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minor timbit of news - Just doing my rad onc rotation right now, and it seems that collectively all the rad onc program directors have decided to prevent any transfers into rad onc during residency due to the current job situation - so the only way to do a rad onc residency is directly through CARMS.

 

They should be doing more... I can't believe they are -still- training 11 rad onc residents per year in Ontario, when there simply isn't the job market to support them. Especially when certain programs (Mac, Queen's) haven't attracted a CMG in the first round (or ?second round) for a couple years.

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Makes perfect sense but for a relatively low exposure field it is a bit harsh if you discover the field late I guess.

 

True, but there has been a few spots in round two available for the past two years. And there are always some residents that transfer out to psych or family or whatever, even if program directors resist transfers in they may still accept a 1:1 swap depending on the situation. Who knows.

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Curiosity

 

What's the average remuneration for Rad Onc?

(Insert *it's not about the money statement*)

 

GP

 

This is a good report to look at for Ontario physicians.

 

http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf

 

It doesn't take into account overhead (which is pretty low with Rad Onc, i.e. admistrative staff you split with 2-3 other physicians). Mean of about $400k. I have heard that Ontario Rad Onc is often a FFS model, therefore the more technical/procedural parts of the specialty pay better (i.e. brachytherapy). Anecdotally, I've heard starting salaries are generally around $300k, but that could very easily change from centre to centre and I wouldn't be surprised that in the current job market, starting salaries continue to drop.

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  • 1 month later...
They should be doing more... I can't believe they are -still- training 11 rad onc residents per year in Ontario, when there simply isn't the job market to support them. Especially when certain programs (Mac, Queen's) haven't attracted a CMG in the first round (or ?second round) for a couple years.

 

Ontario trains 11, the rest of Canada trains 10 (2 of them being francophone spots). Pretty low numbers overall at this point. Some programs are struggling on the edge of viability despite being good radonc residencies because of how much they limited their intake.

 

It seems carms candidates are too often short-sighted when it comes to job situations. The state of radonc jobs right now is a reflection of when they were accepting 3-4x the number of residents 5+ years ago. Why did they do that? Were they retarded? No they were being short-sighted as well because back then there was actually a shortage and they were trying to meet demand. This is not even accounting for the large number of old-timer radoncs getting close to retiring (there are way more old radoncs than young ones) and everyone's retirement being delayed because of the stock markets.

 

So for the past 2 years the number of spots has dramatically shrunk. Couple that with the expanding role of radonc in medicine, the new machines and the more affordable old machines for new sites, and the decrease is graduating residents...it will be ok in 5+ years. 5 years ago once you graduated radonc if you were of average caliber with no fellowship you could find a job at most of the major centers in Canada. Who is to say that won't repeat. I think the carms candidates this year really put those things together because on the 2014 cycle the caliber of applicants and competition suddenly surged compared to previous years.

 

 

Curiosity

 

What's the average remuneration for Rad Onc?

(Insert *it's not about the money statement*)

 

GP

 

On the better end of many specialties. In BC (for some reason a very cash strapped province) they top out at 300k salaried, AB is around 400k salaried, Ontario is between 400-500k fee-per-service (although some young motivated radoncs are ~700k), QC is 350-450k fee-per-service. I believe Nova Scotia is probably around ON's remuneration. These are all first hand numbers that radoncs in the field told me from each of these provinces.

 

In the states the sky is the limit. In a private firm you would start at ~300k as a new sign-on, and once you partner think into the 7 figures. It is the best remunerated specialty in the US.

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Ontario trains 11, the rest of Canada trains 10 (2 of them being francophone spots). Pretty low numbers overall at this point. Some programs are struggling on the edge of viability despite being good radonc residencies because of how much they limited their intake.

 

It seems carms candidates are too often short-sighted when it comes to job situations. The state of radonc jobs right now is a reflection of when they were accepting 3-4x the number of residents 5+ years ago. Why did they do that? Were they retarded? No they were being short-sighted as well because back then there was actually a shortage and they were trying to meet demand. This is not even accounting for the large number of old-timer radoncs getting close to retiring (there are way more old radoncs than young ones) and everyone's retirement being delayed because of the stock markets.

 

So for the past 2 years the number of spots has dramatically shrunk. Couple that with the expanding role of radonc in medicine, the new machines and the more affordable old machines for new sites, and the decrease is graduating residents...it will be ok in 5+ years. 5 years ago once you graduated radonc if you were of average caliber with no fellowship you could find a job at most of the major centers in Canada. Who is to say that won't repeat. I think the carms candidates this year really put those things together because on the 2014 cycle the caliber of applicants and competition suddenly surged compared to previous years.

 

 

 

 

On the better end of many specialties. In BC (for some reason a very cash strapped province) they top out at 300k salaried, AB is around 400k salaried, Ontario is between 400-500k fee-per-service (although some young motivated radoncs are ~700k), QC is 350-450k fee-per-service. I believe Nova Scotia is probably around ON's remuneration. These are all first hand numbers that radoncs in the field told me from each of these provinces.

 

In the states the sky is the limit. In a private firm you would start at ~300k as a new sign-on, and once you partner think into the 7 figures. It is the best remunerated specialty in the US.

 

Deeman has provided some quality information. Even now, the job situation isn't as bleak as everyone claims. I took a peek earlier this week, and saw that Edmonton was hiring 1.5 FTE's in locums, and what looks like 2 full time staff as well, and I was really only looking around there while I was bored on call the other night. As for salaries, the overhead is great in Canada as you're attached to a cancer centre, so your percentage take home is a lot better than many other specialties. This chart is a good example of that - http://postimg.org/image/hvq7puh8z/ originally posted here: http://www.premed101.com/forums/showthread.php?t=72191 . It's older data, and not necessarily of the best quality, but it gives a rough baseline to compare specialties with at a glance.

 

I would also echo Deeman's comments on this year's CaRMS cycle as well. Last year, there were 5 extra spots left after the first round. This year, there was an extra spot in Edmonton compared to last year, and only one CMG spot left after first round. People are indeed looking longer term, and realizing that the reality that we have now will not necessarily be the one we will be facing when we graduate.

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  • 2 months later...

So now that CaRMS stats are released, it looks like radiation oncology applicant numbers were about the same from last year, although there were fewer spots available left after first round. So all in all, things remained relatively unchanged. Things seem different from going through the process yourself, I suppose.

 

30 people applied to rad onc in 2014 compared to 31 in 2013, with 17 choosing the specialty as their first choice in 2014 compared to 16 in 2013.

 

There was one spot available at Queen's after first round in 2014 compared to 2 at Queen's and 3 at McMaster at 2013.

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Out of curiosity, for those who wants to use working in the US as a last option, would a fellowship at Toronto be enough? Or do we need a US fellowship? The reason I ask is because USMLE is necessary for most US fellowships according to the grapevine. So would you advice us to start early in getting it?

 

As well, do I need to do a residency in Toronto to remain competitive for US job positions?

 

Thank you in advance!

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  • 9 months later...

Just bumping this up, since there is a new batch of 3rd (and 4th) year clerks who may have questions about one of the best kept residency secrets out there (IMO). Job market is still tight in Rad Onc, but not as bad as some surgical specialties. Doing a fellowship after residency is the norm, but finding a job after a fellowship is very possible. There is a feeling that the job market will be wide open in ~5 years (YMMV as it is based on modeling, but since the specialty is so small, it is easier to model - they did predict the job crunch that has been going on for the past few years) There are a lot of great things about being a radiation oncologist (and a radiation oncology resident), I'm happy to try and answer questions in this thread (or by PM)

I see no one answered the above post - there is no clear answer, and ultimately like any job in medicine there isn't a simple equation to finding a job. It is important to realize, just like a residency position, you aren't entitled to a staff physician job - you should have the attitude of selling yourself to obtain a residency position and ultimately will have to go through a much less transparent process to sell yourself as a staff physician to a group. I'm sure you could be a superstar Rad Onc resident at any program across the country and get a job in the US without a fellowship in the right circumstances. Will doing a fellowship or residency in Toronto make a difference? Probably not. Keep in mind, the rad onc community is small, and there is a lot of collaboration across the border.

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Currently in my last year of medical school. CaRMs coming up soon and this is definitely a specialty I am interested in. Great lifestyle, technical aspects of the specialty very interesting. \

 

Something I haven't been able to get a sense of though is how much do rad oncs typically make. I've been to hesitant to ask this while on a couple electives. I've read previous posts in this page about estimates and I was just wondering if anyone has updated info or just numbers from rad oncs first hand. My decision is not all about the money of course, I just wanna get a better sense of what my financial prospects could be since I've already discussed the obvious negative about rad onc with residents and staff already (job market!) 

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Currently in my last year of medical school. CaRMs coming up soon and this is definitely a specialty I am interested in. Great lifestyle, technical aspects of the specialty very interesting. \

 

Something I haven't been able to get a sense of though is how much do rad oncs typically make. I've been to hesitant to ask this while on a couple electives. I've read previous posts in this page about estimates and I was just wondering if anyone has updated info or just numbers from rad oncs first hand. My decision is not all about the money of course, I just wanna get a better sense of what my financial prospects could be since I've already discussed the obvious negative about rad onc with residents and staff already (job market!) 

See the bottom of

http://www.caro-acro.ca/Assets/Academic+Radiation+Oncologist$!2c+Lung+Site+-+Princess+Margaret+Cancer+Centre$!2c+University+Health+Network.pdf?method=1

and

https://www.cma.ca/Assets/assets-library/document/en/advocacy/Radiation-Oncology-e.pdf

 

It varies province to province. Rad Oncs have little to no overhead.

I've been quoted 350-450k depending on how many clinics you run/how many consults you do and community vs academic.

 

Planning radiation is technically procedural which tends to be among the best paying. 

 

If you have any other questions ask away.

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See the bottom of

http://www.caro-acro.ca/Assets/Academic+Radiation+Oncologist$!2c+Lung+Site+-+Princess+Margaret+Cancer+Centre$!2c+University+Health+Network.pdf?method=1 This is just anecdotal evidence but I've been told that rad oncs at Princess Margaret seem to make the least in ON compared to other academic centers and less than community, might have to do with the fact that PMH has such a huge emphasis on research productivity that clinical duties are less (so this is a pretty good estimate of the bottom end of what you''ll make in ON)

and

https://www.cma.ca/Assets/assets-library/document/en/advocacy/Radiation-Oncology-e.pdf the estimate here is from ALL medical specialties so maybe not as accurate for an average in rad onc. this data is older (latest numbers are 2009-2010) but something i came across a couple years back

http://www.ices.on.ca/~/media/Files/Atlases-Reports/2012/Payments-to-Ontario-physicians-from-MOHLTC-sources/Full%20report.ashx

 

if you go to the rad onc section, it says median is about 400K, upper 10th percentile earn >/=500K and bottom 10th percentile </=280K. I hear stories about rad oncs in sudbury making 700-800k

 

 

 

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Rad onc varies quite a bit from province to province. Some provinces operate on a salary, others fee for service. To make it more confusing, in Ontario, it is a combination of both. It is safe to assume a salary starting at 300k, and likely higher depending on your patient load. The median salary is above 400k from what I remember (there is a PPT presentation from about 5 years ago showing this, ontario physician data). There are very few outliers (i.e. 600k+). People have often compared it to the salary of a surgeon (~400k) with a much better lifestyle. It is entirely dependent on your work load - radiation treatment planning is the major money maker, and what separates rad onc from most other predominantly outpatient specialties.

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  • 4 weeks later...

For one reason or another, a lot of radoncs have told me what the pay structure looks like in different provinces. Here is what I know:

 

ON and QC are fee per service. ie. you see more consults, you bill more. It also depends on the type of consult, as in if its a standard breast RT one, or stereotactic plan, or brachytherapy, etc. They differ in how much the provinces pay per consult though, but QC radoncs seem to make up for it by having higher consult volume. They have a base salary for things like follow-ups, phone calls, etc. Doing administrative duties also gives extra pay, ex: being the residency program director, or department director, cancer site lead, etc. I'm not sure how call plays into this but I believe it is extra pay. There are some nuances past this. The tl;dr is yes they make 350-450k on average, but there are some that see a lot of new consults and push 700k. Especially in ON. It would make sense that the PMH staff don't make as much given that they need to be very academically involved, and you don't really get paid for research beyond the base salary. Each institution also has a different way of splitting revenue and costs within the group. Ex: some groups pool all the billings and split it evenly amongst the radoncs, others leave each individual radonc in charge of their own pay.

 

The western provinces like AB and BC are salaried. So its a lot easier to tell what radoncs make there. In AB the starting pay is about 300k, and there are 3 levels of seniority, with the top bracket making about 450k. In BC the starting salary is more like 185k, with again 3 levels of seniority with the top one making about 300k.

 

On the whole, overhead for radoncs is quite low despite the expensive to buy and maintain machines. Its basically left to the department to shoulder those costs for the most part.

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For one reason or another, a lot of radoncs have told me what the pay structure looks like in different provinces. Here is what I know:

 

ON and QC are fee per service. ie. you see more consults, you bill more. It also depends on the type of consult, as in if its a standard breast RT one, or stereotactic plan, or brachytherapy, etc. They differ in how much the provinces pay per consult though, but QC radoncs seem to make up for it by having higher consult volume. They have a base salary for things like follow-ups, phone calls, etc. Doing administrative duties also gives extra pay, ex: being the residency program director, or department director, cancer site lead, etc. I'm not sure how call plays into this but I believe it is extra pay. There are some nuances past this. The tl;dr is yes they make 350-450k on average, but there are some that see a lot of new consults and push 700k. Especially in ON. It would make sense that the PMH staff don't make as much given that they need to be very academically involved, and you don't really get paid for research beyond the base salary. Each institution also has a different way of splitting revenue and costs within the group. Ex: some groups pool all the billings and split it evenly amongst the radoncs, others leave each individual radonc in charge of their own pay.

 

The western provinces like AB and BC are salaried. So its a lot easier to tell what radoncs make there. In AB the starting pay is about 300k, and there are 3 levels of seniority, with the top bracket making about 450k. In BC the starting salary is more like 185k, with again 3 levels of seniority with the top one making about 300k.

 

On the whole, overhead for radoncs is quite low despite the expensive to buy and maintain machines. Its basically left to the department to shoulder those costs for the most part.

Starting at 185k and capping at 300k? Isn't that similar to what a FP makes? 

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Any rad onc residents on here have an opinion about proton therapy? Theoretically seems like the next amazing thing but the economic costs are hard to justify given we do pretty well with xray photons already. Have any of the residents heard any plans for it to come to their centers? i'd imagine toronto to be likely the first place it would show up should it ever even come here

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There is a proton center in BC that's part of a physics laboratory called TRIUMF that has treated a few patients over the years with ocular melanomas. I haven't read up on any data about the outcomes though. Otherwise the closest proton therapy centers are in the US (i think something like 20 with quite a few more expected to be completed in the next five years) but there are proton centers in other countries as well.

 

You are correct in that they have enormous economical costs, into the hundreds of millions however like all technology, it gets cheaper overtime with advances. The costs of opening up a proton center 10 years ago was significantly more then it is today. I think there are smaller proton therapy units available in the 30-40 million dollar range now. It's still in its infancy to be honest. I wouldn't expect there to be any superior locoregional control but rather better side effect profile so definitely worth exploring in sites like brain, spinal cord, head and neck, GI, GU sites where there's a lot of healthy tissue in the way that unfortunately has to take some of the damage. Also could be big for pediatric solid tumors as you rarely want to radiate kids due to the small risk that any radiation to the body can have on developing secondary cancers decades down the road. Due to the nature of protons (their Bragg peak) you can accurately target tumors while significantly sparing healthy tissue from radiation damage! Therefore this leads to minimal to no side effects

 

Basically we'll have to wait and see. It may or may not be the next big thing in rad onc and right now, the economical downside probably isn't worth the investment for many canadian centers. I can definitely see it gaining some serious steam if the costs to start up and maintaining proton machines continues to go down as is the trend now.

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At CARO this past year, there was some data presented with regards to the Rad Onc job market that is relevant to any medical students interested in the specialty.

 

In brief, the job market is anticipated to open up over the coming years, potentially even leading to a shortage of rad oncs in the medium term future (i.e. 6-10 years). No plans for re-opening the closed residency spots. Things have improved even over the last 1-2 years, though doing a fellowship after residency is still the norm. They aren't my slides so I won't post them publicly, but if any medical students are interested shoot me a message and I'll forward you the slide set.

 

According to the slide set, competition for residency spots in radiation oncology have been trending downwards, likely due to concerns with regards to jobs.

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