Perspective of PGY2 at "top 10" program

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fiji128 said:
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.


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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I guess a lot of clinics do the same thing. Getting in some SDN time between otvs.

Good thing Cedars and COH both opened during the era of residency expansion to address all those non-existent jobs in southern California
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medgator said:
I guess a lot of clinics do the same thing. Getting in some SDN time between otvs.

Good thing Cedars and COH both opened this decade to address all those non-existent jobs in southern California
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I do not believe COH opened this decade.
 
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As someone planning my career and was strongly considering rad onc, what exactly f*cked it up so badly and are there any other specialties that will follow suite? I know you mentioned IM and rads, but aren’t those specialties also heading toward a similar future? IM and rads are both relatively uncompetitive with huge increases in residency spots and uncertain future job prospects (most hospitalist positions are filling up quickly)
 
ace_inhibitor111 said:
As someone planning my career and was strongly considering rad onc, what exactly f*cked it up so badly and are there any other specialties that will follow suite? I know you mentioned IM and rads, but aren’t those specialties also heading toward a similar future? IM and rads are both relatively uncompetitive with huge increases in residency spots and uncertain future job prospects (most hospitalist positions are filling up quickly)
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Not nearly as bad though as this specialty, rads demand continues to grow
 
ace_inhibitor111 said:
As someone planning my career and was strongly considering rad onc, what exactly f*cked it up so badly and are there any other specialties that will follow suite? I know you mentioned IM and rads, but aren’t those specialties also heading toward a similar future? IM and rads are both relatively uncompetitive with huge increases in residency spots and uncertain future job prospects (most hospitalist positions are filling up quickly)
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most hospitals dont have XRT and we are married to expensive machines. Field has a great QOL so people never retire. This keeps market pretty tight in desirable areas. Inability to “hang a shingle” Or do “side gigs” and inability to increase skills by training ( non GI doing scopes, FM doing gyn or vasectomies, etc. besides the expansion and bad leadership theres that...
 
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ace_inhibitor111 said:
As someone planning my career and was strongly considering rad onc, what exactly f*cked it up so badly and are there any other specialties that will follow suite? I know you mentioned IM and rads, but aren’t those specialties also heading toward a similar future? IM and rads are both relatively uncompetitive with huge increases in residency spots and uncertain future job prospects (most hospitalist positions are filling up quickly)
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Listen, I feel like no one ever talks about this part on these boards - but whatever you pick, you have to actually be able to stomach doing. I literally enjoy going to work every day. I would have not been able to read films all day or god forbid be a hospitalist.

By all means, consider other fields, but pick something you can do and stomach doing, because demand is elastic.

I actually WISH more rad oncs would burn out haha, that would open up the market!

the only thing forcing some of these old guys out are major hospitals buying out practices and shining a light on dinosaurs.
 
ace_inhibitor111 said:
As someone planning my career and was strongly considering rad onc, what exactly f*cked it up so badly and are there any other specialties that will follow suite? I know you mentioned IM and rads, but aren’t those specialties also heading toward a similar future? IM and rads are both relatively uncompetitive with huge increases in residency spots and uncertain future job prospects (most hospitalist positions are filling up quickly)
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Challenges are definitely faced by virtually every specialty in medicine now (I can hear the Google Spreadsheet kids - 'omg SDN wizards recognize things outside RadOnc'). It's impossible to predict the "safest" specialty, or which one will see the most growth, etc. As Healthcare in America continues to evolve, this will become increasingly interesting. Previously, and probably still currently - medicine in America was seen as a safe/"guaranteed" career with an almost certain top-tier income if you survived the training. It's why you can track the health of America's economy by looking at the number of medical school applications - more kids apply when the economy is bad, whereas maybe those kids would have pursued business or finance in better years.

Would agree with @PhotonBomb that you need to pick something you can stomach, regardless of what it is. I would personally think IM with Fellowship training might be the best bet. If your fellowship-trained specialty collapses for whatever reason, you could always go back to IM - or retrain in a new Fellowship.
 
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PhotonBomb said:
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
Click to expand...
We are looking for medoncs and I know hospital has been giving offers 500-600 and having hard time.
 
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elementaryschooleconomics said:
Challenges are definitely faced by virtually every specialty in medicine now (I can hear the Google Spreadsheet kids - 'omg SDN wizards recognize things outside RadOnc'). It's impossible to predict the "safest" specialty, or which one will see the most growth, etc. As Healthcare in America continues to evolve, this will become increasingly interesting. Previously, and probably still currently - medicine in America was seen as a safe/"guaranteed" career with an almost certain top-tier income if you survived the training. It's why you can track the health of America's economy by looking at the number of medical school applications - more kids apply when the economy is bad, whereas maybe those kids would have pursued business or finance in better years.

Would agree with @PhotonBomb that you need to pick something you can stomach, regardless of what it is. I would personally think IM with Fellowship training might be the best bet. If your fellowship-trained specialty collapses for whatever reason, you could always go back to IM - or retrain in a new Fellowship.
Click to expand...
Totally agree. Things for a certain specialty change all the time. Some things we can control and some things we can't. Reimbursement for IMRT was amazing to radiation oncology, but now there's hypofractionation, APM, CMS changes. What if MR linacs are the next IMRT? Maybe that's magical thinking, but that could potentially be a good thing.

Since I started med school about 10 years ago:
Rad onc - probably reached it's peak when I started med school and has since nose dived. In the 90s it was apparently worse than it is now.
GI - was hot and still hot
Onc - started getting hot in the last few years. What if there is a medical oncology APM in the future? They would be royally screwed with how expensive their agents are.
Cards - was hot, but not so much anymore. Everyone is doing a fellowship for their fellowship.
FM/Psych - was good fallback options, now good fields to go into
EM - was a semi-hot, now oversupplied.
Rads - oversupply, and everyone started to do fellowships, now things are good, but worried about AI in the future?
 
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'What if there is a medical oncology APM in the future?'

there is it's called the oncology care model. It’s coming
 
RickyScott said:
We are looking for medoncs and I know hospital has been giving offers 500-600 and having hard time.
Click to expand...

You must be in a area where it would be tough to recruit a rad onc too.
 
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PhotonBomb said:
You must be in a area where it would be tough to recruit a rad onc too.
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A few years ago I would have disagreed with you, but now seeing what is happening in my market and hearing from elsewhere, seems like NPs/PAs have a better job market in med onc than the doctors do, as many existing practices are simply hiring/using extenders rather than new docs
 
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PhotonBomb said:
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
Click to expand...

I agree. I've been puzzled by all the love for medical oncology here. I agree starting salaries are higher than rad onc now, but most of those jobs are hospital based (thank you CMS for killing PP med onc), and a lot of these guys are getting killed in their clinics. (I think Kaiser may be the exception. The Kaiser Med Oncs I know seem to be happy). Many of the private med oncs in my community were bought out by hospitals, and while their salaries have increased, it has not been proportionate to the volume increase.
 
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Reaganite said:
I agree. I've been puzzled by all the love for medical oncology here. I agree starting salaries are higher than rad onc now, but most of those jobs are hospital based (thank you CMS for killing PP med onc)
Click to expand...

There's a few big groups around the country surviving and thriving. FCS is big in Florida, topa in Texas and many smaller groups under McKesson/uson, but yes, thanks in part to the 340b scam, many groups have been taken out
 
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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, and I have edited my previous post.

Regardless of the salary, the work of med onc is just not interesting to me. Most places will pay a prettier penny to recruit med oncs than they will rad oncs.
 
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Reaganite said:
I agree. I've been puzzled by all the love for medical oncology here. I agree starting salaries are higher than rad onc now, but most of those jobs are hospital based (thank you CMS for killing PP med onc), and a lot of these guys are getting killed in their clinics. (I think Kaiser may be the exception. The Kaiser Med Oncs I know seem to be happy). Many of the private med oncs in my community were bought out by hospitals, and while their salaries have increased, it has not been proportionate to the volume increase.
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We seem to take our nights, evenings, and weekends for granted. Ask med oncs about this and they'll kill to be rad oncs. Grass is greener on the other side. Principle of life, principle of this forum, principle of all medicine.
 
medgator said:
There's a few big groups around the country surviving and thriving. FCS is big in Florida, topa in Texas and many smaller groups under McKesson/uson, but yes, thanks in part to the 340b scam, many groups have been taken out
Click to expand...

For sure there are some groups who have learned how to navigate treacherous chemotherapy billing. I think it takes significant market clout with amazing contracts (probably the case for bigger PP groups above), ridiculously unfair governmental reimbursement (340-B, PPS exempt), or strategic use (or even underutilization) of expensive drugs (i.e. send your immunos to the hospital or don't use them at all) to make it work. Otherwise, one unpaid immuno can put you in the red in a given month. These bigger groups probably also have their own in-house PET and LINAC. I spoke to a med onc friend several years back who told me the sole source of income for their practice was basically the ancillaries. For the life of me, I will never understand why CMS decided to kill PP med onc. All this concern about cost, and you change chemo reimbursement to drive the gatekeepers of oncology care into the hospital?
 
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PhotonBomb said:
'What if there is a medical oncology APM in the future?'

there is it's called the oncology care model. It’s coming
Click to expand...
Our practice participates in OCM. Not exactly equivalent to APM. APM is a much bigger fundamental shift.
 
I wonder what's main wRVU driver for our MedOnc friends who are in the employed model. Kind of like for us is keeping patients under the beam. Is it the number of separate chemo drug administrations?
 
Rads is still more flexible, geographically. Just hit my inbox:

I have a few needs for radiologists who are open to working from home. They are looking for someone to work the 7 PM to 7 AM (or 3 AM - 5 AM) shift. 8 to 12-hour shifts available.



Benefits and Compensation for the Tele-Radiologist Position

  • Compensation $400K with benefits; additional shifts available, if interested
  • Top 5% make between $600 and $800K per year
  • Sign On/Relocation Bonuses are on a case by case basis
  • 7 days on 7 off
  • Comprehensive Benefits package, including medical and dental
  • Read 10 to 13 work units per hour
  • Technology provided by the company
Click to expand...
 
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medgator said:
Rads is still more flexible, geographically. Just hit my inbox:
Click to expand...

This is true.

There will always be geographic flexibility in DR. But that comes at the cost of being seen as a faceless, easily-discarded PACS user. Rad Oncs probably understand that the fields are fundamentally quite different with respect to workflow, of course. In DR, your mind is engaged non-stop through the shift, with a necessary level of vigilance to make sure that no details are missed in the tens of thousands of images seen over eight or nine hours. Rad Onc, being a specialty that involves a lot of patient interaction, has more mental downtime.
 
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radsisrad said:
This is true.

There will always be geographic flexibility in DR. But that comes at the cost of being seen as a faceless, easily-discarded PACS user. Rad Oncs probably understand that the fields are fundamentally quite different with respect to workflow, of course. In DR, your mind is engaged non-stop through the shift, with a necessary level of vigilance to make sure that no details are missed in the tens of thousands of images seen over eight or nine hours. Rad Onc, being a specialty that involves a lot of patient interaction, has more mental downtime.
Click to expand...

diagnostic rads made a mistake by giving up power to order imaging. That would be a strong card for them to hold right now. It’s like us allowing Med oncs to prescribe radiation.
 
I wouldn’t do diagnostic rads if you paid me.
 
have a buddy on the west coast, and apparently the med oncs in the UC system are doing well for themselves (approaching 7 figures). Their compensation is public.
 
kjamess said:
have a buddy on the west coast, and apparently the med oncs in the UC system are doing well for themselves (approaching 7 figures). Their compensation is public.
Click to expand...

Interim division chief for UCSF is listed at $304,761

Andrew Ko, MD | UCSF Helen Diller Family Comprehensive Cancer Center

cancer.ucsf.edu cancer.ucsf.edu


Catherine Park is listed at $697,976
 
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medgator said:
Never heard that to be the case?
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I mean it was a decision made long ago but they should have made themselves the gatekeepers to imaging by having referring docs write what they want to investigate, and then DR will order the appropriate scan.
 
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radiation said:
Interim division chief for UCSF is listed at $304,761

Andrew Ko, MD | UCSF Helen Diller Family Comprehensive Cancer Center

cancer.ucsf.edu cancer.ucsf.edu


Catherine Park is listed at $697,976
Click to expand...
Let’s look at junior faculty vs physics and dosimetry
 
radiation said:
Interim division chief for UCSF is listed at $304,761

Andrew Ko, MD | UCSF Helen Diller Family Comprehensive Cancer Center

cancer.ucsf.edu cancer.ucsf.edu


Catherine Park is listed at $697,976
Click to expand...

look at LA. I'm seeing multiple people at 900k. And these are regular faculty at satellites.
 
Krukenberg said:
I mean it was a decision made long ago but they should have made themselves the gatekeepers to imaging by having referring docs write what they want to investigate, and then DR will order the appropriate scan.
Click to expand...
Didn't realize this to be the case, but it makes sense sometimes, although most specialists are going to know what they need. CT works great for the thoracic surgeons and pulmonologist, MRI for Ortho/neurosurgeon. Even if DR was deciding which study to order, they were still getting the referral in the first place.

I don't see it analogous to RadOnc, sometimes patients self refer when they don't want surgery, sometimes I won't offer radiation if surgery is the better option etc.
 
radiation said:
Interim division chief for UCSF is listed at $304,761

Andrew Ko, MD | UCSF Helen Diller Family Comprehensive Cancer Center

cancer.ucsf.edu cancer.ucsf.edu


Catherine Park is listed at $697,976
Click to expand...
assoc and assistant profs at ucla are making 900k+/yr. no need to become steinberg and chair the rad onc department to make $ just go into med onc.


 
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aspiring rapper said:
assoc and assistant profs at ucla are making 900k+/yr. no need to become steinberg and chair the rad onc department to make $ just go into med onc.
aspiring rapper said:
assoc and assistant profs at ucla are making 900k+/yr. no need to become steinberg and chair the rad onc department to make $ just go into med onc.


Click to expand...


Click to expand...
This is certainly an inconvenient truth for #RadonCrocks folks. Ralph is probably apoplectic. Maybe I’m wrong but I don’t think you can find numbers like these openly attached to any same-level rad onc in this solar system. If #radoncrocks I guess #medoncbadonkadonks?
 
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aspiring rapper said:
assoc and assistant profs at ucla are making 900k+/yr. no need to become steinberg and chair the rad onc department to make $ just go into med onc.


Click to expand...

Academics doesn't want to pay this kind of money, but they have to. Med onc is on fire right now. There's a ton of money being made in medical oncology, and there is a shortage of med oncs. If academics doesn't pay competitively, they don't get medical oncologists.

We've been going through this in the hell where I work. There's a real shortage of quality med oncs, and it's very hard to retain med oncs due to high salary offers outside the institution. My "academic" institution instead hires med oncs with red flags, visa issues, serious personality problems, questionable English, or make special deals like part-time work with low pay. Sure they hire some bubbly new grads who think they want "academics", but then they're out the door in a few years to double their salaries, usually without going too far.

In rad onc there's no such luck. The money still comes in from insurance and the government, but it only goes into the hands of the established practice owners, department chairs, and other hospital admins. Who cares if my global was over $4 million? Oversupply means take what salary you're given or be replaced. In rad onc you have no leverage. Good luck on getting another job in your area if you want to leave. Good luck finding a decent job anywhere at all.

Med onc means pick your location and make high 6 figures, maybe even 7 figures. The right specialty choice should be abundantly clear for medical students.
 
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clearly something is going on lol with those salaries because they are obviously a true outlier. Many states have publically searchable salaries. Try searching some of the other UC ones too.

but for example, here is MDACC (known for paying well) assistant prof med onc salaries. Lower than rad onc. some of you will believe anything.


Search | Texas Tribune Government Salaries Explorer

The Texas Tribune's Government Salaries Explorer lists compensation for Texas state employees.
salaries.texastribune.org salaries.texastribune.org
 
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PhotonBomb said:
clearly something is going on lol with those salaries because they are obviously a true outlier. Many states have publically searchable salaries. Try searching some of the other UC ones too.

but for example, here is MDACC (known for paying well) assistant prof med onc salaries. Lower than rad onc. some of you will believe anything.


Search | Texas Tribune Government Salaries Explorer

The Texas Tribune's Government Salaries Explorer lists compensation for Texas state employees.
salaries.texastribune.org salaries.texastribune.org
Click to expand...

agreed. Rad Onc median salary higher then med Onc on MGMA and AAMC
 
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PhotonBomb said:
clearly something is going on lol with those salaries because they are obviously a true outlier. Many states have publically searchable salaries. Try searching some of the other UC ones too.

but for example, here is MDACC (known for paying well) assistant prof med onc salaries. Lower than rad onc. some of you will believe anything.


Search | Texas Tribune Government Salaries Explorer

The Texas Tribune's Government Salaries Explorer lists compensation for Texas state employees.
salaries.texastribune.org salaries.texastribune.org
Click to expand...

Can't speak for rad onc but for radiology those public salaries for MDA do not include yearly bonuses which can add an additional ~30%

Search | Texas Tribune Government Salaries Explorer

The Texas Tribune's Government Salaries Explorer lists compensation for Texas state employees.
salaries.texastribune.org salaries.texastribune.org
 
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Yes. Total comp is what matters. Not saying it’s unique to one specialty or another. It’s just that “salary” can be WAY lower than net.
 
Medoncs at my hospital employed job make into 7 figures and some ~ double radiation. They are very busy and the hospital keeps trying to salary them or hire more to drive down their pay.
 
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How are assistant ucla MO profs making more than the 21c onc rad onc chair? WOW. Someone please explain to me
 
metallica81788 said:
Medoncs at my hospital employed job make into 7 figures and some ~ double radiation. They are very busy and the hospital keeps trying to salary them or hire more to drive down their pay.
Click to expand...
Never let them know what you make.
 
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Where I work they have been trying to hire a permenant med onc for over a year now. I pretty much just work with peri retirement med onc locums. If I wanted to find a simillary paying rad onc job in a better location for myself it would be exceedingly difficult. The law of supply and demand is a hell of a thing.
 
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The med onc market is def pretty good right now but that some were making 7 figures as assistant profs is definitely news to me. WOW
 
This is what rad onc looked like to many ~10 yrs ago. To everyone encouraging med srudents to go the Hem Onc route, who's to say where the field will be in 6-8 years? This conversation has been had more than once on this forum.

I for one doubt the current situation is sustainable and think cuts will come.

Sent from my Pixel 2 XL using Tapatalk
 
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CaesarRO said:
This is what rad onc looked like to many ~10 yrs ago. To everyone encouraging med srudents to go the Hem Onc route, who's to say where the field will be in 6-8 years? This conversation has been had more than once on this forum.

I for one doubt the current situation is sustainable and think cuts will come.

Sent from my Pixel 2 XL using Tapatalk
Click to expand...

And has been pointed out that UCLA data point is an outlier and clearly there is more to the story.
 
CaesarRO said:
This is what rad onc looked like to many ~10 yrs ago. To everyone encouraging med srudents to go the Hem Onc route, who's to say where the field will be in 6-8 years? This conversation has been had more than once on this forum.

I for one doubt the current situation is sustainable and think cuts will come.

Sent from my Pixel 2 XL using Tapatalk
Click to expand...
Completely disagree. Radonc issues are beyond residency expansion. Apm, hypofractionation. Etc. drugs are only improving and adding more lines of chemo etc.
 
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Not sure where to put this, but this seems like an okay spot....

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