ASTRO Actively Working Against Member's Interest

[communitydoc13]

to artificially prop up the job market

It is what it is. I'll take it.

Obviously residency contraction is never going to happen.

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[Mandelin Rain]

I don't think any reasonable rad onc wants a telehealth-only practice

Again, doctors, particularly reasonable doctors, haven't been in charge of health care for some time. No reasonable Emergency Medicine doctor wants any emergency medicine job.

 

[Reaganite]

Again, doctors, particularly reasonable doctors, haven't been in charge of health care for some time. No reasonable Emergency Medicine doctor wants any emergency medicine job.

OK, LOL. No reasonable radonc trying to run a successful practice in a competitive market is going to convert to telehealth only. Obviously rural is an exception, but you're talking rotating locums vs. NPs an maybe a consistent doc a week with JJ. Pick your poison there.

 

[NotMattSpraker]

Again, doctors, particularly reasonable doctors, haven't been in charge of health care for some time. No reasonable Emergency Medicine doctor wants any emergency medicine job.

Haha well thats a sweeping generalization and definitely not true in my very large, national hospital system.

If you want to be in charge, don't let people make policies for us without our input. 🤷‍♂️

 

[communitydoc13]

Is there any data showing this has compromised outcomes in any specialty?

It will be extremely hard to demonstrate this. It doesn't mean that there is not value to in person care.

A number of years ago we discussed the trial for outsourcing breast CA f/u to PCPs in Canada. The numbers were close enough that they called non-inferiority (the gross data indicated that it is likely that the oncs found a few more recurrences).

In general, I believe that the more virtual we become in providing health care, the more devalued we will become as a profession. I'm pretty confident of this, maybe I shouldn't be?

The very nature of community medicine is threatened by virtual care. Eventually, community hospitals will be repositories of hospitalists making 5 virtual consultations an admission. It's on the way.

 

[pikachu]

It will be extremely hard to demonstrate this. It doesn't mean that there is not value to in person care.

A number of years ago we discussed the trial for outsourcing breast CA f/u to PCPs in Canada. The numbers were close enough that they called non-inferiority (the gross data indicated that it is likely that the oncs found a few more recurrences).

In general, I believe that the more virtual we become in providing health care, the more devalued we will become as a profession. I'm pretty confident of this, maybe I shouldn't be?

The very nature of community medicine is threatened by virtual care. Eventually, community hospitals will be repositories of hospitalists making 5 virtual consultations an admission. It's on the way.

There's really no one like MD's for trying to put themselves out of work.

Compare and contrast with WGA and SAG...who are proactively addressing issues related to encroachment of AI into their professions. We are practically begging admins to take our jobs away from us and replace with less-trained 'providers' and/or computers. Insane

 

[RickyScott]

If you were allowed to be off site, would you do it every day?
NPs are at infusion centers. Medoncs still are working. Not marginalized.

Exactly. Much more risky in medonc, but it is done

 

[elementaryschooleconomics]

To take a different point of view:

We can argue amongst ourselves, to the most beautiful of eloquent highs and the most bizarre of pedantic lows, about the concept of "virtual OTVs", or supervision in general.

No one cares.

I say that bluntly not to be cruel but because this needs to be reframed.

This is how we got into trouble over the last 20 years. Probably longer.

How many people in this country can understand the points being made in this thread? Or even if they could, would they care?

I don't think anyone can stop this from happening. Technically it already happened.

You can either pivot into this new reality or...not.

Personally, if the only thing standing between me and unemployment is a requirement for me to be in the same building as a patient on the right day at the right time...

Well good Lord that sounds like a tenuous thread to be hanging on by.

I think we provide immense value to our patients and our hospitals, regardless of supervision requirements. It's up to us to make sure that our value is appreciated, because "linac babysitter" was never a long-term economic strategy.

 

[Ray D. Ayshun]

OTV day is when I get my baked goods and moonshine. Can't do that virtually.

 

[Mandelin Rain]

Haha well thats a sweeping generalization and definitely not true in my very large, national hospital system.

If you want to be in charge, don't let people make policies for us without our input. 🤷‍♂️

Sure. And I hope it was clear that it was a bit tongue in cheek.

But extend it out. I'm sure no reasonable anesthesiologist said "I want my career to be supervising 5 CRNAs simultaneously while rarely doing my own case."

Devalue your role in direct patient care for whatever gain at your own peril in this game.

 

[deleted1111261]

I think we devalue you ourselves by our actions, not rules.

Some things we do more than what is required - go to machine for each fx of a 70/10 lung case, 2 otvs a week for HNC (one is free), several visits in first 90 days after tx, etc.

Being a responsible physician is doing the minimum required for our patients, not what the government says.

As I said, this rule change doesn’t change my practice. But I hate this idea of “you absolutely cannot do this” when there isn’t a medical reason to force me to anything.

 

[temujim]

There was a time RTTs held us by the balls and/or other private parts when it came to the schedule. "Sorry, Dr. Johnson, 80 year old Mrs Brown with the T1a breast cancer getting partial breast radiation can only come in at 630 AM...you better be here or else."

I hate this attitude from RTTs and patients. Guess what Mrs Brown I got a job too... and that's between 8-5. These patients probably has more respect for their hair appointments than medical appointments. Just had this conversation with an RTT scheduling a SBRT after 5 without checking if acceptable -- the patient requested it! She'll be upset if we can't! It's your fault you didn't put timing in the sim order! GTFO. Change. This is not a negotiation.

 

[RadRadRad]

If you were allowed to be off site, would you do it every day?
NPs are at infusion centers. Medoncs still are working. Not marginalized.

Medoncs are not marginalized because their is still a shortage of them
As soon as their is a surplus, they too would be marginalized

 

[drowsy12]

How about if you're a solo doc in a rural location, maybe legally you'll be able to do telehealth 25 days a year. Like instead of casual Fridays it's casual telehealth days. Perhaps the sky's not falling if we do that. But if you have two or more docs in practice, no jeans days and and no telehealth EVER. I want to be a uniter and not a divider.

It is quite the sleight of hand for the tertiary referral centers to be so gung ho on telehealth consults (and oh my do the MSKCCs of the world love telehealth consults) but derisive about telehealth OTVs.

Sure I’m all for exception rules like this

 

[RickyScott]

To take a different point of view:

We can argue amongst ourselves, to the most beautiful of eloquent highs and the most bizarre of pedantic lows, about the concept of "virtual OTVs", or supervision in general.

No one cares.

I say that bluntly not to be cruel but because this needs to be reframed.

This is how we got into trouble over the last 20 years. Probably longer.

How many people in this country can understand the points being made in this thread? Or even if they could, would they care?

I don't think anyone can stop this from happening. Technically it already happened.

You can either pivot into this new reality or...not.

Personally, if the only thing standing between me and unemployment is a requirement for me to be in the same building as a patient on the right day at the right time...

Well good Lord that sounds like a tenuous thread to be hanging on by.

I think we provide immense value to our patients and our hospitals, regardless of supervision requirements. It's up to us to make sure that our value is appreciated, because "linac babysitter" was never a long-term economic strategy.

our value, like that of everything else, is set by scarcity. period.

 

[NotMattSpraker]

Sure. And I hope it was clear that it was a bit tongue in cheek.

But extend it out. I'm sure no reasonable anesthesiologist said "I want my career to be supervising 5 CRNAs simultaneously while rarely doing my own case."

Devalue your role in direct patient care for whatever gain at your own peril in this game.

I think we provide immense value to our patients and our hospitals, regardless of supervision requirements. It's up to us to make sure that our value is appreciated, because "linac babysitter" was never a long-term economic strategy.

Yea MR, and I agree. There is definitely something to be said for carefully taking on non-clinical duties because it's easier to cut or eliminate pay/jobs there compared to patient care in general.

ESE has it right though. We're not going to be able to control some powerful market pressures, even if we were all working together. We need to think carefully about collaborative strategy and every real life medical society level discussion keeps getting shut down.

Maybe one day we will get to a place where we can discuss supervision policy like in this thread today. But not anonymous and in an open town hall. I've seen ACR do this for radiology policies. Kind of ironic the best policy discussion happens on the big bad SDN...

Our most prominent policy influencer is clearly telling everyone with their actions that they are not supportive of open discussion of policy. Super damaging, I hope things get better soon.

Everyone should join the ACRO town hall, maybe that will show a better way (no idea, not involved).

 

[udrag14]

OTV day is when I get my baked goods and moonshine. Can't do that virtually.

You will lose weight virtually. Your PCP will be happy.

 

[sirspamalot]

ASTRO Mission is to help it's large academic centers. Anything they say.. All I hear is... "trust me bro"

Announcer : he did not

 

[radoncftw]

I hate this attitude from RTTs and patients. Guess what Mrs Brown I got a job too... and that's between 8-5. These patients probably has more respect for their hair appointments than medical appointments. Just had this conversation with an RTT scheduling a SBRT after 5 without checking if acceptable -- the patient requested it! She'll be upset if we can't! It's your fault you didn't put timing in the sim order! GTFO. Change. This is not a negotiation.

yes this happens to me.
and i tell them sorry i have to pick up my kids (actually my puppies) from daycare

 

[elementaryschooleconomics]

I hate this attitude from RTTs and patients. Guess what Mrs Brown I got a job too... and that's between 8-5. These patients probably has more respect for their hair appointments than medical appointments. Just had this conversation with an RTT scheduling a SBRT after 5 without checking if acceptable -- the patient requested it! She'll be upset if we can't! It's your fault you didn't put timing in the sim order! GTFO. Change. This is not a negotiation.

This.

This.

This.

The debate around RadOnc supervision in the post-pandemic world has very clear battle lines.

Anti-tele supervision? You assume the job market is held up by the frayed rope of linac babysitting (ASTRO), your job really is entirely dependent on linac babysitting (yikes), you're a resident/student who has yet to enter independent practice, or you're at a big academic system (where you did residency, or very similar to where you did residency) and you have strict departmental policies that you have never questioned so you think it's "law" (dogma is bad).

Obviously there's more nuance than that, but you get the point.

Because ASTRO is run by academics who forget to look outside their garden walls (and also the alleged criminals at 21C), and almost all publications are authored by people who work for or with the ASTRO cult, there is little understanding of what the majority of RadOnc practices are.

They are community hospitals, now increasingly part of a big system and/or a network satellite of an academic system that is only loosely attached to the mothership. There's even some traditional private practices too!

Rigid direct supervision requirements absolutely castrated the Radiation Oncology physician.

I'll ask a simple question:

Has anyone taken a job replacing a retiring Boomer RadOnc at a 1-2 doc practice in the last 5 years? Did that practice have a small staff that had been there forever, and most notably, a couple therapists who had been working with that Boomer RadOnc for the last 10-20 years?

Because I've done that.

Twice.

The first time you see an SBRT double booked with something you know will be a problem (challenging consult, meeting in another building, long after normal treatment times end etc) and you try to address it...what happens?

Do they do it again the very next chance they get?

Do they angrily throw things in your face about "the hometown touch", or do you get unexpectedly ambushed in chart rounds and one of them pulls out a folder with a piece of printer paper with patient names written in pencil and a precise accounting of all the times you somehow almost destroyed the planet because you told them you couldn't be triple booked with two clinic appointments and an SBRT at noon?

I could go on for about 100 more very specific examples, but the point is that this is happening over and over and over across the country right now.

Not being shackled by direct supervision has allowed me to be exponentially more productive. I'm genuinely confused by some of the arguments against it, but I recognize it's probably because in my current job I was able to get a raise in my first 6 months using the line "good luck finding someone to replace me" and it definitely wasn't a bluff.

But even though I've completely modernized the clinical pathways and radiotherapy regimens, optimized the revenue cycle and have had us nailing the budget targets month over month...

I'm basically Satan to the old RTTs because I usually show up 7 minutes after the linac turns on, make them adhere to our established treatment times, and just shrug when they say "well we used to ALWAYS do XYZ so..."

 

[DebtRising]

Disagree, virtual options only hurt young MDs on the whole, and also are subpar clinical evaluations at best. If the visits don’t matter, don’t do them.

 

[medgator]

Sure I’m all for exception rules like this

This would solve the dilemma. Keep a certain % or # as tele eligible. Aka no more than 15% of visits a year.

Tele was invaluable when I too sick to go in but ok enough to sit at a computer and talk to pts via teams

 

[sirspamalot]

It's all made up nonsense. No clinical benefit to being in person has been demonstrated.. We are using good judgment and that is what doctors should be trusted to do.

The lack of trust is what has killed medicine. And by lack of trust I mean "admin doing whatever it wants to max profit"

 

[A_DeMichele]

Under-the-beam patients should be looked after carefully - no one would argue with that. You don't even need formal in-person OTV schedule for that.

What are you guys arguing about is: should admin be able to capture OTV charges with the help of telemedicine? Sure

 

[RadRadRad]

…if only we had the ability to charge based on service….like every other industry in the USA.
You want to actually see your doctor every week in person during radiation then come to cancer Center X. You ok with being seen by the doctor at consult and never again then go to bargain basement cancer center Y

Different levels of service deserve different levels of reimbursement

 

[TheWallnerus]

It's all made up nonsense. No clinical benefit to being in person has been demonstrated.. We are using good judgment and that is what doctors should be trusted to do.

The lack of trust is what has killed medicine. And by lack of trust I mean "admin doing whatever it wants to max profit"

 

[evilbooyaa]

I think it should be an option and I don't think the 5-10% of people who are crap, uncaring Rad Oncs nationally abusing it is sufficient enough to punish the other 90-95%+ of the population that will either 1) not use it or 2) use it in a responsible manner.

 

[RO28]

This.

This.

This.

The debate around RadOnc supervision in the post-pandemic world has very clear battle lines.

Anti-tele supervision? You assume the job market is held up by the frayed rope of linac babysitting (ASTRO), your job really is entirely dependent on linac babysitting (yikes), you're a resident/student who has yet to enter independent practice, or you're at a big academic system (where you did residency, or very similar to where you did residency) and you have strict departmental policies that you have never questioned so you think it's "law" (dogma is bad).

Obviously there's more nuance than that, but you get the point.

Because ASTRO is run by academics who forget to look outside their garden walls (and also the alleged criminals at 21C), and almost all publications are authored by people who work for or with the ASTRO cult, there is little understanding of what the majority of RadOnc practices are.

They are community hospitals, now increasingly part of a big system and/or a network satellite of an academic system that is only loosely attached to the mothership. There's even some traditional private practices too!

Rigid direct supervision requirements absolutely castrated the Radiation Oncology physician.

I'll ask a simple question:

Has anyone taken a job replacing a retiring Boomer RadOnc at a 1-2 doc practice in the last 5 years? Did that practice have a small staff that had been there forever, and most notably, a couple therapists who had been working with that Boomer RadOnc for the last 10-20 years?

Because I've done that.

Twice.

The first time you see an SBRT double booked with something you know will be a problem (challenging consult, meeting in another building, long after normal treatment times end etc) and you try to address it...what happens?

Do they do it again the very next chance they get?

Do they angrily throw things in your face about "the hometown touch", or do you get unexpectedly ambushed in chart rounds and one of them pulls out a folder with a piece of printer paper with patient names written in pencil and a precise accounting of all the times you somehow almost destroyed the planet because you told them you couldn't be triple booked with two clinic appointments and an SBRT at noon?

I could go on for about 100 more very specific examples, but the point is that this is happening over and over and over across the country right now.

Not being shackled by direct supervision has allowed me to be exponentially more productive. I'm genuinely confused by some of the arguments against it, but I recognize it's probably because in my current job I was able to get a raise in my first 6 months using the line "good luck finding someone to replace me" and it definitely wasn't a bluff.

But even though I've completely modernized the clinical pathways and radiotherapy regimens, optimized the revenue cycle and have had us nailing the budget targets month over month...

I'm basically Satan to the old RTTs because I usually show up 7 minutes after the linac turns on, make them adhere to our established treatment times, and just shrug when they say "well we used to ALWAYS do XYZ so..."

I am consistently between 2-10 minutes late...thankfully I am a nicer person than the boomer rad onc that was here before me

 

[elementaryschooleconomics]

I am consistently between 2-10 minutes late...thankfully I am a nicer person than the boomer rad onc that was here before me

Hahaha -

I've never talked about my arrival time (in real life).

If it happens to come up in the future, I would absolutely not say I show up "late".

I show up precisely when I mean to arrive!

Whether or not the linac is running before I arrive? That's an independent variable.

The linac running and when I first show up in the morning have the same relationship as the migratory patterns of birds and the rotational speed of Jupiter.

 

[sirspamalot]

Yes, indeed. Until the RTT's get uncomfortable with something and one stabs you in the back by writing 'to the chain of command' about how you weren't instantly available.

Be careful out there folks, and make sure you're in tight with higher level admin (and your contract says usual and customary not specific hours of being present!).

 

[elementaryschooleconomics]

Yes, indeed. Until the RTT's get uncomfortable with something and one stabs you in the back by writing 'to the chain of command' about how you weren't instantly available.

Be careful out there folks, and make sure you're in tight with higher level admin (and your contract says usual and customary not specific hours of being present!).

This is extremely true.

On a local level, it's very important you make close friends with admin. Nationally, or on the internet, crusade against the word "provider" or "wellness retreats" or anything else of that nature.

Obviously I do.

But on your home turf, the C-suite should be happy to see you, maybe some of them text you back and forth with memes and whatnot.

Totally...theoretical example of course...

 

[RO28]

kindness goes a long way when you suck at getting out the door in the morning

 

[IonsAreOurFuture]

It further marginalizes our role.

if we can never be around, why do the med onc or cancer center even need us?

slippery slope

The jobs that require someone to be around simply for the sake of being around, are not going to be around

 

[IonsAreOurFuture]

It will be extremely hard to demonstrate this. It doesn't mean that there is not value to in person care.

A number of years ago we discussed the trial for outsourcing breast CA f/u to PCPs in Canada. The numbers were close enough that they called non-inferiority (the gross data indicated that it is likely that the oncs found a few more recurrences).

In general, I believe that the more virtual we become in providing health care, the more devalued we will become as a profession. I'm pretty confident of this, maybe I shouldn't be?

The very nature of community medicine is threatened by virtual care. Eventually, community hospitals will be repositories of hospitalists making 5 virtual consultations an admission. It's on the way.

I have been told that already a tele-neurology group is the largest prescriber of TPA for strokes in the ER setting nationwide. No need to go in, just review the case and images from home, like the imaging specialists do.

In theory and in practice, our field could do the same. Isn't there a center in Canada that already proved this?

 

[deleted1111261]

The jobs that require someone to be around simply for the sake of being around, are not going to survive

This is crucial.

We created a system that requires our presence but the data doesn’t suggest we need to be present.

If we had 30-40% less ROs, we would all have enough work to keep us there all day. But, bc of the Pareto situation, guys like Gator and OTN see 12-14 consults a week and many of us see 3-4.

We need to find a role for ourselves. Not just, “be there”. Should be doing something valuable.

And do note, I’m no fan of 100% virtual. I just don’t think it needs to be 100% in-person.

 

[elementaryschooleconomics]

The jobs that require someone to be around simply for the sake of being around, are not going to survive

EXACTLY.

While I am in the "pro" camp for both general supervision and virtual direct - it's not because I am "against" the points made when arguing on behalf of returning to traditional definitions of direct supervision.

The spirit of what supervision is supposed to be about is patient safety.

Traditional direct supervision is ALSO not adequate, by itself, for safety.

But the majority of the anxiety around this seems to be tied to jobs.

If a job only exists because it has a large linac babysitting component - that is not a safe job.

I would rather we see that job lost NOW, likely when a Boomer retires and a practice decides not to replace them, than the alternative:

The job is cut in 3-4 years when a new grad is in it.

Because that's what we're facing at this point in time. Inertia is real. Very real.

This is when the silver tsunami happens. The turnover due to retirement is inevitable.

More than anything, I desperately want that position to just fade into the sunset BEFORE some young kid with a family moves across the country for it, only to be back on the job search before the decade is out.

 

[IonsAreOurFuture]

EXACTLY.

While I am in the "pro" camp for both general supervision and virtual direct - it's not because I am "against" the points made when arguing on behalf of returning to traditional definitions of direct supervision.

The spirit of what supervision is supposed to be about is patient safety.

Traditional direct supervision is ALSO not adequate, by itself, for safety.

But the majority of the anxiety around this seems to be tied to jobs.

If a job only exists because it has a large linac babysitting component - that is not a safe job.

I would rather we see that job lost NOW, likely when a Boomer retires and a practice decides not to replace them, than the alternative:

The job is cut in 3-4 years when a new grad is in it.

Because that's what we're facing at this point in time. Inertia is real. Very real.

This is when the silver tsunami happens. The turnover due to retirement is inevitable.

More than anything, I desperately want that position to just fade into the sunset BEFORE some young kid with a family moves across the country for it, only to be back on the job search before the decade is out.

You can bet that if the code for weekly professional supervision went away, or was bundled into an episode of payment, we as a professional society would very quickly establish how few of these visits are truly medically necessary.

So why do we still do them?

Cue Fiddler on the Roof...

TRADITION! TRADITION!

That, and because they form a very large portion of our bread and butter

 

[drowsy12]

We created a system that requires our presence but the data doesn’t suggest we need to be present.

So it’s a good thing if we all on average do more work for the same money? Isn’t like half the appeal of rad onc golden age people banking while chilling?

Not sure less chill is a boon we should be hoping for?

this is assuming that what Ricky Scott says is true and it’s just all about supply and demand for pay and not about work. Rad onc has been incredibly lucky to get paid very well per unit work on a ‘pound forPound’ fashion. I would be wary of that changing.

Overall though my goal is more to avoid a bridge onc takeover of the field, not having any safety concerns about virtual OTV. I think virtual OTVs are fine, I just know that smart admins and hospital execs can take it father.

Any of us if we were in power and not rad oncs could think of multiple ways to make people work harder or see more patients in a more ‘efficient’ manner. That’s what I’m a bit wary of.

And also I can see why Astro would want to protect the field in this way. It may not be sexy but it absolutely is part of why rad onc has been rad onc for all these decades.

 

[NotMattSpraker]

Overall my goal is more to avoid a bridge onc takeover of the field, not having any safety concerns about virtual OTV

Interesting. I think Bridge Oncology is unlikely to impact the jobs of most radiation oncologists.

Consolidation and hospital employment are much more important trends. In my opinion a better question is: what will the job of a hospital employed or academic satellite rad onc look like in 2035?

 

[elementaryschooleconomics]

So it’s a good thing if we all on average do more work for the same money? Isn’t like half the appeal of rad onc golden age people banking while chilling?

Not sure less chill is a boon we should be hoping for?

You shouldn't assume this is a choice that is ours to make anymore.

"Banking while chilling" was indeed an option from 2002-2012.

And now the rest of us have to pick up the pieces.

Direct supervision isn't the shield to hide behind.

It's, at best, a mosquito net you're holding to stop a freight train.

 

[drowsy12]

Interesting. I think Bridge Oncology is unlikely to impact the jobs of most radiation oncologists.

Consolidation and hospital employment are much more important trends. In my opinion a better question is: what will the job of a hospital employed or academic satellite rad onc look like in 2035?

I mean more the spirit of Bridge than Bridge itself.

You say it exactly. A hospital admin could make your job quite different in 2035, using Bridge principles

 

[drowsy12]

You shouldn't assume this is a choice that is ours to make anymore.

"Banking while chilling" was indeed an option from 2002-2012.

And now the rest of us have to pick up the pieces.

Direct supervision isn't the shield to hide behind.

It's, at best, a mosquito net you're holding to stop a freight train.

Fun analogies aside, it would be willingly giving up the field to turn rad onc into anesthesia with one doc supervising many ‘below’ from a central location.

It’s not something to hide behind. It’s something to protect.

I realize this may sound like I’m going too far, but there’s little to stop it from happening if we let that go.

This is another tragedy of the commons situation pending and people are at risk of ignoring the risks for their own convenience, exactly like residncy expansion.

 

[IonsAreOurFuture]

Interesting. I think Bridge Oncology is unlikely to impact the jobs of most radiation oncologists.

Consolidation and hospital employment are much more important trends. In my opinion a better question is: what will the job of a hospital employed or academic satellite rad onc look like in 2035?

In 2035, the hospital network or academic conglomerate may view the small hospital employed physician as the edge of a large funnel, whose purpose it is to send appropriate cases to the proton center at the tertiary hub, for a "higher level of care." This is by coincidence where they also happen to be exempt from the ROCR model, or are part of the PPS-exempt mothership.

 

[TheWallnerus]

This is crucial.

We created a system that requires our presence but the data doesn’t suggest we need to be present.

If we had 30-40% less ROs, we would all have enough work to keep us there all day. But, bc of the Pareto situation, guys like Gator and OTN see 12-14 consults a week and many of us see 3-4.

We need to find a role for ourselves. Not just, “be there”. Should be doing something valuable.

And do note, I’m no fan of 100% virtual. I just don’t think it needs to be 100% in-person.

We have to remember we had people like Ron D saying 14 years ago that contouring from home was illegal. Eventually, he changed… that one was just too silly long term for people to take seriously.

 

[TheWallnerus]

In 2035, the hospital network or academic conglomerate may view the small hospital employed physician as the edge of a large funnel, whose purpose it is to send appropriate cases to the proton center at the tertiary hub, for a "higher level of care."

Palliate in the community center of excellence, cure at the proton mothership…

Tracks

 

[drowsy12]

In 2035, the hospital network or academic conglomerate may view the small hospital employed physician as the edge of a large funnel, whose purpose it is to send appropriate cases to the proton center at the tertiary hub, for a "higher level of care."

In your dreams

(Sorry had to say it)

 

[elementaryschooleconomics]

Fun analogies aside, it would be willingly giving up the field to turn rad onc into anesthesia with one doc supervising many ‘below’ from a central location.

It’s not something to hide behind. It’s something to protect.

I realize this may sound like I’m going too far, but there’s little to stop it from happening if we let that go.

This is another tragedy of the commons situation pending and people are at risk of ignoring the risks for their own convenience, exactly like residncy expansion.

"Protect"...what?

Almost exactly four years ago (November 1st, 2019) is when CMS issued the final rule regarding general supervision for hospital outpatient departments.

Even though it excludes freestanding...freestanding centers have been a shrinking minority for years. In 2016 only about 33% of radiotherapy was done in freestanding shops...and most of that was 21C/Genesis. It's hard to tell what it's at now, but I would estimate only 25% (based on data floating around not meant to capture that specifically so I can't be precise).

So the only thing not set in absolute stone yet is virtual OTVs, which has been an option for years as well. It's not like a ton of practices are routinely doing virtual OTVs anyway. I've personally never done one, I don't plan on doing any for the foreseeable future - but I deserve the option.

That's what this is about - regulating away our autonomy. Why do I even need to do residency in this dystopian future ASTRO is envisioning?

If everything ASTRO is advocating for comes to pass:

1) My APEx-accredited practice means I am "encouraged" to utilize guidelines/pathways for workup and treatment planning.
2) My reimbursement comes as a flat rate through ROCR.
3) If the linac is on, I must be bodily present until it turns off.
4) I am unable to offer any telehealth services for my patients other than follow-ups and MAYBE the consult.

So if the concern is that virtual services/supervision would hurt the job market because a single doc could oversee multiple sites, facilitated by the help of mid-level providers...

My concern about trying to bring back "the way it used to be" would help turn ME into a mid-level provider.

I didn't go through all this training just so a professional society could publish a small PDF every few years that contains the instructions for how I need to do my day job.

 

[NotMattSpraker]

In 2035, the hospital network or academic conglomerate may view the small hospital employed physician as the edge of a large funnel, whose purpose it is to send appropriate cases to the proton center at the tertiary hub, for a "higher level of care." This is by coincidence where they also happen to be exempt from the ROCR model, or are part of the PPS-exempt mothership.

Pure coincidence. Always assume the best intents

I mean more the spirit of Bridge than Bridge itself.

You say it exactly. A hospital admin could make your job quite different in 2035, using Bridge principles

Right, the admin or admin-y doctor that makes admin-like decisions. The managing partner, chair, clinical vice chair, whatever.

I said it before, there are changes that we cannot impact, the forces are too strong even for the adminiest of admins. You are not going to justify a median salary of 500K a year seeing 4-6 new patients a week just because you are willing to sit around in person for unclear clinical reasons.

My point was that Bridge should not be the concern in this week's completely unnecessary Rad Onc drama. My concern would be all the Rad Oncs that miss their passive income from years ago (see WSJ) and are now in admin roles trying to fight inevitable changes to preserve their own benefit instead of lobbying for the best 2035.

This is just my opinion, but I think actions support it. I do not want admin-y Rad Oncs hiring up all the new doctors as commodities and turning around to lobby on Medicare rules behind closed doors with no discussion.

Maybe this should be way more alarming, or maybe I need a tin foil hat.

 

[sirspamalot]

median salary of 500

You mistyped the #.

That'll be 750 please.

 

[sirspamalot]

D unit has made himself millions and millions and millions telling rad oncs what to do, while becoming the de facto ASTRO and ACRO Rep for all things... with an aw shucks who me attitude and personable demeanor that has served him well.

COI aside with ASTRO/ACRO, which were impressive and beautifully sidetracked, you gotta hand it to the man. While we worried about supervision and 2% medicare cuts, he was able to charge 400/hr for his consultants to tell your admin what to do, while kindly providing his billing services and don't forget those audits.

Admin is happy to pay D unit handsomely, but when it comes to your interchangeable medical services, why, you had best be grateful you get paid at all...