M4 thinking strongly about applying to Rad Onc: Why is there so much dissonance between opinions real life and the internet?

[RadOncDoc21]

I still can't believe that approximately 10 years ago when I was applying for a residency position, this was one of the most competitive fields to get into. Now people can just fall into unfilled residency slots is still insane to me.

Back to post- I likely would have done either IR or DR.

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[gmsquid]

I’d have done med onc or surg onc (probably Head and neck)

 

[xrthopeful]

I still can't believe that approximately 10 years ago when I was applying for a residency position, this was one of the most competitive fields to get into. Now people can just fall into unfilled residency slots is still insane to me.

Back to post- I likely would have done either IR or DR.

I mean has anyone else had the thought that we should see what happens this year before we say things like this? Match 2018 was a normal match just like the last ten years. One year does not make a trend. Maybe I’m crazy for caring about things like facts.

I would not be blown away at all if there were more applicants than spots this year and I will not at all be blown away if there are more spots than applicants this year.

 

[scarbrtj]

I still can't believe that approximately 10 years ago when I was applying for a residency position, this was one of the most competitive fields to get into. Now people can just fall into unfilled residency slots is still insane to me.

Back to post- I likely would have done either IR or DR.

Perhaps the unfilled slots becoming more prevalent

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[medgator]

Match 2018 was a normal match just like the last ten years.

I can't tell if you're being sarcastic, ignorant, or just truly actually believe what you just posted.

Ftr, last year's match was enough to receive an acknowledgement even from ASTRO....

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.

www.astro.org

 

[xrthopeful]

I can't tell if you're being sarcastic, ignorant, or just truly actually believe what you just posted.

Ftr, last year's match was enough to receive an acknowledgement even from ASTRO....

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.

www.astro.org

Dude.

Match 2019 was an embarrassment for the field.

Match 2018 was normal.

I even said the part about 'one year does not make a trend'. Context clues.

 

[medgator]

Dude.

Match 2019 was an embarrassment for the field.

Match 2018 was normal.

I even said the part about 'one year does not make a trend'. Context clues.

It sure was enough to get attention from even the highest echelons of leadership in the field.

I'm guessing match 2020 will be similar to this most recent match assuming the same or more spots are offered in it

 

[deleted956486]

It sure was enough to get attention from even the highest echelons of leadership in the field.

I'm guessing match 2020 will be similar to this most recent match assuming the same or more spots are offered in it

Hopefully we have a repeat. Need people to come up with real solutions. Stop this BS about trust.

 

[Krukenberg]

M4 here, quick question. How much do you guys enjoy the actual day-to-day job? I get it’s good money and lifestyle if you can get a job, but I shadowed one not too long ago and to me it just seems boring. I want to make sure it wasn’t just a bad day or if there’s more to the job that I wasn’t seeing.

I don't think you can accurately judge a specialty with 1 or a few days of shadowing. I'd recommend trying to do a 2 week mini-rotation at your home department if that kind of thing exists. If not, think about doing a month. Then you can attend a few resident didactics and get a better sense of what our specialty does.

 

[GapCalc]

I mean has anyone else had the thought that we should see what happens this year before we say things like this? Match 2018 was a normal match just like the last ten years. One year does not make a trend. Maybe I’m crazy for caring about things like facts.

Agree and disagree.

Agree because if we’re back to a match with “high achievers” in 2020 and beyond, it’ll mean this was a blip. I suspect this will not be the case.

But I disagree because how the match works out may be interpreted differently by different folks. I am concerned that many, including our “leadership”, will look at a near full match (where # applicants is > or = to # spots) as a “success” and “back to business as usual.”

But that’s not the full story. Did we lose quality in the way we typically measure it? Are we matching more folks of lower caliber, however you may wish to define that? That’s not necessarily a bad thing (see recent discussion or the imprtance is Step 1, EQ vs IQ, etc), but it would be intellectually dishonest to say things are “back to normal” if we have a full match with a differently (and perhaps lesser) qualified set of applicants.

And none of this changes the fact that 2019 wasn’t just a bad year, it was a catastrophe. Ten unfilled spots would have been bad compared with historical standards. There were 3x that many. We, as a field, have to understand that something about our field smells bad, and medical students, those famed canaries in the coal mine, can’t be told otherwise.

 

[Krukenberg]

Yeah sorry most people who matched into rad onc were not going to get top consulting jobs right out of college and most people in consulting are not making 300k 2 years into their job!

Agree. Saying med students could have been raking it in in business and therefore shouldn’t do rad onc is not a winning argument. Most would be fine associates but few to none would be Roger Sterlings taking clients out to dinner and drinks 5 nights a week and signing multimillion dollar deals. And that’s fine, different skill sets for different jobs.

 

[Gfunk6]

There has been so much posted on this thread, that I wanted to absorb it for a couple of weeks before posting. I don't think I have any unique insight to offer but I am happy to summarize from my perspective:

1. The best analogy to account for the disconnect between "real life" [PGY5s report they are getting decent jobs] and "the internet" [established ROs like me spreading doom and gloom] is a person standing on train tracks with a train chugging towards her miles away. The train will eventually hit and it won't be pretty, but there is time before it hits.

2. The facts stated by other posters don't lie: more ROs being pumped out (without even the hint of political will to stop/reverse it), treatment courses are shortening due to hypofractionation, geographic maldistribution of ROs, ROs practicing well into their 70s-80s (not seen in other specialties) thereby not giving opportunities for the "new blood," and the inevitability of a federal capitated payment model. This is the train and the train is coming.

3. When medical students apply to RO and residents apply for jobs, they should be looking for the long-game. They are trained to do ONE thing and do it really well and as a consequence there is no venue to diversify except perhaps industry/management which very few people have the interest or capacity to do. The question is will you be able to maintain a decent income stream over the next 30+ years? All the metrics are not optimistic on this.

4. Acceleration of ROs into employment structures in which they are salaried with limited bonuses for productivity or other metrics. This has lead to the decline of entrepreneurship, business strategy savvy, understanding of billing practices, and (most importantly) ceding ownership of the machine which allows you to do 100% of your work. On the latter point, I see a massive disconnect between employed ROs and RO-owners when it comes to a linac near the end of its life (~10 years). The employed ROs are frequently heard petitioning their hospital administrators for a newer/better machine so that they won't lose market share, can treat patients faster, etc. The RO-Owners realize that their linac debt structure is paid off and the window for maximum profitability has just started; in addition, replacing a linac can result in weeks of lost revenue and patients going elsewhere.

Food for thought.,

 

[RickyScott]

Spot on. In terms of when a train hits, 5 years from now when med students enter job market seems a good guess.
Anyway, can’t emphasize enough your point about employment structure. If the vast majority of radoncs are employed, supply and demand should be their number one priority.
Emergency med prof society recognized this and put out statement they would take action.
Lastly, in terms of antitrust, judicial precedence has always been what is in the interest of public good. It would be very difficult to argue that unchecked residency expansion is in the public interest, when shortage of docs in primary care etc, and tax payer dollars subsidize medschools and residencies.

Efforts to reduce residency spots could be challenged in court, but then Astro has to step up legally, just like they do with lobbyists when comes to protons or technical reimbursements, issues that again are secondary to supply and demand for most of us.
A lot of residency expansion came from large programs who provide Astro with much of their leadership. Leadership was advocating for hypofractionation/choose wisely while simultaneously expanding own programs. (edit- and I would argue that hypofractionation financially benefits some of these programs that have linacs at capacity by increasing throughput) This is where nastiness/bad faith starts.

 

[xrthopeful]

I agree with alot of what you say in reasons to be concerned, except point number 1 doesn't make much sense:

'1. The best analogy to account for the disconnect between "real life" [PGY5s report they are getting decent jobs] and "the internet" [established ROs like me spreading doom and gloom] is a person standing on train tracks with a train chugging towards her miles away. The train will eventually hit and it won't be pretty, but there is time before it hits.'

whether that are PGY5s or the established ROs, they're both people on the traintracks seeing the train coming. Neither have gotten hit yet. That does not explain the disconnect.

I think point number 4 is the huge one though.

Also, I have no problem with ASTRO continuing to fight for technical reimbursement rate, that helps everyone in the field. I don't know why you do, Ricky Scott.

 

[RickyScott]

I agree with alot of what you say in reasons to be concerned, except point number 1 doesn't make much sense:

'1. The best analogy to account for the disconnect between "real life" [PGY5s report they are getting decent jobs] and "the internet" [established ROs like me spreading doom and gloom] is a person standing on train tracks with a train chugging towards her miles away. The train will eventually hit and it won't be pretty, but there is time before it hits.'

whether that are PGY5s or the established ROs, they're both people on the traintracks seeing the train coming. Neither have gotten hit yet. That does not explain the disconnect.

I think point number 4 is the huge one though.

Also, I have no problem with ASTRO continuing to fight for technical reimbursement rate, that helps everyone in the field. I don't know why you do, Ricky Scott.

Neither have gotten hit? Locums salaries over past 10 years, moderator on this board posting about residents having to do locums, nonavailabilty of jobs for years where I practice. No mobility of junior faculty which used to be common.

Technical feels doubling or being cut 10% don’t really affect me or most us as much as supply and demand of docs. If hospital wanted to treat me like s—- they could, because you would want my job if I left.

 

[xrthopeful]

Neither have gotten hit? Locums salaries over past 10 years, moderator on this board posting about residents having to do locums, nonavailabilty of jobs for years where I practice. No mobility of junior faculty which used to be common.

Technical feels doubling or being cut 10% don’t really affect me or most us as much as supply and demand of docs. If hospital wanted to treat me like s—- they could, because you would want my job if I left.

Okay then both have gotten hit?

Again the analogy doesn’t make sense and doesn’t answer why there’s a
Disconnect

 

[radoncradonc]

I was a resident that just graduated this July, and I would like to share my experience with the job search. I started out wanting to apply for a job in a mid to large size city, but I did not get any interview offers. So I started to apply for small towns and rural places like the ones advertised by recruiters. That's how I got my first interview and offer, but I still wanted to live in a mid to large town within drivable distance (3-4 hours) to my or my wife's home state so I played the delay game with that rural offer. Guess what, that rural offer was filled in about 2 weeks. I then could not get any additional interviews until spring and close to graduation. I had to do some serious calling to recruiters and beg for interviews. Eventually I got one offer in a small town two plane rides from either my home state or my wife's, and the salary is in the mid 200s (about 100K lower than my first job offer). My job search was horrible and I lost weight stressing about not having employment after graduation. My advice for residents looking for jobs is to accept the first decent offer you get. Employers will low ball you once they know you are desperate as it gets close to graduation. I don't know how people are still getting good jobs because the other residents that I know have similar experiences as I. The miserable likes to co-miserate I guess. Just an FYI, my IM friend got offered 280K in a similar sized town/state as I. Our med onc fellows got offered 425K in a large metro popular with tourists. Med students wanting to go into rad onc at this moment must be crazy.

 

[xrthopeful]

Thanks for posting your story, sorry to hear that. I would continue to look in your shoes and take a job for someone who is looking now.

 

[deleted956486]

I was a resident that just graduated this July, and I would like to share my experience with the job search. I started out wanting to apply for a job in a mid to large size city, but I did not get any interview offers. So I started to apply for small towns and rural places like the ones advertised by recruiters. That's how I got my first interview and offer, but I still wanted to live in a mid to large town within drivable distance (3-4 hours) to my or my wife's home state so I played the delay game with that rural offer. Guess what, that rural offer was filled in about 2 weeks. I then could not get any additional interviews until spring and close to graduation. I had to do some serious calling to recruiters and beg for interviews. Eventually I got one offer in a small town two plane rides from either my home state or my wife's, and the salary is in the mid 200s (about 100K lower than my first job offer). My job search was horrible and I lost weight stressing about not having employment after graduation. My advice for residents looking for jobs is to accept the first decent offer you get. Employers will low ball you once they know you are desperate as it gets close to graduation. I don't know how people are still getting good jobs because the other residents that I know have similar experiences as I. The miserable likes to co-miserate I guess. Just an FYI, my IM friend got offered 280K in a similar sized town/state as I. Our med onc fellows got offered 425K in a large metro popular with tourists. Med students wanting to go into rad onc at this moment must be crazy.

My experience as well to the T. Except ended up breaking up my family at the end :-(

 

[deleted573262]

I was a resident that just graduated this July, and I would like to share my experience with the job search. I started out wanting to apply for a job in a mid to large size city, but I did not get any interview offers. So I started to apply for small towns and rural places like the ones advertised by recruiters. That's how I got my first interview and offer, but I still wanted to live in a mid to large town within drivable distance (3-4 hours) to my or my wife's home state so I played the delay game with that rural offer. Guess what, that rural offer was filled in about 2 weeks. I then could not get any additional interviews until spring and close to graduation. I had to do some serious calling to recruiters and beg for interviews. Eventually I got one offer in a small town two plane rides from either my home state or my wife's, and the salary is in the mid 200s (about 100K lower than my first job offer). My job search was horrible and I lost weight stressing about not having employment after graduation. My advice for residents looking for jobs is to accept the first decent offer you get. Employers will low ball you once they know you are desperate as it gets close to graduation. I don't know how people are still getting good jobs because the other residents that I know have similar experiences as I. The miserable likes to co-miserate I guess. Just an FYI, my IM friend got offered 280K in a similar sized town/state as I. Our med onc fellows got offered 425K in a large metro popular with tourists. Med students wanting to go into rad onc at this moment must be crazy.

The residents at my program had a similar experience this year..

 

[scarbrtj]

I was a resident that just graduated this July, and I would like to share my experience with the job search. I started out wanting to apply for a job in a mid to large size city, but I did not get any interview offers. So I started to apply for small towns and rural places like the ones advertised by recruiters. That's how I got my first interview and offer, but I still wanted to live in a mid to large town within drivable distance (3-4 hours) to my or my wife's home state so I played the delay game with that rural offer. Guess what, that rural offer was filled in about 2 weeks. I then could not get any additional interviews until spring and close to graduation. I had to do some serious calling to recruiters and beg for interviews. Eventually I got one offer in a small town two plane rides from either my home state or my wife's, and the salary is in the mid 200s (about 100K lower than my first job offer). My job search was horrible and I lost weight stressing about not having employment after graduation. My advice for residents looking for jobs is to accept the first decent offer you get. Employers will low ball you once they know you are desperate as it gets close to graduation. I don't know how people are still getting good jobs because the other residents that I know have similar experiences as I. The miserable likes to co-miserate I guess. Just an FYI, my IM friend got offered 280K in a similar sized town/state as I. Our med onc fellows got offered 425K in a large metro popular with tourists. Med students wanting to go into rad onc at this moment must be crazy.

You get a reasonable offer, even if it's in an unreasonable place, take it. Use that first year or two out of residency to angle for a better job. The sad fact is, some people aren't getting offers. So getting offer at all means you're lucky-ish. In this job market, a person with a job offer is like a one-eyed man in the land of the blind: a king.

 

[taserlaser]

That’s a good point with regards to gender equity in medicine. And very depressing to hear more stories about the state of the market now. If this is the case for this year’s class, my speculation is that either next year’s class is only 50% employed, and/or 200k starting. Gulp.

I hope the current R2-4’s are paying attention and evaluating their options critically.

 

[PointA]

How's this for cognitive dissonance: The chairs/ PDs at these programs will go around saying, "All of our residents have gotten jobs! some private, some academic, and in different parts of the country!"

 

[RickyScott]

My experience as well to the T. Except ended up breaking up my family at the end :-(

This stuff is truly outrageous. There is hypocritical virtue signalling on twitter, pretending to be concerned about minorities and women, trying to lure them into this. I hope XRThopeful now has his answer about the disconnect: many junior faculty or residents dont want to risk anything, by lamenting the state of the field to a medstudent.

 

[bluebubbles]

I'm not at the job search process quite yet, but these accounts scare me. I have a significant other dedicated to her career, with income potential equal to or potentially far greater than rad onc. My advice to med students would be to give thought to the flexibility of your SO/spouse's job. Also, if I hadn't done rad onc, I would've either done med onc, given my love of cancer biology, or bailed on medicine entirely, given the nature of healthcare these days.

 

[medgator]

Also, I have no problem with ASTRO continuing to fight for technical reimbursement rate, that helps everyone in the field. I don't know why you do, Ricky Scott.

You weren't in RO yet when ASTRO let freestanding centers take the bulk of the cuts for many years. They also spent years on a vendetta against urorads setups long after that ship had sailed, also hurting the freestanding /pp community

 

[medgator]

I'm not at the job search process quite yet, but these accounts scare me. I have a significant other dedicated to her career, with income potential equal to or potentially far greater than rad onc. My advice to med students would be to give thought to the flexibility of your SO/spouse's job. Also, if I hadn't done rad onc, I would've either done med onc, given my love of cancer biology, or bailed on medicine entirely, given the nature of healthcare these days.

My SO took a hit, changing jobs several times for me. Even now, she is not in an ideal place for her specialty but she is able to do PT work which actually worked out well from a family management perspective, understanding that my job is pretty good and secure.

I can't even imagine how hard it can be now for physician specialists now with one doing RO.

 

[xrthopeful]

Also a lesson to people coming from programs where people are having trouble - start out by applying everywhere. If you start by limiting yourself to bigger metros, you are really hurting yourself. By the time this poster realized he wasn’t getting interviews, a lot of jobs were likely gone. You have to be self aware about yourself and your program. Apply everywhere!

You weren't in RO yet when ASTRO let freestanding centers take the bulk of the cuts for the years. They also spent years on a vendetta against urorads setups long after that ship had sailed, also hurting the freestanding /pp community

That may be, but I still see nothing bad about them fighting to keep technical reimbursements high now. RickyScott somehow doesn’t see how that helps everyone. He keeps repeating ad nauseum about hospitals. He’s ignoring two big things:

1) some places are still free-standing and many ROs take part in that technical money.

2) probably more applicable for most - IF your hospital makes less technical money off of your backs - they obviously have less financial incentive to pay you a high salary because you are worth less to them.

It’s simple logic.

 

[medgator]

Also a lesson to people coming from programs where people are having trouble - start out by applying everywhere. If you start by


That may be, but I still see nothing bad about them fighting to keep technical reimbursements high now. RickyScott somehow doesn’t see how that helps everyone. He keeps repeating ad nauseum about hospitals. He’s ignoring two big things:

1) some places are still free-standing and many ROs take part in that technical money.

2) probably more applicable for most - IF your hospital makes less technical money off of your backs - they obviously have less financial incentive to pay you a high salary because you are worth less to them.

It’s simple logic.

Hard to keep technical reimbursements high when you are doing less radiation on the whole. Also doesn't help most of us when ASTRO fights for protons, and many would argue that it hurts the rest of us as CMS likely views RO spending as a zero sum game.

ROs who still participate in technical revenue of some kind are like unicorns these days. Do you personally know someone who graduated in the last decade who's a technical partner in their practice?

 

[xrthopeful]

Hard to keep technical reimbursements high when you are doing less radiation on the whole. Also doesn't help most of us when ASTRO fights for protons, and many would argue that it hurts the rest of us as CMS likely views RO spending as a zero sum game.

ROs who still participate in technical revenue of some kind are like unicorns these days. Do you personally know someone who graduated in the last decade who's a technical partner in their practice?

Yes I do know someone collecting technical who graduated in the last three years.

Also, listen, this isn’t a case where you need to pick out of a hat and go to one of your three points. Proton and hypofrac are not really relevant here lol. This isn’t hard, man. ASTRO lobbying for reimbursement - both technical and professional, is good for everyone. Why are you arguing this, I know you don’t disagree.

 

[medgator]

By the time this poster realized he wasn’t getting interviews, a lot of jobs were likely gone. You have to be self aware about yourself and your program. Apply everywhere!

Do you think that's a sign of a healthy job market from a resident's perspective?

 

[xrthopeful]

Do you think that's a sign of a healthy job market from a resident's perspective?

For that resident of course not!

I also think that resident (now grad) should continue the hunt. He or she owes nothing to anyone.

Two flights away from where you need to be sounds like it could be anywhere, most places are two flights away. Try one of these non-desirable places, you still may be far away but at least you’ll be making more.

Radiation Oncology Jobs | Nationwide

Radiation Oncology Jobs | Nationwide

www.practicelink.com

 

[medgator]

ASTRO lobbying for reimbursement - both technical and professional, is good for everyone. Why are you arguing this, I know you don’t disagree.

If only technical reimbursement was so simple. Btw, do you know came up with ideas like bundled payments and site neutrality and why?

I'll give you hint: not ASTRO

 

[medgator]

For that resident of course not!

Sounds like he /she isn't unique in that situation, based on other posts we are seeing from PDs and other resident applicants

 

[xrthopeful]

If only technical reimbursement was so simple. Btw, do you know came up with ideas like bundled payments and site neutrality and why?

I'll give you hint: not ASTRO

Okay listen you have some issue with ASTRO. I really don’t care either way about ASTRO. Some day I really would hope you share the backstory you have with them with us.

I don’t really care who or what is doing it, but anyone that fights for our reimbursement is good in my book.


This isn’t hard.

 

[xrthopeful]

For that resident of course not!

I also think that resident (now grad) should continue the hunt. He or she owes nothing to anyone.

Two flights away from where you need to be sounds like it could be anywhere, most places are two flights away. Try one of these non-desirable places, you still may be far away but at least you’ll be making more.

Radiation Oncology Jobs | Nationwide

Radiation Oncology Jobs | Nationwide

www.practicelink.com

 

[Reaganite]

You weren't in RO yet when ASTRO let freestanding centers take the bulk of the cuts for many years. They also spent years on a vendetta against urorads setups long after that ship had sailed, also hurting the freestanding /pp community

They spent yearsssss bashing urorads; meanwhile, a blind eye was turned to the hospitals and academic centers gobbling up the other practices, especially med onc, that refer to us. The hypocrisy is unbelievable. I once had a hospital complain to a local insurer about ONE group we had partnered with even as said hospital had literally purchased half the referring practices in the area. ASTRO does not support PP.

 

[scarbrtj]

You weren't in RO yet when ASTRO let freestanding centers take the bulk of the cuts for many years. They also spent years on a vendetta against urorads setups long after that ship had sailed, also hurting the freestanding /pp community

In reality and in retrospect urologists adding to the number of RO jobs in the US woulda been a good thing. Hopefully, if and it’s a big if that RO’s in future will be looking at cardiac dysrhythmia indications, there will not be same such petty animosity toward cardiology and RO trying to partner.

 

[scarbrtj]

ASTRO fights for reimbursement?
IMRT reimbursement has kinda gone off a cliff relative to where it started. Then there were randomized trials proving IMRT was good for RO’s main indication. ASTRO then said “IMRT bad for breast.” Then rad oncs got with urologists to do some prostate IMRT. Then ASTRO essentially said the only reason those guys were doing IMRT was because $$$, and that they should cut it out. The advent of 77408 77338 was another thing that ASTRO approved but yet hurt reimbursement. It let daily 77014-TC vanish from the hospital without much of fight. ASTRO fights for reimbursement increases like a person who urinates on another person’s head tells that person “I am trying to give you some rain.”

 

[medgator]

Then rad oncs got with urologists to do some prostate IMRT. Then ASTRO essentially said the only reason those guys were doing IMRT was because $$$, and that they should cut it out.

ASTRO PAC email bombed everyone for a few years about the urorads issue. Then not long after, ASTRO mentioned a proposal to split the imrt planning charge into "simple" (breast/prostate) vs "complex" as another way to try and screw urorads setups. Didn't go anywhere that year, but it did give great insight into ASTROs priorities as the leading organization of our field.

I guess ASTRO would rather have urologists continue to cut and cryo instead?

 

[deleted18755]

That’s a good point with regards to gender equity in medicine. And very depressing to hear more stories about the state of the market now. If this is the case for this year’s class, my speculation is that either next year’s class is only 50% employed, and/or 200k starting. Gulp.

I hope the current R2-4’s are paying attention and evaluating their options critically.

You're welcome to your opinion but come one guys please don't exaggerate (it kind of de-legitimizes the entire thread a bit). Even those who are on the "doom and gloom" spectrum of the future outlook think things are still very good right now, and it will be worse in the future but not THAT bad next year or within the next few years. Those who really need to be cautious are medical students looking into this field and entering the workforce 7-10 years from now.

Along those lines, I really don't think 50% of the graduating residents will be "unemployed, and/or 200k starting" even within the next 5-10 years . . . but then again at least a few people are claiming that they are taking jobs in places they don't want to be making well under 300k even this year so what do I know?

Here is some dissonance I don't understand and I bet I'm not the only one who is a little skeptical and/or confused:

There are definitely at least a few jobs in relatively "undesirable" places where people are making incredible salaries in very nice practices (I know this from personal experience and there appear to be such jobs posted as well). If that's the case, why are any graduating residents taking jobs that pay poorly that are "two plane rides" away when they could take one of these jobs (two plane rides covers a whole lot of even this huge, beautiful country?). I understand if one is stuck in a particular city due to family constraints and have to take any job they can, but if one is taking a job that pays poorly and still living far from their desired area, why not take one of these jobs that is likewise far away from where one wants to be but at least pays well in a solid practice? Please help us understand.

Others are posting that newly graduating medical oncology fellows are being recruited to nice practices in their desired location for impressive salaries. I can actually personally verify this (n=only 2-3 though) . . . anybody know why the compensation for medical oncology appears to be great and even increasing?

 

[medgator]

. I can actually personally verify this (n=only 2-3 though) . . . anybody know why the compensation for medical oncology appears to be great and even increasing?

More drugs being given.

Just consider the recent changes in stage III lung, now all of those pts get a year of imfinzi. MOs make money when drug is given. That's a huge new indication for them.

Immunotherapy is replacing chemo in certain stage IV nsclc pts as well. And as immunotherapy has improved OS in places like RCC and melanoma , pts are alive longer to get..... More immunotherapy as maintenence

 

[gmsquid]

One thing I will say to all of this is that as an organization, Astro is dominated by academics but not because they do not solicit community membership for their committees. Increased pp participation in the organization may benefit the field as a whole.

 

[w00tz]

I still can't believe that approximately 10 years ago when I was applying for a residency position, this was one of the most competitive fields to get into. Now people can just fall into unfilled residency slots is still insane to me.

Back to post- I likely would have done either IR or DR.

Definitely feels like a pump and dump scheme. Wolf of Wall Street'd. Bitcoin? Basically feel scammed.

 

[radoncgrad2019]

If anyone entered this field expecting millions a year like Reaganite and Scarb earn(ed), then yeah that sucks. I can see how you feel scammed.

 

[medgator]

If anyone entered this field expecting millions a year like Reaganite and Scarb earn(ed), then yeah that sucks. I can see how you feel scammed.

Yup. Everything is great. Everyone is getting jobs, all 190-200 them/year. Go long RO!!!

Tbh, no one has actually posited that as a problem, but thanks for trolling

 

[deleted18755]

More drugs being given.

Just consider the recent changes in stage III lung, now all of those pts get a year of imfinzi. MOs make money when drug is given. That's a huge new indication for them.

Immunotherapy is replacing chemo in certain stage IV nsclc pts as well. And as immunotherapy has improved OS in places like RCC and melanoma , pts are alive longer to get..... More immunotherapy as maintenence

That's the obvious answer but it's really impressive (in my limited experience) how quickly their starting salary has increased. On the other hand, you are totally correct . . . immunotherapy and targeted agents weren't even a thing not that long ago and between increased indications and marketing they are everywhere (am I the only one who sees patients with something like DCIS who come in questioning why their medical oncologist won't give them Keytruda or other immunotherapies they can name since they have seen so many advertisements?)

 

[scarbrtj]

More drugs being given.

Just consider the recent changes in stage III lung, now all of those pts get a year of imfinzi. MOs make money when drug is given. That's a huge new indication for them.

Immunotherapy is replacing chemo in certain stage IV nsclc pts as well. And as immunotherapy has improved OS in places like RCC and melanoma , pts are alive longer to get..... More immunotherapy as maintenence

“What do you mean you guys give less and less treatments as the years go by?”
- med onc, to rad onc

 

[xrthopeful]

They've also studied giving less (no) chemo to breast cancer patients (bread and butter) in last year's TailoRx NEJM Breast Cancer Study.

(before someone comes in and says rad oncs are the only ones who look at treatment de-escalation)

 

[medgator]

They've also studied giving less (no) chemo to breast cancer patients (bread and butter) in last year's TailoRx NEJM Breast Cancer Study.

Low margin AC/TC being replaced by high margin perjeta, ibrance, adjuvant neratinib etc. Not to mention the immunotherapy examples above which are essentially new indications and pts stay under treatment for a long time