Reaching out to new referrings

[RadOnc2013]

I am about to become Medical Director for a newly built academic satellite rad onc department. I discussed with my chair reaching out to med oncs and surgeons in the area with a bit of a sales pitch (I am thinking of a power point stack with some speaking points that would just take up 5-10 minutes of their time). Has anyone on here every done something similar? Any examples as to what to discuss?

Thanks so much for any input that anyone can give!

---

Members don't see this ad.

 

[RadOncDoc21]

I am about to become Medical Director for a newly built academic satellite rad onc department. I discussed with my chair reaching out to med oncs and surgeons in the area with a bit of a sales pitch (I am thinking of a power point stack with some speaking points that would just take up 5-10 minutes of their time). Has anyone on here every done something similar? Any examples as to what to discuss?

Thanks so much for any input that anyone can give!

Good luck… I was in a similar position in the past. My recommendation is to see where the money goes and if there are any potential new docs in the area. Trying to break into an established referral chain is damn near impossible. It would also help to have the main center supply some new docs for you.

 

[BobbyHeenan]

I personally would prefer just a little hand out with bullet points/pictures and phone numbers/emails on how to send referrals rather than sitting down to watch a powerpoint.

That may just be me though.

Maybe like a map with your center on it, what equipment/services you will have, name(s) of docs there (with any particular sub site prefernce), and how to send patients there.

 

[Mandelin Rain]

No ppt.

Just have them expense a lunch for their clinic. Shake hands with the doc, tell them where you graduated from and how you'd be happy to see any of their patients same/next day if needed. Ask for their cell number so you can text your contact info to get ahold of you directly. Ask if they'd be interested in doing ports, PEGs, bronchs, EBUS, colonoscopies, whatever on the patients you see.... Provide the front desk with a bunch of cards/those little doc picture handouts most systems have and make sure the front desk person has your clinic/cell number as well.

Send a patient every now and again and call them to let them know you're sending them; while also reminding them that you exist.

Pray.

 

[Palex80]

I'm not sure how this works in the US, but:
Shouldn't you try to make the point why your center is better than the rest. And since you are an academic satellite this may have to do with stuff that the mothership provides?

 

[Mandelin Rain]

I'm not sure how this works in the US, but:
Shouldn't you try to make the point why your center is better than the rest. And since you are an academic satellite this may have to do with stuff that the mothership provides?

Nope. The local docs will be suspicious that you'll steal their patients and refer them to the ivory tower for eval.

If you do this ONCE, you'll never see another referral from that doc or anyone in their group. NEVER do this.

If anything, I'd distance myself from the mothership and bill yourself as a fixture in the community.

 

[RadOncDoc21]

I'm not sure how this works in the US, but:
Shouldn't you try to make the point why your center is better than the rest. And since you are an academic satellite this may have to do with stuff that the mothership provides?

Based on my experience… it doesn’t matter. I’ve seen docs who couldn’t contour a breast get patients. It’s all about established relationships and patient volumes. As Mandelin Rain stated, I would distance myself from the mothership as much as you can especially in a community that already has rad oncs.

 

[metallica81788]

Shouldn't the mothership be building networks, providing PCPs, specialists, etc?

That's usually the benefit of working for a big hospital system is that they bring the patients. Obviously if you can generate more and change the local landscape it's great but lots of extra work.
Seems set up to fail without providing support/referral base and expecting the catfish radonc to generate referrals by changing existing patterns.

 

[Mandelin Rain]

Shouldn't the mothership be building networks, providing PCPs, specialists, etc?

That's usually the benefit of working for a big hospital system is that they bring the patients. Obviously if you can generate more and change the local landscape it's great but lots of extra work.
Seems set up to fail without providing support/referral base and expecting the catfish radonc to generate referrals by changing existing patterns.

Yeah, if your system hasn't bought up some of the PCP practices, none of it will matter unless there is no/completely incompetent competition.

 

[Gfunk6]

I'm not sure how this works in the US, but:
Shouldn't you try to make the point why your center is better than the rest. And since you are an academic satellite this may have to do with stuff that the mothership provides?

I agree with others that (in the US) doing this is a very bad idea.

The key to referring's is the RELATIONSHIP between you and them. It should be personal and it should be strong. Focus on what YOU can do for their patients - get them in quickly, give them plenty of time during consults, and take personal responsibility for their follow-up (e.g. don't dump pneumonitis that you caused to pulmonary). Also emphasize that you believe strongly in multi-disciplinary collaboration and that you will share applicable patients if they need EBUS, EUS, surgeries, etc. Tell them if they have a question about a patient to call/text you anytime and give them your cell phone number. If they do indeed call/text you, respond very quickly if not immediately.

Show up to tumor boards, speak up. Before/after tumor boards try and socialize with your referrings - get to know their interests and the names of their family members (particularly relevant if you both have school age kids). REMEMBER WHAT THEY SAY. If you are a doddering idiot like me, write it down in a spreadsheet.

Whatever you do, don't emphasize technology at your site, the prestige of your academic center, or anything which is not your doing or out of your direct control. Ok to emphasize your training and experience in this regard.

If you every decided to leave your position but stay in town with a competing center, all the referrings should say, "that guy was great so I'm going to keep referring to him."

 

[Ray D. Ayshun]

Academic satellite? With performance based pay? The other option is to do nothing.

 

[JumpingShip]

I am about to become Medical Director for a newly built academic satellite rad onc department. I discussed with my chair reaching out to med oncs and surgeons in the area with a bit of a sales pitch (I am thinking of a power point stack with some speaking points that would just take up 5-10 minutes of their time). Has anyone on here every done something similar? Any examples as to what to discuss?

Thanks so much for any input that anyone can give!

Absolutely don't do a power point. Nobody cares about pictures of our fancy machines or anything. Just let them know you're well trained and have access to modern treatment modalities and provide your cell phone number. They just want to know the fasted and easiest way to refer a patient to you and that after that you'll take it from there. Have your department buy lunch for their office (not just the MD's but the office), show up and shake hands for 5-10 minutes, and give your cell phone number and office contact then be out within 15 minutes and let them enjoy the lunch in peace.

I think the biggest question is: why did the academic center build this new satellite?

I've only really heard of them acquiring existing sites (after acquiring the referral base, which is forced to refer to the newly acquired site if they hadn't been doing so before).

Unless you live in an area with explosive population growth, isn't it obvious that they built the site to get a piece of the same (or even shrinking) pie and in doing so put the existing radiation oncology practice out of business? This will not be taken kindly by anybody, not even non-radiation oncologists. Imagine being a fifty year old medical oncologist who has practiced in the area for decades, well aware that there are medical oncology "competitors" at the academic site where you work who would love to put you out of business one way or another (by using you as a "bridge" to funnel their patients to the mother ship or if you are successful in building a practice then the academic center may provide a new medical oncologist at the "satellite" too).

I hate to be so pessimistic, but unless there is no radiation oncology services available anywhere near this new satellite, wouldn't the "referral base" actually want you to fail miserably so the academic center that you are apart of goes away and doesn't even think about bringing in additional specialties? If nothing else, I strongly agree with others that the affiliation with the academic center may actually be a HUGE negative for you and you should distance yourself as much as possible from them. Sorry but it seems like you were put in a very difficult situation.

I hope that you at least have specific protected time and/or other compensation for being medical director. It seems like on top of everything else academic centers are exploiting the fact that it's human nature to feel good when one is given a title such as "medical director" but oftentimes it comes with just more responsibility and no extra compensation, a relatively younger MD is kind of blinded by the praise and title, and it takes a year or two to realize one has been duped. I hope that's not the case for you and best of luck.

 

[RadOncDoc21]

There is usually a substantial gain in compensation in regards to the medical director title but I definitely agree with what everyone is saying on here. This was me a few years ago and not worth it in my opinion unless you are the only rad onc on the block or the mothership has taken over the region.

Another thing to consider is how long of a leash do you have? There are some centers that want to hand hold you all the way through in which you have very little autonomy. Yes, it can be nice to have an academic center to support you but they usually don’t treat the sattelite docs the same regardless of your experience. There is nothing like a fresh new attending board eligible “breast specialist” telling you why 15 fx is a better option then 16 fx.

 

[JumpingShip]

I agree with others that (in the US) doing this is a very bad idea.

The key to referring's is the RELATIONSHIP between you and them. It should be personal and it should be strong. Focus on what YOU can do for their patients - get them in quickly, give them plenty of time during consults, and take personal responsibility for their follow-up (e.g. don't dump pneumonitis that you caused to pulmonary). Also emphasize that you believe strongly in multi-disciplinary collaboration and that you will share applicable patients if they need EBUS, EUS, surgeries, etc. Tell them if they have a question about a patient to call/text you anytime and give them your cell phone number. If they do indeed call/text you, respond very quickly if not immediately.

Show up to tumor boards, speak up. Before/after tumor boards try and socialize with your referrings - get to know their interests and the names of their family members (particularly relevant if you both have school age kids). REMEMBER WHAT THEY SAY. If you are a doddering idiot like me, write it down in a spreadsheet.

Whatever you do, don't emphasize technology at your site, the prestige of your academic center, or anything which is not your doing or out of your direct control. Ok to emphasize your training and experience in this regard.

If you every decided to leave your position but stay in town with a competing center, all the referrings should say, "that guy was great so I'm going to keep referring to him."

Couldn't agree with the bolded more (but the second is only applicable if you don't have a non-compete in your contract).

It might be a good idea to talk with the two or three most senior academic people in the mother ship of your department and ask them exactly how you should introduce yourself to an interact with the referring providers in your new position . . . then literally do the opposite!!!

 

[RickyScott]

I have always viewed the competition as a possible future employer.

 

[TheWallnerus]

Shouldn't you try to make the point why your center is better than the rest

This is very touchy IRL to pull off.

My dad would always say “When YOU think you’re good, you tell other people; but if you actually ARE good, other people tell you.”

And if that doesn’t work, and you really want referrals, another saying comes to mind: money talks and bulls**t walks.

 

[elementaryschooleconomics]

My dad would always say “When YOU think you’re good, you tell other people; but if you actually ARE good, other people tell you.”

Really? I assumed Papa Wallnerus just made deep, angry grunting sounds...

 

[RadOncDoc21]

Really? I assumed Papa Wallnerus just made deep, angry grunting sounds...

View attachment 356457

Handsome fella!

 

[RickyScott]

Most satellite and community departments now have Trilogy/true beam and eclipse. How do you distinguish yourself on the treatment side? What would you actually put in a power point?

 

[jondunn]

Most satellite and community departments now have Trilogy/true beam and eclipse. How do you distinguish yourself on the treatment side? What would you actually put in a power point?

‘Our therapists have the biggest asses’

 

[TheWallnerus]

‘Our therapists have the biggest asses’

that you Al?

 

[Palex80]

Most satellite and community departments now have Trilogy/true beam and eclipse. How do you distinguish yourself on the treatment side? What would you actually put in a power point?

Protons in the mothership! Oh, wait…

 

[Pointless]

Some good advice being given here. I agree that short and to the point is best, with lunch thrown in. Make sure to give our your cell number and let them know that you will see new patients same day/next day and do all the work of getting them in, so that they literally just need to give you a name and you will do the rest; this might get you an in if their current rad oncs are more difficult about scheduling, etc.

People are busy and anything that makes their day easier is welcome.

 

[ramsesthenice]

Show up to tumor boards, speak up.

Totally agree. But also, learn the lay of the land first. For gods sake, don't be the douche that comes in and says, "well at Harvard...". No one likes that person or wants to interact with them any more than they have to. Unless they are proposing frank malpractice, spend time figuring out how they like to network and function as a group before trying to make substantial changes.

 

[RO28]

Totally agree. But also, learn the lay of the land first. For gods sake, don't be the douche that comes in and says, "well at Harvard...". No one likes that person or wants to interact with them any more than they have to. Unless they are proposing frank malpractice, spend time figuring out how they like to network and function as a group before trying to make substantial changes.

actually, it would be more like "well where I trained, in BOSTON"....

 

[RadioactiveMan]

It sounds like you've been in academics awhile and as such may view academics differently than community practices do. I hate to say it but there is a groupthink that takes over in academic centers that the quality of care in academics is vastly superior to the community. While that may be true for some community practices, the blanket assumption that the academic center is superior is not only insulting to community practices, it's also off base. If you go selling academic superiority, you will struggle.

Instead, follow the 3 A's. There's a reasons Availability is the first A. People will come if you see them the same day or next day while the competitor is making them wait 2 weeks to be seen. No PowerPoint. That's again, is an academic thing that is offputting. If I'm meeting a new doc, I don't need a lecture from them. Just go meet them, chat them up for 3-5 minutes, give them your personal cell phone to call if they have a patient. When they do call, all you need is a name and a phone number or DOB. There is nothing more annoying when you call someone to refer them a patient and they start grilling you about insurance, etc. That's for your office to figure out.

When you do get referrals that haven't been called directly to you, make sure to make up an excuse to call referring docs the first couple of times they refer to close the loop and make sure they have your number. Keep the call brief but let them know you are taking care of everything.

And always always always send the patient back. The first time you get a patient from a med onc and send them to the academic center for a "second opinion", it will be the last time you get a patient from that doc. I've even gone so far as when patients explicitly ask for a second opinion, I will tell them I can't make a direct referral for political reasons and give them the number to call themselves. I have never had a patient who didn't completely understand.

 

[deleted1116990]

It sounds like you've been in academics awhile and as such may view academics differently than community practices do. I hate to say it but there is a groupthink that takes over in academic centers that the quality of care in academics is vastly superior to the community. While that may be true for some community practices, the blanket assumption that the academic center is superior is not only insulting to community practices, it's also off base. If you go selling academic superiority, you will struggle.

Instead, follow the 3 A's. There's a reasons Availability is the first A. People will come if you see them the same day or next day while the competitor is making them wait 2 weeks to be seen. No PowerPoint. That's again, is an academic thing that is offputting. If I'm meeting a new doc, I don't need a lecture from them. Just go meet them, chat them up for 3-5 minutes, give them your personal cell phone to call if they have a patient. When they do call, all you need is a name and a phone number or DOB. There is nothing more annoying when you call someone to refer them a patient and they start grilling you about insurance, etc. That's for your office to figure out.

When you do get referrals that haven't been called directly to you, make sure to make up an excuse to call referring docs the first couple of times they refer to close the loop and make sure they have your number. Keep the call brief but let them know you are taking care of everything.

And always always always send the patient back. The first time you get a patient from a med onc and send them to the academic center for a "second opinion", it will be the last time you get a patient from that doc. I've even gone so far as when patients explicitly ask for a second opinion, I will tell them I can't make a direct referral for political reasons and give them the number to call themselves. I have never had a patient who didn't completely understand.

I'll also add that academic stuff (this is how we did it at X) rubs off the wrong way on your own staff too. If you've taken over a community practice, I'd be careful about rapidly making them do things the way they are done at the mothership.

When I took my first job out of residency I made a big point, as I suppose most do, of trying to practice the way things were done at my residency. I walked into a practice where everyone had been there for 20+ years and were doing some truly bizarre things. I told them it was bizarre and immediately forced them to do things the way I used to. They never forgave me, viewed me as an elitist, resisted every step of the way, and quickly conspired to run me out. Admin didn't care how the practice was run and wanted me gone because the staff complaining was a headache. Low quality locums was preferable because they did what they were told. Lesson learned.

 

[RickyScott]

I'll also add that academic stuff (this is how we did it at X) rubs off the wrong way on your own staff too. If you've taken over a community practice, I'd be careful about rapidly making them do things the way they are done at the mothership.

When I took my first job out of residency I made a big point, as I suppose most do, of trying to practice the way things were done at my residency. I walked into a practice where everyone had been there for 20+ years and were doing some truly bizarre things. I told them it was bizarre and immediately forced them to do things the way I used to. They never forgave me, viewed me as an elitist, resisted every step of the way, and quickly conspired to run me out. Admin didn't care how the practice was run and wanted me gone because the staff complaining was a headache. Low quality locums was preferable because they did what they were told. Lesson learned.

There is so much in this forum that mimics my own experience

 

[Gfunk6]

Although the three A’s are equally applicable for success in a true private practice and an academic satellite, the sad reality is that successful application of those principles will probably not be recognized or financially rewarded in the latter. Which is precisely why most people don’t make the effort

 

[deleted1116990]

There is so much in this forum that mimics my own experience

It would have been helpful if we had been taught practical things like how to take over a practice independently and not piss everyone off. Instead, residency teaches you the exact opposite: anybody who doesn't do things exactly this way is an idiot and push your staff as hard as you can because you are the doctor and all that matters is taking care of the patient. In retrospect, it blows my mind that hospitals prefer to hire new grads for solo positions. I guess admin thinks it's worth it to be able to snag someone who doesn't know how to negotiate contract terms.

 

[Mandelin Rain]

I'll also add that academic stuff (this is how we did it at X) rubs off the wrong way on your own staff too. If you've taken over a community practice, I'd be careful about rapidly making them do things the way they are done at the mothership.

When I took my first job out of residency I made a big point, as I suppose most do, of trying to practice the way things were done at my residency. I walked into a practice where everyone had been there for 20+ years and were doing some truly bizarre things. I told them it was bizarre and immediately forced them to do things the way I used to. They never forgave me, viewed me as an elitist, resisted every step of the way, and quickly conspired to run me out. Admin didn't care how the practice was run and wanted me gone because the staff complaining was a headache. Low quality locums was preferable because they did what they were told. Lesson learned.

I did the exact opposite of this and the staff loves me everywhere I've worked.

Gotta be open minded to different approaches as long as they are safe/reasonable. May even learn something new that you prefer.

 

[RadOncDoc21]

It would have been helpful if we had been taught practical things like how to take over a practice independently and not piss everyone off. Instead, residency teaches you the exact opposite: anybody who doesn't do things exactly this way is an idiot and push your staff as hard as you can because you are the doctor and all that matters is taking care of the patient. In retrospect, it blows my mind that hospitals prefer to hire new grads for solo positions. I guess admin thinks it's worth it to be able to snag someone who doesn't know how to negotiate contract terms.

So true… I used to believe that all that mattered was the very “best” level of care but honestly this is a false belief since 90-95% of rad oncs practice “best” level of care and the majority of community/private practice is in regards to the relationship building steps.

 

[Mandelin Rain]

Although the three A’s are equally applicable for success in a true private practice and an academic satellite, the sad reality is that successful application of those principles will probably not be recognized or financially rewarded in the latter. Which is precisely why most people don’t make the effort

Nor in any employed setting. Which is part of the reason employed docs are less happy than private docs.

 

[metallica81788]

Nor in any employed setting. Which is part of the reason employed docs are less happy than private docs.

It's eye-opening practicing the three As way (or private mindset) starting as hospital employed then realizing nobody else you work with cares. What contributes to the apathy and burnout is when you're making things happen, working hard, seeing patients quickly, turning plans around fast, but none of your colleagues/referrings are reciprocating or at best hit-or-miss.

 

[Mandelin Rain]

It's eye-opening practicing the three As way (or private mindset) starting as hospital employed then realizing nobody else you work with cares. What contributes to the apathy and burnout is when you're making things happen, working hard, seeing patients quickly, turning plans around fast, but none of your colleagues/referrings are reciprocating or at best hit-or-miss.

Bingo. Take away the financial incentives and the care factor diminishes dramatically.

 

[deleted1116990]

It's eye-opening practicing the three As way (or private mindset) starting as hospital employed then realizing nobody else you work with cares. What contributes to the apathy and burnout is when you're making things happen, working hard, seeing patients quickly, turning plans around fast, but none of your colleagues/referrings are reciprocating or at best hit-or-miss.

Yep. The realization comes that you will be best served by keeping on treatment numbers as low as possible since you will never bonus above your base salary, and that fighting with staff over who is in control is pointless and it is in your best interest to minimize effort at work and maximize life enjoyment on your free time.

In private practice, it is clear who is in control. Nobody told me that in an employed situation, the RTTs, dosimetrist, and physicist all think they can direct clinic operations and expect to have an equal voice about how patients should be treated.

I think that some of these employed job could be the cushiest set-ups ever for a rad onc, but you have to be willing to totally check out and tolerate whatever time-wasting silliness the staff wants to make you do (and admin, who is their actual boss, entertains). Simple stuff, like training your nurse to go over bladder filling with a patient then having an RTT throw a fit that only a therapist has the training to explain bladder filling and having 40 meetings about it.

 

[deleted1116990]

I did the exact opposite of this and the staff loves me everywhere I've worked.

Gotta be open minded to different approaches as long as they are safe/reasonable. May even learn something new that you prefer.

I've actually learned a lot of things in the private clinics I've been at that I have incorporated into my practice. However, I know that if I took these things into an employed job and said "this is the way I am going to do things here" there would be an absolute mutiny with staff complaining to the CEO that I am unreasonable and need to be fired. You simply do not run the show as an employed doc and your choice is to let the staff tell you how to practice or refuse and stick it out until they make you so miserable that you quit. If you are lucky maybe increment small changes over a very long period of time.

 

[metallica81788]

Bingo. Take away the financial incentives and the care factor diminishes dramatically.

Luckily for me I have financial incentives, which helps and I still practice the AAAs way. I'm not in the never-ending "you can't actually be productive enough to get your bonus" situation. If that ever changes, though, I very well might change.

 

[RickyScott]

we

Yep. The realization comes that you will be best served by keeping on treatment numbers as low as possible since you will never bonus above your base salary, and that fighting with staff over who is in control is pointless and it is in your best interest to minimize effort at work and maximize life enjoyment on your free time.

In private practice, it is clear who is in control. Nobody told me that in an employed situation, the RTTs, dosimetrist, and physicist all think they can direct clinic operations and expect to have an equal voice about how patients should be treated.

I think that some of these employed job could be the cushiest set-ups ever for a rad onc, but you have to be willing to totally check out and tolerate whatever time-wasting silliness the staff wants to make you do (and admin, who is their actual boss, entertains). Simple stuff, like training your nurse to go over bladder filling with a patient then having an RTT throw a fit that only a therapist has the training to explain bladder filling and having 40 meetings about it.

a number of years ago the chief tech wanted to have meetings abt treating 8 gy x1 and asked for a meeting with the chief medical officer of the hospital.

 

[OTN]

we

a number of years ago the chief tech wanted to have meetings abt treating 8 gy x1 and asked for a meeting with the chief medical officer of the hospital.

ngl I'm impressed by the stones on said chief tech

 

[Radonky]

This thread is clutch

 

[temujim]

Yep. The realization comes that you will be best served by keeping on treatment numbers as low as possible since you will never bonus above your base salary, and that fighting with staff over who is in control is pointless and it is in your best interest to minimize effort at work and maximize life enjoyment on your free time.

In private practice, it is clear who is in control. Nobody told me that in an employed situation, the RTTs, dosimetrist, and physicist all think they can direct clinic operations and expect to have an equal voice about how patients should be treated.

I think that some of these employed job could be the cushiest set-ups ever for a rad onc, but you have to be willing to totally check out and tolerate whatever time-wasting silliness the staff wants to make you do (and admin, who is their actual boss, entertains). Simple stuff, like training your nurse to go over bladder filling with a patient then having an RTT throw a fit that only a therapist has the training to explain bladder filling and having 40 meetings about it.

No lie this post should be pinned.

If one is willing to check out VA style and settle for those types of dollars then rad onc still very nice.

 

[elementaryschooleconomics]

From the stories I've heard, things I've witnessed, and my personal experience: I suspect that virtually every new grad who doesn't stay at their residency institution/health system has versions of @Moonbeams' story.

In academics, I watched one new attending get "let go" because they tried to practice the way they were trained (a completely reasonable way!) but it was different than what my system did, and the newbie didn't course-correct fast enough. I watched additional new attendings leave ~2 years after joining because they were able to basically conform in a timely manner but were never really "accepted" (didn't say the right things to the right people, etc).

I came into my community job knowing I shouldn't try to rock the boat too hard. However, my department has this utterly bizarre mix of telling me they want to be new and innovative, do whatever it takes to keep the numbers up, get new technology, blah blah - and then fight me tooth and nail on everything, even the new things THEY wanted and I had nothing to do with. There's a lot of backstory that I won't get into on a public forum (nothing is truly anonymous, ever). My "favorite" example is when a new piece of equipment was purchased to be used with a treatment that was commonly done. This purchase was made a year before my arrival, was budgeted to be used a certain way, and was presented to me as something that everyone was excited about.

The first time I used that piece of equipment, you would think I was trying to burn down a nursing home by lighting puppies on fire and making them run through gasoline. I was so confused. I thought it was something THEY wanted because, you know, THEY bought it. I kept trying to use the equipment and consistently met the same resistance. Then, when I said I was going to dial back any attempt to use the equipment, I was told that was also unacceptable, because it was "in the budget" and needed to be used a certain number of times.

In modern Radiation Oncology, if you're junior in any way (meaning new grad, early career, or just in a new place), it's important to remember that you will not be practicing medicine. The system will be practicing medicine, and you're just there to make sure no one dies directly and obviously from something attached to your name. I don't think there's any other specialty like this, because the therapists, physicists, dosimetry, and admin run a department. Clinicians are outsiders, and this includes nursing.

As demonstrated with the "I lost my job" thread, there's nothing you can really do about it either, unless you're prepared to pack up and move around the country. Even then, who knows how long that option is going to be available.

RadOnc is where dreams go to die. It's incredibly important to just mentally check out and find hobbies and passions not related to your job. With the shift from "direct" to "general" supervision weakening the death grip therapists have on physicians, and RadOnc becoming literally the least desired specialty in modern medicine killing the "I'm just happy to be here, I'll put up with anything" mentality, I'm hopeful things will improve somewhat. It'll just probably take a couple decades.

 

[RickyScott]

From the stories I've heard, things I've witnessed, and my personal experience: I suspect that virtually every new grad who doesn't stay at their residency institution/health system has versions of @Moonbeams' story.

In academics, I watched one new attending get "let go" because they tried to practice the way they were trained (a completely reasonable way!) but it was different than what my system did, and the newbie didn't course-correct fast enough. I watched additional new attendings leave ~2 years after joining because they were able to basically conform in a timely manner but were never really "accepted" (didn't say the right things to the right people, etc).

I came into my community job knowing I shouldn't try to rock the boat too hard. However, my department has this utterly bizarre mix of telling me they want to be new and innovative, do whatever it takes to keep the numbers up, get new technology, blah blah - and then fight me tooth and nail on everything, even the new things THEY wanted and I had nothing to do with. There's a lot of backstory that I won't get into on a public forum (nothing is truly anonymous, ever). My "favorite" example is when a new piece of equipment was purchased to be used with a treatment that was commonly done. This purchase was made a year before my arrival, was budgeted to be used a certain way, and was presented to me as something that everyone was excited about.

The first time I used that piece of equipment, you would think I was trying to burn down a nursing home by lighting puppies on fire and making them run through gasoline. I was so confused. I thought it was something THEY wanted because, you know, THEY bought it. I kept trying to use the equipment and consistently met the same resistance. Then, when I said I was going to dial back any attempt to use the equipment, I was told that was also unacceptable, because it was "in the budget" and needed to be used a certain number of times.

In modern Radiation Oncology, if you're junior in any way (meaning new grad, early career, or just in a new place), it's important to remember that you will not be practicing medicine. The system will be practicing medicine, and you're just there to make sure no one dies directly and obviously from something attached to your name. I don't think there's any other specialty like this, because the therapists, physicists, dosimetry, and admin run a department. Clinicians are outsiders, and this includes nursing.

As demonstrated with the "I lost my job" thread, there's nothing you can really do about it either, unless you're prepared to pack up and move around the country. Even then, who knows how long that option is going to be available.

RadOnc is where dreams go to die. It's incredibly important to just mentally check out and find hobbies and passions not related to your job. With the shift from "direct" to "general" supervision weakening the death grip therapists have on physicians, and RadOnc becoming literally the least desired specialty in modern medicine killing the "I'm just happy to be here, I'll put up with anything" mentality, I'm hopeful things will improve somewhat. It'll just probably take a couple decades.

Again, the issue is supply and demand. Much harder to replace dosimetrists, techs, physicists. Zero respect for the actual doc in a large department. A lot of the techs and dosimetrists probably feel they know more than the doc. And don’t get me started on sycophant community college managers of these places….

 

[seper]

at my University, signing bonus for therapists already equals to that of the attendings (very low 5 digits)

 

[jondunn]

I think it’s not as easy to replace hired docs as we say - it’s a major pain in the ass for the hospital with some sunk costs.

Rotating locum is way easier

 

[RadRadRad]

Again, the issue is supply and demand. Much harder to replace dosimetrists, techs, physicists. Zero respect for the actual doc in a large department. A lot of the techs and dosimetrists probably feel they know more than the doc. And don’t get me started on sycophant community college managers of these places….

Totally agree. I’m hearing NP/PA market getting oversupplied. I suspect therapy headed that way too with decreased fractionation. Seems like nursing doing best job of managing labor market for their benefit. Maybe we need a nurse in charge of Astro

 

[RickyScott]

I think it’s not as easy to replace hired docs as we say - it’s a major pain in the ass for the hospital with some sunk costs.

Rotating locum is way easier

In a large academic mothership w/multiple satellites and 2-3 graduating residents a year, it wont be hard. Over last 15 years, physics has instituted requirements for a degree in radiation physics + residency. When I was in training, anyone from any area of physics could sit for the exam and there was no residency. These guys will be in short supply at some point.

 

[medgator]

I think it’s not as easy to replace hired docs as we say - it’s a major pain in the ass for the hospital with some sunk costs.

Rotating locum is way easier

Depends on location. A well known hospital system in a desirable sunbelt metro fired a big private group last decade and literally had 10+ docs hired within 6-12 months.

 

[deleted1111261]

Depends on location. A well known hospital system in a desirable sunbelt metro fired a big private group last decade and literally had 10+ docs hired within 6-12 months.

just say floriduh

reminds me of McKinsey saying "our client, a beverage manufacturer in Georgia..."