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[deleted1111261]

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

Man, even if I didn’t have kids, who doesn’t like being done by 3? Don’t parent-splain me

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[TheWallnerus]

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.

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…

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

Why have the top billing people not come up with a way to house the rad onc in hospital, and/or build a “Ronald McDonald” house for the rad onc attached to the rad onc dept. A “Ron McDigiamo” house maybe. Then that way you could “go home” during the day with the wife and little kids but still maintain compliance so the hospital can continue billing. Seems where we should follow all this to its logical conclusion. I can accidentally sleep late, and everyone can still be compliant.

 

[Lamount]

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.

Man… I wish I was as efficient as you. I am in clinic 3 days with ~20 on beam and definitely spend a good portion of my “academic” days mopping up.

 

[deleted1116990]

Man… I wish I was as efficient as you. I am in clinic 3 days with ~20 on beam and definitely spend a good portion of my “academic” days mopping up.

If you are site specific and have 20 H&N and GI patients on treatment, that's a little different. Apples and oranges to compare that to a community practice with 5 prostates, 5 breasts, 3 lungs, 3 palliative, and a couple random GI/H&N/CNS. Machine was usually done treating by 1, and I was out of there by 3 or 4 at the latest.

Since I wasn't getting paid for more than 3 days a week for that gig, the work was going to get done in those 3 days. Very do-able with an efficient clinic and staff and you're not in a follow-every-patient-ever-treated-here-forever type of environment.

 

[TheWallnerus]

If you are site specific and have 20 H&N and GI patients on treatment, that's a little different. Apples and oranges to compare that to a community practice with 5 prostates, 5 breasts, 3 lungs, 3 palliative, and a couple random GI/H&N/CNS. Machine was usually done treating by 1, and I was out of there by 3 or 4 at the latest.

Since I wasn't getting paid for more than 3 days a week for that gig, the work was going to get done in those 3 days. Very do-able with an efficient clinic and staff and you're not in a follow-every-patient-ever-treated-here-forever type of environment.

The guy I took over from 8 years ago flew his plane into town Sunday night, worked all day Monday seeing new patients and followups and 15-20 OTVs, got his "contouring" (he wasn't very IMRT-y) done, and flew back home Monday night. One day in clinic a week. Did it for YEARS. I guess he couldn't ever find as lucrative a gig (medium-light patient load, doing your own billing) back home. The only reason I was able to sneak in was he had a harrowing flight experience one day (he was about 60yo) and said "No more piloting for me."

 

[radoncftw]

The guy I took over from 8 years ago flew his plane into town Sunday night, worked all day Monday seeing new patients and followups and 15-20 OTVs, got his "contouring" (he wasn't very IMRT-y) done, and flew back home Monday night. One day in clinic a week. Did it for YEARS. I guess he couldn't ever find as lucrative a gig (medium-light patient load, doing your own billing) back home. The only reason I was able to sneak in was he had a harrowing flight experience one day (he was about 60yo) and said "No more piloting for me."

I actually heard a story on the job hunt about some guy that wanted > 1 milli in the boonies and wanted the hospital to pay for a private jet to fly him in/out of town weekly. i think the RN MBA MSN BSN passed on that candidate.

 

[RadOncDoc21]

I actually heard a story on the job hunt about some guy that wanted > 1 milli in the boonies and wanted the hospital to pay for a private jet to fly him in/out of town weekly. i think the RN MBA MSN BSN passed on that candidate.

Thank you for doxing me… I would have settled for a personal helicopter.

 

[deleted1116990]

The guy I took over from 8 years ago flew his plane into town Sunday night, worked all day Monday seeing new patients and followups and 15-20 OTVs, got his "contouring" (he wasn't very IMRT-y) done, and flew back home Monday night. One day in clinic a week. Did it for YEARS. I guess he couldn't ever find as lucrative a gig (medium-light patient load, doing your own billing) back home. The only reason I was able to sneak in was he had a harrowing flight experience one day (he was about 60yo) and said "No more piloting for me."

That's a bit much but a good example of what happens when rad onc allowed themselves to become hospital employed. This guy set his own rules.
I've known people who covered a site one day a week, but it also involved a lot of remote work. Doing all of the treatment planning same day as your OTVs and consults for that clinic volume, then presumably filing an IFR flight plan and wheels up in the middle of the night is insane (this takes a decent amount of time, you don't just get in a plane, set your GPS, and drive like you do a car). How much coke was that guy on? Did he have a side gig making scud runs for the cartel?

I had finally convinced my old place to let me cover Fridays remotely. It would have been pretty chill, however, in reality it would have probably taken Fridays and Mondays remotely to make it work long term. After I left I was informed that admin was extremely pissed about the whole situation and were explicit that they would never agree to any contract that did not have a rad onc sitting on his butt in the clinic 5 days a week. I don't know why they care so much, but they really, really do. Sad, because they will have locums forever then.

 

[thecarbonionangle]

Of course they are never going to agree to this. They want to be able to see you as they walk by in their empty suits/pantsuits. How else would they justify their existence? They are there to “watch you”.

 

[RadOncDoc21]

Of course they are never going to agree to this. They want to be able to see you as they walk by in their empty suits/pantsuits. How else would they justify their existence? They are there to “watch you”.

And control… never forget control!

 

[thecarbonionangle]

Unfortunately this is the reality of the corporatization of medicine. In many jobs when you apply now, you hardly even speak to physicians. They immediately hand you off to an admin who then makes all business decisions with the cabal of admins. The physicians are supposedly “too busy” to be involved with this and this is exactly how we got here.

 

[metallica81788]

Unfortunately this is the reality of the corporatization of medicine. In many jobs when you apply now, you hardly even speak to physicians. They immediately hand you off to an admin who then makes all business decisions with the cabal of admins. The physicians are supposedly “too busy” to be involved with this and this is exactly how we got here.

Realized this very quickly when interviewing for jobs - the fewer actual physicians you speak with, more you need to be on the lookout

Why would you not want to meet the doctors you will be working with on a daily basis? That is extremely important. They will significantly drive your job satisfaction.

I've told admin as we're recruiting for new medoncs to have them meet with me, lunch, dinner, whatever. How else are you going to get a feel for what the job is really like?

 

[deleted1116990]

Of course they are never going to agree to this. They want to be able to see you as they walk by in their empty suits/pantsuits. How else would they justify their existence? They are there to “watch you”.

Inability to set your own schedule is one of the biggest negatives in a potential job for candidates to consider. This is not why I went to med school. The therapists were salaried, so if the machine finished treating at 2, they made them sit there until 5 like they were in high school detention. Likewise, if I was done with my work at 3 PM, the department manager didn't like the idea of me leaving at 3, and definitely not showing up on Fridays, lest they not feel like they were "getting our money's worth" (his exact words).

In many jobs when you apply now, you hardly even speak to physicians.

In this environment, on a job interview, if you ask questions admin doesn't like, you don't get an offer. Questions about schedule, autonomy, and practice collections (the backbone of independent practice), for instance.

 

[evilbooyaa]

Realized this very quickly when interviewing for jobs - the fewer actual physicians you speak with, more you need to be on the lookout

Why would you not want to meet the doctors you will be working with on a daily basis? That is extremely important. They will significantly drive your job satisfaction.

I've told admin as we're recruiting for new medoncs to have them meet with me, lunch, dinner, whatever. How else are you going to get a feel for what the job is really like?

That's why it's a red flag. Admins can hide you from those who would in some way or another suggest that it's not the best wplace to work.

I was on an interview once, and a surgeon I happened to be interviewing with (small rad onc practice so meeting other specialties) asked me if I had visa issues. When I told him no, he asked me what I was doing interviewing at the hospital he was working at.

 

[metallica81788]

That's why it's a red flag. Admins can hide you from those who would in some way or another suggest that it's not the best wplace to work.

I was on an interview once, and a surgeon I happened to be interviewing with (small rad onc practice so meeting other specialties) asked me if I had visa issues. When I told him no, he asked me what I was doing interviewing at the hospital he was working at.

Trying to decide if that's terrible or hilarious. Probably both.

 

[deleted1116990]

That's why it's a red flag. Admins can hide you from those who would in some way or another suggest that it's not the best wplace to work.

I was on an interview once, and a surgeon I happened to be interviewing with (small rad onc practice so meeting other specialties) asked me if I had visa issues. When I told him no, he asked me what I was doing interviewing at the hospital he was working at.

Always also a good idea to find the person who was previously in the position and reach out to them to get a feel for why they left.
Easy to do with Doximity.

The funny nature of rad onc is that in a hospital where all the MDs are FMGs on visas, the rad onc will still probably be a US grad who has a name brand school somewhere on their CV. You would think that would buy us some cred with the hospital admin, but no. Just resentment in my experience.

 

[deleted1111261]

I’m so surprised how people don’t reach out to former employees. Leap of faith.

 

[medgator]

.

The funny nature of rad onc is that in a hospital where all the MDs are FMGs on visas, the rad onc will still probably be a US grad who has a name brand school somewhere on their CV. You would think that would buy us some cred with the hospital admin, but no. Just resentment in my experience.

Just like for some of us who were in hellpit residency programs!

 

[deleted1116990]

I’m so surprised how people don’t reach out to former employees. Leap of faith.

I did it when I was a resident. I reached out to a former partner at a PP opportunity. She was kind of taken aback and said that nobody had ever called her before (confirming your observation) and that she wished she had thought to call people. Basically told me that I would never be a "real" partner there as only one guy was really in charge and I would basically be his employee. Was helpful because that is of course not how it was presented to me.

 

[Mandelin Rain]

I’m so surprised how people don’t reach out to former employees. Leap of faith.

"The administrator assured me that the doctor was a problem and the program will now be stronger given this great opportunity for a change."

 

[jondunn]

I interviewed for a job once where one doc told me NOT to talk to the other doc as she didn’t know they were looking to hire

I didn’t pursue a second interview with them, too shady

 

[mheat3]

Realized this very quickly when interviewing for jobs - the fewer actual physicians you speak with, more you need to be on the lookout

10000000000%

 

[RickyScott]

No xx
Lo

I did it when I was a resident. I reached out to a former partner at a PP opportunity. She was kind of taken aback and said that nobody had ever called her before (confirming your observation) and that she wished she had thought to call people. Basically told me that I would never be a "real" partner there as only one guy was really in charge and I would basically be his employee. Was helpful because that is of course not how it was presented to me.

Some of these sound very familiar

 

[jondunn]

Some of these sound very familiar

rad onc job hunt stories are full of repeated themes, whether someone applied now or 15 years ago. it's pretty wild