Supply of Rad Oncs to Outpace Demand 2015-2025

[scarbrtj]

I like the part, "Further research is needed to determine whether this is an appropriate correction or will result in excess capacity." (Hey young people, experiment with radiation oncology as a residency/career choice; if you find yourself unemployable after residency, please write Dr. Smith at [email protected] so he can update the data...)

www.redjournal.org/article/S0360-3016(16)00233-9/fulltext

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[medgator]

Took the ivory tower a couple of years to finally publish what most of us have already seen in the job market

http://forums.studentdoctor.net/threads/bloodbath-in-red-journal.1014614/

 

[BobbyHeenan]

We've discussed this a ton here, but one point that many have brought up is that using SEER to research this is pretty imprecise. It gives you the most "numbers" and produces something you can do calculations on and put out a paper, but that's not the whole story. This is discussed in some detail in these JCO and Red Journal papers, but I think these difficult-to-quantify dynamics are very important. I'm not sure that we are fully taking into account some phenomena that practicing rad oncs have been discussing or implementing for years which also contributes to decreasing demand....

1. Hypofractionation and SBRT. Breast, prostate, lung, palliative cases et al are often treated in shorter courses than were used 10 years ago. You may see the same number of new consults you saw 10 years ago, but your linac isn't treating as many fractions.
2. Use of mid levels. When senior partners are retiring many groups are not hiring replacements - they're picking up mid levels/NP to help in clinic and just disbursing the retiring partners volume through the group. With declining reimbursement its more palatable to just pick up that volume and use your mid level to help manage some of the clinic while you do more treatment planning.

It's going to be hard to get a perfect estimate of supply/demand, but a combination of "soft variables" like input from community physicians, surveys from graduating residents, etc are important in this whole discussion as well.

 

[scarbrtj]

Hypofractionation and SBRT. Breast, prostate, lung, palliative cases et al are often treated in shorter courses than were used 10 years ago. You may see the same number of new consults you saw 10 years ago, but your linac isn't treating as many fractions.

Amen. The one big overlooked variable IMHO. The main (only?) two determinants of how busy the linacs are: 1) number of new consults per week, 2) average number of weeks of treatment per patient. So, if you see 5 new patients a week and average treatments are five weeks long, you will treat on average 5x5 patients a day. Nowadays, with single-fx bony met tx, more hypofx of breast, GBM, prostate, and definitive lung, I'd say the average number of weeks of treatment per patient is closer to three, maybe less. That's HUGE in terms of decreasing rad onc demand... as now, if you see 5 new patients per week, daily treatments would drop to 5x3 = 15 from 5x5 =25. (This is why the pure prostate centers can be SO profitable as their average number of weeks of treatment per patient can be 9, so with just 5 new patients per week 5x9 = 45 patients under treatment per day.)

BTW, am I the only guy who uses this average number of weeks treatment "rule"? I made it up on my own, but I guess lots of other people realize this, too. If not, you're welcome

 

[CaesarRO]

Amen. The one big overlooked variable IMHO. The main (only?) two determinants of how busy the linacs are: 1) number of new consults per week, 2) average number of weeks of treatment per patient. So, if you see 5 new patients a week and average treatments are five weeks long, you will treat on average 5x5 patients a day. Nowadays, with single-fx bony met tx, more hypofx of breast, GBM, prostate, and definitive lung, I'd say the average number of weeks of treatment per patient is closer to three, maybe less. That's HUGE in terms of decreasing rad onc demand... as now, if you see 5 new patients per week, daily treatments would drop to 5x3 = 15 from 5x5 =25. (This is why the pure prostate centers can be SO profitable as their average number of weeks of treatment per patient can be 9, so with just 5 new patients per week 5x9 = 45 patients under treatment per day.)

BTW, am I the only guy who uses this average number of weeks treatment "rule"? I made it up on my own, but I guess lots of other people realize this, too. If not, you're welcome

Formula makes sense and you are right when considering the impact of hypofractionation. You're just not considering the factors that affect the other variable - the number of new consults per week. As prevalence of cancer increases and new indications pop up you might end up with enough new patients to compensate.

I'm still early on and far from the "looming employment crisis", but I wanted to point out that even using your formula, you're only looking at one of many factors.

 

[Krukenberg]

Formula makes sense and you are right when considering the impact of hypofractionation. You're just not considering the factors that affect the other variable - the number of new consults per week. As prevalence of cancer increases and new indications pop up you might end up with enough new patients to compensate.

I'm still early on and far from the "looming employment crisis", but I wanted to point out that even using your formula, you're only looking at one of many factors.

I also wonder whether radiation for prostate may become more appealing to patients as the time burden decreases, hence maybe increasing the number of new consults. Even if it's just more patients interested in hearing about RT from a rad onc, that should increase the number of people on treatment.


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[thecarbonionangle]

"Further research is needed to determine whether this is an appropriate correction or will result in excess capacity."

Translation: Nothing will be done. The ivory tower "leadership" will "consider" doing something about it if the job market ever gets bad enough to affect our graduates.

 

[Mandelin Rain]

"Further research is needed to determine whether this is an appropriate correction or will result in excess capacity."

Translation: Nothing will be done. The ivory tower "leadership" will "consider" doing something about it if the job market ever gets bad enough to affect our graduates.

I think they've already done it. They've added PGY6 years.

 

[evilbooyaa]

I also wonder whether radiation for prostate may become more appealing to patients as the time burden decreases, hence maybe increasing the number of new consults. Even if it's just more patients interested in hearing about RT from a rad onc, that should increase the number of people on treatment.


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Wouldn't bank on that IMO. Urologists will still get the patients first and RP everyone they want to regardless of risk, Rad Onc will perenially deal with the adjuvant/salvage cases or the medically inoperable folks.

 

[medgator]

Wouldn't bank on that IMO. Urologists will still get the patients first and RP everyone they want to regardless of risk, Rad Onc will perenially deal with the adjuvant/salvage cases or the medically inoperable folks.

RP? Takes too long and can get difficult to do on older/sicker patients. The real upstanding community urologists will do Cryo/HIFU if they aren't part of a uro-rads setup.

 

[Mathguy12]

RP? Takes too long and can get difficult to do on older/sicker patients. The real upstanding community urologists will do Cryo/HIFU if they aren't part of a uro-rads setup.

Only as long as the public is fearful of "radiation." Imagine if we had commercials like new drugs that come out: "Ask your oncologist if temperature controlled light beam therapy is right for your cancer." People would much rather go to a glorified tanning booth than an OR for their cancer treatment.

 

[medgator]

Only as long as the public is fearful of "radiation." Imagine if we had commercials like new drugs that come out: "Ask your oncologist if temperature controlled light beam therapy is right for your cancer." People would much rather go to a glorified tanning booth than an OR for their cancer treatment.

Advertising only works so well. Unlike most other cancers, urologists almost always get the elevated PSA and prostate nodule pts first, hence they control the flow of patients to radiation.

 

[RadOncDoc21]

Advertising only works so well. Unlike most other cancers, urologists almost always get the elevated PSA and prostate nodule pts first, hence they control the flow of patients to radiation.

True, but maybe it could get patients to ask their Urologist if there are alternative treatments.

I could not tell you how many of my post RP patients that told me RT wasn't even mentioned to them as an option or if it was, it was stated in a way that made them think it's not a definitive form of treatment.

 

[subatomicdoc]

True, but maybe it could get patients to ask their Urologist if there are alternative treatments.

I could not tell you how many of my post RP patients that told me RT wasn't even mentioned to them as an option or if it was, it was stated in a way that made them think it's not a definitive form of treatment.

This is why radiation oncologists would benefit from public discourse on the value we bring to cancer care. Increasingly, patients are doing their own research. If we can explain what we do well, then the power of the referral chain weakens and patients may seek consults after seeing their surgeon.

Currently, many pathologists and radiologists have figured out this concept and are very active online raising public awareness. Why? Because when if comes to value based payments, if we don't explain our value, others will.

 

[Krukenberg]

This is why radiation oncologists would benefit from public discourse on the value we bring to cancer care. Increasingly, patients are doing their own research. If we can explain what we do well, then the power of the referral chain weakens and patients may seek consults after seeing their surgeon.

Currently, many pathologists and radiologists have figured out this concept and are very active online raising public awareness. Why? Because when if comes to value based payments, if we don't explain our value, others will.

I know you're very active on social media, what are some things individual rad oncs can do to get the word out to patients more broadly?


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[thecarbonionangle]

does anybody know anything about military radiation oncology? they claim that one can practice one's specialty in the military and you will have a job plus give back to this country. I'm curious if anybody knows anything about this specifically. As job concerns grow, is this an option?

 

[Sheldor]

does anybody know anything about military radiation oncology? they claim that one can practice one's specialty in the military and you will have a job plus give back to this country. I'm curious if anybody knows anything about this specifically. As job concerns grow, is this an option?

I looked into it years ago, and for our specialty the options are very limited. The positions are at the military few military hospitals you generally hear about. What really turned me off to it as that when I spoke with a doc they really drove home that you are a "soldier first." This means that you could be chilling zapping people with radiation and then the next day you're in Iraq because they need soldiers. I know it may seem obvious now in retrospect, but I thought that there must be a way to serve in the military as a doctor and not be at risk for going to war.

 

[medgator]

I looked into it years ago, and for our specialty the options are very limited. The positions are at the military few military hospitals you generally hear about. What really turned me off to it as that when I spoke with a doc they really drove home that you are a "soldier first." This means that you could be chilling zapping people with radiation and then the next day you're in Iraq because they need soldiers. I know it may seem obvious now in retrospect, but I thought that there must be a way to serve in the military as a doctor and not be at risk for going to war.

I would think working for the VA would be the obvious choice there. Plus in some of the large VAMC hospitals, you'll have university/academic hospital affiliation, rotating residents through etc. Pay isn't amazing (seemed to on par with starting hospital salaries with not much upside), but there is the reasonable/predictable schedule and fringe benefits.

 

[RadOncDoc21]

You wouldn't want me out there with a gun! I think he meant more being on a base without having to actually be involved in fighting ISIS or possibly Mexico in the future.

 

[thecarbonionangle]

Certainly there is not doubt that the chance of war will be higher under the next administration (Iran, North Korea, Re-invasion of Iraq, anybody who tweets things he doesn't like). However, you are an "officer" and if you are "deployed" you aren't the guy/woman out there with a gun clearing a house. My undestanding is that working at the VA and working in a military hospital are two different things. The military hospitals are staffed by physicians in the branches of the military and the VA are government employees but not in the military. I was hoping maybe someone knew someone who has done this but It's probably quite rare to be a rad onc in the military but they are out there for sure.

 

[thesauce]

does anybody know anything about military radiation oncology? they claim that one can practice one's specialty in the military and you will have a job plus give back to this country. I'm curious if anybody knows anything about this specifically. As job concerns grow, is this an option?

I know quite a bit about it. Money is not as good, but excellent job security. Depending on the branch, there are a handful of places you could end up working. Patient load per doc is generally pretty low and you can locums.

 

[thecarbonionangle]

which locations would be options for Navy, Army, Airforce? (I presume there is no such thing as coastguard rad onc)