Locum Search

[alwaysbeIMRTing]

Revisiting this, is is normal for a 1 week locums gig to involve contouring patients?

It is common for some rural clinics to only have locums because they are unwilling to do what it takes to recruit a permanent rad onc. Typically they have 3 or 4 of them rotating in and out from agencies on a 2 week basis (I'm seeing lots of these ads now looking for someone who can commit to 2 weeks a month -- this is why). In these cases, if the locums doesn't contour, then who will? Because it's all locums. This is abysmal care and these patients would almost universally be better served by a competent permanent BC rad onc who takes ownership of the patients and comes out for 2-3 days a week. But ASTRO and the guys at the WashU toxic clownshow are actively fighting this with their obsession over direct supervision and ROCR because they can't stand the idea of rad oncs double dipping (because they want to capture that extra revenue themselves - one rad onc shouldn't cover two separate rural clinics... unless you are being rotated around in them by your academic chair because that makes it ok).

If, on the other hand, you are talking about a locums filling in for a week while someone is on vacation, then absolutely not. There is no way in hell I would let a locums be involved in routine treatment planning if I am gone < 2 weeks. I will re-arrange my schedule to get everyone seen beforehand and contour while I'm away if need be. I don't even like them covering stereos. Any rad onc who hands off their contours to a locums should be ashamed. Even dumping it on a partner is pretty lame.

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[medgator]

Oof man, my time off is my time off. I do not want to do routine work during my Time off. Otherwise it isn't even time off.

It's the upside and downside of continuity of care sometimes. This is where gas, rads and EM win

 

[madchemist89]

It is common for some rural clinics to only have locums because they are unwilling to do what it takes to recruit a permanent rad onc. Typically they have 3 or 4 of them rotating in and out from agencies on a 2 week basis (I'm seeing lots of these ads now looking for someone who can commit to 2 weeks a month -- this is why). In these cases, if the locums doesn't contour, then who will? Because it's all locums. This is abysmal care and these patients would almost universally be better served by a competent permanent BC rad onc who takes ownership of the patients and comes out for 2-3 days a week. But ASTRO and the guys at the WashU toxic clownshow are actively fighting this with their obsession over direct supervision and ROCR because they can't stand the idea of rad oncs double dipping (because they want to capture that extra revenue themselves - one rad onc shouldn't cover two separate rural clinics... unless you are being rotated around in them by your academic chair because that makes it ok).

If, on the other hand, you are talking about a locums filling in for a week while someone is on vacation, then absolutely not. There is no way in hell I would let a locums be involved in routine treatment planning if I am gone < 2 weeks. I will re-arrange my schedule to get everyone seen beforehand and contour while I'm away if need be. I don't even like them covering stereos. Any rad onc who hands off their contours to a locums should be ashamed. Even dumping it on a partner is pretty lame.

Preach!

 

[A_DeMichele]

It is common for some rural clinics to only have locums because they are unwilling to do what it takes to recruit a permanent rad onc. Typically they have 3 or 4 of them rotating in and out from agencies on a 2 week basis (I'm seeing lots of these ads now looking for someone who can commit to 2 weeks a month -- this is why). In these cases, if the locums doesn't contour, then who will? Because it's all locums. This is abysmal care and these patients would almost universally be better served by a competent permanent BC rad onc who takes ownership of the patients and comes out for 2-3 days a week. But ASTRO and the guys at the WashU toxic clownshow are actively fighting this with their obsession over direct supervision and ROCR because they can't stand the idea of rad oncs double dipping (because they want to capture that extra revenue themselves - one rad onc shouldn't cover two separate rural clinics... unless you are being rotated around in them by your academic chair because that makes it ok).

If, on the other hand, you are talking about a locums filling in for a week while someone is on vacation, then absolutely not. There is no way in hell I would let a locums be involved in routine treatment planning if I am gone < 2 weeks. I will re-arrange my schedule to get everyone seen beforehand and contour while I'm away if need be. I don't even like them covering stereos. Any rad onc who hands off their contours to a locums should be ashamed. Even dumping it on a partner is pretty lame.

good point - there are these 2 distinct types of RO locum positions now

 

[Reaganite]

It is common for some rural clinics to only have locums because they are unwilling to do what it takes to recruit a permanent rad onc. Typically they have 3 or 4 of them rotating in and out from agencies on a 2 week basis (I'm seeing lots of these ads now looking for someone who can commit to 2 weeks a month -- this is why). In these cases, if the locums doesn't contour, then who will? Because it's all locums. This is abysmal care and these patients would almost universally be better served by a competent permanent BC rad onc who takes ownership of the patients and comes out for 2-3 days a week. But ASTRO and the guys at the WashU toxic clownshow are actively fighting this with their obsession over direct supervision and ROCR because they can't stand the idea of rad oncs double dipping (because they want to capture that extra revenue themselves - one rad onc shouldn't cover two separate rural clinics... unless you are being rotated around in them by your academic chair because that makes it ok).

If, on the other hand, you are talking about a locums filling in for a week while someone is on vacation, then absolutely not. There is no way in hell I would let a locums be involved in routine treatment planning if I am gone < 2 weeks. I will re-arrange my schedule to get everyone seen beforehand and contour while I'm away if need be. I don't even like them covering stereos. Any rad onc who hands off their contours to a locums should be ashamed. Even dumping it on a partner is pretty lame.

agree wholeheartedly with the first paragraph, but you lost me on the second. Why should any radonc taking a vacation feel ashamed asking a locum to draw if the rate is fair? I locumed during and initially out of residency and drew for everyone. It never once crossed my mind it was inappropriate since I was, you know, a rad onc after all. I agree-I wouldn't ask a locum to treatment plan other than urgent cases, but sheesh, I feel no shame asking a guy I'm paying top dollar for to draw a prostate or any other case for that matter. It's akin to a resident drawing for an attending really. I'm still going to "approve" the contours when I get back.

 

[fiji128]

agree wholeheartedly with the first paragraph, but you lost me on the second. Why should any radonc taking a vacation feel ashamed asking a locum to draw if the rate is fair? I locumed during and initially out of residency and drew for everyone. It never once crossed my mind it was inappropriate since I was, you know, a rad onc after all. I agree-I wouldn't ask a locum to treatment plan other than urgent cases, but sheesh, I feel no shame asking a guy I'm paying top dollar for to draw a prostate or any other case for that matter. It's akin to a resident drawing for an attending really. I'm still going to "approve" the contours when I get back.

Quality of locums is extremely variable. I wouldn't trust an unknown locums to contour non urgent cases.

 

[drowsy12]

Yeah and Reaganite I guess if it was a situation where they wouldn’t plan until I came back and approved contours, then I would just do them when I got back. Easier for me than checking someone else’s.

 

[alwaysbeIMRTing]

agree wholeheartedly with the first paragraph, but you lost me on the second. Why should any radonc taking a vacation feel ashamed asking a locum to draw if the rate is fair? I locumed during and initially out of residency and drew for everyone. It never once crossed my mind it was inappropriate since I was, you know, a rad onc after all. I agree-I wouldn't ask a locum to treatment plan other than urgent cases, but sheesh, I feel no shame asking a guy I'm paying top dollar for to draw a prostate or any other case for that matter. It's akin to a resident drawing for an attending really. I'm still going to "approve" the contours when I get back.

2 main reasons why I don't feel ethically ok with this:
1. Taking both pride and ownership in my work. I am not an interchangeable cog (despite what many admins may think), and the guy from Weatherby is not going to draw the same way I do and go through the effort to create PRVs and customized dose constraints on a plan-by-plan basis.
2. Honesty. When I consult with a patient, often they will ask if I will be the one treating them. I explain that I will be doing their treatment plan and what that involves. If we don't have this conversation, then I assume it is assumed. How would you feel if you consulted with a surgeon then when you are under anesthesia you find out later the guy who you consulted with was in Cancun and somebody else cut on you?

I also see two practical issues with having a locums draw the contours while you are away then approving them when you get back before sending to the planner.
1. The delay. If you're going to wait a week or two to send them to the planner and you don't want to draw on vacation, then what's the point? Just draw when you get back. If you're going to have the locums draw the plan, you might as well let them go ahead and plan it. I don't understand why you would trust someone to draw but not trust them to approve a plan. Residents do this because they are intentionally being trained. For a good attending, modifying, and approving and discussing a trainee's contours takes extra time. If it's saving the attending time they are lazy and a bad instructor.
2. The headache of having to modify contours. One of two things is happening here. You are either accepting contours that you otherwise wouldn't have drawn because they seem good enough (i.e., lowering your standards to avoid re-drawing), or you are having to modify them significantly, often in which case it is easier to just start over.

In the past, when I've been gone for a long time and the manager made the locums see a consult anyway, I have come back to nonsense like a patient under treatment for an oral tongue cancer with the lateral tongue and level 2-3 ipsilateral neck only receiving treatment or something.

 

[A_DeMichele]

Nowadays locums often cover an employed, RVU-compensated doc. I've seen those docs wanting to sign plans remotely during their vacation to capture RVUs.