medstudents entering the match

[deleted941485]

Yup.... Biggest risk are the professional groups at existing hospitals where the hospital partners up with a nearby academic center

Once an academic medical center gets a hold of you. Forget it. If your PC PP group is in the mix, you might as well just send them your CV make it easier for them to find you. It’s game over.

Only in Rad Onc is this acceptable. You literally get one employer in town and if you don’t like it sorry gonna have to move across country.

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Members don't see this ad.

 

[medgator]

Shift from private practice to academic hubs: Radiation oncologists also are shifting from working primarily in private practice to treating patients at academic centers and hospitals. The 2017 survey marks the first time that fewer than half of these doctors work in private practice (38 percent), with 41 percent practicing at academic/university centers and 17 percent at non-academic hospitals.

Been going for years, RO is no different than most of the other specialties. We are just getting extra screwed thanks to residency expansion

Employed physicians outnumber self-employed physicians for 1st time in U.S.

Self-employed physician numbers continue to decrease as a new American Medical Association study shows employed physicians outnumber self-employed physicians for the first time in U.S. history.

www.beckersasc.com

Hospital-employed physicians less satisfied with work than independent physicians, survey finds

Independent physicians and those working in physician-owned practices tend to be happier with work than hospital-employed physicians, according to a survey from Geneia, a provider of healthcare data, technology, business and education solutions.

www.beckershospitalreview.com

 

[deleted941485]

So this takeover isn't limited to rural/far suburbia locations but is also happening in metro areas?

Are kidding, metro areas have been toast for a while. The only ones left are at ****ty hospitals that no one wants to work at. The boonies are the last bastion and guess what academic centers are building right next to them and not even partnering with them anymore. They just suck your patients away.

Oh also, they don’t want you working at any sites that are near any type of civilization they want you driving an hour each way to some far flung place for years and they’ll string you along with the prospect of better pay or a promotion but it never comes.

 

[VivaElBirdos]

I see, so the issues are a lot deeper than just a "bad job market." All the income upside of the specialty is getting slashed. I kind of figured if I got into a top residency, I could get a good job and still make good money with equity but sounds like things are changing.

 

[deleted941485]

I see, so the issues are a lot deeper than just a "bad job market." All the income upside of the specialty is getting slashed. I kind of figured if I got into a top residency, I could get a good job and still make good money with equity but sounds like things are changing.

Dude...that’s all dead. You’re about 10 years late to the party. It ended. All that upside is gone and is now being distributed amongst the admin of the mega health systems. You’ll never see it again.

Medicine is changing for the worst and Rad Onc is just extremely poorly positioned.

Don’t even give this **** a second thought.

 

[xrthopeful]

Been going for years, RO is no different than most of other specialties

Employed physicians outnumber self-employed physicians for 1st time in U.S.

Self-employed physician numbers continue to decrease as a new American Medical Association study shows employed physicians outnumber self-employed physicians for the first time in U.S. history.

www.beckersasc.com

Hospital-employed physicians less satisfied with work than independent physicians, survey finds

Independent physicians and those working in physician-owned practices tend to be happier with work than hospital-employed physicians, according to a survey from Geneia, a provider of healthcare data, technology, business and education solutions.

www.beckershospitalreview.com

The corporitization of medicine changed the game in so many ways

 

[medgator]

The corporitization of medicine changed the game in so many ways

Sure, but on top of that we have the double whammy of greedy academic RO residency expansion to contend with, unlike derm, uro, Ortho etc.

As otn alluded to earlier, you can't just hang a shingle and start an RO practice

 

[deleted941485]

Plus with the instability in Washington it’s anybodies guess what happens next. All those mgma numbers or the salary figures that students use you know the make “informed” decisions are BS. You need to whack like 20-40% of those numbers. And all this so called “demand” is gonna evaporate real quick.

 

[deleted956486]

Sure, but on top of that we have the double whammy of greedy academic RO residency expansion to contend with, unlike derm, uro, Ortho etc

What we see in RO has little to do with the "corporitization" of medicine. It is a result of greedy academic chairs and the fact that there is so much overhead in RO (i.e competing with what has effectively become government funded departments becomes risky). Regardless, all that is moot/semantics for medical students. Psychiatry, heme/onc, IM, optho, Uro, all have better outlooks and are stronger fields.

 

[deleted941485]

What we see in RO has little to do with the "corporitization" of medicine. It is a result of greedy academic chairs and the fact that there is so much overhead in RO (i.e competing with what has effectively become government funded departments becomes risky). Regardless, all that is moot/semantics for medical students. Psychiatry, heme/onc, IM, optho, Uro, all have better outlooks and are stronger fields.

Those fields are for the most part better able to weather the **** storm.

And would advise prudent medical students to strongly consider them.

 

[medgator]

What we see in RO has little to do with the "corporitization" of medicine. It is a result of greedy academic chairs and the fact that there is so much overhead in RO (i.e competing with what has effectively become government funded departments becomes risky). Regardless, all that is moot/semantics for medical students. Psychiatry, heme/onc, IM, optho, Uro, all have better outlooks and are stronger fields.

Psych has pretty much done a 180 compared to the last decade when fmgs could walk into psych and the cream of the crop was matching into ro. Now it is reversed

 

[deleted956486]

Those fields are for the most part better able to weather the **** storm.

And would advise prudent medical students to strongly consider them.

Plus less "buy-in." A five year residency?? For what? Smh, this was a scheme from the start. At least in heme onc, there is always IM to fall back on. Don want to do surgery anymore? Thats ok in Urology, you can fall back on non-surgical management. Ditto for psych, ophtho...i couId go on, but i could also be searching for a second career so...

 

[deleted941485]

Plus less "buy-in." A five year residency?? For what? Smh, this was a scheme from the start. At least in heme onc, there is always IM to fall back on. Don want to do surgery anymore? Thats ok in Urology, you can fall back on non-surgical management. Ditto for psych, ophtho...i couId go on, but i could also be searching for a second career so...

Not many skills outside of RT we can draw on. I always thought a fellowship in heme/Onc would be a nice out even if they allows ROs to do it.

OH BUT THE HOLY HELL THAT RAISED with people here and in Med Onc you’d think that I proposed that mid levels should be allowed manage all oncology patients from start to finish.

 

[VivaElBirdos]

I saw it discussed a couple years ago but haven't recently seen anything. Is there any chance RO could get their hands in interventional oncology?

 

[RickyScott]

This is a complete pipe dream. IR would never give that up.

Just want to point out now that trump is poised to nominate steve Hahn for fda commisioner- isn’t he also a medonc?

 

[deleted941485]

I saw it discussed a couple years ago but haven't recently seen anything. Is there any chance RO could get their hands in interventional oncology?

I wouldn’t bet a budding medstudent career on that one. Unless I didn’t like them.

 

[OTN]

I would consider our group to be a very good private group, and we are located in both very rural and very urban areas. While we do face competition from other pp groups, Hospital corporations, and academic programs, we have been able to succeed. The RO APM will, of course, be a challenge, but per our payers we cost 1/5th that of the large academic center with which we compete, with equivalent outcomes. As a result, I think we will be decently well-positioned compared to more costly operations.

The day of the small radonc practice was becoming numbered when I left training 10 years ago, and that was somewhat due to the incoming cost of IMRT/IGRT/SRS/SBRT/4DCT/HDR etc. Look at all those acronyms, whew. Remember that they weren’t necessarily mainstream 10 years ago, and the equipment cost to be able to provide them is high. I trained at a progressive institution and knew what was coming. With larger practices comes increased purchasing power with respect to radiation hardware and software and ability to market enough to compete with larger systems. Helps on the “negotiating with payers” side of things too.

There are plenty of examples of smaller practices that disprove what I said above, no doubt. Many of very good radiation oncologists provide very good care at small practices and are doing well, but at least in our market it’s become tougher for them to compete.

So, in conclusion to the rant, there are private practices that are doing well, are competing well, and look forward to continued success. They will hire people at some point, there will be pp jobs available, just as there have been.

However, the number of them has dropped a little (smaller practices either selling or -in our market this happened- simply closing as the guy retired), while the number of trainees has doubled. Math. Just a simple math issue.

Not everyone wants to work in academics, and that’s ok. So, if it’s becoming much more difficult to get a good pp radonc job, you’re naturally going to have a lot of people who are no longer going to be interested in the specialty. Shame, though, because I know several practicing radoncs in academics from my era who started thinking private practice and changed their minds.

It’s also a shame because I really do enjoy being a radiation oncologist and think our future is bright. (Granted, I just heard Bob Timmerman talk, which definitely helps.) I want good medical students to be interested in the field, because I also think from a “being a clinician” standpoint it’s just fantastic. Additionally, Bob Timmerman has shown what kind of impact you can have as a clinical academic, and I know of several lab-based MD/PhDs who are doing great work. However, until a good balance of number of trainees vs diverse job opportunities is found, I can’t blame anyone for thinking twice.

 

[Mandelin Rain]

I think large yet nimble PP groups are well positioned to ride this out. Particularly those away from the coasts. APM WILL reduce reimbursement making building/acquiring rad onc centers less desirable. Additionally, if parity of reimbursement ever becomes a reality, I think we'll see the exact opposite trend. Academics pulling out of satellites and retreating back to the main campus. Honestly, that is probably the best thing that can happen for the future of this field. Allow the academics to focus on innovation rather than profits. Let the PP guy actually treat patients. APM stems the opportunity for abuse on both sides.

 

[deleted956486]

Honestly, that is probably the best thing that can happen for the future of this field. Allow the academics to focus on innovation rather than profits. Let the PP guy actually treat patients. APM stems the opportunity for abuse on both sides.

Exactly

 

[Mandelin Rain]

 

[medgator]

I love my "specialty" too. Doesn't mean med students who elect to pursue RO residency are going to ever get anything close to my actual "job" when they finish training in RO.

 

[Mandelin Rain]

MD Anderson has 7 spots to fill this year.

 

[thecarbonionangle]

There are still excellent large private groups with clear partnership tracks out there. I interviewed at multiple of these places. These may not be in the coasts and “desirable” areas but very decent midsized cities. No way to know how many of these jobs will be available when you graduate as much of it is timimg (partner retiring or moving, growth in volume).

I am thankful i do not care about being in “desirable” areas as this opened up signigicantly my pp and academic possibilities.

 

[thecarbonionangle]

I love my "specialty" too. Doesn't mean med students who elect to pursue RO residency are going to ever get anything close to my actual "job" when they finish training in RO.

Also the experience at the Mecca for RO is vastly different than the majority of residencies. You don’t go into rad onc cause one of their grads appeared to have had a great time and stayed on as faculty.

 

[thecarbonionangle]

MD Anderson has 7 spots to fill this year.

Will have no problem filling, guaranteed!

 

[medgator]

Also the experience at the Mecca for RO is vastly different than the majority of residencies. You don’t go into rad onc cause one of their grads appeared to have had a great time and stayed on as faculty.

Someone should ask her how she likes her "actual job", whether she feels valued for the work that she does and whether she gets protected research time

 

[thecarbonionangle]

Someone should ask her how she likes her "actual job" and whether she feels valued for the work that she does and whether her she gets protected research time

Sniff sniff! You may be onto something there brotha!

 

[Mandelin Rain]

The writer and institution are incident to my surprise on seeing (any) rad onc faculty trying to sell rad onc residency to med students. Let alone an MD Anderson faculty. That wasn't really the case 10, 5, 2-years ago. Apps must be WAY down.

 

[medgator]

The writer and institution are incident to my surprise on seeing (any) rad onc faculty trying to sell rad onc residency to med students. Let alone an MD Anderson faculty. That wasn't really the case 10, 5, 2-years ago. Apps must be WAY down.

Surprised no ranting so far about SDN this week in the radonc Twitter bubble

 

[scarbrtj]

Great tweet. Give her much more credit for being a marathoner than a pragmatist. "Perfect balance of multidisciplinary collaboration"... sometimes reality hits you hard bro.

 

[OTN]

Should I reply and begin a conversation about how MDA docs talk trash about their pp competition, often outright lying about us and what we can deliver in order to convince patients to live in Houston for weeks on end for no reason? I could bring up the time one of her colleagues (VERY well-known on Twitter) told a patient of mine I "wouldn't be able to spare her heart" the way he would with radiation, so I called him up to have a little dialogue about it. Did he admit to what he said? No, no he did not.

I could also talk about how one of my patients with a thymoma was told she absolutely HAD to have protons at MDA, so she uprooted herself and part of her family to Houston for 5 weeks, only to be told on arrival that she was actually going to be getting IMRT and IGRT, which could have been done locally? Should I talk about how we all know MDA is going to continue to expand into communities in which they are NOT needed, threatening the livelihoods of practicing oncologists?

Maybe I can conclude with how MDA specifically states their mission is NOT to take care of the underprivileged in their state, so they leave it up to pp oncologists to pick up the slack.

The sad thing is, I agree with her statement about radonc and why it's great. I would love for there to still be great opportunities for graduating residents to have the same job/life I do. However, due to actions of departments like hers, that's becoming increasingly rare.

 

[scarbrtj]

Should I reply and begin a conversation about how MDA docs talk trash about their pp competition, often outright lying about us and what we can deliver in order to convince patients to live in Houston for weeks on end for no reason? I could bring up the time one of her colleagues (VERY well-known on Twitter) told a patient of mine I "wouldn't be able to spare her heart" the way he would with radiation, so I called him up to have a little dialogue about it. Did he admit to what he said? No, no he did not.

I could also talk about how one of my patients with a thymoma was told she absolutely HAD to have protons at MDA, so she uprooted herself and part of her family to Houston for 5 weeks, only to be told on arrival that she was actually going to be getting IMRT and IGRT, which could have been done locally? Should I talk about how we all know MDA is going to continue to expand into communities in which they are NOT needed, threatening the livelihoods of practicing oncologists?

Maybe I can conclude with how MDA specifically states their mission is NOT to take care of the underprivileged in their state, so they leave it up to pp oncologists to pick up the slack.

The sad thing is, I agree with her statement about radonc and why it's great. I would love for there to still be great opportunities for graduating residents to have the same job/life I do. However, due to actions of departments like hers, that's becoming increasingly rare.

Yuck.

 

[Mandelin Rain]

I think I would just leave her alone. I'm sorry I linked it because the discussion has been more about her/the institution rather than the content, which I personally found to be interesting and perhaps revealing to the state of med student applications.

 

[OTN]

I think I would just leave her alone. I'm sorry I linked it because the discussion has been more about her/the institution rather than the content, which I personally found to be interesting and perhaps revealing to the state of med student applications.

I don't have any beef with her whatsoever and like I said, I agree with her statement.

I don't like, though, how the docs at academic institutions somehow get to be disassociated from the actions of those institutions or their own colleagues. They get to write the Choose Wisely campaigns while simultaneously advertising protons for prostate cancer in my town. It's completely disingenuous and I think it is fair to be able to hold physicians in part responsible for the actions of their institution, especially when those actions have directly caused the crisis we now face.

 

[baculum1]

Should I reply and begin a conversation about how MDA docs talk trash about their pp competition, often outright lying about us and what we can deliver in order to convince patients to live in Houston for weeks on end for no reason? I could bring up the time one of her colleagues (VERY well-known on Twitter) told a patient of mine I "wouldn't be able to spare her heart" the way he would with radiation, so I called him up to have a little dialogue about it. Did he admit to what he said? No, no he did not.

I could also talk about how one of my patients with a thymoma was told she absolutely HAD to have protons at MDA, so she uprooted herself and part of her family to Houston for 5 weeks, only to be told on arrival that she was actually going to be getting IMRT and IGRT, which could have been done locally? Should I talk about how we all know MDA is going to continue to expand into communities in which they are NOT needed, threatening the livelihoods of practicing oncologists?

Maybe I can conclude with how MDA specifically states their mission is NOT to take care of the underprivileged in their state, so they leave it up to pp oncologists to pick up the slack.

The sad thing is, I agree with her statement about radonc and why it's great. I would love for there to still be great opportunities for graduating residents to have the same job/life I do. However, due to actions of departments like hers, that's becoming increasingly rare.

The majority of the charity XRT in Houston is done in the county hospitals which is staffed by BCM.

 

[APath2CR]

This. It is becoming wham-bam-thank-you-ma'am. Truly feel like a technician. I know it's right to HF and it is even better for certain things, but it has attenuated the long term care aspect of radonc. Thank you for putting it in those words. I've been feeling 'something' and that is it.

The longevity of the patient relationship doesn’t end at treatment completion. If you follow them regularly and indefinitely in many cases, the rad onc will still see patients quite a bit- as much or more than the pcp in some cases. Also rad oncs have plenty of time with the patient (1 hr consult, 30 min fu). More time than many of our colleagues get unfortunately. This is all present even in the hypofX setting.

 

[medgator]

The longevity of the patient relationship doesn’t end at treatment completion. If you follow them regularly and indefinitely in many cases, the rad onc will still see patients quite a bit- as much or more than the pcp in some cases. Also rad oncs have plenty of time with the patient (1 hr consult, 30 min fu). More time than many of our colleagues get unfortunately. This is all present even in the hypofX setting.

I've treated second and third separate malignancies in patients I've been following up since I've been in practice.... H&n getting prostate ca, Stage III lung getting sbrt for new primary etc.

I generally let my breast pts fu with med onc or surgery, but sometimes I end up being the one to follow them, if they have ER- dcis, or refuse AI etc and don't want to go back to their surgeon

 

[medgator]

The majority of the charity XRT in Houston is done in the county hospitals which is staffed by BCM.

Seems to be par for the course for many NCI designated cancer centers that I've seen. Most don't participate with medicaid leaving us private folks to take of them

 

[deleted1002574]

The longevity of the patient relationship doesn’t end at treatment completion. If you follow them regularly and indefinitely in many cases, the rad onc will still see patients quite a bit- as much or more than the pcp in some cases. Also rad oncs have plenty of time with the patient (1 hr consult, 30 min fu). More time than many of our colleagues get unfortunately. This is all present even in the hypofX setting.

Thank you for that wisdom.

Perhaps maybe the point is that when you 'literally' used to treat patients for 33 (breast) or 44 (prostate) fractions, you see then for 6-9 on treatment visits, and if you work at single site, in the hallway and as they pass by your office many times and you exchange pleasantries and jokes. If you treat a prostate patient in 5 fractions, happen to be taking a couple days off that week, it's maybe a little different, or is that not apparent? If you worked in 2008 and prior and don't notice that difference, then we probably are talking past each other.

I think it's poor form to follow a stage I breast "regularly and indefinitely" in this era of increasing medical expenditures, <5% recurrence rates and very low toxicity when there are plenty of other people seeing them "regularly and indefinitely". But, that is up to individual physicians, I guess.

 

[Mandelin Rain]

The thing about the breast and prostate (and skin, and some rectal) OTVs is that there usually wasn't much of an agenda. They were doing well, needed nothing, and you could just talk with them. About anything. You got to know them as people beyond their disease. It broke up the day, which otherwise could be really heavy.

I agree about breast follow ups. Unless they want to continue to see me, I don't want them taking off work and paying a co-pay to come see me if I'm just glancing at their skin. I encourage the informal hallway hug follow up when they come to see their med onc or surgeon. Baked treats required.

 

[evilbooyaa]

I don't have any beef with her whatsoever and like I said, I agree with her statement.

I don't like, though, how the docs at academic institutions somehow get to be disassociated from the actions of those institutions or their own colleagues. They get to write the Choose Wisely campaigns while simultaneously advertising protons for prostate cancer in my town. It's completely disingenuous and I think it is fair to be able to hold physicians in part responsible for the actions of their institution, especially when those actions have directly caused the crisis we now face.

While I understand your frustrations with MDACC, Emma Holliday treats GI cancers and most divisions of MDACC (meaing sub-specialty specific Rad Onc departments) are bigger than 99% of regular Rad Onc departments. She is not somebody in a position of power and she 1) does not treat sites related to choosing wisely and 2) is not going to be putting prostate patients on protons.

Just because she works at MDACC does not mean she is part of the problem IMO.

I don't know her personally at all, just sayin'. Your frustration would be more reasonable if she was the chair, a breast rad onc, or a GU rad onc.

 

[medgator]

I don't know her personally at all, just sayin'. Your frustration would be more reasonable if she was the chair, a breast rad onc, or a GU rad onc.

It's still disingenuous to be a pollyanna about the field if you are in your own little niche and unaware of the bigger issues that are coming into play

 

[radonconogs]

Confirmed with PD (Doximity top 15 program) that applications are down ~25-30% this year. Usually see in the 180s and have around 140 applying. Ruh roh, Scooby...

 

[Neuronix]

I don't like, though, how the docs at academic institutions somehow get to be disassociated from the actions of those institutions or their own colleagues.

I'm just a pawn in this game trying to stay employed and get promoted. Even when I don't agree, the people who have the power usually don't want to hear it and aren't going to change anything just because I disagree with them.

 

[medgator]

I'm just a pawn in this game trying to stay employed and get promoted. Even when I don't agree, the people who have the power usually don't want to hear it and aren't going to change anything just because I disagree with them.

Fine but don't sit there and act kumbaya about the field either. Clearly applications to RO are being impacted and I'm guessing someone put her up to it, or maybe she is naive enough to think everything is still well

 

[evilbooyaa]

It's still disingenuous to be a pollyanna about the field if you are in your own little niche and unaware of the bigger issues that are coming into play

While I do feel that there are a multitude of issues with our field, there is not one piece of her tweet that I disagree with. I do love this specialty, because of the patient care, the cutting edge tech, and multidisciplinary collaboration.

And, I imagine that if you focus on just her tweet and not the projections one has about rad onc as a field, you would feel the same.

In my opinion, saying something positive about Rad Onc does not obligatorily make you a pollyanna (like the tweeter) just like saying something negative about Rad Onc does not obligatorily make you a cassandra (like a lot of SDN posters). There is something in-between the extremes, and until she has tweets that say "there is nothing wrong with the field of rad onc, why are apps so low??" I'm not going to put her in the same class of person as KO.

 

[medgator]

While I do feel that there are a multitude of issues with our field, there is not one piece of her tweet that I disagree with. I do love this specialty, because of the patient care, the cutting edge tech, and multidisciplinary collaboration.

And, I imagine that if you focus on just her tweet and not the projections one has about rad onc as a field, you would feel the same.

Saying something positive about Rad Onc does not obligatorily make you a pollyanna (like the tweeter) just like saying something negative about Rad Onc does not obligatorily make you a cassandra (like a lot of SDN).

Agreed. Just wondering why now. Maybe I'm too cynical, but the timing is quite suspect

 

[deleted1002574]

But, you think that one tweet makes someone not applying to the field change their mind? If you do, you're very much a believer in the power of suggestion and maybe an advertiser's dream!

Aside from the job prospects, the incompetency of leadership, the decreasing salary, the ever quickening pace of the treadmill of patients (used to be 200 consults could get you an average of 20 on treatment, now maybe 350-400??), the anxiety of mergers and acquisitions, the potential new payment program ... she's right!

I think this junior faculty member was just saying something positive. Ain't going to move the needle.

Need a separate thread for bets on unmatched spots.

 

[xrthopeful]

What’s the deal with the LA pp job that was posted today?

 

[Reaganite]

What’s the deal with the LA pp job that was posted today?

Which one are you referring to?