Well, you are right that the regulation would be terrible for clinics like yours. As in all regulations, they should be scapels and not hammers, but alas...
You and your patients would be screwed by this I acknowledge that... need to think about this some more as the regulations will likely not have the exceptions that are needed.
Yeah, to be clear I'm obviously not against the concept of supervision, haha
But there appears to be two main "boogeymen" of no more Direct Supervision - which again, neither of which have happened in the years since it went away:
1) Psychos are gonna do crazy stuff without guardrails
This...already happens. It will always happen. They let that Mantz guy treat the wrong breast!
2) There will be 50 Radiation Oncologists staffing 2,000 ghost linacs and the rest of us will be unemployed
There is NO WAY that's happening. First, I'm not alone in my own opinion of what being a good Radiation Oncologist looks like. Many of us will continue on practicing in a similar manner to Direct Supervision.
But most importantly: good luck getting existing, entrenched hospitals to sign off on completely virtual/ghost linacs at scale. I know for an absolute fact that even though my hospital knows and supports general supervision, if I were to suggest routinely not coming in 1-2 days per week from now on...that would...that would not go over well.
Maybe new entities (like the dreaded Bridge!) could have a fleet of ghost linacs because they're not fighting inertia.
Well...then they're up against state regulations. The majority of states have CON laws, and the majority of those CON laws are crazy.
But let's say some ghost linacs are installed somewhere. There are two options really:
1) They're in an area that lacked a linac because of geography/it didn't make financial sense. As long as they're practicing cookbook/NCCN medicine, I would argue that's a tremendous benefit for the community. Everyone wins!
2) They dropped a ghost linac in an area with competition. Let's say they dropped one next to me.
Will I lose some patients? Sure, probably. But not many. The ad campaign writes itself - "hometown touch".
Really just to emphasize: we left Direct Supervision behind in the pre-pandemic days. The long long ago.
It was enforced for a decade, 2009-2019.
The decade the job market steadily deteriorated and the specialty's competitiveness collapsed. Safety events still happened. Sketchy doctors treated too many patients.
We ran the trial with 10 years of follow-up. The results were negative.
Direct Supervision is not recommend by the evidence.