Thoughts from a PGY-5

[20181121]

For medical students, from an anonymous PGY-5 midway through my final year, here are some thoughts about Radiation Oncology:

If you're someone who likes medicine, surgery, oncology, advanced technology, and a lot of time with patients, I can't think of a better field than Radiation Oncology. Even though things like resident and attending lifestyle and compensation are similar to fields like Dermatology, Ophthalmology, Radiology, etc., the day-to-day work in each of these fields couldn't be more different. I have noticed that the people who ultimately thrive in Radiation Oncology are the ones who go into this field because they want to take care of cancer patients. Bottom line: we can cure cancers and deliver effective symptom relief.

If you match at a reputable center, you will get a good job. In my view, too many programs have opened up, and it doesn't make sense for a field like Radiation Oncology. We have a critically important job that requires significant cognitive and technical expertise: for patients with limited disease, our treatment can make the difference between cure and relapse, and this absolutely depends on the decision-making and technical skills of the individual radiation oncologist. Our field is much more like surgery than medical oncology in this way (which is in no way intended to diminish the important role medical oncologists play). It demands expert educators and high patient volume. My point is that for a treatment as specialized and important as radiotherapy, good training is extremely important. Unfortunately, like surgery and medical oncology, there is a lot of variability in the quality of clinical training among different programs. When I was a medical student, some of my residents told me that the quality of clinical training was good at most programs. On the other hand, some attendings disagreed and recommended I steer clear of certain programs. Knowing what I know now, I agree with my attendings.

Your best bet is to train at a reputable program. What defines a reputable program? The way I personally approach that question is to think to myself, "If I or my family member got cancer, would I go to this center for a primary or second opinion, not only for Radiation Oncology, but also for Medical Oncology and surgical opinions?" When I was in medical school, that would have generated a short list of big-name universities that are highly-regarded in medicine (e.g., Harvard, Johns Hopkins, University of Pennsylvania, Mayo Clinic, WashU St. Louis, etc.). But after talking with my medical school and away rotation residents and attendings for their thoughts, of course I learned about well-regarded specialized cancer centers like MD Anderson, Memorial Sloan Kettering, Moffitt, Fox Chase, etc. On the other hand, I also learned about big-name universities that I would have assumed would be top programs, but in fact should be avoided. When I look at the applicants’ Google spreadsheet, I think their perceptions of programs are pretty accurate in terms of reputation and graduate placement.

There are a number of reputable Radiation Oncology residencies in my city, and both this year and in past years, graduating residents have consistently taken fantastic jobs: these include the most nationally competitive private practices and academic satellites, as well as top academic main-center positions. The offers can be extremely generous in terms of compensation or start-up funds (but in my view, if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients). Many PGY-5 residents in my city have already accepted positions this year. Others are interviewing at top centers.

I think it is important to keep things in perspective. When I was applying for Radiation Oncology five years ago, I ranked every program that interviewed me since I knew that I wanted to be a radiation oncologist. I knew that the better the program, the more and better job opportunities I would have after graduation. I also knew that if I matched at a newer program or one without a strong reputation, I wouldn’t have the same options after residency. I expected that if I matched at certain programs on my list, a fellowship would be a real possibility – and one that I would be okay with. I was lucky enough to match at a top residency, and in early PGY-5 year I ultimately accepted a top academic main center faculty position at the center of my choice, in the city of my choice. And to reiterate what I wrote above: I am observing the other residents at my program and in my city also doing very well for themselves.

Am I worried about the job market going forward? Not for good doctors who train at good programs – I think they will continue to have their pick year after year. Will demand for radiotherapy decrease? I don’t know, but my view is that it will actually increase: the move toward hypofractionation reduces the number of fractions needed per patient, but other factors may disproportionately increase the number of patients – e.g., aging Baby Boomers/more cancer/earlier detection, more SBRT over surgery for certain indications, treating more patients with oligometastatic disease, more proton reirradiation, better systemic therapies leading to more palliative RT, emerging indications for RT that are in clinical use or trials at top centers that are not yet in widespread use. I am particularly excited about advancements in surgical techniques and systemic treatments that are generating new indications for radiation in some cases, and making radiation work better in others.

Papers have been published modeling future demand for radiotherapy. These are academically interesting but, in my view, of limited use. The mutual fund industry produces orders of magnitude more economic modeling than our field, and theirs is statistically wrong more often than right! Is there a problem on the supply side? Maybe. But I think about that question more from the perspective of absolute number of graduating residents from reputable programs vs. other. I believe that far into the future there will be plenty of great positions for trainees from great programs. One could recalculate our field’s published supply/demand models with only graduates from top X programs to support this point, but even still, no one can predict the future.

All in all, I am excited for the future of Radiation Oncology. We do some of the most challenging and rewarding work in the hospital, and my co-residents, attendings, and I frequently talk about how privileged we are to be able to do this meaningful work.

Thanks for reading. I hope that others who have had similar experiences will also chime in with their thoughts.

---

Members don't see this ad.

 

[RickyScott]

Agree with many of your points regarding the merits of practicing xrt, but you dont have perspective of someone who has switched jobs or tried to get a promotion or raise. Training program has no bearing on this, but job market does. In your wisdom, you also neglect geographic issues, which are the single biggest priority of most residents.

Dogma in the field traditionally was that your first job is not your last. Training program really only has much value out of training. Lastly, if you truly believe that you cant predict the future, the absolute worst /dumbest thing you can do is double training numbers in a short period of time when fractions are declining. Also, the fact that Harvard, MDACC are cutting resident slots shows they know there is a real problem, even for good programs. The good programs disagree with you.

Lastly, there are similar to posts to yours on the pathology boards in a field with obligatory fellowships and only 20% US med students and low pay. (but at least does not have the geographic restriction of XRT) One prediction I have: no matter how bad things get in XRT, we will still see posts like yours to the effect that 1) we cant predict the future. 2) Things arent really that "bad". 3) Things are really bad in every field, and we are actually better off (what north korea tells their people)

 

[Tigerstang]

Come back in five years. The world seems rosy as a new graduate. Wait till you've been churned and burned by a few practices/health systems.

 

[scarbrtj]

Good points and encouraging. "[M]y view is that [radiotherapy demand] will actually increase"... it had best get going. All plans for the future are gambles, including and especially what kind of doctor to become. In my eyes the rad onc gamble's gotten riskier over time: this was unnecessary. I set a Siri reminder to go off in 5y and come back here and see if my thoughts have changed.

 

[evilbooyaa]

Thanks for posting. The work is still great, there are good (IMO) jobs to be had, and reputation of the residency program you come from seems to be a very important factor for what jobs one is competitive for. All current medical students should try to get in the 1) best reputation program that is 2) in the location they ideally want to practice in after residency, I believe in that order. Doubly so on that order if you are gung ho on academics.

 

[deleted18755]

Slightly tangential, but while everybody knows the baby boomers are getting older and it's realistic to assume that the incidence of cancers in America will be elevated because of this, when is a reasonable estimate for when most of them, or at least the excess relative to any average cohort, will be dead and gone?

I am still trying to wrap my head around the fact that it is 2020, but this means that a medical student thinking about specializing in radiation oncology won't enter the workforce until something like 2027-2030 and plans to work until the 2060's or 2070's?

These numbers are making my head explode and I'm well aware that nobody can predict the next decade let alone what the career of a 25 year old medical student in the year 2020 may be like in the 2060's, but I think it's safe to say that relying on the "aging baby boomers" and their contribution to the increased incidence in cancers in the US will not sustain a current medical student's career in oncology, but may not even do so past the first 5-10 years of his or her career.

I honestly think the hardest part of being a medical student is not the coursework but trying to figure out what specialty will work out best for their profession and personal lives 10-30+ years later (especially in an ever rapidly changing world!!!)

 

[Gfunk6]

I agree with much of what you wrote, but I do take exception to a few points.

Your best bet is to train at a reputable program. What defines a reputable program? The way I personally approach that question is to think to myself, "If I or my family member got cancer, would I go to this center for a primary or second opinion, not only for Radiation Oncology, but also for Medical Oncology and surgical opinions?"

I've phone interviewed about ~150 RO MD candidates over the last five years and face-to-face interviewed dozens. My view is that the reputation of your residency program (with certain narrow exceptions) is pretty irrelevant. I think the vast majority of programs (I would venture > 95%) train their residents adequately to function as private practice generalists. If you seek a pediatric or brachytherapy job this does not neecssarily apply.

Am I worried about the job market going forward? Not for good doctors who train at good programs – I think they will continue to have their pick year after year.

The mathematics of RO resident production, need for RO services nationwide, and fundamental changes in RO reimbursement structure do not support this statement at all.

I believe that far into the future there will be plenty of great positions for trainees from great programs.

Again, I disagree for the same reasons as have been expounded upon in countless threads.

I would also agree with other responses above in that you are new to this process and need to enter the job market for a few years to gain a more insightful perspective. Jobs that look good to new grads are at times "too good to be true" and are filled with bosses who are predatory and manipulative.

 

[scarbrtj]

Slightly tangential, but while everybody knows the baby boomers are getting older and it's realistic to assume that the incidence of cancers in America will be elevated because of this, when is a reasonable estimate for when most of them, or at least the excess relative to any average cohort, will be dead and gone?

I am still trying to wrap my head around the fact that it is 2020, but this means that a medical student thinking about specializing in radiation oncology won't enter the workforce until something like 2027-2030 and plans to work until the 2060's or 2070's?

These numbers are making my head explode and I'm well aware that nobody can predict the next decade let alone what the career of a 25 year old medical student in the year 2020 may be like in the 2060's, but I think it's safe to say that relying on the "aging baby boomers" and their contribution to the increased incidence in cancers in the US will not sustain a current medical student's career in oncology, but may not even do so past the first 5-10 years of his or her career.

I honestly think the hardest part of being a medical student is not the coursework but trying to figure out what specialty will work out best for their profession and personal lives 10-30+ years later (especially in an ever rapidly changing world!!!)

NEWS FROM THE FUTURE: Luddite in 2070 refuses to merge consciousness with A.I. treatment planning system.

 

[radiation]

Slightly tangential, but while everybody knows the baby boomers are getting older and it's realistic to assume that the incidence of cancers in America will be elevated because of this, when is a reasonable estimate for when most of them, or at least the excess relative to any average cohort, will be dead and gone?

I am still trying to wrap my head around the fact that it is 2020, but this means that a medical student thinking about specializing in radiation oncology won't enter the workforce until something like 2027-2030 and plans to work until the 2060's or 2070's?

These numbers are making my head explode and I'm well aware that nobody can predict the next decade let alone what the career of a 25 year old medical student in the year 2020 may be like in the 2060's, but I think it's safe to say that relying on the "aging baby boomers" and their contribution to the increased incidence in cancers in the US will not sustain a current medical student's career in oncology, but may not even do so past the first 5-10 years of his or her career.

I honestly think the hardest part of being a medical student is not the coursework but trying to figure out what specialty will work out best for their profession and personal lives 10-30+ years later (especially in an ever rapidly changing world!!!)

Proportion of population that is older is projected to continue to grow

 

[RickyScott]

I've phone interviewed about ~150 RO MD candidates over the last five years and face-to-face interviewed dozens. My view is that the reputation of your residency program (with certain narrow exceptions) is pretty irrelevant. I think the vast majority of programs (I would venture > 95%) train their residents adequately to function as private practice generalists. If you seek a pediatric or brachytherapy job this does not neecssarily apply.

The poster is unrealistic and shows unbridled optimisim, yet still seems to grant/accept that a resident from a lower tier program- (who almost certainly is still AOA, multiple pubs and high board scores 260+) may have issues finding a job: what does that say about the state of the field to medstudents?
This is so self-contradictory: Radonc is a wonderful career choice, but I wholeheartedly admit that a pgy3-5 from univ kansas with aoa and 260+ usmle will have difficulty finding a decent job over next year/two? The OP is an unintended indictment of the field.

 

[goodkerma]

Yeah sorry OP but the “reputable program” is garbage advice for the majority. And I’ve seen my fair share of subpar physicians get jobs at some of those “elite” cancer centers on nothing more than a connection or family member and surprise they didn’t train at “top” programs. If you have cancer make sure you trust the individual doctor you see, not just the institution’s name.

Advice to entering students would be - train where you want to be long term, make connections and be a team player and you’ll probably find a job in the region on graduation.... but don’t except it to be perfect.

 

[RickyScott]

[

Lets expound on false elitism. Do you think the Middle of class/average medstudent who will be entering mskcc 4 years from now will somehow be more valued by the job market than the elite medstudent now turned resident/pgy4 in middle of road/lower tier program today? Is that what the op wants us to believe? We are so dumb and name obsessed, this won’t enter Anyone’s considerations.
Going by history as my guide- some top 3 programs had carribean grads in late 80s.

 

[20181121]

Do you think the Middle of class/average medstudent who will be entering mskcc 4 years from now will somehow be more valued by the job market than the elite medstudent now turned resident/pgy4 in middle of road/lower tier program today?

Yes. Board scores and grades are merely the price of entry - they alone do not make a good radiation oncologist. Just like everyone who goes into neurosurgery has good scores and grades, some emerge better surgeons than others, thanks to both personal traits and quality of training. A student with lower scores but better training will absolutely be a better radiation oncologist - and fare better on the job market - than one with high scores and lower-quality training (or worse interpersonal skills, or worse patient-care skills, etc.).

 

[Haybrant]

This was gold, who fed you this brilliant line: “if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients”

 

[Mandelin Rain]

This was gold, who fed you this brilliant line: “if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients”

Written like a true hospital administrator (which may not be far off).

"Of course we're not going to pay you for the honor of taking care of cancer patients. Or... are you one of those greedy doctors who only cares about money?"

 

[goodkerma]

Yes. Board scores and grades are merely the price of entry - they alone do not make a good radiation oncologist. Just like everyone who goes into neurosurgery has good scores and grades, some emerge better surgeons than others, thanks to both personal traits and quality of training. A student with lower scores but better training will absolutely be a better radiation oncologist - and fare better on the job market - than one with high scores and lower-quality training (or worse interpersonal skills, or worse patient-care skills, etc.).

more flawed logic. those things in parenthesis are most important and most are inherent abilities that no training program can give you.

As has been discussed on this board before, what is a quality training program? One with a year of research time outside of clinic and midlevel support - where maybe residents just see consults for three years and don’t even learn OTV management.. but have time to prepare good didactics... since their system functions without them or a high volume clinical place where you develop the skills for independent practice?

Using your logic- intern year is probably most important to how good a physician you will be. Once you start PGY2 the expectation is you know how to take care of patients, just need to learn what RT is and how to use it.

going to a larger program does have benefits though.. you know larger alumni network and those things that don’t exist *cough* recalls cough* that make life easier for you.

 

[KHE88]

This was gold, who fed you this brilliant line: “if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients”

Sounds like something out of the soviet union.
It is duty of good communist to produce for state and fellow communist.
So who's profiting off your labor when your name and license is being used to bill 3 million in global fees annually but you're only getting paid $250k?
You're getting paid in the privelege of treating your fellow man I suppose? This tactic only works on the foolish/brainwashed or when you have an enormous standing army pointing guns at you and ready to throw you in gulags if you don't go along.

 

[RickyScott]

Sounds like something out of the soviet union.
It is duty of good communist to produce for state and fellow communist.
So who's profiting off your labor when your name and license is being used to bill 3 million in global fees annually but you're only getting paid $250k?
You're getting paid in the privelege of treating your fellow man I suppose? This tactic only works on the foolish/brainwashed or when you have an enormous standing army pointing guns at you and ready to throw you in gulags if you don't go along.

Agree that compensation should not be sole focus, and it is not for most residents. But geography is (for most) . If you are forced to live thousands of miles from family/friends to the detriment of your spouses career, you deserve a lot of compensation for this.
btw medonc offers a lot of compensation and favorable geography. Medstudents can always apply to xrt out of Im if suddenly medonc prospects worsen and Xrt is somehow underserved In 4 years. (I would bet my life savings that xrt residencies will be less selective 4 yrs from now.) plus, you will probably end up doing fellowship in xrt so that route is not much longer.

 

[scarbrtj]

This was gold, who fed you this brilliant line: “if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients”

I’m here to radiosurgerize some AVMs, prevent some keloids, and treat arthritis!

 

[Lamount]

OP: Nothing will elicit more dissension and pushback from posters on these forums than optimism. For many here, if you aren't angry, you must be naive (and could be dangerous)

 

[RollTideRadOnc]

It's fine to be optimistic. But as we've discussed ad nauseam, that optimism is unfounded because the numbers at work are inexorable: more grads, fewer indications for RT, hypofractionation, declining reimbursement, and fewer supervision requirements. Not only will there be fewer jobs, there will also be a strong downward pressure on income.

The OP's post can be summed up as "I went to a top program and found a great job, so everything is actually fine in Radiation Oncology!" This is actually a post almost entirely without substance.

Don't get me wrong. I'm glad the OP has found a good job. And good jobs will still be out there. But they will be increasingly hard to find for the majority of docs. Just because the OP found one such job is the very definition of anecdotal.

And don't forget, about 50% of grads change jobs within the first three years of practice. So good luck to the OP when he is changing positions in three years and is competing with the 600 other new docs who will have graduated into a terrible job market since then.

 

[RickyScott]

prestige - not often mentioned along with salary/geography etc- is important for many of us in medicine (myself included). If you went to a good program in a highly selective field, but are now faced with being “king of sh— mountain” as field is no longer desirable, that’s got to be disheartening!

I honestly think that some of the posters who refuse to recognize the obvious are coming at it from this angle. Given what it took to match at a top program, declining desirability of specialty must threaten the identity of some, and they react angrily to anyone calling it like it is.

 

[yesmaster]

The OP is correct that if you match at a top program, you will be well positioned. Oysters everywhere. However, if you match to a merely good or average program, you'll be a leper for the rest of your life in radiation oncology.

It's not clear if top program is top 3, top 5, or top 15 in 2019-2020, but as the job market worsens, the club will only become more exclusive.

 

[RickyScott]

OP: Nothing will elicit more dissension and pushback from posters on these forums than optimism. For many here, if you aren't angry, you must be naive (and could be dangerous)

I guess, if an oyster is a university satellite in a semi-desirable location, which no one from a top program would have taken in the past. Not very compelling to top med students, who have other options, like being an oncologist.

 

[metview]

Thanks for sharing your thoughts being that you are so close to the job hunt. It is good to have people sharing different perspectives on this topic.

One thing that I found interesting from your post is that you suggest that the job is good for those graduating from top programs (top 10-15). This makes sense given the reputation and alumni network. But what about those graduating from not "top" programs? If they aren't able to find good jobs then that suggestst there is a huge problem at hand and does imply that the job market isn't very good. We need to get back to a point where EVERY program is providing good training and EVERY graduate has an opportunity to be employed after graduating. Unfortunately, we are far from that with new programs with poor teaching opening/expanding.

 

[yesmaster]

The OP's post is so interesting. It's consistent with the views of residents and attendings I know IRL from top centers. In saying that "residents in my city" are doing well, it seems to foster an idea of inclusiveness and all-is-right-in-the-world. It's always sunny in Philadelphia (Penn/Fox Chase)! The California Gold Rush is alive and well in San Francisco (UCSF/Stanford)!

The problem with this viewpoint is several-fold.

1) The health of the job market for top 5-15 programs is partly due to aggressive expansion of their sponsoring institutions through acquisitions, takeovers, etc. because of a regulatory climate that's favored "bigger is better" healthcare organizations. Satellites upon satellites. Unfortunately, this just converts a former private practice, for example, to an academic satellite. This is akin to taking a bigger slice of a shrinking per-provider pie.

2) Ignoring or downplaying the job market outside the top 5-15 programs is the sign of a bubble.

3) Part of the difference between a graduate of a top 5-15 program and a merely good/average program may be prestige/name recognition. It might be 1%, or 99%. It’s a problem if these graduates provide a similar level of care as physicians and radiation oncologists, but one is employed, and the other is not.

 

[RickyScott]

Thanks for sharing your thoughts being that you are so close to the job hunt. It is good to have people sharing different perspectives on this topic.

One thing that I found interesting from your post is that you suggest that the job is good for those graduating from top programs (top 10-15). This makes sense given the reputation and alumni network. But what about those graduating from not "top" programs? If they aren't able to find good jobs then that suggestst there is a huge problem at hand and does imply that the job market isn't very good. We need to get back to a point where EVERY program is providing good training and EVERY graduate has an opportunity to be employed after graduating. Unfortunately, we are far from that with new programs with poor teaching opening/expanding.

The emphasis on name is from a time when radonc was a bottom dwelling specialty and the joint center and a handlful of other good programs accounted for 1/3 or more of all residency positions. I guess some felt at this time that the bar to entry was so low that you really should attend a good program. Everything changes when good candidates started swarming into the field.

It was not that prestigious programs gave so much better training than that there were a lot of losers at other programs.


The resident has and always will be so much more important than the program, especially now with everything online. Until the early 2000s almost all your learning came from Perez,Astro handouts, and your program. Internet really did not impact xrt learning/teaching until mid 2000s. We are not procedure heavy where you need to practice a lot of procedures to hone your skills.

There will soon be a time when an average medstudent will again be matching at top programs. Field and job market is not stupid and this will be blatantly obvious. Not going to be valued more than top medstudent today at avg program. Girl in rural mass who went to princeton,Upenn, southwestern, and proton fellow at Harvard very well may be in job market 7 years from now competing with mskcc new grad who came from Ross. (And,yes I had an attending In training with almost those exact credentials.)

A program’s name is not a golden ticket to the rest of career. Supply/demand in job market is so much more important. It really is like gravity, the other major enlightenment contribution from 17th century England.

 

[deleted941485]

Once the rationale became: “if you go to a good program then jobs will abound” is the first sign to RUN!

After reading this tripe,The OP needs a serious mental adjustment.

 

[Lamount]

Once the rationale became: “if you go to a good program then jobs will abound” is the first sign to RUN!

After reading this tripe,The OP needs a serious mental adjustment.

Serious mental adjustment? Lol Right back at you, buddy.

The OP is a PGY-5 who is optimistic about the career that he/she chose. Seems an appropriate mentality for anyone in their final year of training. There are legitimate concerns about the job market, and then there is being angry that someone isn’t as bitter as you... yours is the latter.

Edited to fix quote syntax

 

[deleted1002574]

Serious mental adjustment? Lol Right back at you, buddy.

The OP is a PGY-5 who is optimistic about the career that he/she chose. Seems an appropriate mentality for anyone in their final year of training. There are legitimate concerns about the job market, and then there is being angry that someone isn’t as bitter as you... yours is the latter.

Edited to fix quote syntax

But, La Mount (that’s The Mount, in Spanish)-

If the OP is saying all is well, I went to a great program and I got a job, so don’t worry... do you not see how that may cause .. La Consternation ... amongst the populace? Are there other fields where you have to say “if you graduate from top 10 program, you’ll be fine”?

It’s a sad state of affairs. I’m okay with optimism. But, what they said is actually truth - we are in a situation where we have to justify picking this field...

 

[RadOncDoc21]

But, La Mount (that’s The Mount, in Spanish)-

If the OP is saying all is well, I went to a great program and I got a job, so don’t worry... do you not see how that may cause .. La Consternation ... amongst the populace? Are there other fields where you have to say “if you graduate from top 10 program, you’ll be fine”?

It’s a sad state of affairs. I’m okay with optimism. But, what they said is actually truth - we are in a situation where we have to justify picking this field...

And it’s not even an accurate statement. The next fake news headlines will claim that doing a fellowship helps. It’s a path of uncertainty with no merits vs. just stating the obvious that the job market sucks right now.

 

[deleted18755]

This was gold, who fed you this brilliant line: “if compensation is your focus, Radiation Oncology is not the field for you: we are here to take care of cancer patients”

I lot of people your age feel (or at least verbalize) this way about compensation, but I'd like to point out a few things I've come to realize that are difficult for a medical student or even graduating resident to understand (I know it was for me):

1. If/when a physician's compensation decreases, it doesn't mean that the patient actually pays less or saves any money at all. In fact, reimbursement has held roughly steady over the past few years but patient's insurance and out of pocket costs are actually increasing. Trust me, if/when the physician is compensated less, I can assure you that not all (if any) of that money is passed onto the patient. In other words, if one physician is making $300,000 and another is making $250,000 for the same work, that's fine as long each party is happy with their arrangement, but the physician making less would be foolish to think that that the $50,000 is somehow benefiting his patients. Of course if there is another physician making $1,000,000 for the same work, then there is probably something shady going on.

In any event, some of the concerns expressed with regard to radiation oncology future employment is not if salary is going to go down 5-10% or even 25-50%, but 100% (unemployment).

2. It's easy to be a 25-30 year old single man or even husband who is married with a child and think "I don't need a mansion in Southern California or to drive a BMW . . . I'm happy to live in a modest house and drive a Honda (that's honestly what I still do) while taking care of patients: I'm not here for the compensation, I'm here to take care of cancer patients." It's easy to predict that one will need a home and a car, but what is not possible to predict is having a special needs child, parent who is otherwise healthy and may live 20-25 years but is showing signs of dementia, or even a more likely divorce or other life event that requires a tremendous amount of money and/or move.

It's one thing to have an out of state parent or family member experience an acute event like a car accident that requires weeks or months or maybe even a year of recovery but a more likely scenario is a an aging parents who you would like to keep an eye on for literally a decade or two and whom you would like to live near so can run over at 3am when she falls or your father in law calls saying he can't find her, or find top notch nursing home care, etc.

What about when a marriage falls apart and your wife and kids move far away?

These are the type of situations were having more than a little extra money and geographic flexibility really matter even to those who don't care to live in mansions in big cities or drive fancy cars (and to those who do if you earned your money whatever floats your boat).

Maybe you've thought about these type of things already, I know I didn't when I was a medical student or resident (heck or even a 35 year old man with a very healthy kid and parents/in laws) and in the past 10-12 years most of the above have already happened to me and all of them have happened to people I know well.

 

[scarbrtj]

In fact, reimbursement has held roughly steady over the past few years but patient's insurance and out of pocket costs are actually increasing

Over the last few years it's held (kind of steady). But at least in my sphere I have felt a decline in reimbursement (of course I hypofx a lot), and maybe I am looking out past a few years too. Just yesterday I came across the old UroRads brochure. They claimed ~$45,000 reimbursement for 45-fx IMRT, and that was pre-IGRT, so let's just round to $50,000. Now, 30 fx IMRT (IGRT would be included) reimburses ~$20,000. Worst case, it should reimburse 2/3 of $50,000, or ~$33K. So IMRT multi-fx courses of tx have seen a reimbursement drop of >33% since UroRad heyday. That's a biiiig drop.

 

[RickyScott]

Serious mental adjustment? Lol Right back at you, buddy.

The OP is a PGY-5 who is optimistic about the career that he/she chose. Seems an appropriate mentality for anyone in their final year of training. There are legitimate concerns about the job market, and then there is being angry that someone isn’t as bitter as you... yours is the latter.

Edited to fix quote syntax

Where I think the issue becomes heated and nasty is the implication that someone from a mid or lower tier program may not have good job prospects. These guys are still aoa and have high board scores so why shouldn’t they? They could have gone into so many other rewarding fields.

doesn’t that mean the field is really sick? Is it really reasonable to be optimistic about a field where top med students at mid/lower tier program are in this position? Again, an average medstudent at top program in future will still be competing with these candidates for jobs and we are not so stupid that the name is going to wash over everything.

 

[Mandelin Rain]

At some point, the name won’t save you. That point is when a person from a lesser name is willing to accept $10,000 (Maybe 5,000) less than you.

 

[Tigerstang]

I lot of people your age feel (or at least verbalize) this way about compensation, but I'd like to point out a few things I've come to realize that are difficult for a medical student or even graduating resident to understand (I know it was for me):

1. If/when a physician's compensation decreases, it doesn't mean that the patient actually pays less or saves any money at all. In fact, reimbursement has held roughly steady over the past few years but patient's insurance and out of pocket costs are actually increasing. Trust me, if/when the physician is compensated less, I can assure you that not all (if any) of that money is passed onto the patient. In other words, if one physician is making $300,000 and another is making $250,000 for the same work, that's fine as long each party is happy with their arrangement, but the physician making less would be foolish to think that that the $50,000 is somehow benefiting his patients. Of course if there is another physician making $1,000,000 for the same work, then there is probably something shady going on.

In any event, some of the concerns expressed with regard to radiation oncology future employment is not if salary is going to go down 5-10% or even 25-50%, but 100% (unemployment).

2. It's easy to be a 25-30 year old single man or even husband who is married with a child and think "I don't need a mansion in Southern California or to drive to a BMX . . . I'm happy to live in a modest house and drive a Honda (that's honestly what I still do) while taking care of patients: I'm not here for the compensation, I'm here to take care of cancer patients." It's easy to predict that one will need a home and a car, but what is not possible to predict is having a special needs child, parent who is otherwise healthy and may live 20-25 years but is showing signs of dementia, or even a more likely divorce or other life event that requires a tremendous amount of money and/or move.

It's one thing to have an out of state parent or family member experience an acute event like a car accident that requires weeks or months or maybe even a year of recovery but a more likely scenario is a an aging parents who you would like to keep an eye on for literally a decade or two and whom you would like to live near so can run over at 3am when she falls or your father in law calls saying he can't find her, or find top notch nursing home care, etc.

What about when a marriage falls apart and your wife and kids move far away?

These are the type of situations were having more than a little extra money and geographic flexibility really matter even to those who don't care to live in mansions in big cities or drive fancy cars (and to those who do if you earned your money whatever floats your boat).

Maybe you've thought about these type of things already, I know I didn't when I was a medical student or resident (heck or even a 35 year old man with a very healthy kid and parents/in laws) and in the past 10-12 years most of the above have already happened to me and all of them have happened to people I know well.

Youngins here, listen to this guy. He knows of what he speaks. As a fellow old guy, I can tell you all of the above is oh too real, and in some way or another 1 or more of the above will impact you. At 250k a year, it's going to be very hard to manage these things. Just being honest.

 

[deleted18755]

Youngins here, listen to this guy. He knows of what he speaks. As a fellow old guy, I can tell you all of the above is oh too real, and in some way or another 1 or more of the above will impact you. At 250k a year, it's going to be very hard to manage these things. Just being honest.

I'm not even that old (not even 50) and I've already had to deal with (or am actively doing so . . . as in literally at 3am this morning) at least one of these issues that I wouldn't even have imaged as recently as a decade ago. These aren't the kinds of things that you can prepare for with even the best personal disability or life insurance and a lot of it has to do with geographic flexibility vs money (I guess if you had enough money you could pay for 24/7 care for your parents or in laws for the next 10-15+ years or make sure your special needs or disabled child is cared for well after your gone . . . but what about if you get divorced and your wife and kids move forget across country but even a few hundred miles away and you can't get a job the area).

Getting a job in a specific location so you have access to shops and restaurants and your Biryani is nothing compared to being able to get a job near your kids or aging parents.

People used to tell me as you get older that experiences and peace of mind become more important than money but I feel as though as you get older experiences and peace of mind (which require geographic flexibility) become more important AND money becomes more important to make sure ones loved ones are cared for properly.

Just something to think about...

 

[RadOnc37]

Cancel culture on point here (p.s. if you haven't seen that NYT Middle Ages Cancel Culture video, I do recommend it)

OP - I appreciate the positivity behind what you describe as your driving force for entering the field. Keep your head up. We welcome good people in our group, so feel free to reach out for networking at any time.

Oldking - sorry to hear about your family, and I hope things improve as soon as possible. Many (myself included) have struggled with the same - I have many regrets at not traveling to see family more, and of not being right there with them during health-related issues. I struggle with the stress around shutting down clinic to get away for emergent issues. It is an unfortunate aspect of the specialty (of many physician specialties, for that matter). Best of luck in your situation. Not to downplay the significance, but if, in the spirit of the discussion, I may offer a few counterpoints to yours and tigerstand's posts:

You suggest for interested med students that higher-earning specialties are more preferable, and while the potential life stressors listed are substantial, let's not pretend that any of the high-earning subspecialties allow you to very easily pick up your bags, move cities and have great pay, great case volume and great quality of life, should one of those life stressors arise. Might they do so more easily than radonc? That's fair, "more easily" isn't "easily." We are playing the odds - I would argue that at baseline, radiation oncology has a better day-to-day quality of life than many of the higher-earning subspecialties, so if you can get your parents or whatever to relocate to your city, you may in fact be available more than [X] subspecialty with worse work hours. I raised kids during residency - one of the hardest things I've ever done - and every single day as I was home and continue to be home for dinner and bedtime routine without distraction from work, I am thankful that I chose this field over others that would require night shifts, nighttime call or longer hours (timely good piece from the NYT regarding parenting as a surgeon: When the Surgeon Is a Mom). To repeat, for students and residents who want to be present for their families: stable work hours without nighttime shifts is invaluable. You have a spouse with career aspirations, too? My spouse travels not infrequently for work (the reality of the vast majority of high-earning jobs at big companies). She traveled some when we were in a major metroplex for my residency (hard on the family) and now even more that we are in a mid-tier metroplex (even harder on the family). If I had the vast majority of other specialty jobs, our two careers would be outrageously difficult to balance. No, I don't believe that hiring someone to parent your kids is parenting. Yes, divorce is incredibly awful, but ignoring your career interests and being a hospitalist such that you can easily move cities is not an appropriate career planning move to minimize the difficulty of a potential divorce in the future. Instead, to you med students out there who choose radonc, I would suggest using those free nights and weekends to invest more in the most important thing in your life: your families.

Regarding financial planning: yes, you should not expect your salary to be your golden ticket to stable retirement, and that holds true in pretty much any medical specialty nowadays. I won't expound on that further here as we all know it well.

Regarding salary: no subspecialtist can reasonably expect his/her salary to increase substantially in the future. It is a zero sum game. Maybe we are talking about a higher level concern here, as to whether students should reconsider becoming a physician? Beyond the scope of this post.

TLDR: as oldking is showing us now, money is not the most important thing in life. Ignoring the select few of elective derm (i.e. cash payments), elective plastics, etc, the reality for physicians in general is that we cannot realistically expect our salaries to hold steady in the future. If your plan for retirement is summed up as "I will save some of my salary each year," please read some financial planning books. IMO, taking a flexible hospitalist job if you aren't very interested by the work is not the answer to risk-mitigating many of life's potential stressors. Getting that high-paying neurosurgery job, cardiology job, IR job or ortho job comes at a cost of work hours. That may be acceptable to you, and if it is, great. I'll be back in a week or so to check the bashing that has unfolded against me (you know it's true. I don't mind)

 

[RickyScott]

Right now a part time medonc earns more than a full time radonc and has tremendous geographic choice and by all accounts a brighter future as a field. Personally know several medonc part time moms in top places in top 3 cities who earn more than 400k

 

[deleted18755]

Cancel culture on point here (p.s. if you haven't seen that NYT Middle Ages Cancel Culture video, I do recommend it)

OP - I appreciate the positivity behind what you describe as your driving force for entering the field. Keep your head up. We welcome good people in our group, so feel free to reach out for networking at any time.

Oldking - sorry to hear about your family, and I hope things improve as soon as possible. Many (myself included) have struggled with the same - I have many regrets at not traveling to see family more, and of not being right there with them during health-related issues. I struggle with the stress around shutting down clinic to get away for emergent issues. It is an unfortunate aspect of the specialty (of many physician specialties, for that matter). Best of luck in your situation. Not to downplay the significance, but if, in the spirit of the discussion, I may offer a few counterpoints to yours and tigerstand's posts:

You suggest for interested med students that higher-earning specialties are more preferable, and while the potential life stressors listed are substantial, let's not pretend that any of the high-earning subspecialties allow you to very easily pick up your bags, move cities and have great pay, great case volume and great quality of life, should one of those life stressors arise. Might they do so more easily than radonc? That's fair, "more easily" isn't "easily." We are playing the odds - I would argue that at baseline, radiation oncology has a better day-to-day quality of life than many of the higher-earning subspecialties, so if you can get your parents or whatever to relocate to your city, you may in fact be available more than [X] subspecialty with worse work hours. I raised kids during residency - one of the hardest things I've ever done - and every single day as I was home and continue to be home for dinner and bedtime routine without distraction from work, I am thankful that I chose this field over others that would require night shifts, nighttime call or longer hours (timely good piece from the NYT regarding parenting as a surgeon: When the Surgeon Is a Mom). To repeat, for students and residents who want to be present for their families: stable work hours without nighttime shifts is invaluable. You have a spouse with career aspirations, too? My spouse travels not infrequently for work (the reality of the vast majority of high-earning jobs at big companies). She traveled some when we were in a major metroplex for my residency (hard on the family) and now even more that we are in a mid-tier metroplex (even harder on the family). If I had the vast majority of other specialty jobs, our two careers would be outrageously difficult to balance. No, I don't believe that hiring someone to parent your kids is parenting. Yes, divorce is incredibly awful, but ignoring your career interests and being a hospitalist such that you can easily move cities is not an appropriate career planning move to minimize the difficulty of a potential divorce in the future. Instead, to you med students out there who choose radonc, I would suggest using those free nights and weekends to invest more in the most important thing in your life: your families.

Regarding financial planning: yes, you should not expect your salary to be your golden ticket to stable retirement, and that holds true in pretty much any medical specialty nowadays. I won't expound on that further here as we all know it well.

Regarding salary: no subspecialtist can reasonably expect his/her salary to increase substantially in the future. It is a zero sum game. Maybe we are talking about a higher level concern here, as to whether students should reconsider becoming a physician? Beyond the scope of this post.

TLDR: as oldking is showing us now, money is not the most important thing in life. Ignoring the select few of elective derm (i.e. cash payments), elective plastics, etc, the reality for physicians in general is that we cannot realistically expect our salaries to hold steady in the future. If your plan for retirement is summed up as "I will save some of my salary each year," please read some financial planning books. IMO, taking a flexible hospitalist job if you aren't very interested by the work is not the answer to risk-mitigating many of life's potential stressors. Getting that high-paying neurosurgery job, cardiology job, IR job or ortho job comes at a cost of work hours. That may be acceptable to you, and if it is, great. I'll be back in a week or so to check the bashing that has unfolded against me (you know it's true. I don't mind)

Excellent points. I was just trying to provide some insights and hope that this discussion helped the "next generation" make whatever may be the best decision for themselves (which is my only goal in posting here). I've said it before and I'll say it again, perhaps the most difficult part of medical school is trying to figure out at age 25 or so what specialty is best for you for the next 30-40 years!!!

I hope we provided some things to think about without excessively swaying anybody in one direction or another...

 

[RollTideRadOnc]

Even if good jobs will be available to graduates of the top 3, I doubt that there will be geographic flexibility. Maybe you can get a great job in the same region or across the country... but this will field will always and forevermore be luck of the draw if you have your heart set on a particular city. And that's going to be true whether or not you graduate from Harvard or MSKCC. It just won't matter as all the best cities have very few good practices, and new positions may not open for years at time.

Contrast this with MedOnc (or other IM subspecialties), Derm, Plastics, (and to a less extent, Ophthalmology, ENT, etc), in which docs can quite literally choose not just a state or region, but have an easy time finding a job in whatever city they want, and many times can even be choosy about practices within a city.

This will never be the case for RadOnc.

 

[20181121]

A few points:

- I actually do think that most programs today provide good training and job placement and that there are only a few to avoid. My thoughts about reputable programs apply to a greater extent for those who hold a pessimistic view of the future, which (clearly!) I do not. The data show that nearly all graduating residents are taking highly compensated positions and very few do fellowships (see the Mohamad paper), which is frankly unusual compared to most highly specialized fields of medicine (take a look at the data for Dermatology, Ophthalmology, Orthopedic Surgery, ENT, to name a few - not to mention Radiology and Anesthesiology!).

- Radiation Oncology is a small field and has more geographic restrictions than larger fields. This is not new. I was told about this limitation when I first learned about the field ten years ago. I have actually been pleasantly surprised to see that the residents in my city are taking positions in their preferred geographic locations, which are highly desirable large cities. This is not just my program, these are multiple programs.

- The compensation discussed by others is not in line with reality - see MGMA and AMGA (you will find 2018 numbers if you search for them), AAMC (should be available through your institution's library), and Terry Wall's survey data for actual median or mean numbers. Radiation Oncology remains much better compensated than Medical Oncology - and is one of the best-compensated fields in medicine - but again, I hope that is not why anyone goes into this field.

- To put things in perspective, if you take a look at other specialty forums, you will see that, just like in Radiation Oncology, there is a vocal, small group of posters who have complaints. In Dermatology they worry about private equity, NP/PA encroachment, and Mohs volume; ENTs worry about their field's recent need to SOAP; and specialized orthopedists also have geographic restrictions.

- People's focus on board scores and grades leads me to believe that interpersonal and clinical skills, emotional intelligence, etc., are being strongly undervalued. As do many other residents at programs across the country, I interview and rank medical students for residency. Everyone we interview has an impressive CV - 260 vs. 250 Step 1, 8 vs. 4 first-author publications, impressive experiences, you name it - so soft skills end up being the most important attributes. Of course, this is even more true when looking for positions after residency, since no one is asking about Step 1 scores or ACGME evaluations. People want to hire a doctor they would send their mother to see.

- To the posters here who are not happy with how things have turned out for their careers, I truly sympathize with you and sincerely hope the future brings you personal and professional satisfaction!

 

[deleted18755]

A few points:

- I actually do think that most programs today provide good training and job placement and that there are only a few to avoid. My thoughts about reputable programs apply to a greater extent for those who hold a pessimistic view of the future, which (clearly!) I do not. The data show that nearly all graduating residents are taking highly compensated positions and very few do fellowships (see the Mohamad paper), which is frankly unusual compared to most highly specialized fields of medicine (take a look at the data for Dermatology, Ophthalmology, Orthopedic Surgery, ENT, to name a few - not to mention Radiology and Anesthesiology!).

I have no idea how many programs are out there that provide sub-par training, but I really wish that the programs that consistently do that more than a few people seem to know about would shut down! With regards to fellowship training, what makes radiation oncology unique is that most think that everything other than the very obviously specialized things we do (pediatrics and ... actually maybe that's just it) can be mastered or at least trained to proficiency within a four year residency. At the very least, fellowships should be standardized and accredited.

- Radiation Oncology is a small field and has more geographic restrictions than larger fields. This is not new. I was told about this limitation when I first learned about the field ten years ago. I have actually been pleasantly surprised to see that the residents in my city are taking positions in their preferred geographic locations, which are highly desirable large cities. This is not just my program, these are multiple programs.

No doubt about that!

- The compensation discussed by others is not in line with reality - see MGMA and AMGA (you will find 2018 numbers if you search for them), AAMC (should be available through your institution's library), and Terry Wall's survey data for actual median or mean numbers. Radiation Oncology remains much better compensated than Medical Oncology - and is one of the best-compensated fields in medicine - but again, I hope that is not why anyone goes into this field.

You may be correct but just be careful since there is definitely a lag in the data, which is more pronounced in a potentially rapidly changing environment. Data published in 2018 was probably collected in 2016 and 2017 so it doesn't mean that it's valid for jobs in 2020 or 2021, etc. More importantly, there are so many variables to consider that it's almost impossible to compare (if compensation is steady but workload increases even 5-10%, vacation is likewise modified, one has to travel now to centers 60 vs 15 minutes away, etc).

- To put things in perspective, if you take a look at other specialty forums, you will see that, just like in Radiation Oncology, there is a vocal, small group of posters who have complaints. In Dermatology they worry about private equity, NP/PA encroachment, and Mohs volume; ENTs worry about their field's recent need to SOAP; and specialized orthopedists also have geographic restrictions.

No doubt about that! This also applies to some extend to maybe literally every job in every corner of the world with how fast things are changing! PS: what's up with ENT needing to SOAP now too?

- People's focus on board scores and grades leads me to believe that interpersonal and clinical skills, emotional intelligence, etc., are being strongly undervalued. As do many other residents at programs across the country, I interview and rank medical students for residency. Everyone we interview has an impressive CV - 260 vs. 250 Step 1, 8 vs. 4 first-author publications, impressive experiences, you name it - so soft skills end up being the most important attributes. Of course, this is even more true when looking for positions after residency, since no one is asking about Step 1 scores or ACGME evaluations. People want to hire a doctor they would send their mother to see.

I honestly never understood the extreme emphasis on board scores, as if having a 99th percentile step I has any meaningful difference than 90th, and definitely not so if it's at the sacrifice of clinical and interpersonal skills. I never understood the emphasis on research, especially when most medical students (understandably) just publish very low level "research" that nobody cares about.

- To the posters here who are not happy with how things have turned out for their careers, I truly sympathize with you and sincerely hope the future brings you personal and professional satisfaction!

I sincerely hope this for everybody. Radiation Oncology was the best thing that ever happened to me and I hope the same for others. In any event, I hope you all make the best decision you can for yourselves and don't envy the position most of you younger folks find yourselves in!!!

My thoughts in bold in case anybody is interested in what some random anonymous community radiation oncologist on the internet who has been out of training for a while thinks....

 

[RickyScott]

A few points:

1) Again you seem to believe that doubling resident numbers have no effect. Moderator of thread reports graduating residents from his program that were not able to find employment. Data simply dont show that all graduating residents take highly compensated positions.

2) If geographic restriction was an issue when you learned about the field 10 years ago- wouldnt it follow that situation is much worse today since residency numbers have increased substantially over that time!

3) You are quick to invoke "north korea propaganda" type approach as I said you would- every field has problems, but we are actually better off than others.

4) If this fuss is due to small group of vocal protesters- why are Harvard, and MDACC cutting back on residency positions- because of anonymous small group of internet malcontents? Really? Or maybe there is a serious problem at hand.

5) starting compensation in medonc is much better than raddonc right now. That point is just flat out wrong. Medonc has caught fire in the past year. Medstudents can easily verify it with medonc fellows!

6) Medstudents should look at job boards and compare numbers/ratio to graduating residents with other fields and will see that we are an order of magnitude off. Search astro and indeed.com etc. This has been discussed ad nauseam. (of course your response is that for radiation, as opposed to other fields, the large instituitions have a hidden bank of jobs for connected residents, despite bylaws mandating they publicize all jobs.)

7) Regarding sympathy for posters. I am anonymous but my career has turned out great. I love my job. I actually sympathize with you because it is very possible you came into the field, not motivated by compensation, but partially by prestige/recognition, which is plummeting as we have have less applicants than spots. 10 years from now medstudents and colleagues will not regard you as the "best of best" with 260+ board scores and slew of publications... I think we have some residents at top programs (previously some of the most highly driven medstudents.rhodes scholars etc), part of whose motivation for entering radonc stemmed from the "exclusivity" and difficulty of getting into the field, the hardest specialty to match in. Being viewed figuratively as a bum lording the best spot around a dumpster fire on a cold night, could seriously threaten the core identity of some top grads, and they are desperate to preserve the exclusivity/prestige of radonc by recruiting top medstudents with propaganda.

 

[scarbrtj]

- The compensation discussed by others is not in line with reality - see MGMA and AMGA (you will find 2018 numbers if you search for them), AAMC (should be available through your institution's library), and Terry Wall's survey data for actual median or mean numbers. Radiation Oncology remains much better compensated than Medical Oncology - and is one of the best-compensated fields in medicine - but again, I hope that is not why anyone goes into this field.

Yesterday's reality is tomorrow's alternative fact. There will be ~20-30% more rad oncs 10y from now than today, total U.S. rad onc reimbursement will be flat (it hasn't grown in 7+ years) due to more SBRT, less fractions for everything, less utilization per "cancer capita" (affecting rad onc disproportionately vs other cancer specialties due to decreasing cancer incidence), yada yada. (And a large uptick in initial and repeat Stage IV spot-welding seems to be as reliable as the abscopal effect.) Don't have to be a PhD economist to foresee this will all have a suppressive effect on rad onc salaries/compensation. (Predict the magnitude of that suppression on your own.) Rad onc will be well compensated, but not one of the "best-compensated" by that time. "Which is fine," I would ordinarily say. But couple that with a rising chance of post-training un- or under-employment (ie fellowship, part-timing, job splitting, etc) and the most intense geographic immobility of any specialty... it'll further call into question of "best-compensated." Rad onc in 2030, just OK. (Tip O'Neill said, "All politics is local": FWIW the med onc in my practice gets more time off and compensation than I. FWIW.)

Being viewed figuratively as a bum lording the best spot around a dumpster fire on a cold night

I laughed at that one RS.

 

[w00tz]

Everyone comparing rad onc to med onc salaries.
Yes, med onc salaries have really taken off in the last couple years with how well immunotherapy reimburses. But anyone else see this as the med onc equivalent of the IMRT boom?
The country simply cannot afford it. It will not last. I suspect a med student thinking about heme/onc and completing fellowship in 6-8 years, is not going to be entertaining the same offers that are getting today as far as salary goes. Of course they will always have more geographic flexibility, but I think honestly hard to predict long-term salaries either specialties

 

[RickyScott]

Everyone comparing rad onc to med onc salaries.
Yes, med onc salaries have really taken off in the last couple years with how well immunotherapy reimburses. But anyone else see this as the med onc equivalent of the IMRT boom?
The country simply cannot afford it. It will not last. I suspect a med student thinking about heme/onc and completing fellowship in 6-8 years, is not going to be entertaining the same offers that are getting today as far as salary goes. Of course they will always have more geographic flexibility, but I think honestly hard to predict long-term salaries either specialties

Medonc salaries arent related to drug prices as far as I understand, because markup is legally capped at small margins of 4% and one denial will put you in the red for a month. An expensive injectable drug would be a negative in terms of how much they are worth to a practice/hospital. 340B is over. It is an issue of supply and demand.
This specialty just wont acknowledge supply and demand.

 

[RickyScott]

Demand may be issue specifically. Lot of pts now getting immuno, biological therapies who couldn’t have tolerated systemic treatment in past because they were too old or sick or simply no line of systemic therapy left.

Some disease like myeloma are getting so many lines of treatment and doing so well. Actually see this paradigm extending to other disease sites so future is very bright for them.

Btw Anecdotally 10 yrs ago would always have couple Myeloma pts on beam, but see it less today. Hard to judge because not in same practice, but worries me about notion of better systemic control increasing role of xrt. I have been in same practice for 7 yrs and during this time myeloma numbers have not increased despite so many new drugs, and from what I understand real advancements in survival.

 

[scarbrtj]

but I think honestly hard to predict long-term salaries either specialties

The 75 %ile rad onc salary I saw in 2010 is now the 90 %ile as of 2018. U.S. rad onc spending is flat-to-mild-decreased over the last 5y with no indications it will suddenly upswing (ie no sudden increase in rad onc demand, no sudden appearance of new lucrative rad onc codes, etc.) to "feed" ever-growing numbers of new rad onc MD mouths. Leaves one a bit wistful because the best and highest number I've seen of annual XRT patients is ~1 million which evenly divided by ~5000 rad oncs is 200 XRT patients per rad onc annually—I know personally I could see 400 a year. I don't now, but I have. And if we all had that level of "busy-ness" we'd need half the number of rad oncs. If you use the maybe "more in touch with reality" number of about ~550K new XRT patients this year, it's an even more stark realization: there just aren't enough new XRT patients to go around, nationally, for all the new rad oncs. (Especially if cancer incidence continues its drop, rad onc utilization continues its drop, hypofractionation gets more "penetrance," etc.) So it's not "hard to predict long-term salaries" per se. It's only hard to predict whether rad oncs are making equal, or more, now versus what they will in 10 years (of course maybe that's just modern American life).

Btw Anecdotally 10 yrs ago would always have couple Myeloma pts on beam, but see it less today. Hard to judge because not in same practice, but worries me about notion of better systemic control increasing role of xrt.

True. Now that you mention it, I think it's probably 2018 since I last saw a MM patient. (Obviously wouldn't be a big loss of XRT business for anybody but still.)

 

[OTN]

The 75 %ile rad onc salary I saw in 2010 is now the 90 %ile as of 2018. U.S. rad onc spending is flat-to-mild-decreased over the last 5y with no indications it will suddenly upswing (ie no sudden increase in rad onc demand, no sudden appearance of new lucrative rad onc codes, etc.) to "feed" ever-growing numbers of new rad onc MD mouths. Leaves one a bit wistful because the best and highest number I've seen of annual XRT patients is ~1 million which evenly divided by ~5000 rad oncs is 200 XRT patients per rad onc annually—I know personally I could see 400 a year. I don't now, but I have. And if we all had that level of "busy-ness" we'd need half the number of rad oncs. If you use the maybe "more in touch with reality" number of about ~550K new XRT patients this year, it's an even more stark realization: there just aren't enough new XRT patients to go around, nationally, for all the new rad oncs. (Especially if cancer incidence continues its drop, rad onc utilization continues its drop, hypofractionation gets more "penetrance," etc.) So it's not "hard to predict long-term salaries" per se. It's only hard to predict whether rad oncs are making equal, or more, now versus what they will in 10 years (of course maybe that's just modern American life).


True. Now that you mention it, I think it's probably 2018 since I last saw a MM patient. (Obviously wouldn't be a big loss of XRT business for anybody but still.)

I keep saying this, but the problem with these kinds of analyses is that they assume new grads will enter the market and be employed. You can't "hang a shingle" as a radonc as we all know, so those of us in practice are not necessarily going to see a drop in income (APM/CMS/etc aside). I'm not going to hire someone just to dilute my practice, and a hospital isn't going to hire another MD just because they're around. I don't think the crisis is going to be salary/income of practicing radoncs, I think the crisis is going to be what the hell to do with all the graduated radoncs who can't find jobs.