Would you advise M3/M4s to go into this field?

[Cremaster reflex]

Hi all,

I appreciate everyone's time as I am trying to figure out what to do with my life. We are now getting to the end of M3 and I haven't really liked much and am starting to panic because I don't know what to do. My priorities are lifestyle, enjoying the work, and pay in that order.

I am a third year, going to be starting M4 around April/May and have been set on Rad Onc since the beginning of medical school and have made myself somewhat competitive for it (i.e. step 1 >260; ~8ish publications). However, given the posts I see around here and what I hear about the job market I am very reluctant to apply to this field. From what I have seen shadowing and doing research I like the work but I don't think I would enjoy living in the middle of nowhere working a high volume job for declining compensation (considering i have ~300k in loans).

Would you advise someone like me to apply to this field? Why or why not?

For those who regret entering this field, what would you have applied to instead?

Thank you so much,

Cremaster Reflex

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[deleted18755]

Hi all,

I appreciate everyone's time as I am trying to figure out what to do with my life. We are now getting to the end of M3 and I haven't really liked much and am starting to panic because I don't know what to do. My priorities are lifestyle, enjoying the work, and pay in that order.

I am a third year, going to be starting M4 around April/May and have been set on Rad Onc since the beginning of medical school and have made myself somewhat competitive for it (i.e. step 1 >260; ~8ish publications). However, given the posts I see around here and what I hear about the job market I am very reluctant to apply to this field. From what I have seen shadowing and doing research I like the work but I don't think I would enjoy living in the middle of nowhere working a high volume job for declining compensation (considering i have ~300k in loans).

Would you advise someone like me to apply to this field? Why or why not?

For those who regret entering this field, what would you have applied to instead?

Thank you so much,

Cremaster Reflex

It's the best job in medicine and after my wife (who is a medical oncologist who wishes she went into radiation oncology) and having immigrated to America the absolute best thing that ever happened to me. I would happily do this for a 25% pay reduction starting tomorrow and 50% reduction as long as it happens over the next 8-10 years. If you're like me, then by all means enter and welcome!

However, if you just a M3 and already thinking that you would not "enjoy living in the middle of nowhere working a high volume job for declining compensation" then this field probably isn't for you.

That being said, I suspect that regardless of what field you choose, by the time you enter the workforce 7-10 years from now most specialties will see a higher volume of patients for declining compensation, so I'm not sure you should avoid radiation oncology just for that reason. The "living in the middle of nowhere" part is what you really need to consider. By the way, what do you mean by "middle of nowhere"?

If it's rural Kansas that is one thing but if you think cities like Birmingham, AL; Winston-Salem, NC; or Toledo, OH type cities (all with populations over 250,000 city and 1-1.5 million in the metro) are "middle of nowhere" then this field isn't for you. By the way, I picked those three cities because I actually have a friend who has been trying to get a job within an hour of Birmingham for years (I bet because UAB has such a large resident pool to hire from every year) with no success and another that was turned down after interviewing for one at W-S. Toledo isn't even the 3rd best city in Ohio but I doubt there are any job openings now so it's not like getting a job in any of those cities is guaranteed or even likely in any given year.

 

[medgator]

RadOnc Is Still The Best Field in Medicine

Radiation Oncology is not the best field in medicine.

Tough to see the future... absolutely do not go into this field if you have a specific high-population metro area to live in mind, particularly if its a desirable metro. There could be a job when you get out there, or not. And if you think you'd be miserable in a populated midwest metro as the "only" option for a big city positions with decent pay/lifestyle/job quality, again don't go into the field. There are much better options for geographic flexibility out there....

That being said, IMO this continues to remain the best field in medicine.... outpatient oncology focus providing a lot of curative treatment (and meaninful palliative treatment when cure is not possible) with relatively good remuneration, certainly better than MO on the whole IMO. But with MO, you will probably have more open geographic options

 

[RickyScott]

It's the best job in medicine and after my wife (who is a medical oncologist who wishes she went into radiation oncology) and having immigrated to America the absolute best thing that ever happened to me. I would happily do this for a 25% pay reduction starting tomorrow and 50% reduction as long as it happens over the next 8-10 years. If you're like me, then by all means enter and welcome!

However, if you just a M3 and already thinking that you would not "enjoy living in the middle of nowhere working a high volume job for declining compensation" then this field probably isn't for you.

That being said, I suspect that regardless of what field you choose, by the time you enter the workforce 7-10 years from now most specialties will see a higher volume of patients for declining compensation, so I'm not sure you should avoid radiation oncology just for that reason. The "living in the middle of nowhere" part is what you really need to consider. By the way, what do you mean by "middle of nowhere"?

If it's rural Kansas that is one thing but if you think cities like Birmingham, AL; Winston-Salem, NC; or Toledo, OH type cities (all with populations over 250,000 city and 1-1.5 million in the metro) are "middle of nowhere" then this field isn't for you. By the way, I picked those three cities because I actually have a friend who has been trying to get a job within an hour of Birmingham for years (I bet because UAB has such a large resident pool to hire from every year) with no success and another that was turned down after interviewing for one at W-S. Toledo isn't even the 3rd best city in Ohio but I doubt there are any job openings now so it's not like getting a job in any of those cities is guaranteed or even likely in any given year.

Most of us who are out 5-10 years have good jobs and pay and really enjoy the field. The big issue is that field has self destructed by doubling residency slots over the past 10-12 years, and now with bundling and hypofractionation (which still has not been widely adopted) the number of delivered treatments will go down significantly, so I just cant see how this will end well for those entering the field 5 years from now. Yes, there will be some grads who get great jobs (which is now defined as MSKCC/MDACC satellite, something I would never have chosen out of residency), and some who will be screwed- and, I dont think that should be the case for a highly competitive field.

In terms of medical oncology, I dont think any field has seen more dramatic advancements over the past 10 years (they started from a low baseline) and I certainly think that progress in that field will continue to accelerate.

 

[emt409]

It's the best job in medicine and after my wife (who is a medical oncologist who wishes she went into radiation oncology) and having immigrated to America the absolute best thing that ever happened to me. I would happily do this for a 25% pay reduction starting tomorrow and 50% reduction as long as it happens over the next 8-10 years. If you're like me, then by all means enter and welcome!

However, if you just a M3 and already thinking that you would not "enjoy living in the middle of nowhere working a high volume job for declining compensation" then this field probably isn't for you.

That being said, I suspect that regardless of what field you choose, by the time you enter the workforce 7-10 years from now most specialties will see a higher volume of patients for declining compensation, so I'm not sure you should avoid radiation oncology just for that reason. The "living in the middle of nowhere" part is what you really need to consider. By the way, what do you mean by "middle of nowhere"?

If it's rural Kansas that is one thing but if you think cities like Birmingham, AL; Winston-Salem, NC; or Toledo, OH type cities (all with populations over 250,000 city and 1-1.5 million in the metro) are "middle of nowhere" then this field isn't for you. By the way, I picked those three cities because I actually have a friend who has been trying to get a job within an hour of Birmingham for years (I bet because UAB has such a large resident pool to hire from every year) with no success and another that was turned down after interviewing for one at W-S. Toledo isn't even the 3rd best city in Ohio but I doubt there are any job openings now so it's not like getting a job in any of those cities is guaranteed or even likely in any given year.

DM me. There is a job in Birmingham at the new PP cancer center that opened up. I'll take a look at the resume, and if it looks solid, I'll forward to the medical director.

 

[Neuronix]

How many threads do we need on this exact same topic?

We have had numerous threads discussing the future of rad onc. We have had dozens of opinions about whether current attendings would choose this specialty again or whether they would recommend this specialty to future residents.

Radiation Oncology is not the best field in medicine.
RadOnc Is Still The Best Field in Medicine
FUTURE RESIDENT, DO NOT BECOME A RADIATION ONCOLOGIST!!!

... and more.

I will have a low threshold to close this thread if the discussion becomes a repetition of the existing threads.

 

[deleted18755]

DM me. There is a job in Birmingham at the new PP cancer center that opened up. I'll take a look at the resume, and if it looks solid, I'll forward to the medical director.

Right after I posted here I just randomly looked at the Career Center and saw that! It's a colleague I haven't spoken with in a few weeks but I'll text him real quick thanks!

For others looking for a job in Alabama there is a new center being built in Auburn, Alabama too (east side of the state about two hours from Atlanta where the University/football team is located).

 

[RSAOaky]

If it's what you want to do and you're open geographically then yes. At the end of the day we will always make a fair wage with a reasonable work life balance doing something that is intellectually and professionally rewarding. I can't really think of any other field in medicine that offers this combination which may be why I chose the field to begin with.

 

[Cremaster reflex]

How many threads do we need on this exact same topic?

We have had numerous threads discussing the future of rad onc. We have had dozens of opinions about whether current attendings would choose this specialty again or whether they would recommend this specialty to future residents.

Radiation Oncology is not the best field in medicine.
RadOnc Is Still The Best Field in Medicine
FUTURE RESIDENT, DO NOT BECOME A RADIATION ONCOLOGIST!!!

... and more.

I will have a low threshold to close this thread if the discussion becomes a repetition of the existing threads.

Yes I understand there have been quite a few threads on the topic and I have read every single reply in each of those threads. With that being said, I don't think its unreasonable to ask for more opinions and advice from those higher up with more knowledge to help us make one of the most important decisions of our lives as medical students. Thank you for your advice

 

[evilbooyaa]

Hi all,

I appreciate everyone's time as I am trying to figure out what to do with my life. We are now getting to the end of M3 and I haven't really liked much and am starting to panic because I don't know what to do. My priorities are lifestyle, enjoying the work, and pay in that order.

I am a third year, going to be starting M4 around April/May and have been set on Rad Onc since the beginning of medical school and have made myself somewhat competitive for it (i.e. step 1 >260; ~8ish publications). However, given the posts I see around here and what I hear about the job market I am very reluctant to apply to this field. From what I have seen shadowing and doing research I like the work but I don't think I would enjoy living in the middle of nowhere working a high volume job for declining compensation (considering i have ~300k in loans).

Would you advise someone like me to apply to this field? Why or why not?

For those who regret entering this field, what would you have applied to instead?

Thank you so much,

Cremaster Reflex

Agree with Neuronix that this question has been asked and discussed ad-nauseum multiple times before.

The main pro of this field is the work and the patients.

The main cons are the geographic restrictions (real) and declining compensation (depends on your job).

If you cannot stomach being not in a major metro, I would not do this field. If you are OK with cities throughout the entire country that are not major metros, then you will likely be OK. The unknown is where this field will be in 5 years, and whether the situation will definitively worsen (which is a major, valid (IMO), concern for many of the 'negative/regrets' posters on this website)

 

[Neuronix]

Yes I understand there have been quite a few threads on the topic and I have read every single reply in each of those threads. With that being said, I don't think its unreasonable to ask for more opinions and advice from those higher up with more knowledge to help us make one of the most important decisions of our lives as medical students. Thank you for your advice

I think if you're considering rad onc, your expectations need to be in line with reality.

Radiation oncology residency is one of the easier ones, but it's still no cake walk and some of the programs are very hard working. You are expected to study and know a lot which requires a lot of extra reading on top of clinic workloads.

The job market in radiation oncology is lousy. Currently, you should be ready to take a job anywhere. You may need to do a fellowship. When you graduate residency, you should not expect even close to the "average" rad onc salaries that you can Google. Maybe you'll end up making that kind of money mid-career, maybe not. You should not expect a job where you work 40 hours a week or less. You should be very flexible--when you get whatever job you do get, you may have no opportunity to move elsewhere.

If you like research or have a disease site preference, you may not have an opportunity to do any of it. There is little difference between academics and private practice anymore, so you should expect to be clinical in a general capacity (and likely at multiple physical locations on different days). If you like academics, you may get to do some academic work in your free time if you have any opportunity at all.

Things will likely continue to worsen over the next decade. We are training too many residents and the specialty is not expanding. There are a lot of practices and hospital systems waiting to take advantage of you. How bad things will get is yet to be seen.

If you take all those cons and still think the pros outweigh them and can't find another specialty you like better, then I think you have your answer to apply.

 

[Chartreuse Wombat]

OP wrote "My priorities are lifestyle, enjoying the work, and pay in that order."
I humbly suggest that you find another specialty; we already have too many that prioritize lifestyle over patient care.

 

[Neuronix]

OP wrote "My priorities are lifestyle, enjoying the work, and pay in that order."
I humbly suggest that you find another specialty; we already have too many that prioritize lifestyle over patient care.

I missed that. What is lifestyle to you? My car is often one of the first in the physician parking lot and one of the last to leave.

 

[evilbooyaa]

OP wrote "My priorities are lifestyle, enjoying the work, and pay in that order."
I humbly suggest that you find another specialty; we already have too many that prioritize lifestyle over patient care.

I mean Rad Onc is a lifestyle field for most residents (compared to other specialties it's not even close), and even busy attendings generally still get weekends off. Grass is greener phenomenon.
Citation needed on the bolded.

 

[medgator]

I mean Rad Onc is a lifestyle field for most residents (compared to other specialties it's not even close), and even busy attendings generally still get weekends off. Grass is greener phenomenon.
Citation needed on the bolded.

To be fair, some of the med oncs I see take fri afternoons off weekly....They can rearrange their schedules and chemo infusions to make that happen. They are doing q5-6 week call, so the lifestyle ends up being pretty decent, while I'm still sitting there at fri 4+ pm with a busy clinic and machine

 

[thecarbonionangle]

OP wrote "My priorities are lifestyle, enjoying the work, and pay in that order."
I humbly suggest that you find another specialty; we already have too many that prioritize lifestyle over patient care.

Yeah agree. I think the future of our field hangs in attracting a new breed of candidates. The poster seems geographically restristed. Its not a good foeld for them

 

[Radiator20]

Would you advise someone like me to apply to this field?

No. I am not one of the naysayers on this forum, but it is important to be realistic. Rad onc is a very small field and even without job market concerns, that makes geography a challenge due to stochasticity. Moreover, if lifestyle is your primary motivation, you should find a field that isn't so emotionally laden. I enjoy lifestyle as much as anybody, but if it's your primary motivation, that just feels trite and shallow in contrast to what our patients are going through. I advise you to look elsewhere.

 

[KHE88]

I mean Rad Onc is a lifestyle field for most residents (compared to other specialties it's not even close), and even busy attendings generally still get weekends off. Grass is greener phenomenon.
Citation needed on the bolded.

No citation needed. Agree completely with Chartreuse Wombat. From the 2005-2015 decade, the heyday of rad onc ultra-competitiveness, there were a lot of people that applied and got into this field purely because of lifestyle. They were on the fence between derm and rad onc, sitting on a 250+ step 1 score and made a game day decision to apply to rad onc with little prior interest or knowledge about the field purely for money and low work hours. Sadly these people now occupy a lot of junior and midlevel faculty positions where they rely on residents to publish for them, do their clinical work, and contribute nothing other than extolling the virtues of hypofractionation and, with extreme cognitive dissonance, bad mouthing the private practice money grubbing lifestyle chasers every chance they get. These are our future leaders.

 

[Reaganite]

Hi all,

I appreciate everyone's time as I am trying to figure out what to do with my life. We are now getting to the end of M3 and I haven't really liked much and am starting to panic because I don't know what to do. My priorities are lifestyle, enjoying the work, and pay in that order.

I am a third year, going to be starting M4 around April/May and have been set on Rad Onc since the beginning of medical school and have made myself somewhat competitive for it (i.e. step 1 >260; ~8ish publications). However, given the posts I see around here and what I hear about the job market I am very reluctant to apply to this field. From what I have seen shadowing and doing research I like the work but I don't think I would enjoy living in the middle of nowhere working a high volume job for declining compensation (considering i have ~300k in loans).

Would you advise someone like me to apply to this field? Why or why not?

For those who regret entering this field, what would you have applied to instead?

Thank you so much,

Cremaster Reflex

While the naysayers on this board make valid points, don't kid yourself--most doctors think medicine in general is tanking. The glory days of our profession are long gone. Every damn specialist I know bitches on the daily about how terrible their specialty is. (They all still think I have the greatest job in the world, though). Many young, millenial docs have a hard time accepting that unless you are really lucky or a private practice god (and trust me, few doctors are), income in any sort of desirable area will be **** for most specialists, not just rad onc. Moving forward, you're going to have to choose the lesser of the evils. I personally feel rad onc will continue to fit that role, particularly on the lifestyle side. Weekends off and limited call will always be a big draw for our field. If you want lifestyle and OK pay, you should definitely consider Rad Onc. There's a lot of talk on this board about being abused at academic centers and satellites (which appears to be the future for many in our field), but I honestly haven't seen that. All my friends--and I have many--in these settings are very happy. They all make decent money (300kish), have good benefits/vacation time, and usually tell me their clinics are over-staffed with docs. All of this being said, by far the biggest drawback of this field is geographic restriction. You absolutely should NOT choose this field if you have even one iota of geographic restriction in mind. Everything that has been said on this board about this issue is a million percent true.

 

[deleted18755]

While the naysayers on this board make valid points, don't kid yourself--most doctors think medicine in general is tanking. The glory days of our profession are long gone. Every damn specialist I know bitches on the daily about how terrible their specialty is. (They all still think I have the greatest job in the world, though). Many young, millenial docs have a hard time accepting that unless you are really lucky or a private practice god (and trust me, few doctors are), income in any sort of desirable area will be **** for most specialists, not just rad onc. Moving forward, you're going to have to choose the lesser of the evils. I personally feel rad onc will continue to fit that role, particularly on the lifestyle side. Weekends off and limited call will always be a big draw for our field. If you want lifestyle and OK pay, you should definitely consider Rad Onc. There's a lot of talk on this board about being abused at academic centers and satellites (which appears to be the future for many in our field), but I honestly haven't seen that. All my friends--and I have many--in these settings are very happy. They all make decent money (300kish), have good benefits/vacation time, and usually tell me their clinics are over-staffed with docs. All of this being said, by far the biggest drawback of this field is geographic restriction. You absolutely should NOT choose this field if you have even one iota of geographic restriction in mind. Everything that has been said on this board about this issue is a million percent true.

I totally agree . . . it's almost mandatory for older physicians in literally every specialty to bitch everyday about how their field is going downhill (sometimes followed under their breath with . . . "I should have done rad onc or derm").

Taking the broader perspective of the "grass is greener" outlook, it's not just radiation oncology vs all of medicine but all of medicine vs everything else. Just as radiation oncologists like to complain about how bad things are getting while forgetting that a career in medicine in general is similarly going "down hill" to some degree. I definitely hear from too many doctors about how medicine is a terrible career choice these days but they fail to realize that basically every single profession is more difficult than it used to be and one has to do something (maybe it's just me but I know way too many arrogant older doctors who have no idea how difficult it is to succeed in basically every profession these days and how hard everybody is working)! Sometimes when I hear older doctors talk about how great medicine was 20-30 years ago (it does sound wonderful!) and how they would not go into the field today I think "yeah but basically every job is more demanding and not as wonderful as it was 20-30 years ago" and straight up ask them "well if not medicine what field would you choice today?" They are usually kind of surprised and say "hospital administration" or "computers!"

To tie this back to the original discussion: I think medical students need to take a broader perspective when evaluating specialty choices. Of course when you post on a radiation oncology forum you are going to get specific answers to why the future of our wonderful specialty isn't looking too bright but the truth is that all of medicine is to some degree headed in the same direction (and maybe all of corporate America the international economy?) so it's all relative. I bet if you go on any specialty forum on SDN you'll get some degree of pessimism just like you would if you go on a lawyers' or electricians' forum (maybe not so much on for hospital administrators' or "computer" forums!).

Unfortunately, nobody can tell the future but as far as I can tell things are still great in radiation oncology and will be for at least a few more years but a 3rd year medical student's outlook is more like 10-30+ years in the future and if your priority is lifestyle and anything resembling a specific location in a particularly desirable location then enter at your own risk.

Reaganite: do you really know more than a few people who think their clinics are overstaffed? At first I thought "that sounds nice, I'd love to work there!" but then realized that over-staffing in 2018 with a endless supply of new residents AND increasing hypofractionation = can't last forever!

 

[seper]

True, other specialists are complaining of their lot. We are, however, the only specialty that does not enable a graduate to find a job in Detroit. Employed salaries are dropping so over-staffing by RadOncs carrying 5-10 patients each will continue.

I totally agree . . . it's almost mandatory for older physicians in literally every specialty to bitch everyday about how their field is going downhill (sometimes followed under their breath with . . . "I should have done rad onc or derm").

Taking the broader perspective of the "grass is greener" outlook, it's not just radiation oncology vs all of medicine but all of medicine vs everything else. Just as radiation oncologists like to complain about how bad things are getting while forgetting that a career in medicine in general is similarly going "down hill" to some degree. I definitely hear from too many doctors about how medicine is a terrible career choice these days but they fail to realize that basically every single profession is more difficult than it used to be and one has to do something (maybe it's just me but I know way too many arrogant older doctors who have no idea how difficult it is to succeed in basically every profession these days and how hard everybody is working)! Sometimes when I hear older doctors talk about how great medicine was 20-30 years ago (it does sound wonderful!) and how they would not go into the field today I think "yeah but basically every job is more demanding and not as wonderful as it was 20-30 years ago" and straight up ask them "well if not medicine what field would you choice today?" They are usually kind of surprised and say "hospital administration" or "computers!"

To tie this back to the original discussion: I think medical students need to take a broader perspective when evaluating specialty choices. Of course when you post on a radiation oncology forum you are going to get specific answers to why the future of our wonderful specialty isn't looking too bright but the truth is that all of medicine is to some degree headed in the same direction (and maybe all of corporate America the international economy?) so it's all relative. I bet if you go on any specialty forum on SDN you'll get some degree of pessimism just like you would if you go on a lawyers' or electricians' forum (maybe not so much on for hospital administrators' or "computer" forums!).

Unfortunately, nobody can tell the future but as far as I can tell things are still great in radiation oncology and will be for at least a few more years but a 3rd year medical student's outlook is more like 10-30+ years in the future and if your priority is lifestyle and anything resembling a specific location in a particularly desirable location then enter at your own risk.

Reaganite: do you really know more than a few people who think their clinics are overstaffed? At first I thought "that sounds nice, I'd love to work there!" but then realized that over-staffing in 2018 with a endless supply of new residents AND increasing hypofractionation = can't last forever!

 

[medgator]

I totally agree . . . it's almost mandatory for older physicians in literally every specialty to bitch everyday about how their field is going downhill (sometimes followed under their breath with . . . "I should have done rad onc or derm").

Happens outside of medicine too....boomers think they are greatest generation ever, and probably will enjoy the greatest Medicare and Ss benefits ever, but I digress.

Taking the broader perspective of the "grass is greener" outlook, it's not just radiation oncology vs all of medicine but all of medicine vs everything else. Just as radiation oncologists like to complain about how bad things are getting while forgetting that a career in medicine in general is similarly going "down hill" to some degree. I definitely hear from too many doctors about how medicine is a terrible career choice these days but they fail to realize that basically every single profession is more difficult than it used to be and one has to do something (maybe it's just me but I know way too many arrogant older doctors who have no idea how difficult it is to succeed in basically every profession these days and how hard everybody is working)!

Yup, all of us were still getting paid in practice/residency while the great 08-09 recession wiped out thousands of jobs in the finance/I-banking/construction/housing industry. Decreasing but still good pay + job security > losing your six figure job in a bad recession imo

 

[RickyScott]

Happens outside of medicine too....boomers think they are greatest generation ever, and probably will enjoy the greatest Medicare and Ss benefits ever, but I digress.



Yup, all of us were still getting paid in practice/residency while the great 08-09 recession wiped out thousands of jobs in the finance/I-banking/construction/housing industry. Decreasing but still good pay + job security > losing your six figure job in a bad recession imo

Every specialty complains and may face reduced reimbursement/salaries, but I dont get the sense that other competitive specialties have concerns about oversupply of docs/shrinking job market.

 

[medgator]

Every specialty complains and may face reduced reimbursement/salaries, but I dont get the sense that other competitive specialties have concerns about oversupply of docs/shrinking job market.

Agreed. I think derm actually regulates things to make sure that doesn't happen

 

[RickyScott]

Also, we will be delivering less radiation fractions with hypo. I dont think the number of exams/procedures of optho/derm etc is going down, they just may be reimbursed less. I am much more concerned about a future lack of jobs than less pay.

 

[OTN]

Derm has their own problems though- venture capital has run rampant over their field. I wouldn't be surprised if they ran into dramatic rate cuts for their services sooner rather than later.

Edit: "Their own problems" is kind of the point. All fields of medicine right now are facing huge challenges, and radonc isn't unique there. We are rather unique, however, in that the biggest problems are of our own making.

 

[Reaganite]

Reaganite: do you really know more than a few people who think their clinics are overstaffed? At first I thought "that sounds nice, I'd love to work there!" but then realized that over-staffing in 2018 with a endless supply of new residents AND increasing hypofractionation = can't last forever!

Ugh, I hate hospitals, academic centers, and satellites as much as anyone, but I have to begrudgingly admit at least in my area the docs in those settings are treated very well. Not saying it's the same elsewhere, but that's what I'm seeing and hearing (with an n=15-20).

Derm has a big issue with venture capital encroachment as others have stated. It's in it's heyday now with all the cosmetic, out-of-pocket work they do, but VC is buying up more and more, and with the way this country is going, god only knows when we'll start to see these procedures specially taxed (i.e. "botax)"

All of this being said, I think this board is good for the field. When I graduated, my program didn't give two ****s about me and whether or not I found a job. I could barely even get them to sign necessary paperwork to actually start my job. I'm glad people are calling out these d-bags destroying our field.

 

[deleted18755]

Ugh, I hate hospitals, academic centers, and satellites as much as anyone, but I have to begrudgingly admit at least in my area the docs in those settings are treated very well. Not saying it's the same elsewhere, but that's what I'm seeing and hearing (with an n=15-20).

Derm has a big issue with venture capital encroachment as others have stated. It's in it's heyday now with all the cosmetic, out-of-pocket work they do, but VC is buying up more and more, and with the way this country is going, god only knows when we'll start to see these procedures specially taxed (i.e. "botax)"

All of this being said, I think this board is good for the field. When I graduated, my program didn't give two ****s about me and whether or not I found a job. I could barely even get them to sign necessary paperwork to actually start my job. I'm glad people are calling out these d-bags destroying our field.

How can you even stay busy for 30 hours a week with 15 patients under treatment? That sounds nice but there is NO WAY that is going to last...

 

[Reaganite]

How can you even stay busy for 30 hours a week with 15 patients under treatment? That sounds nice but there is NO WAY that is going to last...

The satellites around me usually treat anywhere from mid 20s to low 30s. Even in a freestanding setting, 30 on treat can easily yield 500k+ in prof charges. You can imagine the hospital cut will be even greater, so it's not hurting them to pay 2 guys 250k-300k each. I think this is more in line with the millenial doc mentality anyway. I don't want to generalize, but it's my impression more new docs prefer making 250k a year working 3-4 days a week vs. 5+ days a week making 500k+.

 

[deleted18755]

The satellites around me usually treat anywhere from mid 20s to low 30s. Even in a freestanding setting, 30 on treat can easily yield 500k+ in prof charges. You can imagine the hospital cut will be even greater, so it's not hurting them to pay 2 guys 250k-300k each. I think this is more in line with the millenial doc mentality anyway. I don't want to generalize, but it's my impression more new docs prefer making 250k a year working 3-4 days a week vs. 5+ days a week making 500k+.

Millennial or not (and especially for woman who are starting families and/or have very young children) 250k for 3-4 days of work is awesome.


I just hope medical students aren’t reading hearing numbers like that and signing up thinking it’ll be that way 7-10 years from now (let alone for an entire career) even in the middle of nowhere!

 

[Neuronix]

The satellites around me usually treat anywhere from mid 20s to low 30s. Even in a freestanding setting, 30 on treat can easily yield 500k+ in prof charges. You can imagine the hospital cut will be even greater, so it's not hurting them to pay 2 guys 250k-300k each. I think this is more in line with the millenial doc mentality anyway. I don't want to generalize, but it's my impression more new docs prefer making 250k a year working 3-4 days a week vs. 5+ days a week making 500k+.

I applied for jobs all over the country and did not get numbers anything like this, nor found any positions interested in hiring 3-4 days/week.

Just because you generate 500k+ in professional charges doesn't mean you're going to get paid 500k (or even close).

 

[RickyScott]

How can you even stay busy for 30 hours a week with 15 patients under treatment? That sounds nice but there is NO WAY that is going to last...

I used to find ways in my previous job center.

I applied for jobs all over the country and did not get numbers anything like this, nor found any positions interested in hiring 3-4 days/week.

Just because you generate 500k+ in professional charges doesn't mean you're going to get paid 500k (or even close).

Absolutely, your salary is set by supply and demand. I certainly dont earn what I bill professionally and know of many situations where it is less than half.

 

[OTN]

How can you even stay busy for 30 hours a week with 15 patients under treatment? That sounds nice but there is NO WAY that is going to last...

I'm not so sure. If all of the sudden 15 patients on treatment isn't going to be enough to support a machine, that could spell real problems for patients in rural areas who need treatment.

 

[Reaganite]

Haha, man, don't know what else to tell you guys. No reason for me to make these numbers up. Trying to give people a perspective as someone in the thick of all of this. The world of rad onc isn't 100% doom and gloom as people here would have you believe. As many have said before, there are many jobs that go unadvertised. Most of these positions I'm referencing have been filled internally by graduates of the program. Is it like this elsewhere? I have no idea. I can only speak to the practices in my area. And I'll repeat--the guys around me in these satellites and the mother ship are happy with good hours and OK pay. And, neuronix, I agree with you completely--you probably aren't getting paid in salary what you are generating in professional charges. Of course, you're also not having to deal with all the stress and marketing work it takes to maintain a 30 patient private practice.

 

[RickyScott]

I'm not so sure. If all of the sudden 15 patients on treatment isn't going to be enough to support a machine, that could spell real problems for patients in rural areas who need treatment.

It may be cheaper to buy them transportation or house them during treatment. When I was in training, Keiser in South Cal did this: No matter where you lived in South Cal, you came to LA for your treatment. (and so do other countries)

 

[Neuronix]

Haha, man, don't know what else to tell you guys. No reason for me to make these numbers up. Trying to give people a perspective as someone in the thick of all of this.

Same.

As many have said before, there are many jobs that go unadvertised. Most of these positions I'm referencing have been filled internally by graduates of the program. Is it like this elsewhere? I have no idea. I can only speak to the practices in my area. And I'll repeat--the guys around me in these satellites and the mother ship are happy with good hours and OK pay.

No, it's not like that elsewhere. Maybe some places. But there are only so many unadvertised dream jobs to go around.

And, neuronix, I agree with you completely--you probably aren't getting paid in salary what you are generating in professional charges. Of course, you're also not having to deal with all the stress and marketing work it takes to maintain a 30 patient private practice.

I've built my practice thank you very much. Yes I'm in a healthcare system, but much of what I'm treating went to smaller community centers before I started. I'm in a highly competitive market and get phone calls all the time with questions and referrals. I'm compensated on a $/RVU model. I was hired with "figure out what you can treat" and picked up all my volume from tumor boards (and to a lesser extent inpatient consults) where I have a reputation for being outstanding with all of my referrings. I'm in a highly competitive market and have to hold my own and keep the referrings happy, as they make it very clear they will send to another center if I don't get the patients in quickly and keep them happy.

I considered private practice positions when I graduated residency and the compensation was essentially the same without a technical partnership track. The idea that you're going to walk out of residency and make $500k/year is ludicrous to me. Where is that job? Please PM me so I can think about it. Every time someone has told me about some high paying, good lifestyle job somewhere, I've always asked for details and specifics to consider the position myself but never get a serious response.

 

[Reaganite]

Same.

No, it's not like that elsewhere. Maybe some places. But there are only so many unadvertised dream jobs to go around.

I've built my practice thank you very much. Yes I'm in a healthcare system, but much of what I'm treating went to smaller community centers before I started. I'm in a heavily competitive market and get phone calls all the time with questions and referrals. I'm compensated on a $/RVU model. I was hired with "figure out what you can treat" and picked up all my volume from tumor boards. I'm in a highly competitive market and have to hold my own and keep the referrings happy, as they make it very clear they will send to another center if I don't get the patients in quickly and keep them happy.

I considered private practice positions when I graduated residency and the compensation was essentially the same without a technical partnership track. The idea that you're going to walk out of residency and make $500k/year is ludicrous to me. Where is that job? Please PM me so I can think about it. Every time someone has told me about some high paying, good lifestyle job somewhere, I've always asked for details and specifics to consider the position myself but never get a serious response.

Apologies--by "you," I didn't mean you personally. Meant it in a collective sense...working on salary few are likely to take home what they actually generate in professional charges.

Also, I certainly never said people are walking out residency making 500k with good lifestyle. Pretty sure I said most of the positions I'm aware of are paying 250-300k. And I'll re-state: I know many rad oncs making this kind of money in desirable areas with good lifestyles. They are all very happy too. My honest advice to anyone entering this field is that unless you are very lucky or insanely business savvy, you need to be happy with working for someone else (hospital or some private guy in his 70s) and making OK money with decent lifestyle. The days of your average baller rad onc are over.

 

[Neuronix]

Ok sounds like we're in agreement. I dunno what decent lifestyle is. If 50-60 hours a week is "decent", then we'll agree on that too.

 

[OTN]

It may be cheaper to buy them transportation or house them during treatment. When I was in training, Keiser in South Cal did this: No matter where you lived in South Cal, you came to LA for your treatment. (and so do other countries)

I believe that's illegal in my state. We looked into providing transportation for patients but were told it was not allowable.

 

[medgator]

I believe that's illegal in my state. We looked into providing transportation for patients but were told it was not allowable.

It is considered an "incentive" to come to your facility, per CMS guidelines iirc. We found out the same thing. National, not a state issue, I believe

Same reason why you have to send the patient a bill for co insurance, otherwise Medicare thinks you are incentivizing patients to come to your facility via waiving copay/co insurance responsibilities

 

[KHE88]

I don't think the above posts are fairly representative of the current job market in terms of compensation. The number 250-300k keeps getting thrown around for satellite jobs. This is a correct number for jobs in places like coastal California (300k would actually be fairly high 225-250k more likely). For the midwest, add an extra $100k to this. I know someone who started a midwest academic satellite job well in the 400s. Additionally, these are starting numbers for new grads.

To go back to the OP, this is a heavily geographic dependent field. Both in terms of job availability and compensation.

It is not accurate to say the days of 500k+ jobs are over. The MGMA, AMGA, Becker, etc. data says otherwise. This is the money that we bring in with professional fees with around 25 patients on treatment (500-600k). If you're not keeping what you bring in, someone else is and you're getting a raw deal unless your location is worth at least how much is being scalped off your professional fees by your employer. And this doesn't even touch the amount of additional revenue you generate by referring patients elsewhere within your hospital system for further tests/imaging and treatment. I've seen this happen before where an academic system gobbles up a PP and gives the current partners sweetheart deals as part of the deal getting partner level income in the form of a salary. The hospital can clearly afford to pay the rad oncs this much. Meanwhile new hires are coming in with salaries up to 50% less.

You can absolutely make 600k+ as a new grad. I personally had three offers with salary guarantees above 500k and significant bonuses. I have talked to numerous others who have had similar, even in fairly large sized Midwestern metros. You get this either by joining a hospital system in a rural midwestern area (rural within driving distance of a top 10 city doesn't count), or joining a legit private practice with a 2 year partnership track that makes you an equitable technical partner (yes, these do exist, I know multiple people in them; however, typically are found in less desirable areas far away from large metros. Partner income is usually in the 800k range after 2 years of associate level 350k salary).

So, no, I don't think it's fair to tell people that their only option is a 250k job where their employer is scalping 50% or more of their professional fees. This is absolutely true on the coasts in big cities. I would be shocked if Neuronix is not within a few hours of a major metro on the coast. There exists jobs where you keep all of your professional fees and potentially a lot more if you're willing to move to the nether reaches of the country's interior (for now). And in-between compensation can be found in midwestern metro areas. (FOR NOW).

It is important for med students like OP to understand that statements like "average rad onc salary is $565k per MGMA, this is what I'll make out of residency" or "days of 500k jobs are over, your only choice is a 250k job" are gross generalization and making light of complex physician complication models, market competition, and payor mixes.

 

[scarbrtj]

Hi all,

I appreciate everyone's time as I am trying to figure out what to do with my life. We are now getting to the end of M3 and I haven't really liked much and am starting to panic because I don't know what to do. My priorities are lifestyle, enjoying the work, and pay in that order.

I am a third year, going to be starting M4 around April/May and have been set on Rad Onc since the beginning of medical school and have made myself somewhat competitive for it (i.e. step 1 >260; ~8ish publications). However, given the posts I see around here and what I hear about the job market I am very reluctant to apply to this field. From what I have seen shadowing and doing research I like the work but I don't think I would enjoy living in the middle of nowhere working a high volume job for declining compensation (considering i have ~300k in loans).

Would you advise someone like me to apply to this field? Why or why not?

For those who regret entering this field, what would you have applied to instead?

Thank you so much,

Cremaster Reflex

One aspect that never gets enough play is the mind-numbing babysitting aspect of the job. It may not be likely that you won't find a job, but it is highly likely your first job will be basically warm-body function in nature. We rad oncs have all these wonderful neurons to make these 260+ Step scores and then go into a job where you literally sit watching cat videos all day. Say what you will: it's not stressful, it's not hard work... but after a while it wears on you. You kind of become like Red in 'Shawshank Redemption'... "Can I take a pee break boss?" Your schedule is exceedingly brittle with no way to re-arrange things to get a day off. Patients need treatment five days a week. It used to be in the 90's and early 2000's that rad oncs would come in and out of clinic at will; it took a while for folks to be disabused of that notion but lord knows when I trained the attendings came in and out of clinic at will. (In fact, America is the only country I know of where constant rad onc presence is legally mandated.) To that point, radiation oncology is heavily scrutinized; the thing is, no one seems to be able to escape rad onc's obtuse, byzantine billing requirements and get it right. Entire industries have built up around keeping rad onc "compliant." The billing issues are far more complex (and subjective!) than the medical issues in rad onc. I've heard that something like ~10% of all practicing rad oncs have had a brush with government audits/cases; the biggest private practices have and even academic centers too. That 10% is the highest of any specialty. The subject matter of rad onc itself is fascinating and different than any other field in medicine. Unfortunately, for these reasons and others which have been discussed, they've really sucked a lot of the fun out of it. Rad onc is probably also the specialty in which you will be least likely to own your own practice. The fellows above have mentioned that "everyone" in medicine is unhappy. There are degrees of unhappiness: you will almost certainly fall into the employed by hospital/corporation lot and stay there the rest of your life.

 

[Mandelin Rain]

Reflecting... I'd be much more apt to not choose medicine than I would be to not choose rad onc once committed to medicine.

Caution, Rant: I do think some kind of reckoning will be coming with how this nation chooses to value it's physicians. The current path is completely unsustainable. Win the genetic intelligence and self motivation lottery, give up the best decade of your life, turn yourself into a debt slave, work abnormally long hours and take on absurd levels of responsibility, get treated like replaceable **** by some MBA in a suit, lose all professional autonomy to some company name Evicore, get blamed for not treating/treating pain, see your pay decrease every year and heath care premiums increase every year (Seriously, why do my premiums keep going up, but pay keep going down? Who is getting that money?).

 

[Haybrant]

Reflecting... I'd be much more apt to not choose medicine than I would be to not choose rad onc once committed to medicine.

Caution, Rant: I do think some kind of reckoning will be coming with how this nation chooses to value it's physicians. The current path is completely unsustainable. Win the genetic intelligence and self motivation lottery, give up the best decade of your life, turn yourself into a debt slave, work abnormally long hours and take on absurd levels of responsibility, get treated like replaceable **** by some MBA in a suit, lose all professional autonomy to some company name Evicore, get blamed for not treating/treating pain, see your pay decrease every year and heath care premiums increase every year (Seriously, why do my premiums keep going up, but pay keep going down? Who is getting that money?).

There is no reckoning coming. Nobody gives a F what physicians think or feel with the exception of physicians. Just curious though how much is your healthcare premium?

 

[medgator]

(Seriously, why do my premiums keep going up, but pay keep going down? Who is getting that money?).

Medicine’s Top Earners Are Not the M.D.s

Health insurance CEOs earned $342.6M in 2017 | FierceHealthcare

 

[DukeNukem]

I personally had three offers with salary guarantees above 500k and significant bonuses.

Please post these jobs! Or if you want, message me directly. I have applied to dozens of positions around the country and I'm not even getting interviews.

I'm working very hard for much less money with bosses that are a jerk to me every day. I have no geographic restrictions.

 

[PointA]

I know this information doesn't fit the SDN narrative but it is true: I personally know of 3 new grads who were either offered or accepted jobs making >500k right out of residency. None of these offers were in major cities but some were in my opinion fairly decent small towns. I have seen multiple job postings over the past year or so in which salaries >500k are advertised. There is currently a job in North Dakota that hasn't filled in over 2 years. Have you applied? I bet it pays really well.

And before people come at me with pitchforks, I agree our field has a major problem with ongoing residency expansion and the job market in rad onc is woeful compared to other specialities based on my discussions with med school friends in other specialities.

 

[Gfunk6]

The mantra of SDN is that jobs in desirable locations with good compensation/lifestyle are becoming vanishingly small. I think this is true.

However, if you are flexible and are willing to live in mid size cities/rural regions then there is still tremendous opportunity to be had. I think this will be true for a while yet.

 

[DukeNukem]

Thanks to medgator for sending me a job ad I missed since it was only posted on the hospital system's website and not on the several job sites I've been checking for a year now.

I think these posts are ridiculous. It's not that I think you're lying--I have similar discussions with people I know. Supposedly some great job is out there if I keep looking. Supposedly someone they know got some high paying job somewhere that doesn't require them to work most of the weekend like I am doing right now with dozens of leftover charts despite a 60 hour week.

"Oh buddy I think you're great and would be happy to recommend you, but I don't know of anything. Maybe so and so has a job why don't you ask them?" Answer is: they don't. How many times do I have to go through that discussion?

So where are these decent jobs available? Be specific. Where is there a legit job opening? I have applied to dozens of ads. I'm making phone calls and e-mails, plenty of them cold calls, and getting nowhere.

Please either post something real, send me the link, or stop posting about how much availability there is. I have applied to DOZENS of jobs ALL OVER THE USA and I am getting ZERO real interviews. Maybe an e-mail back, maybe a phone discussion, but that's it. I am board certified and have been in practice several years. I'm stuck in a bad academic satellite position. Even though I try to not let on that I hate my job, it's like the other academic satellite jobs (most of the availability) recognize immediately that their job is exactly the same underpaid, overworked, underappreciated academic satellite job I have now. My impression is that they would rather take a sucker new grad (like I was a few years ago) who will beg and plead them for any exploitation available.

If you don't have a specific job ad to offer to be helpful, please just stop posting about how there are opportunities out there. Maybe you like your job that you've had. Good for you. Please hire me. Oh, I already know that you're not hiring. Any good practice is already full since the market isn't expanding and everyone is too concerned about the future of our specialty.

The job market died and needs a eulogy, not a posthumous attempt at Weekend at Bernie's.

 

[KHE88]

Duke, I'll send you a PM. Not sure why you're having a hard time finding decent compensation if you're literally and honestly willing to live anywhere.

The above referenced North Dakota job is in Minot, ND. They've been looking for a while and are flat out advertising a starting $550k salary guarantee + bonus. I wouldn't be surprised if you could negotiate this close to $700k and in the end be looking a total compensation around a million depending on volume. If you go to a place nobody else wants to live where there is a great demand and literally no other rad onc competition, then the sky is the limit.

These ultra rural/isolated places will do anything to get a desirable BC rad onc in. 8 weeks vacation? Sure. 4 day work week? We can make that happen. You want 90th percentile MGMA everything? Lets talk to the lawyers and see what we can do. Want to buy-in some shares or tech ownership? Lets talk numbers. 7 year salary guarantee on contract? You mean you'll stay here for SEVEN YEARS? Here, sign here right now. Keep the pen. Like my Rolex? Take that too. In fact, here's my car keys...

I get an email every week where they are trying to fill the same jobs for the past year: Carlsbad, NM. Vincennes, IN, Eau Claire, WI, Laredo, TX, Salina, KS, Russellville, AR, etc. Sure some of these are trying to get someone on the cheap and take advantage of a desperate grad who needs a visa and flat out won't respond to someone who clearly has other options. But if you look long enough, you'll find a legit non-exploitative opportunity that pays well.

I have serious doubts that this situation will still exist in 10 years as new grads have to fight for any job, not just jobs on the coasts and cities.