Job posting

[TheWallnerus]

This is the big question, imo.

EDIT: Expanding on this. I could definitely see a situation (in the not so distant future) where AI and planning algorithms can take a sim scan, deformably register the diagnostic imaging, contour all OARs and estimate target volumes based on PET uptake, create a plan based on NTCP modeling, and spit out a percent complication and tumor control probability based on historic data that a physician can review with a patient.

Sounds nuts, but really, how far off from that are we from being able to do that today?

It does not sound nuts

It sounds like what Thanos was telling Thor at the start of Infinity War

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[DoctwoB]

These products will come out, and they will aid in efficiency. But they will also fail in spectacular ways and require significant human oversight. Which is fine, one of the best things about AI/machine learning in medicine is it will fail differently and for different reasons then humans, which means a human/AI team will probably be more efficient and do a better job then either alone.

Think about the autonomous vehicle debacles. On average, they may well be safer then a human driver. But failures are blown out of proportion because it drives into a lake or wall, or fails in ways that a human (hopefully) would not.

 

[medgator]

You are not a millennial. Plenty of them would be perfectly happy to see zero consults per week and get paid half rate to sit around all day.

Sounds like some boomers i know too. GenX keeping things afloat

 

[thecarbonionangle]

Some of the laziest people are the boomers. I heard of a boomer who no longer even wants to treat high risk prostate cancer and leaves the “complex” cases to his younger coworkers. Yet these boomers make significantly more and have contracts that their younger coworkers will never get!

 

[communitydoc13]

I'm a lazy doc. The terms of the posted job are fine IMO. This week, 5 consults, 1 old pt new problem with emergent sim, 25 f/u, and 6 sims. In the office 5 days. A reasonable week for someone who is a bad robot, agonizes over treatment plans and spends good amount of time with patients. I'm still behind on documentation.

Go ahead and complain about the salary on any other specialty forum at SDN.

The issue is the location and that there aren't 80-100 of these offers per year, with similar offers in locations close to where people grew up (both coasts, Chicago, big city mid-west).

The person who takes this job will likely have very good credentials, will have been affiliated with a name brand undergraduate, med school or training program. They will look different on paper than their colleagues by a significant margin. They will likely be a plane ride away from family.

 

[RadOncDoc21]

Looks like I'm in about the 7-8/week range on average, which is plenty in a rural place tbh, when it comes to coordinating with other random medical systems, getting patients properly staged, etc. Back at my training site, I'd be fine with 15-20/week, but I'd imagine Fargo is more similar to where I am than where I trained. Though, if I were averaging 5/week, would get pretty antsy.

This is me… I spend most of my time coordinating the care and workup while my competition get all the chip shots.

 

[Doctorer]

You are not a millennial. Plenty of them would be perfectly happy to see zero consults per week and get paid half rate to sit around all day.

I am a millennial who is more than happy to see more patients than the boomers I work with, while delivering better care, and earning a fraction of what they did.

 

[Chartreuse Wombat]

I am a millennial who is more than happy to see more patients than the boomers I work with, while delivering better care, and earning a fraction of what they did.

Save the virtue signalling for twitter.
Signed Boomer

 

[evilbooyaa]

You are not a millennial. Plenty of them would be perfectly happy to see zero consults per week and get paid half rate to sit around all day.

Clearly a Gen Xer. How many hours a week do you work? Do you understand that everybody wants to work but maybe not at 60+ hours a week as was expected in the past, because they have families with responsiblities, and desires to enjoy life outside of work?

 

[RadOncDoc21]

I feel like all we do as rad oncs is eat our own… we fraction shame, age shame, salary shame… we are a cancer within our own field!

 

[communitydoc13]

age shame

I agree this is sad. Gen-Xer here. I can understand global jealousy at those who technically qualify as baby boomers. Particularly millennials hit by 2008 crises, insane college/med school costs and a much more competitive culture. But I think there are lessons to be learned from both groups.

First, the boomers made the field great (and boomer leadership has contributed to its demise). Boomers with vision chose a very unpopular field and made it a fulcrum for evidence based medicine. They oversaw the integration of 3D and IMRT treatment planning. They oversaw early combined modality clinical trials. They worked hard, made a difference and were NOT heavily selected for. This is a lesson. All that selectivity means very little in driving something forward. If you ever get a chance to look at old rad-bio and physics work from old boomer and pre-boomer UK rad docs, its absolutely foundational.

The millennials (and maybe more so GenZ) also work hard and had to work harder to get into a good college, med school or residency than anyone born in the boomer era. I've noticed many younger folks are markedly less materialistic, are focused on community and global sustainability and are more tolerant than older folks. All good things. They also want to make sure that they raise their own kids, and in an era of much greater gender equity, this means nobody gets to work 80 hours/week and leave their spouse holding the bag.

Both groups are good. I have met the very occasional dumb boomer radonc who is gazillionaire (Never met a dumb millennial radonc, but that may change?). I have met the occasional intolerable millennial doc, who feels that winning the meritocracy through residency means that they shouldn't have to do work that they don't get credit for (never seen this in a boomer).

 

[Ray D. Ayshun]

I don't know about y'all but the reason I go to work everyday is to help people get back to contributing to the GDP.

 

[elementaryschooleconomics]

I feel like all we do as rad oncs is eat our own… we fraction shame, age shame, salary shame… we are a cancer within our own field!

 

[jondunn]

Save the virtue signalling for twitter.
Signed Boomer

Save your false accusations for the next AARP meeting

 

[deleted1116990]

You are not a millennial. Plenty of them would be perfectly happy to see zero consults per week and get paid half rate to sit around all day.

I think you are confusing them with GenZs. Maybe young millennials.

I had a side business and hired a 17 year old GenZ who lived down the street to work for me. His job was stupidly simple and I way overpaid him for it. It was still pulling teeth to get him to do the bare minimum of what I asked. He constantly lied and flaked out, didn't do the work, and eventually decided it wasn't worth his time. I would have killed for an opportunity to make some easy cash when I was in high school. His mom just bought him whatever he wanted and that was the expectation for the rest of his life -- to just be handed free stuff.

GenZs are on a different planet. There have always been slackers, but my observation is that more in that generation are like my lazy employee than not, and there didn't use to be this expectation that you could both slack and be financially successful -- slackers knew they would be poor and were fine with that. Our country is doomed when we get to the point where GenZ is supposed to be working to pay for the retired generation to keep the social security Ponzi scheme going.

Survey finds college graduates have unrealistic expectations about first-year salaries

As universities begin to hold their graduation ceremonies over the next month, college graduates have high expectations for their first job.

www.cbsnews.com

The most unrealistic are journalists and communications majors whom the study called "delusional" for expecting $107,000 while averaging $45,000.

 

[Doctorer]

Save the virtue signalling for twitter.
Signed Boomer

Sorry I don't tweet: too busy making money for boomers.

 

[ramsesthenice]

I think you are confusing them with GenZs. Maybe young millennials.

I had a side business and hired a 17 year old GenZ who lived down the street to work for me. His job was stupidly simple and I way overpaid him for it. It was still pulling teeth to get him to do the bare minimum of what I asked. He constantly lied and flaked out, didn't do the work, and eventually decided it wasn't worth his time. I would have killed for an opportunity to make some easy cash when I was in high school. His mom just bought him whatever he wanted and that was the expectation for the rest of his life -- to just be handed free stuff.

So yeah, GenZs are on a different planet. There have always been slackers, but my observation is that more in that generation are like my lazy employee than not, and there didn't use to be this expectation that you could both slack and be financially successful -- slackers knew they would be poor and were fine with that. Our country is doomed when we get to the point where GenZ is supposed to be working to pay for the retired generation to keep the social security Ponzi scheme going.

Survey finds college graduates have unrealistic expectations about first-year salaries

As universities begin to hold their graduation ceremonies over the next month, college graduates have high expectations for their first job.

www.cbsnews.com

The most unrealistic are journalists and communications majors whom the study called "delusional" for expecting $107,000 while averaging $45,000.

Yes, you are right. I’m talking about the generation coming around now which would be genZ. But I can tell my response sounded a bit more curt than I intended. A lot of folks latched on to the first half without the second so let’s try again. Many of the young folks finishing training now are very happy to take less pay to do less work. With current job market trends, that’s not inherently a bad thing.

 

[Chartreuse Wombat]

Sorry I don't tweet: too busy making money for boomers.

Lazy. If you don't like your circumstances do something to change it.

I know your response is OK boomer...again lazy response

 

[Doctorer]

Lazy. If you don't like your circumstances do something to change it.

I know your response is OK boomer...again lazy response

Thankfully, ahead of you there!

 

[thecarbonionangle]

Most of the new rad oncs are destined for lives of servitude serving immortal blood sucking juicy boomers.

 

[jondunn]

Lazy. If you don't like your circumstances do something to change it.

I know your response is OK boomer...again lazy response

'pull yourself up by the bootstraps' or 'network harder'

always the same thing from you folks

 

[Chartreuse Wombat]

'pull yourself up by the bootstraps' or 'network harder'

always the same thing from you folks

Victimhood...blah blah blah

Previous poster is correct that we cannibalize each other

I trained in the good old days...3 year program

Doxxing myself but who cares

Tenured professor...25 on beam no resident for 5 years now...12-14K wRVUs with comfortable $600K salary

Stereotyping is rarely a good look

 

[metview]

Anticipating starting salary 500k in Fargo, ND treating 20-30 pts? If this isn't a joke, then salary 2-3 years out should be over 800k minimum.

 

[temujim]

I think you are confusing them with GenZs. Maybe young millennials.

I had a side business and hired a 17 year old GenZ who lived down the street to work for me. His job was stupidly simple and I way overpaid him for it. It was still pulling teeth to get him to do the bare minimum of what I asked. He constantly lied and flaked out, didn't do the work, and eventually decided it wasn't worth his time. I would have killed for an opportunity to make some easy cash when I was in high school. His mom just bought him whatever he wanted and that was the expectation for the rest of his life -- to just be handed free stuff.

GenZs are on a different planet. There have always been slackers, but my observation is that more in that generation are like my lazy employee than not, and there didn't use to be this expectation that you could both slack and be financially successful -- slackers knew they would be poor and were fine with that. Our country is doomed when we get to the point where GenZ is supposed to be working to pay for the retired generation to keep the social security Ponzi scheme going.

Survey finds college graduates have unrealistic expectations about first-year salaries

As universities begin to hold their graduation ceremonies over the next month, college graduates have high expectations for their first job.

www.cbsnews.com

The most unrealistic are journalists and communications majors whom the study called "delusional" for expecting $107,000 while averaging $45,000.

Doesn't say much for future journalists' investigative skills.

 

[deleted1116990]

25 on beam no resident for 5 years now...12-14K wRVUs with comfortable $600K salary

Nice! You should be making $600k for that.... after tax.

 

[deleted1111261]

Victimhood...blah blah blah

Previous poster is correct that we cannibalize each other

I trained in the good old days...3 year program

Doxxing myself but who cares

Tenured professor...25 on beam no resident for 5 years now...12-14K wRVUs with comfortable $600K salary

Stereotyping is rarely a good look

Certain people, even when given facts that disagree with their narrative, will not back down. There are ****ty people in all generations and great people in all generations. I’ve been guilty of putting people in boxes, too, and I’m done doing that for the generations. It’s far too messy of a delineation.

We all know this. All young people aren’t lazy, all old people aren’t money grubbing hacks. I’ve had senior partners go out of their way to advance my career and also willing to learn from me. At this point, I’m just as willing to ask more junior colleagues their opinions on cases as I am to ask an “expert”.

Thanks for being a great contributor. You’re still just an “anonymous” faculty member to me

 

[jondunn]

Some of the laziest people are the boomers. I heard of a boomer who no longer even wants to treat high risk prostate cancer and leaves the “complex” cases to his younger coworkers. Yet these boomers make significantly more and have contracts that their younger coworkers will never get!

The Accelerators should do a PP Boomer podcast. could be lit.

 

[jondunn]

There are ****ty people in all generations and great people in all generations. I’ve been guilty of putting people in boxes, too, and I’m done doing that for the generations. It’s far too messy of a delineation.

agree. but keep in mind there are young up and coming grifters, conmen, and snake oil salesman, just like there are those people in leadership positons now. being young doesn't give you protection from being a bad guy/gal.

 

[Reaganite]

Grifter Ron at acro stated that despite cms/tele, doc can’t approve cone beams remotely, which sounds rediculous. Went so far as to say cone beams at satellites have to be billed under the doc who was present, not who approved them. Had some very convaluted interpretation that while doc doesn’t have to be present for radiation, somehow he does for cone beam.

I once made the mistake of talking billing with some of his folk, and I was left with the conclusion every center in America is committing billing fraud. They are extremely intense about policy minutia that will make your life miserable, but average at the actual billing/collecting piece. I wasn't at ACRO, but my assumption is Ron stated there is no telehealth modifier associated with CBCT checking, and hence you must approve the CBCT on site for the professional services component of that procedure. That, or you would need to add the address you read the CBCT from remotely to your Medicare list of practice sites, and have one claim for the professional component coming from that location under the doctor who "read" the CBCT, and second claim for the TC under the doctor who was present either in person or virtually. Basically, if you follow their guidelines, anything done remotely or without a physician present cannot be billed. Doing any work from home is technically illegal unless you report the pertinent claim from your home address. Also, you should be sitting next to your physicists/planners while they do all of their work because technically codes like IMRT planning, chart checks, calcs, etc. are being submitted under YOUR name. So if you weren't looking over their shoulder at the time and overseeing all the work, then you really shouldn't be billing for it. You can get really crazy with this stuff.

 

[TheWallnerus]

They are extremely intense about policy minutia that will make your life miserable, but average at the actual billing/collecting piece.

This would be some real truth in advertising stuff if Revenue Cycle put this exact phrase on their website

 

[jondunn]

Some grifters grifted, so now grifter Ron gets paid to tell people worried how not to ‘grift’, meanwhile he prob gets a little extra cash as a whisperer to CMS

This guy Ron is a piece of work. Does he let Lally get his fill too?

 

[Lamount]

Wow… that escalated quickly. There’s a surprising degree of generational resentment here. It’s Friday night… let’s all pour ourselves a drink haha

 

[Reaganite]

This would be some real truth in advertising stuff if Revenue Cycle put this exact phrase on their website

I think most big billing companies are average to be honest. I've worked with several, and they were all the same. They aren't gonna waste time chasing the complicated cases that can make-or-break an individual practice because their scale washes out those outliers. Have never met Ron, and know little about him, but I just know in the process of meeting with different billing companies they were hard core into compliance at a level I've never encountered.

 

[SubserviantToABR]

Some grifters grifted, so now grifter Ron gets paid to tell people worried how not to ‘grift’, meanwhile he prob gets a little extra cash as a whisperer to CMS

This guy Ron is a piece of work. Does he let Lally get his fill too?

Ron DiGiaimo preys on senior residents at meetings like ACRO and instill fear that if they do things wrong when they get out into practice that they will screw up so his companies can come and protect you.

 

[HolySmokes]

Lazy. If you don't like your circumstances do something to change it.

I know your response is OK boomer...again lazy response

 

[RickyScott]

I once made the mistake of talking billing with some of his folk, and I was left with the conclusion every center in America is committing billing fraud. They are extremely intense about policy minutia that will make your life miserable, but average at the actual billing/collecting piece. I wasn't at ACRO, but my assumption is Ron stated there is no telehealth modifier associated with CBCT checking, and hence you must approve the CBCT on site for the professional services component of that procedure. That, or you would need to add the address you read the CBCT from remotely to your Medicare list of practice sites, and have one claim for the professional component coming from that location under the doctor who "read" the CBCT, and second claim for the TC under the doctor who was present either in person or virtually. Basically, if you follow their guidelines, anything done remotely or without a physician present cannot be billed. Doing any work from home is technically illegal unless you report the pertinent claim from your home address. Also, you should be sitting next to your physicists/planners while they do all of their work because technically codes like IMRT planning, chart checks, calcs, etc. are being submitted under YOUR name. So if you weren't looking over their shoulder at the time and overseeing all the work, then you really shouldn't be billing for it. You can get really crazy with this stuff.

M0 is that you are going to jail unless you hire them. Justice department legal standard changed under trump so that cms has to explicitly state something is prohibited for you be in violation, not some Byzantine contortion of interpretation.
Basically Ron is stating that cms is trying to entrap radoncs when they explicitly ok tele, but in effect radonc can not be practiced via tele according to Ron. So then why did cms explicitly permit tele ? A big trap. Hire him and you will be saved.

 

[jondunn]

how is this guy even known? He must have been sponsored per se by someone to get so well known and a platform at ACRO?

 

[BobbyHeenan]

how is this guy even known? He must have been sponsored per se by someone to get so well known and a platform at ACRO?

he's the founder of one of (?if not THE?) biggest rad onc billing company out there. former therapist. big/smooth talker. He’s smart.

There you go.

===

I agree with the sentiments posted above....the MO of these big billing goups and outside consults (Cindy Parman, Ron D) etc is to tell you all the ways you're doing things wrong/risky and how they're the only way that can save you.

I would encourage people to ask around their colleagues about how they do things to make sure you're not out in left field, but if a big group of your former co residents or trusted colleagues around the country do it similar to you you're probably not going to jail . This message board and communication goes a long way to self educate.

 

[RickyScott]

he's the founder of one of (?if not THE?) biggest rad onc billing company out there. former therapist. big/smooth talker. He’s smart.

There you go.

===

I agree with the sentiments posted above....the MO of these big billing goups and outside consults (Cindy Parman, Ron D) etc is to tell you all the ways you're doing things wrong/risky and how they're the only way that can save you.

I would encourage people to ask around their colleagues about how they do things to make sure you're not out in left field, but if a big group of your former co residents or trusted colleagues around the country do it similar to you you're probably not going to jail . This message board and communication goes a long way to self educate.

The kicker for me was when department manager came back from his seminar under the impression that you can’t bill for cbct at a satellite that you viewed remotely even if your partner was present at the satellite at the time of cbct/ treatment.

 

[ramsesthenice]

The kicker for me was when department manager came back from his seminar under the impression that you can’t bill for cbct at a satellite that you viewed remotely even if your partner was present at the satellite at the time of cbct/ treatment.

Don’t get me started. On main campus, they tell me if I step out for an hour during the day for an appointment and have 7 colleagues there, I can’t personally bill for that CBCT. But…if we take images after 5 or on the weekend, it’s magically ok for me to check them from home and bill them. That sounds legit to me. I’m sure CMS has a nights and weekends clause written in there…

 

[evilbooyaa]

Yes, you are right. I’m talking about the generation coming around now which would be genZ. But I can tell my response sounded a bit more curt than I intended. A lot of folks latched on to the first half without the second so let’s try again. Many of the young folks finishing training now are very happy to take less pay to do less work. With current job market trends, that’s not inherently a bad thing.

Big difference, IMO, between "Do zero work for half pay" vs "Do half work for half pay" understanding that half work is still a 40 hour work week.

Although, the reality in 2022 is now "Do half work for 1/3rd pay" or "Do full work for 2/3rd pay"

 

[fiji128]

No one operating in good faith is ever going to go to "jail" or whatever scare tactic. Worst case is maybe a fine after being warned and not following through? The level of fraud and malice really needs to quite significant for anything to go beyond that. Just look what goes on in the non medical business world for comparison.

 

[ramsesthenice]

Big difference, IMO, between "Do zero work for half pay" vs "Do half work for half pay" understanding that half work is still a 40 hour work week.

Although, the reality in 2022 is now "Do half work for 1/3rd pay" or "Do full work for 2/3rd pay"

Didn’t say zero work my friend. Said zero consults. Two of our satellites routinely carry 6-8 on beam and typically most of those are prostate getting 39 fractions. Do the math. Zero consult weeks are not infrequent. Both are staffed by younger folks from the region who are perfectly happy with the set up. Typically leave by 3:30 or 4:00 each day and have lots of time to read etc during the day. This is in direct contrast to two of our other satellites routinely carry 25-30 under beam and are both single physician centers as wells. There is a significant difference in compensation between them.

To be extremely clear, the differences in volume are completely driven by population distribution. It’s not because one physician is particularly industrious (or not).

 

[jondunn]

Why would they want to read tho?

Maybe you mean they have time to watch Netflix and post on SDN!

 

[thecarbonionangle]

Yeah i got a bridge to sell ya if you think these dudes are “reading”!

 

[elementaryschooleconomics]

Didn’t say zero work my friend. Said zero consults. Two of our satellites routinely carry 6-8 on beam and typically most of those are prostate getting 39 fractions. Do the math. Zero consult weeks are not infrequent. Both are staffed by younger folks from the region who are perfectly happy with the set up. Typically leave by 3:30 or 4:00 each day and have lots of time to read etc during the day. This is in direct contrast to two of our other satellites routinely carry 25-30 under beam and are both single physician centers as wells. There is a significant difference in compensation between them.

To be extremely clear, the differences in volume are completely driven by population distribution. It’s not because one physician is particularly industrious (or not).

Wow, where I did residency those satellite gigs absolutely existed, and there was NO WAY the younger faculty got those positions. I think the youngest faculty in one of those sleepy 6-8 on beam arrangements was in her early 50s.

Those must be some satellites out in the WOODS.

 

[evilbooyaa]

Didn’t say zero work my friend. Said zero consults. Two of our satellites routinely carry 6-8 on beam and typically most of those are prostate getting 39 fractions. Do the math. Zero consult weeks are not infrequent. Both are staffed by younger folks from the region who are perfectly happy with the set up. Typically leave by 3:30 or 4:00 each day and have lots of time to read etc during the day. This is in direct contrast to two of our other satellites routinely carry 25-30 under beam and are both single physician centers as wells. There is a significant difference in compensation between them.

To be extremely clear, the differences in volume are completely driven by population distribution. It’s not because one physician is particularly industrious (or not).

Fair enough - perhaps my own defensiveness.

I suppose that I don't need to see 10-15 consults a week to feel like a good doctor... I guess the fact I have time to come to SDN and read twitter during the work day means I'm not as busy as some of the work horses out there are who carry 25-30 on beam while being 40% clinical and running a lab

But to have a machine that has 6-8 on beam... with a physician there 5 days a week... I'd go crazy if I was there 5 days a week. I did not go to residency to simply babysit a machine. Now if I was at the sleepy place 1-2 days per week and at a busier location for the other 3 to the point I still had work to do (contours, notes, etc)... that'd be palatable.

 

[deleted1116990]

But to have a machine that has 6-8 on beam... with a physician there 5 days a week... I'd go crazy if I was there 5 days a week. I did not go to residency to simply babysit a machine. Now if I was at the sleepy place 1-2 days per week and at a busier location for the other 3 to the point I still had work to do (contours, notes, etc)... that'd be palatable.

These are 3 day a week jobs (Tues-Thurs). If that. I've done 3 days carrying 15-20 and done basically no work the 4 days I was off.
It is criminal to make a rad onc go and sit there if it's in a hospital or freestanding facility where other MDs are present (med onc).
The problem is if you can convince your overlords to let you do it in 3 days, they will take your current pay and multiply it by (3/5) even though nothing else has changed except now you approve Monday and Friday's images from home.

 

[ramsesthenice]

Wow, where I did residency those satellite gigs absolutely existed, and there was NO WAY the younger faculty got those positions. I think the youngest faculty in one of those sleepy 6-8 on beam arrangements was in her early 50s.

Those must be some satellites out in the WOODS.

It’s all about the Bejamins. Those types were still carrying “half time” pay that was “half time” from 16 years ago. In the last 5 years one left voluntarily and one refused to take the COVID vaccine and was let go by the partner system who owns the practice. They were happily replaced by more modern half time (not really half but significantly less than the full FTE positions) rates in the $200s and the only folks who were happy to take them were the ones who never made money before.

Honestly, it’s still not a bad gig for the right person. I just have ADD and can’t do it for long stretches. Like I said, the folks doing it love it. COL is next to nothing and with benefits they are more than comfortable.

 

[jondunn]

Those satellite jobs are awesome for the right people. Moms who want to be done by 3? Works great.

Edit - should add dads too, to be inclusive