I may be an outlier in a unique situation, but in my short time in practice, my clinic has gotten very busy. I have consults competing for time with follow ups and 15-20 sick patients under treatment. I won't lie and tell you I hadn't considered what it would be like if I had an APP I could trust to see routine follow ups, knowing that he/she would seek my guidance/refer patients back for complex situation and/or disease progression. I wish that I could see all of my patients for follow up indefinitely, but this is already limiting my ability to see new patients. I also get that the growing role of APPs will result in less work for radiation oncologists... but it's clearly easier/cheaper for my department to get me an APP than to hire another attending, and it could happen much sooner. There's only so many hours in the day, and these patients need to be seen.
I don't know... like I said, perhaps I am in a unique situation.
You are not. You can't be in three places at once. The stuff like follow ups, on treatment issues on non-OTV days, going to see an inpatient and letting them know your plan and arranging logistics with the floor, etc... allow you to do your consults, sims, contours, brachy, etc... without
CONSTANTLY being interrupted. You'll still be interrupted, but it will be filtered through them and you'll have a person to delegate to.
I would add that if your APP is not performing after 2 years, you are either asking WAY too much or you needed to find a new APP about 18 months ago.
Tell them what to look for on followup (PSA trends, women are taking their HT and have mammos ordered, CEA level, scans show no progression, etc...), give them a Texas Oncology handbook for toxicity highlighted with your favored management, and have them follow you for 2-3 months. If they can't handle most routine situations after that, start looking for replacement. Of course they should ask for your input during non-routine situations, but by definition, those are not routine.
EDIT: The other thing that I think is probably universal, is younger attendings tend to hold onto follow ups longer than you will after a few years of practice due to the exact scenario you describe. Start weaning your follow ups if you're just kind of wasting their time (breast patients following with med onc/surgery, prostates following with urology, rectal cancer patients post op, even lung patients on IO, etc...). They'll get back to you if they need you and liked you.