Lost my job and can't move . . . now what?

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Moonbeams said:
Unless you are in one of the 3 or 4 states that protects these groups by prohibiting direct employment or it's an extremely large group, I would not be so confident. The small groups and independent rad oncs are dropping like flies as hospitals cut their contracts and employee directly. I interviewed for a job with a group like this only to find out the job no longer existed, but a new job popped up advertised as a hospital employee.
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Which States?
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CaesarRO said:
Which States?
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California is the big one I'm aware of. Laws vary by state. Most have some sort of carve out in the corporate practice of medicine doctrine to allow hospitals to employ directly.

To be employed in California, you need to work for either:
(1) a nonprofit medical research corporation
(2) a private nonprofit university
(3) a narcotic treatment program
(4) a hospital owned and operated by a health care district
 
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If this happens to me, I'm going to make the switch to palliative medicine. 1 year fellowship.

Would be nice to:
1. Have as full of a schedule as one would like
2. Be able to get a job anywhere
3. Not have to worry about IT coverage

I'm fortunate in that I could do the fellowship without having to leave my current city. Hopefully it doesn't come to pass, but that's my backup option.
 
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OTN said:
If this happens to me, I'm going to make the switch to palliative medicine. 1 year fellowship.

Would be nice to:
1. Have as full of a schedule as one would like
2. Be able to get a job anywhere
3. Not have to worry about IT coverage

I'm fortunate in that I could do the fellowship without having to leave my current city. Hopefully it doesn't come to pass, but that's my backup option.
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Yeah, I would probably do this as well. Could also do so without moving. I just looked up the PC curriculum and it includes pediatric hospice. As someone who has cared for only adults in the last few years this would be really hard.
 
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Moonbeams said:
California is the big one I'm aware of. Laws vary by state. Most have some sort of carve out in the corporate practice of medicine doctrine to allow hospitals to employ directly.

To be employed in California, you need to work for either:
(1) a nonprofit medical research corporation
(2) a private nonprofit university
(3) a narcotic treatment program
(4) a hospital owned and operated by a health care district
Click to expand...

I should point out that in California legal constructs have been built which completely circumvent the spirit and intent of the "corporate ownership of medicine." Specifically, hospitals created "foundations" which directly employ the physicians and these "foundations" are, on paper, completely physician led. In reality, 100% of the funding for foundations comes from the hospital and the physicians within only have the power to recommend. If the foundation physicians "recommend" anything against the hospital's direct interests, it is ignored.
 
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I did enjoy my palliative care rotation, but I like RadOnc more...

On topic I think if I were in your shoes I would probably stick with the family, kids, and keep the worse job. Best wishes and hope everything works out well.
 
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Gfunk6 said:
I should point out that in California legal constructs have been built which completely circumvent the spirit and intent of the "corporate ownership of medicine." Specifically, hospitals created "foundations" which directly employ the physicians and these "foundations" are, on paper, completely physician led. In reality, 100% of the funding for foundations comes from the hospital and the physicians within only have the power to recommend. If the foundation physicians "recommend" anything against the hospital's direct interests, it is ignored.
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The foundation model is actually quite interesting, I work within one. When done well, it’s a good setup and much better then direct physician employment, because it essentially allows the docs to collectively bargain.

It is true that 100% of our funding comes from the hospital group. It is also true that 100% of their physician services in the region come from us. That means when negotiating compensation/everything else, it’s really a sit down of equals since neither of us can exist without the other. If anything we have the upper hand since non competes are a no go in California, so we could dissolve and reform a competing group that steers patients to other hospitals if it really hit the fan, while the hospital system can’t easily replace 1000 docs of dozens of specialties.

So as long as your foundation is led by docs that are trying to do well by the group (and ours are elected) then you’re in good shape. Of course there is politics between specialties/departments, eg how much do you subsidize primary care earnings to keep the wheels moving, etc.
 
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DoctwoB said:
It is true that 100% of our funding comes from the hospital group. It is also true that 100% of their physician services in the region come from us. That means when negotiating compensation/everything else, it’s really a sit down of equals since neither of us can exist without the other. If anything we have the upper hand since non competes are a no go in California, so we could dissolve and reform a competing group that steers patients to other hospitals if it really hit the fan, while the hospital system can’t easily replace 1000 docs of dozens of specialties.
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This is a very interesting perspective for me to hear. If you don't mind DM me, I'd like to know where in CA you work and with which hospital.

In my neck of the woods, the foundations are basically a puppet show to meet legal burdens. The docs in the foundation are functionally powerless. Also, trying to collectively bargain with a physician group is like trying to herd cats - at least as far as I've seen. There are ton of physicians who will happily break with the collective just so that they can curry favor with the hospital.
 
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Moonbeams said:
Unless you are in one of the 3 or 4 states that protects these groups by prohibiting direct employment or it's an extremely large group, I would not be so confident. The small groups and independent rad oncs are dropping like flies as hospitals cut their contracts and employee directly. I interviewed for a job with a group like this only to find out the job no longer existed, but a new job popped up advertised as a hospital employee.
Click to expand...


I had the same experience. I interviewed for a job and went through all the legwork involved in establishing a professional service agreement (finding billers, shopping for rates, licensing, finding my own malpractice carrier, learning about the tax implications and whah can be written off etc etc).. then the hospital decided they wanted to employ docs. I blame the rad oncs as much as the docs though.. I learned that I was the only doc they interviewed who was interested in the PSA model. Everyone else thought it was simpler just to be employed. I had reviewed their professional collections kindly provided to me by the retiring docs (who had a PSA for several decades) and knew employment would be a major financial hit. So when they offered me the employee spot, I declined.
 
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radoncle said:
I had the same experience. I interviewed for a job and went through all the legwork involved in establishing a professional service agreement (finding billers, shopping for rates, licensing, finding my own malpractice carrier, learning about the tax implications and whah can be written off etc etc).. then the hospital decided they wanted to employ docs. I blame the rad oncs as much as the docs though.. I learned that I was the only doc they interviewed who was interested in the PSA model. Everyone else thought it was simpler just to be employed. I had reviewed their professional collections kindly provided to me by the retiring docs (who had a PSA for several decades) and knew employment would be a major financial hit. So when they offered me the employee spot, I declined.
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To a hospital, letting a doc have her own PSA is like throwing money in the garbage… and nobody is that stupid.
 
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TheWallnerus said:
To a hospital, letting a doc have her own PSA is like throwing money in the garbage… and nobody is that stupid.
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Of course, with the oversupply, there are plenty of grads -once at the top of their medschool class -who will now take half of the prof fees. Speaking of stupidity, let’s put to rest the rural radonc trash. A lot of us would fly out one day a week for 250k. It just doesn’t exist
 
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OTN said:
If this happens to me, I'm going to make the switch to palliative medicine. 1 year fellowship.

Would be nice to:
1. Have as full of a schedule as one would like
2. Be able to get a job anywhere
3. Not have to worry about IT coverage

I'm fortunate in that I could do the fellowship without having to leave my current city. Hopefully it doesn't come to pass, but that's my backup option.
Click to expand...

Seems decent in theory but I know the kind of things that go to palliative medicine and it's not for me.

I'd take the worse Radonc job any day. Maybe I'm part of the problem, but won't go down without a fight.
I'd rather less pay, less work and can adjust my spending/savings accordingly. Maybe work on an income producing hobby in my 1-2 days off per week.

If less pay for same work and extra coverage of other sites though, screw that.
I'm in year three and approaching each year as it will be my highest paycheck. One day the mine will tap out and just milking while I can...
 
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Anyone ever thought of part time law school? I’ve been wondering if I had a JD in 4 years when this field hit rock bottom, if that could be a decent alternative career path. I probably just watch too many law tv shows..
 
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Bequerel said:
Anyone ever thought of part time law school? I’ve been wondering if I had a JD in 4 years when this field hit rock bottom, if that could be a decent alternative career path. I probably just watch too many law tv shows..
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I've thought about this, but unless you can go to a top 15 school (or what do those guys say, T17? something like that) then you're basically entering a similarly oversupplied market.

I'd rather take the $100-$200k to get a law degree and put it somewhere else. The one "extra" degree I would get at this point would be something in the MBA family and then really sell out. Hospital wants to employ me? Fine, I'll employ THEM. Checkmate, America.
 
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I’m not sure that and MD needs an MBA to advance in hospital leadership.

Go to meetings- nobody else wants to. Do safety or cancer committee or credentials. Be friendly. Become chief of staff. There is a path to CMO. Again, this is not pleasant stuff. It’s political. You’ll work harder to earn less than a busy RadOnc (at least today). But, i think spend that $100k-200k on .. savings, pay off high interest loans, hell, buy a cottage and spend time with your family/hide your affair there.

Degrees are signaling. An MD requires much less signaling than a non MD.
 
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JD is definitely one of the ways out. I know a colorectal surgeon in his early 50’s who did it and now works for a large law firm in NJ (doing some type of a medical litigation)
 
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Law school and politics… def a way to make money for a “cushy” lifestyle but I would assume most of us didn’t choose these routes for a reason. I know personally I couldn’t stomach any of it. I’ve done the admin role and it drove me crazy. I rather invest in stocks, real estate and be a clinical workhorse if it spares me one worthless meeting.
 
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I have to admit that I never considered retraining because I quite honestly thought that at my age I couldn't tolerate 2-4 years of a grueling residency, but I didn't realize that palliative care is relatively short and not like that at all. Plus we obviously have a lot of experience with many aspects. Perhaps best of all for those of us with families who need structure and at least a reasonable ability to plan, it's well defined: find a program, apply, these are the dates of training, this is when you'll graduate.

I am sure that there are other "ways out" but it takes a certain personality (which I will admit I don't have) to first become a colorectal surgeon then in ones 50's earn a JD and start a second career in a law firm in NJ!

Thanks you all for the recommendations. I am going to look through and hopefully engage in the Facebook and other online groups that were recommended above while thinking more seriously about a palliative care fellowship.
 
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JumpingShip said:
I have to admit that I never considered retraining because I quite honestly thought that at my age I couldn't tolerate 2-4 years of a grueling residency, but I didn't realize that palliative care is relatively short and not like that at all. Plus we obviously have a lot of experience with many aspects. Perhaps best of all for those of us with families who need structure and at least a reasonable ability to plan, it's well defined: find a program, apply, these are the dates of training, this is when you'll graduate.

I am sure that there are other "ways out" but it takes a certain personality (which I will admit I don't have) to first become a colorectal surgeon then in ones 50's earn a JD and start a second career in a law firm in NJ!

Thanks you all for the recommendations. I am going to look through and hopefully engage in the Facebook and other online groups that were recommended above while thinking more seriously about a palliative care fellowship.
Click to expand...
I work in a community hospital and 2 years of IM here is nothing like when I was an intern.
 
JumpingShip said:
I have to admit that I never considered retraining because I quite honestly thought that at my age I couldn't tolerate 2-4 years of a grueling residency, but I didn't realize that palliative care is relatively short and not like that at all. Plus we obviously have a lot of experience with many aspects. Perhaps best of all for those of us with families who need structure and at least a reasonable ability to plan, it's well defined: find a program, apply, these are the dates of training, this is when you'll graduate.

I am sure that there are other "ways out" but it takes a certain personality (which I will admit I don't have) to first become a colorectal surgeon then in ones 50's earn a JD and start a second career in a law firm in NJ!

Thanks you all for the recommendations. I am going to look through and hopefully engage in the Facebook and other online groups that were recommended above while thinking more seriously about a palliative care fellowship.
Click to expand...
Medical marijuana doc if that works in your state. All cash practice. Surprised it hasn't been mentioned yet
 
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Did you guys know that just being boarded in rad onc you used to be able simply to sit for the palliative writtens and if you passed you could get BC in palliative with no fellowship
 
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theradiator said:
One word of general advice. If some type of administrative policy seems wrong, don't assume that it is malice. Sheer incompetence is perhaps more likely in the differential diagnosis because after all, the decision makers are not affected by their decisions. They are too busy counting their money. Plus in this scenario, it sounds like the regional network expanded rapidly thus not a well oiled machine.
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This. Most administrators have no skin in the game and are generally in their positions for short periods, so they don’t really care (or possibly even see) how their decisions affect the institution. It’s sad but also a major competitive advantage for private practices. Hospital admins tend to put their money and efforts in the wrong places and 10 times slower than a normal person who’s livelihood depends on it.
 
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thesauce said:
This. Most administrators have no skin in the game and are generally in their positions for short periods, so they don’t really care (or possibly even see) how their decisions affect the institution. It’s sad but also a major competitive advantage for private practices.
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This x 100
 
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Also with palliative care, could explore the new psychedelic research depending on where you live and what is legal. That stuff is really interesting.
 
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RO28 said:
Also with palliative care, could explore the new psychedelic research depending on where you live and what is legal. That stuff is really interesting.
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I have been following this stuff and i also find it fascinating. More THC/psylocybin/LSD remain schedule 1 the more silly it looks.
 
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thecarbonionangle said:
I have been following this stuff and i also find it fascinating. More THC/psylocybin/LSD remain schedule 1 the more silly it looks.
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its not just fascinating. psilo / mdma will literally change the world for people with PTSD and depression
 
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Ketamine is widely available and similar effects. Btw: All these agents do promote hippocampal neurogenesis. How to change your mind is one of the best books I have ever read.
 
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Now are you guys talking about prescribing or using them? I’m definitely down for one… ;)
 
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Do we have enough collective interest here to start a dispensary with an emphasis on medical applications?

We might be able to bill insurance, but it could get tough as soon as Evicore becomes involved.
 
medgator said:
Legal to prescribe and dispense?
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Absolutely. I started my own pharmacy once, hired a pharmacist etc. "In office ancillary exemption," just like a urologist can buy a linac and "prescribe and dispense" RT. The margins are terrible though without good patient volume. You'd need like 50 rad oncs banded together in one pharmacy given the amount of scripts, much of which are quite cheap, to make it work.
 
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TheWallnerus said:
Absolutely. I started my own pharmacy once, hired a pharmacist etc. "In office ancillary exemption," just like a urologist can buy a linac and "prescribe and dispense" RT. The margins are terrible though without good patient volume. You'd need like 50 rad oncs banded together in one pharmacy given the amount of scripts, much of which are quite cheap, to make it work.
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Not sure that flies for narcs, weed, X or special k... Could be wrong
 
medgator said:
Not sure that flies for narcs, weed, X or special k... Could be wrong
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Definitely flies for high schedule drugs (can carry and dispense narcotics… or testosterone!). If it’s a legal drug, it’s able to be sold to patients in a pharmacy you own that is in the same building/office as you. (Must have pharmacist.) But again it will be about margins and if insurance covers etc.
 
TheWallnerus said:
Definitely flies for high schedule drugs (can carry and dispense narcotics… or testosterone!). If it’s a legal drug, it’s able to be sold to patients in a pharmacy you own that is in the same building/office as you. (Must have pharmacist.) But again it will be about margins and if insurance covers etc.
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Depends on the state... like everything


www.texmed.org

Should Texas allow physician dispensing?

www.texmed.org www.texmed.org

Supposedly certain states don't allow a physician to dispense narcotics they write for.. can't find a link but remember reading about it somewhere.

Definitely a great revenue stream to have if you can swing it and have the insurance contracts to fill
 
Back to the original thread- I had to move my family- spouse with their own firm, young children away from both my and spouse's elderly parents for a job making 1/2 what I had made in private practice- non-compete was enforceable, etc.
I looked at hospice -the jobs I saw were paying like $175K. I looked at retraining- internal medicine program said I would have to repeat intern year since it had been so long. We have gone from being highly skilled well paid and respected physicians to highly skilled day labor. As long as you remember that you are a replaceable widgit doing a "job" - it's much easier to just put your head down, treat patients, and save save save your money. The patients think you are their doctor. The administrator knows you are just a means to bill.
 
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Manatee3 said:
The patients think you are their doctor. The administrator knows you are just a means to bill.
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I have been thinking more and more about this: how does a hospital VP or department MBA admin view the rad onc in their heart of hearts?

This is the only logical answer:

Animated GIF


(In truth many MDs besides just rad onc, as long as they are “employees,” are probably viewed this way.)
 
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Manatee3 said:
Back to the original thread- I had to move my family- spouse with their own firm, young children away from both my and spouse's elderly parents for a job making 1/2 what I had made in private practice- non-compete was enforceable, etc.
I looked at hospice -the jobs I saw were paying like $175K. I looked at retraining- internal medicine program said I would have to repeat intern year since it had been so long. We have gone from being highly skilled well paid and respected physicians to highly skilled day labor. As long as you remember that you are a replaceable widgit doing a "job" - it's much easier to just put your head down, treat patients, and save save save your money. The patients think you are their doctor. The administrator knows you are just a means to bill.
Click to expand...
Supply and demand can’t be stressed enough. Difference between a diamond and a piece of coal.
 
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