Non clinical jobs

[medgator]

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I was hoping to hone in on my inpatient palliative RT skills a little more.

Yep, some will definitely need more experience trying to figure out whether it's an inpatient 8/1, 20/5 or 30/10 situation, thankfully Columbia has come through with this very clutch fellowship.

 

[evilbooyaa]

I still consider the fact that the Columbia "fellowship" exists to be a blight on our specialty as a whole. Spend half a year perfecting your palliative RT technique!!111

 

[FrostyHammer]

Think it's a ripe time to resurrect this thread based on the recent Red Journal editorial suggesting us to look at non clinical things. There was some spirited conversation on how to find these jobs and how many existed, closer to the beginning (until it, as per usual, degenerated to a rant on the job market like all SDN rad onc threads do). Anyone want to chime in about the constructive portion minus the ranting?

 

[scarbrtj]

If you want to be dean of a medical school, usually a mostly-to-totally non-clinical job, don't be a radiation oncologist. It seems exclusionary. I was very struck by Halperin's recent editorial, especially his section entitled "Even when the radiation oncologist wants the job, the search committee doesn't want a radiation oncologist"... "[T]he chairman of surgery referred to radiation oncology as a 'clinical catfish: the bottomfeeding garbage-eater at the end of the clinical referral chain.'" Ouch. (I think we even get that rap from non-MDs, hospital administration, etc.) Ed's point, seemingly borne out by his own experience, is the words "radiation oncologist" have a bad connotation in academic medicine. Now if one enters a non-clinical arena where other non-rad onc MDs already exist, I would not be surprised by a look-down-the-nose attitude there too. Hopefully not, but let's be real.

There's always a job at the IAEA for a radiation oncologist with an "attractive" remuneration package of about $150K a year. Of course, no surprise: you gotta move to Austria.

 

[medgator]

Think it's a ripe time to resurrect this thread based on the recent Red Journal editorial suggesting us to look at non clinical things. There was some spirited conversation on how to find these jobs and how many existed, closer to the beginning (until it, as per usual, degenerated to a rant on the job market like all SDN rad onc threads do). Anyone want to chime in about the constructive portion minus the ranting?

Wouldn't call it ranting, more like disclosure of unpleasant truths.

The bottom line is that this thread is really grasping at straws. Most of the jobs are going to be in RO and quite frankly my, and many others, interactions with non clinical ROs has been when we have to argue with them at evicore, AIM specialty health etc to get prior authorizations approved.

If that's your idea of a backup plan, have at it. Just make sure you figure out a way to deal with all that negative karma you accumulate in the course of delaying and denying patient care with capricious and arbitrary insurance guidelines for what deserves imrt, igrt, sbrt etc

 

[TDDro]

I get lots of headhunter emails for non-clinical jobs. I only know one rad onc who has done it, and they've done very well for themselves. I think the best advice is to avoid saying you're a RADIATION oncologist, just present yourself as an oncologist (which you are) -- adding 'radiation' in front confuses people since it's such a small field and they don't know what it means. The companies are looking for someone with oncology experience, so they want to see a few years of clinical practice and board certification in oncology under your belt. The jobs range from clinical trial design/management to medical science liaisons in pharma/biotech to 'research' for consulting/investment firms. This isn't bench research, it's where you go through a company's science and product portfolio and make the call whether it's a legit investment venture.

Talk to a headhunter. Worst case scenario is you waste someone's time. If you're looking to jump, divorce the word "radiation" from your top line and you're good.

 

[deleted941485]

Was talking to a friend at another program. One if their RO pgy 3s is sending out resumes for Stryker and Medtronic for Orthopedic Sales. Wish them luck in that endeavor.

A few years ago a very charming young lady in the IM program pulled it off actually got a job in pharmaceutical sales.

 

[TDDro]

Was talking to a friend at another program. One if their RO pgy 3s is sending out resumes for Stryker and Medtronic for Orthopedic Sales. Wish them luck in that endeavor.

A few years ago a very charming young lady in the IM program pulled it off actually got a job in pharmaceutical sales.

Decent lifestyle...good (not doctor) money, nice expense acct, work as little/much as you want. Ultimately I think it'd be unfulfilling for most docs though. Would be hard to rationalize all those years of studying and debt just to take a job you could have gotten fresh out of college. Sunk cost fallacy is real.

 

[evilbooyaa]

Was talking to a friend at another program. One if their RO pgy 3s is sending out resumes for Stryker and Medtronic for Orthopedic Sales. Wish them luck in that endeavor.

A few years ago a very charming young lady in the IM program pulled it off actually got a job in pharmaceutical sales.

WTF does a RO PGY3 know about orthopedics? Or basically saying as somebody with zero residency training, just an MD, going into Orthopedic Sales?

 

[domestique]

WTF does a RO PGY3 know about orthopedics? Or basically saying as somebody with zero residency training, just an MD, going into Orthopedic Sales?

The firm would obviously train him/her prior to setting him/her loose. Regardless, it's a brutal career move.

 

[FrostyHammer]

How does one get into contact with a headhunter? I assume they don't write that as their official job position!

I get lots of headhunter emails for non-clinical jobs. I only know one rad onc who has done it, and they've done very well for themselves. I think the best advice is to avoid saying you're a RADIATION oncologist, just present yourself as an oncologist (which you are) -- adding 'radiation' in front confuses people since it's such a small field and they don't know what it means. The companies are looking for someone with oncology experience, so they want to see a few years of clinical practice and board certification in oncology under your belt. The jobs range from clinical trial design/management to medical science liaisons in pharma/biotech to 'research' for consulting/investment firms. This isn't bench research, it's where you go through a company's science and product portfolio and make the call whether it's a legit investment venture.

Talk to a headhunter. Worst case scenario is you waste someone's time. If you're looking to jump, divorce the word "radiation" from your top line and you're good.

 

[TDDro]

How does one get into contact with a headhunter? I assume they don't write that as their official job position!

lol, true. I've never looked for one, they've always found me. I just kinda assumed they cast a HUGE net to see if anyone will bite. The most recent one I've been contacted by (spam email really) is TriNetPharma, they do a lot of MSLs. There is another forum called 'drop out club' that posts a ton of stuff from recruiters (mostly consulting, startup, and investment research gigs). If you sign up to see some listing services, I'm sure they add your email to a databank that recruiters then spam (Non-Clinical Job Postings/Job Boards - SEAK, Inc.).

 

[deleted941485]

lol, true. I've never looked for one, they've always found me. I just kinda assumed they cast a HUGE net to see if anyone will bite. The most recent one I've been contacted by (spam email really) is TriNetPharma, they do a lot of MSLs. There is another forum called 'drop out club' that posts a ton of stuff from recruiters (mostly consulting, startup, and investment research gigs). If you sign up to see some listing services, I'm sure they add your email to a databank that recruiters then spam (Non-Clinical Job Postings/Job Boards - SEAK, Inc.).

Drop out club was ok. I tried doing free-lance consulting work with a friend of mine who is a radiologist. We did two projects but really the amount of time and effort was not worth it. I think we walked away with like 2000 dollars each before taxes after working for 4 months on project in our spare time. Kind of a waste unless you are really gunning for a full time consulting job and trying to develop a portfolio.

 

[Mandelin Rain]

Drop out club was ok. I tried doing free-lance consulting work with a friend of mine who is a radiologist. We did two projects but really the amount of time and effort was not worth it. I think we walked away with like 2000 dollars each before taxes after working for 4 months on project in our spare time. Kind of a waste unless you are really gunning for a full time consulting job and trying to develop a portfolio.

That's a bummer. As a one off, I was invited to a "consulting" dinner by Puma Pharmaceuticals (only product is Nerlynx) to give an opinion on extended HER2 directed therapy with that uber expensive, minimally effective, megacharged version of lactulose. Again, I just rolled with the "oncologist" title, ate a very nice dinner, listened to a hour long spiel, gave my 2 cents, and was handed a check for $1,000.

Totally gobsmacked that they can do that. I mean, it was essentially just bribery. Is that what med onc is like?

 

[FrostyHammer]

Stop. I started this post for informational purposes and don't want this to degenerate into another "sky is falling" spiel about the job market. Let's stick to informational stuff. Much appreciated.

Here we are, buncha radiation oncologists, after being at the top of our classes in college, medical school, matching to and completing a 5 year residency, passing boards, etc., reduced to scavenging for alternative careers. Medical students: this is your future if you choose this field. STAY AWAY.

Stop

 

[Palex80]

Can you work for an medical insurance company in the US? I have a colleague who works for one in Germany. You can either workfull time or case-based. You basically look into patients files and write down a report declaring if a treatment, which was billed, was reasonable or not indicated.

 

[medgator]

Can you work for an medical insurance company in the US? I have a colleague who works for one in Germany. You can either workfull time or case-based. You basically look into patients files and write down a report declaring if a treatment, which was billed, was reasonable or not indicated.

Many work in that capacity beforehand, reviewing prior authorizations to approve or deny more expensive services like imrt SRS sbrt and igrt, prior to treating the patient

 

[Palex80]

Many work in that capacity beforehand, reviewing prior authorizations to approve or deny more expensive services like imrt SRS sbrt and igrt, prior to treating the patient

Is it mostly "side job" or do people do that full time? And do you have to be a specialist in the indication for which a service is requested or can any physician review cases; in other words do you have to be a radiation oncologist to judge on IMRT reimbursement or can a nephrologist do it?

 

[Neuronix]

Every time I have had to get on the phone with a reviewer for a rad onc plan, it has been a rad onc on the other line.

Haven't done this personally, but I've known several rad oncs who have had no choice but to do this because they could not find a rad onc job within hours of their spouse or children (if divorced) or had to leave a position and were locked out of a large area by a several year non-compete. So given the job market there are plenty of rad oncs available to do this work.

I imagine that the pay isn't great, but the hours are probably flexible. Rad onc is thrown around as a lifestyle specialty, but I was noting in another thread recently that many positions are not so friendly. Thus, this was the fallback for women rad oncs I know with children who could not successfully maintain a full-time rad onc job with children and didn't have a satisfactory part-time option, particularly with non-compete.

 

[scarbrtj]

Every time I have had to get on the phone with a reviewer for a rad onc plan, it has been a rad onc on the other line.

Haven't done this personally, but I've known several rad oncs who have had no choice but to do this because they could not find a rad onc job within hours of their spouse or children (if divorced) or had to leave a position and were locked out of a large area by a several year non-compete. So given the job market there are plenty of rad oncs available to do this work.

I imagine that the pay isn't great, but the hours are probably flexible. Rad onc is thrown around as a lifestyle specialty, but I was noting in another thread recently that many positions are not so friendly. Thus, this was the fallback for women rad oncs I know with children who could not successfully maintain a full-time rad onc job with children and didn't have a satisfactory part-time option, particularly with non-compete.

A friend of mine does it. Because there's so many rad oncs now clamoring for these spots, the minimum you can work is 20 hours/week. And for that you get about 10K a month. Pretty assembly line-ish, must make certain amount of calls per day, can't deviate from company guidelines, etc. If you're like me, you have to talk to "these people" on a semi-routine basis.

 

[PointA]

OK I'll take the bait, here are a few options:

You can work for the FDA as a medical officer. There are several docs in our field who have done this and you can reach out to them to learn more. Salary starts around 180k and I believe they have posted on the ASTRO board in the past. The job is an 8-5pm work day with most of your time spent looking at a computer and reviewing applications for drug and device approval.

Medical Officer Positions at FDA

Medical Officer position description

www.fda.gov

Here's an interesting take on what it is like to work for an insurance company. Salary reportedly around 200-220k at least for this IM doc:

https://doctorscrossing.com/working-for-health-insurance-is-this-really-the-dark-side/

I know of a couple docs that have taken jobs in the tech sector either for small start-ups or one of the big companies (Apple, Google). You have to move to the very expensive bay area though:

Apple now has dozens of doctors on staff, showing it's serious about health tech

The hires could help Apple win over doctors and suggest it will build applications that can help people with serious medical problems.

www.cnbc.com

If none of the above are appealing, you can always get in shape, style your hair, and start auditioning for roles in Hollywood as one of our successful rad onc colleagues has done:

Article Host page - fall 2014

www.buffalo.edu

 

[domestique]

A friend of mine does it. Because there's so many rad oncs now clamoring for these spots, the minimum you can work is 20 hours/week. And for that you get about 10K a month. Pretty assembly line-ish, must make certain amount of calls per day, can't deviate from company guidelines, etc. If you're like me, you have to talk to "these people" on a semi-routine basis.

I would avoid this work if you don't want to be brutally verbally assaulted by rad oncs like me who have 20 - 25 pts in planning and as such don't take kindly to my planning staff's time being wasted with 3d comparison plans for situations in which at least IMRT is the only answer. I also routinely file complaints to my state's insurance board among other interested regulatory bodies and I always name names.

 

[deleted18755]

I also routinely file complaints to my state's insurance board among other interested regulatory bodies and I always name names.

I’m curious how easy is it to file a complaint and more importantly if it results in any meaningful actions

 

[RadOncDoc21]

Insurance companies are evil. I know somebody has to work for them but I def couldn’t do it.

 

[domestique]

I’m curious how easy is it to file a complaint and more importantly if it results in any meaningful actions

Each state has its own procedure. In my state it is not complicated. I did this for the first time because of a repeated bad actor. evicore and aim off the hook here because these guys have their own internal team.

My state was very interested in the payer's conduct by the time I contacted them because of other complaints in other specialities. This payer is in process of being booted from our state. My understanding is that if certain corrective actions aren't taken, they will be booted. Worth remembering that each payer has to get auth at state level to do business in a given state so it's each state's dept of insurance (or whatever local name it goes by) that has the most direct jurisdiction over who can play and who can't in the state in question.

Other entities that are on my "speed dial" when I encounter what I determine to be arbitrary and/or not PUBLICLY-available-guideline-driven conduct are the National Committee for Quality Assurance NCQA and URAC Utilization Review Accreditation Commission. I also have my go to US Senator who, while not having direct jurisdiction of a state level matter, takes a great interest in helping my patients and this senator's office seem to get results. I prefer to bring pain from all directions as you can see.

If anyone from the insurance world is on here, my identify is now probably clear at least to them. I am a salaried employee with a directorship role and no production incentive of any kind (ie i get nothing to do imrt instead of 3d just as an example). What gets me up in the morning are my patients not getting ****** by crazy admin decisions, insurance stooges, or turncoat rad oncs who decide they need 10 k a month to bust the ***** of the rest of us. Get a life.

 

[Reaganite]

I did insurance reviews a number of years ago. Not because I was looking to make a buck (the pay is whatever), but because I wanted to learn the tricks to get my own patients approved as my practice grew. It was pretty eye opening. This board is NOT a microcosm of what goes on elsewhere. There are a lot of unnecessary requests for IMRT, especially by the older guys. I know there is a lot of antipathy towards reviewers, but some of the things our more-often-than-not boomer colleagues are requesting are just ridiculous. 33 fractions of hippocampal sparing whole brain IMRT for a patient with diffuse GBM, innumerable requests for 25 fraction palliative IMRT for bone mets, repeated requests for 30 fraction L breast IMRT for 80+ year olds with T1a lesions...just a few of the cases that stood out. I was basically bound to the published guidelines of the insurance company, but they were quite fair, and I honestly never had to deny something that I really thought should be approved. Of course, every insurance company (and geography) is different, and I know there are entities out there with much tougher guidelines.

 

[KHE88]

innumerable requests for 25 fraction palliative IMRT for bone mets,

This is the really the most egregious of them all, IMO. Worse than 20 fraction whole brain, worse than 32 fraction for low grade DCIS in an 80 year old, etc.

I was shocked when I saw a patient who had been horribly mismanaged and received 25 fraction IMRT for a bone met, which wasn't even planned properly, and the person had severe toxicity from outrageous hot spots.

I'm wondering now how common this actually is and how people are able to get away with it at all.

 

[medgator]

This is the really the most egregious of them all, IMO. Worse than 20 fraction whole brain, worse than 32 fraction for low grade DCIS in an 80 year old, etc.

I was shocked when I saw a patient who had been horribly mismanaged and received 25 fraction IMRT for a bone met, which wasn't even planned properly, and the person had severe toxicity from outrageous hot spots.

I'm wondering now how common this actually is and how people are able to get away with it at all.

Also a lot of 1.8/39 for h&n (and lung). Really worse control when you drop below 2 a day for something that could be highly curable otherwise.

I've seen some insurance companies deny auth for more than 35 fractions for h&n. Can't say I blame them for that guideline.

What bothers me is the routine denial of stuff like imrt for stage III lung where the data is clearly better, or the use of igrt for patients with bone Mets where you are between the kidneys etc

 

[Palex80]

I'm wondering now how common this actually is and how people are able to get away with it at all.

I believe this mostly happens in single-person clinics. When you work with colleagues, you still decide how to treat your patients, but at the same time know quite well that people are "looking" at what you do.

I got a call by a colleague working in such an outpatient clinic years ago. He asked if we could overtake the treatment of his patient. It was a lady with 15+ brain mets, NSCLC was the primary. Quite a bit extracranial disease too and she had completed third line systemic treatment. She was having difficulties travelling to his outpatient clinic (lots of curves on the road and she kept vomitting). She was roughly "halfway" through treatment.

When I got her details, I was shocked to see, that he was treating her with 20 fractions WBRT with 1.8 Gy/fraction with some kind of intergrated boost to the mets going up to 50 Gy to the GTV... So she had 14.4 Gy WBRT and 20 Gy to the mets when we had to overtake treatment.

We have her 3 x 5 Gy WBRT and told her to go home to her family... She died roughly 2 months later.

 

[Palex80]

Also a lot of 1.8/39 for h&n (and lung). Really worse control when you drop below 2 a day for something that could be highly curable otherwise.

Data to back that up?
Quite a few "highly curable" diseases are treated with 1.8 Gy/d --> rectum, esophagus, gastric, extensive RNI for breast. I don't think there are any good data showing that 1.8 Gy/d are "bad", as long as you compensate in terms of total dose. Some H&N-patients will benefit from higher dose/week, but you can do that with 1.8 Gy per day too (give 1 extra fraction on Fridays) and the benefit diminishes as soon as you give chemo.

 

[medgator]

Data to back that up?
Quite a few "highly curable" diseases are treated with 1.8 Gy/d --> rectum, esophagus, gastric, extensive RNI for breast. I don't think there are any good data showing that 1.8 Gy/d are "bad", as long as you compensate in terms of total dose. Some H&N-patients will benefit from higher dose/week, but you can do that with 1.8 Gy per day too (give 1 extra fraction on Fridays) and the benefit diminishes as soon as you give chemo.

Total treatment time ends up being 8 weeks in the US when you treat at 1.8/day. No one does 6 fractions a week here afaik. It could easily end up as a 10 week package time if it is a typical h&n case where a patient sometimes ends up needing a break from tx.

The impact of radiation treatment time on survival in patients with head and neck cancer - PMC

To assess the impact of radiation treatment time (RTT) in head and neck cancers on overall survival (OS) in the era of chemoradiation. Patients diagnosed with tongue, hypopharynx, larynx, oropharynx, or tonsil cancer were identified using the ...

www.ncbi.nlm.nih.gov

The effect of fraction size on control of early glottic cancer - PubMed

A retrospective analysis of 600 patients treated for head and neck malignancy at the Cooper Hospital/University Medical Center was undertaken. Patients who had surgical intervention (excluding biopsy) were withdrawn from this review. Fifty-eight patients with Stage I Glottic Laryngeal Carcinoma...

www.ncbi.nlm.nih.gov

 

[Palex80]

Total treatment time ends up being 8 weeks in the US when you treat at 1.8/day. No one does 6 fractions a week here afaik. It could easily end up as a 10 week package time if it is a typical h&n case where a patient sometimes ends up needing a break from tx.

The impact of radiation treatment time on survival in patients with head and neck cancer - PMC

To assess the impact of radiation treatment time (RTT) in head and neck cancers on overall survival (OS) in the era of chemoradiation. Patients diagnosed with tongue, hypopharynx, larynx, oropharynx, or tonsil cancer were identified using the ...

www.ncbi.nlm.nih.gov

The effect of fraction size on control of early glottic cancer - PubMed

A retrospective analysis of 600 patients treated for head and neck malignancy at the Cooper Hospital/University Medical Center was undertaken. Patients who had surgical intervention (excluding biopsy) were withdrawn from this review. Fifty-eight patients with Stage I Glottic Laryngeal Carcinoma...

www.ncbi.nlm.nih.gov

True, glottic cancer is an issue, I forgot about that.

 

[Reaganite]

Not to derail the intent of the original post, but like I said being a reviewer was eye-opening. I did see a lot of 1.8 GY per day on head and necks including early stage glottic. While I was forced to deny IMRT for T1 and T2 glottic, I couldn't deny extended fractionation at that time. In the cases where I had to review the comparison plan for IMRT vs. 3D I saw a lot of terrible stuff. Guys doing IMRT for cervix and endometrial without an ITV drawn/limited margins (and I knew the practice did not have CBCT), nodal stations completely missed, etc. I couldn't deny for those reasons, however, as the guideline only required IMRT have an advantage in sparing certain normal tissues. All in all, doing review work took away any remorse I had about forcing a boomer competitor into retirement. My advice to people dealing with reviewers is to understand they receive a ton of bogus requests. Sometimes just being nice and finding some middle ground (I believe someone mentioned they would be willing to do fewer fractions if IMRT was allowed...I think this is a great line) can go a long way. If I had any leeway at all in cases, I would always look to approve especially if the doc on the other line was nice.

The stage III lung denials have come up a lot here, but the insurance I was covering for was reasonable and allowed lung IMRT if it dropped V20 by some percent compared to 3D plan.

 

[domestique]

of course there are bad radiation oncologists out there doing bad stuff but i'm not interested in their practice. i'm interested in mine. And it's nice that you did your best but i'm interested in the reviewers who I have to deal with now. Routinely these reviewers spew nonsense and make **** up as they go along, they talk over me, they suggest, for example, I do electron patches instead of IMRT for high risk left CW/breast with comp nodes for a huge lady whose distance from skin surface to IMNs is roughly a km. If you do any of these things, I will be very aggressive in the manner described previously and I always win. Sometimes it takes a little while and sometimes it's messy but I always win. I'm just not going to deliver a dog**** plan because Dr. Cockup on the other line told me I have to.

 

[evilbooyaa]

I think there's extremes of reviewers just as there is extremes of radiation oncologists submitting plans.

I think the examples Reaganite and domestique give are both problematic.

Some reviewers have been reasonable while others have been unreasonable.

 

[scarbrtj]

of course there are bad radiation oncologists out there doing bad stuff but i'm not interested in their practice. i'm interested in mine. And it's nice that you did your best but i'm interested in the reviewers who I have to deal with now. Routinely these reviewers spew nonsense and make **** up as they go along, they talk over me, they suggest, for example, I do electron patches instead of IMRT for high risk left CW/breast with comp nodes for a huge lady whose distance from skin surface to IMNs is roughly a km. If you do any of these things, I will be very aggressive in the manner described previously and I always win. Sometimes it takes a little while and sometimes it's messy but I always win. I'm just not going to deliver a dog**** plan because Dr. Cockup on the other line told me I have to.

CAUTION
We are highlighting an aspect of modern radiation oncology that makes our specialty very undesirable (and makes us SDNers look like misanthropes).
"Other specialties have to deal with insurance guidelines too. Don't be such a sitzpinkler."
Ha, how true.
Evicore medical oncology guidelines: 6 pages, one source cited (the NCCN).
Evicore radiation oncology guidelines: 272 pages! Thousands of sources cited!* It's a cookbook, er, mini-textbook!

* little known fact: insurance co. rad oncs think they've gone into academics

 

[TDDro]

Here we are, buncha radiation oncologists, after being at the top of our classes in college, medical school, matching to and completing a 5 year residency, passing boards, etc., reduced to scavenging for alternative careers. Medical students: this is your future if you choose this field. STAY AWAY.

FWIW, I only knew the one rad onc that jumped (or even was looking to jump). Most of the people I talk with about this are non-rad oncs who are tired of the grinding system (med onc, IM, peds).

 

[pikachu]

Each state has its own procedure. In my state it is not complicated. I did this for the first time because of a repeated bad actor. evicore and aim off the hook here because these guys have their own internal team.

My state was very interested in the payer's conduct by the time I contacted them because of other complaints in other specialities. This payer is in process of being booted from our state. My understanding is that if certain corrective actions aren't taken, they will be booted. Worth remembering that each payer has to get auth at state level to do business in a given state so it's each state's dept of insurance (or whatever local name it goes by) that has the most direct jurisdiction over who can play and who can't in the state in question.

Other entities that are on my "speed dial" when I encounter what I determine to be arbitrary and/or not PUBLICLY-available-guideline-driven conduct are the National Committee for Quality Assurance NCQA and URAC Utilization Review Accreditation Commission. I also have my go to US Senator who, while not having direct jurisdiction of a state level matter, takes a great interest in helping my patients and this senator's office seem to get results. I prefer to bring pain from all directions as you can see.

If anyone from the insurance world is on here, my identify is now probably clear at least to them. I am a salaried employee with a directorship role and no production incentive of any kind (ie i get nothing to do imrt instead of 3d just as an example). What gets me up in the morning are my patients not getting ****** by crazy admin decisions, insurance stooges, or turncoat rad oncs who decide they need 10 k a month to bust the ***** of the rest of us. Get a life.

More of us need to do just this and speak up for our patients in all available avenues instead of just rolling over for the bureaucrats.

I have also complained to our state's insurance board regarding a certain insurer (blanket denials for IMRT in the upper abdomen) but have never called the other entities or my congress-bots. But I may start...

 

[FrostyHammer]

Anyone know anything or have advice for full time locums? Seems nice for flexibility and especially if you don't care about making $300K and would rather make less while working less...

 

[seper]

Did it work? Did the board contact the insurer regarding the matter?

More of us need to do just this and speak up for our patients in all available avenues instead of just rolling over for the bureaucrats.

I have also complained to our state's insurance board regarding a certain insurer (blanket denials for IMRT in the upper abdomen) but have never called the other entities or my congress-bots. But I may start...

 

[pikachu]

Did it work? Did the board contact the insurer regarding the matter?

I never received direct feedback from the board about what happened but have not experienced the blanket upper abdomen IMRT denials for the past year or so. SBRT is another story, unfortunately. My understanding is that the company’s guidance on the indications for IMRT changed; I doubt my complaint had anything to with the change, but guess you never know. We are at somewhat of an information disadvantage compared with the payers with respect to complaints received and it often feels like you are shouting into the void when you do speak up. however nothing will change if everyone assumes that everyone else is just letting things slide and never saying anything. This doesn’t just apply to the insurance companies obviously either.

 

[FrostyHammer]

Anyone know anything or have advice for full time locums? Seems nice for flexibility and especially if you don't care about making $300K and would rather make less while working less...

Crickets...

 

[RandomRadiator]

Anyone know anything or have advice for full time locums? Seems nice for flexibility and especially if you don't care about making $300K and would rather make less while working less...

Locums opportunities are split into short and long term appointments. Short term are generally one or two weeks, while long term varies from one month to upwards of six months. In my opinion, full time locums work is feasible but would be a challenge long term. However, this is all relative to what you want and how many assignments you'd be willing to take. In general short term assignment varies between $1000 to $2000 per day depending on site, need, and placement company with travel and lodging covered. Assistance with licensing and privileges also varies per placement company.

 

[FrostyHammer]

$2K per day - seriously? I assume it's in the middle of nowhere but 2K/day is a bit high for even the sticks...

 

[medgator]

$2K per day - seriously? I assume it's in the middle of nowhere but 2K/day is a bit high for even the sticks...

$1500 is a pretty standard rate from what I've seen. If they need ASTRO coverage in the boonies, I could easily see it at $2k+

 

[TDDro]

Is there enough locums opps to really make it a good part-time gig? Between needing a different license for every state and the hesitation of large institutions to hire locums (with the concomitant decline in small groups across the board), I'd think you'd spend a lot of time with no job.

 

[Palex80]

There is a rise in online second opinion centers in Europe.
Some of the insurance companies have teamed up and are offering them to their customers. And there are some big hospitals doing aggressive advertisement for those.

I had a patient a few years ago which paid a considerable amount of money out of her pocket asking at MGH about proton therapy. She had to send in all images and reports and received within a few weeks a very well written report with a treatment recommendation.

I presume we will see more of this in the future, as the patients become more familiar with modern technology and perhaps require professional second opinions rather than huge influx of non-professional information found online to guide their decisions.

 

[radiaterMike]

2k per day for locums seems reasonable (not high). There are 260 working days per year, so if you did locums with no vacation, that would amount to 520K per year, with no benefits. I am not sure what the real median salary is for Rad Onc, but per doximity it is ~480k per year. Add benefits, retirement (if hospital employed), vacation, etc. and that number is higher. For locums, you get housing and food paid for, but presumably you need a home base, so you would pay something for housing.

 

[RandomRadiator]

$2K per day - seriously? I assume it's in the middle of nowhere but 2K/day is a bit high for even the sticks...

The listed rate is negotiable. Locums work has an opportunity cost for which I feel I should be compensated.

It is possible to be a part time gig, perhaps even full time depending on personal desires. However, there isn't much upside relative to traditional employment given locum 1099 status. In my opinion, locum assignments are best as brief one off opportunities.

 

[KHE88]

Locums companies take around a 30% cut, so the hospital will typically pay the firm something around 3k.
2k would be a reasonable rate. More saturated areas less, Less saturated areas more, obviously.
Tend to be more of an option for people who are not BC/BE or part-time retired docs.
Locums as a new grad would be a disaster unless you're doing it in the same city you already live in while you wait for something else to open up.