry there is where we don't set our own prices, rife with middlemen, a hugely inefficient "insurance" industry, lobbied by big pharma, with special favors to the big guys. This is crony "capitalism," far from the real thing. There's no reason it has to be this way or that this is the natural end-state of a flawed principle.

 

[medgator]

. The idea that seems to be permeating is that it's not morally acceptable to become wealthy as a radiation oncologist, perhaps even that we are still overpaid and our complaints are unworthy of any sympathy. Perhaps this is a cultural shift from a time when people expected and preferred for their doctors to be rich, the rewards of sacrificing a decade of their life in low income study and intense training.

Ralph W, chair at U chicago, said so much on Twitter...
Rad oncs should be making less so that we can raise peds pay. Wrong idea altogether. Peds should make more. It should have nothing to do with us

 

[Pointless]

This phrase sounds like something conjured up by an ignorant Marxist faculty member in the academic bubble (not saying this is you). It's annoying because the problem is not capitalism. Capitalism is the greatest system for prosperity and lifting people out of poverty. History is replete with examples of the destitution and despair brought on by other systems. The problem is that the American healthcare industry is far from true capitalism. You have the second most regulated industry there is where we don't set our own prices, rife with middlemen, a hugely inefficient "insurance" industry, lobbied by big pharma, with special favors to the big guys. This is crony "capitalism," far from the real thing. There's no reason it has to be this way or that this is the natural end-state of a flawed principle.

This is a very important point. People look at our deteriorating economy with ever-widening gaps between rich and poor and point the finger at capitalism. The US may have been a capitalist economy two hundred years ago, but it sure as $hit isn't now. This is crony capitalism at its finest and no longer represents anything close to a free economy; healthcare obviously included. Bemoan our condition but don't conflate the causes. True capitalism is the best system we can aspire to.

 

[deleted1168505]

This is a very important point. People look at our deteriorating economy with ever-widening gaps between rich and poor and point the finger at capitalism. The US may have been a capitalist economy two hundred years ago, but it sure as $hit isn't now. This is crony capitalism at its finest and no longer represents anything close to a free economy; healthcare obviously included. Bemoan our condition but don't conflate the causes. True capitalism is the best system we can aspire to.

Exactly this. Capitalism is not responsible for the runaway inflation that's given us all a 30% wealth haircut in just a few years. True free enterprise did not get us in this situation. Quite the opposite. Something else has encouraged the development of monopolies and the constant smackdown on small business.

Our society is truly perverse. The new generation aspires to become wealthy by becoming influences and YouTubers. This is justified in their eyes. These people are deserving of their wealth. Yet as noted above, self-deprecating physicians like Ralph W bemoan financial success of physicians and spout nonsense about redistributing wealth. News outlets (especially the NYT) routinely publish hitjobs on physicians to outright lie to the public that their medications cost so much because of greedy doctors who have yacht payments to make.

Instagram models, crypto traders, professional poker players. All totally legitmate ways to become wealthy in America. All non-W2 income and tax dodges abound.
Studying as hard as you can your whole life, taking on enormous risk to provide lifesaving services, then you want to try and start your own practice instead of work for people like Ralph who decides how the money for your services is divided up? Hey you're the real bad guy. Lets chain you as a W2 employee and raise your taxes even more.

What is capitalism? It is a very simple concept: Your labor belongs to you. That's it. That's all it is.
There are certainly those that think doctors should share their labor. They shouldn't own it. They certainly shouldn't own a LINAC. They should be public servants.

Maybe that's the whiff of suspicion I got, because I have seen these kinds of attitudes before in academia. Maybe I'm wrong.

 

[yesmaster]

What is the point of this thread?

You’re just kicking early career rad oncs in the b***s, yeah I know that the boomers did better financially than me and my peers, in all respects —

Hour per hour

Ownership vs wage slave

 

[medgator]

What is the point of this thread?

SK trying to tell us we still have it good

"Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis."

 

[medgator]

This is a very important point. People look at our deteriorating economy with ever-widening gaps between rich and poor and point the finger at capitalism. The US may have been a capitalist economy two hundred years ago, but it sure as $hit isn't now. This is crony capitalism at its finest and no longer represents anything close to a free economy; healthcare obviously included. Bemoan our condition but don't conflate the causes. True capitalism is the best system we can aspire to.

PPS exempt vs HOPPS vs Medicare PFS.

W-2 vs long term capital gains/qualified dividends vs carried interest loopholes and RE deductions etc

Everyone is equal, some are more equal than others

 

[yesmaster]

The one thing I will say is that the rad onc chairs and hospital exec’s may not be fully satisfied with their 8k RVU slaves. If you have part-ownership of a practice, you’ll be more motivated to put in nights and weekends to grow the practice, so that you can reap the rewards at age 40-55. Us underutilized slaves can just put our effort & time into other investments, I would prefer to focus on radiation oncology but not if the incentives aren’t in place.

 

[yesmaster]

a ROCR presentation last week where he said, in total, Medicare is handing out $4B a year to America's rad oncs. That's about $700K per rad onc. This would include all technical and professional, so it's feasible. If Medicare is ~1/3 of a person's practice, which is a reasonable assumption, then the average rad onc is getting about $2.1m a year global, and a further reasonable number to pay a rad onc based on $2.1m a year in collections would be $400-$450K a year.

Does this include Medicare Advantage? With the boom of Medicare Advantage, I would guess that Medicare + MA is at least 50% of most practices.

 

[NotMattSpraker]

SK trying to tell us we still have it good

"Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis."

We do have it good. Of course cream of the crop physicians are going to want to make things better for themselves and their patients.

SK and his "leader" friends wanted the best of the best, and they got them. Now they are out of training and have a future to think about. These people are far too smart to do things like fake a town hall or come in with a pop media article like "see Rad Oncs make the 3rd most of all doctors".

I've never seen a more clear demonstration of the problem than the last few weeks on SDN. Rad Oncs volunteer up tons of feedback. "Leaders" respond with pleasantries and gaslighting.

By the way, I hate the term gaslighting, but there is no other way to describe it.

 

[thecarbonionangle]

Exactly this. Capitalism is not responsible for the runaway inflation that's given us all a 30% wealth haircut in just a few years. True free enterprise did not get us in this situation. Quite the opposite. Something else has encouraged the development of monopolies and the constant smackdown on small business.

Our society is truly perverse. The new generation aspires to become wealthy by becoming influences and YouTubers. This is justified in their eyes. These people are deserving of their wealth. Yet as noted above, self-deprecating physicians like Ralph W bemoan financial success of physicians and spout nonsense about redistributing wealth. News outlets (especially the NYT) routinely publish hitjobs on physicians to outright lie to the public that their medications cost so much because of greedy doctors who have yacht payments to make.

Instagram models, crypto traders, professional poker players. All totally legitmate ways to become wealthy in America. All non-W2 income and tax dodges abound.
Studying as hard as you can your whole life, taking on enormous risk to provide lifesaving services, then you want to try and start your own practice instead of work for people like Ralph who decides how the money for your services is divided up? Hey you're the real bad guy. Lets chain you as a W2 employee and raise your taxes even more.

What is capitalism? It is a very simple concept: Your labor belongs to you. That's it. That's all it is.
There are certainly those that think doctors should share their labor. They shouldn't own it. They certainly shouldn't own a LINAC. They should be public servants.

Maybe that's the whiff of suspicion I got, because I have seen these kinds of attitudes before in academia. Maybe I'm wrong.

Very true regarding the state of our society. Arse instagram models making millions a year. This mr beast dude makes so much money on youtube. I mean good for him but what skills does he have? Yet society thinks you make way too much and should actually be cut. Supply and demand i guess. The current guys making tons are one admin away from being pushed out and being replaced by a younger grad who sees it as a blessing to take the same job for half just to live in a “desirable” area. So the real question is why isnt this happening yet? Only a matter of time? Nobody is safe

 

[deleted1111261]

The study authors took a unique approach, linking Medicare's registry of physicians (the National Plan and Provider Enumeration System, or NPPES) to physicians' tax information with their NPIs and specialties. They analyzed more than 10 million tax records from 965,000 physicians over 13 years. They focused on “peak earning years”, ages 40-55.

Radiation oncology fell 3rd on the list, at $709,000. Neurosurgeons (about $920,000) and orthopedic surgeons ($789,000) were 1st and 2nd. These 2 specialties worked, on average, substantially more hours per week than RO according to their analysis.

The WaPo article did acknowledge high student debt and the relative lack of doctors in the US as compared to other countries. Most importantly, IMO, they did acknowledge that doctor pay consumes only 8.6% of overall health spending.

From the article: “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”

Links to both the WaPo article and the actual NBER article are below.

https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/

Who Values Human Capitalists' Human Capital? The Earnings and Labor Supply of U.S. Physicians

Founded in 1920, the NBER is a private, non-profit, non-partisan organization dedicated to conducting economic research and to disseminating research findings among academics, public policy makers, and business professionals.

www.nber.org

$709k, eh?

The vast majority of us are hospital based and vast majority of those positions are academic or academic adjacent. As the leaked salary survey from our transparent society shows, this just doesn’t jive with reality.

Pareto or not, that is simply not accurate. Sameer - at Mayo, hardly anyone makes that much. At CCF, same. At Banner where I worked non of the non chiefs make that. In MI, I don’t think more that 5-10% of ROs make that much. I do better than many in the region, but there are many that work harder and make less than $500k.

Tax returns are tricky things, especially in a business situation. My K1 had a lot of “income” that was not.

If the point of posting this is to say “see, things are pretty good”, I will point you to the SCAROP report and say, “junior faculty are getting bent over because of giant salaries for senior staff”. If it’s just to provide a data point, I too, can talk to 50 RadOncs of my choosing and get a mean of either 450 or 900k.

But, I do love that Astro’s data has to get leaked, while WaPo just puts it out in the open. I’m so done with them.

 

[communitydoc13]

The problem is that the American healthcare industry is far from true capitalism.

True capitalism is the best system we can aspire to.

Late stage capitalism basically refers to the absurdities of the system we live in now. I stand by the phrase, and I think it accurately describes a system where high value individuals rule everything with absolutely zero culture of noblesse oblige, risk for wealthy capitalists is close to zero (yes cronyism), there is massive consolidation of wealth and opportunity, a perverse tax structure and labor is moving rapidly towards having no value at all.

I personally think only strong regulation can prevent late stage capitalism.

BO-->a truly capitalist enterprise.

Also, overwhelmingly labor has never belonged to the laborer in capitalist systems. Imagine phlebotomists "owning their labor" and opening corner phlebotomy stores, construction workers or bar tenders "owning their labor". They do own their tips.

All those YouTube millionaires (not that many of them) are creating a brand. This is itself a bit of a symptom of late stage capitalism. Branding becomes much more important than content or service. I would say that protons are largely a brand.

But I digress. It is good that we have opposing opinions. We need a new thread for all of this. It also says something big that we are both vehemently opposed to the messaging of ASTRO leadership and the direction of the field in general. I do agree with you that physicians are targeted when they make money. They're just Jelly. There is nothing worse than someone who both does good and does well.

Disaffected radoncs are a diverse group.

Would you do it?

I didn't do it in the first place for the money and actually was unaware of how much radoncs could make when I started residency.

I liked physics and I went to med school late. I had kids early in med school. I almost quit entirely. Radonc provided me an opportunity to see oncology patients, at least do some basic physical thinking and have a reasonably controlled schedule. I am enormously grateful for this. It would have been hard to make it through 4 years of overnight call schedules with a young family and a physician spouse. It has also provided a reasonably controlled schedule and good paycheck since training. I'd be a schmuck to not be thankful.

But, the opportunity cost has been much higher than I thought. Med student friends who went into other fields got academic opportunities or other opportunities exactly where they wanted to live without too much hustle. I am also bored (not because I don't work, but because the progressive part of medicine is not in radonc), losing real income by the year, and have very little leverage despite being in leadership at my hospital. (A marginal medical oncologist has far more leverage than I do, not hyperbole at all.)

If I knew 15 years ago how oncology was going to change in just this short interval, I would not have done radonc. At the same time, I'm grateful for what I've had.

 

[yesmaster]

Rad Oncs volunteer up tons of feedback. "Leaders" respond with pleasantries and gaslighting.

My prediction is that at this year’s ASTRO, during the Q&A for talks, we will see some very pointed questions.

“Dr. Court, with your work on automating radiation planning workflows, and whatever it is you’re doing Dr. Spratt with your AI prostate nomograms, have your institutions considered the potential for reductions-in-force for employers of radiation oncologists? Why are you expanding your training program Dr. Spratt if this work is making the individual rad onc more productive?”

Spillover of online angst to real world?

 

[NotMattSpraker]

My prediction is that at this year’s ASTRO, during the Q&A for talks, we will see some very pointed questions.

“Dr. Court, with your work on automating radiation planning workflows, and whatever it is you’re doing Dr. Spratt with your AI prostate nomograms, have your institutions considered the potential for reductions-in-force for employers of radiation oncologists? Why are you expanding your training program Dr. Spratt if this work is making the individual rad onc more productive?”

Spillover of online angst to real world?

I dont think so. Some don't care that much about this topic and many likely don't feel they can speak freely.

 

[deleted1111261]

My prediction is that at this year’s ASTRO, during the Q&A for talks, we will see some very pointed questions.

“Dr. Court, with your work on automating radiation planning workflows, and whatever it is you’re doing Dr. Spratt with your AI prostate nomograms, have your institutions considered the potential for reductions-in-force for employers of radiation oncologists? Why are you expanding your training program Dr. Spratt if this work is making the individual rad onc more productive?”

Spillover of online angst to real world?

Fantasy

People at these conferences are milquetoast. It’s just softballs and “this was an incredible study, done perfectly, more research to be done. Disparities blah blah. Oh sorry there wasn’t a question. Bravo!”

 

[sirspamalot]

In case your anguished outcries haven't noticed....

SK had left the building. I'm still waiting for that Healthcare Unfiltered podcast to be released.

I used to sign off my messages with # but I think I like this one better:

FASTRO?

HELL NO
.... F ASTRO

 

[deleted1111261]

Late stage capitalism basically refers to the absurdities of the system we live in now. I stand by the phrase, and I think it accurately describes a system where high value individuals rule everything with absolutely zero culture of noblesse oblige, risk for wealthy capitalists is close to zero (yes cronyism), there is massive consolidation of wealth and opportunity, a perverse tax structure and labor is moving rapidly towards having no value at all.

I personally think only strong regulation can prevent late stage capitalism.

BO-->a truly capitalist enterprise.

Also, overwhelmingly labor has never belonged to the laborer in capitalist systems. Imagine phlebotomists "owning their labor" and opening corner phlebotomy stores, construction workers or bar tenders "owning their labor". They do own their tips.

All those YouTube millionaires (not that many of them) are creating a brand. This is itself a bit of a symptom of late stage capitalism. Branding becomes much more important than content or service. I would say that protons are largely a brand.

But I digress. It is good that we have opposing opinions. We need a new thread for all of this. It also says something big that we are both vehemently opposed to the messaging of ASTRO leadership and the direction of the field in general. I do agree with you that physicians are targeted when they make money. They're just Jelly. There is nothing worse than someone who both does good and does well.

Disaffected radoncs are a diverse group.


I didn't do it in the first place for the money and actually was unaware of how much radoncs could make when I started residency.

I liked physics and I went to med school late. I had kids early in med school. I almost quit entirely. Radonc provided me an opportunity to see oncology patients, at least do some basic physical thinking and have a reasonably controlled schedule. I am enormously grateful for this. It would have been hard to make it through 4 years of overnight call schedules with a young family and a physician spouse. It has also provided a reasonably controlled schedule and good paycheck since training. I'd be a schmuck to not be thankful.

But, the opportunity cost has been much higher than I thought. Med student friends who went into other fields got academic opportunities or other opportunities exactly where they wanted to live without too much hustle. I am also bored (not because I don't work, but because the progressive part of medicine is not in radonc), losing real income by the year, and have very little leverage despite being in leadership at my hospital. (A marginal medical oncologist has far more leverage than I do, not hyperbole at all.)

If I knew 15 years ago how oncology was going to change in just this short interval, I would not have done radonc. At the same time, I'm grateful for what I've had.

Is there really a lot of YouTube / TikTok millionaires?

I know a fair amount of millionaires. One near B. But not one has made it from capturing views. My wife watches this lady Frills Drills or something that does home reno, I wonder how much she makes, she has lots of viewers.

I wonder if this is one of those things that is clickbait and made to be a thing but it’s not really (tide pods, Benadryl parties, teen sex cults, caring quality chairman)

 

[communitydoc13]

Is there really a lot of YouTube / TikTok millionaires?

Very rare from what I can gather, but maybe not an uncommon aspiration?

The younguns are definitely insecure about what their labor will mean. Rightly so.

I mean, being a writer for a Warner Bros production is a pretty elite gig. Lots of very funny, very smart people.

Zaslav crowing that the strike has saved more than 100m. Investing in AI.

Late stage...nevermind.

 

[winstonfoot5]

Late stage capitalism basically refers to the absurdities of the system we live in now. I stand by the phrase, and I think it accurately describes a system where high value individuals rule everything with absolutely zero culture of noblesse oblige, risk for wealthy capitalists is close to zero (yes cronyism), there is massive consolidation of wealth and opportunity, a perverse tax structure and labor is moving rapidly towards having no value at all.

I personally think only strong regulation can prevent late stage capitalism.

BO-->a truly capitalist enterprise.

Also, overwhelmingly labor has never belonged to the laborer in capitalist systems. Imagine phlebotomists "owning their labor" and opening corner phlebotomy stores, construction workers or bar tenders "owning their labor". They do own their tips.

All those YouTube millionaires (not that many of them) are creating a brand. This is itself a bit of a symptom of late stage capitalism. Branding becomes much more important than content or service. I would say that protons are largely a brand.

But I digress. It is good that we have opposing opinions. We need a new thread for all of this. It also says something big that we are both vehemently opposed to the messaging of ASTRO leadership and the direction of the field in general. I do agree with you that physicians are targeted when they make money. They're just Jelly. There is nothing worse than someone who both does good and does well.

Disaffected radoncs are a diverse group.


I didn't do it in the first place for the money and actually was unaware of how much radoncs could make when I started residency.

I liked physics and I went to med school late. I had kids early in med school. I almost quit entirely. Radonc provided me an opportunity to see oncology patients, at least do some basic physical thinking and have a reasonably controlled schedule. I am enormously grateful for this. It would have been hard to make it through 4 years of overnight call schedules with a young family and a physician spouse. It has also provided a reasonably controlled schedule and good paycheck since training. I'd be a schmuck to not be thankful.

But, the opportunity cost has been much higher than I thought. Med student friends who went into other fields got academic opportunities or other opportunities exactly where they wanted to live without too much hustle. I am also bored (not because I don't work, but because the progressive part of medicine is not in radonc), losing real income by the year, and have very little leverage despite being in leadership at my hospital. (A marginal medical oncologist has far more leverage than I do, not hyperbole at all.)

If I knew 15 years ago how oncology was going to change in just this short interval, I would not have done radonc. At the same time, I'm grateful for what I've had.

I agree with the phrase and I think it gets close to capturing where we are in the current cycle. Ray Dalio articulates much of this thoroughly in his book (and makes a compelling argument for it): Principles for Dealing with the Changing World Order: Why Nations Succeed and Fail.

Observing it is different from advocating for it (late stage capitalism)

the challenges in rad Onc are a product of its environment

​

 

[WanderingRad3]

I agree with what most are saying here including that NEBR/WashPo data being way outdated and those numbers are way beyond what most of us can attain, but I disagree with the hard cap.

There are states where hospitals cannot employ you and you can try to join/form/create a strong independent physician group. There are places where strong independent groups still exist. You can bring value to hospitals and get a share of global collections. You can branch out and do stuff outside of the hospital in addition to your main job (help build/cover urorads, radiopharm, build clinical referral business/benign programs and negotiate medical directorships, consulting, etc). I know people 5-10 years out doing these things and doing well.

But yes with the huge increase in supply and consolidation, our ability to negotiate those types of set ups is becoming more and more limited.

 

[elementaryschooleconomics]

I agree with what most are saying here including that NEBR/WashPo data being way outdated and those numbers are way beyond what most of us can attain, but I disagree with the hard cap.

There are states where hospitals cannot employ you and you can try to join/form/create a strong independent physician group. There are places where strong independent groups still exist. You can bring value to hospitals and get a share of global collections. You can branch out and do stuff outside of the hospital in addition to your main job (help build/cover urorads, radiopharm, build clinical referral business/benign programs and negotiate medical directorships, consulting, etc). I know people 5-10 years out doing these things and doing well.

But yes with the huge increase in supply and consolidation, our ability to negotiate those types of set ups is becoming more and more limited.

Ah, yes, sorry, I should have been more precise:

You are absolutely correct.

What I mean to say is the "hard cap" is for the majority of Radiation Oncologists by nature of the self-selecting nature of this field, and medicine in general.

There is always a small percentage of entrepreneurial doctors - and an even smaller subset of successful ones.

Actually the WaPo article and paper it cites demonstrates the phenomenon perfectly: the top 1% have 85% of their wealth from ownership.

So the "hard cap" is for 99% of Radiation Oncologists.

And that's an evidence-based statement.

 

[A_DeMichele]

bad article. Thank god SDN commenters exist

 

[Pointless]

Late stage capitalism basically refers to the absurdities of the system we live in now. I stand by the phrase, and I think it accurately describes a system where high value individuals rule everything with absolutely zero culture of noblesse oblige, risk for wealthy capitalists is close to zero (yes cronyism), there is massive consolidation of wealth and opportunity, a perverse tax structure and labor is moving rapidly towards having no value at all.

I personally think only strong regulation can prevent late stage capitalism.

Late stage capitalism is when all of the big money interests have ascended to power through bribery. The market is no longer free, all of the resources are directed to the top few who have control of the system. I agree with you that it seems to be the inevitable end-stage of capitalism, but the cure for it is not regulation, but deregulation. Government cannot, and will never, be able to redirect funds in a way that is equitable and fair. In other words, regulation is what got us here.

 

[sirspamalot]

Late stage capitalism is when all of the big money interests have ascended to power through bribery. The market is no longer free, all of the resources are directed to the top few who have control of the system. I agree with you that it seems to be the inevitable end-stage of capitalism, but the cure for it is not regulation, but deregulation. Government cannot, and will never, be able to redirect funds in a way that is equitable and fair. In other words, regulation is what got us here.

Yes we need less regulation of near monopolies. Because then everyone will have a fair chance!

NO minimum wage!
NO workplace safety!

Everyone for themselves.. Cause that's fair!


You sound like you have a 12 year Olds grasp of end stage capitalism. Lol.

 

[DireMoose]

What is the point of this thread?

You’re just kicking early career rad oncs in the b***s, yeah I know that the boomers did better financially than me and my peers, in all respects —

Gaslighting could have been the point of this thread.

An alternative, super-generous interpretation would be that SK came across this article, found it somewhat interesting and wanted to bring it to the forum to open it for criticism. With it being roundly shot down, has now gained new perspective.

This may even have been sent to him by ASTRO folks, with a comment to the effect of “take THIS to that collection of malcontents and see what they say.”

So, a range of potential purposes. But I don’t know that I would take his lack of frequently reappearing in this or other threads as a negative just yet. Not all are able to post q4h. I’d prefer if someone was trying to gain new perspective, to take time and read a range of responses, be thoughtful, and distill an informed opinion.

That opinion should ultimately be we are massively overtraining, and cutting spots is the only hope.

 

[doctalaughs]

Didn’t have a chance to read the actual study yet - but I’m interested why they didn’t include median earnings for each specialty as well as the means?

For my specialty (derm) some of the same forces including consolidation, increasing both residency slots and midlevels have also come together to decrease earnings for new + younger physicians, albeit perhaps to a lesser degree than radonc.

In derm though there are a handful of high-up private equity owners and celebrity YouTubers/ cosmetic branders that don’t make a “measly” few million in that “top 1%” of doctors- they make hundreds of millions. I would be interested if the study corrected for supreme-outliers like this which could really skew that mean (as well as the “top 1%” numbers). Literally a handful of these could move the mean earnings up 100k or so.

Also, is there any selection bias here (was there any way for doctors to not allow viewing of their anonymized tax info?)

 

[Pointless]

Yes we need less regulation of near monopolies. Because then everyone will have a fair chance!

NO minimum wage!
NO workplace safety!

Everyone for themselves.. Cause that's fair!


You sound like you have a 12 year Olds grasp of end stage capitalism. Lol.

Regulation, i.e. government picking favorites and enabling them to consolidate power such that there is no source of viable competition, is how you get to having monopolies in the first place. Obviously there need to be protections in place for the individual, like workplace safety; that's not what I am referring to as regulation. You're using a straw man argument (and ad hominem attacks) to make your point, though I'm not quite sure what that point is.

Are you suggesting that MORE government is the answer to all of our ills? Like, watching recent events play out has left you thinking "you know what we need, is more power in the hands of these people"? If that is the case, I'm frankly surprised you aren't more supportive of ASTRO's efforts; they are just as good as government officials!

 

[medgator]

Regulation, i.e. government picking favorites and enabling them to consolidate power such that there is no source of viable competition, is how you get to having monopolies in the first place. Obviously there need to be protections in place for the individual, like workplace safety; that's not what I am referring to as regulation. You're using a straw man argument (and ad hominem attacks) to make your point, though I'm not quite sure what that point is.

Are you suggesting that MORE government is the answer to all of our ills? Like, watching recent events play out has left you thinking "you know what we need, is more power in the hands of these people"? If that is the case, I'm frankly surprised you aren't more supportive of ASTRO's efforts; they are just as good as government officials!

You'll never avoid that, whoever has the best lobbyists wins esp post citizens United since corporations are people too.

That's why hedge fund managers get their tax loophole, hospitals get treated better than independent practices etc.

What you are describing is great and completely unrealistic/dissociated from reality. It won't happen with the way the system is now

 

[RadOncDoc21]

You'll never avoid that, whoever has the best lobbyists wins esp post citizens United since corporations are people too.

That's why hedge fund managers get their tax loophole, hospitals get treated better than independent practices etc.

What you are describing is great and completely unrealistic/dissociated from reality. It won't happen with the way the system is now

Unless we had Bernie in there… but that’s another issue!

 

[Pointless]

You'll never avoid that, whoever has the best lobbyists wins esp post citizens United since corporations are people too.

That's why hedge fund managers get their tax loophole, hospitals get treated better than independent practices etc.

What you are describing is great and completely unrealistic/dissociated from reality. It won't happen with the way the system is now

I wonder what the world would be like if politicians were randomly selected from society, had only one term, and lobbyist groups were not allowed to exist. Though I suppose lobbyists would already become moot in this system, since they couldn't buy politicians during their campaigns.

 

[sirspamalot]

I wonder what the world would be like if politicians were randomly selected from society, had only one term, and lobbyist groups were not allowed to exist. Though I suppose lobbyists would already become moot in this system, since they couldn't buy politicians during their campaigns.

We already had our fantasy thread
..

Reality is: Carlsbad