Reaching out to new referrings

[Mandelin Rain]

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.

This story cracks me up. I'm assuming OSMS/AlignRT/whatever optical guidance?

Whenever some change is foisted on us and everyone throws a **** fit, I remind them it will just become their new routine in approximately 2 weeks. Just like the last change foisted on us, that now seems "not so bad".

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[RickyScott]

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.

It can actually hurt you. Have definitely had staff complain that I am seeing too many consults or sims in a day (4-5!). Mid level administrators often focused on operations (not so much revenue) and feel that I am throwing the clinic in to total dissaray because I simmed 4 pts in a day or told consults to come right over from surg/medonc. (the discussion was framed as "leadership") Hell hath no wrath like a 350lb nurse/secretary who has to register an unexpected new consult at 3:30- the hate in their eyes!. Now if a surgeon wanted to see a new pt at 4:00?

 

[Mandelin Rain]

It can actually hurt you. Have definitely had staff complain that I am seeing too many consults or sims in a day (4!), mid level administrators often care more about operations than finances (someone else in the c-suite)

That's when you know you need a new lead therapist. The best leads acutely understand the economic realities and job security that comes from more patients.

 

[medgator]

just say floriduh

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

Probably could apply to any decent metro in the southeast i bet... Hotlanta, Austin, Nashville etc

 

[RickyScott]

just say floriduh

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

BTW this has a happy ending

 

[metallica81788]

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.

It's already here - have you tried hired a physicist lately?

Plus way more candidates trying to match physics residency vs spots. So strange, they are worsening the bottleneck for a needed and desired profession which is the complete opposite of the radonc MD side of things.

 

[RickyScott]

That's when you know you need a new lead therapist. The best leads acutely understand the economic realities and job security that comes from more patients.

senior admin: "how can you have 4 sims/consults on one day and 0/1 the next? why arent you spacing them out? The staff are going crazy.

 

[RickyScott]

It's already here - have you tried hired a physicist lately?

Plus way more candidates trying to match physics residency vs spots. So strange, they are worsening the bottleneck for a needed and desired profession which is the complete opposite of the radonc MD side of things.

This is the essence of what a "profession" actually is supposed to be. It harks back to the guilds of the middle ages in Germany. Sure, we say it is to establish quality, safety etc, but it is really a monopoly to protect workers according to economists. This is why I am so disgusted with ASTRO.

 

[deleted1116990]

senior admin: "how can you have 4 sims/consults on one day and 0/1 the next? why arent you spacing them out? The staff are going crazy.

Are you me? I tried to setup a rational clinic schedule where I would block off time for sims 2 afternoons a week, have 2 consult days, follow-ups on one morning and OTVs another day. Nope. Community college admin wanted to be able to just throw random visits all over the schedule so staff could have more facebook time at work rather than being efficient. I forced them to do it anyway and they literally submitted safety incident reports about it. Seeing 4 consults on a day was not "safe" and I just stacked the schedule that way to make my life easier (see up to double that in PP sometimes).

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….

Community college admin would literally hold meetings when I was on vacation to brainstorm with staff about how to deal with me. Told administrators I was incompetent because I wanted to use fiducials in prostate and didn't understand cone beam. Personally told referring urologists that I didn't trust them to place fiducials to try and undermine me (that was fun to do damage control on). Accused me of breaking up their "family." It was nuts. Created an us vs. them division of front end (MD, RN, CNA, front desk) vs. back end (admin, dosi, RTT, physics). I think they literally thought they could do everything themselves and I was just there to sign papers.

I could go on. Wish I could just call them out to prevent another poor schmuck from walking into that.

 

[Mandelin Rain]

Very important to integrate the front of the house with the back of the house in a department. The clinic vs linic dynamic is fraught.

The doc has to be that dude.

 

[deleted1116990]

Mid level administrators often focused on operations (not so much revenue) and feel that I am throwing the clinic in to total dissaray because I simmed 4 pts in a day or told consults to come right over from surg/medonc. (the discussion was framed as "leadership")

This was perhaps the most shocking early career revelation for me. I assumed the hospital was greedy and only cared about maximizing profit and was worried they would push me to do 33 fraction breast and 45 fraction prostate on everybody. It took some time for me to understand that they were greedy, but they were lazy more than they were greedy. Not rocking the boat was the number 1 thing. That means scheduling and treatment courses that make staff lives chill as possible while on the clock, even if it results in the hospital missing out on revenue. Hospital admin will do everything in their power to reduce a physician's salary by 50k but will ignore the fact that they are leaving 500k a year on the table from poor clinic operations.

 

[RickyScott]

i dont even block of slots for sims or consults for efficiency, although many do. Am willing to do them anytime as preauth can already delay care. 99.9% of time a clinical radonc is not so busy that he cant see an extra consult or 2. Sure, it may involve staying until 5-6 instead of 4.

 

[deleted1116990]

i dont even block of slots for sims or consults for efficiency, although many do. Am willing to do them at anytime as preauth can already delay care. 99.9% of time a clinical radonc is not so busy that he cant see an extra consult or 2. Sure, it may involve staying until 5-6 instead of 4.

Make a therapist stay past 4PM? Are you serious? Did they not tell you about their kids? They have kids that have activities and stuff. In fact, we really need you here at 7AM as we are going to start treating at 6:30. Our kids get out of school at 3PM and we really need to be done by then.

 

[RickyScott]

t took some time for me to understand that they were greedy, but they were lazy more than they were greedy. Not rocking the boat was the number 1 thing.

we are the same person. Another subtle point is that often only (c suite) cares strongly about revenue/see the books. These are they guys you may only interact with once a year. The department and cancer center managers are focused on operations and dont want to field staff complaints/limiting overtime etc.

 

[jondunn]

This is the essence of what a "profession" actually is supposed to be. It harks back to the guilds of the middle ages in Germany. Sure, we say it is to establish quality, safety etc, but it is really a monopoly to protect workers according to economists. This is why I am so disgusted with ASTRO.

This is what the litany of board exams are SUPPOSED to do, is the argument of the ABR

 

[RadOncDoc21]

Had a community college admin take over the schedule, made sure to leave no room for anything. Would have follow ups on top of brachy implants on top of OTV’s.

 

[OTN]

Make a therapist stay past 4PM? Are you serious? Did they not tell you about their kids? They have kids that have activities and stuff. In fact, we really need you here at 7AM as we are going to start treating at 6:30. Our kids get out of school at 3PM and we really need to be done by then.

This thread makes me really, really happy I'm in a true pp where I get to lead a department, but it also makes me really, really sad that others don't have the same opportunity. We are supposed to be the captains of the ship, leading nursing, dosimetry, physics, and therapy. Being in charge of such a large operation is part of the fun of radonc. I said a few years ago that academic satellite and hospital jobs were not good jobs, and I'm not happy to say that I think I've been proven right. There are exceptions, of course, but they are indeed exceptions.

I did some locums last year in a hospital-based practice to make a little extra money but also to see what things were like in a hospital department. The disdain from the administrator was palpable, and I could tell she was doing everything she could to make me feel as if I were "under" her in some way. She hated me from the moment I set foot in the door. I shudder to think what it would be like to try and work with her every day.

Of course, it was the most inefficiently-run radonc department I have ever seen, with a TrueBeam STX treating 18 patients from 8-5 pm. My clinic would be able to knock that out in a morning.

 

[elementaryschooleconomics]

This story cracks me up. I'm assuming OSMS/AlignRT/whatever optical guidance?

Whenever some change is foisted on us and everyone throws a **** fit, I remind them it will just become their new routine in approximately 2 weeks. Just like the last change foisted on us, that now seems "not so bad".

It's not even something at that level of complexity. It's Capital Budget Season here (as I think it is everywhere right now), and I was asked if we should pursue getting optical guidance. It was my partner asking me this in my office, so I didn't sugar coat it: "I don't think the staff is capable of learning that system at present, and I don't have the bandwidth to do it with them. Perhaps the 2025 budget?"

I wish it was 2 weeks to routine here. There's one particularly loud therapist who thinks she's God's gift, and she will fight me for 3 months on literally anything, regardless how small. Not joking. 3 months. I have repeated measurements of time. By "anything", I mean one time she got furious at me because a secretary double-booked sim appointments by accident, so I went to the secretary who did it and asked it to be changed. No big deal, right? Well, this therapist took my actions as a personal attack because "the therapists are in charge of the sim schedule". No, it doesn't make any sense, it will melt your brain if you think about it too deeply.

This was perhaps the most shocking early career revelation for me. I assumed the hospital was greedy and only cared about maximizing profit and was worried they would push me to do 33 fraction breast and 45 fraction prostate on everybody. It took some time for me to understand that they were greedy, but they were lazy more than they were greedy. Not rocking the boat was the number 1 thing. That means scheduling and treatment courses that make staff lives chill as possible while on the clock, even if it results in the hospital missing out on revenue. Hospital admin will do everything in their power to reduce a physician's salary by 50k but will ignore the fact that they are leaving 500k a year on the table from poor clinic operations.

Completely and utterly accurate. In the era of hypofrac, our on beam average is down. Because...duh. So this gets brought to my attention a lot.

Small issue: our consults are up over the last 5 years, our new starts are up over the last 5 years, and I am close to batting 1000 on my on beam conversion rate.

If consults and new starts are up already, that means the only way to "fix" this is to somehow get EVEN MORE consults. I know how to do this, and began to try to implement it, but it was like pulling teeth or actively resisted.

What I hear now, whenever "we need to increase numbers" is said to me:

"We need you to get our numbers higher, but we want you to do it without changing any of our practices or workflows, and we don't want anyone to have to do any more work, except for you."

Laziness > Greed, 10 times out of 10.

 

[elementaryschooleconomics]

The disdain from the administrator was palpable, and I could tell she was doing everything she could to make me feel as if I were "under" her in some way.

This is what it always boils down to. Always.

 

[deleted1116990]

The disdain from the administrator was palpable, and I could tell she was doing everything she could to make me feel as if I were "under" her in some way. She hated me from the moment I set foot in the door. I shudder to think what it would be like to try and work with her every day.

Of course, it was the most inefficiently-run radonc department I have ever seen, with a TrueBeam STX treating 18 patients from 8-5 pm. My clinic would be able to knock that out in a morning.

Exactly my experience. I can sniff these admins out within 5 seconds of talking to then. Their tone is obvious if they are going to be on a power trip about controlling doctors. I've had multiple initial phone calls that almost gave me PTSD. A notable one I remember in, oh lets say a place called, Display High, New Mexico.

Well, this therapist took my actions as a personal attack because "the therapists are in charge of the sim schedule".

Legit PTSD on this one. I said the trick is checking out mentally in these employed jobs, but there are some things you just can't check out on. If being able to set your schedule is not a given, you have to just quit. Because this is just something you have to say "No" to. Fighting to appropriately simulate patients. Unbelievable. I got written up by an RTT for making a prostate patient do an enema because the rectum had stool in it. They were mad they had to resim the patient and claimed the enema was the result of a medical error (poor bowel prep because I can totally control that 100% of the time) that resulted in a unnecessary procedure to the patient. It got sent to a med onc to peer review the "safety incident" and he came to me with a wtf is this and what is wrong with your staff? You will win the battle but you will lose the war. #LOCUMSDONTSAYNOANDAPPROVEALLSIMS

 

[RickyScott]

Exactly my experience. I can sniff these admins out within 5 seconds of talking to then. Their tone is obvious if they are going to be on a power trip about controlling doctors. I've had multiple initial phone calls that almost gave me PTSD. A notable one I remember in, oh lets say a place called, Display High, New Mexico.



Legit PTSD on this one. I said the trick is checking out mentally in these employed jobs, but there are some things you just can't check out on. If being able to set your schedule is not a given, you have to just quit. Because this is just something you have to say "No" to. Fighting to appropriately simulate patients. Unbelievable. I got written up by an RTT for making a prostate patient do an enema because the rectum had stool in it. They were mad they had to resim the patient and claimed the enema was the result of a medical error (poor bowel prep because I can totally control that 100% of the time) that resulted in a unnecessary procedure to the patient. It got sent to a med onc to peer review the "safety incident" and he came to me with a wtf is this and what is wrong with your staff? You will win the battle but you will lose the war. #LOCUMSDONTSAYNOANDAPPROVEALLSIMS

About 10 years ago, I interviewed with one of these specimens who complained how the prior doc broke the law by leaving the basement during treatment hours to attend tumor board, eat at cafeteria upstairs or even see inpt consults!

Hard to understand for medstudents and new grads. But oversupply means you will be dancing to the whims of these freaks. Luckily, have a cool manager right now, but have had so many horror stories previously.

 

[RadOncDoc21]

About 10 years ago, I interviewed with one of these specimens who complained how the prior doc broke the law by leaving the basement during treatment hours to attend tumor board, eat at cafeteria upstairs or even see inpt consults!

Hard to understand for medstudents and new grads. But oversupply means you will be dancing to the whims of these freaks. Luckily, have a cool manager right now, but have had so many horror stories previously.

I used to and still believe some of the staff are looking for the opportunity to be a whistleblower. One time I was accused of not being in the department when I was literally in the exam room.

 

[Mandelin Rain]

Y'all gotta get the staff to like you better than any of the administrators. It's usually not too hard. Buy some lunches. Look at pics of their kids. Ask when they last got a raise and comment on how ****ty that is.

Once you do that, it's really easy as the admin is powerless and want to get in your good graces so the staff doesn't start talking to their boss.

 

[RadOncDoc21]

Y'all gotta get the staff to like you better than any of the administrators. It's usually not too hard. Buy some lunches. Look at pics of their kids. Ask when they last got a raise and comment on how ****ty that is.

Once you do that, it's really easy as the admin is powerless.

I agree, having a happy staff helps but in the employed setting, the admins can pull rank… unfortunately.

 

[elementaryschooleconomics]

Legit PTSD on this one. I said the trick is checking out mentally in these employed jobs, but there are some things you just can't check out on. If being able to set your schedule is not a given, you have to just quit.

Mentally checking out is clutch! Depending on what you have for EMR user rights, and how dumb your staff might be, it's pretty easy to do some behind-the-scenes alchemy and gain control of the schedule without talking to people. For me, personally, it's not that I don't have "control" over my schedule, it's more that each group of people only sees their narrow focus while I need to do everything. Why do the therapists staffing the machine care about my consults and follow-ups on a particular day? Stuff like that.

I was discovering that it was like squeezing a water balloon, and making changes in Area A would cause problems in Area B. But, the alchemy I did with my schedule here to make it work probably aren't generalizable outside of this environment.

Mentally. Check. Out.

 

[Mandelin Rain]

I'm starting to feel much better about my job. Thanks guys!

 

[deleted1116990]

Why do the therapists staffing the machine care about my consults and follow-ups on a particular day? Stuff like that.

They want to make sure their workday goes as smoothly as possible and don't understand that we are not a radiology department where our job is to just simply move the meat through the CT machine all day without surprises.

The annoying thing is that admin could easily shut all this down by going to the staff and saying, "please welcome Dr. ESE. We have hired him to be the new director of this department. We are lucky to have him and trust his leadership. He is in charge and you will do whatever he says", and that would be the end of it. But no, staff are free to complain about Dr. ESE making their lives harder than dear old Dr. Boomer did, and admin will entertain it and want to have endless meeting to discuss how Dr. ESE needs to communicate better with staff (in other words stop saying no), and not clarify that the MD outranks the clinic manager in terms of department leadership.

Working with a clinic manager who understands that the MD is in charge and doesn't tolerate or worse encourage staff insubordinance is really something special when you have experienced it.

 

[medgator]

Seeing 4 consults on a day was not "safe" and I just stacked the schedule that way to make my life easier (see up to double that in PP sometimes).

Normal day for us. To echo @OTN it's a damn shame when physicians can't even run their own schedules and practices how they see fit in the current labor market/residency expansion environment. Sometimes I'll have to throw an add on myself into aria and tell the MA/nurse to get them registered and scheduled. Competing against a hospital is sometimes like taking candy from a baby

 

[RadOncDoc21]

Normal day for us. To echo @OTN it's a damn shame when physicians can't even run their own schedules and practices how they see it in the current labor market/residency expansion environment. Sometimes I'll have to throw an add on myself into aria and tell the MA/nurse to get them registered and scheduled. Competing against a hospital is sometimes like taking candy from a baby

Truly is… I would take my private practice experience and try to use it in the hospital setting and it was like pulling teeth to make things run more efficiently. There are so many hurdles and admin garbage, just for the sake of making it difficulty for the physician.

 

[thecarbonionangle]

I have never met a good admin. Its sort of like poop, just some stink more than others, but in the end all turds!

 

[Mandelin Rain]

Best thing I ever did. 1 month out of residency...

Me: [finished dictating at 3:30, patients all gone. Packing up to leave]

Manager: "Where are you going?"

Me: "Home."

Manager: "I have a meeting scheduled for you to meet with the physical therapy leadership at 4:30."

Me: "News to me. You should have asked me. We'll have to reschedule as I have plans."

Manager: "I think I have you until 5:00."

Me: "No. You have me until all the patients are safely treated and gone. After that, I will choose what to do with my time, thanks."

Manager: "But they're already coming."

Me: "Well, they'll be disappointed."

Manager: "They'll be upset."

Me: "I refer dozens of patients to PT every year and have never once heard of a PT referring a patient to radiation oncology. I think we'll be okay."

Manager: "Well, will you at least call them?"

Me: "No. Next time, just ask me. Goodnight."


Never dealt with much BS after that. Gotta lay down the law early. I'm still here and the admin is not.

 

[deleted1116990]

Manager: "I think I have you until 5:00."

Never dealt with much BS after that. Gotta lay down the law early. I'm still here and the admin is not.

Good for you. However, I did something similar right out of residency. Showed up at 8:15 AM first week and left at 3. Manager told me they had me from 8-5 then went behind my back to the CEO and asked for them to fire me when "I laid down the law." (I'm sure he also mentioned the nights I was there until 10-11 when work needed to be done). They quickly stopped challenging me to my face but continuously tried to get admin to fire me. They goaded me into quitting voluntarily eventually then fired the manager after I was gone. Because that order of events totally made sense.

In my experience, laying down the law stops the direct confrontation but dramatically escalates the passive aggressive behind-the-scenes f--kery.

 

[elementaryschooleconomics]

In my experience, laying down the law stops the direct confrontation but dramatically escalates the passive aggressive behind-the-scenes f--kery.

Totally agree. In my current job, I have experimented with multiple tactics. Initially, I played it completely straight and nice while I figured out how things worked. I think it's very important to give everyone the benefit of the doubt. When it became clear that certain egregious things were behavioral patterns and not one-off mistakes, I tried various methods to address them, up to (and including) direct confrontation.

Doing this for too long, though, pushes things underground. It's basically like treating the symptoms without addressing the cause. So after I "fixed" the 2-3 major things that were in my control, I retreated back to guerilla tactics almost overnight (in addition to the mental checkout, of course).

Lemme tell you, few things are more hilarious or satisfying then watching someone work themselves up to try to "fight" me on a random point, only to have me shrug and say "cool, whatever you want to do". They visibly deflate. It's glorious.

10/10 would bait-and-switch again.

 

[RadOncDoc21]

Totally agree. In my current job, I have experimented with multiple tactics. Initially, I played it completely straight and nice while I figured out how things worked. I think it's very important to give everyone the benefit of the doubt. When it became clear that certain egregious things were behavioral patterns and not one-off mistakes, I tried various methods to address them, up to (and including) direct confrontation.

Doing this for too long, though, pushes things underground. It's basically like treating the symptoms without addressing the cause. So after I "fixed" the 2-3 major things that were in my control, I retreated back to guerilla tactics almost overnight (in addition to the mental checkout, of course).

Lemme tell you, few things are more hilarious or satisfying then watching someone work themselves up to try to "fight" me on a random point, only to have me shrug and say "cool, whatever you want to do". They visibly deflate. It's glorious.

10/10 would bait-and-switch again.

💯… we are literally the same mind… it’s creepy!

 

[TheWallnerus]

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

The state nursing society in every state keeps a running and detailed count of the number of nurses working in the state, and nursing school graduates, etc

At any given point in time it is much easier eg to state how many nurses there are in America versus how many rad oncs there are; their data keeping re supply and demand is just that much better in nursing world

 

[NotMattSpraker]

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!

I did exactly this in my final 16 or so months at my current job and really enjoyed it! I agree with a lot of what has been proposed already, especially the need to assess the catchment area you will be serving in your new academic satellite. Who will refer to you? For me, it was a mix of very established PP that had a lot of anxiety about being "pushed out" and new academics trying to build their practices. You need to approach those people differently.

Cant stress enough the importance of bringing the academics to that community versus treating your center as a funnel to main. If you don't have techniques or trials at your center, make your department implement them. That should be the point of the new build. Once they are there, show them off. If you are perceived as a funnel to the main site, you're done.

Consider teaming up with multi-D colleagues to approach new catchment together, even if you are different practices. Rising tides raises all boats.

I found reaching out to introduce myself to the locals in an informal meeting to be well received; I'd avoid a lecture. Its really a discussion. Food is always nice, make your center buy it for them. Or offer to go to them, which might be really early or late. Go to the meeting with the goal of serving their needs and listen closely for opportunities. If you are talking with GU about prostate and they lament challenging RCC cases in passing, jump on that and share the data on SBRT (actual example that generated new referrals). Remember the PCPs too (prostate, lung screening, etc.). We even planned an "open house", but COVID prevented it from getting off the ground and now I am leaving.

The rest is the same advice for personal practice building. Keep an open mind, be comfortable treating like the team (assuming legit strategies), and be available.

Hope this helps, reach out if you want to talk further!

 

[temujim]

The other part have seen over and over in academics is those who don't give flip about clinic or being a good physician... are precisely the ones promoted to chair in rad onc.

 

[deleted1116990]

The other part have seen over and over in academics is those who don't give flip about clinic or being a good physician... are precisely the ones promoted to chair in rad onc.

It's amazing isn't it? VIPs come in and specifically request the chair to treat their prostate cancer, then the chair has to get a PGY-2 to help with the prostate plan because their clinical practice consists of treating about 4 breast patients a week for the past 10 years. Then dump all over community rad oncs who consistently have 30+ on treatment of everything for being not current to manage complicated cases or even certain disease sites at all.

 

[Lamount]

This thread makes me really, really happy I'm in a true pp where I get to lead a department, but it also makes me really, really sad that others don't have the same opportunity. We are supposed to be the captains of the ship, leading nursing, dosimetry, physics, and therapy. Being in charge of such a large operation is part of the fun of radonc. I said a few years ago that academic satellite and hospital jobs were not good jobs, and I'm not happy to say that I think I've been proven right. There are exceptions, of course, but they are indeed exceptions.

I did some locums last year in a hospital-based practice to make a little extra money but also to see what things were like in a hospital department. The disdain from the administrator was palpable, and I could tell she was doing everything she could to make me feel as if I were "under" her in some way. She hated me from the moment I set foot in the door. I shudder to think what it would be like to try and work with her every day.

Of course, it was the most inefficiently-run radonc department I have ever seen, with a TrueBeam STX treating 18 patients from 8-5 pm. My clinic would be able to knock that out in a morning.

Where I work (at a bigger mothership academic department), things are actually pretty easy with regard to admin and therapists. I get along well with the admin folks because I stay on the busier side... and they are all about it -so when I need them to write off an IMRT that was rejected by insurance, they don't bat an eye. They also go to bat with therapists for us to try to maximize throughput. I wouldn't say I am in control per se, but our interests align so it all works out.

 

[RickyScott]

Where I work (at a bigger mothership academic department), things are actually pretty easy with regard to admin and therapists. I get along well with the admin folks because I stay on the busier side... and they are all about it -so when I need them to write off an IMRT that was rejected by insurance, they don't bat an eye. They also go to bat with therapists for us to try to maximize throughput. I wouldn't say I am in control per se, but our interests align so it all works out.

Your experience is typical of academic centers where chairman and manager under him have much more authority than docs in the community.