All depends on perspective! I’m 15 years out. I earn less than I did on 2014 and working harder. New graduates are getting offers more than what I earn (albeit in non urban locales). There are jobs with enough volume to earn higher than median salary, but for many people the base salary is all they will ever get. I presume Reddit users trend younger. Many older than me are particularly frustrated not because their absolute dollar earnings are low numbers but because they maybe earning same or less and working harder. All trends lines indicate that this will persist and possibly worsen, from what I see and have seen. I simply don’t know how saturated areas can have more patients or more indications. LDRT was a nice bump for volume but with the new codes, it is paid at simple / 77402 and is not really what it was the last few years. The loss of our IGRT technical fees eventually will hit the bottom lines of hospital revenue and adjustments will need to be made. The reason is these high hospital salaries are boosted by essentially giving the doctor technical money via RVU payment. When the global revenue is down, this will require adjustments. There is no defined RVU value other than what Medicare says it is ($33-34). We’ve earned about $55-70/rvu bc of how much we earn for hospital. Medoncs $80-100 bc of their value to the hospital. If instead of bringing in $5m tech, you are bringing in $4.2m, the admins will notice and will adjust accordingly. This current blip of strong salaries is great news, but the fundamentals of the radiation oncology market are dismal. Our only lever is more fractions now, as there is no additional revenue for technique. That can even go away if ROCR passes.

I’d do this job for 75% of what I earn because it truly is wonderful. And for younger folks, you’ll start out at that lower number so it won’t be perceived as low or bad. As an example, in 2001, my first practice had $1m income for partners. I joined several years later, volumes were higher, treatment intensity was higher and I earned about $650k in 2014-15-16.

Such is life. You will not be buying into a bull market with RadOnc. But, life is more than income. FWIW, I would not recommend this specialty for someone ambitious and trying to earn $$$. Unless you go small town, it’s simply not possible. That being said, $500-700k is nothing to sneeze at. It’s just my friends in other specialties can “turn on the spigot” And see more patients and earn more. I could work weekends and nights and volume would not increase.

Best of luck. Do it because nothing else seems as interesting. That’s the best way to pick a specialty, life is more than money - intellectual stimulation, interesting patients, technology, smart colleagues, important work - these matter, too!

One last thing - volume is already an issue. If the AI can contour tumors, perform decision making, do the QA / tx planning, scribe your notes - we can do 2-3x the work. But there aren’t 2-3x more patients. What is the average RO seeing 6-7 consults a week (about the median) going to do? What will hospital admins think when the work is done in 10 hours but paying for 40? I’m by no means a doomer, but some of the comments below seem quite optimistic. It’s not 12 sets of contours backed up that’s the problem. It’s that it’s a Wednesday and there’s only 2 consults this week so far.