Cassandra? Hah! I'm not telling you prophecies. This is the way it is NOW.
Let me tell you how it is where I did residency and where I'm faculty. Because they're both basically the same thing.
These places are opening satellites all over the place with the competitive advantage that they get paid higher reimbursements than the private practices in the area.
They then staff them with new grads at half or less of what the established private practice rad oncs are making. There is no private market hiring since they're fighting to survive and being gobbled up by the academic centers.
Where I work they have close to taken over the market in the area. There are no other jobs in the area, and once you sign on you're given a huge area non-compete so you're stuck at this job unless you move far out of the area. You could say "oh that's your fault for signing the non-compete". Yeah ok I applied all over the country and got two job offers, both at academic satellites and both with huge non-negotiable non-completes so what choice did I have?
They are actively decreasing everyone's salary to 25% or less of AAMC academic salary with 100% clinical effort and demanding PP level RVU outputs. They are cutting benefits--healthcare, vacation, etc etc etc. Anyone who makes more than 25th percentile AAMC due to seniority or whatever is getting their salary cut.
If you complain or even ask too many questions, they will threaten to replace you with a desperate new grad. Your contract is at their will--they can and will fire you for any reason and everyone is scared of being let go. They post a job ad on the ASTRO site and get hundreds of applications. Even without posting a job ad, they get dozens and dozens of CVs from qualified people and new grads every year unsolicited. Sometimes they don't even have to take desperate new grads. They can take people from failing PPs or other problematic academic positions and pay experienced faculty the same non-negotiable peanuts as a desperate new grad. At first these suckers are just happy to be employed, given that often times they've been totally unemployed for awhile and like me they have no other options.
So what's it like working rad onc "academics"? They treat us like crap every day. No clinic support. Pay on par with general IM except my pay will never increase--only decrease if I don't make target for whatever reason and I'm losing benefits. 12 hours a day between clinic, machine, and hospital coverages. Made fun of and disrespected by chair, vice chair, administration, etc. We talk among each other about how bad it is and look for new jobs hoping that something else will come up (hint: it doesn't). It's like a game of musical chairs but the music stopped and there's nowhere else to sit.
Hey good news everyone, we're still expanding the residency program! We have all these satellites that could use residents. You think the chair cares that there are no jobs for grads? For them it's great--they'll do fellowships that way. The chair, vice chair, and program director need 100% resident coverage. Maybe the other faculty can have 20-40% coverage (amount depending on how much they kiss up to the chair and residents). It's sold as--if we get more residents, maybe you can have more coverage. They'll never hire midlevels since the department has to pay for them (except for the chair who can't live without a resident and midlevel AT ALL TIMES). Fellows are also great--they can support us to do research. Otherwise the heck with research, that's industry's job to fund med onc immunotherapy trials. The NIH is a waste of time (too little funding, rate of success too low).
I'm a Cassandra? No. This isn't the future. I'm telling you reality as it is NOW. It's only going to get worse. Stay away from this field.
DukeNukem is correct on all counts.
The attitudes of academic chairs and cancer center leadership are shocking. They are ecstatic at the oversupply of new grads in the job market because they can offer $325,000/year for a new grad in an undesirable city. In desirable areas, $225,000 or maybe even less.
Do you think they are passing that savings on to the patient? Of course not. How else are they going to fund the upper 6 and 7 figure salaries of the growing contingent of senior administrators in these "non-profit" hospitals? The people who make hiring decisions and run the departments are heavily incentivized to pass along as much profit as possible, and that means reducing physician salary expense. The prices are kept secret, the collections are kept secret, the production numbers are kept secret, and everyone's salary and bonus structure is kept secret. Do you think that this secrecy is just an accident? Everything, literally everything, is about maximizing the percentage of dollars from payors that flow through to the hospital. Getting a $100,000/year discount on a new grad compared to 5 years ago is HUGE. If competition resulted in a situation where a new rad onc was willing to work for $75,000/year, do you think the administration would say, "No, that's wrong -- you're bringing in $600,000 in professional fees alone plus the multiples that we are able to bill in technical fees for your work -- we're going to pay you more."?
I am thrilled that the current national leadership is trying to expose the corruption that exists in healthcare pricing. However, we have a long way to go and are devolving at a much more rapid rate than anything is being fixed.
We spend years in residency memorizing trivial data points from 20-30 year old trials. Where was the part where we were taught how the business of radiation oncology works and how much we are worth? Was that also an accident? Or did the leaders have an incentive to keep us ignorant on everything money-related? We are taught that the academic centers are the ones who encourage providers to choose treatments wisely, so surely they would not be doing anything unethical with the flow of service charges, right?
Partners in private practices that were bought out are seeing their salaries slashed in their new contracts. RVU numbers are hidden. Non-compete scopes are expanded to the point that if you find the terms of a future contract unacceptable, which are given yearly and not automatically renewable, your only choice if you want to continue working is to sell your house and move your family. Justification for cuts to satellite provider pay is to support the academic mission at the main site, which mostly consists of publishing retrospective reviews and biased sociopolitical commentary no one asked for. Residency spots are expanded and fellowships are added to support this mission.
This is all happening at an alarming rate.
Hospital administration is keenly aware of your bargaining power, or in words they prefer, whether they "have you." Your best bet is to be single with no geographic restrictions and no financial obligations so that you can scour the country for the fair opportunities, which are becoming few and far in between, and take them wherever they come and leave them when the terms become bad. However, people like this are well in the minority. Most of us entering the field and early in our careers nowhere near retirement have families with children in school. We have spouses with highly specialized professional careers who also don't have job flexibility. Many of us have student loan burdens and mortgages. Especially in "desirable" areas where we can be hit with the trifecta of higher housing costs, higher taxes, and significantly lower pay. And nearly every millennial wants to be within a few minutes of Whole Foods, a hundred different restaurants, and an international airport.
The hospitals know they "have you." If they can get you for a bargain as a new grad, do you honestly think they are going to start paying you more out of the goodness of their hearts as you become even more settled? I have seen it. The more rooted you are in the area, the worse your next contract will be.
You gave up 15 years of your life to become a radiation oncologist. Your friends that studied other STEM fields in college such as computer science started their careers over a decade ago. They maxed out their 401(k)s and company stock plans, bought houses, and enjoyed life in the private sector likely now making $200,000 or more with net worths close to $1M if they have done things right. They've got 6 figures in a retirement account that will enjoy compound interest for the next 3-4 decades and be worth millions. Graduating residents at age 30-35 not only have nothing, but can be $300,000 or more in the hole. The bottom line is that we are worth a lot, and it is a travesty to allow the programs to flood the marketplace with new grads and then reap the benefits of their actions through cheaper labor and higher profit margins.
I cannot recommend this field to anyone who is not single (or at the very least has a spouse/family that will happily follow you anywhere), has literally any geographic restriction, or any debt or financial obligation. What else should you do? I honestly don't know. Medicine in general is a not a great career choice going forward due to the monster that the American healthcare system is morphing into, but radiation oncology is especially bad.
The residents and new grads who comment that the job market is healthy because so-and-so got a job in SoCal and point to a few hybrid academic jobs on a website remind me of Dan Quayle seeing a "help wanted" sign at Burger King at brushing off concerns about the economy. Could you be any more out of touch? Willful ignorance is not a virtue.
