ASTRO Position Statement on the U.S. Radiation Oncology Workforce

Mandelin Rain

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Hard to justify 1.7 million when you can't get medical students to have interest in your department.

Warm bodies welcome at Long Island Jewish Medical Center.
 
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RickyScott

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Hard to justify 1.7 million when you can't get medical students to have interest in your department.

Warm bodies welcome at Long Island Jewish Medical Center.
Unlike ortho or cards, LIJ wouldn’t loose a single pt if he were replaced at 1/3 of his salary. Let alone r01, or any research to speak of.
 

RickyScott

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Anyone else just get this email?

I would hope this email finds you well.

Here are some highlights of one of my Radiation Oncologists looking for work; Dr. Xx, MD. is in driving distance of your worksites.

· Board Certified and MA licensed

· Harvard educated, trained at Yale, MD and PhD

· CompHealth Credentialed

· Excellent bedside manner

· IMRT, IGRT, SBRT, SRS (frame and frameless)

· 4-D CT, 3-D Conformal for all cancer sites.

· Partial Breast Irradiation

· Prostate seed implant (with or without urologist).

· High and low dose rate brachytherapy for GYN.

· Well-versed in many common electronic medical record systems, voice recognition software, ICD-10, and radiation oncology billing codes


Do you have your doctor’s schedule for the first semester of 2021?
Any gaps, or vacation coverage you may consider Dr. X ?
 
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RadsWFA1900

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Anyone else just get this email?

I would hope this email finds you well.

Here are some highlights of one of my Radiation Oncologists looking for work; Dr. Xx, MD. is in driving distance of your worksites.

· Board Certified and MA licensed

· Harvard educated, trained at Yale, MD and PhD

· CompHealth Credentialed

· Excellent bedside manner

· IMRT, IGRT, SBRT, SRS (frame and frameless)

· 4-D CT, 3-D Conformal for all cancer sites.

· Partial Breast Irradiation

· Prostate seed implant (with or without urologist).

· High and low dose rate brachytherapy for GYN.

· Well-versed in many common electronic medical record systems, voice recognition software, ICD-10, and radiation oncology billing codes


Do you have your doctor’s schedule for the first semester of 2021?
Any gaps, or vacation coverage you may consider Dr. X ?
LOL hes gotta be Boomer or Older at this point and very very bored
 
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lhl

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Upenn actually complied with the 2021 mandate- the actual dollars they recover from select insurance companies, plus the average reimbursement per code

very interested data. Thanks for sharing! I went around and looked at some other hospital websites and was able to find a list of what they "charge" but not a list of the "negotiated rate" like what UPenn is showing. Do the new rules/regulations require institutions to post the "negotiated rates" in addition to what they "charge"?
 

RickyScott

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very interested data. Thanks for sharing! I went around and looked at some other hospital websites and was able to find a list of what they "charge" but not a list of the "negotiated rate" like what UPenn is showing. Do the new rules/regulations require institutions to post the "negotiated rates" in addition to what they "charge"?
Absolutely, you are fined daily 300$ if you don’t post, but that may increase. About 20% hospitals have posted.
1610572774526.png
 
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Reaganite

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I was trying to find this info on NCI designated cancer centers and it is difficult to find. As others have said, many are posting their charge list only. City of Hope does have an option on its website to estimate your co-pay by insurance for a limited number of radiation related codes and I believe when I ran a 3D CRT code it appeared the patient copay was based on a negotiated rate of over $2,000 per fraction for their PPO business. That would be over 600% of Medicare. I'm guessing other NCI designated Cancer Centers are in that range as well.
 
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RickyScott

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I was trying to find this info on NCI designated cancer centers and it is difficult to find. As others have said, many are posting their charge list only. City of Hope does have an option on its website to estimate your co-pay by insurance for a limited number of radiation related codes and I believe when I ran a 3D CRT code it appeared the patient copay was based on a negotiated rate of over $2,000 per fraction for their PPO business. That would be over 600% of Medicare. I'm guessing other NCI designated Cancer Centers are in that range as well.
Smart. It will become increasingly clear that the crazy/stupid money that flowed into these large centers led to satellites and expanded residencies and faculties, and ... waste. (All the while virtue signalling about hypofract while screwing the public good.)

If a place like COH had to get by on let’s say 400-500% Medicare (100-200% less than they are recovering)- they would collapse.
 
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scarbrtj

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Smart. It will become increasingly clear that the crazy/stupid money that flowed into these large centers led to satellites and expanded residencies and faculties, and ... waste. (All the while virtue signalling about hypofract while screwing the public good.)

If a place like COH had to get buy on let’s say 400-500% Medicare (100-200% less than they are recovering)- they would collapse.
We quote The Big Short a lot here. Time to do it again. It’s like the restaurant scene where the CDO manager, explaining to Steve Carell the orgy of riches he rakes in for doing nothing, goes “Apparently society values me very much.” (Steve responds he’s gonna be sick.) Apparently society values COH and Penn etc. very much! (Or so I am sure they think.) They can’t help it if society chooses to pay them 18 grand for a 3D plan... society values them very much. It is not shameful! We should applaud them and the arena in which they are “succeeding.”
 
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RadOncDoc21

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We quote The Big Short a lot here. Time to do it again. It’s like the restaurant scene where the CDO manager, explaining to Steve Carell the orgy of riches he rakes in for doing nothing, goes “Apparently society values me very much.” (Steve responds he’s gonna be sick.) Apparently society values COH and Penn etc. very much! (Or so I am sure they think.) They can’t help it if society chooses to pay them 18 grand for a 3D plan... society values them very much. It is not shameful! We should applaud them and the arena in which they are “succeeding.”
Tells me we all went into the wrong side of the medicine BUSINESS! How long will it take for me to get an online MBA, where can I get it the cheapest?
 
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fiji128

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ARRO should put a statement as unequivocal as this. This is from the emergency medicine equivalent of ARRO.

AAEM/RSA Statement of Concern for Graduating EM Residents and the Current Job Market​

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is gravely concerned that graduating resident physicians are having significant difficulty in finding adequate jobs due to the current job market.

We believe that COVID has unearthed a very concerning combination of issues including:
  • Dramatic overproduction of residents by Contract Management Group (CMG) run residencies.
  • The inappropriate overuse of NPs and PAs practicing beyond their training in roles that should be filled by highly trained board certified emergency physicians.
  • The significant conflict of influence of CMGs in our specialty societies, which prohibits physicians from advocating for themselves on these topics.
AAEM/RSA is fearful that this dramatic decline in job opportunities will result in increased medical student caution and avoidance in choosing emergency medicine as a specialty and will ultimately result in under-filling of residency spots in the 2022 Match. We advise all senior residents to vocalize their concerns to their specialty societies and advise their programs to do the same.
 
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RickyScott

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But, I thought Astro had a member who was a never practicing lawyer who believes that this type of speech is constitutionally prohibited?
 
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Doctorer

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But, I thought Astro had a member who was a never practicing lawyer who believes that this type of speech is constitutionally prohibited?
This is the medical student/resident society, ie, the one without any power to do anything. ASTRO saying something substantive would be nice, though.
 

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From the original ASTRO post by Eichler in January of 2021:

ASTRO leaders have sought to be forthright with our members about challenges in the field (see previous blog posts below) and ASTRO’s role in addressing them. While there are strict anti-trust principles ASTRO must abide by, the Board of Directors felt compelled to issue a definitive statement so that there is no ambiguity about our position.

As we prepare the next generation of radiation oncologists for independent practice, we encourage stakeholders to carefully consider these aspects affecting our specialty as they review the size and scope of their training programs. (That is as strong as the wording gets from the ASTRO blog post).

Meanwhile, between 2019 and 2021 and after careful consideration these programs said f*** it. And just like that Loma Linda grew from 5 to 6, Case Western Reserve 6 to 7, Columbia 6 to 8, Northwestern 8 to 9, Thomas Jefferson 9 to 11 and Duke 13 to 14 even though most of these places were in the SOAP these past two years.
 
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fiji128

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I wonder what strict anti-trust principles Google, Facebook and Amazon and their lawyers tell them they need to abide by. Maybe astro should ask their lawyers for a second opinion.
 
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thecarbonionangle

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I wonder what strict anti-trust principles Google, Facebook and Amazon and their lawyers tell them they need to abide by. Maybe astro should ask their lawyers for a second opinion.
These companies pay them big money not to tell them it is ilegal but to make it legal.
 
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OTN

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Statement from ARRO wouldn't do anything. The bottom fell out of the applicant pool and it didn't do anything. ASTRO in truth doesn't care about the law, and they simply DO NOT CARE if the job outlook will be poor to quite poor for most grads. They want their academic programs to remain the size they are, thank you very much, and take great umbrage to us unwashed masses daring to suggest otherwise.

Trying to encourage minorities with lower levels of generational wealth to enter this specialty so you can feel good about your CHEDI initiatives is morally bankrupt.
 
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radonc17

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But, I thought Astro had a member who was a never practicing lawyer who believes that this type of speech is constitutionally prohibited?


I can’t like this enough!

I’m sure he is a good guy, but how in the world did our specialty organization decide to make (more like not make) workforce decisions off 1 guys opinion?
 
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RickyScott

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I can’t like this enough!

I’m sure he is a good guy, but how in the world did our specialty organization decide to make (more like not make) workforce decisions off 1 guys opinion?
It just seems like an important enough issue that you want to have a consultation with high powered anti trust lawyer, not a friend in the law school. Obviously any position can be legally challenged, but us antitrust doctrine centers on what benefits the consumer/public. Just because it can be challenged means nothing.
 
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radonc17

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It just seems like an important enough issue that you want to have a consultation with high powered anti trust lawyer, not a friend in the law school. Obviously any position can be challenged, but us antitrust doctrine centers on what benefits the consumer/public.

we literally debate merits of a positive RT study like POP-RT and whether it needs 10 confirmatory studies

but somehow antitrust passed without a second look?

@OTN @RickyScott you may be on to something
 
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fiji128

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Statement from ARRO wouldn't do anything. The bottom fell out of the applicant pool and it didn't do anything. ASTRO in truth doesn't care about the law, and they simply DO NOT CARE if the job outlook will be poor to quite poor for most grads. They want their academic programs to remain the size they are, thank you very much, and take great umbrage to us unwashed masses daring to suggest otherwise.

Trying to encourage minorities with lower levels of generational wealth to enter this specialty so you can feel good about your CHEDI initiatives is morally bankrupt.

It wouldn't do anything per se but it singles that people are taking it seriously as really THE biggest issue facing rad onc. Instead all you get from astro is deflections about anti trust non sense and asking programs to carefully consider how they may have individually contributed the destruction of the specialty.
 
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RickyScott

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Because they got the answer they wanted.
Exactly. Apparently their freedom of speech is limited even though they have no power over residencies.

“Judge Robert Bork's writings on antitrust law (particularly The Antitrust Paradox), along with those of Richard Posner and other law and economics thinkers, were heavily influential in causing a shift in the U.S. Supreme Court's approach to antitrust laws since the 1970s, to be focused solely on what is best for the consumer rather than the company's practices.[48]
 
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Chartreuse Wombat

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Repeating...ASTRO is a membership organization. Success is defined by growth...more members is more dues is larger budget.

The other beneficiary of overtraining is employers (which is the majority of the ASTRO Board members through the years).

Salaries go down...exactly what the leadership wants
 
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RickyScott

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Repeating...ASTRO is a membership organization. Success is defined by growth...more members is more dues is larger budget.

The other beneficiary of overtraining is employers (which is the majority of the ASTRO Board members through the years).

Salaries go down...exactly what the leadership wants
Why I am not a member .
 
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TheWallnerus

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ARRO should put a statement as unequivocal as this. This is from the emergency medicine equivalent of ARRO.

AAEM/RSA Statement of Concern for Graduating EM Residents and the Current Job Market​

The American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) is gravely concerned that graduating resident physicians are having significant difficulty in finding adequate jobs due to the current job market.

We believe that COVID has unearthed a very concerning combination of issues including:
  • Dramatic overproduction of residents by Contract Management Group (CMG) run residencies.
  • The inappropriate overuse of NPs and PAs practicing beyond their training in roles that should be filled by highly trained board certified emergency physicians.
  • The significant conflict of influence of CMGs in our specialty societies, which prohibits physicians from advocating for themselves on these topics.
AAEM/RSA is fearful that this dramatic decline in job opportunities will result in increased medical student caution and avoidance in choosing emergency medicine as a specialty and will ultimately result in under-filling of residency spots in the 2022 Match. We advise all senior residents to vocalize their concerns to their specialty societies and advise their programs to do the same.
It is so sad for these people. I plan to minister to them during their prison sentences.
 
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TheWallnerus

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I wonder what strict anti-trust principles Google, Facebook and Amazon and their lawyers tell them they need to abide by. Maybe astro should ask their lawyers for a second opinion.
Facebook: controls the news feed to everyone in Australia. That's OK.

ASTRO: says there are too many rad oncs in US for society's needs. FBI puts ASTRO under the jail.

Makes sense.
 
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If they originally were thinking there would be an undersupply of radiation oncologists wouldn't they want to keep the number of rad ones steady or slightly increase? Similar to surgical subspecialties like Urology where no matter how many patients need a urologist they decided there will always be a undersupply to keep salaries and opportunities high for doctors.
 
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Mandelin Rain

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Guys, I'm sure anti-trust law is straightforward without nuance or complexity. Especially, when numerous interests are at stake, not the least of which the taxpayer. I'd trust anyone with a JD to have exhaustive knowledge of the topic and would trust them implicitly. Like a guy without possessions drafting a will.
 
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thesauce

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Who actually decides the ASTRO leadership? I still don’t understand why we can’t put forward a candidate like Chirag or someone who truly represent the majority of this field to be empowered to make necessary changes
 
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Chartreuse Wombat

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Who actually decides the ASTRO leadership? I still don’t understand why we can’t put forward a candidate like Chirag or someone who truly represent the majority of this field to be empowered to make necessary changes
The nomination committee...which is chosen by the members (but the slate is chosen by the Board).

Write-in is possible but so many are lazy
 
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RickyScott

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Guys, I'm sure anti-trust law is straightforward without nuance or complexity. Especially, when numerous interests are at stake, not the least of which the taxpayer. I'd trust anyone with a JD to have exhaustive knowledge of the topic and would trust them implicitly. Like a guy without possessions drafting a will.
Even consulting with an anti trust lawyer is in and of itself, anti trust, just like speaking about it.
 
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medgator

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Who actually decides the ASTRO leadership? I still don’t understand why we can’t put forward a candidate like Chirag or someone who truly represent the majority of this field to be empowered to make necessary changes
Too late at this point #CancelASTRO
 
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fiji128

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I wonder how many actual votes it takes to be ASTRO president. I get the annual ballot but never vote as its always just these ivory tower academic types all pushing for the same agenda so who really cares. I would guess most members don't bother to vote either for the same reason so the total number of votes needed to win is probably fairly low. Between the viewership on this forum (which is much higher then the people posting) and twitter a grass roots write in candidate may have decent chance.
 
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Chartreuse Wombat

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Might provoke Twitter mob from #radoncrocks. I don’t tweet I live vicariously thru SDN rummaging through Twitter
 

fiji128

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Might provoke Twitter mob from #radoncrocks. I don’t tweet I live vicariously thru SDN rummaging through Twitter
The #radoncrocks hashtag has kinda died a slow twitter death and has been de-trending for some time. I think it was killed off by the various rad onc troll accounts who pointed out the ridiculousness and hypocrisy of those originally using the hashtag.
 
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RadOncDoc21

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The #radoncrocks hashtag has kinda died a slow twitter death and has been de-trending for some time. I think it was killed off by the various rad onc troll accounts who pointed out the ridiculousness and hypocrisy of those originally using the hashtag.
Stop the count!
 
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elementaryschooleconomics

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The #radoncrocks hashtag has kinda died a slow twitter death and has been de-trending for some time. I think it was killed off by the various rad onc troll accounts who pointed out the ridiculousness and hypocrisy of those originally using the hashtag.
It's actually pretty hilarious to watch. Actual discussion of trials? Totally normal. Someone starts trying to recruit hapless students into RadOnc? It's like a tornado siren activates and certain folks IMMEDIATELY descend on the thread.
 
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medgator

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The #radoncrocks hashtag has kinda died a slow twitter death and has been de-trending for some time. I think it was killed off by the various rad onc troll accounts who pointed out the ridiculousness and hypocrisy of those originally using the hashtag.
RadOnCrocks was my favorite to see
 
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