Astro work force survey

[DebtRising]

Is out, free on red journal. I think it is best summarized by this -

DEFINE_ME

Implications and Next Steps​

What are the implications of these findings? First, the most likely scenario supports a relative projected balance between supply and demand until 2030 without significant oversupply or undersupply of ROs at this time. These results may provide a measure of reassurance to medical students who may be concerned about future job opportunities. At the same time, due to substantial slowing in growth of Medicare beneficiaries beyond 2030, which will likely require future supply reductions, these trends could not be projected beyond 2030, leaving an element of uncertainty for students who would have a much longer time horizon


Which in my translation is that beyond 2030, accepting uncertainties, this field has serious supply / demand concerns. Please make available to any applicant so that they can at least be informed.

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Members don't see this ad.

 

[BobbyHeenan]

They need to share the raw data if not already done. WOuld love to see these numbers crunched in all kinds of different ways.

 

[medgator]

 

[sirspamalot]

ASTRO and Academics have a message for you newcomers. Can you feel it yet? GLTA. Glad I'm in the last 5-7 of my career and arbitraged correctly.

I don't know what the next step down in radonc training #'s is, but we are about to see capitulation. If they close half the residency spots for 3 years, we might survive. Think its gonna happen? See above for your answer. Should make the leg into the sunset even better for us in the final third of career who are flexible geographically/locums though, so I guess thanks for that (?)

#tonedeafdip****sincharge

 

[DebtRising]

They discussed methodology at Astro 2022 and can watch that presentation.

Emotion aside, yes it’s pretty clear why this was timed how it was. The more you read, the more it’s clear that over the next 7 years, could go either way, 7 years on, serious oversupply is the projection. Appreciate HMA for using the strongest but probably most careful language Astro would allow. Not a good picture for applicants, current residents, or young attendings.

 

[sirspamalot]

"however, critically, the demand model accounts for neither lost technical/delivery revenue for practices when utilizing more hypofractionation nor the gain from use of SBRT."

(accident, handwaving, nothing to see here)

"Though the impact of hypofractionation on workforce needs is commonly raised as a major concern, even with aggressive hypofractionation estimates, the number of ROs needed in the model changed less than 5%"

(fire burning, smoke everywhere, still ... nothing to see here)

"With continued follow up of trends, substantial reductions in trainee positions may be needed"

(huh, I thought we were good. hmm... well then surely you'll take a strong position, I mean, with all that data you just shared)

As part of recruiting and training our future generations of ROs, programs should focus on recruiting individuals with a strong desire to enter our specialty, providing care to cancer patients, and fostering a culture of quality, safety, and innovation as well as diversity, equity, and inclusion10. In this regard, programs that do not fill their NRMP match positions with applicants who are enthusiastic and passionate about a career in radiation oncology, should consider forgoing the SOAP process to fill their resident complement or only consider candidates who have demonstrated a strong interest in radiation oncology as a primary choice.

(THIS IS A JOKE RIGHT? Ok, so as long as the trainee really really wants to do it, then its okay. Carry on, as you were, nothing to see here.. )


We faced a similar situation 25-30 years ago and we must learn from this moment.

(We ain't gunna, thanks for playin)


ps. Academic RO should be embarassed by this report and embarassed at its lack of call to action. Simply saying "elasticity" (ie work harder/faster/cmon you donkeys) isn't gonna help. There is only one solution: immediately cut 25% of program slots at major centers, and eliminate the bottom 25% of programs forcing them to reapply when metrics make sense to do so. Consolidate and survive, or carry on and wither. Talk about elasticity.. the "Academic" RO's will actually have to do patient care for realz..

 

[OTN]

These projections re: Medicare populations should be obvious, and are also why my group in town won't be hiring any more radiation oncologists for the next 15-20 years. We've discussed it many times over the last few years and have always arrived at the same consensus.

 

[sirspamalot]

7 years ago "Conclusion: The supply of radiation oncologists is expected to grow more quickly than the demand for radiation therapy from 2015 to 2025. Further research is needed to determine whether this is an appropriate correction or will result in excess capacity." Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025 - PubMed


How much more 'research' or platitudes are sustainable? I think we're already over the cliff at this point..

 

[yesmaster]

These projections re: Medicare populations should be obvious, and are also why my group in town won't be hiring any more radiation oncologists for the next 15-20 years. We've discussed it many times over the last few years and have always arrived at the same consensus.

That’s good to know. If all the independent rad onc groups across the country stated their hiring needs over the next 10-15 years, those boots-on-the-ground statements would hold a lot more weight versus ivory tower “modeling projections”.

It’s funny to me when medical students applying to radiation oncology say they want to be in a particular city or geographic location, only to be surprised as PGY-4’s that the 1-3 practices in your home city have no plans to hire.

Sadly this is a best case scenario since your practice is physician-led. I have no doubt that academic centers and hospital systems, aka the vast majority of rad onc practices will simply pay less and create more positions. But everyone is employed, so supply equals demand in the labor market.

 

[Gfunk6]

Here is my "executive" summary:

1. Program Directors can do what they want through 2030 since we are all good until then. Expand, contract, whatever . . . it's all good playa!

2. Boomers (especially in academics) have until 2030 to either retire (with full benefits and pension) or sell their practice to affluent big health. Though they will be very well off in both scenarios, they still have a profitable role to play once Rad Onc achieves "Beyond Thunderdome" status. They can serve as consultants and advisors to struggling physicians to help meet the new "austerity guidelines" which have been implemented by their non-physician overlords (RN, MSN, ABCDEFG)

3. Med Students can happily and securely apply to Rad Onc residencies and they can be assured that ASTRO will 100%, absolutely, and with certainly have a plan in place to magically fix this problem by 2030.

4. If you are having a problem filling your residency ranks due to this jobs report, you could voluntarily forgo residents that year or you could get someone with a pulse. Kudos if you are able to swindle POC or LBGTQ+ individuals into sacrificing their future so that the attendings don't have to click all those annoying boxes to affirm that they reviewed each patient's gender identity, food insecurity, and pain.

 

[sirspamalot]

A few of us will carry on in the boonies, making bank because its a 1 or 0 problem. I got a call yesterday that a center 2 hours outside of Phoenix is desperate for help. 5 on treatment and dwindling.

You could work 2 weeks a month and offer 2600/d or better, and if they don't pay you, they close. Easy retirement gig.

Thank goodness its Direct Supervision in the wild west of PP, or it'd be staffed by an NP full time, working remotely with a Radonc. No joke.

 

[NotMattSpraker]

They need to share the raw data if not already done. WOuld love to see these numbers crunched in all kinds of different ways.

This is the most important point. The raw data should at least be open to members and provided with no questions asked other than verifying membership.

My biggest take away and concern is ASTROs approach and attitude. Reasonable people can conclude different things out of the same dataset. That's how science works. But I do not think the way they frame the issue or treat the arguments of "oversupply advocates" (a ridiculous choice of words) is fair or healthy.

Unbelievable lack of transparency.

 

[winstonfoot5]

Maybe, Im over simplifying this, but if I'm a newly matched medical student (present day, year 2023), and I'm in training (internship + rad onc residency) for the next 5 years (graduate year 2028), then Ive got a solid 2 years of practice, one of which is as a Board Certified doc (one year pre-oral boards (2029), one year post-oral boards (2030)) before I enter the Complete Unknown (according to this analysis) regarding the compensation, geography, and scope of practice employment landscape for my chosen profession (rad onc)... which also happens to be right around when I might finally qualify for full Partnership in the practice I joined (give or take a couple years). So who knows what happens for the next 28 years of a 30 year career.... Orthopedic surgery starting to sound pretty good...

 

[sirspamalot]

These projections re: Medicare populations should be obvious, and are also why my group in town won't be hiring any more radiation oncologists for the next 15-20 years. We've discussed it many times over the last few years and have always arrived at the same consensus.

Can you imagine a real world survey, ie I call up and speak to the senior MD of the top 50 practices in the USA and do a brief 5 question survey by phone.

You think the Red, Green, White or Shyt color Journal(s) would publish the devastating results?

 

[Gfunk6]

Maybe, Im over simplifying this, but if I'm a newly matched medical student (present day, year 2023), and I'm in training (internship + rad onc residency) for the next 5 years (graduate year 2028), then Ive got a solid 2 years of practice, one of which is as a Board Certified doc (one year pre-oral boards (2029), one year post-oral boards (2030)) before I enter the Complete Unknown (according to this analysis) regarding the compensation, geography, and scope of practice employment landscape for my chosen profession (rad onc)... which also happens to be right around when I might finally qualify for full Partnership in the practice I joined (give or take a couple years). So who knows what happens for the next 28 years of a 30 year career.... Orthopedic surgery starting to sound pretty good...

You are not oversimplifying. The clear message to med students interested in Rad Onc is:

 

[Mandelin Rain]

[calls anti-trust attorney]

 

[RickyScott]

They discussed methodology at Astro 2022 and can watch that presentation.

Emotion aside, yes it’s pretty clear why this was timed how it was. The more you read, the more it’s clear that over the next 7 years, could go either way, 7 years on, serious oversupply is the projection. Appreciate HMA for using the strongest but probably most careful language Astro would allow. Not a good picture for applicants, current residents, or young attendings.

When baby boomers start to dissapear in mid 2030s the then 7-8k radoncs in this one trick pony of a specialty are screwed.

 

[Doctorer]

The only "fair" solution would be to cut 50% of training spots immediately, but that's not happening. The sad part is that there is zero willingness from the leadership to do anything about this: tragedy of the commons etc etc.

Yes I get this means cutting spots from "great" programs. It'll be okay: your mom is still very proud of you being program director.

 

[grenz]

This is the most important point. The raw data should at least be open to members and provided with no questions asked other than verifying membership.

My biggest take away and concern is ASTROs approach and attitude. Reasonable people can conclude different things out of the same dataset. That's how science works. But I do not think the way they frame the issue or treat the arguments of "oversupply advocates" (a ridiculous choice of words) is fair or healthy.

Unbelievable lack of transparency.

You should check out the interactive spreadsheet the paper links to. It allows you to make your own assumptions and see how demand changes. I would guesstimate that few SDN users have the expertise to analyze the raw data, so this is a pretty good solution

 

[Fpg1245]

the big question at this point is who cares? Med students already got the message which is why it’s not competitive anymore. Academic programs aren’t going to contract to any appreciable extent. In fact they may be pressured to add more residents because it’s hard to find other staff. And community practices won’t be hiring.

The soft language is meant to obfuscate and the DIY data analysis while a nice touch not sure what else to say.

 

[NotMattSpraker]

You should check out the interactive spreadsheet the paper links to. It allows you to make your own assumptions and see how demand changes. I would guesstimate that few SDN users have the expertise to analyze the raw data, so this is a pretty good solution

I will for sure, just havent had time yet.

I disagree though. Opening datasets is important whether you personally think there are individuals out there that can use it. Most seem to agree and a lot of people write about the need for more open data sharing. Providing a curated spreadsheet that limits how you can assess the raw data is not the same as sharing an open dataset.

Really, this is more about ASTRO. They are incredibly shady. The lack of transparency with this analysis is a huge mistake. If they were super open and released the raw data, it would be such a turnaround from their prior behavior that it might make me become a member again.

Remember they continue to collect and conceal salary and work activity data about a large portion of employed physicians and physicists in the US.

 

[Fpg1245]

Remember they continue to collect and conceal salary and work activity data about a large portion of employed physicians and physicists in the US.

No one else has a comprehensive data set on this?

 

[communitydoc13]

Boomers (especially in academics) have until 2023 to either retire (with full benefits and pension) or sell their practice to affluent big health.

I have no doubt that academic centers and hospital systems, aka the vast majority of rad onc practices will simply pay less and create more positions.

Key points. Us in the community never needed this study. We know what our opportunities are, relative to our credentials and compared to our peers in every other specialty, and they are not even close and have not been for a long time.

Boomers are leaving practice now and will be major cancer generators for next 15 years. The unknown is always how human behavior (which is the hardest variable to predict) will impact things.

Two factors, boomers ready for retirement and Gen-Xers/early millennials trying to FIRE. will likely drive further consolidation. No better time to sell a practice than the present. Combine this with a general sense that "working is for suckers" and I wouldn't be surprised to see a fair number of 50 something radoncs cash out of the field pretty soon.

While our opportunities in terms of location and type of practice have been bad, we have not hit rock bottom in terms of compensation (ID/Palliative care levels). This will come.

If I were in academics, I'd be pushing for radical restructuring of the specialty. It wouldn't help me, but it would help them and their relevance. Unfortunately, this takes real work.

 

[GapCalc]

They really went all in on this, including a careful proofreading:

The authors note, "[oversupply] is also possible if growth in radiation oncologist supply does not parallel Medicare beneficiary growth." As stated elsewhere, this is a demographic certainty.

So if I were a med student and I liked RO but had concerns about the job market, this analysis would tell me exactly what I need to know: stay away.

 

[Sheldor]

Anybody know what the reaction on rad onc twitter is to this?

 

[BobbyHeenan]

They really went all in on this, including a careful proofreading:
View attachment 367341

The authors note, "[oversupply] is also possible if growth in radiation oncologist supply does not parallel Medicare beneficiary growth." As stated elsewhere, this is a demographic certainty.

So if I were a med student and I liked RO but had concerns about the job market, this analysis would tell me exactly what I need to know: stay away.

I agree. BUt how closely do the med students look? Especially if your program director is saying "everything is fine."

We need to look at this data set and have someone not in academia and/or hired by academia as a consultant (where there is an inherent bias for status quo) to give an opinion as well.

 

[NotMattSpraker]

No one else has a comprehensive data set on this?

As far as I can tell you cannot get these specific data from MGMA or AAMC, but I am not an expert in this area and dont review these reports annually.

I've only seen one ASTRO report and it is just way more detailed and has a broader scope than the other reports that are available for purchase.

 

[Mandelin Rain]

As far as I can tell you cannot get these specific data from MGMA or AAMC, but I am not an expert in this area and dont review these reports annually.

I've only seen one ASTRO report and it is just way more detailed and has a broader scope than the other reports that are available for purchase.

I "believe" ASTRO's data is indeed available for purchase to the right buyers.

 

[sirspamalot]

Good ol' ASTRO. Putting their money where your mouth is.. ooops...

 

[elementaryschooleconomics]

Anybody know what the reaction on rad onc twitter is to this?

Suspiciously quiet.

Some major methodological issues have been brought up (via the Usual Suspects), and the pro-ASTRO crowd, aka "Twitteratti", aka "raraRadOnc"...have basically said nothing.

In their defense, it's still the middle of the workday, and the study was "officially" released only this morning.

...although, SOME people were given the data early...

 

[yesmaster]

The summary paper isn’t horrible, glancing through it. At least it discourages program expansion. It also acknowledges that AI & autocontouring can boost productivity and reduce demand for more rad onc’s.

My biggest question is methodological. How did they model Medicare growth through 2030, why does it differ from CBO projections, and is part of Medicare growth just reallocation from private insurers?

Other questions/comments

“the model may have underestimated the number of practicing radiation oncologists (e.g., 4,718 ROs were estimated in 2019, but data sources including NPI registry and VRDC were up to approximately 5,600”

So at year 0, there may be an oversupply of 900 rad onc’s. Or there’s 900 FTE’s of excess slack in the system, of doctors that don’t have as many patients as they’d like. But the model conveniently used the lower estimate of practicing rad oncs?

“the Congressional Budget Office (CBO) does not project beneficiary numbers to increase at the same rate from 2020-2030 as the trend seen in the HMA analysis”

You ignored the government’s analysis for Medicare growth?

“In the most extreme scenario, these parameters translated into an substantial oversupply of 1,300 ROs in 2030”

If your estimate of practicing rad onc’s in 2019 was wrong, then there’s an oversupply of 2,200 ROs in 2030 in the worst case scenario, okay cool

“due to substantial slowing in growth of Medicare beneficiaries beyond 2030, which will likely require future supply reductions, these trends could not be projected beyond 2030, leaving an element of uncertainty for students who would have a much longer time horizon”

I have yet to meet a medical student who is planning to practice for just 2 years after residency. That’s not even enough time to PSLF your loans.

“it is imperative that non-billable tasks are appropriately accounted for in measuring work effort…including participation in quality improvement efforts, education, research, and administrative responsibilities”

Don’t forget DEI director and eviCore utilization reviewer in non-billable jobs for rad oncs

 

[NotMattSpraker]

I "believe" ASTRO's data is indeed available for purchase to the right buyers.

Of course. But I also know of at least 1 program director at a center that participates in the survey who was also not able to get it. Technically they qualify by the new criteria that they made up on the fly when I tried to purchase the report, but unfortunately still could not get it.

I suspect they were blocked from getting it because their boss is on the ASTRO board and they didn't want the PD and other faculty in their department seeing the data.

Im still not sure this is legal, but beyond that it is their right to do what they want with their data. Similarly, it is my right not to trust anything they do or say based on my past experience.

 

[medgator]

Thank goodness its Direct Supervision in the wild west of PP, or it'd be staffed by an NP full time, working remotely with a Radonc. No joke.

Virtual direct option still there (at least until CMS kills it off). Now that the pandemic emergency has been ended, it's a possibility, but quite frankly, i think they'll let it stay

 

[pikachu]

This is the most important point. The raw data should at least be open to members and provided with no questions asked other than verifying membership.

My biggest take away and concern is ASTROs approach and attitude. Reasonable people can conclude different things out of the same dataset. That's how science works. But I do not think the way they frame the issue or treat the arguments of "oversupply advocates" (a ridiculous choice of words) is fair or healthy.

Unbelievable lack of transparency.

They are used to the model in which the advocate's point of view informs the conclusions of the inquiry

 

[TheWallnerus]

The summary paper isn’t horrible, glancing through it. At least it discourages program expansion. It also acknowledges that AI & autocontouring can boost productivity and reduce demand for more rad onc’s.

My biggest question is methodological. How did they model Medicare growth through 2030, why does it differ from CBO projections, and is part of Medicare growth just reallocation from private insurers?

Other questions/comments

“the model may have underestimated the number of practicing radiation oncologists (e.g., 4,718 ROs were estimated in 2019, but data sources including NPI registry and VRDC were up to approximately 5,600”

So at year 0, there may be an oversupply of 900 rad onc’s. Or there’s 900 FTE’s of excess slack in the system, of doctors that don’t have as many patients as they’d like. But the model conveniently used the lower estimate of practicing rad oncs?

“the Congressional Budget Office (CBO) does not project beneficiary numbers to increase at the same rate from 2020-2030 as the trend seen in the HMA analysis”

You ignored the government’s analysis for Medicare growth?

“In the most extreme scenario, these parameters translated into an substantial oversupply of 1,300 ROs in 2030”

If your estimate of practicing rad onc’s in 2019 was wrong, then there’s an oversupply of 2,200 ROs in 2030 in the worst case scenario, okay cool

“due to substantial slowing in growth of Medicare beneficiaries beyond 2030, which will likely require future supply reductions, these trends could not be projected beyond 2030, leaving an element of uncertainty for students who would have a much longer time horizon”

I have yet to meet a medical student who is planning to practice for just 2 years after residency. That’s not even enough time to PSLF your loans.

“it is imperative that non-billable tasks are appropriately accounted for in measuring work effort…including participation in quality improvement efforts, education, research, and administrative responsibilities”

Don’t forget DEI director and eviCore utilization reviewer in non-billable jobs for rad oncs

Ditto.

 

[fiji128]

I think there are two fundamental flaws with the Workforce Analysis.

First, the underlying assumption of the whole analysis is that the work force is currently in balance. However, it can very easily be argued that Rad Onc currently has amongst the worst job markets in all of medicine and this is because of there is currently an imbalance in the supply of and demand for rad oncs. Previous work has shown the most rad oncs out of residency may get 1 to 3 real job offers and over the past five years the total numbers of positions advertised on the Career Center is less then the total number of new grads (not to mention all the other rad oncs out there that may want a new position). Also, as we all know quality positions can be exceptionally hard to find let alone obtain for new grads and later career docs. The analysis essential argues that whatever the current job market is (not great and likely terrible when compared to other specialties), it is likely to remain about the same in the 2025 and 2030 time frame.

Second, the analysis also admits to significant difficultly in nailing down the number of working ROs with an estimate of 4,718 RO in 2019 (growing to 5,057 in 2030) used for the analysis but the report says this could also be as high as could be as high as 5,600 in 2019 based off of different data sets. Not sure how useful an analysis looking at the job market is when the number of employees might be underestimated by 20%.

Overall, though, I think the analysis is probably not unreasonable in saying the job market (whatever it is and whatever it looks like compared to alternatives in other specialties for potential med students) is likely to remain the same over the next five years or so. At least the analysis states that creating more residency positions is less then wise given these findings.

 

[sirspamalot]

At least the analysis states that creating more residency positions is less then wise given these findings.

All that time and effort (and your, not my, ASTRO dues) spent to create a study that luke-warm says "maybe we should do something."

I would have done the work for 10% of the cost, come up with the following, and the conclusion would be more forceful.. "CUT THE DAMN SLOTS"

 

[DoctwoB]

Good thread by Simul on twitter on the errors of using RVUs to model demand. We we all know, docs create their own demand. You could double the number of radoncs (or urologists) and total RVUs generated might not double due to fewer low hanging fruit and underemployment, but it would go up at least 75%. Longer treatment courses, treating more marginal indications, more frequent follow up visits, the list goes on. This also has a big social cost in terms of high cost but low value medical payments and care.

Conversely if you’re understaffed, everyone would get shorter courses, fewer follow ups, more centralized/less convenient care.

 

[TheWallnerus]

Good thread by Simul on twitter on the errors of using RVUs to model demand. We we all know, docs create their own demand. You could double the number of radoncs (or urologists) and total RVUs generated might not double due to fewer low hanging fruit and underemployment, but it would go up at least 75%. Longer treatment courses, treating more marginal indications, more frequent follow up visits, the list goes on. This also has a big social cost in terms of high cost but low value medical payments and care.

Conversely if you’re understaffed, everyone would get shorter courses, fewer follow ups, more centralized/less convenient care.

Of course one of the logical offshoots of what you’re saying that is not talked about much is properly staffed results in less healthcare cost to society versus overstaffed/oversupplied.

 

[fiji128]

There are significant issues with the analysis and at the end of the day. From what I understand, the whole precipitating factor for the analysis was starting in 2019 fewer and fewer "quality" med students were applying to rad onc. Med students aren't applying to the specialty because fundamentally there are much better alternatives out there that don't have the significant downside risk of rad onc. So Astro commissions a study that basically says well the job market for rad onc is most likely to be about the same in 5 years as it is today (which of course is terrible when compared to other medical specialties). I don't see this analysis convincing any potential reasonable applicants to ignore the jobs issues. Also on the other hand I don't see any programs looking at this and saying we should be contracting positions (because everyone knows their program is awesome).

So at the end of the day the analysis will change nothing and our specialty will continue being among the least if not the least selective in the match.

 

[RickyScott]

Good thread by Simul on twitter on the errors of using RVUs to model demand. We we all know, docs create their own demand. You could double the number of radoncs (or urologists) and total RVUs generated might not double due to fewer low hanging fruit and underemployment, but it would go up at least 75%. Longer treatment courses, treating more marginal indications, more frequent follow up visits, the list goes on. This also has a big social cost in terms of high cost but low value medical payments and care.

Conversely if you’re understaffed, everyone would get shorter courses, fewer follow ups, more centralized/less convenient care.

such an important point.

 

[Chartreuse Wombat]

Medical students aren't stupid. This analysis was released after ROL were submitted so can't effect results. Next years match will have this information baked in but I expect you will continue to hear from BIG RAD ONC (trademark to Simul) that "all is well." Indeed it is well if you are an employer of RadOnc.

 

[Doctorer]

Medical students aren't stupid. This analysis was released after ROL were submitted so can't effect results. Next years match will have this information baked in but I expect you will continue to hear from BIG RAD ONC (trademark to Simul) that "all is well." Indeed it is well if you are an employer of RadOnc.

I feel dumb for not realizing why they timed it like this. Sign of a thriving specialty.

 

[medgator]

Medical students aren't stupid. This analysis was released after ROL were submitted so can't effect results. Next years match will have this information baked in but I expect you will continue to hear from BIG RAD ONC (trademark to Simul) that "all is well." Indeed it is well if you are an employer of RadOnc.

Rank List certification deadline was March 1.

I got the impression from your post in a different thread that this wasn't done intentionally? Felt like it was

 

[NotMattSpraker]

Good thread by Simul on twitter on the errors of using RVUs to model demand. We we all know, docs create their own demand. You could double the number of radoncs (or urologists) and total RVUs generated might not double due to fewer low hanging fruit and underemployment, but it would go up at least 75%. Longer treatment courses, treating more marginal indications, more frequent follow up visits, the list goes on. This also has a big social cost in terms of high cost but low value medical payments and care.

Conversely if you’re understaffed, everyone would get shorter courses, fewer follow ups, more centralized/less convenient care.

Those poor women with 8 mm ER+ breast cancers following with a Rad Onc 12 years out

 

[sirspamalot]

Lol. As a specialty we're f-cked.

 

[Fpg1245]

Those poor women with 8 mm ER+ breast cancers following with a Rad Onc 12 years out

You should expect more of this to occur as they keep pumping out grads. RO cogs have a base plus RVU benchmarks.

 

[sirspamalot]

 

[communitydoc13]

RVUs to model demand

RO cogs have a base plus RVU benchmarks.

RVUs are an administrative tool to ensure that the employer is getting reasonable productivity.

It is a terrible tool in many circumstances and does not represent value well at all. It also does not represent well how hard someone is working.

Like most community practices, we are understaffed regarding medoncs, and I am trying to structure contracts for them where we don't emphasize RVUs much for bonus.

Why? Because there is tremendous inefficiency in chasing RVUs. So many unnecessary f/u and so many services that can be delegated to mid-levels or skipped altogether.

We gotta serve the community and we collectively get rich by treating patients not by seeing them for their 3 year f/u. I need medoncs to be willing to supervise a team while not worrying that their compensation is going to fall through the floor when they don't have 15 f/u on the schedule.

Meanwhile, got enough radoncs (and good ones). Don't even need a single mid-level. Running lean to keep viable moving into the future.

 

[winstonfoot5]

There are significant issues with the analysis and at the end of the day. From what I understand, the whole precipitating factor for the analysis was starting in 2019 fewer and fewer "quality" med students were applying to rad onc. Med students aren't applying to the specialty because fundamentally there are much better alternatives out there that don't have the significant downside risk of rad onc. So Astro commissions a study that basically says well the job market for rad onc is most likely to be about the same in 5 years as it is today (which of course is terrible when compared to other medical specialties). I don't see this analysis convincing any potential reasonable applicants to ignore the jobs issues. Also on the other hand I don't see any programs looking at this and saying we should be contracting positions (because everyone knows their program is awesome).

So at the end of the day the analysis will change nothing and our specialty will continue being among the least if not the least selective in the match.

Can someone closer to this work comment on the Demand side of the workforce model? They did not account for SBRT/SRS, correct? (this seems problematic?) How about moderate hypofrac - where did they get estimates for rates of adoption from? Related, just because RO-APM is dead does not mean all APMs are dead -- what about enhancing oncology model and future iterations? Its not a question of "if" but "when" fee for service finally dies. Havent seen these discussed much in the context of this new analysis, but havent been following the twitter discussion closely
Edit: also, what about decreasing utilization? (active surveillance in prostate, less XRT in elderly ER+ breast, etc). Table 3 Percent of patients for whom RT is no longer indicated by 2030 - these estimates seem conservative and if I am reading the IJROBP paper correctly, based on data from 2004-2014