I couldn't agree more.
One of the senior docs in my group and I talk about the ACR a lot. When he was practicing back in the 90s, he was very involved in the ACR, and often speaks about how tremendously valuable that experience was, and how much influence/infrastructure the ACR has compared to ASTRO.
I do think that the factors which turned RadOnc in the 2000s into an ultra-competitive specialty at the residency level - namely, that American healthcare reimbursement has been weighted towards procedures and practices/institutions had tremendous cash flow from IMRT (which I have heard described as a "buck-a-Rad"), and the perceived lifestyle of a specialty without an inpatient service - also drove people to think we could "do it ourselves" at the policy level. We were among the most coveted specialties in the House of Medicine, and that meant we excelled in all arenas, right? Ego begets ego. While I'm certain people like you and Join Luh recognized the danger in this thinking, I suspect your opinion was in the minority. Unfortunately, our rise coincided with the Radiology Recession of the mid-to-late 2000s, which incentivized Diagnostic Radiology to shore up their own walls, and accelerated the divide between societies.
In the grand scheme of things, we're a very small specialty. Our modality has mostly fixed costs after a huge upfront capital expense. We aren't viewed as a potential revenue vehicle for Big Pharma/medical device companies, so they wont' fight for us in DC (or elsewhere). In fact, as the RO-APM painfully demonstrates, we're evidently viewed as a liability on the accounting books of anyone involved in the Oncology space. Money which flows to RadOnc is money which is not flowing to Merck, or AstraZeneca, or Abbvie, etc. I'm not necessarily saying that there's some Deep State (Deep Pharma?) conspiracy against us, more that when all the major players witnessed the continually proposed and enacted cuts to our specialty over the years, they have basically shrugged and said "sucks for them".
In an alternate reality, 20 years ago when the modern RadOnc bubble started, instead of pulling away from the ACR, what if we had embraced them? I think bundled payments for RadOnc was an inevitability, but I suspect (know) that part of the reason this is happening now and not 10 years ago was because the government wanted to cut reimbursements as much as possible before introducing capitation/bundled payments. Could a continued partnership with a much larger and more powerful organization have driven this in a more favorable direction? We can never know for sure, but I have to imagine it would.
I agree that re-engaging with the ACR would take a massive political shift, but isn't it worth trying? We have 5 years before the APM is rolled out everywhere. I don't see departments cutting resident spots to slow our supply, I don't see research aimed at decreasing or omitting radiation slowing down, I don't see an IMRT-equivalent technological revolution for the next decade, and I don't see APM going away.
Perhaps, if the Editor-in-Chief of our main journal and the President of CARROS championed an effort to bring RadOnc back to the relationship it once enjoyed with the ACR, we could have stronger leverage in working with CMS on APM and future challenges?
