Yes, it does.
What does a typical "non-compete" look like these days? Defined by city or county or x miles (how many miles and a radius?) or "drive time"? Also does it include just were you work or all satellites of the academic center (so if it's I don't know 10 miles from each center but they have multiple centers spread every 25-50 miles then the no-compete is literally a multiple hundred square mile area?)
Also what's up with the contract being renewed annually? Is that really happening (and if so does that mean they can let you go if the private practice they just acquired and made a satellite for which they hired you sees patient volume drop or only for just cause)?
This is all very new to those of us who are even just 10-15 years out . . .
The issue with some of these non-competes is that it still holds if they cut your salary. They can cut your salary in half and you have very little recourse. You cant go to a competitor in your area and with the job market, the way it is, you may have to go across the country.
I swear some of you GET OFF on scaring med students and being downers.
Stanford having an 'instructor' position where you START at 150-180k, which is a KNOWN OUTLIER, is not reason for that to be the EXPECTATION for someone who wants to live in a NON-RURAL area as the OP hypothetical example included - especially 5 years in.
I feel like I'm talking to a wall.
and Medgator - I applied this year and look at the ASTRO job center every day - there have been a number of Texas jobs posted this year, and outside of Texas, plenty of plenty of jobs posted on the coasts and in Chicago.
You guys have become a parody of yourselves. There are many many good reasons to curb residency expansion - I am 100% on board, but I'm also a rational human being and know the facts.
Look OP and any other medical students reading this - the best thing you can do is talk to real people in real life - recent grads if you know them - and ask them about their job experience and what range of locations they were looking at and what range of salaries.
Personally, Im happy with where I ended up. My starting salary is in the mid 300's and I am ending up in a major metropolitan area.
Also - if you spend time looking at the ASTRO site - which I encourage everyone to do - there are honestly not that many 'RURAL' jobs posted. There is a wide range of Top 20 city types, mid-size cities (places like des moines, springfield IL, Charleston SC, etc etc etc) and then the true random rural places with no airport are few and far between). We are at the end of the 'cycle' so less jobs are being posted now compared to the summer/fall when the board was more active
Bottom Line: The truth is, just as it has been for the last 10-15 years in rad onc, that if you want to 100% guarantee that you can stay in City X for a job when you are out of residency, that guarantee is not there. It all depends on the timing of when you graduate. BUT if you are a bit more flexible, you can find a decent job where you will be happy and paid decently well, and hopefully you will be able to get back to City X in a few years if that's your long term plan. Your first job does not have to be your forever job. It is merely the best of what's available your year.
I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.
If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?
With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.
If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?
With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.
If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?
With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.
If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?
With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
I suspect we are going to see more program closures over the coming years, followed by a shortage of rad oncs, but who knows!)
I agree with you - the same few posters are highly vocal and have derailed most threads to the point that this forum is no longer useful for medical students. I feel bad that these posters are unhappy with their situations or their personal experiences with the job market, but their comments reflect only their experience and not some universal truth.
If this were, say, an accounting forum, and the same 10 accountants complained incessantly about a terrible job market - but you have plenty of colleagues moving up the ranks at a big firm, others joining or establishing a small practice, etc., and your real-world colleagues tell you accounting is a great field - whom would you believe? People who spend quite a bit of time complaining on internet forums? Or people you know, employed in the field, in real life?
With respect to Radiation Oncology specifically, I think most people you talk with in person would tell you that the job market was pretty good this past year. Both personal advice and published data will tell you that jobs are found through personal networking, rather than internet job postings (to return to the accounting analogy - how many of your friends at EY applied for their job online? I would estimate zero). Most of us entered this field expecting to be geographically flexible, just as we interviewed at places across the country for residency. People enjoy their jobs, which frankly cannot be said about the majority of careers out there, let alone highly compensated ones.
I am sure anonymous posters will disagree with my post online, but I bet if you ask residents and practicing radiation oncologists what they think in person, most would agree with me.
Rad onc who fly upside down have big crack up.This is a field based on data. The data about the future employment situation is published and as clear as can be. Predictions can always be off, but the published prediction is oversupply. Full stop. There was a PRO paper that there were more positions posted for 1 year on the affirmative as only rebuttal. There was a survey which said >50% of the practicing work force thought oversupply was the main concern. There is the increased and increasing fellowship numbers. I stopped posting because my emotion diluted the points - but repeating these statements feels like deva ju.
Here is my additional insight. This is a mature industry. The older guys in practice had chances to build from the ground up - not easy. But, and no judgement, those opportunities are no long possible. You always in someone else's shadow in any setting. People 10 yr in practice waiting for guy 20-30 yr in practice to retire. 30 yr guy doesn't want to retire, does good enough job, name known. 30 yr guy not necessarily being parasitic, he/she just enjoys what she does. Guy 20-30 yr in practice also has zero idea how hard to break head in competitive field, how business landscape has changed, does not have the perspective of what it is like today to start. Talking to them may be counter productive.
This is an industry that makes widgets. Large part of industry is doing research on how to make less widgets and cheaper. This is good for society. But already too many company make widgets, and more coming. Some company do special thing to make widget fancier (fellowship), but still there is more senior company with better name recognition making widget. Some company get foot in industry door by making small widget part or helping when senior widget company has downtime (satellite, non partner private practice). Eventually senior company will retire, but the rad onc widget company careerspan longer than most other medical company. By time your company ready, how many other widget companies come before and ready? How long do you want to wait?
The emotion expressed on board, at least mine, realization of above too late. Take chances you want to take, but understand market forces not absolute but hard to overcome.
I suspect we are going to see more program closures over the coming years, followed by a shortage of rad oncs, but who knows!) .
The doubters regarding the current and future state of RO under current leadership simply need a time machine to see how bad things were in the 80s and 90s.Those who cannot remember the past are condemned to repeat it - George Santayana.
Radiation Oncology Workforce Recruitment Survey of 2000–2010 Graduates: Is There a Need for Better Physician Resource Planning?
http://www.caro-acro.ca/wp-content/uploads/2016/10/Stuckless-2012-Canadian-RO-Workforce-modeling.pdf
Hi all,
M3 here with great board scores, publications, clinical grades etc. who cannot decide on a specialty and hasn't really liked much of anything I have done and keeps circling back to Rad Onc.
I understand the job market is **** and probably only going to get worse. Would it be a reasonable approach to pursue Rad Onc now with the intention of taking a job in the middle of no where and getting paid great $$? I have seen people throw around figures of $650k+ for jobs in rural areas ( is this accurate? will these jobs still exist when/if I would finish residency in 7 yrs?), I don't want to live in one of these places long term but I could see myself living in one of these places for ~5 years and investing enough money to:
1. Get close to retiring
2. Go back and get a MPH or MBA and some lower paying work but with a good schedule
3. Find a very low paying ($100-200k) Rad Onc job in a desirable location with great hours
4. Do something entirely different from medicine that I enjoy (i.e. personal training, opening up a gym, etc.)
Excuse my ignorance but is that a realistic approach for someone like me? I cannot decide what I want to do with my life and have not really found any other field to be acceptable to me for either lack of meaningful/interesting work to me, or terrible schedule etc. and this is the one way I could potentially see myself being fulfilled and proud of what I do (did) and still have an enjoyable life.
Thanks
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.
My advice is not to use this site as a resource for such an important decision. Most of the people here are now unhappy with their job choice and didn't properly analyse the field before joining. .
Best of luck! I've been doing it for 20 years and I love it. There are other fields I would have also liked, but I enjoy cancer patients and all the new things that Rad Onc can do over 20 years. I have not regretted it for 1 sec, but I did do the research and had reasonable expectations.
So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.
The issue is that the discussion over there is quite reasonable and grounded, and over the past year SDN has become a cesspool of extremism and lack of rationality. What is happening at ROHub is what SDN used to be like.
Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.
So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.
My advice is not to use this site as a resource for such an important decision. Most of the people here are now unhappy with their job choice and didn't properly analyse the field before joining.
Try twitter (#radonc) or other resources for more accurate info about the specialty and it's future.
Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.
It's very naive to think differently and that part of the field has not changed in more than 20 years that I've been here.
So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.
Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.
So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.
You may find a high paying job, or you may find a great location, but it's rare to find both in the same setting as a new graduate. Work your way up in the field, prove your value, and most times you'll get a good combination of location and job quality. That is how 99% of jobs work, btw. The new grad from law school doesn't expect the Boston office with corner spot....especially if they graduate from Nebraska State Law School.
Another thing to note, don't go into this field for money. It's a very good field for it, btw, but don't do that. Cancer patients require a lot of emotional durability and if you're very competitive as a student and mostly want a good lifestyle I would suggest derm or ophthalmology. The patients require less of you and the work hours are still manageable.
It is also an important point to consider that pedigree does matter for PP and academics. I have noticed in the largest cities, the good practices in many fields of medicine take physicians from top residencies - plus graduates of local programs - plus people with really stellar personal attributes (some “x factor”) for a given job. This has been the case for any pediatrician I’ve personally seen as a patient/parent. This is also true of basically any well-compensated white collar field outside of medicine, just like the example in law given above. That Nebraska State Law School graduate could get a job in Omaha, or if his dad is a senator, maybe he could get one in Boston.
That Hopkins Rad Onc graduate could take a high-paying PP job in Texas, or an academic spot in New York.
Ha. Nepotism at its finest. "X factor?" give me a break. That's a joke.
Let me put it another way and more bluntly: some people are a pleasure to work with, great with patients and staff alike, and some people are jerks. Clinical grades and letters of recommendation tease this out for residency applicants, phone calls do for job applicants. Again, true for any job within and outside of medicine.
It is also an important point to consider that pedigree does matter for PP and academics.
At least we've established that the majority of fellowships in RO are not related to self-improvement and further education in the field. Which should shock no one considering none of them are ACGME accredited.willing to do a fellowship if they need to be in a specific city,
Wrong At least for pp. Connections to the area and the 3As are far more important once you are BC
Or, more likely, interview.Depends on the practice - all other things equal, pedigree can be the tiebreaker.
It is totally reasonable to tell students that they should be geographically flexible, willing to do a fellowship if they need to be in a specific city, and that the better the program they attend, the more options they will have. These were my expectations when I applied, and other posters have indicated that these were their expectations as well.
I guess we are in agreement here. If you are willing to be geographically open and willing to consider fellowships, by all means consider radiation. That person is not likely to be my cup of tea, if their scores/grades provided them with other options.
It is also fundamentally exploitative and sexist. Women are more likely to have a spouse with a career than visa verse and thus more geographically restricted. (I would love to hear account from a woman about taking the job in North Dakota, and her scientist husband becoming a stay at home dad.) Similar constraints hold for disadavantaged minorities who should not be forced into MAGA country. I hope such sentiments on your part are not a dog whistle for women and disadvantaged minorities to avoid the field.
I guess we are in agreement here. If you are willing to be geographically open and willing to consider fellowships, by all means consider radiation. That person is not likely to be my cup of tea, if their scores/grades provided them with other options.
It is also fundamentally exploitative and sexist. Women are more likely to have a spouse with a career than visa verse and thus more geographically restricted. (I would love to hear account from a woman about taking the job in North Dakota, and her scientist husband becoming a stay at home dad.) Similar constraints hold for disadavantaged minorities who should not be forced into MAGA country. I hope such sentiments on your part are not a dog whistle for women and disadvantaged minorities to avoid the field.
Well the academic center I work for has had job postings in small regional centers (not big cities mind you) with little/no interest. The job is with an NP and another Rad Onc, they treat 20-30 patients between the two of them, have a 1/2 day for academic research, and pay 75% of AAMC. Not a single qualified applicant. We had a couple that pulled out before the interview b/c they had a better job offer.
So, YMMV. Seriously, I sometimes think Radiology posts here to increase the applicant pool to Radiology.
jesus. this is scaryI am a senior resident who still has no job, nor do any of my graduating co-residents. We have been very flexible on geography, practice type, compensation, etc., and have gotten very few contracts - none worth signing. In the end, we will all probably get jobs, but certainly not the jobs we envisioned 5 years ago on match day.
I agree that probably the best jobs come from networking. IMO to land a job like that you've got to be really lucky. I've worked on making connections for the last couple of years, but the bottom line is no one is going to make room for you or save you a spot until you graduate. Especially not in a market like this. You can see the saturation happening, with many places having hired a new grad within the last 5 years. A couple of graduating residents from my institution have gotten jobs through networking, but the majority responded to online postings. I wouldn't say those networking jobs are much better, but they did get the locations they wanted.
I was in denial that this job market problem was real until I was slapped in the face with it this year. It's hard to admit you've made a wrong decision when you've dedicated so much time and effort to this career. My regret isn't that I've chosen the wrong field of medicine, it's that I shouldn't have chosen medicine at all. You can be just as successful working in another sector without all the loans and training, and you don't have to be a physician to help people. I suppose that's not very useful for a med student who has already put in 4 years and accumulated loans. If you're going to choose this field, you need to have realistic expectations and know that things can change dramatically from the time you match to the time you are looking for a job (i.e. become much worse than they are now). There are no job guarantees at the end of this.
I've never posted on SDN until recently but feel compelled to warn medical students.
Could you further elaborate on doing a full medicine residency prior to Rad/Onc? Would that be in the event that you needed a backup plan? Interesting thought though, but I guess that would end up lengthening your training by 2 yrs.If I were going through this again, I would give some thought to doing an internal medicine residency (in a cushy program) prior to radonc.