Perspective of PGY2 at "top 10" program

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I disagree.

There are not half of graduating classes not finding jobs. nowhere close. If that was the case, then I would agree with you that cutting by half immediately wouldn't have a big enough impact.
That’s because of elasticity. With radoncs midcareer routinely in mid 300s,you can replace one doc with 2, and there was babysitting linacs involved. It’s why in the 90s to fix the issue you has to stop an entire class from graduating.

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Not to be antagonistic, but it’s magical thinking to consider that these programs will voluntarily contract or close down in any self-directed fashion. I have a couple friends from the interview trail that I would see at ASTRO every year and they said as recently as this year that expansions are still being considered at their programs.

I’m generally an optimist (I think you have to be in oncology), but I am nothing but pessimistic about current leadership making any real changes to address the current situation.
Absolutely, and I don’t see why if it happened in path, it wouldn’t happen here. On path boards you still have DMs and KOs saying that everything is a ok, even with multiple fellowships.
 
it’s magical thinking to consider that these programs will voluntarily contract or close down in any self-directed fashion

Who said anything about voluntary? Leadership at the top, in the form of RRC or others, would need to develop the moral courage and willpower to close these programs.

The other possibility is that applicant quality (via the initial MATCH or the SOAP) declines so precipitously that programs refuse to take these applicants as residents, or employers refuse to take these SOAP-ed residents 5 years later. That would be sad, for the bottom 50% to churn through resident labor, without those residents ever finding real jobs.

I agree this is the more likely scenario.

That's why AMG's should avoid rad onc like the plague. IMG's, especially those from countries where the per-capita GDP hovers at $5k/year or less, may still be attracted to rad onc residency and the chance at US residency or citizenship down the line.
 
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I really doubt cutting 50% of residency spots could fix oversupply in a few years. With 1000 residents already committed 5 years, we are talking about a correction that would only slowly start to take effect 6 years from now and then would take 10 years to really take effect.

Were about 100 residents in my graduating class 2006 and that’s probably correct number given that job search was not that easy (even DM admitted such) and now we have hypofra/apm. Cutting down to the correct number without overcorrecting would still take generation to have impact on the job market.

I am going to define a healthy job market as one in which you can find employment in almost any city, but may have to take salary on par with pimary care in very desirable locations.

What is your solution then? Shut down 75 percent of programs immediately? 90 percent?
 
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Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle
 
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Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle


or Terry Wall data.

that actually did happen to me last year with one super private practice (solo guy) offer - he tried to low ball me, misunderstanding the market. I shared with him my other academic and PP offer at the time and he quickly wised up. ended up rejecting the job.
 
The other possibility is that applicant quality (via the initial MATCH or the SOAP) declines so precipitously that programs refuse to take these applicants as residents, or employers refuse to take these SOAP-ed residents 5 years later. That would be sad, for the bottom 50% to churn through resident labor, without those residents ever finding real jobs.

I agree this is the more likely scenario.

That's why AMG's should avoid rad onc like the plague. IMG's, especially those from countries where the per-capita GDP hovers at $5k/year or less, may still be attracted to rad onc residency and the chance at US residency or citizenship down the line.
Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle
totally depends on your location and the candidate.
 
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What is your solution then? Shut down 75 percent of programs immediately? 90 percent?
I honestly think only long term practical solution will be creation of fellowship to train clinical oncologist like in the uk. don’t see residencies being cut in half and if you add a year, why not make it 2 and get a medonc out of it.

regarding, salaries 200k. I work for hospital and they pay 50-75% based on salary surveys, but have been contacted cold called by a lot residents who made it known they are willing to take low salaries in this area, because there are just no jobs here. There are always some people desperate for certain locations. They may have a parent or spouses parent with cancer? (It happens! and some may not want to abandon their mom despite KO and DM seeing that as a lack of dedication to radonc.)

edit: it’s easy but hollow to shame doc for seeking higher salary, but tougher case to make shaming them for geographic or religious restrictions (orthodox Jews need kosher and temple in walkable distance) or implying that they are somehow less dedicated to their craft. it seems that other small fields- gyonc is much smaller than us, handle job market very well historically .
 
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Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle
totally depends on your location and the candidate.
Yup. SoCal and FL pp jobs last decade started at $200-225k partnership track.

Isn't that what some are still quoting for junior faculty at Stanford or MGH starting?
 
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Yup. SoCal and FL pp jobs last decade started at $200-225k partnership track. Isn't that what some are still quoting for Stanford or MGH starting?
The thing about SoCal and nocal for that matter, tons of Indians and Asians, who also make up really disproportionate number of residents (until self hating umich prof has her way). Lot of them like to go back home to their families and communities. Absolute last place you would ever need a new residency program.
 
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Back to BlueBubble's post - I think he is on the money that we need to shut down the bottom programs and redirect some to the bigger, better programs while also overall reducing the total number of trained/residents a year.

This would cause so many people to cry FOUL though, I doubt it would ever be allowed to happen. People would cry 'IVORY TOWER!'
 
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Like if the 8 residents a year matching at BCM, UTSA, UTMB, and Texas A and M were immediately diverted to MDACC and UTSW, this would be great. Absolutely great. of course, there's the other issue of also decreasing overall numbers, but ignoring this for a second. For the resident experience alone, they would be better served at one of those programs.
 
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Completely agree. We should have about 25 total residencies at centers of excellence, and they should train 4-6 residents per year.
 
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It’s incumbent on the rrc to raise the bar for residencies. Treating a bunch of bone meta and breast cancer can get you across the line to board eligible currently. It’s ridiculous.
 
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There a huge presumption that “centers of excellence” with larger number of residents provide good clinical training. I’ve seen people from high tier places be poorly trained or not ready to practice at the end of residency. I also don’t know if more residents at a particular program makes it better. I think 2-3 residents a year is probably ideal given it allows more direct oversight of individual residents.
 
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Completely agree. We should have about 25 total residencies at centers of excellence, and they should train 4-6 residents per year.

You have a good eye. Coincidentally, if you aggregate the residency programs rated "Good" on average or better on the interview spreadsheet, this adds up to ~30 residencies with ~100 total spots this year.

I have never heard a residency program director state that his/her program was in the bottom 50%. Everyone thinks their own residency program is just fine.

I wouldn't rely on self-reporting or self-policing to drive program closure or program down-sizing. That's what got us into this mess.

Instead, an independent body such as RRC ought to apply uniform, objective standards across programs. Ideally, without prejudice for program size, etc. This is similar to governments or regulatory agencies shutting down factories that don't meet emissions standards, or restaurants that violate health codes. My guess is that many programs would not pass a set of rigorous, comprehensive, modern standards for residency training.

Alas, inertia is the path of least resistance. All aboard the one-way train ride back to the IMG applicant pool from whence we came.
 
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What are current PGY5's supposed to do?

I am considering signing with a relatively rural clinic that is part of a larger hospital system. I want to sign because I really don't mind small towns and historically it seemed like these rural jobs were fairly stable. As soon as my first contract expires am I going to be on the chopping block? Will they outsource my clinic to one of the other hospitals that has more than a single doc to come 1-2 days a week?

I can't do another residency, I am so sick of being in training and just want to graduate and do the job I enjoy doing but it seems like there is a good chance that 1-2 years down the line when all this shakes out you're going to see mass layoffs of rad oncs even in the rural clinics that used to be somewhat "safe" jobs. I wish I had just done internal medicine. Hospitalists are making good salaries and demand seems to only be going up.

I worry that this rule is the death of our field.

I would say to strongly consider the rural clinic if you think you will be professionally happy and its not too far from family. I'm working rural now and I would take this job in a heartbeat if it wasn't so far from family. I spent 12 hours at DFW last weekend because of a flight cancellation.

The staff here are fantastic. The machine is mediocre but they are upgrading to SRS/SBRT in a few months. They are used to working with old, locums docs who haven't stayed up to date and I've really been working hard to do the right thing for patients here. They definitely appreciate it. They really want me to stay but I have an offer closer to home and that's whats more important to me.

You are worried about being on the chopping block but if you really establish yourself then they will not be in any hurry to get rid of you. JUST DON'T BUY A HOME! Also, be sure you have someone review the contract regarding penalties for leaving early. Being damn good at what you do and being willing to pick up and leave is what will give you the upper hand in this instance.
 
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Completely agree. We should have about 25 total residencies at centers of excellence, and they should train 4-6 residents per year.

Yes, let's let the major academic centers filled with SJWs like the Reshma character you're all always quoting determine the limited supply of docs who get to enter the field. Good luck as a non-URM male matching in that scenario. Count me in as one of the guys who will start hiring NPs and having offices covered by a "doctor" if that ever happened.
 
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Yes, let's let the major academic centers filled with SJWs like the Reshma character you're all always quoting determine the limited supply of docs who get to enter the field. Good luck as a non-URM male matching in that scenario. Count me in as one of the guys who will start hiring NPs and having offices covered by a "doctor" if that ever happened.

KHE?
 
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Yes, let's let the major academic centers filled with SJWs like the Reshma character you're all always quoting determine the limited supply of docs who get to enter the field. Good luck as a non-URM male matching in that scenario. Count me in as one of the guys who will start hiring NPs and having offices covered by a "doctor" if that ever happened.
Personally I don't care where the fat is trimmed, I just want it trimmed. Realistically, podunk U that never had a training program until 2015 and decided to jump on the expansion bandwagon probably isn't going to match the mid and upper tier places that have been training residents for awhile in terms of training experience.
 
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Personally I don't care where the fat is trimmed, I just want it trimmed. Realistically, podunk U that never had a training program until 2015 and decided to jump on the expansion bandwagon probably isn't going to match the mid and upper tier places that have been training residents for awhile

For sure we need to cut the number of programs. No argument from me there. Seriously, though, to people essentially saying we should let the major academic centers do all the training...don't they have enough power as it is? Do we really want them fully controlling the labor supply as well?!
 
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For sure we need to cut the number of programs. No argument from me there. Seriously, though, to people essentially saying we should let the major academic centers do all the training...don't they have enough power as it is? Do we really want them fully controlling the labor supply as well?!
It's a legit point, but then you also have reasonable places like UF and CCF that provide solid training and have been very clear about acknowledging the problems in the field.

Seriously not every state needs a program and that seems to by and large what has happened the last decade, coinciding with the rise of the number of trash unaccredited fellowships. I don't think that's a coincidence.

The best option is strengthening the acgme reqs. If you don't have the high sbrt load plus brachy/peds/unsealed cases etc to support your program, tough luck. That would be location and program independent
 
It's a legit point, but then you also have reasonable places like UF and CCF that provide solid training and have been very clear about acknowledging the problems in the field.

Seriously not every state needs a program and that seems to by and large what has happened the last decade, coinciding with the rise of the number of trash unaccredited fellowships. I don't think that's a coincidence.

The best option is strengthening the acgme reqs. If you don't have the high sbrt load plus brachy/peds/unsealed cases etc to support your program, tough luck. That would be location and program independent

Regardless of location, the programs that don't make any attempt at actually educating/training the radiation oncologists of the future should be on the chopping block. While there is a lot to be said about learning to do things on your own and having very high volume, many attendings at these type of programs treat residents as note machines and there is little to no education involved plus mountains of scut/secretary work.

These attendings operate an "academic" private practice with residents as their mid levels and offer little to no educational benefit. These are the places where there is no attending involvement in didactics, no resident involvement in plan evaluation or contour criticism other than "this is terrible". One attending at my program once said that they would actually prefer no residents as they "are not incentivized to teach" and "mid-levels would be easier but we can't administration to pay."
 
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Regardless of location, the programs that don't make any attempt at actually educating/training the radiation oncologists of the future should be on the chopping block. While there is a lot to be said about learning to do things on your own and having very high volume, many attendings at these type of programs treat residents as note machines and there is little to no education involved plus mountains of scut/secretary work.

These attendings operate an "academic" private practice with residents as their mid levels and offer little to no educational benefit. These are the places where there is no attending involvement in didactics, no resident involvement in plan evaluation or contour criticism other than "this is terrible". One attending at my program once said that they would actually prefer no residents as they "are not incentivized to teach" and "mid-levels would be easier but we can't administration to pay."
I get the sense that many of the recent programs that have opened fit that bill. Didn't COH essentially absorb a bunch of private practices right around the time they started a residency?
 
I get the sense that many of the recent programs that have opened fit that bill. Didn't COH essentially absorb a bunch of private practices right around the time they started a residency?

Listen I agree with you that we didn’t need new programs but that description describes TONS of older programs too. So many, it’s sad how common it is. Also I don’t even think city of hope is that new?
 
Regardless of location, the programs that don't make any attempt at actually educating/training the radiation oncologists of the future should be on the chopping block. While there is a lot to be said about learning to do things on your own and having very high volume, many attendings at these type of programs treat residents as note machines and there is little to no education involved plus mountains of scut/secretary work.

These attendings operate an "academic" private practice with residents as their mid levels and offer little to no educational benefit. These are the places where there is no attending involvement in didactics, no resident involvement in plan evaluation or contour criticism other than "this is terrible". One attending at my program once said that they would actually prefer no residents as they "are not incentivized to teach" and "mid-levels would be easier but we can't administration to pay."


This guy gets it. Nailed it. This is why I support shutting down all the bad programs. Idgaf if new or old or where they are located. Shut em down.
 
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Regardless of location, the programs that don't make any attempt at actually educating/training the radiation oncologists of the future should be on the chopping block. While there is a lot to be said about learning to do things on your own and having very high volume, many attendings at these type of programs treat residents as note machines and there is little to no education involved plus mountains of scut/secretary work.

These attendings operate an "academic" private practice with residents as their mid levels and offer little to no educational benefit. These are the places where there is no attending involvement in didactics, no resident involvement in plan evaluation or contour criticism other than "this is terrible". One attending at my program once said that they would actually prefer no residents as they "are not incentivized to teach" and "mid-levels would be easier but we can't administration to pay."

yes these programs claim “great clinical traininng” but in reality you are just seeing high volume without discussion of the cases in detail and minimal education. You are just breaking GME sim weekly limits weekly and writing notes. Attendings are not held to any reasonable standard. Sadly many of these places is just blind leading blind and attendings take no ownership in education.
 
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Listen I agree with you that we didn’t need new programs but that description describes TONS of older programs too. So many, it’s sad how common it is. Also I don’t even think city of hope is that new?
I thought coh was only a few years old and I know they took over a bunch of the vantage practices

Most of the older programs seemed to be established at universities/academic centers afaik, outside of the occasional NY Methodist or something
 
I get the sense that many of the recent programs that have opened fit that bill. Didn't COH essentially absorb a bunch of private practices right around the time they started a residency?

COH needs to be shut down
 
I thought coh was only a few years old and I know they took over a bunch of the vantage practices

Most of the older programs seemed to be established at universities/academic centers afaik, outside of the occasional NY Methodist or something

But that’s the rub - many programs are at ‘established’ universities doesn’t mean they have any sort of established educational program or responsibility to the residents
 
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in all honesty, you don’t need great training in this field- I didn’t have it and am very confident in my abilities-and new programs are probably fine, but someone has to be shutdown.
 
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in all honesty, you don’t need great training in this field- I didn’t have it and am very confident in my abilities-and new programs are probably fine, but someone has to be shutdown.

Sad. Yes most people will be fine and can be rad oncs with out good training. Doesn’t mean residency shouldn’t be enriching and maximized to make you the best you can be.
 
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It certainly is a bottom tier program. Which is sad because it’s a major cancer center, with big name Med oncs.

Also city of hope is like the perfect example of how age of program doesn’t matter. They are an NCI Cancer Center and have been established as a rad onc department for DECADES.

Still not a place for an enriching rad onc experience

I would add Loma Linda as a place to be shut down also even tho they’ve been around forever
 
in all honesty, you don’t need great training in this field- I didn’t have it and am very confident in my abilities-and new programs are probably fine, but someone has to be shutdown.
It's true. It's more about the individual than the program. That being said, the best programs are probably the ones that can expose you to the most pathology and types of treatment, so tightening up standards through the RRC and acgme will be the best way to go about it, with the idea of improving the training experience while closing down a lot of these borderline places, which will end up reducing spots.

No 450 bone met caseload experience to meet your numbers and then proceeding on to an SBRT fellowship because the RRC didn't feel it necessary for you to have more than 5-10 cases under your belt
 
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Also city of hope is like the perfect example of how age of program doesn’t matter. They are an NCI Cancer Center and have been established as a rad onc department for DECADES.

Still not a place for an enriching rad onc experience

I would add Loma Linda as a place to be shut down also even tho they’ve been around forever
Vs a place like Beaumont which was really a near top notch place when I interviewed despite it being a "community hospital" program. Huge names like Martinez, kestin and vicini before their exodus to 21C
 
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Also city of hope is like the perfect example of how age of program doesn’t matter. They are an NCI Cancer Center and have been established as a rad onc department for DECADES.

Still not a place for an enriching rad onc experience

I would add Loma Linda as a place to be shut down also even tho they’ve been around forever
COH is example of place that paid 200 in the not so distant past. I thought Uci residents used to rotate through, but I guess they needed their own program to supply SoCal with docs.
 
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Regardless of location, the programs that don't make any attempt at actually educating/training the radiation oncologists of the future should be on the chopping block. While there is a lot to be said about learning to do things on your own and having very high volume, many attendings at these type of programs treat residents as note machines and there is little to no education involved plus mountains of scut/secretary work.

These attendings operate an "academic" private practice with residents as their mid levels and offer little to no educational benefit. These are the places where there is no attending involvement in didactics, no resident involvement in plan evaluation or contour criticism other than "this is terrible". One attending at my program once said that they would actually prefer no residents as they "are not incentivized to teach" and "mid-levels would be easier but we can't administration to pay."
You may have trained where I trained
 
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Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle

I have been telling people my minimum salary for consideration once I had an offer that I was not ecstatic about, would accept. I would laugh at any employer that suggested 200k. However, I am geographically flexible.

I have personally heard that starting salaries at major centers, including MGH, Stanford, and potentially UTSW are somewhere in the 185-250k range. Whether that includes incentive or not, I do not know, but those are numbers I would not seriously entertain at this time.

*EDIT* - I have been anonymously informed that starting salaries at MGH/Stanford are somewhere in the 260k range, with UTSW at 295k + incentive that can reach up to 400k. Just an FYI.


It's a legit point, but then you also have reasonable places like UF and CCF that provide solid training and have been very clear about acknowledging the problems in the field.

Seriously not every state needs a program and that seems to by and large what has happened the last decade, coinciding with the rise of the number of trash unaccredited fellowships. I don't think that's a coincidence.

The best option is strengthening the acgme reqs. If you don't have the high sbrt load plus brachy/peds/unsealed cases etc to support your program, tough luck. That would be location and program independent

Bolded is the best solution for this problem, IMO, rather than just looking at closing new or small programs.
 
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I have been telling people my minimum salary for consideration once I had an offer that I was not ecstatic about, would accept. I would laugh at any employer that suggested 200k. However, I am geographically flexible.

I have personally heard that starting salaries at major centers, including MGH, Stanford, and potentially UTSW are somewhere in the 185-250k range. Whether that includes incentive or not, I do not know, but those are numbers I would not seriously entertain at this time.
Exactly.

I'm not making this stuff up. There are in fact people who are probably taking this salary somewhere because of geography, which goes to show the "salary shamers" what is really happening in this field. Getting back on topic, coming from a top 10 program isn't going to save you from a low-ball salary in a more geographically desirable location


P.S. not sure how Dallas could warrant that but whatever, to each their own
 
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Also just to put it out there - the misinformation here about salaries probably serves to drive down potential private practice offers in the future. I’m sure next time medgator hires he thinks he can get away with a lowball 200k offer LOL.

Not gonna happen. That’s not the reality of what people graduating RIGHT NOW are getting in their offers.

Don’t believe just me? Ask @evilbooya or @thecarbonionangle

I think what drives the lowball offer is the guy willing to take it.
 
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I have been telling people my minimum salary for consideration once I had an offer that I was not ecstatic about, would accept. I would laugh at any employer that suggested 200k. However, I am geographically flexible.

I have personally heard that starting salaries at major centers, including MGH, Stanford, and potentially UTSW are somewhere in the 185-250k range. Whether that includes incentive or not, I do not know, but those are numbers I would not seriously entertain at this time.




Bolded is the best solution for this problem, IMO, rather than just looking at closing new or small programs.
In many specialties it is common to take up to a 50% paycut to be in academics, especially large places like Stanford or MGH so that salary range is not too shocking to me. But then there should be sufficient academic time and support for research. And a private practice job in this salary range just can't ever seem justified to me, I don't care where it's located.
 
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yeah MGH and Stanford have historically had models that start quite low, but rise. Stanford especially for me always seemed like a tough pill to swallow, to try and live in Palo Alto on that salary, but people have always done it - to get into the system and live in the area, and they know the salary rises. I don't think these jobs/salaries are symptoms of the market, they just have always been this way.
 
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meanwhile here is a Med Onc job posting I got sent with subject title 'Top Paying Hematology/Oncology position near Sarasota with Partnership!'

for people who say that med onc jobs are paying significantly more than rad onc. earning -potential- for 400k and you have to stomach med onc:

We are seeking a full-time Hematology/Oncology physician to work in a growing office in Coastal Florida area. This is an excellent opportunity for an experienced physician that is comfortable with 18-20 patients per day. The practice offers competitive salary including bonuses and a full benefits package.

Practice details include:


  • Multi Specialty Group Employee w/ Partnership, Outpatient with call
  • Telephone Consultation with 1:4 Call Ratio
  • $325-350K Annual Salary
  • Earning Potential of $400,000
  • WRVU production incentives
  • Signing Bonus possible, contact us for details
  • Relocation Bonus possible
  • Ancillary income available from Diagnostics
  • Partnership Possibility
  • Full infusion suites, clinical lab, PET/CT, and oral pharmacy
 
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meanwhile here is a Med Onc job posting I got sent with subject title 'Top Paying Hematology/Oncology position near Sarasota with Partnership!'

for people who say that med onc jobs are paying significantly more than rad onc. earning -potential- for 400k and you have to stomach med onc:

We are seeking a full-time Hematology/Oncology physician to work in a growing office in Coastal Florida area. This is an excellent opportunity for an experienced physician that is comfortable with 18-20 patients per day. The practice offers competitive salary including bonuses and a full benefits package.

Practice details include:


  • Multi Specialty Group Employee w/ Partnership, Outpatient with call
  • Telephone Consultation with 1:4 Call Ratio
  • $325-350K Annual Salary
  • Earning Potential of $400,000
  • WRVU production incentives
  • Signing Bonus possible, contact us for details
  • Relocation Bonus possible
  • Ancillary income available from Diagnostics
  • Partnership Possibility
  • Full infusion suites, clinical lab, PET/CT, and oral pharmacy
Sarasota is a nice part of FL. And 400k there probably goes farther than the metropolitan ne or socal/NorCal. At least there is an option their for a job, med onc wise.

Sarasota was home to a notorious RO group resident mill that never gave anyone partnership
 
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I'm setting in clinic today treating patients so everyone can have the Friday after Thanksgiving off. While going through the sports news, as it snows outside my office window, I get one of those targeted ads on my phone asking me to considering working at Kaiser Permanente in Southern California. So I figure sure, and I click through and see what they have.

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Alas, no sunshine and warm weather for me until May.

They do have many other available opportunities though, so long as your specialty is not rad onc.
 
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