Irrational Exuberance

[deleted1111261]

Something very bizarre is happening with the job market.

The main drivers of our little economy have not changed - number of ROs, number of cancer patients, number of fractions all within a FFS system. We are net positive on docs, net negative on number of patients, net negative on number of fractions and the reimbursement is going down.

And yet, based on not just my perception, but talking to many PGY5s and people 1-2 years out - the market is on fire. Caveat - these are almost all hospital employed jobs, but I have heard multiple people have solid private practice/single specialty offers and opportunities. I even have some opportunities that I am not considering. And, y'all know I love to jump ship.

In addition, the locums $$$ has increased substantially. From $1600ish before to what seems like $2000 plus (everywhere but Florida, it seems)

What is happening?

Will go through some hypotheses in very little detail to stimulate discussion

1. Retirements - this is possible and very hard to measure. That being said, I know a lot of us. And, I am just not hearing about mass retirements or even clusters. The job is just too good to give up, even at 70+. There is very little data to suggest one way or the other, right now.

2. Post Covid quiet quitting/choosing life over work - there is some validity in this. I'm doing this in a way. I hear others are asking for 4 day weeks or part time opportunities. And, when places are sticklers about coverage, this does add a bit of slack to the market. Maybe people are taking more vacation and this is contributing to the higher locums wages and part time opportunities.

3. Patient numbers are increasing - perhaps we are undercounting, b/c of all the metastatic and oligometastatic work. Even though patient numbers are down, the number of treatments on each patient may be going up? There was some evidence about this. And, when we treat these patients we are doing more SBRT / IMRT, which is high technical revenue.

4. Total revenue increasing - tech fees increasing and pro fees stable or decreasing; hospitals are pushing higher reimbursed treatments like IMRT, daily IGRT, SGRT, DIBH, SBRT, protons, adaptive planned MRL treatments and less low reimbursement treatments (brachy, 2D/3D, port films as imaging).

5. Hospitals thinking global - i.e. - employed low volume physicians are essentially getting technical, b/c their professional collections are not approaching their salary. But, they are treating "high tech" and hospital is happy with this. They are okay giving 30% of 2 million to you, versus 20% of 1.5 million. Until RO-APM comes, this works out in their favor.

6. Subtle decreases don't hurt perceptibly - if you nick everyone 3-5% and use that to pay the surplus docs, you don't notice as much individually and perhaps you take more time off or leave earlier, b/c you have good colleagues. Equivalent of the sugar subsidies where everyone in the country pays a few cents more to prop up a small group of farmers.

I think a lot of these play a role, but they are so fragile. Bundling will hurt us, badly. Another market correction will short circuit retirements/quiet quitting. Medicare can just keep hitting us, maybe go after tech and prof next time around. Hospitals can start mistreating us (further).

What are you seeing out there?

---

Members don't see this ad.

 

[Palex80]

What are you seeing out there?

An iceberg.

 

[Fpg1245]

Something very bizarre is happening with the job market.

The main drivers of our little economy have not changed - number of ROs, number of cancer patients, number of fractions all within a FFS system. We are net positive on docs, net negative on number of patients, net negative on number of fractions and the reimbursement is going down.

And yet, based on not just my perception, but talking to many PGY5s and people 1-2 years out - the market is on fire. Caveat - these are almost all hospital employed jobs, but I have heard multiple people have solid private practice/single specialty offers and opportunities. I even have some opportunities that I am not considering. And, y'all know I love to jump ship.

In addition, the locums $$$ has increased substantially. From $1600ish before to what seems like $2000 plus (everywhere but Florida, it seems)

What is happening?

Will go through some hypotheses in very little detail to stimulate discussion

1. Retirements - this is possible and very hard to measure. That being said, I know a lot of us. And, I am just not hearing about mass retirements or even clusters. The job is just too good to give up, even at 70+. There is very little data to suggest one way or the other, right now.

2. Post Covid quiet quitting/choosing life over work - there is some validity in this. I'm doing this in a way. I hear others are asking for 4 day weeks or part time opportunities. And, when places are sticklers about coverage, this does add a bit of slack to the market. Maybe people are taking more vacation and this is contributing to the higher locums wages and part time opportunities.

3. Patient numbers are increasing - perhaps we are undercounting, b/c of all the metastatic and oligometastatic work. Even though patient numbers are down, the number of treatments on each patient may be going up? There was some evidence about this. And, when we treat these patients we are doing more SBRT / IMRT, which is high technical revenue.

4. Total revenue increasing - tech fees increasing and pro fees stable or decreasing; hospitals are pushing higher reimbursed treatments like IMRT, daily IGRT, SGRT, DIBH, SBRT, protons, adaptive planned MRL treatments and less low reimbursement treatments (brachy, 2D/3D, port films as imaging).

5. Hospitals thinking global - i.e. - employed low volume physicians are essentially getting technical, b/c their professional collections are not approaching their salary. But, they are treating "high tech" and hospital is happy with this. They are okay giving 30% of 2 million to you, versus 20% of 1.5 million. Until RO-APM comes, this works out in their favor.

6. Subtle decreases don't hurt perceptibly - if you nick everyone 3-5% and use that to pay the surplus docs, you don't notice as much individually and perhaps you take more time off or leave earlier, b/c you have good colleagues. Equivalent of the sugar subsidies where everyone in the country pays a few cents more to prop up a small group of farmers.

I think a lot of these play a role, but they are so fragile. Bundling will hurt us, badly. Another market correction will short circuit retirements/quiet quitting. Medicare can just keep hitting us, maybe go after tech and prof next time around. Hospitals can start mistreating us (further).

What are you seeing out there?

I concur. It’s on fire alright. On fire for cheap new grads. For Everyone else it’s the same bleak picture it’s always been. To top it all off, big academic HS which is pretty much most desirable cities are on a heavy DEI kick at the moment so if you don’t fit the demo don’t bother

The residents should enjoy being wanted for now because the longer they stay the less mobile they’ll become.

 

[fiji128]

Something very bizarre is happening with the job market.

The main drivers of our little economy have not changed - number of ROs, number of cancer patients, number of fractions all within a FFS system. We are net positive on docs, net negative on number of patients, net negative on number of fractions and the reimbursement is going down.

And yet, based on not just my perception, but talking to many PGY5s and people 1-2 years out - the market is on fire. Caveat - these are almost all hospital employed jobs, but I have heard multiple people have solid private practice/single specialty offers and opportunities. I even have some opportunities that I am not considering. And, y'all know I love to jump ship.

In addition, the locums $$$ has increased substantially. From $1600ish before to what seems like $2000 plus (everywhere but Florida, it seems)

What is happening?

Will go through some hypotheses in very little detail to stimulate discussion

1. Retirements - this is possible and very hard to measure. That being said, I know a lot of us. And, I am just not hearing about mass retirements or even clusters. The job is just too good to give up, even at 70+. There is very little data to suggest one way or the other, right now.

2. Post Covid quiet quitting/choosing life over work - there is some validity in this. I'm doing this in a way. I hear others are asking for 4 day weeks or part time opportunities. And, when places are sticklers about coverage, this does add a bit of slack to the market. Maybe people are taking more vacation and this is contributing to the higher locums wages and part time opportunities.

3. Patient numbers are increasing - perhaps we are undercounting, b/c of all the metastatic and oligometastatic work. Even though patient numbers are down, the number of treatments on each patient may be going up? There was some evidence about this. And, when we treat these patients we are doing more SBRT / IMRT, which is high technical revenue.

4. Total revenue increasing - tech fees increasing and pro fees stable or decreasing; hospitals are pushing higher reimbursed treatments like IMRT, daily IGRT, SGRT, DIBH, SBRT, protons, adaptive planned MRL treatments and less low reimbursement treatments (brachy, 2D/3D, port films as imaging).

5. Hospitals thinking global - i.e. - employed low volume physicians are essentially getting technical, b/c their professional collections are not approaching their salary. But, they are treating "high tech" and hospital is happy with this. They are okay giving 30% of 2 million to you, versus 20% of 1.5 million. Until RO-APM comes, this works out in their favor.

6. Subtle decreases don't hurt perceptibly - if you nick everyone 3-5% and use that to pay the surplus docs, you don't notice as much individually and perhaps you take more time off or leave earlier, b/c you have good colleagues. Equivalent of the sugar subsidies where everyone in the country pays a few cents more to prop up a small group of farmers.

I think a lot of these play a role, but they are so fragile. Bundling will hurt us, badly. Another market correction will short circuit retirements/quiet quitting. Medicare can just keep hitting us, maybe go after tech and prof next time around. Hospitals can start mistreating us (further).

What are you seeing out there?

Based off of what's going on everywhere else in the larger labor economy right now and acknowledging these same forces are also playing out in the rad onc labor market, I vote 1 and 2.

I wouldn't use the term "on fire" desirable positions are still very limited.

 

[Ray D. Ayshun]

It's hard to say where I am. The grads behind me are all signed and happy. I've grown my department/rvus by about 50% over the last 2 years. Otoh, I seen to get very little traction with corporate when it comes to expanding further, offering new services. I'm happy with my income, but unclear if anyone running things actually understands any of this. I think that's what explains the higher pay. It allows them to not be thoughtful while simultaneously giving us little incentive to leave and do it right. Obviously, in a con state it's tougher to open a new site, but if my competition hired me and let me do what I wanted, id shut this place down in a year.

 

[deleted1111261]

Based off of what's going on everywhere else in the larger labor economy right now and acknowledging these same forces are also playing out in the rad onc labor market, I vote 1 and 2.

I wouldn't use the term "on fire" desirable positions are still very limited.

Just off top of my head in last year or so

- several Colorado jobs near Denver and also further out
- So Cal jobs (COH, USC, private one)
- Seattle - Swedish may have had 2 jobs
- Oregon - there was a Portland area private job (not the shady one)
- Chicagoland - Indiana area and then other suburbs (Niles, west suburbs)
- Florida - endless
- Atlanta - a friend offered two jobs there at hospitals
- DC area - few jobs in MD and VA

Limited for sure, but vastly different when I was on the prowl last few years. Plus, the solicitation is different - getting calls for jobs. Very different "feel". Perhaps just my personal experience.

 

[fiji128]

Just off top of my head in last year or so

- several Colorado jobs near Denver and also further out
- So Cal jobs (COH, USC, private one)
- Seattle - Swedish may have had 2 jobs
- Oregon - there was a Portland area private job (not the shady one)
- Chicagoland - Indiana area and then other suburbs (Niles, west suburbs)
- Florida - endless
- Atlanta - a friend offered two jobs there at hospitals
- DC area - few jobs in MD and VA

Limited for sure, but vastly different when I was on the prowl last few years. Plus, the solicitation is different - getting calls for jobs. Very different "feel". Perhaps just my personal experience.

For sure it is a lot more open then it was even a few years back. 2019 Astro job market was legit awful. Still a long term bear on the job market though.

 

[medgator]

For sure it is a lot more open then it was even a few years back. 2019 Astro job market was legit awful. Still a long term bear on the job market though.

Yup, this is a rip your face off bear market rally this year

 

[thesauce]

Yup, this is a rip your face off bear market rally this year

Agreed. This is the worse possible time for it too because it gives the PDs/chairmen an excuse to continue expansion. This is a temporary phenomena and then it will crash 10X worse than before.

 

[medgator]

Agreed. This is the worse possible time for it too because it gives the PDs/chairmen an excuse to continue expansion. This is a temporary phenomena and then it will crash 10X worse than before.

It's all hospital employed, at least what is publicly available. I'm aware of some pp/technical partnership jobs being offered in reasonable parts of the country still but those folks aren't getting hired through the ASTRO career center or PracticeLink etc.

The hospitals in my area have jobs because existing docs have left for greener pastures, which have likely become roomier as older docs retire finally?

 

[NotMattSpraker]

Agreed. This is the worse possible time for it too because it gives the PDs/chairmen an excuse to continue expansion. This is a temporary phenomena and then it will crash 10X worse than before.

Haha do they need an excuse? No one is making these decisions based on data.

 

[brushbeamscanning]

I interviewed extensively at ASTRO and so far have heard nothing, although it's been admittedly only 2 weeks. I guess there's some truth that you shouldn't place much hope in ASTRO interviews.

 

[evilbooyaa]

A certain proportion of this for academic programs is making sure they have enough attendings so that within the next 2-3 years when the new ACGME rules go into effect, residency programs do not have to be shrunken extensively due to lack of attendings. For example, if you have 8 residents, you better have 12 clinical attendings, otherwise you're going to start losing residency positions whenever the ACGME rules go into effect.

My personal thought is that this is also one of the last year or two of residents who matched during the "Rad Onc is incredibly competitive" portion of residency, and thus the goal is to get as many new grads hired NOW rather than in say 2-3 years. Everyone (nearly) graduates from Rad Onc residency - do you want someone who was top of the class in med school or someone who couldn't match in anything else, assuming the rest of their education was all the same?

A proportion of folks that are moving are doing lateral transfers because they are burned out from carrying 1.5 FTEs of work for years at their academic institution.

A proportion of folks are understanding that working 80 hours a week in Rad Onc for hospital employed salaries without any significant skin in the game (low bonuses for RVUs > threshold) is unnecessary.

 

[RadOncDoc21]

A certain proportion of this for academic programs is making sure they have enough attendings so that within the next 2-3 years when the new ACGME rules go into effect, residency programs do not have to be shrunken extensively due to lack of attendings. For example, if you have 8 residents, you better have 12 clinical attendings, otherwise you're going to start losing residency positions whenever the ACGME rules go into effect.

My personal thought is that this is also one of the last year or two of residents who matched during the "Rad Onc is incredibly competitive" portion of residency, and thus the goal is to get as many new grads hired NOW rather than in say 2-3 years. Everyone (nearly) graduates from Rad Onc residency - do you want someone who was top of the class in med school or someone who couldn't match in anything else, assuming the rest of their education was all the same?

A proportion of folks that are moving are doing lateral transfers because they are burned out from carrying 1.5 FTEs of work for years at their academic institution.

A proportion of folks are understanding that working 80 hours a week in Rad Onc for hospital employed salaries without any significant skin in the game (low bonuses for RVUs > threshold) is unnecessary.

Agree, made a lateral move myself for a better location and overall better gig but chalked up some of my earnings, so you really can’t have it all but I would say able to get a better feel for what you may want. I would jump on the potential opportunities now as this current window may be closed for a very long time.

 

[evilbooyaa]

Just looking at the ASTRO Jobs board for academic places looking to hire for what seems to be a main campus position:

U of Rochester - 9 main campus attendings (unclear if satellite attendings have resident coverage). 8 residents. Better get up to 12 faculty.
Emory University - going to count all the attendings since I know emory residents rotate at like 4 sites or something crazy, 30 attendings, 16(!) residents. Maybe not all 30 of those attendings count as clinical faculty?
U of Maryland - 15 attendings, 11 residents. Need 16.5 attendings. They have 2 positions open.
Beaumont - 19 attendings (unclear if they all count), 11 residents.
Boston University - Ugh I can't keep track of HROP and where the residents rotate.

 

[evilbooyaa]

Agree, made a lateral move myself for a better location and overall better gig but chalked up some of my earnings, so you really can’t have it all but I would say able to get a better feel for what you may want. I would jump on the potential opportunities now as this current window may be closed for a very long time.

Agreed. If I was unhappy in my position now would be the perfect time to make an attempt at a lateral move with either an improvement in workload OR money OR potentially both.

A fair amount of folks have left academia (likely due to the increasing amount of non-sense that one has to deal with as an academic rad onc attending) in the past 3-5 years, or at least shifted from larger programs to smaller programs. Decent number of new grads that start as "assistant professor of big name U" that then transition into a job more agreeable to their lifestyle/location/salary expectations

 

[deleted1111261]

A certain proportion of this for academic programs is making sure they have enough attendings so that within the next 2-3 years when the new ACGME rules go into effect, residency programs do not have to be shrunken extensively due to lack of attendings. For example, if you have 8 residents, you better have 12 clinical attendings, otherwise you're going to start losing residency positions whenever the ACGME rules go into effect.

My personal thought is that this is also one of the last year or two of residents who matched during the "Rad Onc is incredibly competitive" portion of residency, and thus the goal is to get as many new grads hired NOW rather than in say 2-3 years. Everyone (nearly) graduates from Rad Onc residency - do you want someone who was top of the class in med school or someone who couldn't match in anything else, assuming the rest of their education was all the same?

A proportion of folks that are moving are doing lateral transfers because they are burned out from carrying 1.5 FTEs of work for years at their academic institution.

A proportion of folks are understanding that working 80 hours a week in Rad Onc for hospital employed salaries without any significant skin in the game (low bonuses for RVUs > threshold) is unnecessary.

Spot on about the ACGME and the lateral transfers.

Another person mentioned that they think people hiring want to "get the good grads NOW". I will tell you working in 3 community hospitals nobody has any idea about what is happening with the grads. ROs are ROs to them. Didn't notice it was ultra-competitive, didn't notice it has fallen. It may be different where you are at - but our HR is like college grad local people who have to get their kids to hockey and don't know anything about NRMP statistics. And, I don't care either. If I needed a partner right now, doesn't matter to me. You don't have to be a rocket scientists to be a good radonc. We just thought we did b/c of the competitiveness.

 

[Ray D. Ayshun]

Spot on about the ACGME and the lateral transfers.

Another person mentioned that they think people hiring want to "get the good grads NOW". I will tell you working in 3 community hospitals nobody has any idea about what is happening with the grads. ROs are ROs to them. Didn't notice it was ultra-competitive, didn't notice it has fallen. It may be different where you are at - but our HR is like college grad local people who have to get their kids to hockey and don't know anything about NRMP statistics. And, I don't care either. If I needed a partner right now, doesn't matter to me. You don't have to be a rocket scientists to be a good radonc. We just thought we did b/c of the competitiveness.

Sure, don't have to be a rocket scientist. But, do have to be a diplomat to a degree. I'm only barely competent, but I am funny and nice. So, 2/3. As the field crashes in competitiveness, employers will begin to notice going 0/3.

 

[Fpg1245]

Sure, don't have to be a rocket scientist. But, do have to be a diplomat to a degree. I'm only barely competent, but I am funny and nice. So, 2/3. As the field crashes in competitiveness, employers will begin to notice going 0/3.

I don’t know. I see the ones coming up the line. Not particularly bright but can still function, take orders, and complete the notes. I know it’s not a popular view but it’s remarkable how little intelligence you need for day to day RO.

You’d be surprised at what a “win” looks like from an HR perspective.

Did they get them for a good price? (Probably a top priority)
Did they leave within 3 years of hiring?
Patient satisfaction?
Generating revenue?
DEI?

I hate to sound sexist but it’s true…good looking women. There’s nothing male admin love more than A good looking female they recruited. And also probably the Dept as well.

That’s about it.

 

[deleted1111261]

Sure, don't have to be a rocket scientist. But, do have to be a diplomat to a degree. I'm only barely competent, but I am funny and nice. So, 2/3. As the field crashes in competitiveness, employers will begin to notice going 0/3.

funny + nice + pass exams = great candidate!

 

[NotMattSpraker]

Agreed. If I was unhappy in my position now would be the perfect time to make an attempt at a lateral move with either an improvement in workload OR money OR potentially both.

A fair amount of folks have left academia (likely due to the increasing amount of non-sense that one has to deal with as an academic rad onc attending) in the past 3-5 years, or at least shifted from larger programs to smaller programs. Decent number of new grads that start as "assistant professor of big name U" that then transition into a job more agreeable to their lifestyle/location/salary expectations

It is life changing. Send that CV today.

I didn't even think about people expanding to meet ACGME rules. Expanding clinical satellite operations + collusion to keep salaries low + ACGME pressures to expand = tread lightly my friends.

 

[Ray D. Ayshun]

I don’t know. I see the ones coming up the line. Not particularly bright but can still function, take orders, and complete the notes. I know it’s not a popular view but it’s remarkable how little intelligence you need for day to day RO.

You’d be surprised at what a “win” looks like from an HR perspective.

Did they get them for a good price? (Probably a top priority)
Did they leave within 3 years of hiring?
Patient satisfaction?
Generating revenue?
DEI?

I hate to sound sexist but it’s true…good looking women. There’s nothing male admin love more than A good looking female they recruited. And also probably the Dept as well.

That’s about it.

Tbh, I'm not that worried. We are at the end of the referral line, and all this hypofrac only makes me more competitive. I get patients in within a day, keep the referring docs up to speed on things, and am pleasant to be around. It's amazing how frequently this is not the case. Beyond that, they are happy with my competence and pedigree, which is also important as I've developed relationships with the more specialized surgeons nearby. The only real concern is how completely divorced from knowledge regarding the inner workings of all of this the c suite is. The only way they'll learn is seeing a drop in revenue after a change, but by then it will be a whole new set of people occupying the c-suite.

 

[deleted1111261]

Tbh, I'm not that worried. We are at the end of the referral line, and all this hypofrac only makes me more competitive. I get patients in within a day, keep the referring docs up to speed on things, and am pleasant to be around. It's amazing how frequently this is not the case. Beyond that, they are happy with my competence and pedigree, which is also important as I've developed relationships with the more specialized surgeons nearby. The only real concern is how completely divorced from knowledge regarding the inner workings of all of this the c suite is. The only way they'll learn is seeing a drop in revenue after a change, but by then it will be a whole new set of people occupying the c-suite.

and you should see Ray in high heels. a real knockout

 

[Fpg1245]

It is life changing. Send that CV today.

I didn't even think about people expanding to meet ACGME rules. Expanding clinical satellite operations + collusion to keep salaries low + ACGME pressures to expand = tread lightly my friends.

= 🏃‍♀️

 

[Ray D. Ayshun]

and you should see Ray in high heels. a real knockout

I can always go there and play the dei card if need be. Though I'm not sure it'd go over well with the population down here.

 

[URochester]

U of Rochester - 9 main campus attendings (unclear if satellite attendings have resident coverage). 8 residents. Better get up to 12 faculty.

OK- hopefully I come out relatively unscathed from this, but I wanted to clarify a few things about the University of Rochester program.

Residents rotate at 2 sites other than the main site. One site (which is also an ABS training site for visiting residents) treats all of the Gyn/GU HDR brachy. Another site is our freestanding breast center. Residents can choose to do an elective at one of the suburban or rural satellites – though I can only recall 2 who have done this in the past 10 years.

If we count all of the teaching ‘core’ faculty (not including those at the more remote satellites) we have 12 for our 8 residents.

We have been recruiting for 2 faculty positions. One of GI our attendings retired this past July. A current PGY5 resident has been hired for this position. We have a new satellite that was designed to be an outreach of the main center, with an emphasis on clinical trials. Our other open position is to help with this satellite as well as the main site. For now, 3 rad oncs go to this new satellite (including me and the chair), but not our residents. Our Cancer Center Director (also JCO editor) also sees patients there. Since this site will not be ‘disease specific’ (though the academic attendings who go there see only patients with specific disease sites) there is no plan for residents to rotate there.

We are a great teaching program and we treat our residents well. For many years, we have had PAs and NPs help with clinical duties, offloading some of the work that historically would have gone to the residents. We have always had radiation biologists on faculty who have been and are outstanding teachers. Our coordinator has been championing wellness for years - before it was a buzzword. Yet, it is no secret that we have not fared well in the match. Fortunately, we have been able to recruit residents who had exposure to radiation oncology (rotations, LORs, research) and would have been people we would have recruited in the past.

The job market is great but I am well aware that the future is less certain. For the current application cycle we are planning to match for 1 position to replace 3 graduating residents (i.e. go from 8 to 6). We will continue to train and treat our residents well.

Now I will go duck in a corner and may never resurface again

Mike Milano

 

[deleted1111261]

OK- hopefully I come out relatively unscathed from this, but I wanted to clarify a few things about the University of Rochester program.

Residents rotate at 2 sites other than the main site. One site (which is also an ABS training site for visiting residents) treats all of the Gyn/GU HDR brachy. Another site is our freestanding breast center. Residents can choose to do an elective at one of the suburban or rural satellites – though I can only recall 2 who have done this in the past 10 years.

If we count all of the teaching ‘core’ faculty (not including those at the more remote satellites) we have 12 for our 8 residents.

We have been recruiting for 2 faculty positions. One of GI our attendings retired this past July. A current PGY5 resident has been hired for this position. We have a new satellite that was designed to be an outreach of the main center, with an emphasis on clinical trials. Our other open position is to help with this satellite as well as the main site. For now, 3 rad oncs go to this new satellite (including me and the chair), but not our residents. Our Cancer Center Director (also JCO editor) also sees patients there. Since this site will not be ‘disease specific’ (though the academic attendings who go there see only patients with specific disease sites) residents will not rotate there.

We are a great teaching program and we treat our residents well. For many years, we have had PAs and NPs help with clinical duties, offloading some of the work that historically would have gone to the residents. We have always had ‘real’ radiation biologists on faculty. Our coordinator has been championing wellness for years - before it was a buzzword. Yet, it is no secret that we have not fared well in the match. Fortunately, we have been able to recruit residents who had exposure to radiation oncology (rotations, LORs, research) and would have been people we would have recruited in the past.

The job market is great but I am well aware that the future is less certain. For the current application cycle we are planning to match for 1 position to replace 3 graduating residents (i.e. go from 8 to 6). We will continue to train and treat our residents well.

Now I will go duck in a corner and may never resurface again

Mike Milano

Rochester is currently my favorite residency program in the country

Thanks for posting, Mike!

 

[taserlaser]

Small anecdote on the canadian RO market (where there has been decade+ of oversupply)

A few positions are stale, but a quick peek at the canadian job board shows >20 positions advertised right now, or around the size of the canadian graduating cohort. I remember as a senior medical student, there might have been 3 posted throughout the whole year as a compariosn. I know of PGY-5s being interviewed now for direct entry into jobs, something that hasn't happened in forever (as opposed to fellowships). Stats I think shows we've hit 'peak rad onc' in Canada, and commensurate with aging population, increased prevalence, etc we are seeing significantly increased demand for ROs. British Columbia has been going on a hiring spree and huge expansion plans, and alone has almost sucked all of the extra 'slack' out of the system.

So Canada is about to enter a new period of RO 'scarcity' I think, after a long period of 'abundance' and limiting entry cohorts.

 

[deleted1111261]

Small anecdote on the canadian RO market (where there has been decade+ of oversupply)

A few positions are stale, but a quick peek at the canadian job board shows >20 positions advertised right now, or around the size of the canadian graduating cohort. I remember as a senior medical student, there might have been 3 posted throughout the whole year as a compariosn. I know of PGY-5s being interviewed now for direct entry into jobs, something that hasn't happened in forever (as opposed to fellowships). Stats I think shows we've hit 'peak rad onc' in Canada, and commensurate with aging population, increased prevalence, etc we are seeing significantly increased demand for ROs. British Columbia has been going on a hiring spree and huge expansion plans, and alone has almost sucked all of the extra 'slack' out of the system.

So Canada is about to enter a new period of RO 'scarcity' I think, after a long period of 'abundance' and limiting entry cohorts.

Probably needs spun off into another thread, but wonder what the major differences are working there vs here. Income of course is different. I wonder about the rest - paperwork, liability, work life balance, coverage/supervision, wait times, being able to obtain studies/imaging. I always think about Toronto... I'm sure those jobs are very hard to come by, as well.

 

[TheWallnerus]

Probably needs spun off into another thread, but wonder what the major differences are working there vs here. Income of course is different. I wonder about the rest - paperwork, liability, work life balance, coverage/supervision, wait times, being able to obtain studies/imaging. I always think about Toronto... I'm sure those jobs are very hard to come by, as well.

Canadians a bit more lax reasonable re: supervision

 

[thesauce]

OK- hopefully I come out relatively unscathed from this, but I wanted to clarify a few things about the University of Rochester program.

Residents rotate at 2 sites other than the main site. One site (which is also an ABS training site for visiting residents) treats all of the Gyn/GU HDR brachy. Another site is our freestanding breast center. Residents can choose to do an elective at one of the suburban or rural satellites – though I can only recall 2 who have done this in the past 10 years.

If we count all of the teaching ‘core’ faculty (not including those at the more remote satellites) we have 12 for our 8 residents.

We have been recruiting for 2 faculty positions. One of GI our attendings retired this past July. A current PGY5 resident has been hired for this position. We have a new satellite that was designed to be an outreach of the main center, with an emphasis on clinical trials. Our other open position is to help with this satellite as well as the main site. For now, 3 rad oncs go to this new satellite (including me and the chair), but not our residents. Our Cancer Center Director (also JCO editor) also sees patients there. Since this site will not be ‘disease specific’ (though the academic attendings who go there see only patients with specific disease sites) there is no plan for residents to rotate there.

We are a great teaching program and we treat our residents well. For many years, we have had PAs and NPs help with clinical duties, offloading some of the work that historically would have gone to the residents. We have always had radiation biologists on faculty who have been and are outstanding teachers. Our coordinator has been championing wellness for years - before it was a buzzword. Yet, it is no secret that we have not fared well in the match. Fortunately, we have been able to recruit residents who had exposure to radiation oncology (rotations, LORs, research) and would have been people we would have recruited in the past.

The job market is great but I am well aware that the future is less certain. For the current application cycle we are planning to match for 1 position to replace 3 graduating residents (i.e. go from 8 to 6). We will continue to train and treat our residents well.

Now I will go duck in a corner and may never resurface again

Mike Milano

Awesome to hear that Mike. That shows true leadership.

 

[elementaryschooleconomics]

Things I have personally observed:

1) The data from the ASTRO workforce "preliminary" presentation indicates an uptick in retirement/leaving clinical work. We're small, so an additional 30-50 retirements in a single year or so really matters.

2) Lateral transfers. The first thing I noted, before it was clear we were having an abnormally good job market, was Spratt disrupting the GU space. He went to Ohio, Zaorsky went too - and I watched people in my personal bubble (also primary GU attendings) who shuffled around. No net increase in jobs, but a net perception increase. It was very interesting timing, because I think a lot of it took place when the academic year was already in full swing for 2021-2022, which meant it had nothing to do with new grads. To me, that was the start of the market we're currently in.

3) While probably not the ONLY reason, there are definitely places currently hiring in part because of the decrease in competitiveness of the specialty and this is one of the last "hyper-competitive" classes.

Things I'm speculating about:

There was a lot of tension "uncorked" after the COVID hiring freezes were lifted and it was clear APM was off the table.

We're basically a case study in "tragedy of the commons". Even with the continued reimbursement cuts, at the institutional level, we are very profitable. We're still a long way off from that fact ever changing.

But there's a difference in what's good for the hospital and what's good for the individual doctor as a human being. With APM no longer looming, I think there are some CFO purse strings being loosened and expansions taking place. In the short term this is contributing to the "good" job market, but in the long term this will continue to narrow the floor-ceiling distance of an individual Radiation Oncologist's salary.

We're all at the mercy of an incentivized system. They'll get every last drop of blood from the RadOnc stone.

 

[yesmaster]

We need a reality check. The job market is not on fire.

- are people getting multiple offers & counter offers?
- are people getting significantly higher than the mgma median, risk-adjusted for partnership track positions?
- are people getting jobs with TC in desirable cities?

I’m aware of jobs in different areas of the country, many that are posted publicly and some that are not. I look at them and pass, a graduating resident or someone who is strongly motivated to be in a particular city might bite. Most of the jobs don’t strike me as particularly desirable.

As for explanations why the job market seems to be on fire:

1. Take a look at Fast Company’s magazine and the fastest growing private companies. A HUGE number are medical staffing agencies, for nurses, but also for doctors. You might be flattered that you’re getting emails and calls from recruiters (“is the rad onc job market reborn?!”) but they’re sitting on the beach in Miami or San Diego, sipping on mojitos. Their work culture is much more permissive of remote option after 2020, Zoom, Microsoft Teams, Salesforce facilitate this. There’s not necessarily more jobs, but more recruiting.

2. Healthcare spending is unfettered. GOP isn’t trying to kill ACA. Democrats aren’t trying to kill private insurance. APM is dead. United, Elevance, Anthem, etc. are doing extremely well, so there’s some trickle-down to hospitals and clinics. The control arm is other specialties who do similar work as us, medical oncologists, radiologists, surgical subspecialists. Our job market isn’t on fire compared to that of other doctors.

I agree with many of the other factors that have been discussed that are supporting a perception of a decent job market.

 

[deleted1111261]

We need a reality check. The job market is not on fire.

- are people getting multiple offers & counter offers?
- are people getting significantly higher than the mgma median, risk-adjusted for partnership track positions?
- are people getting jobs with TC in desirable cities?

I’m aware of jobs in different areas of the country, many that are posted publicly and some that are not. I look at them and pass, a graduating resident or someone who is strongly motivated to be in a particular city might bite. Most of the jobs don’t strike me as particularly desirable.

As for explanations why the job market seems to be on fire:

1. Take a look at Fast Company’s magazine and the fastest growing private companies. A HUGE number are medical staffing agencies, for nurses, but also for doctors. You might be flattered that you’re getting emails and calls from recruiters (“is the rad onc job market reborn?!”) but they’re sitting on the beach in Miami or San Diego, sipping on mojitos. Their work culture is much more permissive of remote option after 2020, Zoom, Microsoft Teams, Salesforce facilitate this. There’s not necessarily more jobs, but more recruiting.

2. Healthcare spending is unfettered. GOP isn’t trying to kill ACA. Democrats aren’t trying to kill private insurance. APM is dead. United, Elevance, Anthem, etc. are doing extremely well, so there’s some trickle-down to hospitals and clinics. The control arm is other specialties who do similar work as us, medical oncologists, radiologists, surgical subspecialists. Our job market isn’t on fire compared to that of other doctors.

I agree with many of the other factors that have been discussed that are supporting a perception of a decent job market.

Email below from today.

$300/hr or $2400/day. Something is different.

“Fire” maybe too strong, but it is not the same as last 5-7 years.

I don’t believe this is more than a signal. The fundamentals of the market are dismal.

 

[TheWallnerus]

Email below from today.

$300/hr or $2400/day. Something is different.

“Fire” maybe too strong, but it is not the same as last 5-7 years.

I don’t believe this is more than a signal. The fundamentals of the market are dismal.

"The fundamentals of the market are dismal." That seems to be settled. Lord knows I've quoted (and not fabricated) the data as much as anyone (too much). But that rad oncs are oversupplied RIGHT NOW is beginning to conflict with that data. Reminds me of like when all the data showed Hillary Clinton was going to win the Presidency in a walk (right up to election night) but then every news report showed cars and people lined up for 10 miles at each Trump rally (even in blue states) and I'd see anti-Hillary signs in people's windows in even liberal pockets of California. Data versus reality; which to believe? Reality can't be tricked, and sometimes the data has a flaw.

 

[evilbooyaa]

OK- hopefully I come out relatively unscathed from this, but I wanted to clarify a few things about the University of Rochester program.

Residents rotate at 2 sites other than the main site. One site (which is also an ABS training site for visiting residents) treats all of the Gyn/GU HDR brachy. Another site is our freestanding breast center. Residents can choose to do an elective at one of the suburban or rural satellites – though I can only recall 2 who have done this in the past 10 years.

If we count all of the teaching ‘core’ faculty (not including those at the more remote satellites) we have 12 for our 8 residents.

We have been recruiting for 2 faculty positions. One of GI our attendings retired this past July. A current PGY5 resident has been hired for this position. We have a new satellite that was designed to be an outreach of the main center, with an emphasis on clinical trials. Our other open position is to help with this satellite as well as the main site. For now, 3 rad oncs go to this new satellite (including me and the chair), but not our residents. Our Cancer Center Director (also JCO editor) also sees patients there. Since this site will not be ‘disease specific’ (though the academic attendings who go there see only patients with specific disease sites) there is no plan for residents to rotate there.

We are a great teaching program and we treat our residents well. For many years, we have had PAs and NPs help with clinical duties, offloading some of the work that historically would have gone to the residents. We have always had radiation biologists on faculty who have been and are outstanding teachers. Our coordinator has been championing wellness for years - before it was a buzzword. Yet, it is no secret that we have not fared well in the match. Fortunately, we have been able to recruit residents who had exposure to radiation oncology (rotations, LORs, research) and would have been people we would have recruited in the past.

The job market is great but I am well aware that the future is less certain. For the current application cycle we are planning to match for 1 position to replace 3 graduating residents (i.e. go from 8 to 6). We will continue to train and treat our residents well.

Now I will go duck in a corner and may never resurface again

Mike Milano

Thanks for clarifying! I am unclear as to what sites residents rotate at outside my own institution as more and more academic programs have more and more 'satellites'. More importantly, kudos on the voluntary downsizing of the program. Is the long-term goal dropping to 6 total? U of Rochester may join the vaunted ranks of MDACC and CCF if that is the plan.

 

[URochester]

@evilbooyaa
That is the long-term plan (alternating 1-2-1-2) unless something major changes -- SRS for functional disorders and/or low dose radiation for arthritis takes off, radiation oncology becomes "the primary users of radiation therapy for skin cancer" (ugh), radiation to supplement drug therapy for widely metastatic cancer, radiation for all cardiac stenting ....

 

[evilbooyaa]

@evilbooyaa
That is the long-term plan (alternating 1-2-1-2) unless something major changes -- SRS for functional disorders and/or low dose radiation for arthritis takes off, radiation oncology becomes "the primary users of radiation therapy for skin cancer" (ugh), radiation to supplement drug therapy for widely metastatic cancer, radiation for all cardiac stenting ....

Excellent to hear.

Welcome to the hallowed halls of internet (well at least SDN Rad Onc) fame, Dr. Milano. Take your position alongside MDACC and CCF as the first 3 to voluntarily downsize their program in the setting of the job market.

In all seriousness, this is something your department's twitter account should consider posting, for all those in Rad Onc who do not peruse SDN on a regular basis.

 

[URochester]

@evilbooyaa
Thanks! It looks like @RealSimulD spread the word on Twiter (which works for me since we do not have a departmental or residency program account), that apparently unleashed a love fest (which leaves me a bit unsettled but I will deal with it).

 

[thecarbonionangle]

i worry this narrative will only provide cover for more expansion and ignoring the issues at hand. When i hear people say the job market is “fire” i tune out, but i would also do the same if someone told me the job market is terrible for all. The fact is there has been a continued inequality in the outcomes between the haves and have nots, little rad onc and big rad onc, whatever you wanna call it. So when i talk to someone from a top program with many job offers and they say job market is “fire”, i believe them. Likewise, when i know people who get 1-2 job offers take it or leave it, i dont see these people say things are “fire” for them. Both things can be true. What i know for sure is I am very bearish about the future of the field and I tell every rotating medical student when I can away from the many throne sniffing ears around me, to avoid the field and to consider something else. I simply cannot lie to people about what i see and feel.

 

[deleted1111261]

That is very true - it will be used to justify expansion.

 

[thecarbonionangle]

Btw i think Rochester is a great place. I have never heard a single bad thing about the program and i would encourage people to consider it. There is no reason this place should go unmatched. I would avoid SOAP filling, warm body loving hellpits like the plague. I feel pretty strong about this. These places are pretty awful and they simply just need “anybody”. I have faith the canaries will continue to speak and reject these places.

 

[thecarbonionangle]

That is very true - it will be used to justify expansion.

The job market is on fire and great no issues. Yeah lets expand. Nothing to see here.

Wait so you say there are some issues? Lets study it and come up with reasons why we cannot cut spots significantly.

T’is the way.

 

[fiji128]

Glad to see a soft contraction at U Rochester and I really appreciate the post. Also Harvard has soft contracted by 1 position per year as well per acgme enrollment numbers.

 

[radoncftw]

We need a reality check. The job market is not on fire.

- are people getting multiple offers & counter offers?
- are people getting significantly higher than the mgma median, risk-adjusted for partnership track positions?
- are people getting jobs with TC in desirable cities?

I’m aware of jobs in different areas of the country, many that are posted publicly and some that are not. I look at them and pass, a graduating resident or someone who is strongly motivated to be in a particular city might bite. Most of the jobs don’t strike me as particularly desirable.

As for explanations why the job market seems to be on fire:

1. Take a look at Fast Company’s magazine and the fastest growing private companies. A HUGE number are medical staffing agencies, for nurses, but also for doctors. You might be flattered that you’re getting emails and calls from recruiters (“is the rad onc job market reborn?!”) but they’re sitting on the beach in Miami or San Diego, sipping on mojitos. Their work culture is much more permissive of remote option after 2020, Zoom, Microsoft Teams, Salesforce facilitate this. There’s not necessarily more jobs, but more recruiting.

2. Healthcare spending is unfettered. GOP isn’t trying to kill ACA. Democrats aren’t trying to kill private insurance. APM is dead. United, Elevance, Anthem, etc. are doing extremely well, so there’s some trickle-down to hospitals and clinics. The control arm is other specialties who do similar work as us, medical oncologists, radiologists, surgical subspecialists. Our job market isn’t on fire compared to that of other doctors.

I agree with many of the other factors that have been discussed that are supporting a perception of a decent job market.

as long as programs are hiring for instructor positions/fellowships then market is not on fire. i know academic institutions are still offering PGY5s instructor positions instead of true asst professor jobs. that is complete bs. heres 100k, hope you like having 30 on treat.

sounds kinda like a self fulfilling prophecy from that response to the bloodbath red j 2013

 

[medgator]

as long as programs are hiring for instructor positions/fellowships then market is not on fire. i know academic institutions are still offering PGY5s instructor positions instead of true asst professor jobs. that is complete bs. heres 100k, hope you like having 30 on treat.

sounds kinda like a self fulfilling prophecy from that response to the bloodbath red j 2013

In the current job market, pgy5 would be an idiot to take that job

 

[Fpg1245]

In the current job market, pgy5 would be an idiot to take that job

But how are they ever going to perfect their prostate contouring and publish ground breaking research if they don’t take that position?

 

[NotMattSpraker]

@evilbooyaa
Thanks! It looks like @RealSimulD spread the word on Twiter (which works for me since we do not have a departmental or residency program account), that apparently unleashed a love fest (which leaves me a bit unsettled but I will deal with it).

This was heart warming to see, I loved it.

 

[TheWallnerus]

This was heart warming to see, I loved it.

‘Twas practically community/academic detente

 

[RickyScott]

We need a reality check. The job market is not on fire.

- are people getting multiple offers & counter offers?
- are people getting significantly higher than the mgma median, risk-adjusted for partnership track positions?
- are people getting jobs with TC in desirable cities?

I’m aware of jobs in different areas of the country, many that are posted publicly and some that are not. I look at them and pass, a graduating resident or someone who is strongly motivated to be in a particular city might bite. Most of the jobs don’t strike me as particularly desirable.

As for explanations why the job market seems to be on fire:

1. Take a look at Fast Company’s magazine and the fastest growing private companies. A HUGE number are medical staffing agencies, for nurses, but also for doctors. You might be flattered that you’re getting emails and calls from recruiters (“is the rad onc job market reborn?!”) but they’re sitting on the beach in Miami or San Diego, sipping on mojitos. Their work culture is much more permissive of remote option after 2020, Zoom, Microsoft Teams, Salesforce facilitate this. There’s not necessarily more jobs, but more recruiting.

2. Healthcare spending is unfettered. GOP isn’t trying to kill ACA. Democrats aren’t trying to kill private insurance. APM is dead. United, Elevance, Anthem, etc. are doing extremely well, so there’s some trickle-down to hospitals and clinics. The control arm is other specialties who do similar work as us, medical oncologists, radiologists, surgical subspecialists. Our job market isn’t on fire compared to that of other doctors.

I agree with many of the other factors that have been discussed that are supporting a perception of a decent job market.

exactly, compared with other specialties we are still at the bottom despite a rising tide lifting everybody. Almost every other specialty is on fire.
Our goal posts have shifted to just having some jobs available somewhere.