Arkansas gets new rad onc residency program

[scarbrtj]

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On "The Bachelor" this season there was a girl from Weiner, Arkansas. And I kept wondering if she won... could she ever really leave Weiner behind? That's all I got.

UAMS to Offer Arkansas' First-ever Radiation Oncology Residency Program

 

[medgator]

“UAMS has recognized the need for a residency program for many years."

 

[RickyScott]

Xia hopes to see that number increase in the future. “The UAMS Radiation Oncology Center sees about 900 patients each year. As that number grows, we have the potential to increase our residency numbers as well,”

What a pos

 

[OTN]

Xia hopes to see that number increase in the future. “The UAMS Radiation Oncology Center sees about 900 patients each year. As that number grows, we have the potential to increase our residency numbers as well,”

What a pos

Only 193 spots available in all the country, huh? Glad she pointed that out- hopefully the new Arkansas program can help fill such a desperate need. What an dingus.

 

[OTN]

Only 193 spots available in all the country, huh? Glad she pointed that out- hopefully the new Arkansas program can help fill such a desperate need. What an dingus.

Just so everyone knows, I most definitely did not write the word “dingus”, but I do think it’s funny so I’m going to leave it.

 

[evilbooyaa]

Language filters ^^

FWIW, Arkansas grads are somewhat more likely to stay in the surrounding area (the Midwest), right? right? There has to be some silver lining to unchecked residency expansion?

They only have 5 attendings at main campus so I'm not sure how the chair is already planning for more than 1 resident per year.

 

[scarbrtj]

Language filters ^^

FWIW, Arkansas grads are somewhat more likely to stay in the surrounding area (the Midwest), right? right? There has to be some silver lining to unchecked residency expansion?

They only have 5 attendings at main campus so I'm not sure how the chair is already planning for more than 1 resident per year.

Is Arkansas midwestern? I've always dithered on that. First, Bill Clinton is considered Southern. Second, the Razorbacks are an SEC team. But regardless I'm not super sure it's going to stop the horrendous hegira of Arkansas med students who are rad onc-curious leaving for Tennessee or Missouri or Texas, e.g. They're sure gonna have to travel farther than that once they get out of their Arkansas rad onc residency for a job.

 

[scarbrtj]

Xia hopes to see that number increase in the future. “The UAMS Radiation Oncology Center sees about 900 patients each year. As that number grows, we have the potential to increase our residency numbers as well,”

What a pos

Germane:

"Radiation oncology as a specialty suffers from a crisis in identity, and at times even reputation, among those outside of our field. If that is to change, it is incumbent on radiation oncologists to take ownership over the dissemination of knowledge about our value in patient care and the oncology team."

 

[fiji128]

Great news for the 4 or 5 attendings at UAMS who thus far have no doubt been obligated to do their own notes and contours but bad news for everyone else.

 

[kristofer]

I actually don't have too much of a problem with more spots in the Midwest, but only with a concomitant decrease in spots on the coasts. Instead we have new programs starting in Pennsylvania and expansions everywhere. If anybody really cared about fixing the maldistribution problem, this is the way to do it (hint: nobody cares). Instead we'll continue to oversaturate the coasts and metro areas while the rural Midwest and Southeast slowly becomes more competitive with downward pressure on physician compensation everywhere.

 

[Haybrant]

we have 193 spots now?! wtf?!

 

[Neuronix]

we have 193 spots now?! wtf?!

When I was at ASTRO years ago as a resident they were projecting over 200 spots by 2020. The response from ASTRO leadership (which was discussed in other threads) was that the medical students will simply self-select out of the specialty when the job market crashes.

 

[MDACCRules]

Great news for the 4 or 5 attendings at UAMS who thus far have no doubt been obligated to do their own notes and contours but bad news for everyone else.

Well, do you ever do your own notes and contours?? We aren't peasants. There is a lot of Hulu to watch during work hours, and not that much time to do it if you don't have indent-, um residents.

 

[kristofer]

When I was at ASTRO years ago as a resident they were projecting over 200 spots by 2020. The response from ASTRO leadership (which was discussed in other threads) was that the medical students will simply self-select out of the specialty when the job market crashes.

So their explanation was that a large number of those 200 spots would go unfilled in the match and remain unfilled? Or did they seriously propose as a solution that we push more competitive students out of the field and flood the market with FMGs? How is that a solution? There still would be 200 new rad oncs a year. Maybe more of them would fail boards and reduce pressure on the job market? LOL.

 

[MDACCRules]

So their explanation was that a large number of those 200 spots would go unfilled in the match and remain unfilled? Or did they seriously propose as a solution that we push more competitive students out of the field and flood the market with FMGs? How is that a solution? There still would be 200 new rad oncs a year. Maybe more of them would fail boards and reduce pressure on the job market? LOL.

Didn't something like 12 or 13 Harvard Medical Students match into rad onc this year? If 6-7% of the entire field is coming from the Best Medical School, I'd say people aren't really self-selecting out.

 

[Neuronix]

So their explanation was that a large number of those 200 spots would go unfilled in the match and remain unfilled? Or did they seriously propose as a solution that we push more competitive students out of the field and flood the market with FMGs? How is that a solution? There still would be 200 new rad oncs a year. Maybe more of them would fail boards and reduce pressure on the job market? LOL.

My understanding of their position is that they cannot know when the job market will completely saturate. It is believed by some that there is a distribution problem for rad oncs, not a numbers problem, and there are still plenty of jobs out there. When the job market crashes, their argument is that yes, the spots in the match will go unfilled and the market will self-regulate.

I'm not saying I agree, it's just what was said.

 

[laserbeams]

The total # of spots this year in the match per NRMP is 194 (16 categorical, 177 PGY2, 1 spot for someone who already completed an intern year or is from the military).

There's a Google spreadsheet that the current batch of applicants have filled out (you can find it here). It's an impressive piece of collaborative work, replacing prior years' summaries of the interview process, program reviews, etc.

More germane to this discussion is the stated expansions reported by the applicants. Of note, this info was not filled out for all programs, so this likely represents a low estimate:

AZ Mayo - expansion to 8 residents (currently 5, +3)
CA City of Hope - expansion to 8 residents (currently 4, +4)
MD Johns Hopkins - expansion, unknown amount; minimum of +1
OH Ohio State - Expanding to 12-14 residents (currently 10, +2-4)
AR UAMS - new program, +4
PA Penn State - new program, min+4 (discussed in another thread, not actually a program yet)

In summary, there are stated plans (i.e. shared with residency applicants or publicly discussed) to increase the total number of residency spots to approximately 212-214 per year in the not-too-distant future.

Could these be empty promises to applicants to our field, a la "protons in 2-3 years"? Sure. But given the current situation of new programs with a move toward fewer treatment fractions, we're heading for a cliff.

 

[Neuronix]

Additionally, I personally know of 3 programs not listed here looking to expand or open at +2 to +4 residents within the next five years.

 

[manbeast8]

Only 193 spots available in all the country, huh? Glad she pointed that out- hopefully the new Arkansas program can help fill such a desperate need. What an dingus.

The dingus autocorrect may be the best thing I’ve seen all day. Thanks

 

[RickyScott]

When I was at ASTRO years ago as a resident they were projecting over 200 spots by 2020. The response from ASTRO leadership (which was discussed in other threads) was that the medical students will simply self-select out of the specialty when the job market crashes.

I am counting that when the job market totally crashes, there will be significant momentum to boycott ASTRO for what they have done to the field.

 

[deleted18755]

I am counting that when the job market totally crashes, there will be significant momentum to boycott ASTRO for what they have done to the field.

I'm very sure that 5-10 years from now (maybe sooner if the market doesn't crash) all of current "leaders" in ASTRO will be retired, having been basically the only people on Earth who benefited from the crazy non-site neutral payment scheme they developed, residency expansion/explosion they allowed (or even actively encouraged), with debt they left from empty proton centers, etc after the previous generation handed them the most awesome field in medicine that they subsequently mismanaged, milked for all it was worth, then will abandon once they are done juicing out every last drop they can and leaving it in total disarray for the next generation while sitting in their retirement communities blaming those lazy millennials whom they put in this impossible position for ruining this once awesome field. Baby boomer mentality + current academic radiation oncology laziness/arrogance is a deadly combination!

PS: I'm in my mid-40's so in between baby boomers and millenials (I think at least) and love my job and this field plus think I can still make a full career out of it but so sad to helplessly watch this all happen . . .

 

[thecarbonionangle]

The total # of spots this year in the match per NRMP is 194 (16 categorical, 177 PGY2, 1 spot for someone who already completed an intern year or is from the military).

There's a Google spreadsheet that the current batch of applicants have filled out (you can find it here). It's an impressive piece of collaborative work, replacing prior years' summaries of the interview process, program reviews, etc.

More germane to this discussion is the stated expansions reported by the applicants. Of note, this info was not filled out for all programs, so this likely represents a low estimate:

AZ Mayo - expansion to 8 residents (currently 5, +3)
CA City of Hope - expansion to 8 residents (currently 4, +4)
MD Johns Hopkins - expansion, unknown amount; minimum of +1
OH Ohio State - Expanding to 12-14 residents (currently 10, +2-4)
AR UAMS - new program, +4
PA Penn State - new program, min+4 (discussed in another thread, not actually a program yet)

In summary, there are stated plans (i.e. shared with residency applicants or publicly discussed) to increase the total number of residency spots to approximately 212-214 per year in the not-too-distant future.

Could these be empty promises to applicants to our field, a la "protons in 2-3 years"? Sure. But given the current situation of new programs with a move toward fewer treatment fractions, we're heading for a cliff.

Miami Expanded to 4 a year. UTSW also expanded to 4 a year. Stanford expanded last year. All these programs are expanding. 2 wants to take 4 a year. 4 wants to take 7. Its a complete joke. Our "leaders" don't give a F about you.

 

[thecarbonionangle]

I'm very sure that 5-10 years from now (maybe sooner if the market doesn't crash) all of current "leaders" in ASTRO will be retired, having been basically the only people on Earth who benefited from the crazy non-site neutral payment scheme they developed, residency expansion/explosion they allowed (or even actively encouraged), with debt they left from empty proton centers, etc after the previous generation handed them the most awesome field in medicine that they subsequently mismanaged, milked for all it was worth, then will abandon once they are done juicing out every last drop they can and leaving it in total disarray for the next generation while sitting in their retirement communities blaming those lazy millennials whom they put in this impossible position for ruining this once awesome field. Baby boomer mentality + current academic radiation oncology laziness/arrogance is a deadly combination!

PS: I'm in my mid-40's so in between baby boomers and millenials (I think at least) and love my job and this field plus think I can still make a full career out of it but so sad to helplessly watch this all happen . . .

Reminds me of the babyboomer buy out mentality for companies. Build up a bunch of debt for buying up a new company, then pass off the debt to the newly acquired company. The new company is in massive debt, wages are cut, company goes down, thousands lose their jobs. Company declares bankrupcy. Their personal wealths are untouched. This is Trump style. Thats the baby boomer generation for you.

 

[medgator]

Build up a bunch of debt for buying up a new company, then pass off the debt to the newly acquired company. The new company is in massive debt, wages are cut, company goes down, thousands lose their jobs. Company declares bankrupcy.

That's Toys R Us in a nutshell

 

[medgator]

Miami Expanded to 4 a year.

I still remember when Miami was 4-6 resident program total. 3-400% expansion in a decade. Crazy

 

[scarbrtj]

Population growth is going down, people are taking better care of themselves and smoking less to prevent cancers, HPV vax rates up, fractionation numbers are going way down, age of population going up and calls for less treatment, anti-cancer chemoarmamentarium increasing exponentially, rad onc reimbursements going down, number of patients "on beam" going down. Protons are tired mayonnaise. And many go in to rad onc for research and the academics, but would I be correct that only 1 out of 69 of the leaders of NCI centers in the US is a rad onc (ie, rad oncs do not easily climb to the highest rungs of the current academic oncology ladders... be a med onc or surgeon if you want to do that... or be a PhD only instead of a rad onc for much better chances).

And yet, rad onc residency numbers: going up. A true paradox!

 

[RickyScott]

Heres how its playing out: Initially, there is some elasticity in that starting salaries stagnate and some practices will be tempted to take on extra docs (that they ordinarily would not have). A lot of academic centers will continue to hire docs in the upper 2's, but not advance them much. The new faculty will have 10-15 pts on treat and required to produce yearly garbage retrospective review/national database drek for the red journal and attend all sorts of worthless hospital and departmental committee meetings. Faculty sizes will initially increase as docs with salaries in the high 3s/low 4s retire/attrition, allowing the departments to increase staffing somewhat. Private practices will probably offer 20% more, but a normal case load and no advancement. (the partners in these practices will get to cut back on hours and patients with minimal salary change) After these "elastic" positions are filled, the real pain will start and the bottom will fall out. Thats when FMGs, some of whom may be working as taxi drivers, will jump at the chance for the now undesirable residency slots.

 

[medgator]

Heres how its playing out: Initially, there is some elasticity in that starting salaries stagnate and some practices will be tempted to take on extra docs (that they ordinarily would not have). A lot of academic centers will continue to hire docs in the upper 2's, but not advance them much. The new faculty will have 10-15 pts on treat and required to produce yearly garbage retrospective review/national database drek for the red journal and attend all sorts of worthless hospital and departmental committee meetings. Faculty sizes will initially increase as docs with salaries in the high 3s/low 4s retire/attrition, allowing the departments to increase staffing somewhat. Private practices will probably offer 20% more, but a normal case load and no advancement. (the partners in these practices will get to cut back on hours and patients with minimal salary change) After these "elastic" positions are filled, the real pain will start and the bottom will fall out. Thats when FMGs, some of whom may be working as taxi drivers, will jump at the chance for the now undesirable residency slots.

Don't forget about the "fringe" private world... there will be more proton and derm babysitters who will be working more odd days and hours. I expect to see a lot more of those positions getting posted, as well as part time rural linac babysitting positions

 

[OTN]

I can speak only for my private practice, but here’s what I think is going to happen: we will still hire just as we always have, with the same change to make full partner, the same buy-in, etc. However, I work in a center with another radonc. When she retires (5? 10? 15 years? I have no idea), due to reimbursement pressures, APMs giving is more freedom in selecting Tx schedules, hypofractionation, improvements in tech which are upcoming which will improve efficiency, and the addition of mid levels, I likely will not be bringing another radonc to take her place. So, the problem is two-fold: not only is the supply of radoncs increasing far too rapidly, I believe demand will crater much more quickly than some realize. ASTRO may push CMS to require radonc supervision for all treatments, which would greatly help the employment situation, but at the cost of reduced salaries for all.

 

[scarbrtj]

If certain unscrupulous types really wanted to be unscrupulous (and cut-throat), they would act upon the fact that there has never been a requirement that BC rad oncs have to babysit the rad onc treatments (much like med oncs hire retired family practice docs to supervise chemo on the weekend); there have actually been judicial opinions stating as much. So if you didn't legally need a rad onc to be a babysitter that would really depress the employment prospects. Let's face it: a person who's blind and mute and barely cogent can babysit rad onc treatments. E.g. you can cross over the border into Canada and they don't have the direct supervision requirement (I don't know of a country besides the US that does, would love to know if one does) which of course is sensible in the extreme. I've always thought it might be rather forward-thinking in fact to have a one year post-med school "rad onc lite" training for MDs who wanted to avoid a FP or IM residency and just wanna come out and have a super cush job working low hours. If I owned my own center I would easily pay $120K a year to have some lightly-trained-in-the-basics-of-radiation MD available 40 weeks a year at 20 hours a week. We could drastically trim the BC rad onc workforce. It'll never happen of course.

 

[medgator]

there has never been a requirement that BC rad oncs have to babysit the rad onc treatments (much like med oncs hire retired family practice docs to supervise chemo on the weekend); there have actually been judicial opinions stating as much.

And there are settled cases showing the opposite as well.... guess it depends on the whims of the court involved? I don't believe BC is a requirement, but rather (I'm guessing) residency training which would indicate that you can "furnish assistance" during IGRT, electron setups etc. as per the Medicare direct supervision requirement.

 

[RickyScott]

1) doesnt step in and furnish assistance etc language only apply to hospital based centers? Thats why sometimes 21c and others sometimes will have a retired pediatrician there. The language for outpt centers just says they need an MD

2) these guidelines are not binding according to recent Trump justice department memo
DOJ Enforcement Memorandum Signals Policy Shift in Deference to Agency Guidance Documents for Civil Health Care Enforcement Matters - Lexology

Aalysis of Implications on Health Care Guidance Documents

In the health care context—where much federal enforcement is through civil litigation managed by DOJ under the False Claims Act—guidance documents historically have played a role of particular importance. Given the complexity of the laws and regulations governing federal health care programs, the U.S. Department of Health and Human Services (“HHS”) along with its agencies, including the Centers for Medicare & Medicaid Services (“CMS”) and its contractors, and the HHS Office of Inspector General (“HHS-OIG”), have issued countless volumes of sub-regulatory guidance documents in the form of preamble commentary, manuals, special fraud alerts, advisory opinions, national and local coverage determination policies, and similar materials. DOJ litigators, qui tam relators and defendants alike historically have relied upon such guidance documents in developing their respective understandings of, and legal positions regarding, the laws and regulations governing the federal health care programs, both for litigation and ongoing compliance purposes.

The memorandum serves to limit substantially the sources of authorities that DOJ may use in ACE matters. This may be significant for health care companies, life sciences companies, and other industry stakeholders facing DOJ civil enforcement actions in areas layered with complex and voluminous sub-regulatory guidance. In addition, the memorandum may serve to discourage DOJ litigators from pursuing ACE matters that turn on factors cited in guidance documents if those factors are not apparent from the underlying laws and regulations. Similarly, the memorandum may provide defendants and their attorneys a stronger footing to persuade DOJ litigators that certain claims, whether originally raised by a qui tam relator or otherwise, are meritless and should not be pursued.

 

[scarbrtj]

I don't believe BC is a requirement

It's ludicrous that no one knows the right answer and conflicting scenarios abound both ways. More ludicrous is that radiation oncologists have not taken ownership of the guidelines.

 

[medgator]

1) doesnt step in and furnish assistance etc language only apply to hospital based centers? Thats why sometimes 21c and others sometimes will have a retired pediatrician there. The language for outpt centers just says they need an MD

I actually thought the language was stricter on freestanding vs hospital-based centers.... i.e. both centers need someone who can furnish assistance, but campus counts for hospital-based, while freestanding needs "immediate" availability by being in the building. Again, all of this is as clear as mud, but FL, CA, and a few other states have had real settlements regarding this.

2) these guidelines are not binding according to recent Trump justice department memo
DOJ Enforcement Memorandum Signals Policy Shift in Deference to Agency Guidance Documents for Civil Health Care Enforcement Matters - Lexology

That doesn't seem like it will extend beyond the current administration/DOJ leadership.... I believe under Obama, qui tams and relator complaints soared as there was felt to be a good return on the dollar in pursuing Medicare fraud cases.

Oh yeah, and this:

The precise effect that the memorandum will have on health care enforcement actions is difficult to assess given its limitations in scope. The memorandum does not address the distinction between the permissible use of agency guidance to “explain or paraphrase legal mandates from existing statutes or regulations” and the impermissible use of guidance to demonstrate a “binding rule.” As the difference between these two types of usages is not always straightforward, differences of opinion are sure to arise.

Further, the memorandum applies only to the civil division of DOJ. As such, at least as a formal matter, the policy articulated in the memorandum does not extend to the criminal division of DOJ. Similarly, although DOJ often works closely with CMS, HHS-OIG, and other agencies in pursuing ACE matters, the memorandum does not apply to administrative actions brought by or before those agencies. It also does not bind qui tam relators litigating non-intervened actions that they have brought under the False Claims Act.

 

[RickyScott]

I used to think the same, but just had a meeting with our compliance department.

https://www.astro.org/uploadedFiles...tice/Content_Pieces/SupervisionWhitePaper.pdf

hospital outpt section:"Direct supervision is required for radiation therapy services provided in the hospital outpatient department. In general and per Medicare regulations, either a physician or a non-physician practitioner may directly supervise hospital outpatient therapeutic services.1 However, the supervising physician or non-physician practitioner must have within his or her State scope of practice and hospital-granted privileges the ability to perform the service or procedure that he or she supervises.2 As it specifically pertains to radiation therapy services, many states (as well as hospital privilege guidelines) are likely to limit a non-physician practitioner’s scope of practice such that he
..."

For the freestanding section,there are no such qualifications other than he has to be an MD- It says nothing about whether it is in scope of practice, privileges board certification etc.

"Regarding clinical qualifications for the supervising provider of freestanding radiation therapy services, CMS only indicates that direct personal supervision by a physician is required. A “physician” is defined by the Social Security Act as a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function"

 

[medgator]

"Regarding clinical qualifications for the supervising provider of freestanding radiation therapy services, CMS only indicates that direct personal supervision by a physician is required. A “physician” is defined by the Social Security Act as a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function"

Seems like they updated it a couple years ago, thanks for the link.

It looks like ASTRO did give an opinion on the issue though:

Radiation therapy services furnished in a freestanding radiation therapy center are covered under a separate benefit category from therapeutic services provided in a hospital outpatient department. Freestanding center radiation therapy services are specifically covered under Section 1861(s)(4) of the Social Security Act. Further guidance pertinent to physician supervision of these services is provided in Chapter 15, Section 90 of the Medicare Benefit Policy Manual. Direct personal supervision by a physician is required for radiation therapy services provided in the freestanding setting.5 Although the Code of Federal Regulations does not define “direct personal supervision”, the Medicare Benefit Policy Manual does provide a description that is similar to the definition of “direct supervision” under the CFR. Per the Manual, the physician does not need to be in the same room where the therapeutic service is performed, but must be in the area and immediately available to provide assistance and direction throughout the performance of the procedure.

Regarding clinical qualifications for the supervising provider of freestanding radiation therapy services, CMS only indicates that direct personal supervision by a physician is required. A “physician” is defined by the Social Security Act as a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function.6 Therefore, non-physician practitioners are not eligible to supervise radiation therapy services in the office setting. While CMS does not explicitly state that a radiation oncologist must supervise radiation therapy, it is ASTRO’s opinion that a board-certified/board-eligible Radiation Oncologist is the clinically appropriate physician to supervise radiation treatments.

It's probably one of those situations where things are probably going to be fine 99.9999% of the time, but if something happens, the lawyers will have a field day when they find out a retired OB/GYN was supervising IGRT when a patient fell off a table or something. Irrelevant to the case, but just another straw that will make the settlement juicier.

 

[RickyScott]

Seems like they updated it a couple years ago, thanks for the link.

It looks like ASTRO did give an opinion on the issue though:



It's probably one of those situations where things are probably going to be fine 99.9999% of the time, but if something happens, the lawyers will have a field day when they find out a retired OB/GYN was supervising IGRT when a patient fell off a table or something. Irrelevant to the case, but just another straw that will make the settlement juicier.

As an employed doc, it is no extra money out of my pocket to tell the hospital they need bc radiation oncologist coverage, but if it was...
Regarding 21C- they have been under really intense legal scrutiny. Everyone and there mother has filed a qui tam against them, but not in this area as far as i am aware. (i know semi retired internists who work for them- they are not allowed to approve films etc.)

 

[scarbrtj]

In general and per Medicare regulations, either a physician or a non-physician practitioner may directly supervise hospital outpatient therapeutic services.

We might be straying off topic but I guess that's ok... I've never figured out why these cheap, er uh choosing wisely and managing resources efficiently, hospitals don't contract a rad onc to be there once a week at like $200K a year (plus do all the planning and prescribing) and hire a rad onc NP, for example, at $120K a year for the other four days. Or, in a hospital or multi-specialty clinic, just use any of the docs around (ie the radiologists or med oncs down the hallway) as the supervising physician and they don't even need to know that they are doing the supervising:

"The Court is persuaded by the interpretation of the incident to rules and the Medicare Benefit Policy Manual § 60.3, that in a physician directed clinic setting, any one of multiple physicians who are available in the office suite may be deemed to be supervising the incident to service. Thus, in any given administration of an incident to service, the supervising physician may not and need not be aware that she is supervising a particular incident to service."

The "official" rad onc can do all the planning and film approvals from home, just like a radiologist. I do think we will see that one day.

 

[Bequerel]

I feel like I am getting mixed information. I am an employeed bc radiation oncologist at a hospital based practice. The manager at our practice will not let a patient be treated unless I am in the building. I would love to have an NP hired to help me in clinic and, more importantly, allow for patients to be treated when I am not in the building. Is this allowed? If so, please provide link to proof. My hospital administration would be open to this, but my manager has convinced them that this is basically illegal and we will all be taken away in handcuffs if a bc radiation oncologist is not in the building when patients are being treated. Medical oncologists don’t count either, according to my manager. Thanks!

 

[medgator]

I feel like I am getting mixed information. I am an employeed bc radiation oncologist at a hospital based practice. The manager at our practice will not let a patient be treated unless I am in the building. I would love to have an NP hired to help me in clinic and, more importantly, allow for patients to be treated when I am not in the building. Is this allowed? If so, please provide link to proof. My hospital administration would be open to this, but my manager has convinced them that this is basically illegal and we will all be taken away in handcuffs if a bc radiation oncologist is not in the building when patients are being treated. Medical oncologists don’t count either, according to my manager. Thanks!

Probably because of the cases in the recent past that have been settled like this one

Radiation oncology services provided to patients served by Medicare and TRICARE, the Department of Defense’s health care program, must be directly supervised by a radiation oncologist or similarly qualified personnel.

The "official" rad onc can do all the planning and film approvals from home, just like a radiologist. I do think we will see that one day.

Which will make it even all the more reason to have this UAMS program come online (getting back on topic...) 🙄

 

[BobbyHeenan]

I feel like I am getting mixed information. I am an employeed bc radiation oncologist at a hospital based practice. The manager at our practice will not let a patient be treated unless I am in the building. I would love to have an NP hired to help me in clinic and, more importantly, allow for patients to be treated when I am not in the building. Is this allowed? If so, please provide link to proof. My hospital administration would be open to this, but my manager has convinced them that this is basically illegal and we will all be taken away in handcuffs if a bc radiation oncologist is not in the building when patients are being treated. Medical oncologists don’t count either, according to my manager. Thanks!

Here is a pretty good review article on the topic.

Our group looked into the NP/PA option for coverage of some rural centers (though not rural enough to meet whatever special rural designation medicare sometimes has). Some adjacent hospitals are/did use mid levels or med onc for basic radiation coverage some days so we decided to dive deeper into the issue. We hired an attorney to look into it further and the hospital system had their own in house attorneys look at it.

Cliff's Notes:
- It was clear to us that only rad onc could do SBRT, CT sims, and HDR.
- It's a little murkey about CBCT/image guidance - ie can an NP be in the building but an off site rad onc check the film. Differing opinions here.
- There has never been case law written or a court case where there was a definitive judgement to set said case law about family docs or NP's or whatever covering the linac on the day to day standard treatments
- There have been a lot of cases fairly recently (see some links above) where disgruntled therapists start "blowing the whistle" on practices they perceive against the letter of the law. The therapists end up getting a good bit of money if a settlement happens, so there's incentive there.
- Thus, even though you may "win" a court case regarding your mid level cover, you don't want the feds sniffing around your clinic for any reason....so while one of our attorneys thought a well trained NP that went through appropriate hospital credentialing (medicare really leaves a lot of credentialing of mid levels at the discretion of the hospitals credentialing committees - shifting some responsibility from medicare to the local hospital system) would be OK to cover a linac on babysitting days (ie no CT sims, HDRs, SBRTs, etc)...the overarching input from administrators and attorneys was that the risk was not worth it.

 

[nkmiami]

Sounds like doj presently wont take these kind of cases unless clear violation of the underlying law, although as pointed out, that could change in the next administration. I cant see how an NP/PA with training and hospital privileges doesnt comply with the letter of the law and cms gudidance. I am sure the qui tam attorneys arent thrilled with that memo.

 

[Haybrant]

boomers think we're crazy bc they all own houses they bought for pennies and we're all left in the dirt. I don't know about you all but wtf w housing prices right now

 

[medgator]

boomers think we're crazy bc they all own houses they bought for pennies and we're all left in the dirt. I don't know about you all but wtf w housing prices right now

This is the point where all of those docs away from the coasts are laughing right now in their reasonably-priced mansions....

 

[deleted18755]

If you're cool with grocery shopping at Walmart and considering Target to be a fancy department store you can easily build a 5-6 bedroom/4000 sq ft mansion on more land then you know what to do with for ~$450,000 in many places I've worked. It's crazy how intense supply and demand is in our field and blows my mind what people are willing to accept to be in a big city while there are jobs out there where a mansion literally costs less than a single year's salary but to each his own!

 

[Mandelin Rain]

Here's a secret. Most medium sized (200-500k) cities even in *gasp* the midwest, have a lot of things to do on a day-to-day basis (beyond Walmart and Target) with minimal traffic, low cost of living, and good public school districts in the initial suburbs. Many of them also have airports with direct flights to larger cities. When you make twice as much, spend half as much on living expenses, and get more vacation you are able to afford enjoying a different bigger city 6-10 weeks per year. And then, when you retire at 52 you get an extra 10 years to enjoy life however you want.

Take a chance on it. You may actually like something different.

 

[deleted18755]

Here's a secret. Most medium sized (200-500k) cities even in *gasp* the midwest, have a lot of things to do on a day-to-day basis (beyond Walmart and Target) with minimal traffic, low cost of living, and good public school districts in the initial suburbs. Many of them also have airports with direct flights to larger cities. When you make twice as much, spend half as much on living expenses, and get more vacation you are able to afford enjoying a different bigger city 6-10 weeks per year. And then, when you retire at 52 you get an extra 10 years to enjoy life however you want.

Take a chance on it. You may actually like something different.

I couldn't agree more, although I would consider 500,000 to a be full blown big city. Come out to an area with 50,000-150,000 and enjoy an nice quite life with zero traffic, no noise, all the space you could need and twice the money then just drive 20-30 minutes to the regional airport (which will seem like forever since your commute to work is 6-8 minutes) and take a 45-120 minute direct flight to any number of several big cities and go nuts every weekend or from there take a flight basically anywhere in the world.

Now that I have three boys I spend more time locally just running around outside (which is free!) but there were times in my life when I lived like I recommend above and would meet friends in cities several times per month. It always struck me as odd when they would complain non-stop about the stress and costs of big city life then when I recommended they move out to the country they would say "but it's so boring, there is nothing to do out there." Then I would ask them when the last time they went out to dinner or to a sporting even was and it was 1-2 weeks ago (with me). I'm sure there are people out there who catch Broadway shows on a Tuesday or ball games at Fenway on a Thursday but the vast majority of people are just sitting at home in their living rooms during the week . . . why take such a huge pay cut and all the added stress of big city life just to sit in your sweatpants in your tiny apartment contouring all week looking forward to the weekend when you could be doing the same thing in your mansion in the boonies during the week then heading out on the weekend anyway.

Obviously a bit over-simplified, especially once you factor in your spouse's interests and career options (but if he or she is a physician too then it's double the increased income with even less cost of living) and again to each his own but something to consider (or perhaps to get used to accept if your still in training and this may be your only option once you graduate).

 

[MDACCRules]

Maybe the new grads from the Arkansas program can take this position in Russellville, AR that has:

"Almost every type of church is found in Russellville from quite small to very large. Shopping is remarkably diverse and available locally with the usual big malls in Conway and Little Rock. We have a large number of diverse restaurants for Mexican, Italian, American, and oriental appetites."

Bahahahahahaha... This is a real job post on the ASTRO jobs page.

 

[medgator]

The term 'Oriental' is outdated, but is it racist?

 

[MDACCRules]

The term 'Oriental' is outdated, but is it racist?

Do you really want to defend using that nomenclature and use an editorial from one Japanese-America to make the case for it?