What is a normal patient volume?

[boredatwork04]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

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[yesmaster]

I hope you’re getting paid well.

 

[Palex80]

Sounds like a lot of patients with hypofractionated schedules to me.

10-15 consults should lead to 10 treatment starts per week. If you have 20-25 on beam, that means average length of treatment is 2-2.5 weeks.

Do you see only a few H&N, primary NSCLC, GBM and breast with RNI cases?

 

[Ray D. Ayshun]

You're busy. Not sure how you're also bored at work.

 

[CaesarRO]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

Definitely sounds on the busier side. You are likely > 75th if not 90th percentile volume.

Separately, commented mainly to point out that your username probably needs an update.

 

[TheWallnerus]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

You are likely > 75th if not 90th percentile volume.

You’re at 99%ile on workload, at least. And this is rather amazing to be at 99%ile. And I know workloads and the data.

There is a "tremendous gulf" between the 75%ile, or the 96%ile, and the 99%ile e.g. (in our field, for workloads, and in meth synthesis).

 

[TheWallnerus]

Sounds like a lot of patients with hypofractionated schedules to me.

10-15 consults should lead to 10 treatment starts per week. If you have 20-25 on beam, that means average length of treatment is 2-2.5 weeks.

Do you see only a few H&N, primary NSCLC, GBM and breast with RNI cases?

The mean fraction number in America is 16. So 2-2.5 weeks is probably within a S.D. (maybe 1.5 S.D.'s ha) of the mean IMHO.

 

[brushbeamscanning]

I'm also early, I see about 5-7 consults a week and have about 12 on beam.

 

[evilbooyaa]

That seems incredibly busy. Hope you're making 750+, if not 7 figures.

 

[metallica81788]

That is very busy especially if you do any level of brachy - the 3 tumor boards per week and seeing way too many follow ups would kill me
Cutting down follow ups and trying to minimize tumor board could be first steps to reduce your workload

Are you solo or have partners?

 

[Chartreuse Wombat]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

Do you know your wRVUs? Good data on that.

Compensation depends on wRVUs but also negotiated contracts. I have seen $/wRVU ranges from $45-85; not counting the PPS-exempt places

 

[Mandelin Rain]

If you’re not making close to 1 million, you’re getting badly taken advantage of

 

[BobbyHeenan]

This is a busy practice. Very similar to mine. I work hard five days a week but make good money. I hope you are too.

I really like what I do but if I didn't it would be rough. It takes really good nursing (and/or nurse navigation), good physics and dosimetry to make it all work though. It can be done though and be very rewarding. Has potential to be awful though if you have a bad support system.

 

[boredatwork04]

Thanks for the feedback. Just wasn’t sure. Money is okay, think it needs to be higher. Lots of different practice types that we don’t really think about in residency.

 

[RadOncMegatron]

Yo you busy homey.

 

[drowsy12]

Another question would be do you have other people working there too and are they similarly busy? May be worth talking to them if so, think you guys have a good argument, though one consideration (speak from personal knowledge) is the answer from admin may to be hire another person, not raise pay significantly more

 

[Neuronix]

We have wRVU benchmarks and percentiles in the private forum.

Do you know your professional wRVUs or professional collections?

 

[elementaryschooleconomics]

The people who know me in real life know that I have a very busy practice.

So coming from that frame:

Yo, you busy homey.

 

[RickyScott]

Median radonc sees less than 5 consults a week.

 

[OTN]

Seems like a healthy practice. Comparatively, brachy is going to take up a lot of time, energy, and effort, as will SpaceOAR placement.

 

[RadRadRad]

I think the ideal practice volume really varies from person to person. Also depends on experience. You run with 30 on treats for a few years and you will get extremely efficient /used to the load

Some people get stressed with too much work. Some people get stressed with too little work (especially if they are on straight rvus)

I will say too much work is usually an easier problem to fix than too little

 

[deleted1111261]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

Sounds rigorous.

Like everyone says, if you’re getting paid what you think is fair and you are enjoying yourself, it’s all good. One person’s burnout is another person’s engagement. I.e. - there is probably a dozen people here that would want your volume and another dozen that would run.

If not, then eventually going to have to change. I presume those mornings you’re up at 530 and getting home 500-5.30ish? Are you working after you get home and on weekends? Are the loved ones in your life feeling neglected or no issues with it because they are busy and/or you have older kids?

Young fellas and @OTN level capacity handle it. I would not be able to for more than a short stretch. In addition, I want to be around my family by the time it’s 4 or so, with no work interruptions. Everyone is different - so it’s good to ask but only you will know what is best for you. (Kenji Lopez has a children’s book about pizza being the best; really helped me sort all this out).

Figure out what’s most important to you and try to find that. I continually worked to find a place that aligns with what I want out of my professional and personal life. It took over a decade, but now it would be hard to be in any other environment, but has mostly to do with administrative respect, autonomy and relaxed pace. PGY5 Simul would not have agreed, and would have been really bored.

I agree - way easier to taper than to increase. I’ve been at my job for 18 months and we will treat 14 tomorrow and thats HUUGE for us, but would make others freak out about how low that is. But, I can’t turn on a spigot to make an ADT of 14 a reality. So, if I wanted to earn more, I’d have to move.

 

[Palex80]

In addition, I want to be around my family by the time it’s 4 or so, with no work interruptions.

My life:

 

[grenz]

I

My life:
View attachment 379471

Your knowledge of American pop culture is incredible

 

[deleted1111261]

I

Your knowledge of American pop culture is incredible

It’s incredible. Truly.

 

[jpace]

Anyone aware of typical new start (or consult) case distribution by disease site for a community hospital? Sure -- breast, prostate, and palliative I imagine are the top 3, but after that what % is typical for GI, Lung, H&N, GYN, etc? For those who have a robust OA practice, where does that end up ranking on your new start stats?

 

[deleted1111261]

Anyone aware of typical new start (or consult) case distribution by disease site for a community hospital? Sure -- breast, prostate, and palliative I imagine are the top 3, but after that what % is typical for GI, Lung, H&N, GYN, etc? For those who have a robust OA practice, where does that end up ranking on your new start stats?

If you heavily market OA, it will easily become #1, but if you have a busy cancer practice, I would not consider starting it, or at least marketing it.

 

[Ray D. Ayshun]

If you heavily market OA, it will easily become #1, but if you have a busy cancer practice, I would not consider starting it, or at least marketing it.

Have we in the other threads discussed navigating ortho with OA. Not a ton of data supporting knee injections either, but that's usually step 1. I'm finally having patients respond, but the biggest initial issue had been not seeing patients until ortho was done injecting em and the femur and tibia had become one bone.

 

[deleted1111261]

Have we in the other threads discussed navigating ortho with OA. Not a ton of data supporting knee injections either, but that's usually step 1. I'm finally having patients respond, but the biggest initial issue had been not seeing patients until ortho was done injecting em and the femur and tibia had become one bone.

Some are open to it, some are resistant.

The local group made a fake call to our office asking about it and then hung up midway through call. The caller ID showed who it was.

But, a few have seen the success and reports from their referring PCP, so we are getting some from ortho now.

At our other hospital that is about to open up, I met with internist and his son is an ortho. They have a million patients they want to send.

 

[OTN]

Some are open to it, some are resistant.

The local group made a fake call to our office asking about it and then hung up midway through call. The caller ID showed who it was.

But, a few have seen the success and reports from their referring PCP, so we are getting some from ortho now.

At our other hospital that is about to open up, I met with internist and his son is an ortho. They have a million patients they want to send.

If you're on the receiving end of a little corporate espionage you must be doing something right

 

[RSAOaky]

Just curious. I’m early out of residency and just not sure what is normal for a community type hospital based practice. I see about 10-15 consults a week, and about 30-40 followups, with about 20-25 on treatment. Averaging about 70 patient visits per week. Also have tumor board at 630am on 3 days per week (not helping with my energy levels). We also do a lot of brachy and spaceoar, sbrt. Suppose I’d just like to know if this is normal, because then I can go with it. But if not normal, then I probably need to figure out some options. Residency was abnormal from day 1 so not a good comparison for me.

This doesn't make any sense. 10-15 consults a week at an average 4 week length of treatment is 40-60 patients on beam. How do you only have 20-25?

Assuming all your follow ups are 99214 and your consults are 99245, and that you see patients 46 weeks a year, you are generating 4375-6120 wRVUs in E&M alone. Assuming $50/wRVU that's 220k-306k in E&M alone on 1840-2530 E&M visits.

To put things in perspective, I average 6 consults a week, 11 follow ups a week, and will generate about 13k-16k wRVUs. I aggressively hypofrac breast and prostate, do Livi APBI when I can, and don't do a ton of oligomet treatments so these are probably pretty typical bread and butter numbers. You should be generating 30-40k wRVUs based on the numbers you mentioned so if you aren't getting paid 1.5-2 million a year either you're doing something wrong or your employer's doing something right.

 

[deleted1111261]

This doesn't make any sense. 10-15 consults a week at an average 4 week length of treatment is 40-60 patients on beam. How do you only have 20-25?

Assuming all your follow ups are 99214 and your consults are 99245, and that you see patients 46 weeks a year, you are generating 4375-6120 wRVUs in E&M alone. Assuming $50/wRVU that's 220k-306k in E&M alone on 1840-2530 E&M visits.

To put things in perspective, I average 6 consults a week, 11 follow ups a week, and will generate about 13k-16k wRVUs. I aggressively hypofrac breast and prostate, do Livi APBI when I can, and don't do a ton of oligomet treatments so these are probably pretty typical bread and butter numbers. You should be generating 30-40k wRVUs based on the numbers you mentioned so if you aren't getting paid 1.5-2 million a year either you're doing something wrong or your employer's doing something right.

Like .. how?

When I was at Banner, I was around 300-350 consults a year and barely could get 9000 RVUs

I’m not doubting you - I’m presuming I / Banner doing something wrong

 

[Ray D. Ayshun]

Like .. how?

When I was at Banner, I was around 300-350 consults a year and barely could get 9000 RVUs

I’m not doubting you - I’m presuming I / Banner doing something wrong

Yes, someone was doing something wrong.

 

[RSAOaky]

Like .. how?

When I was at Banner, I was around 300-350 consults a year and barely could get 9000 RVUs

I’m not doubting you - I’m presuming I / Banner doing something wrong

A hypofrac breast generates ~30-35 wRVUs, comprehensive 40-50. SBRT lung is ~45, Conventional lung is ~80, SRS ~35. I cut out unnecessary follow ups so a lot of my follow ups are patients needing additional treatments and the number of palliatives I see overall is pretty low. A hypofractionated breast is on the low end of reimbursement for a definitive treatment. Most of the treatment course numbers above do factor in the consult (~3.5 wRVUs) but not follow up billing. If you assume a blended wRVU rate of about 45 per course, you should have been generating 13000-16000 wRVUs.

 

[NotMattSpraker]

The local group made a fake call to our office asking about it and then hung up midway through call. The caller ID showed who it was.

LOL local Rad Onc?!

Hahaha, wow this field.

 

[deleted1111261]

thank god i'm off the rvu train

 

[metallica81788]

Those sound like RVU numbers, not wRVU numbers

 

[deleted1111261]

Those sound like RVU numbers, not wRVU numbers

(I was speaking about wRVU, sorry for unclear)

 

[RSAOaky]

Those are wRVU numbers

 

[RSAOaky]

These are the wRVU's generated on a 33 fraction lung course.

 

[Neuronix]

Is there a boost in there? How do you get a 77301 and a 77295 ?

 

[RSAOaky]

Is there a boost in there? How do you get a 77301 and a 77295 ?

Sorry good catch, updated it. Meant 77293 (4DCT)

 

[windcolour99]

These are the wRVU's generated on a 33 fraction lung course.

View attachment 379565

Does this include technique wRVU? or just professional wRVU?

In my practice, we only get professional wRVU. For a lung IMRT, it is much lower.

 

[TheWallnerus]

Does this include technique wRVU? or just professional wRVU?

In my practice, we only get professional wRVU. For a lung IMRT, it is much lower.

This is just wRVU

Your lung IMRTs might have more wRVU if you did an adaptive replan or two (and hopefully your hospital knows they can bill wRVUs for IGRT even though they get zero for the technical)

 

[RSAOaky]

Does this include technique wRVU? or just professional wRVU?

In my practice, we only get professional wRVU. For a lung IMRT, it is much lower.

wRVU's by definition are professional RVUs. They are RVUs generated by physician work.
You:
1) see the patient in consult
2) review the sim once it is done
3) comes up with contours
4) Review the treatment plan
5) See the patient each week for OTV
6) Review their CBCT daily

If you aren't getting credit for the above codes, you are doing work for free.

 

[RSAOaky]

This is just wRVU

Your lung IMRTs might have more wRVU if you did an adaptive replan or two (and hopefully your hospital knows they can bill wRVUs for IGRT even though they get zero for the technical)

This too, I generally don't replan my lungs but most head and necks get replanned during the course of treatment which generates new planning/sim codes.

 

[TheWallnerus]

This too, I generally don't replan my lungs but most head and necks get replanned during the course of treatment which generates new planning/sim codes.

In general, IMRT should achieve more wRVUs than 3D, for lung. This is a bit outdated now, in terms of codes (and especially fractions), but the idea still stands:

 

[RSAOaky]

The numbers I gave were the professional codes we bill for an IMRT lung with the current wRVU values attached to each of those codes, searchable here: Overview of the Medicare Physician Fee Schedule Search | CMS

Edit: The reason for IMRT generating more than 3D on the professional side is almost exclusively due to daily CBCT. The IMRT planning charges are generally slightly higher too.

 

[TheWallnerus]

The numbers I gave were the professional codes we bill for an IMRT lung with the current wRVU values attached to each of those codes, searchable here: Overview of the Medicare Physician Fee Schedule Search | CMS

Edit: The reason for IMRT generating more than 3D on the professional side is almost exclusively due to daily CBCT. The IMRT planning charges are generally slightly higher too.

Yes. It actually can be a close call on wRVUs, and in many other situations, depending on how the MD does the case, 3D can net more wRVUs than IMRT. Ascribing greediness to using IMRT is not always so pat and straightforward.

 

[NotMattSpraker]

Yes. It actually can be a close call on wRVUs, and in many other situations, depending on how the MD does the case, 3D can net more wRVUs than IMRT. Ascribing greediness to using IMRT is not always so pat and straightforward.

Please use IMRT on all cases of locally advanced NSCLC.

If you're a cost shaming ivory tower research type, feel free to quote me in your future paper.