I could write my own substack on the joys of perm and 1099 lyfe, and the absolute insanity of dealing with some very shady scumbags. I will, I think, in the near future. Ahem.. anyway, You learn as you go along how to deal. Eventually, you learn (if brutally) the most sacrosanct rule:
ALWAYS RECORD EVERY SINGLE CONVERSATION OF SUBSTANCE GOOD OR BAD whether on the phone, or in person. Door closes? Unexpected meeting? Recording IS ON (out of sight). Every. Single. Time. Now, there are some states that have certain laws about these things. But exculpatory evidence is.. exculpatory. Recall the date, time and words with exactness if recordings are not uh, permitted. You think I'm kidding when I say "only the paranoid survive".. but wait until you read my book. You exclaim: "But everything is so swell at the beginning and the middle, why record the nice parts where they' tell me I'm great?" - because that very substance may be what you need to build your case that you were an excellent doc right up until (fill in the blank). And for those keeping score, no, I've never had malpractice or been found to have actually done anything wrong, EVER, and yet... when admins or practice owners want to turn on you, beware and be ready. It has nothing to do with medicine. Wanna take a guess what it is about? On that subject..
Your legal rights are enumerated in your contract. You had better find a g-damned highly experienced contract lawyer to READ EVERY SENTENCE and convey to you what the 'holes' are.. you spent years learning radonc, take a week and read up on how to interpret a contract. Eventually you'll realize if you didn't write the contract, you're gettin' the HOSE. Termination clauses are laughable. Indemnify a hospital? What, are you f'n kidding me? Its the other way around numnuts. Oh, big city and noncompete swiss cheese? Sure, if you're an employee. What if you're a contractor?
Why would you want to be a 1099 instead of an W2? Let me count the (15 cents on the dollars or MORE) ways. Sigh. So much to say.. but if the above helps even one person, I've done something good for today.
I should clarify, the FTC bans noncompetes as of now.. FOR EMPLOYEES. But if you're a contractor.. best you push for one that eliminates your risk of being not allowed to work elsewhere in the locale you are currently in.
Interesting, but I'd suggest the best of both worlds if you can swing it. W2 for your main gig. Private insurance is not cheap. Take the hospital-provided health and malpractice insurance, 401k match, and paid locums coverage. Then set up an LLC and funnel some locums work while you're on vacation or anything else medical related (surveys, expert witness, etc) 1099 through it, so you can still expense things.
The benefit of being a contractor with an S-corp is not as much as it's made out to be for a rad onc. You make too much to qualify for QBI deduction. You can save a tiny percentage on medicare taxes. That's about it. Unless you are doing something stupidly illegal like paying yourself a $25k salary and taking the rest as pass through income not subject to FICA withholding or something (paying your wife $300k to be your secretary, listing your boat as a business expense, etc).
The other problem is that more and more hospitals will refuse to pay doctors any other way than W2 because they are afraid of the more stringent regulations on employee vs. contractor classifications so they don't even want to risk it. I dealt with a hospital in Montana that wouldn't even agree to 1099 for a week of locums.
Also, the flip side of being a contractor is that while yes you can avoid a non-compete, the hospital can also cut you loose immediately (ask me how I know). You'll have a lot more protection and be harder to get rid of as an employee and usually they have to pay you for 90-180 days if they want to get rid of you so you don't have to spend months finding a new gig with zero income coming in.
Well, you've made some good points but they need clarification. First, if you're making W2 at 750k a year, at the 37% adjusted fed tax bracket, you're giving up 20%. Give back 5% for your own overhead.. Sure, one has to pay their own health insurance but if you're smart, and you have you and your spouse on a plan, its maybe 15k a year. ~50k deductible towards your retirement neutralizes it. Obviously, if you're working from a nearby home, you have to get creative. But if you're traveling..(see: geographical arbitrage) its a no brainer requirement to be a 1099... and then if you have legal expenses..and accounting expenses.. and on and on. There are plenty of ways to work the system (see: www.bradfordtaxinstitute) that are perfectly legal. You have no more real protection than what is elucidated in your contract, period. Otherwise, its lawyer time. I doubt I will ever be a W2 again, and recommend others negotiate a 1099 in such a way that it gives them control over their taxes, retirement, and health insurance.
Great story (also terrible story, I'm sorry). Sadly, this is very common.
I experienced a similar situation as the author and wish someone had written advice like this when I was graduating residency. The bottom line is that I sold myself short as a PGY-4 looking for jobs. I received literally (this word is overused, but in this case literally literally) no education during residency on how the business of radiation oncology works. I didn't know what a CPT code was, let alone which ones were pertinent for our specialty. I only vaguely knew what RVUs were. I was tricked into thinking with a salary mindset rather than understanding that almost all of us operate in a fee-for-service environment. So, this resulted in looking for jobs that offered the highest "base guarantee." I asked all the wrong questions. I wasn't focused on how many patients were treated or how.
In retrospect, it is very simple. You evaluate a job based on volume and resources. You should get paid $X per RVU. So you need to figure out how many RVUs there are per year, and you do that by figuring out how many consults there are and what kind of consults they are. Then you just negotiate X as high as you can get. It's actually remarkably simple. I created an IMRT plan. This pays 7.99 wRVU. My "X" number is $65. You owe me $519.35 for this plan. You don't have to pay me right now, just do it once a month is fine. This is how it works at a GOOD job.
What happened to me as a new grad, not understanding the above, is that I got suckered into a predatory position that offered what seemed like a high "base guarantee" ($650k -- more money that I ever thought I would make). The downside was that it was in the middle of nowhere. It was hard to get many job offers coming out of a lesser known program, and the other ones had numbers around $500k. So, I went with the higher number with the cherry on top being a $125k "sign on" check they gave me as a PGY-4. That felt good depositing that, having to bring the bank manager come for approval for this ballar who just showed up with a 6 figure check.
So, you can see where this is going. If you're playing poker at a table, and you can't figure out who the patsy is, then you're the patsy. I was the patsy and the other poker players were the hospital admin. In fact, I later heard the CEO of the hospital boast to a board member, "We really try to focus on recruiting new grads since they aren't business saavy."
The problems were many:
1. The clinic actually generated about 13k wRVU per year. At $70/wRVU this is $910k/year. Much more than the $650k I was "guaranteed" even accounting for benefits. The hospital had developed all sorts of tricks to make sure you would not get paid anything beyond your "guarantee." Their "RVU bonus" was smoke and mirrors. I signed up for a salary job to do $910k worth of work for $650k. The hospital just kept the rest. I got suckered. What I didn't understand is that I could have taken one of the $500k jobs that actually did pay out RVU overages correctly OR just simply have taken a job that paid strictly per RVU (the so-called eat-what-you-kill job) and not have had to move to the middle of nowhere and also made more money. I had a beautiful home and partner that I lost to move to the middle nowhere because I thought I was going to make maybe an extra $80-90k after taxes. Even if that were true, which it wasn't, this was a monumentally stupid trade off and a catastrophic life decision.
2. The $125k sign-on check was actually a loan. You took on a debt by accepting it. If you quit within 5 years, you have to pay it back. Again, you can see where this is going... they expect you to quit within 5 years. Because you moved to the MIDDLE OF NOWHERE.
3. Knowing that they expect you to quit within 5 years, they treat you like complete garbage. I thought I would be welcome with open arms coming to a place nobody else wanted to go. Wrong. I walked into a place where the dosimetrist wanted to play doctor. He wore scrubs every day. He explained treatment plans to patients. He told patients I hadn't seen yet that they would be getting 20 fractions to their prostate. When you tried to override them and practice like you were trained, they took it as an offense. When I discussed this with the CEO to try and explain how inappropriate it was, I was told that I needed to be careful how I communicated with the dosimetrist because it was hard to replace staff like him. Seriously. Secret meetings were held to try and undermine me and try and get rid of me. Any attempt to exercise discretion and autonomy as a physician was fiercely fought against. You know what the number 1 leading factor to physician burnout/moral injury is? Loss of autonomy. You don't want burnout a few months into your first job.
4. It wasn't just me. All the other specialties had constant turnover due to poor treatment of doctors (a good rule of thumb is that if a hospital admin refuses to address you as a doctor and rather as a "provider" or worse as their "associate" you're probably not going to be treated well and valued). You can guess what trying to take care of patients is like when you are dealing with disgruntled med oncs, surgeons, radiologists, and midlevels or the revolving door of non-BC locums that are constantly filling in the gaps.
5. The issue with the cones. That's funny. I have seen this so many times. Cones are purchased and then never commissioned. Again, if you are interviewing at a clinic that has purchased cones but never commissioned them... huge red flag.
Recommendations for senior residents on the job hunt:
1. You get paid per RVU. Think like this instead of thinking with a salary mindset. When reviewing your contract make sure that you get paid for each and every last RVU and that these payments happen OFTEN. Do not agree to baloney systems like I did where they promise to pay you an "RVU bonus" at the end of the year if you do "extra." They almost certainly will not properly account for the RVUs and just leave off all of the RVUs for December or something and tell you "oh, don't worry those will show up on next year's"
2. Make sure you understand every single professional CPT code in radiation oncology. 77427, 77014, 77435, 77301, 77263 are the big ones. Start there. Learn what they are, when they can and should be billed, and how many wRVUs they are worth. Make sure you know each and every charge that should be billed during the course of a standard prostate treatment course and when. You will have to self-educate on this. But you absolutely MUST. Make sure they are transparent with the charges and how the RVUs are counted. If they don't share this information with doctors (and many won't), then this should automatically disqualify them. Continue your job search. Never work for someone who refuses to prove that your payments for your services are correct. Trust but verify. The IRS doesn't accept "what, you don't trust me?" as an excuse for why you listed 14 dependents on your tax return. Nor should you when the hospital tells you generated 500 wRVU in a month where you had 50 consults.
3. Be extremely wary of hospitals in hard-to-recruit areas offering high salary guarantees and 6 figure sign on checks, especially to new grads. A responsible/ethical practice is not going to recruit a brand new grad to a rural area to practice in a solo role (nor should you take such a role without experience). If a place in BFE is dangling a 6 figure check in front of a PGY-4, you are very likely going to be exploited and in 5 years will end up in a much worse financial and emotional state than if you had just started in the better clinic that was offering a normal junior starter salary and modest signing bonus.
4. Never take a private practice job that doesn't have a very clear track record of making everyone partner and very clear terms about how you buy-in to the practice. All of the above relates to hospitals, because that's where most of the jobs are, but there absolutely are equally predatory private practices that prey on new grads. Instead of dangling large paychecks at them upfront, what these practices do is the opposite. The offer a 5th percentile fixed salary for the first two years and promise you millions after that, which you will never see. You will quit once you get tired of managing 30 patients at a time for the cost of managing 5 and that the owners are never going to split the pie with you or anyone else and will just repeat the cycle of luring in new grads indefinitely.
A lot of rules written in blood .. the bottom line: be a 1099, determine the practice volume, and if rural, demand no less than 750k a year - and I don't care if they average 12 on treatment. Otherwise, go pay your dues at a well-established, well-regarded practice in the 'city' and take your W2 and eventually, you'll probably make a pretty good living and your wife will be happier that you're home raising the kids. Otherwise, go learn to fly, charge what you want, work 3.5 d/wk and get your tax to 18 cents on the dollar and play to win.
You can "charge what you want," but nobody is going to pay it. You are competing in a locums pool full of drooling 80 year olds who remember buying a pack of baseball cards for a nickel and will accept $1600/day. Hospitals will always go with the lowest bid for locums coverage. Most outsource to agencies as they don't want to handle malpractice and travel internally, and there is no transparency as to what the middleman is actually willing to place you at. I was bidding a couple weeks ago for emergency coverage at a site (<2 weeks out) at $3k/day. I thought it was a sure thing because a scenario finally emerged where they would have no choice but to pay a fair rate. Sure enough somebody underbid me. I have never once successfully negotiated placement with an agency, and I've tried probably 30 times. The agency will always find somebody willing to accept less and have less travel expenses and that's who will get placed so the middleman gets a bigger cut. I can't imagine intentionally making a career out of this. In med/onc or anesthesia where you can make double what an employed doc makes, yes. In rad onc, no. You make half because of the oversupply of bored octogenarians with active licenses.
I've PM'd you to assist. But for anyone reading: If you're clean sheet, experienced and present well.. if you aren't getting 3k a day (or more) at rural locations you're simply not understanding the rules of the game. 10 years ago I was charging 2600/day and had up to a year long placement PLUS EXPENSES.
Where are your radiation therapists in all this? Did you find them irrelevant to your practice/experience? Were they equally incompetent as administration? As a lead radiation therapist, I oversee a lot of the issues you addressed here especially as it came to advocating for higher standards in patient care delivery. I work closely with three radiation oncologists, two of them with little experience, so I definitely resonate with your experiences here, but no mention of radiation therapists while focusing solely on the physicists and dosimetrists leaves me with more questions.
I could write my own substack on the joys of perm and 1099 lyfe, and the absolute insanity of dealing with some very shady scumbags. I will, I think, in the near future. Ahem.. anyway, You learn as you go along how to deal. Eventually, you learn (if brutally) the most sacrosanct rule:
ALWAYS RECORD EVERY SINGLE CONVERSATION OF SUBSTANCE GOOD OR BAD whether on the phone, or in person. Door closes? Unexpected meeting? Recording IS ON (out of sight). Every. Single. Time. Now, there are some states that have certain laws about these things. But exculpatory evidence is.. exculpatory. Recall the date, time and words with exactness if recordings are not uh, permitted. You think I'm kidding when I say "only the paranoid survive".. but wait until you read my book. You exclaim: "But everything is so swell at the beginning and the middle, why record the nice parts where they' tell me I'm great?" - because that very substance may be what you need to build your case that you were an excellent doc right up until (fill in the blank). And for those keeping score, no, I've never had malpractice or been found to have actually done anything wrong, EVER, and yet... when admins or practice owners want to turn on you, beware and be ready. It has nothing to do with medicine. Wanna take a guess what it is about? On that subject..
Your legal rights are enumerated in your contract. You had better find a g-damned highly experienced contract lawyer to READ EVERY SENTENCE and convey to you what the 'holes' are.. you spent years learning radonc, take a week and read up on how to interpret a contract. Eventually you'll realize if you didn't write the contract, you're gettin' the HOSE. Termination clauses are laughable. Indemnify a hospital? What, are you f'n kidding me? Its the other way around numnuts. Oh, big city and noncompete swiss cheese? Sure, if you're an employee. What if you're a contractor?
Why would you want to be a 1099 instead of an W2? Let me count the (15 cents on the dollars or MORE) ways. Sigh. So much to say.. but if the above helps even one person, I've done something good for today.
I should clarify, the FTC bans noncompetes as of now.. FOR EMPLOYEES. But if you're a contractor.. best you push for one that eliminates your risk of being not allowed to work elsewhere in the locale you are currently in.
Interesting, but I'd suggest the best of both worlds if you can swing it. W2 for your main gig. Private insurance is not cheap. Take the hospital-provided health and malpractice insurance, 401k match, and paid locums coverage. Then set up an LLC and funnel some locums work while you're on vacation or anything else medical related (surveys, expert witness, etc) 1099 through it, so you can still expense things.
The benefit of being a contractor with an S-corp is not as much as it's made out to be for a rad onc. You make too much to qualify for QBI deduction. You can save a tiny percentage on medicare taxes. That's about it. Unless you are doing something stupidly illegal like paying yourself a $25k salary and taking the rest as pass through income not subject to FICA withholding or something (paying your wife $300k to be your secretary, listing your boat as a business expense, etc).
The other problem is that more and more hospitals will refuse to pay doctors any other way than W2 because they are afraid of the more stringent regulations on employee vs. contractor classifications so they don't even want to risk it. I dealt with a hospital in Montana that wouldn't even agree to 1099 for a week of locums.
Also, the flip side of being a contractor is that while yes you can avoid a non-compete, the hospital can also cut you loose immediately (ask me how I know). You'll have a lot more protection and be harder to get rid of as an employee and usually they have to pay you for 90-180 days if they want to get rid of you so you don't have to spend months finding a new gig with zero income coming in.
Well, you've made some good points but they need clarification. First, if you're making W2 at 750k a year, at the 37% adjusted fed tax bracket, you're giving up 20%. Give back 5% for your own overhead.. Sure, one has to pay their own health insurance but if you're smart, and you have you and your spouse on a plan, its maybe 15k a year. ~50k deductible towards your retirement neutralizes it. Obviously, if you're working from a nearby home, you have to get creative. But if you're traveling..(see: geographical arbitrage) its a no brainer requirement to be a 1099... and then if you have legal expenses..and accounting expenses.. and on and on. There are plenty of ways to work the system (see: www.bradfordtaxinstitute) that are perfectly legal. You have no more real protection than what is elucidated in your contract, period. Otherwise, its lawyer time. I doubt I will ever be a W2 again, and recommend others negotiate a 1099 in such a way that it gives them control over their taxes, retirement, and health insurance.
Great story (also terrible story, I'm sorry). Sadly, this is very common.
I experienced a similar situation as the author and wish someone had written advice like this when I was graduating residency. The bottom line is that I sold myself short as a PGY-4 looking for jobs. I received literally (this word is overused, but in this case literally literally) no education during residency on how the business of radiation oncology works. I didn't know what a CPT code was, let alone which ones were pertinent for our specialty. I only vaguely knew what RVUs were. I was tricked into thinking with a salary mindset rather than understanding that almost all of us operate in a fee-for-service environment. So, this resulted in looking for jobs that offered the highest "base guarantee." I asked all the wrong questions. I wasn't focused on how many patients were treated or how.
In retrospect, it is very simple. You evaluate a job based on volume and resources. You should get paid $X per RVU. So you need to figure out how many RVUs there are per year, and you do that by figuring out how many consults there are and what kind of consults they are. Then you just negotiate X as high as you can get. It's actually remarkably simple. I created an IMRT plan. This pays 7.99 wRVU. My "X" number is $65. You owe me $519.35 for this plan. You don't have to pay me right now, just do it once a month is fine. This is how it works at a GOOD job.
What happened to me as a new grad, not understanding the above, is that I got suckered into a predatory position that offered what seemed like a high "base guarantee" ($650k -- more money that I ever thought I would make). The downside was that it was in the middle of nowhere. It was hard to get many job offers coming out of a lesser known program, and the other ones had numbers around $500k. So, I went with the higher number with the cherry on top being a $125k "sign on" check they gave me as a PGY-4. That felt good depositing that, having to bring the bank manager come for approval for this ballar who just showed up with a 6 figure check.
So, you can see where this is going. If you're playing poker at a table, and you can't figure out who the patsy is, then you're the patsy. I was the patsy and the other poker players were the hospital admin. In fact, I later heard the CEO of the hospital boast to a board member, "We really try to focus on recruiting new grads since they aren't business saavy."
The problems were many:
1. The clinic actually generated about 13k wRVU per year. At $70/wRVU this is $910k/year. Much more than the $650k I was "guaranteed" even accounting for benefits. The hospital had developed all sorts of tricks to make sure you would not get paid anything beyond your "guarantee." Their "RVU bonus" was smoke and mirrors. I signed up for a salary job to do $910k worth of work for $650k. The hospital just kept the rest. I got suckered. What I didn't understand is that I could have taken one of the $500k jobs that actually did pay out RVU overages correctly OR just simply have taken a job that paid strictly per RVU (the so-called eat-what-you-kill job) and not have had to move to the middle of nowhere and also made more money. I had a beautiful home and partner that I lost to move to the middle nowhere because I thought I was going to make maybe an extra $80-90k after taxes. Even if that were true, which it wasn't, this was a monumentally stupid trade off and a catastrophic life decision.
2. The $125k sign-on check was actually a loan. You took on a debt by accepting it. If you quit within 5 years, you have to pay it back. Again, you can see where this is going... they expect you to quit within 5 years. Because you moved to the MIDDLE OF NOWHERE.
3. Knowing that they expect you to quit within 5 years, they treat you like complete garbage. I thought I would be welcome with open arms coming to a place nobody else wanted to go. Wrong. I walked into a place where the dosimetrist wanted to play doctor. He wore scrubs every day. He explained treatment plans to patients. He told patients I hadn't seen yet that they would be getting 20 fractions to their prostate. When you tried to override them and practice like you were trained, they took it as an offense. When I discussed this with the CEO to try and explain how inappropriate it was, I was told that I needed to be careful how I communicated with the dosimetrist because it was hard to replace staff like him. Seriously. Secret meetings were held to try and undermine me and try and get rid of me. Any attempt to exercise discretion and autonomy as a physician was fiercely fought against. You know what the number 1 leading factor to physician burnout/moral injury is? Loss of autonomy. You don't want burnout a few months into your first job.
4. It wasn't just me. All the other specialties had constant turnover due to poor treatment of doctors (a good rule of thumb is that if a hospital admin refuses to address you as a doctor and rather as a "provider" or worse as their "associate" you're probably not going to be treated well and valued). You can guess what trying to take care of patients is like when you are dealing with disgruntled med oncs, surgeons, radiologists, and midlevels or the revolving door of non-BC locums that are constantly filling in the gaps.
5. The issue with the cones. That's funny. I have seen this so many times. Cones are purchased and then never commissioned. Again, if you are interviewing at a clinic that has purchased cones but never commissioned them... huge red flag.
Recommendations for senior residents on the job hunt:
1. You get paid per RVU. Think like this instead of thinking with a salary mindset. When reviewing your contract make sure that you get paid for each and every last RVU and that these payments happen OFTEN. Do not agree to baloney systems like I did where they promise to pay you an "RVU bonus" at the end of the year if you do "extra." They almost certainly will not properly account for the RVUs and just leave off all of the RVUs for December or something and tell you "oh, don't worry those will show up on next year's"
2. Make sure you understand every single professional CPT code in radiation oncology. 77427, 77014, 77435, 77301, 77263 are the big ones. Start there. Learn what they are, when they can and should be billed, and how many wRVUs they are worth. Make sure you know each and every charge that should be billed during the course of a standard prostate treatment course and when. You will have to self-educate on this. But you absolutely MUST. Make sure they are transparent with the charges and how the RVUs are counted. If they don't share this information with doctors (and many won't), then this should automatically disqualify them. Continue your job search. Never work for someone who refuses to prove that your payments for your services are correct. Trust but verify. The IRS doesn't accept "what, you don't trust me?" as an excuse for why you listed 14 dependents on your tax return. Nor should you when the hospital tells you generated 500 wRVU in a month where you had 50 consults.
3. Be extremely wary of hospitals in hard-to-recruit areas offering high salary guarantees and 6 figure sign on checks, especially to new grads. A responsible/ethical practice is not going to recruit a brand new grad to a rural area to practice in a solo role (nor should you take such a role without experience). If a place in BFE is dangling a 6 figure check in front of a PGY-4, you are very likely going to be exploited and in 5 years will end up in a much worse financial and emotional state than if you had just started in the better clinic that was offering a normal junior starter salary and modest signing bonus.
4. Never take a private practice job that doesn't have a very clear track record of making everyone partner and very clear terms about how you buy-in to the practice. All of the above relates to hospitals, because that's where most of the jobs are, but there absolutely are equally predatory private practices that prey on new grads. Instead of dangling large paychecks at them upfront, what these practices do is the opposite. The offer a 5th percentile fixed salary for the first two years and promise you millions after that, which you will never see. You will quit once you get tired of managing 30 patients at a time for the cost of managing 5 and that the owners are never going to split the pie with you or anyone else and will just repeat the cycle of luring in new grads indefinitely.
A lot of rules written in blood .. the bottom line: be a 1099, determine the practice volume, and if rural, demand no less than 750k a year - and I don't care if they average 12 on treatment. Otherwise, go pay your dues at a well-established, well-regarded practice in the 'city' and take your W2 and eventually, you'll probably make a pretty good living and your wife will be happier that you're home raising the kids. Otherwise, go learn to fly, charge what you want, work 3.5 d/wk and get your tax to 18 cents on the dollar and play to win.
You can "charge what you want," but nobody is going to pay it. You are competing in a locums pool full of drooling 80 year olds who remember buying a pack of baseball cards for a nickel and will accept $1600/day. Hospitals will always go with the lowest bid for locums coverage. Most outsource to agencies as they don't want to handle malpractice and travel internally, and there is no transparency as to what the middleman is actually willing to place you at. I was bidding a couple weeks ago for emergency coverage at a site (<2 weeks out) at $3k/day. I thought it was a sure thing because a scenario finally emerged where they would have no choice but to pay a fair rate. Sure enough somebody underbid me. I have never once successfully negotiated placement with an agency, and I've tried probably 30 times. The agency will always find somebody willing to accept less and have less travel expenses and that's who will get placed so the middleman gets a bigger cut. I can't imagine intentionally making a career out of this. In med/onc or anesthesia where you can make double what an employed doc makes, yes. In rad onc, no. You make half because of the oversupply of bored octogenarians with active licenses.
I've PM'd you to assist. But for anyone reading: If you're clean sheet, experienced and present well.. if you aren't getting 3k a day (or more) at rural locations you're simply not understanding the rules of the game. 10 years ago I was charging 2600/day and had up to a year long placement PLUS EXPENSES.
Where are your radiation therapists in all this? Did you find them irrelevant to your practice/experience? Were they equally incompetent as administration? As a lead radiation therapist, I oversee a lot of the issues you addressed here especially as it came to advocating for higher standards in patient care delivery. I work closely with three radiation oncologists, two of them with little experience, so I definitely resonate with your experiences here, but no mention of radiation therapists while focusing solely on the physicists and dosimetrists leaves me with more questions.