radiation oncology.
Good pay for relatively low hours and almost no emergencies.
It's a secret field that very few people know or think about.
On a downward trend salary-wise (like rest of medicine, it seems like) but still good compared to some other non-procedural fields.
According to the RadOnc forum, the specialty is anything but high paying these days. From what those guys are saying, going into that field is a good way to waste 5 years of residency time and a stellar step score just to end up making what a 7 on/7 off hospitalist makes while having a tiny fraction of the geographical flexibility of said hospitalist. Also, their governing society is in rabid pursuit of massive residency expansion despite the already ruinous job market. No thanks.
Pay has likely diminished due to decreasing reimbursements, burgeoning over supply as well as formation of multiple new "fellowships" which are generally not overtly educational, but a way to stay in a competitive/semi-competitive locale (aka desireable place to live) while attempting to wait out the job market one more year. There are certain fellowship types which are well-entrenched and respectable to pursue (focused exposure to a new technology or procedure base, significant exposure to pediatrics, etc), but most of them are fellowships in things most, if not all, of us do more than a fair share of in residency. At least one fellowship (in NYC) seems silly to even offer, IMO, as I imagine even a competent 2nd (out of 4) year resident in Rad Onc would be more than capable of providing the services deemed necessary. More residents with same or lower # of jobs = More folks willing to do fellowships to try to get an edge = Vicious cycle = Walking towards the road of radiology and pathology.
There does seem to be a lot of doom and gloom on the radonc forum regarding the job market.
Most residencies responded to a paper from a few years ago saying there was going to be a shortage of Rad Oncs, and therefore more needed to be trained. However, it was found (a few years later) that the paper made some pretty strong assumptions, most of which were unintentionally untrue or obviously going in the opposite direction. Despite this, residencies are expanding (and starting) at an alarming rate, and there is apparently nobody who wants to take the role of 'Limit the output of Rad Oncs for reasons of the job market'. The way they want to force people into the rural areas (once again, it's always a maldistribution rather than true shortage) is by cutting pay (cause 20 people interviewing for 1 or 2 jobs in a geographic local will race to the bottom) in reasonable areas, and the expansion of non-educational 'fellowships'. As private practices dry up and more and more places become 'satellites' to the big health system in each town (along with unequal reimbursement for hospital-based vs free-standing facilities)
There seems to be a push to decrease the number of treatments of radiation (aka fractions) to give when you are treating a site(also known as hypofractionation, popular in breast and, more recently, prostate and metastatic palliation nowadays) or to eliminate Rad Onc from treating certain sites/diseases at all. To maintain the same number of treatments over time (which is how Rad Onc gets paid in the FFS system) folks are seeing more patients, or taking pay cuts. In addition, reimbursement for things continues to shift down.
It's not all doom and gloom, obviously, and at least we don't have to deal with any issues of midlevel takeover (although instead of hiring 2 doctors, you may have 1MD and 1PA now), but these are the issues that are coming into play.
