I work for a large private practice oncology organization. Several reasons why I like the multi-specialty model:
You have a “built-in” referral base as mentioned. 40% of my referrals are still external, however.
As long as you’re getting paid fairly as a radonc (not all groups are the same), if at least some of the overall practice revenue is spread around, it protects you a bit from “specialty-specific” problems like urorads taking all your prostate business, etc.
I really, really have enjoyed building relationships with and learning from our medoncs, surgical oncologists, neuro-oncologists, pharmacists, etc. In building those relationships in multispecialty groups, in ours at least, it has eliminated any sort of adversarial relationship between specialities, allowing me to be able to help advocate more strongly for radiation therapy.
Large groups have an advantage: If the hospitals and academic centers have to start competing on cost, they are in trouble. We’ve been told by insurers that our outcomes are equal to those of the closest prominent academic medical center, while our costs are 20% of theirs. We are cheaper by five fold. The local hospital is reimbursed 3X what we would be for SRS. Getting to this level of efficiency, though, requires a larger physician organization, to secure a larger revenue base to fund everything you will need to be able to run such an organization. The insurers know about all this and are starting to look at their patterns of coverage.
As I thought we all knew (but some over the last decade some conveniently forgot), you don’t need a lot of radiation oncologists to treat a large population, so the size of a radonc group is naturally limited, which limits both your buying power for new equipment and your bargaining power with payers. By combining with a local/regional/national (ideally all three) organization, you gain stability of contracting and a great deal of negotiating power that goes a long way towards being profitable.
Larger groups have very good administrators and leaders who are not physicians. In my opinion physicians are good at being physicians but may or may not be good at “business”, for lack of a better term. Businesspeople are good at business. That’s their job. I like to have them do the business stuff so I can do the doctor stuff. Larger multispecialty organizations attract better candidates than smaller practices due to the possibility of promotion throughout the levels of the organization.
It’s true, though, that there are not many jobs available in these groups. Two reasons: 1. They’re great jobs, so not many people leave the practice. 2. The businesspeople referenced before help limit over-exuberant MD expansion efforts, which aren’t uncommon. Growth will be steady but not explosive. They’re not owned by a VC firm trying to get bought out.
So, if the larger groups have 50-75 radoncs and the average physician practices for 20-30 years, each group just won’t need that many people each year. The groups know how good the jobs are and look for very strong candidates who will fit in with the practice and get up and running right away. Experience and comfort with SRS/SBRT/HDR for skin/breast/gyn, multiple IGRT systems, 4D sim, etc would be considered a given for a newer grad. Pedigree helps but is one factor among many.
