ERAS Stats- RadOnc Uptrending

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Moonbeams said:
This was the biggest surprise for me coming out of training. To a large extent admin and team members and even referring doctors believe that RT can largely be handled by non-physician staff (the way diagnostic CTs and MRIs are) and that we are really just there for supervision purposes and sign off on volumes and fractionation decisions. The clinic was already on autopilot before we got there. Your job is to write notes and sit there 8-5 M-F. To that extent, there is not much difference between a non-BC or 80 year old grandfathered locums and a BC rad onc with 5-10 years of experience managing a busy independent clinic alone. Who do we have to blame for that?

Want to put in spaceOAR, do DIBH breast, adaptively replan patients, see all your patients M-Thurs and sign films remotely on Friday? Whoa there, that's not how any of this works. That's not the job we hired you for. Staff might have to do something different and are uncomfortable. They already treat cancer patients fine, stop re-inventing the wheel and changing things to benefit yourself only.
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That’s really an interesting perspective.

I’ve never felt treated that way in any of my 4 jobs - from admin or staff or referrings.
 
RealSimulD said:
That’s really an interesting perspective.

I’ve never felt treated that way in any of my 4 jobs - from admin or staff or referrings.
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Not sure if you're trying to imply I didn't experience this or I'm making it up in my head. I've definitely heard it from others (especially those who took over a solo hospital gig from a checked out boomer or revolving locums). In PP it's been less of an issue, but I promise you it was the culture at my first gig. It's a miserable environment to operate in, and I'm glad your decision to move jobs hasn't involved that as a reason.

With regards to how you're viewed by peers. The "catfish" is a thing everyone knows about that. I didn't make that up in my head.
 
Moonbeams said:
Not sure if you're trying to imply I didn't experience this or I'm making it up in my head. I've definitely heard it from others (especially those who took over a solo hospital gig from a checked out boomer or revolving locums). In PP it's been less of an issue, but I promise you it was the culture at my first gig. It's a miserable environment to operate in, and I'm glad your decision to move jobs hasn't involved that as a reason.

With regards to how you're viewed by peers. The "catfish" is a thing everyone knows about that. I didn't make that up in my head.
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Not implying anything.

I said it was interesting because it was not my experience.

That being said, maybe I’m just misinterpreting my own high value of myself for their’s.

I’ve been somewhat “Gator”ized and recently become the reflexive consult for all inpatients (not just medonc) and angle for direct referrals.

Idk, man. I’m not at all saying you aren’t experiencing what you are. I’m sorry that it has all been negative. I hate the oversupply issue and leadership problems, but I’ve always enjoyed the day to day.

Everyone is different, that’s for sure.
 
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RealSimulD said:
That’s really an interesting perspective.

I’ve never felt treated that way in any of my 4 jobs - from admin or staff or referrings.
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I mean, you have however experienced the "MD Anderson Way" though, right? Imagine that instead as (made up example) "The Good Samaritan Kearney, Nebraska Way". I've had an overall great experience in the real world, but I've seen/heard first and second-hand plenty of places highly resistant to any change.
 
Moonbeams said:
To a large extent admin and team members and even referring doctors believe that RT can largely be handled by non-physician staff (the way diagnostic CTs and MRIs are) and that we are really just there for supervision purposes and sign off on volumes and fractionation decisions.

They already treat cancer patients fine, stop re-inventing the wheel and changing things to benefit yourself only.
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At least where I'm at, the referring docs know how the job really goes...I'd go nuts if even they thought I was here to push buttons.

But man, staff can have a real interesting perspective on how this whole enterprise functions. A lot of silo/tunnel vision.

My favorite is their disdain for me not lingering late into the evening. I jet the second that last patient is done, and they're used to Boomers who don't have remote access. Never mind that the time stamps on everything I do are plainly visible literally everywhere. Nope. I must be lazy/not want to work. But...if I didn't work...how do patients get on and off beam...oh well. Mystery!

I have also been hit with the "we treat patients fine, no need to change" line.

Well, sure they think that. It's almost impossible for a therapist to witness serious harm to a patient, unless the gantry crushes them. I could literally hit someone in the face with 500Gy and they'd make it out of the department unscathed.

Nuance. A basic understanding of radiation biology. Logic. Who needs it?
 
Mandelin Rain said:
I mean, you have however experienced the "MD Anderson Way" though, right? Imagine that instead as (made up example) "The Good Samaritan Kearney, Nebraska Way". I've had an overall great experience in the real world, but I've seen/heard first and second-hand plenty of places highly resistant to any change.
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I certainly have experienced the MDACC way and really enjoyed my Banner years.

There was a job that had “XXX Values” thrown around as a weapon, but that was not the RadOnc department itself, which was very open to change.

I believe in what your saying - I’m sure it exists. My lived experience is that there are some people that are just really good at seeing the positive and some are really good at seeing the negative. The value judgment that negative = bad employee is not one I make. I tend to think most people that complain have real issues. At the same time, personally, I have mellowed A LOT. 12 years ago the same stuff that used to really bug me (about coworkers, or policies, or bosses, or the hospital) - they just don’t carry the same weight, especially recently becoming a patriarch of a family.

It hurts hearing that people are suffering. I believe it. Trust me - I got two phone calls from ROs last week that were heart wrenching.
 
thecarbonionangle said:
The latest ASTRO PAC email claims “the dog days of summer are behind us”. T’is might be literally true. The “dog days” campaign reports only 4% participation. This is a very sad dog campaign, maybe as sad as those Dr. Oz dogs. The narrative is the “dog days” are over for the field as well. Yet winter is a’ coming, folks! There ain’t no hiding from reality.
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Explains why Florence+The Machine is the entertainment at ASTRO this year
RealSimulD said:
That’s really an interesting perspective.

I’ve never felt treated that way in any of my 4 jobs - from admin or staff or referrings.
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I have experienced it. Go to a place that’s looking to hire a locums for 6 months or more as the sole rad onc and it’s definitely noticeable…

elementaryschooleconomics said:
My favorite is their disdain for me not lingering late into the evening. I jet the second that last patient is done, and they're used to Boomers who don't have remote access. Never mind that the time stamps on everything I do are plainly visible literally everywhere. Nope. I must be lazy/not want to work. But...if I didn't work...how do patients get on and off beam...oh well. Mystery!
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Couldn’t resist
 
TheWallnerus said:
Explains why Florence+The Machine is the entertainment at ASTRO this year

I have experienced it. Go to a place that’s looking to hire a locums for 6 months or more as the sole rad onc and it’s definitely noticeable…


Couldn’t resist
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I’m sure that is a terrible situation!
 
Mandelin Rain said:
Imagine that instead as (made up example) "The Good Samaritan Kearney, Nebraska Way". I've had an overall great experience in the real world, but I've seen/heard first and second-hand plenty of places highly resistant to any change.
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TheWallnerus said:
I have experienced it. Go to a place that’s looking to hire a locums for 6 months or more as the sole rad onc and it’s definitely noticeable…
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I've never been to Kearney as I couldn't even get them to return a phone call, but given that they seem to be operating on a permalocums-until-desperate-for-visa-sponsor-comes-along model, I'd be willing to wager heavily that you would encounter exactly what I am talking about there.

On a side note, I've interacted in the past with another organization in their system and would advise steering clear.
 
Moonbeams said:
had unrealistic expectations of being an independent professional
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It's everywhere in medicine and most other industries. Independence is rare and not really valued within professional organizations. Standardization is valued.

I think there is a group of people (not sure if you are one) who are fiercely independent. This is a characteristic that can engender innovation and personal excellence. At one time, I think it was a fairly common characteristic of independent physicians.

I would never discourage a young person from pursuing medicine. There is just too much upside. But I would encourage any fiercely independent and intellectually precocious young person inclined to medicine to strongly consider surgery. Of course, entrepreneurship is a natural avenue for these folks. Radonc is near the bottom when it comes to maintaining professional independence. It is one big team building exercise at best and doc as a widget at worst.

That mix of entrepreneurship and independent medical practice is just out of reach for most people and it has been for a long time. I don't think we even select for these people often anymore regarding med school admissions. (Although I would, we need surgeons.)

Hospitals will accommodate fiercely independent surgeons if they are going to bring in revenue. Some of these docs form the backbone of high functioning community hospitals. Others are a complete nightmare who bring bad outcomes and toxic culture with them.
 
RealSimulD said:
personally, I have mellowed A LOT. 12 years ago the same stuff that used to really bug me (about coworkers, or policies, or bosses, or the hospital) - they just don’t carry the same weight, especially recently becoming a patriarch of a family.

It hurts hearing that people are suffering. I believe it. Trust me - I got two phone calls from ROs last week that were heart wrenching.
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Reading your post about negative attitudes and such, my mind immediately went to this episode of the Simpsons I probably last watched 15 years ago...



It's basically the situation for some of us lol.
 
communitydoc13 said:
It's everywhere in medicine and most other industries. Independence is rare and not really valued within professional organizations. Standardization is valued.
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But that's the reason I chose medicine and not one of the other industries! Of course, if I were a chemical engineer it would be a crazy expectation to go start my own oil and gas exploration company after graduation, and I would apply for a chemical engineer, salary band III, position at Exxon or something. At least when I was applying to medical school, that wasn't really the expectation of how your work would be viewed when you got out. Every day it's moreso. Perhaps the students now will not have this disappointment as they will know what they are getting into.

With regards to your comments about surgery, you are absolutely correct and I wish I had considered it more. Surgeons get an enormous amount of leeway that rad oncs don't even come close to getting in these organizations.
 
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Moonbeams said:
But that's the reason I chose medicine and not one of the other industries! Of course, if I were a chemical engineer it would be a crazy expectation to go start my own oil and gas exploration company after graduation, and I would apply for a chemical engineer, salary band III, position at Exxon or something. At least when I was applying to medical school, that wasn't really the expectation of how your work would be viewed when you got out. Every day it's moreso. Perhaps the students now will not have this disappointment as they will know what they are getting into.

With regards to your comments about surgery, you are absolutely correct and I wish I had considered it more. Surgeons get an enormous amount of leeway that rad oncs don't even come close to getting in these organizations.
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100% right regarding surgical autonomy vs ours.

Medoncs, too.

That part is not even debatable, except at certain institutions
 
Moonbeams said:
Reading your post about negative attitudes and such, my mind immediately went to this episode of the Simpsons I probably last watched 15 years ago...



It's basically the situation for some of us lol.
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Lol, that’s good

Let me give real life example

Around 2011, soon after whelan came out I was using 16 Fx for dcis. I was an associate and my partners didn’t approve, but they had some respect for me and said to create another consent and proceed. I was livid. Made zero sense to conventionally fx Dcis. I found all the subsets in the different studies and made my case, and they still said “write up a consent.” Was steamed for months.

Today if they said that to me, I’d make the consent and move on with my life. Few similar things have happened at new job, and I just roll with it and go homer
 
Moonbeams said:
they will know what they are getting into
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I think one of the best indicators of independence is what happens when you move on from a larger entity (like a hospital).

Where I am, there is one independent radiology group in the immediate region. They get by, but I wouldn't personally use them. The hospital practice just has better machines and more quality control. The doc loves his independence however and has some allies in the medical community. Able to carve out a niche with extreme hard work.

The independent PCPs have largely moved to concierge care. (A good model if you are OK with it morally. It sucks for the larger community however, because a $1000+ annual retainer is real money for the average person and you will be seeing a fraction of the patients that you once did.)

Surgeons who have had their privileges rescinded still practice at self-established surgical centers. Some have effective brands in the community. All surgeons, that I am aware of, have been able to leverage their way out of non-competes and practice at other regional hospitals if they want.

The hospital kisses the ring of ortho, who may not even accept the hospitals own insurance if payment is deemed not adequate. Ortho is bigger than the hospital in places with lots of old people.

Psych is often fee for service.

The last radonc who was let go (years and years ago) had to take a job a thousand miles away after buying a house locally.
 
Mandelin Rain said:
You've certainly have had a tougher time that me, but I do see these trends all around.

And yes, most of this commentary is generalizable to all physicians of all areas of medicine, but the point that can't be stressed enough is, "you only have as much leverage to enact change as it is difficult to replace you." In radiation oncology, we've made ourselves very replaceable. Not just by overtraining, but by minimizing our role in various cancers, standardizing our practices, and relying heavily on others on the team for support (dosi, physics, RTTs).
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This post is extremely sad but unfortunately so true
 
communitydoc13 said:
The hospital kisses the ring of ortho, who may not even accept the hospitals own insurance if payment is deemed not adequate. Ortho is bigger than the hospital in places with lots of old people.
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Ortho brings in a lot of money. So does cardiology. Rad onc is often next. You would think this would mean they would kiss our ring too? Nope, opposite for the catfish. There was an employed ortho at my old hospital job with 1.2M compensation. I couldn't get paid more than half that (despite the money that rad onc brought in globally and through ancillary imaging) because of fair market value legal concerns. Those concerns obviously didn't apply to the ortho. I was also directly lied to and told I was the highest paid doctor in the hospital. Some googling turned up some tax documents for the foundation, which listed a lot of doctors' compensations on them. An ob-gyn got paid more than I did.

communitydoc13 said:
The last radonc who was let go (years and years ago) had to take a job a thousand miles away after buying a house locally.
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It's funny to watch other specialties get all worked up about non-competes. At this point I don't even care. 15 miles? 100 miles? What does it matter? If I am let go, getting another job will be a long, nationwide search process.
 
communitydoc13 said:
The independent PCPs have largely moved to concierge care. (A good model if you are OK with it morally. It sucks for the larger community however, because a $1000+ annual retainer is real money for the average person and you will be seeing a fraction of the patients that you once did.)
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I heard this sentiment about "morality" from an older doc a few weeks ago.

I've been out of the loop, if there's a larger conversation around this. Isn't it arguably returning to "how medicine used to be", as in, a doctor offering their services directly without having the 14 middlemen take a bite?
 
elementaryschooleconomics said:
I heard this sentiment about "morality" from an older doc a few weeks ago.

I've been out of the loop, if there's a larger conversation around this. Isn't it arguably returning to "how medicine used to be", as in, a doctor offering their services directly without having the 14 middlemen take a bite?
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As a consumer, and yes - higher ses than most people - I love the model. Locally, there is one for like $200 a month for the whole family. Great access , same day visitd
 
elementaryschooleconomics said:
I heard this sentiment about "morality" from an older doc a few weeks ago.

I've been out of the loop, if there's a larger conversation around this. Isn't it arguably returning to "how medicine used to be", as in, a doctor offering their services directly without having the 14 middlemen take a bite?
Click to expand...

medgator said:
Email access, cellphone etc in some of those setups at higher price points
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5% of pts can eat up 80% of time.
 
RealSimulD said:
As a consumer, and yes - higher ses than most people - I love the model. Locally, there is one for like $200 a month for the whole family. Great access , same day visitd
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How large of a panel are these concierge guys holding?
 
RickyScott said:
In my neck of the woods, they generally say that their salary doesn’t change much but they are seeing 80% less pts.
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Wow! Avg panel size typically 5000 so 1000 in a cash pay. So what are they charging like 50/minth?
 
Fpg1245 said:
Maybe I’ll cancel that med onc fellowship after all
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They get paid upfront i think too... Six figures of cash flow before the first patient walks through the door. Definitely need a good successful practice in the community before transitioning though. Many pts will not follow you even if they want to.

In those cases, I've seen them hire an arnp/pa and the non concierge pts can continue to see the extender...
 
medgator said:
They get paid upfront i think too... Six figures of cash flow before the first patient walks through the door. Definitely need a good successful practice in the community before transitioning though. Many pts will not follow you even if they want to.

In those cases, I've seen them hire an arnp/pa and the non concierge pts can continue to see the extender...
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That's the model I'm seeing. Concierge doc for concierge pt and APP for others. Non-concierge pts not necessarily happy, but outside of affluent urban/suburban areas, PCPs are in major demand. Where I am, new appt for PCP takes months.

Concerning in community can be branding/relationship of concierge care with larger tertiary centers. "Pay me retainer and you have great access to me and I will facilitate your tertiary care at brand name academic place." Relationship to community hospital can become less significant.
 
What are "new grads" making these days? For giggles.. in 2005 I went from an academic salary (a joke) to.. get this.. 20X my academic salary when I took over a busy PP as solo at a hospital.. as my first job. Your "experience" has nothing to do with your pay, according to CMS and private payors. They pay the same.

Beware the RVU nonsense. If your RVU isn't 75$ and up with a guaranteed floor, you're getting smoked. Hard.

Until experienced people stop taking crap pay and crap jobs.. the beatings will continue. The only thing that matters is your ability to #2500orGTFO.
 
sirspamalot said:
What are "new grads" making these days? For giggles.. in 2005 I went from an academic salary (a joke) to.. get this.. 20X my academic salary when I took over a busy PP as solo at a hospital.. as my first job. Your "experience" has nothing to do with your pay, according to CMS and private payors. They pay the same.

Beware the RVU nonsense. If your RVU isn't 75$ and up with a guaranteed floor, you're getting smoked. Hard.

Until experienced people stop taking crap pay and crap jobs.. the beatings will continue. The only thing that matters is your ability to #2500orGTFO.
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Saw this posted on Reddit. Congrats to the PGY5

 
sirspamalot said:
What are "new grads" making these days? For giggles.. in 2005 I went from an academic salary (a joke) to.. get this.. 20X my academic salary when I took over a busy PP as solo at a hospital.. as my first job. Your "experience" has nothing to do with your pay, according to CMS and private payors. They pay the same.

Beware the RVU nonsense. If your RVU isn't 75$ and up with a guaranteed floor, you're getting smoked. Hard.

Until experienced people stop taking crap pay and crap jobs.. the beatings will continue. The only thing that matters is your ability to #2500orGTFO.
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This guy gets it.

Yeah, I thought I had hit the lotto with my first job as well. Then you learn about the money changing hands behind the curtain before you are paid. And the fact that others are making just as much if not more in much nicer areas.

4.5 days? Nope. Rad oncs are professionals and don't "clock out" at noon regardless of what's going on. That's a fake benefit. Full contractually guaranteed admin/personal day out of clinic at my discretion whether I come in at not or take calls from the ski slope or we are not talking. If I'm forced to come in on this day, you owe me a day of PTO.
 
Did I miss where they said they are Rad Onc?

ETA:
Oh I found it. In the comments. My bad
 
One of our satellites is paying $515K + token bonus for new grads hires. It is a miserable little town > 1h from airport though
 
I don't really care if people are applying at this point. The information about the huge risk involved in matching into a specialty with an ever shrinking foot print that only allows you to treat with one modality and literally can do nothing else is well known and publicized at this point. Taking on that type of risk wouldn't make sense to me and it apparently doesn't to a ton of folks that have other options. The gate keepers of the specialty don't really seem to be interested in being good stewards of the specialty either (except for maybe Harvard, MDACC, Cleveland Clinic and Colorado who have soft contracted spot(s)). The days of 10+ people from Harvard Medical School applying are over.
 
fiji128 said:
I don't really care if people are applying at this point. The information about the huge risk involved in matching into a specialty with an ever shrinking foot print that only allows you to treat with one modality and literally can do nothing else is well known and publicized at this point. Taking on that type of risk wouldn't make sense to me and it apparently doesn't to a ton of folks that have other options. The gate keepers of the specialty don't really seem to be interested in being good stewards of the specialty either (except for maybe Harvard, MDACC, Cleveland Clinic and Colorado who have soft contracted spot(s)). The days of 10+ people from Harvard Medical School applying are over.
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I think if we get back to 100-110 a year in the match, things might turn the corner, the prisoners dilemma, esp from more recently accredited, weaker programs coupled with ASTROs complete impotence and incompetence regarding workforce issues ensures that will likely never happen
 
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medgator said:
I think if we get back to 100-110 a year in the match, things might turn the corner, the prisoners dilemma, esp from more recently accredited, weaker programsb coupled with ASTROs complete impotence/incompetence ensures that will likely never happen
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Imagine what that type of contraction would look like. Even places taking fewer residents then permitted are not officially contracting yet via the acgme. We are a loooong ways from 110 spots/year.
 
As always, I also want to point out the awful wage stagnation in RadOnc. I have it buried in my bookmarks folder and need to dig it back out, but there was the data published in 2020 or so showing we were dead last (#17 of 17).

I remember 10 or so years ago the starting salary for an East Coast academic position was $260k.

Today, I personally know multiple people who had starting salaries in East Coast academic spots for $280k-$290k...or less.

I think the ARRO survey is spot on with "average starting salary". Most of the hospital employed positions seem to be offering $500-600k. Most academic positions seem to be offering $250-$290k. The average salary reported this year was approximately $360k.

I looked back at the old ARRO salary data over the years and there hasn't been a lot of movement. As I recall (haven't looked in awhile), it was around $300k for quite some time, then it's been at this $350k-ish mark for a few years now. Yadda yadda inflation.

This Reddit post about $514k and how they "can't believe it" perfectly captures the average attitude. In one sense, it's "a lot" of money compared to the American average, the negative salary of medical school, the $50-60k in residency, and the salary increase happens almost overnight. I get it.

In another sense, it's an abysmal salary compared to just 20-30 years ago, not just when you adjust for inflation and spending power but also in absolute terms. When you consider your upfront investment of time/money/effort (med school debt + training time debt) and the revenue you generate not only through your own practice but through your total activities within a hospital (labs, imaging, referrals, etc) it's an INSANELY low percentage.

The RadOnc pitch on Shark Tank:

"I will pay you a $500k salary. The investment I'm looking for is 13 years of post-high school training, $300k in debt, limited geographic mobility, total assumption of liability, generating $3-$5 million dollars per year in collections (not charges) for the hospital with a total ROI for labs/imaging etc generating another $1-2 million per year."

"Where do I sign?"
 
1668956418144.png
The youngsters on here won't know this reference, but ya'll do.

If you want to make 750k a year, you're going to have to work somewhere you don't want to live full time. and your family won't go. Unless you are already in on the dealio (think 2 years with Texas Oncology or equivalent) or somehow are magically transported in time back about 15 years ago when you could still be a real partner in a multispeciality practice and get paid.

Those days are gone. Forever. For those of us who are mid to late mid career... you're stuck. Unless you drink red bull..
 
sirspamalot said:
View attachment 362278 The youngsters on here won't know this reference, but ya'll do.

If you want to make 750k a year, you're going to have to work somewhere you don't want to live full time. and your family won't go. Unless you are already in on the dealio (think 2 years with Texas Oncology or equivalent) or somehow are magically transported in time back about 15 years ago when you could still be a real partner in a multispeciality practice and get paid.

Those days are gone. Forever. For those of us who are mid to late mid career... you're stuck. Unless you drink red bull..
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This isn't strictly true. Don't ask me how I know...
 
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