An invitation to discussion- RadOnc Forum

[CurbYourExpectations]

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[vector2]

Rad onc supervision, the epilogue

Was looking at SDN year-end stuff, favorite threads, etc, and this 4 year old post from @elementaryschooleconomics… the smartest poster on SDN… struck me: I would place a footnote on this - CMS hit us totally randomly with the supervision rule change on November 1st, with uncertain but almost...

forums.studentdoctor.net

Hey everyone so there has been a discussion going on in the RadOnc forum for a while, it spans multiple threads and this thread I've linked I feel gives some good info. In the past year there has been multiple publications about starting encroachment from non physicians into radiation oncology, as well as the possibility of decreasing the need for Radiation Oncologists to be at the hospital/site they are treating patients at.

This raises multiple concerns to me because I frequent EM and Anesthesiology forums and read a lot of your threads and appreciate your thoughts. Would love for you to come and give input on what you think.

For reference, most of the people think our field is oversupplied and we do not have significant encroachment and are required to be on site most of the days, but people are trying to fight that thought process anyways and change it. If I am wrong let me know. Will update this more in the future-

Thanks for everyone who gives their voice,
Curb

Honestly, that thread is pretty hard to follow for most non-radoncs.

In addition to the billion acronyms, we have no frame of reference for what supervision (or encroachment) specifically means for you vis a vis how NPs/PAs, medical physicists, and radiation therapists interact with your practice, plus how being on-site vs off-site affects the treatment planning and delivery.

Need some more explanation of the basics and some more color on the topic before contributing.

 

[kidthor]

Whoa. Yeah the thread is hard for me to understand due to all the technical jargon and acronyms.

But I absolutely only want a radiation oncologist in charge of my radiation (if I need it) and not a random midlevel, just like I only want an anesthesiologist to take care of me (and my family). Virtual "supervision" seems like a recipe for disaster.

 

[abolt18]

Think of it as an anesthesiologist working from home answering a mid levels calls at multiple ORs from multiple hospitals and giving their input.

The moment you let them in, and especially the moment you start being 'available' rather than present, is the moment that the Noctors are going to think they don't need you, and start making decisions they're not qualified to make. They start thinking they know better and decide they don't need to call you. In fact, they'll just call their other Noctor friend for their opinion.

Ask me how I know...

Never never never let this happen. Huge mistake. Keep showing up for your cush 4-5 days/week job with minimal to no call.

 

[abolt18]

Thanks for the input, I don't think our field really understands the power of these other groups. For reference, the people pushing for it call our specialty's society (ASTRO) worthless and unhelpful. Many people hate ASTRO. Our field probably averages 4 days a week in clinic, at most, and makes good money.

In reality I know nothing about your specialty. I imagine there are a lot of things you safely and reasonably delegate to your radiation techs for a treatment plan that obviously does not require your constant supervision, but being on campus, being involved, checking in regularly (not sure if that means multiple times a day, or multiple times a week? Again I have no context) is essential in my opinion if you want to maintain any sort of actual control of your patients and the care they receive.

 

[DesiredMemberName?]

I'd be careful. It sounds like you guys have a super cushy setup where you're getting paid better than most specialties while working very, very little in comparison. I'm happy for you, but don't think this goes unnoticed by the bean counters looking to trim the fat. I agree with others who say that you should try to maximize your face time. The less present you are, the easier it is to justify replacing you (or minimizing your role to some advisory position) in an attempt to cut costs.

 

[Southpaw]

I don’t understand your workflow well enough to comment really. What’s your general day like? If you’re not in the hospital how are you working? What are you doing to generate salary/income?

Importantly, if you are oversupplied why in the world would you need midlevels? Seems like if there are plenty of you to do the work then you’re good, that is unless a bunch of you are just lazy and entitled. And if that’s the case, which it probably is, then those lazy and entitled minority will bring the rest of you down with them.

 

[Maz777]

Shut it down. Once you start letting mid-levels in, game over. The next thing you know hospitals and PE groups will try to cut costs and let the mid-levels run amok independently and you're no longer needed.

I hope your society isn't as spineless as ours. The lazy academicians that run societies tend to embrace mid-levels with open arms because they have built their careers on being lazy and letting others do the clinical work.

 

[sevoflurane]

You may have a honeymoon period w mid levels…. but you will really roast those who come after you.