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she was an ER doc. did not work out well. pretty horrible story altogether
Unsolicited Jobs Thread
- Thread starter Gfunk6
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Serious?
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was wondering the same, have heard of rad oncs getting referrals for elevated PSAs in GU-aggressive markets to do TRUS biopsies and workups, so I wouldn't rule out anything....
Dead serious. How many times do you have a follow up patient ask you about a skin spot? I got sick of calling a couple dermatologists in town and begging them to get them in just to see that the spot was poorly radiated at the patient’s next follow up. But like I said, I don’t use it as much as I intended when I hired her a few years back as I’m in a unique situation where I can’t get too busy or admins might make me hire another full time doc and I’m not ready for that. I’ve got skin biopsies and OA in the back pocket for when we lose breast or some other site in the near future with advancement of ctDNA technology lol.
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Woof dude/ette. I'm all for doing reasonable things to expand a practice but I don't love the idea of unilaterally biopsying skin lesions to identify cancer and then irradiating them in a vaccuum without discussing surgical resection. Like yes, if a patient is getting RT for skin cancer I'd prefer it to be with a Rad Onc and not some Derm who stayed in a Holiday Inn express last night. But is RT the correct answer for EVERY skin cancer out there? I don't think so.
Do you know what skin cancer looks like? What will be your number needed to biopsy to find a skin cancer? And does all skin cancer need treatment, especially if they're in f/u for like.... real cancer?
I get that maybe you're just defending your turf or whatever but I'm not really sure that the best way to combat poor medical practices is by.... also performing poor medical practices. A Rad Onc evaluating a skin lesion and biopsying? Did you do a weekend course on identifying skin cancers? A Rad Onc NP biopsying skin lesions? Are you going to go to local nursing homes as well and try to pick up some skin cases?
Lot of assumptions in your post.
I’m going to assume you don’t treat a lot of skin cancer if you don’t know an obvious skin cancer when you see it. I wouldn’t biopsy anything that wasn’t an obvious skin cancer that needs some type of treatment, otherwise I would send to back to derm. My market is different from yours, but might be like others. There’s a shortage of dermatologists in my area and it takes forever to get into them. Also, the main derm group in town loves RT more than surgery.
I would also assume that you would have a balanced discussion when appropriate with your patients about the role of surgery, just as we do with early stage NSCLC, HCC, brain mets seen on follow-up MRIs, etc…
And no I’m not planning on going to any nursing homes. As I said, I’m too busy as it is and rarely biopsy skin cancers, but I am glad that I have the ability to do it in my clinic and I think it might be a good thing for other clinics to consider. I just think our specialty needs to think outside of the box, quit being so passive and not be so afraid to “rock the boat”. Our leaders should have gotten us into the immunotherapy game years ago. Neuro onc, gyn onc are in the systemic therapy game with a lot less oncology knowledge than us, but I digress.
I’m going to assume you don’t treat a lot of skin cancer if you don’t know an obvious skin cancer when you see it. I wouldn’t biopsy anything that wasn’t an obvious skin cancer that needs some type of treatment, otherwise I would send to back to derm. My market is different from yours, but might be like others. There’s a shortage of dermatologists in my area and it takes forever to get into them. Also, the main derm group in town loves RT more than surgery.
I would also assume that you would have a balanced discussion when appropriate with your patients about the role of surgery, just as we do with early stage NSCLC, HCC, brain mets seen on follow-up MRIs, etc…
And no I’m not planning on going to any nursing homes. As I said, I’m too busy as it is and rarely biopsy skin cancers, but I am glad that I have the ability to do it in my clinic and I think it might be a good thing for other clinics to consider. I just think our specialty needs to think outside of the box, quit being so passive and not be so afraid to “rock the boat”. Our leaders should have gotten us into the immunotherapy game years ago. Neuro onc, gyn onc are in the systemic therapy game with a lot less oncology knowledge than us, but I digress.
alwaysbeIMRTing
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I don't see an ethical problem with this if you (or your tech) performs a biopsy and confirms path and the patient declines referral for excision (which I can see in rural areas without a derm). You are providing a service in these settings as we all have seen the 90 year old farmers with 9 cm neglected basal cells because there were no derm or even gen surg to handle it and they weren't going to travel for anything else. Radiation is the patient's only option to treat the cancer.
I don't even have a problem with a rad onc getting adequately trained to perform WLE. I don't exactly know how you would do that to get properly credentialed, but of course you don't need 4 years of derm residency to learn how to do that. PCPs do it. It's theoretically possible and I'm sure some rad onc out there is doing it.
I don't even have a problem with a rad onc getting adequately trained to perform WLE. I don't exactly know how you would do that to get properly credentialed, but of course you don't need 4 years of derm residency to learn how to do that. PCPs do it. It's theoretically possible and I'm sure some rad onc out there is doing it.
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Maybe my favorite movie of all time is Albert Brooks’ ‘Defending Your Life’ and the main premise of that movie is that human life on earth is dominated by…
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These kinds of deals for rads are common
Someone should do a study of contract-specified vacation days per year radiology vs rad onc
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1 week on, 2 weeks off is becoming very common for night hawks working in large hospital groups from what I'm seeing. And you get to work from home
alwaysbeIMRTing
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And if you live in Puerto Rico for 183 days a year, you can pay 4% federal income tax while you read remotely. I have a total unicorn rad onc job, but still... I chose the wrong field. I cannot practice from Puerto Rico, and if I want to take more than 2 days off in a row I have to do a triple backflip to find someone to cover for me and my RVUs vanish into thin air so time away costs serious $$$.
alwaysbeIMRTing
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Can you imagine a similar job description for a rad onc outside of an alternate universe? In Rad onc the typical job is MGMA median W2 with some awful RVU incentive you will never see, 8-5 M-F, 25 days PTO. If you try to negotiate 1099, <5 days a week on site, eat-what-you-kill RVUs, independent billing, even a single day more PTO, alternating weeks via job share, literally anything other than the boilerplate offer, I kill you. I am not even joking, I have had multiple CEOs and chairs verbally berate me, accuse me of being lazy/greedy, and rescind job offers for simply attempting to negotiate job terms.
Bolded are things you will almost never see in rad onc...
Radiology Imaging Associates is a private, exclusively physician-owned practice in Central Florida with divisions in Ocala and Daytona. We are a group of more than 125 radiologists with numerous hospital and free-standing ER contracts from multiple hospital chains, our own outpatient imaging centers and equipment, multiple real estate holdings, and our own IT staff and servers. We also own a private practice in the U.S. Virgin Islands, which includes access to a timeshare at the Ritz-Carlton in St. Thomas. Additionally, we offer a rental townhome on the Big Island of Hawaii, equipped with a workstation, where radiologists can rotate and work remotely. We staff Level I/II Trauma Centers and certified Comprehensive Stroke Centers. Our group is one of the few remaining true private practices, and we intend to capitalize on the dissatisfaction with corporatized/private equity radiology. We have had numerous consecutive years of double-digit growth and are looking to hire sincere, hard-working radiologists to help us to expand further.
Employees and partners are treated equally with equal pay for moonlighting shifts. We strongly value workplace culture and do not support hierarchies, unequal work distribution/productivity, or cherry-picking.
Bolded are things you will almost never see in rad onc...
- Position also available as 1099 for 510k. W2 rads eligible for group cash balance plan in addition to 401k.
- Typical shift is 150 cases - 40% CT, 10% US/MR, and 50% X-ray. RVU bonus for busy nights ($33/RVU above 100, no cap, some productive nights frequently make an additional $1500/shift).
- Candidates must be residency-trained in Diagnostic Radiology and Board-Certified. Prior work experience and any fellowship preferred. Must read from United States, including Puerto Rico.
- Extensive internal moonlighting shifts are available with hourly and per-per-click options.
Radiology Imaging Associates is a private, exclusively physician-owned practice in Central Florida with divisions in Ocala and Daytona. We are a group of more than 125 radiologists with numerous hospital and free-standing ER contracts from multiple hospital chains, our own outpatient imaging centers and equipment, multiple real estate holdings, and our own IT staff and servers. We also own a private practice in the U.S. Virgin Islands, which includes access to a timeshare at the Ritz-Carlton in St. Thomas. Additionally, we offer a rental townhome on the Big Island of Hawaii, equipped with a workstation, where radiologists can rotate and work remotely. We staff Level I/II Trauma Centers and certified Comprehensive Stroke Centers. Our group is one of the few remaining true private practices, and we intend to capitalize on the dissatisfaction with corporatized/private equity radiology. We have had numerous consecutive years of double-digit growth and are looking to hire sincere, hard-working radiologists to help us to expand further.
Employees and partners are treated equally with equal pay for moonlighting shifts. We strongly value workplace culture and do not support hierarchies, unequal work distribution/productivity, or cherry-picking.
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Honestly considering how good the rads job market has become vs how bad it has become in rad onc, the competitiveness switch makes complete sense
Medical students aren't dumb, even if we all love what we do, the lack of multiple competitive job offers, ability to lateral geographically, ability to negotiate etc vs rads is so stark. Still a lot of decent private groups in rads where you can own equipment, much less so in rad onc
Medical students aren't dumb, even if we all love what we do, the lack of multiple competitive job offers, ability to lateral geographically, ability to negotiate etc vs rads is so stark. Still a lot of decent private groups in rads where you can own equipment, much less so in rad onc
alwaysbeIMRTing
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There are a lot of nasty private practices in rad onc too, which is why I bolded equal partnership and hierarchies. I mentioned the abrasive chairs and CEOs, but the most I have ever been screwed over was by a rad onc peer who obtained ownership through politics (in a practice he did not build) and was determined that no other rad onc besides him would ever do so again.
That being said any smart medical student should enter radiology or many other fields with a healthy caution and understanding that technology, market forces, and government decisions are likely to ensure that their career is going to be different than best case scenarios they hear about
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I still think rads > RO for at least the next decade. Surging volume thanks to indications and increasing APPs vs the dumpster fire of omission, consolidation and inept leadership as it relates to reimbursement challenges in RO, even the workforce report they were forced to create and issue didn't paint a pretty picture
AI can't take liability. Scans will still be signed off by a BC DR
My opinion
This is absolutely nuts in comparison to what we deal with.
yeah my post was more about medicine in general than comparing to rad onc. just think med students should be very open eyed of realities, regardless, and happiness comes from expectations and would be wise not to have the same expectations for their career.
