I actually agree that this is by far the best advise, but trust me this is what I have been doing for several years. I did recalibrate my expectations, I did accept the terms, and I did begin the process of getting out but there is LITERALLY NO WHERE TO GO so I smiled and said thank you but at this point I'm out one way or another.
What everybody needs to understand is that when these things happen it's not like there is some arrogant radiation oncologist making $750,000 working four days week with 12 weeks vacation who sells his practice for millions, then the new "boss" says "hey, I'm cutting your salary by 2% and expect you to work 5% more" over the coming years, and then spoiled doctor says "that's unacceptable, I'm out of here!"
The process unfolds over 2-3 maybe even 5 years where every 6 months "adjustments are made to metrics to reflect the current situation and future outlooks" and we accept them, but after a year or two of that it becomes increasingly clear that the system is set up in a way to fail or at least be unattainable (which justifies the next decrease). Of course I'm not going to pretend like everything was perfect or that I didn't realize that tough times were ahead and adjustments/sacrifices needed to be made, but rather than doing so in the best interest of all as I would have, they use that as an excuse to make changes only in their best interest.
At some point it doesn't even matter anymore, they now know that not only do I have no place else to go but they have what seems like an endless annual supply of graduates. Furthermore, it seems like they now realize that their own graduates don't have a place to go so they get a "two for one" by replacing with me with somebody for far less AND "finding a job" for their resident so they can say "see our residents have no problems finding jobs, in fact they love this department and my leadership so much that instead of going anywhere in the country they chose to stay right here and work for me (in our satellite 80 miles away that a few years ago was a private practice that was doing just fine without us). The craziest thing is my job is literally being split between 1.5-2 people. I have no idea why other than to allow for "greater flexibility for coverage within our satellite offices." Maybe also to make it seems like all of there graduates are employed, when in reality they just took my job and made it into two (and probably somehow cut the pay into thirds and funneled 1/3 back to the guys who hang out all day at the mother ship).
Again, I'm sorry this is happening to you. I really appreciate you came here to talk about it.
This is something all of us not in the bubble of the
Main Campus Academic Department in the middle of a
Metro City, USA are acutely aware of. If you're a resident or mid/late career faculty and feel skepticism about "SDN doom and gloom", look at your own department. Have you added any new satellite locations in the last 10 years? Unless that satellite was built from scratch, it was a private practice before it was "acquired". The RadOnc docs that worked there may have been pro-fee PLLC or hospital employed, but they most certainly were not "clinical faculty".
My residency institution certainly did this. Heck, they managed absorb every single existing RadOnc department in a giant geographic region. Now, there's only one truly independent practice left on the border of their geographic dominance. Otherwise, it's only large multi-specialty organizations or hospitals which have become part of the "Affiliate Syndicate" phenomenon (like when some random practice in Indiana is part of the MD Anderson Network). The state my residency institution is in has very strong Certificate of Need laws which makes it functionally impossible for someone to start an independent RadOnc practice, even if they had the money. I don't mean that theoretically - I literally know it happened at least once in the last decade, when a group of organized physicians with enough capital were unable to get CON approval to install and operate an independent linac.
Why haven't we been hearing about what happened to
@JumpingShip more? Because of the time scales we're dealing with:
1) Residency expansion was insanely rapid but it still takes 5 years to produce a new grad.
2) Boomers are now coming into retirement age and are willing to sell their practice in the process.
3) Community hospitals are being absorbed into Academic Medical Center networks at an accelerating pace.
4) The official
breast and
prostate hypofrac recommendations (saying "do it for everyone") only came out in 2018.
You can actually easily see the lag of expansion hitting the market by looking at the
board certification numbers:
So while the "200 new grads per year" thing has been cooking for quite some time, you can only see it hit the market around 2016.
Even if you don't believe my statement about practices being sold, even if you think the story told by the original poster about what happened to him is a total lie, if you have any ounce of logic, the numbers are as clear as day.
The DOUBLING of new grads per year hit the market around 2016. The hypofrac guidelines for the backbone of any department (breast and prostate) were published in 2018,
which drive insurance reimbursement guidelines. In isolation, those two factors alone set us on a disastrous course. Factor in
@JumpingShip's situation...well, the direction we're heading is clear.
Everybody needs to understand that this is a multi-year process and throughout this entire time (ok maybe not year 0-1 but absolutely before the end of 2) I was trying to figure out what to do because it was so clear. The best advise or plan I could come up with is "consulting" but one has to realize that there are actually a ton of people (who are much younger, better with social media, and good looking than me) with MD's who never practiced and even those who were in primary care or other specialties. Who is going to hire a balding white middle aged radiation oncologist to write medical articles or even promote a product or website/services and why would even an oncology pharmaceutical company hire me vs a medical oncologist. It's not like thousands of these types of jobs exist.
I am an exceptional radiation oncologist but I literally can't do anything else, not even in medicine, and not even in oncology. I have come to the conclusion that I need to literally leave my children and get a job someplace else and see them on the weekends and holidays. Now the question is where is this job and is the same thing just going to happen again?
This needs to be repeated, over and over. Yes, alternative careers definitely exist. But they're not just sitting there, easily acquired for every Radiation Oncologist being backed into a corner. ESPECIALLY if you want to get a new job without uprooting your entire family. I'll go out on a limb and say at least 50%, probably the majority, of practicing Radiation Oncologists today don't have the mindset or personality to really "do well" in the consulting/industry/pharma gigs. Even if you do, unless you know the right people, starting salaries for these jobs are still lower than the satellite academic salaries. That's how they get you! Yes, the ceiling of the industry jobs is significantly higher than practicing clinical medicine. Some of the C-suite jobs come with salaries (not including benefits) of $450k-$900k. But how many of our colleagues can switch from 15 years of clinical practice into industry/consulting and compete with the well-networked MBAs who have been doing "consulting" for their entire careers and obtain these jobs?
I deeply believe this wasn't some grand design formulated behind the scenes by powerful figures. Rather, more of an "invisible hand" created as a natural consequence of the US Healthcare System being focused on extracting wealth from...literally everything.
Most physicians graduate with SIGNIFICANT student loan debt, $300-$500k, and it's getting worse. We don't really come out of training with any concrete "transferrable" skills. If you put in 8 years of school and 5 years of residency to become a Radiation Oncologist, and are finally starting your "real" life and family in the early 30s with several hundred thousand dollars in debt...taking a rural satellite gig making $275k a year is definitely the "best" option.
Salaries will keep going down in these jobs until the market finds the bottom. That's just how capitalism works. This is happening in all specialties, we're not unique in many of these issues (reference: the Private Equity saga of Emergency Medicine). What
IS absolutely unique to us is the rapid doubling of our residents and having our jobs entirely dependent on a multi-million dollar machine
that you can't even buy without government approval. When other doctors talk about how it's "too hard to start their own practice in the modern era", they're "only" talking about overheard costs and dealing with insurance. No one else has to lobby the government after raising millions of dollars of capital.
