Why is rad onc not more competitive?

[steponecloser]

It is reasonable to worry about the future and give actual constructive criticism on what is currently happening. But I don't agree with the burn it all down mentality. It appears some degree of sentiment is changing, at least, off-line in my opinion. Just saying I'm happy to discuss my real world experience (although privately, for obvious reasons).

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[drowsy12]

Some of these arguments are fallacious in that they seem to be based on the premise that most of us went into radonc in order to do as little as possible. If, on the other hand, most of us went in to radonc for more noble reasons and looked forward to being busy, then being under-used might actually be undesirable.

idk. Go back to the Rad Onc FAQs that used to be pinned to the top of this forum. they were certainly there when I was applying in the early 2010s.


there's ZERO question that most of us who applied back then were aware rad onc as a derm-like field with good hours and quality of life, and a good salary to work ratio. Similarly all the bad stuff we know about now (geographic limitations, the ever present concern that systemic therapies will make RT less utilized) were clearly described in the FAQ then too.

to me some of the fallacious stuff is thinking this stuff is new.

 

[drowsy12]

It is reasonable to worry about the future and give actual constructive criticism on what is currently happening. But I don't agree with the burn it all down mentality. It appears some degree of sentiment is changing, at least, off-line in my opinion. Just saying I'm happy to discuss my real world experience (although privately, for obvious reasons).

All viewpoints are needed and I personally don’t think someone should be chastised for expressing their view and lived experience.

This is not ROHUB.

One should not be cancelled for saying hey rad onc isn’t so bad.

 

[Ray D. Ayshun]

idk. Go back to the Rad Onc FAQs that used to be pinned to the top of this forum. they were certainly there when I was applying in the early 2010s.


there's ZERO question that most of us who applied back then were aware rad onc as a derm-like field with good hours and quality of life, and a good salary to work ratio. Similarly all the bad stuff we know about now (geographic limitations, the ever present concern that systemic therapies will make RT less utilized) were clearly described in the FAQ then too.

to me some of the fallacious stuff is thinking this stuff is new.

Good hours is different than what I'm talking about. And just because a lot of us didn't necessarily believe the geographic limitations talk back then, doesn't disqualify us from emphasizing it now.

 

[Lamount]

My residency was not Cush per se. Rad onc residency depending on the program and how well trained you want to be IMO requires a lot of out of work prep time and studying.

Attending life is different but you have more autonomy and control and aren’t seeing someone else’s followups. Still work.

Both different, neither ‘easy’ but pretty decent overall on both sides for being a physician.

Agree.

Would also posit that, as it is practiced today (big caveat!), radiation oncology is one of the better compensated specialties for the workload. Whether or not this offsets geographic constraints that we experience, and whether this remains the case in the future... who knows?

Can't say I wish I did anything differently... would just be more nervous about going into the field now than I was when I matched in 2013

 

[Ray D. Ayshun]

Agree.

Would also posit that, as it is practiced today (big caveat!), radiation oncology is one of the better compensated specialties for the workload. Whether or not this offsets geographic constraints that we experience, and whether this remains the case in the future... who knows?

Can't say I wish I did anything differently... would just be more nervous about going into the field now than I was when I matched in 2013

I agree, and more or less agree with drowsy. as far as things go, I'm in a great location and >75% MGMA in productivity and salary. Which is to say, I'm pretty busy and well-paid. However, to get to that point, there's a lot of non-contouring/non-thinking about cancer/non-counseling patients stuff that goes into it. This is perhaps true of any specialty, but away from academics, where coordination of care is much less cohesive, a lot of brain space is spent on lame ****. Given our spot in the referral chain, and dependence on other specialties, this I think, is much more the case in our specialty than most others. There's really no way to prep for this, and I'm certain it has an impact on QOL.

 

[TheWallnerus]

I remember back in my residency in my final year I bet I was gone from clinic for what seemed like months. Back then you took orals and writtens before you graduated. And you got two weeks fully off before for writtens, and for orals, for studying and exam prep purposes. And I attended two European conferences for presenting abstracts that year and did things like elongate travel times by taking trains and stuff. So that was some more weeks. And I had a grandma die. Got time off for that. And had two bouts of kidney stones, one requiring surgery. Time off for that, no problem. And residency allowed us extra week off time for job interviewing purposes.

 

[MidwestRadOnc]

I'm a signed to a great job PGY-5.


I know the skiing was horrible in the Midwest but that's not the case for the entire country. I don't know why you think what I've said is not believable. Did I take some vacation to accomplish 30 days- yes, I did. But I also haven't gone every weekend, and I'm not going during the work week. It's just a ton of driving. It is also all self funded and done frugally.

I skied exclusively Breck/Vail/Keystone this season. In mid January when I was there when they opened Imperial for the first time. I've never seen it that late. Very rocky, lots closed. Early december conditions in mid January. When I went back a month ago, we were at T-shirt and light jacket level in early March and wet snow. Season was done. Same conditions I saw end of April last year. It was an objectively terrible season, but wherever you are glad your experience was better. I heart upper rocky were better (I went up there once and it was still early conditions late).

There is no "skiing" in the midwest. There are a handful of hills that i honestly don't see how can stay in business at this point.

Ok, I could realistically see you doing 30 days in a good season, weekends only. Not 50.

My residency was also very chill compared. 40 hours per week all-in (PGY2 more like 50-55 with another 10-20 study/work at home due to learning curve), decent vacation. "research" was 6 months of work from home and do whatever you want basically. I'm not arguing with you there. My quality of life was actually better during residency than it is now. I never thought I would be saying that but it was true. Especially with my first trainwreck job out of residency, despite making decent money if I had the option of going back in time and doing residency again I would have taken it in a heartbeat. Find me another specialty where this is true. I hope your experience post-residency is better than mine. I've finally landed in something decent (that I think is decent, many/most would be horrified if this were their terminal career point) years later but I paid a huge cost to get here (periods of unemployment, $7k/week locums gigs, living out of hotels and ratty short term rentals, failed relationships, etc).

 

[MidwestRadOnc]

to me some of the fallacious stuff is thinking this stuff is new.

According to reddit (and a published article by a chairman), information posted here is deliberately misleading to scare quality applicants away from the field so that residencies are either forced to contract or train problematic med students and flood the job market with unimpressive physicians that allows current private practice rad oncs to maintain their competitive advantage.

 

[TheWallnerus]

Navigating Radiation Oncology Emergencies: Are We Maximizing Inpatient Call for Residents?​

 

[evilbooyaa]

It is reasonable to worry about the future and give actual constructive criticism on what is currently happening. But I don't agree with the burn it all down mentality. It appears some degree of sentiment is changing, at least, off-line in my opinion. Just saying I'm happy to discuss my real world experience (although privately, for obvious reasons).

I'm very happy for you that as a PGY-5 are happy with where you are at.

This is about as useful, IMO, as those surveys talking about PGY-5s being employed at a GREAT JOB (not having actually worked there a single day).

Glad your residency life was so cush!

 

[Neuronix]

Just saying I'm happy to discuss my real world experience (although privately, for obvious reasons).

I think most of us are. I certainly am.

Just about every poster here has been verified by me to be a resident or attending physician in radiation oncology. We have hundreds more who have personally verified themselves for the private business forum.

Every path is represented here from small private practices to hospital employed to academics (clinical only and physician-scientist).

So if someone thinks that they are getting some rogue opinions from non-rad oncs trying to troll or just some private practice rad oncs trying to burn academics, they are sorely mistaken.

ASTRO should be taking notice and engaging with the significant percentage of the specialty who participates on this site, many of whom are disgruntled. No other specialty is like this.

Instead, the occasional member of our "leadership" comes to SDN, gaslights, issues threats, and leaves. This is a failure of our primary specialty society that reflects itself in part with the posts you see here.

 

[medgator]

Mods just killing it today

 

[UndecidedMS2]

I paid a huge cost to get here (periods of unemployment, $7k/week locums gigs, living out of hotels and ratty short term rentals, failed relationships, etc).

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

 

[Neuronix]

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

Are you serious? This is not that uncommon.

AAMC instructor and assistant professor median total compensation, as well as low end associate professor are all less than $450k.

I can't find specific hours for American rad oncs, but google search gives averages in Canada and Australia in the 44-50 hour a week range.

I certainly made less than $450k working more than 50 hours a week for my first few years in practice. I haven't been out that long, so it wasn't that long ago.

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

You are not going to find 46 weeks a year of rad onc locums without moving all over the country for it, and even then I find it hard believe you'd be able to make that kind of schedule. That also includes no benefits.

 

[Ray D. Ayshun]

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

I thought the key to happiness was tree fiddy not foe.

 

[MidwestRadOnc]

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

What does the labor market and average income for other physician specialists have to do with rad onc? What about the labor market for mobile home architects or oil and gas engineers? The income of NBA players maybe? We are really struggling.

If you are looking at sporadic 7k/week locums gigs as a positive I would say that you are going out of your way to try and spin everything about rad onc in a positive light and if I were you I would ask why. It sounds like you have identified that rad onc has a good lifestyle and are hyper focused on this. If I told you that being a rad onc involved having to walk across hot coals and flogging yourself in the morning as part of the linac warm up process, I am feeling like your instinctive response would start with “yes, but…”

 

[CurbYourExpectations]

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

1. Glad you're happy about your future career, hope it will be all you hope for
2. Not everyone cares about the pay
3. RadOnc is one of the biggest targets for pay cuts
4. Supply is outpacing demand
5. I doubt many RadOncs have the demand to warrant 50+ hours of work
6. Pretty much any specialty can make that much doing locums

 

[MidwestRadOnc]

1. Glad you're happy about your future career, hope it will be all you hope for
2. Not everyone cares about the pay
3. RadOnc is one of the biggest targets for pay cuts
4. Supply is outpacing demand
5. I doubt many RadOncs have the demand to warrant 50+ hours of work
6. Pretty much any specialty can make that much doing locums

Rad onc actually has one of the lowest locums rate there is. Anesthesia can make that in a day.

 

[elementaryschooleconomics]

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

HAHAHAHAHA

Yes, >90% of my graduating residency class, including me. The field is very stagnant in terms of comp - it's been that way for a long time.

In the years since, I haven't bothered to explore this in detail, but I'm virtually certain it's still at least 50% (conservative estimate), based on casual conversations.

At my residency institution, only the most senior faculty were around that comp, as long as they were at least 0.7 FTE and/or had several titles/tenure etc.

I think one of the non-senior faculty got close to $450k one year with wRVU bonus...but that person was literally the top producing RadOnc in the network. So, like...definitely more than 50 hours a week.

This is part of why that Washington Post article was utter trash, and anyone who thinks it has value is an idiot.

If someone starts talking about "average salary", their opinion isn't worth your time. Expressing salary as an "average" is basically meaningless.

 

[drowsy12]

HAHAHAHAHA

Yes, >90% of my graduating residency class, including me. The field is very stagnant in terms of comp - it's been that way for a long time.

In the years since, I haven't bothered to explore this in detail, but I'm virtually certain it's still at least 50% (conservative estimate), based on casual conversations.

At my residency institution, only the most senior faculty were around that comp, as long as they were at least 0.7 FTE and/or had several titles/tenure etc.

I think one of the non-senior faculty got close to $450k one year with wRVU bonus...but that person was literally the top producing RadOnc in the network. So, like...definitely more than 50 hours a week.

This is part of why that Washington Post article was utter trash, and anyone who thinks it has value is an idiot.

If someone starts talking about "average salary", their opinion isn't worth your time. Expressing salary as an "average" is basically meaningless.

This does not jive with my reality I know. No one I know makes less than 450k and I know a good amount of rad oncs. I graduated > 5 years ago though.

Different worlds I guess?

You’re making less than 450 and work weekends?

 

[MidwestRadOnc]

Anybody else in the > 15k wRVU for 350k club? (Undecided… this amount of work brings in 1M in physician fees alone to whoever is collecting the fee under your name and then paying you what the market bears).

 

[CurbYourExpectations]

This does not jive with my reality I know. No one I know makes less than 450k and I know a good amount of rad oncs. I graduated > 5 years ago though.

Different worlds I guess?

You’re making less than 450 and work weekends?

Do you not know anyone who filled out the ARRO salary data? Or like, most people in Academics?

 

[elementaryschooleconomics]

This does not jive with my reality I know. No one I know makes less than 450k and I know a good amount of rad oncs. I graduated > 5 years ago though.

Different worlds I guess?

You’re making less than 450 and work weekends?

1) Yes. Midwest and Southeast (but not Florida) generally pay more than Northeast and West Coast.

2) I was at the time, yes, which is one of the many reasons I left that practice. I make more than that now, but obviously continue to be above 50 hours.

Do you not know anyone who filled out the ARRO salary data? Or like, most people in Academics?

I...would also ask this question.

This shouldn't be news to anyone.

 

[UndecidedMS2]

Are you serious? This is not that uncommon.

AAMC instructor and assistant professor median total compensation, as well as low end associate professor are all less than $450k.

I can't find specific hours for American rad oncs, but google search gives averages in Canada and Australia in the 44-50 hour a week range.

I certainly made less than $450k working more than 50 hours a week for my first few years in practice. I haven't been out that long, so it wasn't that long ago.



You are not going to find 46 weeks a year of rad onc locums without moving all over the country for it, and even then I find it hard believe you'd be able to make that kind of schedule. That also includes no benefits.

Academic rad onc working 50 hours a week? That means 8-6 every single day. I have not seen a single rad onc attending that works that much. My experience is only with the attendings at the main site so it could be totally different for those covering satellite sites.

 

[elementaryschooleconomics]

Academic rad onc working 50 hours a week? That means 8-6 every single day. I have not seen a single rad onc attending that works that much. My experience is only with the attendings at the main site so it could be totally different for those covering satellite sites.

1) What is your sample size?

2) How closely are you monitoring these attendings?

3) How do you know how much remote work they do?

4) Is this institution hiring?

 

[UndecidedMS2]

What does the labor market and average income for other physician specialists have to do with rad onc? What about the labor market for mobile home architects or oil and gas engineers? The income of NBA players maybe? We are really struggling.

If you are looking at sporadic 7k/week locums gigs as a positive I would say that you are going out of your way to try and spin everything about rad onc in a positive light and if I were you I would ask why. It sounds like you have identified that rad onc has a good lifestyle and are hyper focused on this. If I told you that being a rad onc involved having to walk across hot coals and flogging yourself in the morning as part of the linac warm up process, I am feeling like your instinctive response would start with “yes, but…”

Because this forum was filled with posts like “if you’re a USMD pick any specialty other than rad onc” because apparantly other specialties have it so much better than rad onc right? That’s why i’m comparing it to other ones.

Your analogy is what I have issue with… the exaggeration. No one is disagreeing that there are issues, but you are talking like the only decent jobs out there ones in some random place with 8k population over 3 hours from an airport… that’s literally not true!

 

[drowsy12]

Do you not know anyone who filled out the ARRO salary data? Or like, most people in Academics?

I’ve quoted the AAMC data recently. People I know are associates or professors. The median for assistant is like 370 so I also know people making more than 450 as assistants, yes.

For non academic jobs I’m also well aware of MGMA as is my
Employer haha

 

[UndecidedMS2]

1) What is your sample size?

2) How closely are you monitoring these attendings?

3) How do you know how much remote work they do?

4) Is this institution hiring?

1) 30-40 probably
2) definitely not as closely as the department chair lol
3) i don’t know. But cosidering all the notes and contourings were done by the residents and they had 1 research/adminstration day (some had 2 i believe). I don’t know what they would be doing at home
4) i think one of them is

 

[MidwestRadOnc]

Because this forum was filled with posts like “if you’re a USMD pick any specialty other than rad onc” because apparantly other specialties have it so much better than rad onc right? That’s why i’m comparing it to other ones.

Your analogy is what I have issue with… the exaggeration. No one is disagreeing that there are issues, but you are talking like the only decent jobs out there ones in some random place with 8k population over 3 hours from an airport… that’s literally not true!

To be honest. It’s probably my fault I didn’t network hard enough to get one of these 4 day a week 700k jobs in a desirable metro with a 5 min commute off the bat. I’m working on just trying to own it. If you network hard enough you will be rewarded with one.

I sincerely hope you don’t have to go through the absurdity of applying for 5 different jobs in the dakotas and hearing back from none of them.

 

[medgator]

I know it’s locum and not full time. But let’s say it was employed with 6 week PTO. It would be $320k. That’s more than the average salary for many specialties! The fact that we consider that trash (rightfully so) kinda proves my original post.

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

Not sure you've kept up with the times. That's close to starting salary for psych these days in many locales

 

[TheWallnerus]

Anesthesia can make that in a day.

Anesthesia is doing ok evidently

 

[steponecloser]

I think most of us are. I certainly am.

Just about every poster here has been verified by me to be a resident or attending physician in radiation oncology. We have hundreds more who have personally verified themselves for the private business forum.

Every path is represented here from small private practices to hospital employed to academics (clinical only and physician-scientist).

So if someone thinks that they are getting some rogue opinions from non-rad oncs trying to troll or just some private practice rad oncs trying to burn academics, they are sorely mistaken.

ASTRO should be taking notice and engaging with the significant percentage of the specialty who participates on this site, many of whom are disgruntled. No other specialty is like this.

Instead, the occasional member of our "leadership" comes to SDN, gaslights, issues threats, and leaves. This is a failure of our primary specialty society that reflects itself in part with the posts you see here.

While there clearly is a cohort of rad onc's from all over the country, it seems if you say anything positive or to the contrary, that the beehive comes out to sting. See below quote:

I'm very happy for you that as a PGY-5 are happy with where you are at.

This is about as useful, IMO, as those surveys talking about PGY-5s being employed at a GREAT JOB (not having actually worked there a single day).

Glad your residency life was so cush!

This is a staff member saying this. I'll tell you it does seem to be useful, as I have had DMs saying so. The point stands that radiation oncology offers a lifestyle that few other specialties offer that also is as (in my opinion) as cool of a job.

The funny thing is my residency isn't even considered "cush" within the field. It's just like every other residency though, with the vast majority of weekends free (which was the point). I get that I haven't started my job, but I do know what I'm getting into. I know not everyone has that luxury.

 

[yesmaster]

Rad onc’s are used to working in undesirable rural locations, and oftentimes these are the places that require locums coverage.

If you take any other procedural specialty or treatment-oriented specialty like heme onc or even support specialties like anesthesia or rads, they usually outearn us in rural locations for typical non-academic hospital based job, at least in my neck of the woods. Ymmv

They may do more work but if I’m going to be somewhere rural, I don’t want to be twiddling thumbs

 

[NotMattSpraker]

Navigating Radiation Oncology Emergencies: Are We Maximizing Inpatient Call for Residents?​

Their solution to a 50% rise in inpatient consults in 5 years is... resident education? What is wrong with these people. Take the elevator up to the directors office and talk to them. Bring them Figure 1. Your people who completed an intern year can manage inpatients and they have their whole career to argue with admins about inpatient treatments.

to me some of the fallacious stuff is thinking this stuff is new.

Speaking of fallacious. The "stuff" for me is thinking I can present a very nuanced argument about, for example, the workforce to this field of really smart people and get more back from leadership than "why are you so negative?"

I loved my training and job, but I am now pretty neutral on recommending the field because it is toxic and Im not sure it will be fixed.

Ha, thats pretty negative. But honestly I love my job and Im sorry to new grads that I hope I have it forever. I dont even ski (but love hosting Rad Oncs that do).

 

[NotMattSpraker]

I’m very curious, does anyone here work over 50 hours a week and get paid less than $450k?

Haha I missed this before, did the chairs blow up your DMs?

 

[CurbYourExpectations]

I understand where this conversation is coming from, however looking at it as something stagnant as "good hours and good pay", is not the way to pick a field. Everyone in this forum loves the field and no one is saying there isn't good pay to be had currently. People should go into RadOnc only if they like it more than other specialties AND are okay with not being able to pick where they live. Making 50-100k more, which may be temporary, shouldn't be the ultimate goal for picking a specialty. Things are fine now, but the worry is about the future, RadOnc reimbursement is heavily targeted, supply is outpacing demand and there are not signs that it will be fixed by the time current medstudents become practicing attendings.

tl;dr Don't do RadOnc just because you think the pay is slightly better, do RadOnc because you like doing physics in rural West Virginia.

 

[evilbooyaa]

While there clearly is a cohort of rad onc's from all over the country, it seems if you say anything positive or to the contrary, that the beehive comes out to sting. See below quote:



This is a staff member saying this. I'll tell you it does seem to be useful, as I have had DMs saying so. The point stands that radiation oncology offers a lifestyle that few other specialties offer that also is as (in my opinion) as cool of a job.

The funny thing is my residency isn't even considered "cush" within the field. It's just like every other residency though, with the vast majority of weekends free (which was the point). I get that I haven't started my job, but I do know what I'm getting into. I know not everyone has that luxury.

I very much value your opinion and optimism. I think we definitely need optimists about the field on this website. Never feel like you're not allowed to have an opinion.

However, if you feel slighted by my comments about the fact that I don't think you know the quality of a job (or the job market) as a PGY-5 resident, then that's unfortunate. Because that's my opinion. It's not a knock on you.

There are a lot of graduating residents that get handed a sandwich, and they go "oh yay, what a sandwich!" when people that have been doing this for 5-20+ years have noticed the quality of said sandwich continue to worsen, become smaller, having to work harder for that sandwich, etc.

It's a difference in expectations. Many a graduating resident are happy to have A job in A locale that is livable for them. Making 6-figures is exciting. I get it. One may be happy with 400-500k pre-tax salary for 10-15k RVUs a year for the rest of their life. I would imagine a graduating resident is much more likely to consider that an acceptable offer than someone who graduated 10 yeras ago. But just know that the money being collected in your name is 1.5-3x that.

Maybe one can find the rare unicorn job that puts people on a track to making a 7-figures/year. I'll be honest and say that I honestly cannot expect that in my lifetime because of the greed of those who have those jobs currently and (associated) accelerating consolidation.

You’re making less than 450 and work weekends?

450k pre-tax salary for assistant professor in academics is doable at certain institutions. Easier to achieve if you work at a PPS-exempt center, I imagine. I doubt that it is the norm.
BUT I imagine 450k total comp (what MGMA citesI believe?, which includes thinks like employer match, etc.) is not uncommon.

So, you, and ESE, and others discussing - you guys talking about pre-tax salary? Or total comp?

 

[drowsy12]

Yeah totally agree that assistant professors mostly make below that.

 

[udrag14]

Academic rad onc working 50 hours a week? That means 8-6 every single day. I have not seen a single rad onc attending that works that much. My experience is only with the attendings at the main site so it could be totally different for those covering satellite sites.

I think most people in medicine work >40 hours a week. You may not see them on site but they are still doing things at home.

Rad onc has good lifestyle balance, but I wouldn't go into rad onc (especially academics) thinking you will work 9-5.

 

[elementaryschooleconomics]

450k pre-tax salary for assistant professor in academics is doable at certain institutions. Easier to achieve if you work at a PPS-exempt center, I imagine. I doubt that it is the norm.
BUT I imagine 450k total comp (what MGMA citesI believe?, which includes thinks like employer match, etc.) is not uncommon.

So, you, and ESE, and others discussing - you guys talking about pre-tax salary? Or total comp?

Oh yeah I'm specifically talking about pre-tax salary.

I agree that if we're talking total comp, that's a different story. To be clear I was still below that in my prior gig, which was a stereotypical partner track private practice.

The "total comp" when it comes to academic gigs is...a lot of voodoo. The value of certain benefits isn't standardized, of course, so it requires a more nuanced assessment.

I do think the FAANG culture of "what's your TC" has become more common across industries including medicine.

But in RadOnc, historically, with the Terry Wall data etc, I'm mostly family with people talking salaries instead of total comp.

 

[radoncftw]

Oh yeah I'm specifically talking about pre-tax salary.

I agree that if we're talking total comp, that's a different story. To be clear I was still below that in my prior gig, which was a stereotypical partner track private practice.

The "total comp" when it comes to academic gigs is...a lot of voodoo. The value of certain benefits isn't standardized, of course, so it requires a more nuanced assessment.

I do think the FAANG culture of "what's your TC" has become more common across industries including medicine.

But in RadOnc, historically, with the Terry Wall data etc, I'm mostly family with people talking salaries instead of total comp.

why'd you leave your prior gig?

 

[elementaryschooleconomics]

why'd you leave your prior gig?

Ah, well...there were many issues very specific to that practice and situation which could not be resolved on a timescale I was willing to tolerate - if they could be resolved at all.

The core of it was really around safety, and I don't mean silly things with no clinical consequences. I mean things like...well, like if I was a manager at a Boeing factory and I had brought a bunch of concerns to the C-suite, and they ignored me, and then doors starting falling off planes mid-flight. That kind of stuff.

But, contributing to that was simply my concerns over the future of the last vestige of private practice Radiation Oncology. The group was on a PSA with a couple of hospitals spread out over a small geographic region. Just like literally everywhere else in the country, consolidation had started to rapidly increase in the years before and after I joined.

The hospitals the group covered did not merge with the same networks. The networks had their own Radiation Oncologists in other hospitals. As I recall, they were all employed in some form or the other.

I strongly suspect that there will come a time in the near future where the group's PSA contract will not be renewed. At that time, the best they can hope for is the network(s) off to keep them on as employees, and the deal isn't wildly different (in terms of compensation) than it is now.

Because: this is Radiation Oncology. The hospitals can offer employment with a 50% pay cut, because they know there's no other linacs in a commuting distance. Or, they could have other RadOncs waiting in the wings, already employed, to take over the positions immediately (also cheaper).

Which just brings us to the most important point in business, or the business of medicine:

Always be prepared to walk away.

That's what I did. I had started the job hunt when it became clear the "doors falling off planes" was not going to be addressed. I made one last big plea at a partners meeting.

It fell on deaf ears.

So my resignation letter fell on them, instead.

They never saw it coming. Because it's RadOnc. They knew there were no linacs in commuting distance. They knew geography was important to me.

Always be prepared to walk away.

 

[evilbooyaa]

Yeah totally agree that assistant professors mostly make below that.

Then it's just a difference in who ya know. If one is 1-5 (or 7 or 10) years out from residency and only 'knows' a buncha assistant professors, then the phrase "Folks in academics are all making > 450k" seems ludicrous. Because the frame of reference is academics yes, but 'academics at the same time point as me'.

Alternatively, if you're > 7-10 years out from residency and everyone you know is associate or higher, then "folks in academics are definitely not routinely making > 450k" seems ludicrous. Because the frame of reference is academics yes, but 'academics at the same time point as me'.

 

[UndecidedMS2]

Then it's just a difference in who ya know. If one is 1-5 (or 7 or 10) years out from residency and only 'knows' a buncha assistant professors, then the phrase "Folks in academics are all making > 450k" seems ludicrous. Because the frame of reference is academics yes, but 'academics at the same time point as me'.

Alternatively, if you're > 7-10 years out from residency and everyone you know is associate or higher, then "folks in academics are definitely not routinely making > 450k" seems ludicrous. Because the frame of reference is academics yes, but 'academics at the same time point as me'.

A lot of academic places have the salaries as public record. I think the majority fall in $320-400k starting for assistant professors. However, in my personal experience (n≈30), they barely work 40 hours a week. Obviously those fresh out of residency might not be effiecient yet so the first couple years they might hit 45-50 but after that it’s closer to 36-40hrs. Again, it’s just my personal experience which is limited to attendings that work at main site with multiple residents and APPs.

 

[evilbooyaa]

A lot of academic places have the salaries as public record. I think the majority fall in $320-400k starting for assistant professors. However, in my personal experience (n≈30), they barely work 40 hours a week. Obviously those fresh out of residency might not be effiecient yet so the first couple years they might hit 45-50 but after that it’s closer to 36-40hrs. Again, it’s just my personal experience which is limited to attendings that work at main site with multiple residents and APPs.

You know the work habits of 30 different academic based assistant professors, not only based on the amount of time that they spend at the office, but also the amount of work they do at home?

I don't think I know how much the other attendings in the same department as me consistently work at home, on nights/weekends/etc.
I make it a point to minimize spending time at home doing work and would rather spend an extra hour in the office as necessary, but I know my situation is not the same as others.

 

[drowsy12]

then the phrase "Folks in academics are all making > 450k" seems ludicrous.

Agree.

Luckily nothing close to this was said by me at least

 

[thecarbonionangle]

Even with a season pass, no one is self funding 30-50 days of skiing a year (did we even have that many with this pathetically short season?) on a resident's income while also affording rent in what has got to be a HCOL western or northeastern area. This would require night skiing for a decent amount of this time since even skiing every saturday and sunday would not get you to these numbers, and I am suspicious that a rad onc resident anywhere is getting out of clinic early enough to drive to the mountains, gear up, get a couple hours of night skiing in, then drive home and get enough sleep to be at work at 7-8AM the next day. Vail does not have a rad onc residency so we are talking about at least 1 hour from denver in perfect conditions and no traffic, which if you've ever done this is less than half the time. Salt Lake City to the canyons is closer, sure but I've been stuck, and is the only location I can think of off the top of my head where this would even be remotely doable.

If you are independently wealthy and like the work, sure, rad onc is not a "bad career." There is certainly no shortage of people who fit this bill in the field, especially in the heyday of top USMLE scores reflecting the end of the prep school-->ivy league-->family/trust fund supported T10 med school pipeline.

Dont forget the daddy is a rad onc practice owner scenario. Some people are set.

 

[drowsy12]

You know the work habits of 30 different academic based assistant professors, not only based on the amount of time that they spend at the office, but also the amount of work they do at home?

I don't think I know how much the other attendings in the same department as me consistently work at home, on nights/weekends/etc.
I make it a point to minimize spending time at home doing work and would rather spend an extra hour in the office as necessary, but I know my situation is not the same as others.

Yeah.

Undecided you make some points in this forum. But this thing where you think you understand what it’s like to be a rad onc attending - that ain’t it, son.

 

[thecarbonionangle]

I skied exclusively Breck/Vail/Keystone this season. In mid January when I was there when they opened Imperial for the first time. I've never seen it that late. Very rocky, lots closed. Early december conditions in mid January. When I went back a month ago, we were at T-shirt and light jacket level in early March and wet snow. Season was done. Same conditions I saw end of April last year. It was an objectively terrible season, but wherever you are glad your experience was better. I heart upper rocky were better (I went up there once and it was still early conditions late).

There is no "skiing" in the midwest. There are a handful of hills that i honestly don't see how can stay in business at this point.

Ok, I could realistically see you doing 30 days in a good season, weekends only. Not 50.

My residency was also very chill compared. 40 hours per week all-in (PGY2 more like 50-55 with another 10-20 study/work at home due to learning curve), decent vacation. "research" was 6 months of work from home and do whatever you want basically. I'm not arguing with you there. My quality of life was actually better during residency than it is now. I never thought I would be saying that but it was true. Especially with my first trainwreck job out of residency, despite making decent money if I had the option of going back in time and doing residency again I would have taken it in a heartbeat. Find me another specialty where this is true. I hope your experience post-residency is better than mine. I've finally landed in something decent (that I think is decent, many/most would be horrified if this were their terminal career point) years later but I paid a huge cost to get here (periods of unemployment, $7k/week locums gigs, living out of hotels and ratty short term rentals, failed relationships, etc).

People all have different experiences. I did not go to a “cush” program. I did not spend weeks in Europe presenting a poster with departmental backing. There are absolutely people who had this experience and then went on to get amazing jobs. What is important to recognize is that there is some real pain here for some people. I know unhappy people and people who are unemployed or underemployed. I am mostly ok with my life but this is because of my personal life and family and not because of my job.