Unsolicited Jobs Thread

[deleted1168505]

Thank goodness I'm not in that zone. Maybe we should call that area *...

* working here may have adverse consequences on your mental health


Ps. Your line excluded Laredo, no bueno

I have worked in "the zone" before.
You would think you would be treated nicely.
On the contrary, they are universally butthurt that they have to pay extra to get somebody to come to their lovely town with daily 3PM duststorms in the summer and 40 mph horizontal sleet in the winter. So they make clear who is in charge (not you!)

---

Members don't see this ad.

 

[elementaryschooleconomics]

There is an empty quarter of the US where rad oncs go to die. It's conveniently color coded from space because everything else is dead there too. God help the poor souls that take the # jobs in these parts.

Wait wait wait...

You're telling me...there's more America after Chicago? What?

Fake news. If you posted this on the ASTRO forums they'd ban you!

 

[deleted1168505]

Wait wait wait...

You're telling me...there's more America after Chicago? What?

Fake news. If you posted this on the ASTRO forums they'd ban you!

Just explain that it's that annoying area where the stewardess is serving you your third bloody mary and you wonder how much longer until you land to Vegas.

Cool video for the geography nerds here...

 

[NotMattSpraker]

Just explain that it's that annoying area where the stewardess is serving you your third bloody mary and you wonder how much longer until you land to Vegas.

Cool video for the geography nerds here...

Haha that was a interesting video to kick off the work day, thanks for sharing it.

 

[sirspamalot]

Haha that was a interesting video to kick off the work day, thanks for sharing it.

Amarillo. Weather like out of a bad Sci fi movie. Vast nothingness. Midland? Lol hope you fly a jet level escape mechanism and get paid 1m+

The boonies. Let me tell you..

You can run into some serious wack radonc personnel who are weird and may do some frankly horrible work. Or bizarre interpersonal habits.

 

[medgator]

Thank goodness I'm not in that zone. Maybe we should call that area *...

* working here may have adverse consequences on your mental health


Ps. Your line excluded Laredo, no bueno

#2MorGTFO. Id do it if i was a new grad and they couldn't find anyone else

 

[sirspamalot]

#2MorGTFO - I like the cut of your jib sir.

 

[deleted1168505]

You can run into some serious wack radonc personnel who are weird and may do some frankly horrible work. Or bizarre interpersonal habits.

Looks like the vultures are figuring out how to exploit the supervision rules. Bad news for #?

EDIT: Appears to be Jordon Johnson's company. Isn't this the troll who was making a living scaring practices about violating supervision requirements or I am thinking of someone else?

https://careers.astro.org/jobs/view/remote-and-on-site-physician-opportunity-supplement-your-clinical-practice/70073141/

This means that physicians can provide a combination of remote and on-site services, leveraging technology to deliver consultations, peer-review, treatment planning/review, and follow-up care remotely and limiting travel for on-site activities for required tasks (simulations, weekly OTV’s, special procedures). Bridge Oncology's model allows for a sustainable, long-term partnership between physicians and rural healthcare practices/hospitals, ensuring access and continuity of quality care at an economical cost.

"

1. Remote Clinical Care: Provide remote medical consultations, assessments, and follow-up to patients via telemedicine platforms. Analyze diagnostic scans, define target areas, and determine the optimal dosage and treatment plans. Provide continuous audio-visual availability and clinical peer-review.
2. On-Site Clinical Care: Conduct occasional and limited on-site visits to our partnered healthcare facilities or clinics to provide direct patient care, such as, but not limited to, simulations, special procedures, weekly on-treatment visits.
   "

 

[sirspamalot]

I already do "Bridge Oncology" by flying back and forth. The LAST THING I would want is to give up some of my pay (and 1099) for this clown service.

Only low business IQ and desperate new grads need apply. BridgeOnc gonna try to fool administrators into thinking this "cheap solution" (like Varian with indian physicists doing dosimetry with a usa dosim signoff ie nightawk dosim) is legit.

It ain't. You still need a quality person on the site to do the work and build referrals and trust. You can't simply do this 80% remote. Its not possible.

To my brothers and sisters:

 

[deleted1168505]

LOL you can't make this stuff up.
Clown world rad onc has become, true.

 

[sirspamalot]

Providers – Bridge Oncology

bridgeoncology.com

These guys are, I think, selling APRN with remote physicians who might drop in once in a blue moon maybe. As in, are you KIDDING ME


"Bridge Oncology educates, trains, and staffs radiation oncology-specific Nurse Practitioners who can be placed at your facility to guarantee coverage in your oncology practice while also supplementing other operational management aspects."


#GTFO !

 

[deleted1168505]

I'm guessing he thinks he can arbitrage rural practices paying 3500/day for agency locums by making a deal for slightly less and finding somebody in the nearest big city to come out once a week and make themselves available during their normal job via facetime for 1500/day or something.

The added value he provides vs. the doctor setting this up directly is...??

The problem is that administrators are stupid enough to actually try this.

 

[deleted1111261]

I'm guessing he thinks he can arbitrage rural practices paying 3500/day for agency locums by making a deal for slightly less and finding somebody in the nearest big city to come out once a week and make themselves available during their normal job via facetime for 1500/day or something.

The added value he provides vs. the doctor setting this up directly is...??

The problem is that administrators are stupid enough to actually try this.

Contra:

Can this work? I think maybe

Should we do it? I don’t know

Is this a preview of the future? Bet your ass it is

 

[sirspamalot]

I put the bastards who do this in the same bin as Proton shills.

Scumbag hucksters all of it.

And who is dumb enough to sign off on a NP doing all the work for you?

Yeah I trust that trained up NP to do my head and neck volumes. And then send it to India for dosimetry and physics

uke

Why not just have AI do all of it and have the NP sign off.. You'll save a ton..

 

[deleted1168505]

Contra:

Can this work? I think maybe

Should we do it? I don’t know

Is this a preview of the future? Bet your ass it is

1. Double residency grads
2. Halve fractions per patient
3. Decrease reimbursement
4. Eliminate supervision requirements
and NOW
5. Consolidate high paying rural jobs into the role of less busy urban docs who now singularly occupy previously 2 FTE positions.

What else? What next?
Maybe eliminate OTVs altogether?

 

[deleted1111261]

Contra:

Can this work? I think maybe

Should we do it? I don’t know

Is this a preview of the future? Bet your ass it is

I put the bastards who do this in the same bin as Proton shills.

Scumbag hucksters all of it.

And who is dumb enough to sign off on a NP doing all the work for you?

Yeah I trust that trained up NP to do my head and neck volumes. And then send it to India for dosimetry and physics

uke

You have a blockbuster membership??

🤣

I get it - this could be disaster. But, the way things are going, I think it’s non zero chance of happening

 

[NotMattSpraker]

Contra:

Can this work? I think maybe

Should we do it? I don’t know

Is this a preview of the future? Bet your ass it is

It's here. Radiology and Dermatology told us. We know the risks. We know how it goes. It's so early that actually we could act on it. We're pushing legislative reshaping of Rad Onc! We there is a path, it can be done! We're so close. It's right there!

I'm looking forward to discussing the commoditization of radiation therapy with you all when ASTRO puts out their reactive solution 10 years from now

 

[deleted1168505]

FYI. Jordan Johnson sent me a PM immediately after I posted that asking me to call him. I asked him to post what he wrote publicly to defend this and have a discussion about it if he believes in the merit of this model. Hopefully he does!

 

[Neuronix]

I remember Jordan Johnson insisting to me at ASTRO meeting that APM was definitely happening and there was no way it would be avoided.

Maybe he was right--with a twist. Even if APM didn't happen, ASTRO would keep trying to force it down our throats regardless.

 

[sirspamalot]

FYI. Jordan Johnson sent me a PM immediately after I posted that asking me to call him. I asked him to post what he wrote publicly to defend this and have a discussion about it if he believes in the merit of this model. Hopefully he does!

 

[evilbooyaa]

FYI. Jordan Johnson sent me a PM immediately after I posted that asking me to call him. I asked him to post what he wrote publicly to defend this and have a discussion about it if he believes in the merit of this model. Hopefully he does!

Can we all just discuss a plan based on the merits of the plan and stop having all this nonsense about 'PM me so I can give you the real scoop'?

Why does so much have to be behind closed doors?

Why do people feel the need to not display to the world their plans in a proud manner, instead sneaking around back alleys and PMs and not addressing it?

 

[johnsojo]

Providers – Bridge Oncology

bridgeoncology.com

These guys are, I think, selling APRN with remote physicians who might drop in once in a blue moon maybe. As in, are you KIDDING ME


"Bridge Oncology educates, trains, and staffs radiation oncology-specific Nurse Practitioners who can be placed at your facility to guarantee coverage in your oncology practice while also supplementing other operational management aspects."


#GTFO !

Why don't you just ask?

 

[johnsojo]

I remember Jordan Johnson insisting to me at ASTRO meeting that APM was definitely happening and there was no way it would be avoided.

Maybe he was right--with a twist. Even if APM didn't happen, ASTRO would keep trying to force it down our throats regardless.

Definitely not a matter of right or wrong. there was just a total failure to hold people accountable that made many $$$ driven decisions that have us in the situation we are in. Then you have people that are actually trying to move the needle for the right reasons and we hear every reason why we shouldn't do it, without hearing the why we are doing and ignore what is already being done.

 

[johnsojo]

FYI. Jordan Johnson sent me a PM immediately after I posted that asking me to call him. I asked him to post what he wrote publicly to defend this and have a discussion about it if he believes in the merit of this model. Hopefully he does!

I did send you one out respect to your comments. All of this is self-funded based on the research we have conducted and posted at no charge. Happy to answer questions as I said, just ask or call. There is nothing to defend--- this is designed to keep access to care close to home. The current models drive care away from these sites and make it now sustainable or viable for care. Again, much of this was predictable based on decisions made a decade or two ago. 600+ linacs treating fewer than 10 patients a day and growing. Just the numbers.

 

[NotMattSpraker]

Definitely not a matter of right or wrong. there was just a total failure to hold people accountable that made many $$$ driven decisions that have us in the situation we are in. Then you have people that are actually trying to move the needle for the right reasons and we hear every reason why we shouldn't do it, without hearing the why we are doing and ignore what is already being done.

I did send you one out respect to your comments. All of this is self-funded based on the research we have conducted and posted at no charge. Happy to answer questions as I said, just ask or call. There is nothing to defend--- this is designed to keep access to care close to home. The current models drive care away from these sites and make it now sustainable or viable for care. Again, much of this was predictable based on decisions made a decade or two ago. 600+ linacs treating fewer than 10 patients a day and growing. Just the numbers.

I agree with many of the problems you point out. There are many ways to address those problems and there has been abuse in other fields, it can be done wrong. Understandable for doctors to be suspicious and careful here.

ASTRO and the ABR should work hard to defend physicians on the topic of scope of mid-levels. As always, we could learn a lot from radiology.

Huge topic and fun quality nerd discussion, maybe for a podcast

 

[Mandelin Rain]

I wish I smelled altruism, but all I smell is opportunist.

The sooner doctors realize they are the product, the better. Learn to sell yourself and let the leeches wither away.

 

[Ray D. Ayshun]

Many of these linacs doing this, at least near me, should be closed. They're 20+ years old, using MV setup films and compensator based IMRT, and it's borderline unethical to be using them. They continue to exist because they can be profitable by being run with inadequate staffing, and there's no hope of them ever being upgraded.

 

[Exokie67]

I've worked at a lot of these facilities as a locums and overall the quality of the physician work has been very good, in my judgement. The equipment seems to vary, with most updating at least to the previous generation of equipment although yes, I've seen a Primus here and there. I definitely agree with trying to keep patients from traveling long distances, although in the era of hypofractionation it is at least a little less burdensome.

Having said that, I don't see truly a need for the business model being discussed; it seems to be just another corporate broker inserting itself between physicians and the treatment site. Do these sites and patients really benefit from a turnkey model when they could get the same if not better results by contracting directly with individual physicians or physician-led groups? Maybe we are to blame for taking our hands off the wheel when it comes to advocating for ourselves. Or maybe the leaders of the hospitals just don't want to do the work and want a plug and play solution. Even if this is the case, I would argue that no one understands how to do this better than us.

 

[RadOncDoc21]

Agree, never met an admin who cared more about the patients then the top and bottom line. To be fair, that’s not their job but many (not all) do stand in the way of what I would consider increasing the importance of high quality health care even if it means cutting profits.

Just to give some food for thought:

CEOs got smaller raises. It would still take a typical worker two lifetimes to make their annual pay

After ballooning for years, CEO pay growth is finally slowing. The typical compensation package for chief executives who run S&P 500 companies rose just 0.9% last year, to a median of $14.8 million, according to data analyzed for The AP by Equilar. It was the smallest increase since 2015. Still...

apnews.com

 

[RickyScott]

I agree with many of the problems you point out. There are many ways to address those problems and there has been abuse in other fields, it can be done wrong. Understandable for doctors to be suspicious and careful here.

ASTRO and the ABR should work hard to defend physicians on the topic of scope of mid-levels. As always, we could learn a lot from radiology.

Huge topic and fun quality nerd discussion, maybe for a podcast

I have been ranting here for yrs abt supervision and conventional fractionation prplopping up the job market and am glad that issues are finally coming to a head. Culturally, remote supervision is frowned upon, but that will almost certainly change. You should definitely have a podcast.

 

[deleted1168505]

I did send you one out respect to your comments. All of this is self-funded based on the research we have conducted and posted at no charge. Happy to answer questions as I said, just ask or call. There is nothing to defend--- this is designed to keep access to care close to home. The current models drive care away from these sites and make it now sustainable or viable for care. Again, much of this was predictable based on decisions made a decade or two ago. 600+ linacs treating fewer than 10 patients a day and growing. Just the numbers.

This is wild.

So you are doing this out of the goodness of your heart? You think anybody believes that? There is nothing to defend? Because you say so?

So your expected profit margins are what by arbitraging what the hospital pays you and what you pay the physicians are what, exactly? Vs. those of us who actually would be interested in working full time in these facilities -- hindering our ability to negotiate directly with the hospitals? What rural food bank and health initiatives will you be donating all of your profits to?

I have worked in exactly the kind of facilities you are targeting, so I do know what you are talking about.

Again, "because academic centers already do it" is about the lamest justification I have heard.

The only solace I can take in this is that it won't be successful. I live in and work in a pretty undesirable area with many surrounding rural centers. I am frequently contacted for locums work and have told many centers that I would be willing to fill the gap coming out one day a week and doing the rest remotely until they can line up reliable coverage for a month or two, at an averaged daily rate much less than their typical coverage. Not a single one has ever entertained the discussion. They have always been able to staff 5 days a week with locums.

And no, I do not have an interest in calling you to doxx myself so you can insinuate defamation lawsuits or whatever else nonsense that thinly veiled threat is implying. Ridiculous.

 

[sirspamalot]

I just got pinged for that exact situation. "1500-2000" I laughed and said I wouldn't even consider it for less than 3500/day. I mean, if you're coming 1 day a week to "cover" can you imagine (15+ on tx) what that workday will be like?

Not to mention the risk.. (slim shady) yes, the NP is just like me, studied like me, contours like me, sees patients like me.. but doesn't get paid like me..

 

[deleted1168505]

I just got pinged for that exact situation. "1500-2000" I laughed and said I wouldn't even consider it for less than 3500/day. I mean, if you're coming 1 day a week to "cover" can you imagine (15+ on tx) what that workday will be like?

Well maybe I'm wrong. Actually I know I'm wrong. There are a few centers actually stupid enough to consider this long term. The same few that already use NPs for vacation coverage. But thankfully for now they are definitely the exception. From your standpoint, I totally agree. You are signing up for a heap load of extra liability and having to trust staff you don't know.

The whole thing reeks like the rad oncs at big academic centers "supplementing" their income by closing their doors and secretly doing evicore reviews on the clock. Now they can check films and do facetime clinic visits at some rural center they don't care about too. Notice the word "supplement" used in the ASTRO ad. Not accidental. I know who the target audience is there. No, this will not result in better care for rural patients. Quite the opposite. And rural rad oncs (most of whom are quite competent and well trained -- a unique feature of our sub-specialty unlike others) will get steamrolled too if this ever takes off, which it won't.

 

[sirspamalot]

if this ever takes off, which it won't.

 

[Mandelin Rain]

It will.

Suits trust other suits. they trust meetings. They trust corporate structure.

They won’t listen to what a doc has to say. At all. But some RTT in a suit, on a Zoom call saying some corporate buzz words tells them it’s okay? They’ll lap it up and buy all day.

 

[madchemist89]

Our specialty is surprising in how good the rural docs are. It is a result of our oversupply. Top medical graduates are working in the middle of nowhere. Other specialties in these areas are usually subpar or staffed with foreign docs/DOs (nothing against you guys, just an observation).

 

[RickyScott]

Our specialty is surprising in how good the rural docs are. It is a result of our oversupply. Top medical graduates are working in the middle of nowhere. Other specialties in these areas are usually subpar or staffed with foreign docs/DOs (nothing against you guys, just an observation).

And despite 15+ years of spitting out top grads, large universities continue to disparage the community (probably worse today)

 

[deleted1168505]

Our specialty is surprising in how good the rural docs are. It is a result of our oversupply. Top medical graduates are working in the middle of nowhere. Other specialties in these areas are usually subpar or staffed with foreign docs/DOs (nothing against you guys, just an observation).

There are a few bad apples out there but most are end of career or retired doing locums here and there. And Ray has a point about the handful of centers out there running antiquated equipment treating <10 patients with a business plan to run it into the ground until it can't be fixed anymore and then shut the program down. That is a problem. Letting Dr. Bigname at the university juice his income a little bit by seeing those patients one day a week while some middleman RTT-turned-MBA collects finder-fees isn't the solution.

 

[deleted1111261]

The best way to find out is to see what happens. Also, he was called grifter and other things. It's really not necessary for him to respond, but if you truly are interested in learning, then jump on a call or webinar with him. I also had a negative view of Jordan initially, but we've spoken a bunch and now I am friendly with JJ, even though I don't agree with everything he says.

I don't know that RO in current state is ready for this. But, it could be Pets.com, with Chewy waiting in the wings in 5 years.

JJ - in this era with oversupply, this model is going to piss off a lot of people. Plus, your prior position on physician presence will make some people question motives. The billing aspects are going to be interesting, for sure. Granted, I believe in people evolving with their thinking, but I think we had some pretty fierce debates on supervision. Sounds like I convinced you?

If your model spreads to cities, this is the end. There is no way out. I don't see a way for us to survive.

I would suggest ASTRO / ACRO take a long hard look at what the plan is for Bridge and model out what happens if you have docs going in 1-2 days a week at 25% of centers. It will be a death knell, if done rapidly and without foresight.

If on the other hand, this is strictly a rural "solution" - well, a lot of them have been doing this already with the waiver. There has been no evidence of harm done (yet). This will seem like a new shiny coat of paint on an old car. Maybe some value add, but there are rural centers in the black with low volume (I'm pointing at me). But again, I will learn more if we talk in detail.

I'm not supportive or unsupportive. I was talking with some friends about it yesterday and my view of this is when something this dramatic comes long, it is very important to be aware of it and view it critically, trying your best to remove your own biases. Steel man, not straw man. There are others above who call names or use tautology in their debate, but the best way to look at this is to break it into parts.

- rural oncology does have a shortage (maybe not ROs particularly, but some areas do)
- supervision remains unclear to some people, clear as day to others
- NP/PA role is undefined, but 2020 Medicare wording makes it sound like they can attain privileges
- rural waiver examination did not show any detriment to patient outcomes per Medicare

I want to protect my income and position. And all of yours. But, there is a wave of new stuff coming that we can't predict or fully understand.

 

[thecarbonionangle]

I have been ranting here for yrs abt supervision and conventional fractionation prplopping up the job market and am glad that issues are finally coming to a head. Culturally, remote supervision is frowned upon, but that will almost certainly change. You should definitely have a podcast.

My understanding is that many other countries already do remote and i don’t think Australia has bad radiation treatments.

 

[madchemist89]

I agree some clinics are running substandard equipment. I interviewed at one, but don't be surprised at the number of true beams in the boonies. The docs staffing these locations can be quite smart. I have met them.. They just don't have a choice to go somewhere better due to geographic restrictions or they have some other reason for being there.

 

[RadOncDoc21]

The wave is to get out while you can. We have diluted the status of the physician (rightly or wrongly so) and introduced a new model of medicine where patients are the consumer and anybody who is cheaper can deliver the same amount of care.

We’ve introduced social media and advertisements to the field and there is no turning back. Although I believe that AI can provide a benefit in regards to maximizing efficiency, I don’t see the docs being the first to gain the advantage over the executives who will use it to find ways to make more money.

The field of medicine is a sinking ship!

 

[sirspamalot]

or they have some other reason for being there.

#

 

[Mandelin Rain]

The best way to find out is to see what happens. Also, he was called grifter and other things. It's really not necessary for him to respond, but if you truly are interested in learning, then jump on a call or webinar with him. I also had a negative view of Jordan initially, but we've spoken a bunch and now I am friendly with JJ, even though I don't agree with everything he says.

I don't know that RO in current state is ready for this. But, it could be Pets.com, with Chewy waiting in the wings in 5 years.

JJ - in this era with oversupply, this model is going to piss off a lot of people. Plus, your prior position on physician presence will make some people question motives. The billing aspects are going to be interesting, for sure. Granted, I believe in people evolving with their thinking, but I think we had some pretty fierce debates on supervision. Sounds like I convinced you?

If your model spreads to cities, this is the end. There is no way out. I don't see a way for us to survive.

I would suggest ASTRO / ACRO take a long hard look at what the plan is for Bridge and model out what happens if you have docs going in 1-2 days a week at 25% of centers. It will be a death knell, if done rapidly and without foresight.

If on the other hand, this is strictly a rural "solution" - well, a lot of them have been doing this already with the waiver. There has been no evidence of harm done (yet). This will seem like a new shiny coat of paint on an old car. Maybe some value add, but there are rural centers in the black with low volume (I'm pointing at me). But again, I will learn more if we talk in detail.

I'm not supportive or unsupportive. I was talking with some friends about it yesterday and my view of this is when something this dramatic comes long, it is very important to be aware of it and view it critically, trying your best to remove your own biases. Steel man, not straw man. There are others above who call names or use tautology in their debate, but the best way to look at this is to break it into parts.

- rural oncology does have a shortage (maybe not ROs particularly, but some areas do)
- supervision remains unclear to some people, clear as day to others
- NP/PA role is undefined, but 2020 Medicare wording makes it sound like they can attain privileges
- rural waiver examination did not show any detriment to patient outcomes per Medicare

I want to protect my income and position. And all of yours. But, there is a wave of new stuff coming that we can't predict or fully understand.

This is very fair.

I just remember this guy like a year (?) ago saying it was fraud to not have boots on the ground 5 days a week. Now he has a business promoting exactly that.

Hard not to be leery.

 

[madchemist89]

I am against direct supervision for standard fractionation. I don't think that it is medically necessary for me to be in the clinic when I'm not checking these images until after treatment. For srs or sbrt, a physician definitely needs to be physically present. These treatments can be high stakes. As far as the rest of what we do, NPs are not properly trained to do anything that we do besides maybe seeing an otv or followup. ASTRO needs to take a stance against creep from mid-levels.

 

[sirspamalot]

The best way to find out is to see what happens. Also, he was called grifter and other things. It's really not necessary for him to respond, but if you truly are interested in learning, then jump on a call or webinar with him. I also had a negative view of Jordan initially, but we've spoken a bunch and now I am friendly with JJ, even though I don't agree with everything he says.

I don't know that RO in current state is ready for this. But, it could be Pets.com, with Chewy waiting in the wings in 5 years.

JJ - in this era with oversupply, this model is going to piss off a lot of people. Plus, your prior position on physician presence will make some people question motives. The billing aspects are going to be interesting, for sure. Granted, I believe in people evolving with their thinking, but I think we had some pretty fierce debates on supervision. Sounds like I convinced you?

If your model spreads to cities, this is the end. There is no way out. I don't see a way for us to survive.

I would suggest ASTRO / ACRO take a long hard look at what the plan is for Bridge and model out what happens if you have docs going in 1-2 days a week at 25% of centers. It will be a death knell, if done rapidly and without foresight.

If on the other hand, this is strictly a rural "solution" - well, a lot of them have been doing this already with the waiver. There has been no evidence of harm done (yet). This will seem like a new shiny coat of paint on an old car. Maybe some value add, but there are rural centers in the black with low volume (I'm pointing at me). But again, I will learn more if we talk in detail.

I'm not supportive or unsupportive. I was talking with some friends about it yesterday and my view of this is when something this dramatic comes long, it is very important to be aware of it and view it critically, trying your best to remove your own biases. Steel man, not straw man. There are others above who call names or use tautology in their debate, but the best way to look at this is to break it into parts.

- rural oncology does have a shortage (maybe not ROs particularly, but some areas do)
- supervision remains unclear to some people, clear as day to others
- NP/PA role is undefined, but 2020 Medicare wording makes it sound like they can attain privileges
- rural waiver examination did not show any detriment to patient outcomes per Medicare

I want to protect my income and position. And all of yours. But, there is a wave of new stuff coming that we can't predict or fully understand.

Someone please summarize this "Rural Waiver" - I have no clue.. does this mean freestanding centers get to go to General Supervision like HOPPS?

Or that NP's only have to staff the place half the time in HOPPS? Or what exactly??

Rural Health Clinics | CMS

Rural Health Clinics

www.cms.gov

The whole CAH thing was for hospitals. I assume this is about HOPPS. But some clarity here would help. I think any physician who is willing to let a pseudo-trained NP run the shop and remote in, then show up 1 day a week, is going to find that there will instead be a desire for the hospital to actually hire a starving but competent new/mid-career grad for about the same amount, who will commit to the local docs.

I don't think this business model will fly. I hope it doesn't. Rural Radonc will soon be absorbing the overflow of new trainees and they (perhaps without kids, or unmarried) WILL take those jobs... if the hospitals will have them.

The thing is kids.. radonc isn't just about being the book smartiest doc in the room. In rural america, you need people handling skills. Poor white folks may balk at seeing someone who can't command english (maybe its racist, maybe its ignorance), much less deal with doctors with poor social competence. And if you're not good at this part, the word will spread fast.

We are not all interchangeable widgets... ASTRO/ACRO needs to make sure they say "Be sure to see a board certified radiation oncologist" and not an NP with an occasional TV visit. That is NOT the way our profession needs to go.

 

[NotMattSpraker]

Our specialty is surprising in how good the rural docs are. It is a result of our oversupply. Top medical graduates are working in the middle of nowhere. Other specialties in these areas are usually subpar or staffed with foreign docs/DOs (nothing against you guys, just an observation).

Yes, important point. I've worked in these kinds of centers doing some locums. A big barrier I saw was the talented rad onc did not have a similarly talented multi-D team of oncology physicians. I personally think that is valuable.

It's hard to blame people for responding to incentives. They need a huge overhaul in oncology, but it doesnt seem like anyone wants to talk about it outside SDN.

I wish there were more policy efforts to support these hospitals and their cancer centers supporting their oncologists, not enough of that. I do not like the idea of a remote academic physician leading care 200 miles away through an NP, but a lot of times I feel on an island with that opinion among "decision makers".

 

[deleted1168505]

JJ - in this era with oversupply, this model is going to piss off a lot of people. Plus, your prior position on physician presence will make some people question motives.

Bingo.

I didn't ask for him to respond. I just simply posted the suspicious "job" ad and got a passive-aggressive PM.

The notion that he is doing this out of service to rural patients, a good fight against the system when/if he was previously arguing for supervision to the extreme is absurd on its face. I would guess he is extremely envious of the RT staff who successfully brought qui tam suits in the past. That's not a profitable grift anymore so here we are.

 

[sirspamalot]

 

[thecarbonionangle]

I did some locuming in rural areas before my current job. What i saw was that usually the rad onc was competent but you did not always have the right team around you. Maybe physics or dosimetry was “part time” or remote. Maybe therapy culture was not great (emphasis on “fast” over quality safe care). Maybe Your referrings were not always the best and the specialists were not always available (think of a general surgeon doing sarcoma surgeries, or even more complicated esophagectomies or whipples if they even do them, questionable or crappy radiology reads, hack job ENT/urology jobs). Then the patient population can be challenging, poor, uneducated, social issues, distrust of physicians, misinformation (albendazole to cure cancer) . The rural guys do god’s work. ASTRO elites who have made a career about “equity” but would never step foot in these “hellholes” are completely hypocritical. The whole thing has become substanceless careerism.