Any residents in hot spots being pulled out of the department?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
goodkerma said:
This. I bet most attending physicians who have had resident coverage for >5 years wouldn't be able to manage a COVID order set...
Click to expand...
I'm surprised that academic chairs know what coronavirus even is... Hard to know about it if one permanently lives under a rock...
 
evilbooyaa said:
I would not be OK with any situation without proper PPE, doubly so for any ICU care.

I'm all for helping folks but not at the risk of my own personal health. I think the bandanas and scarves bit is ridiculous, but I also think people have an unrealistic expectation of what PPE to expect. No, you will not get a daily N95 if you are not seeing symptomatic patients. Be OK with a surgical mask.

If they wanted me to swab symptomatic patients, better give me a N95 and eye shield.
Click to expand...
Agreed with all the above; but @evilbooyaa - in a setting such as ours where we are not volunteering, but could potentially be "mandated/assigned" (whatever that means) by the hospital without proper PPE, what is the proper approach? I'm all for helping as well, but could certainly see myself refusing in the above situation without PPE - thoughts on the potential ramifications for refusal? Hopefully wouldn't come to it, but just taking a pessimistic/worse case scenario view for now...
 
Simple question is: What if you say, “No.”?

I didn’t read the ins and outs of my residency contract, or at least I don’t have them in my memory currently, but I doubt there was a clause to interrupt my oncology training to become a frontline urgent care provider.

I wouldn’t let anyone guilt me or scare me into anything I didn’t feel comfortable with. Especially without reviewing what, exactly I signed on for.
 
goodbyeABR said:
Agreed with all the above; but @evilbooyaa - in a setting such as ours where we are not volunteering, but could potentially be "mandated/assigned" (whatever that means) by the hospital without proper PPE, what is the proper approach? I'm all for helping as well, but could certainly see myself refusing in the above situation without PPE - thoughts on the potential ramifications for refusal? Hopefully wouldn't come to it, but just taking a pessimistic/worse case scenario view for now...
Click to expand...
I'm on the COVID physician FB group and they have a lot of useful info. If you are on FB, would recommend joining. Lots of people on the front line sharing their stories and, unfortunately, are in your hypothetical situation in regards to PPE. Anyways, the general consensus seems to be, no proper PPE, no treating coronavirus patients. That is insane. Tell admins to put it in writing that you are being asked to treat a patient without proper PPE. Consensus also is that bandanas are not sufficient, despite what the CDC says.

COVID positive patients need gown, gloves, and N95. But, like Booya said, not every patient you see, needs a HazMat suit. Surgical mask is probably okay for someone without a cough and no known infection. I think the expectation though is if your hospital is low on PPE, you should ration/reuse a sugical mask between non-infected patients.
 
Just out of curiosity. Why can’t an n95 mask be spritzed with alcohol and reused. Do they inherently loose containment/ filtration ability after 12hts?
 
RickyScott said:
Just out of curiosity. Why can’t an n95 mask be spritzed with alcohol and reused. Do they inherently loose containment/ filtration ability after 12hts?
Click to expand...
I believe moisture makes the material deteriorate.
 
Mandelin Rain said:
Simple question is: What if you say, “No.”?

I didn’t read the ins and outs of my residency contract, or at least I don’t have them in my memory currently, but I doubt there was a clause to interrupt my oncology training to become a frontline urgent care provider.

I wouldn’t let anyone guilt me or scare me into anything I didn’t feel comfortable with. Especially without reviewing what, exactly I signed on for.
Click to expand...
Pretty sure patients are still getting diagnosed and need treatment for career during covid19
 
yesmaster said:
@ramsesthenice @Palex80 @Neuronix @Lamount

Serious question. Would you personally be willing to work in an inpatient or ICU environment without proper PPE?

That's the driver of much anxiety. A lack of proper PPE to provide protection, and leadership (national & institutional) at all levels downplaying the need for proper PPE to protect healthcare providers (attendings, residents, nurses, etc.).
Click to expand...
ABSOLUTELY NO without PPE!!
 
1.jpg


You could easily replace "Psychiatrist" with "Radiation Oncologist".
 
And on the other side...the lawyers are eagerly licking their lips at the prospect of cross coverage of other medical disciplines.
 
FrostyHammer said:
And on the other side...the lawyers are eagerly licking their lips at the prospect of cross coverage of other medical disciplines.
Click to expand...

Yes, never forget how short term people's memories can be. In 1-2 years when (hopefully) this is a remote memory but multiple people have bad outcomes related to deviations from the standard of care, the lawyers will be having a field day. Better hope that BUT CORONAVIRUS! holds weight.
 
Mandelin Rain said:
Simple question is: What if you say, “No.”?

I didn’t read the ins and outs of my residency contract, or at least I don’t have them in my memory currently, but I doubt there was a clause to interrupt my oncology training to become a frontline urgent care provider.

I wouldn’t let anyone guilt me or scare me into anything I didn’t feel comfortable with. Especially without reviewing what, exactly I signed on for.
Click to expand...

There are usually some stipulations about extenuating circumstances in the departments of crises or acts of god.

Regardless, ASTRO has left it up to the purview of each PD on what is OK for a Rad Onc resident to do that is not Rad Onc. So the real answer is "they can ask you to do whatever they want".
 
Mandelin Rain said:
Simple question is: What if you say, “No.”?

I didn’t read the ins and outs of my residency contract, or at least I don’t have them in my memory currently, but I doubt there was a clause to interrupt my oncology training to become a frontline urgent care provider.

I wouldn’t let anyone guilt me or scare me into anything I didn’t feel comfortable with. Especially without reviewing what, exactly I signed on for.
Click to expand...

Physicians in Italy (and China, but no surprise there) had their medical licenses permanently revoked if they refused to care for Covid patients.
 
evilbooyaa said:
There are usually some stipulations about extenuating circumstances in the departments of crises or acts of god.

Regardless, ASTRO has left it up to the purview of each PD on what is OK for a Rad Onc resident to do that is not Rad Onc. So the real answer is "they can ask you to do whatever they want".
Click to expand...
I could Google the current contract for residents at my training hospital. No such mention. In fact, I couldn't find a single clause that could even vaguely allow them to compel me to practice outside of the educational scope that I signed on for (i.e. radiation oncology). Maybe they're all different every where.
 
Mandelin Rain said:
I could Google the current contract for residents at my training hospital. No such mention. In fact, I couldn't find a single clause that could even vaguely allow them to compel me to practice outside of the educational scope that I signed on for (i.e. radiation oncology). Maybe they're all different every where.
Click to expand...

I don’t remember that either but reality is that most RO PDs charmin soft and if GME asks for help, they will sacrifice you

On the other hand, If things truly awful in my city and ABR cancels my boards Then I will be 1st to volunteer. Otherwise ill wait for the draft and go in if needed
 
It hasn't taken me long to grow so disillusioned with our industrial medical complex that I feel very little moral imperative to volunteer to throw myself into the fire just because there's an MD after my name. What am I going to do? Tube people? Manage vents? Start IVs? Nah. I'm going to get in the way, get sick, and then get my family sick.

If someone needs circles drawn around something, a chair kept warm, or a 30 page white paper on some topic come find me. I'm a rad onc dammit.


EDIT: This post was only mostly serious.
 
Mandelin Rain said:
It hasn't taken me long to grow so disillusioned with our industrial medical complex that I feel very little moral imperative to volunteer to throw myself into the fire just because there's an MD after my name. What am I going to do? Tube people? Manage vents? Start IVs? Nah. I'm going to get in the way, get sick, and then get my family sick.

If someone needs circles drawn around something, a chair kept warm, or a 30 page white paper on some topic come find me. I'm a rad onc dammit.


EDIT: This post was only mostly serious.
Click to expand...

i dont think you’re wrong for feeling that way

I do think there are ways to utilize us and other non-IM etc ppl. None of those ways involves ICU or tubes or anything with the word stat
 
radoncdoc16 said:
i dont think you’re wrong for feeling that way

I do think there are ways to utilize us and other non-IM etc ppl. None of those ways involves ICU or tubes or anything with the word stat
Click to expand...
Only MOSTLY serious.😉
 
evilbooyaa said:
There are usually some stipulations about extenuating circumstances in the departments of crises or acts of god.

Regardless, ASTRO has left it up to the purview of each PD on what is OK for a Rad Onc resident to do that is not Rad Onc. So the real answer is "they can ask you to do whatever they want".
Click to expand...

Yes. It's how it was where I trained and where I currently work. IMO, whether something like this is in your contract or not won't really provide much of any clarity. If it is there, it will be nebulously worded and won't answer the questions you really want to know. The usual act of god is a bus crash or natural disaster which basically everyone would normally be more than willing to jump into if need be. There will be less than zero guidance on what your potential role in dealing with an infectious pandemic would or could be. Under what circumstances do you have the right to refuse? How do you even define an act of god? There will be no specifics in your contract.

On the flip side, if your contract says nothing about this and your employer tells "asks" you to do something outside of your job description, you refuse, and they enact consequences how confident are you that you would prevail with some eventual legal recourse given how pervasive the idea that doctors took an oath and of course should be ready and willing to help in an emergency? I bet you would be fine but I would have bet a lot of things over the last couple weeks that were wrong so my track record is pretty much shot for the time being.

A lot of these things will be sorted after the fact. I think some of the posters above gave the best advice. You have to decide what you would be willing to do or not. That is a personal decision based on your own values. With that in mind, consider the optics and how to navigate these high-stress situations. If you are asked to do something you don't feel comfortable with, whether it is in your contract or not, your best defense will probably be to suggest something you would feel comfortable with to find a way to respect your own boundaries and show a good faith effort to support the team or whatever you want to call it.
 
ramsesthenice said:
your best defense will probably be to suggest something you would feel comfortable with to find a way to respect your own boundaries and show a good faith effort to support the team or whatever you want to call it.
Click to expand...
This is wise advice. "To thy own self be true" isn't all or nothing. You can take phone triage to hear symptoms and direct patients or something. Not a big deal. Definitely different than taking me out of the basement to man the ICU, to which I respectfully decline.
 
Last edited:
Contractual disputes in RadOnc rarely go to lawyers. It's a small field and changes are usually made by mutual agreement.
 
radoncdoc16 said:
i dont think you’re wrong for feeling that way

I do think there are ways to utilize us and other non-IM etc ppl. None of those ways involves ICU or tubes or anything with the word stat
Click to expand...

And I don’t think any rad oncs are going to be pulled to do anything STAT.

If pulled it will be to do grunt work that requires an MD, stuff like notes, orders, triaging patients
 
We need to stop saying rad onc residents are going to be pulled to go cover an ICU. Nobody, including the CCM folks, wants that.

At most, it'd be covering inpatient admissions for non-COVID things.

Most likely if called in, it'd be outpatient visits for screening/triaging or dealing with phone calls.

Most likely overall, we all get to stay in our basements (or working from home) b/c cancer is not elective and therefore rad onc departments have to stay open.
 
Last edited:
Meh, I feel like we pressure each other into, and subsequently admins/CMS/private insurers/EviCore/pharma/the general population take advantage of, this "ride or die" attitude we're supposed to have about everything.

I think physicians in general would be well served by saying "no" more. Especially, in a collective and united manner. In no way am I saying this is the time to do so, just in general.
 
I don't think anyone is going to ask us to manage vents/lines/pressors ect. If more general MD's are needed it will work like intern year/residency where you have a BC pulm/crit running the show and they might be directing several MD's so they will be able to manage 30 ICU or floor patient's instead of 10 or something like that. In this profession (meaning medicine in general) if you are asked to step up in a crisis like this and you don't that's not going to be a good look.
 
fiji128 said:
I don't think anyone is going to ask us to manage vents/lines/pressors ect. If more general MD's are needed it will work like intern year/residency where you have a BC pulm/crit running the show and they might be directing several MD's so they will be able to manage 30 ICU or floor patient's instead of 10 or something like that. In this profession (meaning medicine in general) if you are asked to step up in a crisis like this and you don't that's not going to be a good look.
Click to expand...

I disagree. Healthcare workers are at high risk in this pandemic, and we have a critical shortage of PPE. No one should feel guilty for not wanting to volunteer to enter the fray. That it is considered a "bad look" to choose to avoid being a martyr is just one of those ideological remnants of the days when overt resident abuse was acceptable and widely practiced.
 
chemsmith said:
I disagree. Healthcare workers are at high risk in this pandemic, and we have a critical shortage of PPE. No one should feel guilty for not wanting to volunteer to enter the fray. That it is considered a "bad look" to choose to avoid being a martyr is just one of those ideological remnants of the days when overt resident abuse was acceptable and widely practiced.
Click to expand...

I agree with you in theory. The guilt trip from superiors is hard to fight in small dept like radonc though
 
chemsmith said:
I disagree. Healthcare workers are at high risk in this pandemic, and we have a critical shortage of PPE. No one should feel guilty for not wanting to volunteer to enter the fray. That it is considered a "bad look" to choose to avoid being a martyr is just one of those ideological remnants of the days when overt resident abuse was acceptable and widely practiced.
Click to expand...
Yup. I think the "bad look" thing is a big problem. As it relates to anything. Fractions. Money. Seeing insured vs uninsured. Whatever. We shame each other into submission. Both willingly and gleefully. Hospital admins are far less submissive, and actively cooperate to take advantage of our stupidity and pettiness.
 
Last edited:
ASSUMING ADEQUATE PPE (big assumption there I know), if radoncs are asked to setup up and we don't, it will be a very bad look and help continue to label us as hapless "technicians", rather than oncologists. With adequate PPE, radoncs should step up if asked just like everyone else. With adequate PPE.
 
Mandelin Rain said:
Yup. I think the "bad look" thing is a big problem. As it relates to anything. Fractions. Money. Seeing insured vs uninsured. Whatever. We shame each other into submission. Both willingly and gleefully. Hospital admins are far less submissive, and actively cooperate to take advantage of our stupidity and pettiness.
Click to expand...

i agree that people above exploit our divisions in residency and in practice. The problem with doctors is that we are almost never united.
 
thecarbonionangle said:
i agree that people above exploit our divisions in residency and in practice. The problem with doctors is that we are almost never united.
Click to expand...
Correct.

CMS ensured this by creating RVUs and the RUC. Get the docs fighting over how big their slice is relative to the other guys', so they never notice how big the pie itself is.

It was a classic divide and conquer technique.
 
Mandelin Rain said:
Correct.

CMS ensured this by creating RVUs and the RUC. Get the docs fighting over how big their slice is relative to the other guys', so they never notice how big the pie itself is.

It was a classic divide and conquer technique.
Click to expand...

So how can we fix it? The AMA or ASTRO seem to be totally useless in advocating for our interests. Is there any good organizations out there or are they all bad? Are doctors mostly petty and cannot unite? NPs and PAs are using current practice to increase their scope and the specter of NP/PA “residencies” is now a reality. These groups seem united in their goals
 
radoncgrad2019 said:
Click to expand...

Something similar is happening in Germany too or at least it is being planned.

This spring a few thousand students would have their final exams (it's an oral exam) and then receive their license.
The government is considering to "drop" the exams now, send all of them to work in the COVID-wards and then come back when the crisis is over so they can have their final exams. It seems the students would get some kind of temporary license until the exams are over.
 
Palex80 said:
Something similar is happening in Germany too or at least it is being planned.

This spring a few thousand students would have their final exams (it's an oral exam) and then receive their license.
The government is considering to "drop" the exams now, send all of them to work in the COVID-wards and then come back when the crisis is over so they can have their final exams. It seems the students would get some kind of temporary license until the exams are over.
Click to expand...

If combined with pay, I think a reasonable amount of students will welcome the opportunity to both help (some people like to help, lest we forget!) while also getting to make money.
 
I probably would have done this if I were a fourth year during these times as long as they paid me as an intern. They've already been sitting around doing nothing for a while. At this point in my fourth year I had already been finished with rotations for over a month. What else are you going to do now? Intern year would be a breeze after dealing with this.
 
metallica81788 said:
I probably would have done this if I were a fourth year during these times as long as they paid me as an intern. They've already been sitting around doing nothing for a while. At this point in my fourth year I had already been finished with rotations for over a month. What else are you going to do now? Intern year would be a breeze after dealing with this.
Click to expand...

I don’t think I would. There are not many instances in life to have none or close to having no responsibilities and the best times of my life were either in between jobs or the times following graduations.
 
RadOncDoc21 said:
I don’t think I would. There are not many instances in life to have none or close to having no responsibilities and the best times of my life were either in between jobs or the times following graduations.
Click to expand...
Agree. Not long enough though, as hospital credentialing committees start asking about breaks of longer than 4-6 weeks between employment/jobs
 
Looks like US just leapfrogged over Italy and China for the most cases, **** is about to get real (or more real?). Yea, I know, it's because of more testing...but still, this looks really bad.
 
w00tz said:
Looks like US just leapfrogged over Italy and China for the most cases, **** is about to get real (or more real?). Yea, I know, it's because of more testing...but still, this looks really bad.
Click to expand...
Cases in China slowed mostly because their authoritarian government was able to achieve what would be completely impossible here. This was always going to be bad in the US.
 
OTN said:
Cases in China slowed mostly because their authoritarian government was able to achieve what would be completely impossible here. This was always going to be bad in the US.
Click to expand...
Yea, I was just hoping that the US would learn from Italy, since we had that 11 day lead time over them. It's just sad and disappointing how it's been dealt with.
 
Last edited:
You must log in or register to reply here.

Similar threads

CurbYourExpectations
The logic of the private forum
Replies
33
Views
5K
evilbooyaa
evilbooyaa
TheWallnerus
The "It" Job in Medicine
Replies
31
Views
6K
gmsquid
G
Kroll2013
financial viability study for a new RT department
Replies
12
Views
2K
deleted1180461
D
Palex80
  • Locked
How does the US election influence the RadOnc market situation in the US?
Replies
2
Views
1K
evilbooyaa
evilbooyaa
T
The end of TORS?
Replies
43
Views
3K
Mandelin Rain
M
Top