private practice

[tomfoolery]

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As a 3rd year med student I'm wondering: Is it fair to say that one negative of this field might be that your skills as a physician are limited by your equipment?

In other words if I want to work in private practice would I be limited to a few private spots (say in California) that have the right combination of equipment, whereas this might not be a problem for other specialties??

Secondly, why aren't some generally great academic institutions considered so great in RadOnc - e.g. UCLA? Is it beacuse of prohibitive equipment costs? I can't imagine linear accelerators being that much more expensive than say an MRI machine

 

[Impressions]

UCLA has had some instability particularly with faculty, both medical and physics. They were in search of a chair for several years. Things should gradually be on the upswing now.

 

[nod]

wow, there are so many things that jump into my head at once at reading your question i hardly know where to start.

you really only need ONE linear accelerator to be a radiation oncologist. most private practice groups in this country have good equipment. they all do IMRT, which is the newest "accepted" technology in radiation oncology. if you have imrt, you should be able to treat the vast majority of the patient you see. even academic centers treat the majority of their patients using IMRT or 3D conformal. so your competency as a doctor is really only limited by your expertise and rarely by your equipment. many private practices, especially the larger ones, owns all the latest toys, with protons being the only real exception, and only a tiny subset of patients need to be referred out for proton therapy.

the quality of a rad onc program is based on the people, not the machines. the typical linear accelerators are not expensive and academic centers can afford them. the trick is getting good faculty who can do research, teach, and treat patients.

 

[MHotep]

In reference to the academic programs...

Most powerhouse academic centers have strong surgery and medicine departments, which generally translates into having strong surgical and medical oncology programs. At some institutions, the growth of radiation oncology was systematically stifled by these über surgical/medical oncology programs.

 

[Palex80]

you really only need ONE linear accelerator to be a radiation oncologist. most private practice groups in this country have good equipment. they all do IMRT, which is the newest "accepted" technology in radiation oncology. if you have imrt, you should be able to treat the vast majority of the patient you see.

One should not forget that one of the primary reason why IMRT got so widespread in the US, is the fact that it is paid for by the insurance companies.
In other countries (for example in Europe), IMRT is not paid as much as it is worth. You generally get some extra money for all the work you are putting into it, but in the end if you are in a private practice and have enough patients to treat, you may be losing money by offering IMRT to many of your patients. It primary has to do with time on the machine. An IMRT treatment can last as long as 3 normal 3D treatments.
In the future things will probably change with Rapid Arc and VMAT becoming available to many institutions and practices, significantly reducing treatment time for IMRT.

 

[clintpark]

Where I do see small private practices being limited due to equipment is many cannot afford brachytherapy source because of low volumes. In my mind, if you cannot do brachytherapy, you should not treat GYN cancers. I have seen patients get referred to academic centers after whole pelvic RT, which is the right thing to do if you cannot offer brachytherapy (rather than some external beam cervix boost).

 

[cdf95cro]

Where I do see small private practices being limited due to equipment is many cannot afford brachytherapy source because of low volumes. In my mind, if you cannot do brachytherapy, you should not treat GYN cancers. I have seen patients get referred to academic centers after whole pelvic RT, which is the right thing to do if you cannot offer brachytherapy (rather than some external beam cervix boost).

We actually see the GYN pts after EBRT for several private practice folks who don't have HDR. Brachy is apparently very cost inefficient comapred to IMRT "whole pelvis" 😉

 

[medgator]

We actually see the GYN pts after EBRT for several private practice folks who don't have HDR. Brachy is apparently very cost inefficient comapred to IMRT "whole pelvis" 😉

for a small practice yes. But if you do a fair amount of mammosite, endometrial, cervix etc., I could see that justifying an HDR machine for a medium-to-large PP.

 

[OTN]

As a 3rd year med student I'm wondering: Is it fair to say that one negative of this field might be that your skills as a physician are limited by your equipment?

In other words if I want to work in private practice would I be limited to a few private spots (say in California) that have the right combination of equipment, whereas this might not be a problem for other specialties??

Secondly, why aren't some generally great academic institutions considered so great in RadOnc - e.g. UCLA? Is it beacuse of prohibitive equipment costs? I can't imagine linear accelerators being that much more expensive than say an MRI machine

I'm not sure what makes one think that California has tons of medical resources- given the prevalence of managed care, my understanding was the opposite was, in fact, true.

Same w/r/t the above post about large successful "powerhouse" medical centers having weak radonc programs. The only center I can think of that would come remotely close would be Indiana, which admittedly did suffer under the opinions of Dr. Einhorn, the medical oncologist. He was openly hostile to the entire concept of radiation therapy. Good for Lance Armstrong's cerebellum and sense of balance, bad for the radonc department.

Other "powerhouse" medical centers (IN NO PARTICULAR ORDER):
- Harvard
- MDAnderson
- UCSF
- Stanford
- Hopkins
- WashU
- UChicago
- Duke
- UMichigan

All have good radonc programs.