The estimated lifetime earnings of a radiation oncologist depend on many choices and have not been calculated. The objective of this work is to project the year-by-year and cumulative lifetime earnings of a US-based radiation oncologist based on various career pathways. We modeled lifetime earnings based on undergraduate training (reference: assumes starting at age 18, tuition/loans of $40,000 x 4 years), MD/DO (reference: assumes tuition/loans of $55,000 x 4 years, 8% interest) vs MD/PhD program (assumes no tuition, $30,000 yearly stipend x 8 years), gap year(s), fellowship, employment paths (academic, private practice, hospital employed, physician scientist with NIH salary cap), adjustable salary during employment (based on 2016-2018 AAMC and MGMA; e.g., promotion for academic track, partnership for private practice), adjustable state and federal income taxes, loan repayment options (e.g., out of pocket, NIH loan repayment program [LRP], public service loan forgiveness [PSLF]). The primary outcome was cumulative lifetime earnings, and additional analyses were conducted based on changes in career paths. We created a web-based application to simulate the various choices using R Shiny: https://physician-earnings.shinyapps.io/rshiny/. For an academic radiation oncologist, assuming MD/DO degree, national average of $220,000 in loans at medical school graduation, 5% state income tax, no gap years, pursuing PSLF, starting as assistant professor, 7 year promotion until associate professor, and 7 subsequent year promotion to full professor, and retirement age of 65, the post-tax median lifetime earnings are $9,610,675 (IQR $8,097,433 - $10,885,824), with $5,242,653 federal + state taxes. With the private practice setting, the median lifetime earnings are $11,383,781 (IQR $9,875,040 - $13,325,316). As a hospital employee, the median lifetime earnings are $8,834,886 (IQR $8,127,132 - $10,166,145). As an NIH-salary capped physician scientist, the median lifetime earnings are $4,678,668 (IQR not provided, given one set cap). Using the academic track as the reference group, the median lifetime earnings would change as follows: $9,333,434 (IQR $7,876,310 - $10,572,388) for those who pursue one paid undergraduate gap year; $9,125,590 (IQR $7,822,115 - $10,274,801) for those who pursue MD/PhD programs; $10,365,300 (IQR $8,725,954 - $11,746,712) for those with 0% state income tax during practice; and $9,565,364 (IQR $7,875,284 - $10,802,830) for those who repay their loans out of pocket at 50% of their attending salary. PSLF and NIH LRP allow one to cross a net worth of $0 by their mid-30s; pursuit of fellowship, starting as an instructor in academics, salary in bottom quartile %, paying loans out of pocket, and gap years all delay this landmark by 1-4 years. NIH-salary capped positions have the largest negative impact on lifetime earnings, by > $5,000,000. We created a model to estimate lifetime earnings of a radiation oncologist in the US.