CMS changes supervision rule. Rad Oncs no longer needed for daily operation of clinics. Med Students. Please read. You deserve to know implications.

[UndecidedM3]

This is absolute worst case, five-alarm, quit the field panic-mode. If you are a med student, don’t even think about going through with the match. Literally throwing your MD in the fire. If you are a resident, god help you. Hopefully you did a prelim Medicine internship. I would seriously go back and finish IM if I were a PGY-2 -3 or -4. PGY-5 just try to sign something ASAP.

There is about 30-40% excess capacity that is about to be wrung out of this field by CMS at a time when we’re training double the number of people that we need.

If you continue with the match this year after hearing this news, you forfeit the right ever to complain. The writing is large clear and on the wall. Ignore it at your peril.

If you were a Transitional Year resident starting at a top 15 rad onc program with good job placement what would you do? Stick out rad onc and hope for the best? Try to find a PGY2 residency that accepts TY? Restart and do medicine? What options do current residents have?

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[elementaryschooleconomics]

If you were a Transitional Year resident starting at a top 15 rad onc program with good job placement what would you do? Stick out rad onc and hope for the best? Try to find a PGY2 residency that accepts TY? Restart and do medicine? What options do current residents have?

From an efficiency standpoint, I would have stayed in Medicine (since I was 1/3 of the way through an IM residency anyway) and done a fellowship. I did an intern year in a regular IM program though, not TY - I'm not sure how they would treat that.

 

[BobbyHeenan]

I have been saying this for years. It will make America equivalent though to most other countries (ie no rad onc needed for direct supervision in a hospital).

Turns out the answer to "Why do we need an MD here if he literally does nothing all day?" is simple. This will, if nothing else, kill the locums market. The locums guy—who walks in the hospital door in the AM and they put him in a back office while he sits there 8am-4pm, reading, doing his one or two day gig—is no longer needed, has zero marketability, etc. So at the very least this WILL directly impact many rad oncs nationwide immediately. If you're a new resident and have a job finding difficulty, locums won't be a temporary save.

It should be noted and of historical interest at this point that, since forever, if you dive into the gargantuan Medicare fee schedule, there is a supervision code written next to every CPT code (1=general, 2=direct, 3=personal, 9=concept does not apply). For every single rad onc code except 77014 (which is "2"), including all the SRS and SBRT codes, they are affixed with number "9." I always felt this was informational if not portentous.

Not just bad; it's radionecrotic.

What would be your take on how to handle CBCT (77014-26) professional billing if you had a mid level covering on a day where you did CBCT?

Just don’t bill it that day or check remotely and bill it?

Maybe a moot point if APM, but right now we bill daily CBCTs on the professional side for things like post op prostate, some prostate, some lungs, etc.

 

[Mandelin Rain]

I have been saying this for years. It will make America equivalent though to most other countries (ie no rad onc needed for direct supervision in a hospital).

Turns out the answer to "Why do we need an MD here if he literally does nothing all day?" is simple. This will, if nothing else, kill the locums market. The locums guy—who walks in the hospital door in the AM and they put him in a back office while he sits there 8am-4pm, reading, doing his one or two day gig—is no longer needed, has zero marketability, etc. So at the very least this WILL directly impact many rad oncs nationwide immediately. If you're a new resident and have a job finding difficulty, locums won't be a temporary save.

It should be noted and of historical interest at this point that, since forever, if you dive into the gargantuan Medicare fee schedule, there is a supervision code written next to every CPT code (1=general, 2=direct, 3=personal, 9=concept does not apply). For every single rad onc code except 77014 (which is "2"), including all the SRS and SBRT codes, they are affixed with number "9." I always felt this was informational if not portentous.

Hell. Yesterday. Right before this rule was disseminated we were talking about it. About 6 hours before I heard this was even a possibility, I estimated that it would instantly decrease demand for rad oncs by 25%. I stand by that.

But yes, you've been banging this drum for a long time. I've been banging the "technical part of what we do isn't so hard that a software package and/or most reasonably intelligent people couldn't be quickly trained do much of it". Turns out CMS agrees with both of us.

Note: I'm not self hating. There is a cognitive portion to what we do. Who to treat? What to treat? When to treat? Add chemo? How to manage the side effect? Does risk outweigh benefit? And an emotional portion to what we do. Obviously not everyone can do that without extensive training. No software package can do that. But the rote, technical portion? Much of what we do amounts to circling (often) obvious abnormalities and then ceding much responsibility to a dosimetrist who has imported fairly standardized dose constraints into a computer that uses an algorithm to inverse plan for you while you eat lunch. Or lining up one picture to superimpose on a nearly identical picture, that software has already automatched for you. If you think you're irreplaceable just because you spent 4 years in residency reciting studies and doing worthless retrospective reviews, I think you're deluding yourself.

 

[OTN]

I have been saying this for years. It will make America equivalent though to most other countries (ie no rad onc needed for direct supervision in a hospital).

Turns out the answer to "Why do we need an MD here if he literally does nothing all day?" is simple. This will, if nothing else, kill the locums market. The locums guy—who walks in the hospital door in the AM and they put him in a back office while he sits there 8am-4pm, reading, doing his one or two day gig—is no longer needed, has zero marketability, etc. So at the very least this WILL directly impact many rad oncs nationwide immediately. If you're a new resident and have a job finding difficulty, locums won't be a temporary save.

It should be noted and of historical interest at this point that, since forever, if you dive into the gargantuan Medicare fee schedule, there is a supervision code written next to every CPT code (1=general, 2=direct, 3=personal, 9=concept does not apply). For every single rad onc code except 77014 (which is "2"), including all the SRS and SBRT codes, they are affixed with number "9." I always felt this was informational if not portentous.

Not just bad; it's radionecrotic.

Not only did I tell my admin that we would be able to open the other center without hiring another doc, I also told her that we would not need any locums next year.

 

[scarbrtj]

What would be your take on how to handle CBCT (77014-26) professional billing if you had a mid level covering on a day where you did CBCT?

Just don’t bill it that day or check remotely and bill it?

Maybe a moot point if APM, but right now we bill daily CBCTs on the professional side for things like post op prostate, some prostate, some lungs, etc.

Before he died, Bogardus was saying it was completely kosher for rad oncs to do remote image analysis. Obviously that's the whole basis e.g. of legality for remote radiology.

 

[Mandelin Rain]

Before he died, Bogardus was saying it was completely kosher for rad oncs to do remote image analysis. Obviously that's the whole basis e.g. of legality for remote radiology.

This is true.

 

[KHE88]

This is a disaster.

50% unmatched this year. Programs will fill with desparate unqualified warm bodies that will destroy the field and reputation.
Significant exodus of matched PGY-1s and current PGY-2s and 3s.
Bail to IM, rads, whatever.

I can't imagine people coming out with significant loan burden into this.
Combined with our ridiculous board certification process, there is no safety net. If you don't get through the board certification process, you're done. Period. 13 years of education after high school before you start your very first real job. Don't pass boards? Hope you like doing medicare physicals, prison doc work, babysitting psych wards in the middle of nowhere for 100k/year. The option of being a locums making $2000/day as a worst case scenario is gone.

The bottom just fell out. As a med student or even an early rad onc resident, I didn't understand how the business works or why this would have been so bad. Med students, listen to everybody. This is real. You should not apply to this field unless you are independently wealthy and just want to work as a rad onc for any cost.

We aren't as bad as nuc med where the speciality basically disappeared and everyone had to retrain.
But we just became worse than pathology.

 

[w00tz]

What is the supervision needed at physician group practices and freestanding rad onc treatment centers under these changes?

 

[scarbrtj]

What is the supervision needed at physician group practices and freestanding rad onc treatment centers under these changes?

Still needs to be direct supervision; i.e. someone on-site. Yet as has been stated here a bazillion times, and is consistent with current federal law and even ASTRO's begrudging admission, a radiation oncologist is not required to do the supervising, simply a physician. (And per federal law a physician is an MD, DO, podiatrist, optometrist, dentist, or chiropractor.) The desire to allow non-rad onc supervision, consistent per the law, may possibly increase now however. There has been little willingness to "go there," but the times they are a-changin'.

 

[GapCalc]

What an exciting time for radiation oncology! If you're an established partner in a group with technical ownership with more colleagues than treatment centers, you're probably going to come out way ahead once the older guys/gals retire. Like OTN said earlier, no need to hire new docs, just add an NP, and even with APM cuts, you'll probably see your income go up.

Assuming this rule trickles out into freestanding centers, this will also be a windfall for people with the kind of capital to buy/build practices only to staff them with an MD 1-2 days per week.

However, if you are:
- employed directly by a hospital on a contractual basis
- employed by a private group (not yet a partner)
- employed/salaried to cover a satellite facility
- reliant on locums for temporary or permanent work
- a resident

then this development is definitely not good and potentially catastrophic.

I sure am glad I worked so hard to get into radiation oncology! This is just super!

 

[OTN]

Still needs to be direct supervision; i.e. someone on-site. Yet as has been stated here a bazillion times, and is consistent with current federal law and even ASTRO's begrudging admission, a radiation oncologist is not required to do the supervising, simply a physician. (And per federal law a physician is an MD, DO, podiatrist, optometrist, dentist, or chiropractor.) The willingness to allow non-rad onc supervision, consistent per the law, may possibly increase now however. There has been little willingness to "go there," but the times they are a-changin'.

That’s precisely what it means for our group- we can have our medoncs provide coverage the days of the week the radonc isn’t there.

Federal requirement of direct supervision was one of the few lifelines left to keep the job market afloat, and it was just taken away.

 

[Pointless]

Established at a busy practice with only one site, so this won't immediately ruin my life but..... it's hard to imagine that there could be a worse confluence of events to bring down a high-flying specialty like RO in such a short amount of time. Truly stunning.

I've been making an effort to save at least 50% of my take home pay to prepare for early retirement... think I'll bump that up some more.

 

[TheIllusionist]

it feels weird to be a top program rad onc total reject and be happy about it

 

[Reaganite]

I'm not totally convinced hospitals nationwide are going to reflexively adopt these rules. I think there will still be medicolegal and pr concerns. I know of several hospitals that have acknowledged certain payor contracts likely do not require direct supervision; nonetheless, they always had strict requirements for a rad onc to be present when any patient was being treated. I mean, if you're a hospital with amazing contracts are u really gonna take the risk of something happening to a patient with no radonc present? Rad onc salary is chump change compared to the technical profit these guys get. Will be interesting to see to say the least. I think more than anything this will totally decimate the rad onc locums market. All the bargaining power just fell in current practitioners' hands. The days of locums companies ripping us off are over. I will await a formal legal opinion from legal counsel, but I feel pretty damn confident I can use a med onc or some other non rad onc for random locums days even in freestanding.

 

[radoncgrad2019]

Agree this will end locums.

Everything else remains to be seen.

 

[scarbrtj]

For all the ASTRO bashers, be aware that they are pushing back against this PROPOSAL (on grounds of safety concerns). Also, be aware that most of these clinics will still need docs physically present to see the patients, which can't be done under another facility's supervision like IGRT can.

I see no reason, again in theory, that weekly OTVs couldn't be done via telepresence. The consults and followups already could be. Radiation oncology, of all specialties besides radiology (with which it obviously has many intersects), is probably the most conducive to "remote" practice. Planning is already done remotely, images can be viewed remotely, and the rad onc could "oversee" almost all the processes from a remote location. Again... in theory.

 

[Mandelin Rain]

Should surprise no one that Ken O is leading the misinformation campaign on Twitter.

 

[ROwROwROw_yourboat]

I am a little confused by the doom and gloom on this board but want to learn more about how the new CMS rule might affect the job market, at least for the sake of my residents. I am a junior attending at an academic center which also has several satellites. Are you guys (or your programs' satellites) really working so little that you would not need to be on-site more than 2 days a week, and the only reason to have a rad onc on staff is to satisfy the billing requirement? I would hardly say that 60% of what I "do" (or even 25% or even 5%) is providing machine coverage. Yes, theoretically I could see all my weeklies on one day and sims/consults/follow-ups on another..but that's just not how things work. Our satellite docs invariably need at least 4 days "on site" to see patients, review/revise plans (could be done remotely but ends up being much more efficient in-person), staff sims, etc. Referring doctors, including when we send a patient from the main campus back to the satellite, and patients expect that patients will be seen usually the same week or soon after referring, and so 1-2 doc satellite can't just have one "consult day" per week which would invariably be too busy to squeeze in urgent consults..

I am just confused by the perception here that the supervision rule was leading to "stuff" for rad oncs to be hired to do... Yes I agree that locums will dry up since small practices can now take vacation/go to ASTRO without worrying about coverage issues, but besides that I don't see how this will affect the job market.

If you could currently do all your work in 2 days and be "off site" the other 3 days, does that mean you could equivalently work 2 days and watch Netflix in your office the other 3 days right now? Rad onc hours are good but not that good...

 

[Mandelin Rain]

Say you staff a 10-20 OTV clinic, of which there are many. Unless you're just incredibly inefficient, somewhere between 40-60% of what you're actually doing is providing supervision.

 

[Pointless]

Should surprise no one that Ken O is leading the misinformation campaign on Twitter.

How does one go about following the commentary on "rad onc twitter". Is there a hashtag or something? I'm woefully short on knowledge of social media...

 

[KHE88]

Should surprise no one that Ken O is leading the misinformation campaign on Twitter.

I'm not seeing any comments from our oh-so-woke colleague at Mayo regarding this. Am I missing something good? I know it's coming.

By the way, what's the coverage requirement for protons at a hospital? 7 assistant professors pumping out retrospective proton series and diversity papers? Will that be enough to ensure the proton machine is safe? We all know the community linacs can be run by a monkey. But protons at main site? Hmm..

Gotta support that main site research mission.

 

[Mandelin Rain]

How does one go about following the commentary on "rad onc twitter". Is there a hashtag or something? I'm woefully short on knowledge of social media...

#radonc




The equivalent: Someone tried smoking weed in California a long time ago and it didn't end well for them, they were arrested. Therefore, no one will smoke weed once the law changes.

 

[KHE88]

How does one go about following the commentary on "rad onc twitter". Is there a hashtag or something? I'm woefully short on knowledge of social media...

It's a handful of extremely annoying virtue signalers, mainly residents and junior faculty, saying whatever they think is going to give them the best image to try and rise through the ranks in academics and national leadership. The sychophantry is painfully obvious, and they all link to each other and use public callout/shaming techniques to try and squelch anybody that points obvious issues with the nonsense they spew. They are few in number and you'll see the same unbearable names coming up over and over again.

 

[Pointless]

#radonc




The equivalent: Someone tried smoking weed in California a long time ago and it didn't end well for them, they were arrested. Therefore, no one will smoke weed once the law changes.

Got it - thanks. Looks like benign boring stuff to me at a quick glance. Where is all the gaslighting/strawmanning/doxxing? I want the good stuff!!

 

[Pointless]

It's a handful of extremely annoying virtue signalers, mainly residents and junior faculty, saying whatever they think is going to give them the best image to try and rise through the ranks in academics and national leadership. The sychophantry is painfully obvious, and they all link to each other and use public callout/shaming techniques to try and squelch anybody that points obvious issues with the nonsense they spew. They are few in number and you'll see the same unbearable names coming up over and over again.

Thankfully, I'm not on Twitter, or I might get myself in trouble with those kinds of folks...

 

[BobbyHeenan]

I am a little confused by the doom and gloom on this board but want to learn more about how the new CMS rule might affect the job market, at least for the sake of my residents. I am a junior attending at an academic center which also has several satellites. Are you guys (or your programs' satellites) really working so little that you would not need to be on-site more than 2 days a week, and the only reason to have a rad onc on staff is to satisfy the billing requirement? I would hardly say that 60% of what I "do" (or even 25% or even 5%) is providing machine coverage. Yes, theoretically I could see all my weeklies on one day and sims/consults/follow-ups on another..but that's just not how things work. Our satellite docs invariably need at least 4 days "on site" to see patients, review/revise plans (could be done remotely but ends up being much more efficient in-person), staff sims, etc. Referring doctors, including when we send a patient from the main campus back to the satellite, and patients expect that patients will be seen usually the same week or soon after referring, and so 1-2 doc satellite can't just have one "consult day" per week which would invariably be too busy to squeeze in urgent consults..

I am just confused by the perception here that the supervision rule was leading to "stuff" for rad oncs to be hired to do... Yes I agree that locums will dry up since small practices can now take vacation/go to ASTRO without worrying about coverage issues, but besides that I don't see how this will affect the job market.

If you could currently do all your work in 2 days and be "off site" the other 3 days, does that mean you could equivalently work 2 days and watch Netflix in your office the other 3 days right now? Rad onc hours are good but not that good...

I think these are good points. I disagree that most of our work can be done remotely. End of life discussions (yes, I do this and don’t farm it to med onc), risky calls (central lung sbrt), to break or not to break, borderline cases require human face to face conversation for best care IMO.

I do think the work of a 20 OTV site could be done in 4 clinic days and rest done remotely while someone covers one day. I think that will improve QoL.

...or at least you can finally leave the clinic to go see the dentist or your own doctor without turning the Linac off.

 

[Mandelin Rain]

Got it - thanks. Looks like benign boring stuff to me at a quick glance. Where is all the gaslighting/strawmanning/doxxing? I want the good stuff!!

I think a lot of people here overreact to the Twitter crowd, but there is a small amount of maddening/mind boggling stuff that one may see.

 

[Lawpy]

Should surprise no one that Ken O is leading the misinformation campaign on Twitter.

Twitter is toxic

 

[medgator]

Got it - thanks. Looks like benign boring stuff to me at a quick glance. Where is all the gaslighting/strawmanning/doxxing? I want the good stuff!!

 

[medgator]

.

...or at least you can finally leave the clinic to go see the dentist or your own doctor without turning the Linac off.

Amen









Or, heaven forbid, see an inpatient consult, or attend off-site tumor boards

 

[deleted573262]

Got it - thanks. Looks like benign boring stuff to me at a quick glance. Where is all the gaslighting/strawmanning/doxxing? I want the good stuff!!

very benign not the excitement we are used to on sdn

 

[ROwROwROw_yourboat]

I think these are good points. I disagree that most of our work can be done remotely. End of life discussions (yes, I do this and don’t farm it to med onc), risky calls (central lung sbrt), to break or not to break, borderline cases require human face to face conversation for best care IMO.

I do think the work of a 20 OTV site could be done in 4 clinic days and rest done remotely while someone covers one day. I think that will improve QoL.

...or at least you can finally leave the clinic to go see the dentist or your own doctor without turning the Linac off.

Yes exactly... so 4 clinic days for 1 doc. I guess if you had 5 such sites you could now cover with 4 docs instead of 5, but there are a lot of challenges to actually achieving this. Many hospital systems do not have 5 sites that 4 docs could cover simply from a commuting perspective...the satellites are not that close together and in the extreme case, you have 1 guy going to a different site every day to give the other doc a day off. This is just not practical and I doubt will actually happen.

The other fact is that there are other changes in radiation oncology that might render this rule change irrelevant. For example, downward financial pressure (like APM) may make it untenable to have a 20 OTV site and promote consolidation to keep 30+ patients per linac. This is generally going to require 2 physicians to keep the machine and support staff busy enough, and at that point, even if each individual doc can do their work in 4 days, they aren't really giving work to someone else for "coverage" since one guy probably works M-Th and another from Tues-Friday. The rule change doesn't suddenly mean that one person is going to be the solo person at a 30+ OTV site. While downward financial pressure in rad onc (and other specialties in medicine) does suck, this makes the CMS rule change irrelevant, rather than additive with the financial pressure.

Bottom line, I can only see this really affecting satellites that routinely have one doc and one linac on site, which is probably a model that will be going away since realistically you need at least 2 docs to fill one linac (or at least will soon).

 

[Mandelin Rain]

The desire to be more productive, see more patients, and make more money does NOT equal a lack of dedication to patient care.

I'd say staffing a satellite with some 80 year dinosaur who doesn't know a GTV from a Gonad is more demonstrative of a lack of dedication to patient care. And I've seen more than a few academic departments do this. Especially during ASTRO.

 

[Mandelin Rain]

Yes exactly... so 4 clinic days for 1 doc. I guess if you had 5 such sites you could now cover with 4 docs instead of 5, but there are a lot of challenges to actually achieving this. Many hospital systems do not have 5 sites that 4 docs could cover simply from a commuting perspective...the satellites are not that close together and in the extreme case, you have 1 guy going to a different site every day to give the other doc a day off. This is just not practical and I doubt will actually happen.

The other fact is that there are other changes in radiation oncology that might render this rule change irrelevant. For example, downward financial pressure (like APM) may make it untenable to have a 20 OTV site and promote consolidation to keep 30+ patients per linac. This is generally going to require 2 physicians to keep the machine and support staff busy enough, and at that point, even if each individual doc can do their work in 4 days, they aren't really giving work to someone else for "coverage" since one guy probably works M-Th and another from Tues-Friday. The rule change doesn't suddenly mean that one person is going to be the solo person at a 30+ OTV site. While downward financial pressure in rad onc (and other specialties in medicine) does suck, this makes the CMS rule change irrelevant, rather than additive with the financial pressure.

Bottom line, I can only see this really affecting satellites that routinely have one doc and one linac on site, which is probably a model that will be going away since realistically you need at least 2 docs to fill one linac (or at least will soon).

No offense, but I think you need to get into the real world of medicine.

Any Rad Onc worth his or her salt can treat 30 patients. 20 patients on beam equates to maybe 5 sims per week. You do NOT need 4 days to sim 5 patients and see 20 OTVs. You need 2-3 depending on your efficiency.

 

[ROwROwROw_yourboat]

Say you staff a 10-20 OTV clinic, of which there are many. Unless you're just incredibly inefficient, somewhere between 40-60% of what you're actually doing is providing supervision.

Ok..so what does this look like for you? Are you spending 40-60% of your time (say M-F 9-5) being called by your RTTs or otherwise providing supervision? I know that I (and our network docs) rarely go to the machine other than for SRS/SBRT cases yet still somehow are busy all day...

 

[ROwROwROw_yourboat]

No offense, but I think you need to get into the real world of medicine.

I agree that my perspective is limited since I am in an academic center. However, I really am trying to learn more about this since I am involved with our residency. I do know a little about the "real world" of medicine since I am also involved with the administration of our department and management of our satellites. It sounds like the main worry here is about my exact situation (main campus with multiple satellites suddenly downsizing) and I am telling you that I just cannot see how this would work, at least for us. But I am eager to hear if I am missing something.

 

[BobbyHeenan]

Yes exactly... so 4 clinic days for 1 doc. I guess if you had 5 such sites you could now cover with 4 docs instead of 5, but there are a lot of challenges to actually achieving this. Many hospital systems do not have 5 sites that 4 docs could cover simply from a commuting perspective...the satellites are not that close together and in the extreme case, you have 1 guy going to a different site every day to give the other doc a day off. This is just not practical and I doubt will actually happen.

The other fact is that there are other changes in radiation oncology that might render this rule change irrelevant. For example, downward financial pressure (like APM) may make it untenable to have a 20 OTV site and promote consolidation to keep 30+ patients per linac. This is generally going to require 2 physicians to keep the machine and support staff busy enough, and at that point, even if each individual doc can do their work in 4 days, they aren't really giving work to someone else for "coverage" since one guy probably works M-Th and another from Tues-Friday. The rule change doesn't suddenly mean that one person is going to be the solo person at a 30+ OTV site. While downward financial pressure in rad onc (and other specialties in medicine) does suck, this makes the CMS rule change irrelevant, rather than additive with the financial pressure.

Bottom line, I can only see this really affecting satellites that routinely have one doc and one linac on site, which is probably a model that will be going away since realistically you need at least 2 docs to fill one linac (or at least will soon).

That 1 Linac model not going away in rural areas. Especially patients with limit financial means to travel to the main site.

Prob doesn’t make sense for the 1 Linac suburb 30 mins from the main site...but these clinics 90 mins from the main site are needed. A good percentage of patients literally just won’t get treatment if they shut down. Hypofrac (think 5 fraction partial breast) can help these situations (plenty of data on breast radiation issues in rural US), but a poverty stricken head and neck or lung patient needs that rural Linac.

 

[medgator]

Twitter is toxic

The irony of course being KOs complete denial of the ills of residency expansion and multiple recent Mayo residency programs being a part of the problem

 

[BobbyHeenan]

I agree that my perspective is limited since I am in an academic center. However, I really am trying to learn more about this since I am involved with our residency. I do know a little about the "real world" of medicine since I am also involved with the administration of our department and management of our satellites. It sounds like the main worry here is about my exact situation (main campus with multiple satellites suddenly downsizing) and I am telling you that I just cannot see how this would work, at least for us. But I am eager to hear if I am missing something.

Lots of professional groups out there that are like 3-4 docs covering 3 centers. Such a pain on vacation, sickness, day off for errands to get coverage (only 1 partner off at once...what if one gets sick?).

You sit in your partner meeting and think maybe you need another doc for coverage/QoL because you’re a little thin, but your volume doesn’t seem to support another FTE.

Then this ruling comes down and you think - nah, maybe we just use an NP 1 day/week or when one site gets slow we flex around coverage.

 

[medgator]

Lots of professional groups out there that are like 3-4 docs covering 3 centers. Such a pain on vacation, sickness, day off for errands to get coverage (only 1 partner off at once...what if one gets sick?).

You sit in your partner meeting and think maybe you need another doc for coverage/QoL because you’re a little thin, but your volume doesn’t seem to support another FTE.

Then this ruling comes down and you think - nah, maybe we just use an NP 1 day/week or when one site gets slow we flex around coverage.

Exactly

 

[Mandelin Rain]

I agree that my perspective is limited since I am in an academic center. However, I really am trying to learn more about this since I am involved with our residency. I do know a little about the "real world" of medicine since I am also involved with the administration of our department and management of our satellites. It sounds like the main worry here is about my exact situation (main campus with multiple satellites suddenly downsizing) and I am telling you that I just cannot see how this would work, at least for us. But I am eager to hear if I am missing something.

How it would work is your docs would get together and decide they are willing to work harder to make more money. Fill the schedules fuller. Have to review other clinic's images remotely. Stay a bit latter to contour after clinic. Not hire a nw guy because we can rearrange ourselves more efficiently than we currently are.

When push comes to shove, most docs make the choice to work harder for more money. Especially those not working too hard currently. Like academic rad oncs.

 

[radoncgrad2019]

Twitter is Toxic?

Lol SDN is toxic. Some of you people act like people who work in academics are literal human garbage.

Get a ****ing grip.

 

[scarbrtj]

I am a little confused by the doom and gloom on this board ...
Our satellite docs invariably need at least 4 days "on site" to see patients, review/revise plans (could be done remotely but ends up being much more efficient in-person), staff sims, etc.

So it's really not confusing. We can quibble over numbers. But you yourself admit 4 days on site is now adequate. Whereas before it was 5, it can now be 4. So that's a ~20% reduction in rad onc manpower need. Know of a site where the 4 days could be 3? That's a ~40% reduction from present needs/requirements. And so on and so forth. And I would also argue your point re: being more efficient to be on-site can easily go the other way.

 

[FrostyHammer]

Literally nobody has said that. Many of us work in academics. The ire is directed towards the academics in power who led this expansion / let it happen / denied the problem. Sometimes “academics” is used as a catch all term, but we all know (or should know) that we’re not blaming everyone.

People like Tendulkar, Vapiwala and Beriwal, who have at least intimated about making helpful changes, are often praised.

If anyone hears anything on Twitter from them about this recent rule change, please post it

 

[deleted573262]

If anyone hears anything on Twitter from them about this recent rule change, please post it

you won't. this rule change is not good for the field. there's no way to spin it for the twitter group. this is deep state stuff here.

 

[Krukenberg]

They are few in number and you'll see the same unbearable names coming up over and over again.

Sounds like SDN job market threads!

 

[medgator]

Sounds like SDN job market threads!

So who do you believe, kruk? Follow SDNs mission and help med students out

 

[medgator]

you won't. this rule change is not good for the field. there's no way to spin it for the twitter group. this is deep state stuff here.

Hate to use that analogy given the source, but it probably fits. It's not in the interest of anyone in academia to admit this is a really bad existential problem

 

[radoncgrad2019]

Yes but we’re on the right side of history - or at least the correct one.

Notice they are slowly coming over to our side, and certain Probationary Members aside, we are not joining theirs.

or more that there are like only 7 people total that think there are 'sides' you weirdo