Positive developments in the field/Expanding indications for RT

[thecarbonionangle]

It might be time to start and exit strategy brainstorming thread!!

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[Carrot0123]

Hilariously, I think the kids over in EM stole our negativity crown. They're a lot bigger specialty so their collective voices are louder, but man, I've really enjoyed Reddit over the weekend after the workforce study came out.

I just went over to that forum and I can't believe they beat rad onc in the negativity department. You guys need to up your game.

 

[Radonky]

I just went over to that forum and I can't believe they beat rad onc in the negativity department. You guys need to up your game.

Our memes are better. And we have a croc.

 

[fiji128]

- We have a much bigger problem, the only thing we can go back to is Primary Care (if even possible) w/o retraining in residency. All radoncs went through 1 + 3 or 1 + 4 (1 yr transitional internship, 1 yr surg internship or whatever and 3-4 yrs of radonc).
Since the vast majority of radonc's have only 1 yr of internship, the only thing we can do is PCP in "the middle of the corn field". IIRC, most recent PCPs have 3-yr family medicine residency. The old-school 1-yr internship PCP is still there but I am not a PCP, so I don't know the rules for PCP. Does anyone know if radonc can do PCP (after tagging a long with a PCP for let's say 6 months to re-learn the rope)? I know this (working as a PCP) sounds depressing but it is better than driving Uber...

Technically I believe you can practice whatever you want once you have your medical license. From a practical standpoint payors only reimburse those that are board certified in whatever specialty they are practicing in. If you do something that's all cash like elective cosmetic procedures or a pain clinic pill mill you don't have to be board certified in derm or pain medicine or whatever. However, if you are in a sufficiently undeserved location (like crazy rural literally places they can't find any BC docs to work) places will let you practice and bill for primary care without being board certified. I won't swear by this 100% but that's my understanding of it.

FWIW, rad onc wouldn't be having any of these labor over supply problems if it had stayed as a fellowship after radiology.

 

[seper]

Technically I believe you can practice whatever you want once you have your medical license. From a practical standpoint payors only reimburse those that are board certified in whatever specialty they are practicing in. If you do something that's all cash like elective cosmetic procedures or a pain clinic pill mill you don't have to be board certified in derm or pain medicine or whatever. However, if you are in a sufficiently undeserved location (like crazy rural literally places they can't find any BC docs to work) places will let you practice and bill for primary care without being board certified. I won't swear by this 100% but that's my understanding of it.

FWIW, rad onc wouldn't be having any of these labor over supply problems if it had stayed as a fellowship after radiology.

I know one guy very well who is a PCP after 1 year of prelim medicine. He did not match into a speciality so he does very basic primary care (physical exams for companies etc). He's got a state license.

 

[medgator]

I know one guy very well who is a PCP after 1 year of prelim medicine. He did not match into a speciality so he does very basic primary care (physical exams for companies etc). He's got a state license.

Many states only require a year of post grad training to get licensed iirc. Internship should do the trick in those situations

 

[dieABRdie]

Technically I believe you can practice whatever you want once you have your medical license. From a practical standpoint payors only reimburse those that are board certified in whatever specialty they are practicing in. If you do something that's all cash like elective cosmetic procedures or a pain clinic pill mill you don't have to be board certified in derm or pain medicine or whatever. However, if you are in a sufficiently undeserved location (like crazy rural literally places they can't find any BC docs to work) places will let you practice and bill for primary care without being board certified. I won't swear by this 100% but that's my understanding of it.

FWIW, rad onc wouldn't be having any of these labor over supply problems if it had stayed as a fellowship after radiology.

I was going to post this earlier. This is my understanding as well. Its a major misconception that doctors have that they can't "legally practice" until they finish a residency. All you need is to be able to get a medical license to be able to "practice medicine or surgery," which in most states is one year internship. I think California requires 3 years of residency. Its another story to get an insurance company or hospital to credential you for your services.

My last resort is to move near a retirement community in Florida and sell testosterone to horny old men. I'd say I was selling my soul but honestly there's not much of it left.

 

[salubalu]

Just to clarify what I mentioned above...

- If ctDNA (or whatever else) causes fewer adjuvant chemo, and if a medonc (who has finished 3 years of IntMed) cannot find a job, he/she can always go back to be hospitalist.
In this case "retraining" means tagging a long with a current hospitalist(s) to re-learn how to manage the usual inpt (stroke, sepsis, MI, diabetic ketoacidosis, infectious diseases etc. etc.). The vast majorit of medonc's are board-certified in I.M.
They may have to do some MOC to keep their I.M. requirements.
But AFAIK, they can always go back to their roots.

- We have a much bigger problem, the only thing we can go back to is Primary Care (if even possible) w/o retraining in residency. All radoncs went through 1 + 3 or 1 + 4 (1 yr transitional internship, 1 yr surg internship or whatever and 3-4 yrs of radonc).
Since the vast majority of radonc's have only 1 yr of internship, the only thing we can do is PCP in "the middle of the corn field". IIRC, most recent PCPs have 3-yr family medicine residency. The old-school 1-yr internship PCP is still there but I am not a PCP, so I don't know the rules for PCP. Does anyone know if radonc can do PCP (after tagging a long with a PCP for let's say 6 months to re-learn the rope)? I know this (working as a PCP) sounds depressing but it is better than driving Uber...

PS: Sorry about my Uber joke...

I always thought opening a food truck would be fun if rad onc didn’t work out

 

[elementaryschooleconomics]

Yeah, the real barrier is making sure you have one to two years of supervised GME training after med school (depending on the state), and that you pass all the USMLE exams. Once you have that, you can legally practice medicine anywhere in America. "Board certification", or really, completing a residency in a specific specialty, is a "guarantee" that you can get credentialed at a hospital for that specialty's privileges, that insurance companies will reimburse you for your work, and reduce your chances (ha) of being successfully sued for malpractice.

Currently, I hold physician licenses in multiple states. Legally, there is nothing stopping me from opening Elementary Burn Surgery, PLLC. Now, have I ever done burn surgery in my life? No. Will I get OR privileges at any hospital? Probably not. But if I rent office space zoned for medical use and buy some scalpels, can the police and/or FBI stop me?

Nope.

I moonlighted outside RadOnc during residency, and know many people who also did various moonlighting outside their specialty in sometimes quite fascinating ways. Is it a viable backup career? Eh...maybe, but you could probably hustle your way into a more secure non-clinical gig.

 

[RadOncDoc21]

Yeah, the real barrier is making sure you have one to two years of supervised GME training after med school (depending on the state), and that you pass all the USMLE exams. Once you have that, you can legally practice medicine anywhere in America. "Board certification", or really, completing a residency in a specific specialty, is a "guarantee" that you can get credentialed at a hospital for that specialty's privileges, that insurance companies will reimburse you for your work, and reduce your chances (ha) of being successfully sued for malpractice.

Currently, I hold physician licenses in multiple states. Legally, there is nothing stopping me from opening Elementary Burn Surgery, PLLC. Now, have I ever done burn surgery in my life? No. Will I get OR privileges at any hospital? Probably not. But if I rent office space zoned for medical use and buy some scalpels, can the police and/or FBI stop me?

Nope.

I moonlighted outside RadOnc during residency, and know many people who also did various moonlighting outside their specialty in sometimes quite fascinating ways. Is it a viable backup career? Eh...maybe, but you could probably hustle your way into a more secure non-clinical gig.

I know a surgery resident drop out who does this and is actually doing pretty well considering they never completed their residency training. Granted, a 3rd year surgery resident does have more “skills” then I would trying to practice anything outside of “zapping” tumors with 0-5 fractions as we move towards that.

 

[elementaryschooleconomics]

I know a surgery resident drop out who does this and is actually doing pretty well considering they never completed their residency training. Granted, a 3rd year surgery resident does have more “skills” then I would trying to practice anything outside of “zapping” tumors with 0-5 fractions as we move towards that.

Yeah, as RadOnc has continued down the road it's on I have spent A LOT of time exploring escape options.

Most people forget that the training to become a doctor in America is basically cult-like, and you're indoctrinated from Day 1 about what your career should look like. Then you meet people or hear stories of people who never bought the company line, and the things you can do if you're comfortable with risk/going outside the box are really pretty cool.

That being said, following the Doctor Assembly Line of school --> residency --> practicing in your residency specialty is obviously the most safe and stable (unless you picked Path, RadOnc, EM, haha).

 

[medgator]

Yeah, as RadOnc has continued down the road it's on I have spent A LOT of time exploring escape options.

Most people forget that the training to become a doctor in America is basically cult-like, and you're indoctrinated from Day 1 about what your career should look like. Then you meet people or hear stories of people who never bought the company line, and the things you can do if you're comfortable with risk/going outside the box are really pretty cool.

That being said, following the Doctor Assembly Line of school --> residency --> practicing in your residency specialty is obviously the most safe and stable (unless you picked Path, RadOnc, EM, haha).

There's employment growth at evilcore... Maybe someone can get that data and plot a graph