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Bingo. Most specialties have had geographic freedom the whole time. The fact it is a big deal that across the sunbelt finally has jobs after several years is a low bar to cross.
Still not a lot of true private practice opps imo compared to what i hear about from my gi gu and rads colleagues for any given area of the country. Mostly hospital employed or academic/satellite gigs
Hits home in many ways
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deleted1111261
Here’s the thing.
There should be some objectivity
No one is throwing us Lambos as signing bonus and $1m for a 4 day work week
That being said, within our field - not compared to others, not compared to 1999, but relative to the last 10 years or so, something is different.
There is a lot of “yah but” - I’m the first one to tell you we are not in good shape and without massive changes, the specialty will be relegated. But, $2000-2500 for locums was simply not seen, and it’s becoming seen now. That reflects … something. My friends that were unhappy with their first job out - I can name 6 that got a much better deal and have changed. Lateral mobility for 2020 grads is another signal of something being up.
I should not have said “on fire”. But something is different.
There should be some objectivity
No one is throwing us Lambos as signing bonus and $1m for a 4 day work week
That being said, within our field - not compared to others, not compared to 1999, but relative to the last 10 years or so, something is different.
There is a lot of “yah but” - I’m the first one to tell you we are not in good shape and without massive changes, the specialty will be relegated. But, $2000-2500 for locums was simply not seen, and it’s becoming seen now. That reflects … something. My friends that were unhappy with their first job out - I can name 6 that got a much better deal and have changed. Lateral mobility for 2020 grads is another signal of something being up.
I should not have said “on fire”. But something is different.
The market isn’t on fire. New grads are just happy making 300k/year and salaries have dropped everywhere. Imagine 10 years ago accepting a full-time position for such an amount! I’m stuck where I am because I’d have to take a massive paycut to move anywhere. There is no real mobility for anyone who’s making >90% MGMA. If you’re fortunate enough to be in a position with a high income, you just have to ride it out.
The job market isn’t great and isn’t on fire. It may be decent if you’re a mid-career person making lateral move but it still isn’t very good as a pgy5. The majority of academic jobs are satellites or make you treat sites that no one else wants. Furthermore, non-academic places want mid-career people and these jobs are not posted. There’s a reason why many new grads take academic jobs and then leave after 2 years. The market still sucks. Jobs that are considered “good” today would be undesirable/unfilled 10 years ago.
Yet so see more than $1900 per day locum offer, including all the usual, completely despicable places
Just got one for 1500/day. 5 consults a day and 20 on treat.
Good times are here again! Ha!
As soon as the agency gives me a rate I immediately cut off contact
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deleted1116990
Just to add another voice, the job market is far from "on fire." Unless you count dumpster fire.
Have we gone from raging thermonuclear landfill to minimally acceptable pile of smoldering diapers and amazon boxes? Maybe.
But I'm not really seeing it. I got a few offers in attempt to lateral over the past year, but got a lot more rejections, and I basically had no negotiating power even in less desirable areas. I fared far better as new grad than this time (in retrospect I was able to negotiate a ridiculous deal as a new grad I don't think I'll ever see again). Everything I could find now involved either some kind of significant income and/or lifestyle hit, and anything in or near to a remotely desirable area I either couldn't even get an initial phone call or lost out to a new grad post-interview. I lost multiple job offers simply by just trying to negotiate better terms, which tells me all I need to know about the supply vs. demand if they can find someone else who will sign a take-it-or-leave-it offer. HOspitals will make all kinds of exceptions for other fields, but not rad onc. My situation is flat out bad on a personal level, but I don't see a better alternative now or in the near future and have basically stopped looking.
Advice for new grads who think this is hot job market: It's not, and you will find that out if you try to leave, so do what you can to make you first job work as you may be stuck in it and whatever surprise problems come up (and there will be a lot).
Have we gone from raging thermonuclear landfill to minimally acceptable pile of smoldering diapers and amazon boxes? Maybe.
But I'm not really seeing it. I got a few offers in attempt to lateral over the past year, but got a lot more rejections, and I basically had no negotiating power even in less desirable areas. I fared far better as new grad than this time (in retrospect I was able to negotiate a ridiculous deal as a new grad I don't think I'll ever see again). Everything I could find now involved either some kind of significant income and/or lifestyle hit, and anything in or near to a remotely desirable area I either couldn't even get an initial phone call or lost out to a new grad post-interview. I lost multiple job offers simply by just trying to negotiate better terms, which tells me all I need to know about the supply vs. demand if they can find someone else who will sign a take-it-or-leave-it offer. HOspitals will make all kinds of exceptions for other fields, but not rad onc. My situation is flat out bad on a personal level, but I don't see a better alternative now or in the near future and have basically stopped looking.
Advice for new grads who think this is hot job market: It's not, and you will find that out if you try to leave, so do what you can to make you first job work as you may be stuck in it and whatever surprise problems come up (and there will be a lot).
I know there were differences between PP and academics, but when I started residency in 2014, I wasn’t really expecting to make much more than 300k in academics right out of training. Was anyone from my training era expecting a lot more?
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I have no sense of the radonc job market today. I have been in my little corner of the world since graduation and the job market has never offered me the type of flexibility that I want (a chance to return home). I tried to land a hometown job a few years into my present practice. It was offered to the child of a faculty member of one of the academic departments in town. At this point, there is no option for moving back. The loss of income would just be too great. Radonc has never offered this type of flexibility, but some folks do get lucky.
I have no doubt that something is different however. The job market is crazy in many fields and has become a real crises regarding many health care jobs. Staffing is hard and I am frankly worried about our global ability to care for the baby boomers.
That this weird combo of COVID, demographic cliff and cultural shift towards quite quitting or leaning out has positively impacted the radonc market is not surprising. That we are being offered what we are for locums is all you need to know about the market not being on fire however. The difference in starting salary between a new radonc hire and a hew hire Masters level physicist is getting very small.
Other specialists are calling their shots regarding contracts (no call, 3-4 day work week, specific number of patients) while being offered 60% more than they were being offered 2-3 years ago.
Your expectations were sound. If you are a real academic with support and research time (and maybe even a pension plan), 300k is a damn good salary. If you are slinging consults and doing all the work out in the community, I would say it's much lower than I would want to make long term.
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Based on data I've seen, academic recruits should expect something more like $350,000 now at median. The RVU curve is pretty flat for academic physicians though, so the "research" people seem to be making the same as the "clinician" people. Also, the "clinician" people are probably carrying a pretty heavy load for docs that aren't 100% clinical on paper. You'd expect academic RVUs to be about 80% of MGMA I'd think? That's not what I've seen.
This jives with my personal experience and talking with friends, many of whom have left academics for greener pastures.
I hope eventually these academic networks admit to themselves that they really are operating like non-academic centers and start to pay clinically busy docs a more fair salary.
Why would they bother to pay them more? We've already seen them specifically increase the resident complement in order to decrease salaries, so I can't imagine they would voluntarily decide to pay academic radoncs more.
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deleted1116990
Exactly, and I figured I wasn't the only one in this situation. Same goes for things like 4 day weeks and generous PTO as well. I was not at >90% MGMA, but I use to have above median salary and a 4 day workweek. Once you start doing 4 day weeks, and realize that it is very do-able even with a very busy census if you are efficient, it is extremely difficult to go back. The QOL improvement is immense.
It is nearly impossible to try and apply for these jobs 200 new grads a year are also competing for and tell them you want to lateral with your current, non-entry level comp (with unlimited eat what you kill, profit sharing, whatever) and a 4 day week. I am confident that by even bringing up the fact I was off Fridays sunk my chances at a few places with comments like "I don't understand that, we work 5 days a week here" and "I hope you don't expect us to pay you a full time salary if you want to work part time"
If you are in a location you hate and/or have a toxic work environment and want to go somewhere else, it appears it will involve a massive hit to your income or schedule to compete with new grads and get the job. If you're early career, you can't reallly afford that risk. For those that are in standard employed median MGMA ceiling 8-5 M-F, 4 weeks PTO, there doesn't seem to be a shortage of these out there if you are just looking to find a semi-tolerable work environment and location.
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deleted1111261
I rescind the statement that the job market is on fire.
I stand by the fact that something odd is going on.
I stand by the fact that something odd is going on.
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Correct. The market went up and a bunch of people retired or otherwise stopped working (in our field and every other one) and temporarily improved the market. That’s all there is to it.
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Some places have but only when forced to by not being able to fill or maintain the positions any other way. Having a robust job market allows physicians to be paid what they're worth.
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And overtraining let's the Dennis Hallahan's of the world keep salaries lower
I get the sense that, for most chairs, it is less about tipping the scales of the global job market in favor of employers (a big picture goal) and more about preserving their supply of cheap labor and academic prestige (a small picture goal). Less macroeconomics… more microeconomics
Furthermore, I came to realize it's not the RadOnc Chairs per se, but the admins who strive to keep training programs going (and expanding)
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Certainly the case in EM with employers like HCA
EM was destroyed by the likes of HCA but I think we are doing a better job than HCA at the moment at destroying RO
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Yeah don't see HCA sponsoring EM elimination studies
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urgent care eliminated some elective EM but guess what, they are mostly run by emergency medicine physicians and allowed for the physician owners to ca$h out to private equity
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One thing that has changed between 3-4 years ago and now is that a significant number of proton centers have opened and are in the works. Maybe like IMRT saved the job market in 2005-2015, protons can do in the next 10 years? The proton planning and evaluation process is generally more labor intensive than X-ray techniques, just like IMRT was more labor intensive than 3D conformal, and protons will be more difficult to automate humans out of the loop due to technical and RBE considerations.
I once met an older doctor who was planning to semi-retire when I was first job hunting. He asked me, "Do you know what IMRT means to me? I Must Retire Tomorrow!" He didn't train in the era of 3D volumes and CT planning, so the contouring for a head and neck plan was like learning a whole new language. I think we'll see the same as protons scale up - the biggest barrier to diffusion will not simply be cost or geography, but the proportion of people who don't feel comfortable using a significantly different modality.
At this point I don’t even care. Bring on the protons and possibly even the carbon ions
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Oh eff-all. This is a terrible take. All those docs who never used protons clinically, retiring to be replaced by docs who believe proton plans represent reality.
Inexorable progress to a worse clinical modality? Again, I don't put it past the radonc intelligentsia to still believe that that 1-D bragg peak graph means that protons are fundamentally better.
I don't buy it for many reasons. But one is that I know a couple docs who have left centers with protons in the very recent past without any regrets. None of them feel that they are providing inferior care presently.
But what this may contribute to is the lack of viability of smaller centers. If you can' t hire a physicist, you can't run a practice.
I'm going to call it what it is. If you don't plan to substantially use your proton facility for fundamental research of proton dosimetry and biology (go ahead and treat some en-face RB cases BTW, totally fine with that), you have no business having a proton facility.
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Absurd take imo.
I have concerns how sustainable rad onc hiring will be in 2023 and 2024. Last year, hospitals benefited from COVID rescue bill monies, low interest rates, APM cancellation. A lot of hospital systems are losing money this year, and I only see this accelerating in 2023.
- Hospital capital expenses are subject to rising interest rates just like any other industry, which for us includes LINAC's, equipment service contracts, real estate leases, etc.
- USA debt crisis will force a reckoning on entitlement spending and Medicare rates could easily be cut, more than usual
I wasn't meaningfully employed in the dot-com bubble or the 2008 financial crisis, but I imagine the austerity and RIF's that big tech is experiencing will eventually affect healthcare.
- Hospital capital expenses are subject to rising interest rates just like any other industry, which for us includes LINAC's, equipment service contracts, real estate leases, etc.
- USA debt crisis will force a reckoning on entitlement spending and Medicare rates could easily be cut, more than usual
I wasn't meaningfully employed in the dot-com bubble or the 2008 financial crisis, but I imagine the austerity and RIF's that big tech is experiencing will eventually affect healthcare.
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deleted1111261
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I have a practice in socal and have noticed locums are increasing in pay. What is strange is that in 2022, we experienced an 8% cut in reimbursement. We are penciled for an equal additional cut in 2023 unless Congress acts. My expenses for almost everything has gone up. So how has doctor pay including coverage going up. So City of Hope and USC are slated for 40% increases next year and both are hiring. 8 other centers including MDA, MSK are also getting huge increases. So that may be part of the story. But hard to figure this out. I know that many older docs are finally retiring and their practices are being swallowed by large corporations or universities . My guess is this will be temporary and in the coming few years things will get harder . To quote game of Thrones: Winter is Coming. The White Walkers commanders are the 10 way overpaid centers, Genesis, and soon Med onc companies will be buying the weak. The younglings had better be prepared for the hard times that are coming. The rest of us too. Until then keep putting away while the sun shines.
The sun is never going to shine. You might as well spend what you have and be happy. Because next year will just be even worse. Sitting around waiting for this to improve is a stupid proposition. You’re a doctor things don’t get better
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Yep... The FIRE movement didn't just appear out of thin air
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Its simple. If we as a specialty begin saying "the most important thing is to protect our specialty. nothing else takes precedent. #2500orGTFO" and that was the hammered theme of every ASTRO/ACRO conference... then things would change immediately.
As long as you keep eating shyte sandwiches, you'll be fed them. With a smile.
When the lure of academic prestige, which does not pay the bills, is of no consequence, and opportunities elsewhere improve, academia will follow.
As long as you keep eating shyte sandwiches, you'll be fed them. With a smile.
When the lure of academic prestige, which does not pay the bills, is of no consequence, and opportunities elsewhere improve, academia will follow.
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Actually things are great and that’s why I haven’t retired yet. Every year seems like destruction is coming . You are right that being a doctor has been a slow gradual decline. And it will only get worse. Thanks to Medicare, then HMOs , and finally Obamacare. I do see a day when doctors finally stand up. The young docs at USC went on strike and won. We won’t strike or quit yet because the money is still good.One day when it’s not we will finally protest. Organizing men is hard, organizing doctors impossible …… for now
By the time that happens. Medicine will be seen as basically a pathway to citizenship for immigrants at which point no one will organize and if they do they’ll just find someone who will. Just another ****ty job people in the first immigrant generation will have to take on their way to becoming a financial trader pushing money around on a screen.
The thing about FIRE is that for most doctors it’s never going to work. There’s always a dirty little secret that most people don’t have.
1. Inherited money
2. High earning spouse
3. A side business they already had
4. No real debt at outset
Most people don’t because they have kids, wife’s that don’t work or have low paying jobs, poor parents, and no real assets to draw from.
And in the future you won’t even be able to FIRE if the cuts keep coming like this
FIRE was and always will be a fad. Just an interesting footnote in an otherwise bleak picture