Rad Onc - Supply & Demand

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As a med student I really appreciate the time everyone further up in the chain is putting in to discuss the issue. I don't have a home rad onc department but during my time in a PP multispecialty office shadowing Rad Oncs I absolutely loved the field. It makes my specialty choice much harder knowing what I do now about the job market from you guys.

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As a med student I really appreciate the time everyone further up in the chain is putting in to discuss the issue. I don't have a home rad onc department but during my time in a PP multispecialty office shadowing Rad Oncs I absolutely loved the field. It makes my specialty choice much harder knowing what I do now about the job market from you guys.

Job markets are cyclic. You don't want to buy high and sell low. I think I bought fairly high into radiology (was told appearently in 2015 there were less than 50 people nation wide with my step score). Perhaps in a different life I would have trained in my beloved NYC rather than the midwest and maybe settled down.

Job market is very important. You should not move away from home to do something unless you cannot see yourself doing it for life without any other alternatives.
 
The job market is way worse than I realized ... newest job posting on the Astro career website under physicians. It appears to be in rural Washington state but at least it's a full time position.

Linen Attendant
 
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The job market is way worse than I realized ... newest job posting on the Astro career website under physicians. It appears to be in rural Washington state but at least it's a full time position.

Linen Attendant

:laugh::laugh::laugh:

Come on ASTRO. You can do better than this. Please clean up your career center website so this non-rad onc physician/physicist work isn't included.
 
:laugh::laugh::laugh:

Come on ASTRO. You can do better than this. Please clean up your career center website so this non-rad onc physician/physicist work isn't included.
At first, it was non rad onc MD career positions that ended up there, and then practice manager and RTT/CMD positions and now it's come to this.

Ridiculous.

All the more reason for a strong practice in a desirable area to NOT have to pay for the privilege of using the astro career site to post a listing...
 
Somebody forwarded that to me as a joke. It just occurred to me that the hospital actually paid money to ASTRO to post that position (and ASTRO took the money) ... more evidence that ASTRO doesn't care about anything other than taking money from whomever they can.

This is a bit of an exaggeration/joke of course but I can't imagine being a resident right now freaking out about the job market then going to the career site of the only major organization in radiation oncology only to find that most of the posts are mislabeled or aren't even for physicians.

After scanning through everything I agree that no reputable, well run organization would post a position there. I can't imagine ASTRO plans to do anything to stop residency expansion when they can't even manage a decent job posting site (that isn't even free!) in the year 2017!
 
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Think about it from Prov St Joes perspective. The entire medical community, and in particular healthcare administration, is really enjoying themselves watching RO cannibalize itself. Now they have an opening for a linen attendant. They think to themselves, what area of medicine is so miserably pathetic that even a linen attendant realizes they are on a sinking ship? Oh yeah, rad onc has brachytherapy and people wear scrubs, right? Let's send that poor schmuck a life vest and hire him for pennies on the dollar.

I'd poach the RO support staff too!
 
Well, if you REALLY need to be in the Pacific NW, it's not unreasonable to take a part-time job as a linen attendant. Maybe with time, patience and networking you could parlay to a full time position.

Then, you could go into the RO department at night, logon to the TPS and "optimize" the attending plans a la Good Will Hunting. Once they recognized your genius, I'm sure you would be offered a full time RO position at Swedish.

You guys are a bit too "the glass is half empty," look on the bright side!!


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I see 123 jobs on astro site, with 200 or so residents. In comparison radiology job site has 500 or so jobs and 1200 residents. Is the job situation super terrible right now?
 
I see 123 jobs on astro site, with 200 or so residents. In comparison radiology job site has 500 or so jobs and 1200 residents. Is the job situation super terrible right now?

If you're a urologist or endocrinologist, you could probably write your contract, depending on the locale....
 
If you're a urologist or endocrinologist, you could probably write your contract, depending on the locale....
Is endocrine really on its way up?

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If you're a urologist or endocrinologist, you could probably write your contract, depending on the locale....

Yeah, but then urology residency is grueling.

I truly believe subspecialty surgery have it the best and I hope IR move toward that model.
 
I see 123 jobs on astro site, with 200 or so residents. In comparison radiology job site has 500 or so jobs and 1200 residents. Is the job situation super terrible right now?
]

I'm not sure that is a good metric. My job was not advertised and I know many residents who got jobs that were never advertised.
 
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I'm not sure that is a good metric. My job was not advertised and I know many residents who got jobs that were never advertised.

I think most radiologists also get unadvertised jobs (just a nature of the beast), I think those job sites are a good gauge of job market.

I was told that when radiology was hot, there were more than 1000 jobs posted at one time. The lowest I heard was around 200.
 
Yeah, but then urology residency is grueling.

I truly believe subspecialty surgery have it the best and I hope IR move toward that model.

Urology can be benign as far as surgical specialties go once you are out in practice compared to say gen surg or nsg. Uro is in many ways similar to ent, good mix of clinic and OR, not a ton of emergencies
Is endocrine really on its way up?

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It's always been in demand per one of my endocrine friends who literally said it's because it's one of the lower paid IM specialties
 
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Wife: It's time to buy a new car, and I think we can afford an upgrade.
Me: Come read these SDN Radiation Oncology threads.
(later)
Wife: I think I can get a few more miles out of the Camry.
 
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Whenever I hear this, a voice in my head says "you get what you pay for"

That being said, I doubt there's much of a difference between 100% clinical at a major academic center and PP in a multispecialty group.

In my experience the salary difference can be quite dramatic.
 
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I just saw this position in my email this morning and I think it does a pretty good job of summarizing the lack of quality positions available out there. Title should read, "Full time job for part time pay at faux academic rad onc department in a third/fourth tier city!"

Job Summary:
  • The Department of Radiation Oncology at the PinnacleHealth Cancer Institute (this is in Harrisburg, PA) is looking for a board-certified or board-eligible part-time (0.6) radiation oncologist to join a growing team of academically oriented oncology providers, with potential for the position to grow to full time effort as our needs expand.
  • Physician will be responsible for practicing radiation oncology in both inpatient and ambulatory care settings.
  • The successful candidate will be part of a multidisciplinary group of physicians, advance care practitioners and allied health professionals.
  • The clinician will be expected to develop an active practice and to actively participate in clinical research and teaching initiatives.
Job Requirements:
  • Qualified applicants must possess an MD degree or equivalent
  • Board certified or board eligible in radiation oncology
  • Eligible for licensure in the state of Pennsylvania
  • Will consider 2017 radiation oncology fellowship graduates for candidacy
Looks like pp version of that job just popped up on the astro job site... rural pp looking for employed cheap labor

Radiation Oncologist in rural setting
 
My wife and several close friends and relatives work or have worked "part-time" as a physician with varying degrees of success (it can definitely work but it's not as easy as it might seem). If you are going to do it be very careful and have everything carefully written out.

What often happens is you get the worst of the worst cases and/or you work part-time in the office/hospital but full time when you add in all the extra you do from home. You can easily end up getting paid part time while working full time. It's doesn't help if you are "off" for two days a week but during that time you are constantly covering calls (even if you are not on call for the practice who is covering your patients while you are "off"?) or working on your notes, etc but doing so from home rather than the office so you are essentially doing it for free rather than paid like a full time employee.
 
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I just read the description and I obviously don't know a thing about this particular position but my point is it's not "part-time" if you're there in the clinic from 8-12 (or "sometimes" which might mean "almost all the time" until 2pm) then instead of going to your office like the "full time" employees you go home and just go to your home office and work on notes, volumes, etc until 4pm (or 6-7pm "depending on census") like the full time employees are doing at the work office but your getting paid "part time."

You also might be seeing all the train wrecks and palliative/low RVU cases while the full time employees get the easiest and highest revenue generating cases (then after a few months when the census consistently builds instead of making you 0.5 to 0.75 FTE or whatever they say you aren't generating enough RVU's even though you are working harder than they are).

Again, I don't know anything at all about this position and I know more than a few people who are very happy working part-time. If this is really a job where you go in at 8am and leave at noon (or occasionally 2pm) with all work done and nothing to do until 8am the next day for $250,000 I will seriously consider applying. In fact, I'm about to right now!
 
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I just read the description and I obviously don't know a thing about this particular position but my point is it's not "part-time" if you're there in the clinic from 8-12 (or "sometimes" which might mean "almost all the time" until 2pm) then instead of going to your office like the "full time" employees you go home and just go to your home office and work on notes, volumes, etc until 4pm (or 6-7pm "depending on census") like the full time employees are doing at the work office but your getting paid "part time."

You also might be seeing all the train wrecks and palliative/low RVU cases while the full time employees get the easiest and highest revenue generating cases (then after a few months when the census consistently builds instead of making you 0.5 to 0.75 FTE or whatever they say you aren't generating enough RVU's even though you are working harder than they are).

Again, I don't know anything at all about this position and I know more than a few people who are very happy working part-time. If this is really a job where you go in at 8am and leave at noon (or occasionally 2pm) with all work done and nothing to do until 8am the next day for $250,000 I will seriously consider applying. In fact, I'm about to right now!

These low(ish) single linac rural places can be very difficult to find the right fit. If you're treating 10-15, and don't have a great payer mix, then it's a pain because like you say you're there daily, at minimum 8-2 PM, but if billing only professional fees it may not be at the income level you'd like. Plus, if it's in a rural location where you don't want to live, when you add in commute time you really are away from home for what feels very much like a full time position for part time pay.

If you can find a position like this in an area where you want to live, then absolutely this can be a good gig...but when you throw commute in there it becomes less than ideal.

Some groups (and academic centers) have sent a rad onc out to the clinic 3 days/week, and had a mid level or a med onc serve as the "supervising" doctor on the other days with off line imaging review from a remote location. We've been round and round about the legality/appropriateness of that on this board before, but that kind of thing I know for a fact was going on across a number of places in the southeast, south, and midwest about 3-5 years ago. I don't have a set up like that, but I know people that do that.
 
Irvine CA and Salina KS are hiring again?
 
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Some groups (and academic centers) have sent a rad onc out to the clinic 3 days/week, and had a mid level or a med onc serve as the "supervising" doctor on the other days with off line imaging review from a remote location. We've been round and round about the legality/appropriateness of that on this board before, but that kind of thing I know for a fact was going on across a number of places in the southeast, south, and midwest about 3-5 years ago. I don't have a set up like that, but I know people that do that.

I think there is a loophole in the supervision guidelines for "CAH" situations or "critical access hospitals" but it had to be pretty rural and I believe Medicare has to define the area as such.

It's really a tough situation, I'm sure some of these areas really need a linac but just don't provide the enticement as you've alluded to
 
What's the deal with the Salina job? it constantly gets dumped on in this board. Is it just the location or location plus predatory practice?
 
What's the deal with the Salina job? it constantly gets dumped on in this board. Is it just the location or location plus predatory practice?
Most jobs don't sponsor visas but that one does... Unfortunately those kinds of jobs can be predatory esp if an img takes the position....their visa is tied to keeping that job.

Plus that job has probably been posted off and on for several years. red flag imo.

On top of all of that, location may be an issue. Kansas city isn't bad, I've been there it's like any large Midwestern city with plenty to do, but I imagine salina is no KC....
 
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I consider Irvine, CA one of the best places to live in the world... The job has been posted numerous times over the past 10 years.
 
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I consider Irvine, CA one of the best places to live in the world... The job has been posted numerous times over the past 10 years.
Which should then make you wonder about what's wrong with the job.... no partnership or advancement within the practice, they may just want to keep new grads coming in as cheap labor and cut them loose after a couple of years
 
One question is whether any group of trainees will be immune to the effects of supply/demand issues in the labor market, if it'll just be bad for residents in smaller programs w/o a long history or brand name, or if residents are more or less the same in the eyes of pp hospital managers and academic chairs

IMO, the nature of physician jobs is such that there isn't much in the way of statistical discrimination in hiring docs 2/2 standardized clinical practices, so it mainly comes down to taste-based discrimination (residency reputation, location-specific ties, "personality", obedience, etc.)
 
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What's the deal with the Salina job? it constantly gets dumped on in this board. Is it just the location or location plus predatory practice?

The Salina people actually had a booth as the Astro Refresher this year. I didn't really talk to them but it is a private practice med onc/rad onc group that has multiple sites across rural Kansas with the home base being in Salina, which is probably why they are frequently posting.
 
Current issue of Red Journal....

Domestic Job Shortage or Job Maldistribution? A Geographic Analysis of the Current Radiation Oncology Job Market

The 3 states with the greatest numbers of openings were California (n=22), New York (n=14), and Pennsylvania (n=13); however, after normalization to state population (per 10 million people), these and other large states, such as Texas and Florida, actually had noticeably small numbers of job opportunities

While health service areas within the Northeast, California, and Florida exhibited a high ratio of ROs to population aged ≥65 years between the years studied, rural areas within the Midwest continued to experience low rates of ROs.

These findings, in concordance with the findings of Aneja et al (18)—that increased RO density is found in more populous cities and states—indicate that the current labor concerns partly stem from applicants not wanting to pursue available opportunities in “less desired” locales.

Our study contains some limitations. The ASTRO Career Center website does not list jobs indefinitely, so postings prior to our study start date were not available. Therefore, we are only able to provide a snapshot of the job market over a 1-year span rather than a definitive long-term trend. In addition, the Career Center website is not the exclusive method of obtaining employment, and other websites or job recruiters may aid residents with their job search. Moreover, anecdotal evidence points toward applicants individually contacting academic department chairs for unadvertised job opportunities. Nonetheless, the Career Center website is the most exhaustive and well-known resource for residents to view open positions.
 
I think ASTRO meeting diminished just because radiation-containing phase III studies are MedOnc-led, and presented at ASCO.
 
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I think ASTRO meeting diminished just because radiation-containing phase III studies are MedOnc-led, and presented at ASCO.
Can't initiate protocols when spending all time acquiring satellites and Varian doesn't fund as well as BMS or Novartis, etc...
 
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I feel it probably best to ask one question in a Phase III rather than two scientifically unrelated and potentially confounding questions.

I think every time RTOG has done this it's turned out to be a dud. Like when RTOG had a negative trial in 0129, and despite that, they took the losing arm to be their standard arm in 0522 +/- Erbitux.

Maybe it's just Erbitux.
 
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Such an article would be a good way to make sure you never work in academics ever again.

That... or one could be a little more diplomatic in the discussion portion and make a name for themselves whose inertia carries them through their career.

I remember this one brash, young resident being appointed to a "Dermatology WorkForce TaskForce" (or some similarly named BS) at the AAD who was ultimately silenced but not before angering several balding old jackasses. 15 years later and he was spot on; that's the funny thing about mathematics, equilibrium dynamics, and non-politically (or financially) driven "analysis" or projections. Oops.
 
That... or one could be a little more diplomatic in the discussion portion and make a name for themselves whose inertia carries them through their career.

To my knowledge it hasn't worked out that way for this rad onc.

Bloodbath in Red Journal

Even though he's my personal hero, he was essentially disavowed by his own department. That said, he is still working in academics so maybe I exaggerated a bit.
 
To my knowledge it hasn't worked out that way for this rad onc.

Bloodbath in Red Journal

Even though he's my personal hero, he was essentially disavowed by his own department. That said, he is still working in academics so maybe I exaggerated a bit.

Probably covering multiple satellites with a "clinical" academic day.... :eek:
 
Could be a flat salary with no incentives/RVU bonus....

Ok 50% of academic jobs :laugh:

The other 40% are:

"We have an RVU incentive package. It's complicated how it is distributed so we can't tell you exactly and it changes from time to time." That means it's going to be ~10% of your base salary despite high RVU levels. Maybe the institution is having a bad year so you don't get a bonus at all.
 
Academic salary is like a shell game. You need to achieve max outcomes in teaching, research and clinical revenue. They are mutually exclusive. Therefore if you exceed in one or two areas, the chair will always have a reason why you don't deserve more income.



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Any particular talk/presentation at astro this year where we can all make a scene? :)
 
academic salary is a complex issue to say the least. Bottom line is If you want a raise, you need to interview elsewhere and be prepared to leave- disregard rvus, pubs etc.

Take a step back, to some extent salaries are a zero sum game. Look at the ratio of attending/ physicists to patients on beam: if you have one attending/physicist for every 10-15 pts, the salary may be a problem in the long run- That's just the model the chairman has chosen. If you end up with 15,000 RVUs, you are basically subsidizing others who are underemployed, like the senior attending with 8 on treatment who writes one paper a year and is constantly traveling, the unfunded md/phd who sees pts one day a week, but still wants a physicians salary, or the physicist who exclusively performs vaginal HDRs, and who knows what the rest of the time. Ultimately, however, if you enjoy being busy and productive, you cant let this grate on you.
 
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