Programs that could be candidates for contracting/closing

[Mandelin Rain]

Everything you speak is of truth but for this (IMHO). Payors are now pricing all skills at the same level. Preparing a Babbette's Feast vs boiling an egg: same reimbursement. If not now, certainly in the future.

Yeah, I have to imagine that this is the death of prostate brachy and Space Oar. Radioactive sources and hydrogels and OR time are expensive. Electricity to run a linac for 5-20 fx, less so.

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[Chartreuse Wombat]

Yeah, I have to imagine that this is the death of prostate brachy and Space Oar. Radioactive sources and hydrogels and OR time are expensive. Electricity to run a linac for 5-20 fx, less so.

SpaceOAR can survive if someone other than a RadOnc does it so it falls outside of APM.

 

[scarbrtj]

Yeah, I have to imagine that this is the death of prostate brachy and Space Oar. Radioactive sources and hydrogels and OR time are expensive. Electricity to run a linac for 5-20 fx, less so.

I have a feeling that SpaceOAR 55xxx CPTs won't be under the RO-APM's (I pronounce it "rope 'em!") rubric. We will see.

 

[Mandelin Rain]

I have a feeling that SpaceOAR 55xxx CPTs won't be under the RO-APM's (I pronounce it "rope 'em!") rubric. We will see.

Doesn't it bundle by diagnosis? i.e. if you put Prostate Cancer C61 (or whatever), all your services are roped in? What other diagnosis would you use for the SpaceOar code? I haven't read the 1000 page document if you can't tell.

 

[scarbrtj]

Doesn't it bundle by diagnosis? i.e. if you put Prostate Cancer C61 (or whatever), all your services are roped in? What other diagnosis would you use for the SpaceOar code? I haven't read the 1000 page document if you can't tell.

I don't think so. E.g., you have to stage (some of) them. The radiologists will get paid. The hospital that owns the scanners will get paid. Gotta pay for fancy PSMA or whatever one day too. MRI when called for. The urologist will get paid to give AAT, and there will be payment for the drug. The pharmacy will get to charge for Casodex. If there's some cathing or uncathing or cystoscoping or whatever a week or three after brachy... you think Urology ain't gonna get paid? There will be payment for a whole slew of things, as it has always been... except for RT. Our train gets removed from the tracks. All the other trains continue onward to their destination.

 

[Mandelin Rain]

I don't think so. E.g., you have to stage (some of) them. The radiologists will get paid. The hospital that owns the scanners will get paid. Gotta pay for fancy PSMA or whatever one day too. MRI when called for. The urologist will get paid to give AAT, and there will be payment for the drug. The pharmacy will get to charge for Casodex. If there's some cathing or uncathing or cystoscoping or whatever a week or three after brachy... you think Urology ain't gonna get paid? There will be payment for a whole slew of things, as it has always been... except for RT. Our train gets removed from the tracks. All the other trains continue onward to their destination.

SpaceOar doesn't really do anything non-RO related. It is solely for local RO treatment like a Vac Loc or Rectal Balloon or DIBH or something. There is literally no other indication for it or reason for it's existence. Not sure why it'd be exempt from the bundle. Definitely could be wrong.

 

[BobbyHeenan]

Yeah, I have to imagine that this is the death of prostate brachy and Space Oar. Radioactive sources and hydrogels and OR time are expensive. Electricity to run a linac for 5-20 fx, less so.

I was under the impression spaceOAR probably safe, as the "episode" for radiation doesn't start until CT sim, so probably not bundled in APM.

 

[Mandelin Rain]

I was under the impression spaceOAR probably safe, as the "episode" for radiation doesn't start until CT sim, so probably not bundled in APM.

That makes sense.

 

[Krukenberg]

IMHO the expansion of EM programs is far more nefarious. Corporate for-profit hospitals opening like crazy to benefit themselves. Getting rad onc faculty resident coverage seems like a more benign intent in comparison.

 

[RickyScott]

IMHO the expansion of EM programs is far more nefarious. Corporate for-profit hospitals opening like crazy to benefit themselves. Getting rad onc faculty resident coverage seems like a more benign intent in comparison.

er docs can work in some primary care urgent clinics etc. much more elasticity. We are one trick pony. Four profit company is worse than mskcc/mdacc charging 5x community practice?

 

[medgator]

IMHO the expansion of EM programs is far more nefarious. Corporate for-profit hospitals opening like crazy to benefit themselves. Getting rad onc faculty resident coverage seems like a more benign intent in comparison.

Both are bad, regardless of who is to blame. Rad Onc faculty should hire scribes and PAs. Not sure why you want to give them a free pass? Are you academic faculty? ER hasn't had hypofractionation/APM to deal with either

Fwiw, easier to get an ER job in my neck of the woods than an RO one.

 

[MegaVoltagePhoton]

Literally two wrongs don't make a right...

 

[elementaryschooleconomics]

Both are bad, regardless of who is to blame. Rad Onc faculty should hire scribes and PAs. Not sure why you want to give them a free pass? Are you academic faculty? ER hasn't had hypofractionation/APM to deal with either

Fwiw, easier to get an ER job in my neck of the woods than an RO one.

Both are bad, but if the RadOnc experience has taught us anything, it's that it will take years to recognize a problem if someone is making money. More residents help departments and hospitals make more money, the academic medicine machine churns on. It's only after 5-10 years of those residents struggling in the job market and choosing to vent their struggles to a wider audience will people take notice.

Or maybe I'm wrong, and EM cares about the health of their specialty and they clamp down on this ASAP.

 

[Krukenberg]

Both are bad, regardless of who is to blame. Rad Onc faculty should hire scribes and PAs. Not sure why you want to give them a free pass? Are you academic faculty? ER hasn't had hypofractionation/APM to deal with either

Fwiw, easier to get an ER job in my neck of the woods than an RO one.

I mean multiple ER docs in that thread said good jobs have dried up

 

[Krukenberg]

er docs can work in some primary care urgent clinics etc. much more elasticity. We are one trick pony. Four profit company is worse than mskcc/mdacc charging 5x community practice?

I mean they could, but the pay must be crap because they’re all staffed by an army of PAs. Why pay EM doc rates when you could just hire a PA? Sure, maybe the doc could be the supervisor for the army. I went to one once and saw the bill. I was seen by a PA, and a physician in an entirely different city billed for the visit. The # of EM docs they would need to hire to supervise the PAs is surely quite low though. Add to that the crap job satisfaction I’d have doing work that is below the level of my training.

 

[RickyScott]

I mean multiple ER docs in that thread said good jobs have dried up

Fot profit residency expansion is awful. What is unique to radonc is not the expansion, but the contracting demand and the fact that the people pushing expansion are often the loudest voices to hypofractionate/ omit xrt etc.
Still not widespread awareness that even if we totally shut down all residency programs to new grads, we would will still have oversupplied job market well into 2030s

 

[evilbooyaa]

IMHO the expansion of EM programs is far more nefarious. Corporate for-profit hospitals opening like crazy to benefit themselves. Getting rad onc faculty resident coverage seems like a more benign intent in comparison.

This 'whataboutism' is dumb IMO, better served for Twitter virtue signalling.

Ofc, twitter in EM is about 2 weeks behind SDN (guess Twitter lagging behind SDN happens across specialties. As someone who mostly lurks the EM forum, I saw this thread started in mid September: We now have a total of 60 new EM residency programs

Getting back to your post.

Residency expansion in Rad Onc is bad.
Residency expansion in EM is ALSO bad.
Just because you care about one does not mean you can't care about the other.

I agree with you that for-profit hospitals opening residencies is bad. And if I was in EM I would be much angrier about it. But I'm not. I'm in Rad Onc, and thus while I empathize with the plight of the EM physician, my focus will be on my specialty's issues.

That being said, EM is not seeing a decrease in volumes (except during the Pandemic). Utilization of EM services is increasing and there is unlikely to be any factors that decrease utilization. Obviously, this is in stark contrast to decrease in utilization we are seeing in Rad Onc.

 

[thecarbonionangle]

It is important to also point out that there are a lot more urgent cares and places for EM. They also have pathways to become hospitalists, intensivists, etc.

In rad onc we have nothing. No path to give systemic therapy. No path to do some radiology. Almost no path to hanging a shingle. Maybe a path to palliative care and MJ Clinic? Chairs who look like the fat toe with nail fungus in the commercials, tell us that we should be happy with peds pay and that is “good living”. Our “leadership” will not help us.

 

[RickyScott]

It is important to also point out that there are a lot more urgent cares and places for EM. They also have pathways to become hospitalists, intensivists, etc.

In rad onc we have nothing. No path to give systemic therapy. No path to do some radiology. Almost no path to hanging a shingle. Maybe a path to palliative care and MJ Clinic? Chairs who look like the fat toe with nail fungus in the commercials, tell us that we should be happy with peds pay and that is “good living”. Our “leadership” will not help us.

Yes yes yes. We can do fellowships in treatment of metastatic disease.

 

[elementaryschooleconomics]

As promised, more reasons:

3) Family legacy! How could I forget? The classic reason to go into RadOnc.

"My Daddy done zapped cancer, now I'm gunna zap cancer like his Daddy 'fore him"

4) Faculty straight up lying to students about job market concerns, students believing them and continuing to apply.

 

[thecarbonionangle]

The amount of lying is quite high this year. Some of these terrible places really want a warm body

 

[Tumba]

Medical university of South Carolina - 1 resident contract not picked up for following year (discrimination lawsuit ongoing) and 3 residents transfers in past 2 years. Malignant attendings (HN attending not allowed to have residents past 1.5 years/breast attending known to scream at residents in clinic/or), scut work and poor treatment by staff (learned from attendings), and attendings with no interest in resident education (see acgme surveys past few years) prompting acgme site visit and evaluation for accreditation.

Now the program is deleting negative things on the spreadsheet perceived as negative (attending or current residents) and being called out for it.

it’s a private practice run on the backs of residents and should be shut down immediately. Look at spreadsheet comments 2017-18 and on.

 

[fiji128]

Sounds like the place where I trained including poor residents evals and malignant non teaching attendings resulting in a slap on the wrist from the acgme (ie just check these boxes to show us you are doing something but change nothing in reality).

MUSC has 6 residents and 6 clinical faculty (assuming chairman has a full service). A ratio like that is a huge read flag for quality training. Obviously, during peak rad onc this place had their choice of top tier motivated med students given their location in beautiful Charleston, SC. I wonder what caliber of the applicants they are getting now?

Also, if the acgme sees these giant red flags as detailed above why not just shut it down? Why not shut down all these private practice like places disguised as "academic" departments running off the backs of residents? In the era of complete oversaturation of rad oncs in just about every market these hell pit training programs need to go.

 

[fiji128]

Went over to that Reddit spread sheet for a first time in a real long time. Saw this nugget as the only comment regarding UWV, "Program should not exist. Residency overexpansion. That the chair is ASTRO prez is hilarious and will use this to try to expand residency spots. One of weakest programs in country."

And off course this from Randall at UK "Chair dismissed that we have a problem in overtraining residents ... The chair is completely delusional when it comes to the job market. He feels there is no issue right now. His evidence is that he has been able to place people in Kentucky jobs just fine. No ****, no one wants to live there, lol."

Ha

 

[scarbrtj]

Medical university of South Carolina - 1 resident contract not picked up for following year (discrimination lawsuit ongoing) and 3 residents transfers in past 2 years. Malignant attendings (HN attending not allowed to have residents past 1.5 years/breast attending known to scream at residents in clinic/or), scut work and poor treatment by staff (learned from attendings), and attendings with no interest in resident education (see acgme surveys past few years) prompting acgme site visit and evaluation for accreditation.

Now the program is deleting negative things on the spreadsheet perceived as negative (attending or current residents) and being called out for it.

it’s a private practice run on the backs of residents and should be shut down immediately. Look at spreadsheet comments 2017-18 and on.

Early this century Mr. SCLC BID Drew Turrisi was chair at MUSC and Charles Thomas (now OHSU chair) was his vice-chair. That was probably peak MUSC. After they left, there was a brief period of time where there was just one attending in the department. A long time ago, but still!

 

[thecarbonionangle]

Medical university of South Carolina - 1 resident contract not picked up for following year (discrimination lawsuit ongoing) and 3 residents transfers in past 2 years. Malignant attendings (HN attending not allowed to have residents past 1.5 years/breast attending known to scream at residents in clinic/or), scut work and poor treatment by staff (learned from attendings), and attendings with no interest in resident education (see acgme surveys past few years) prompting acgme site visit and evaluation for accreditation.

Now the program is deleting negative things on the spreadsheet perceived as negative (attending or current residents) and being called out for it.

it’s a private practice run on the backs of residents and should be shut down immediately. Look at spreadsheet comments 2017-18 and on.

I can confirm this. They fired a female resident who needs just a few months to graduate, joining UPMC in that club. Very malignant place with zero education. This is tied up in federal court, all are being sued for tons of cheese as well as discrimination, sexual harassment, civil and gender rights violations. Highly malignant place. Avoid strongly as well with other programs mentioned in this thread which are all problematic, provide zero education, tons of scut, zero mentorship and career advancement.

a day of recockoning is coming for these bottomless hellpits disguised as “academic” departments which are basically lousy pp.Read this thread and be informed. This is power!

 

[RickyScott]

there is just no reason for a us md to interview ay any of these program-Kentucky, wv etc. In worst case, could just SOAP in. We really should keep a list of such programs

 

[drewdog1973]

Basically, when a certain member reports about a places purported malignancy, she is wrong about 95% of the details. Just saying...
Not saying MUSC doesn't have significant issues, or that UPMC had in the past. But generally, the details are epitome of "fake news"

 

[thecarbonionangle]

Basically, when a certain member reports about a places purported malignancy, she is wrong about 95% of the details. Just saying...
Not saying MUSC doesn't have significant issues, or that UPMC had in the past. But generally, the details are epitome of "fake news"

Please proceed. Say more.

 

[elementaryschooleconomics]

Please proceed. Say more.

 

[fiji128]

If half of the program's residents are actively transferring out and you have a law suit against you from another take a look in the mirror, the problem is the program not the residents.

From reddit, "Ongoing lawsuit with former resident for discrimination. 3 residents have transferred out recently. STAY AWAY!! Also, MUSC attendings are actively deleting negative comments. BEWARE. // This is a program that shouldn't be matching/should not exist. Residents are here for clinical coverage. Very poor job placement. At least 2-3 residents have left somehwat recently. Acgme accreditation now with warning after consistent bad surveys and site visit. Stop deleting the cons from MUSC, applicants will take notice. This is a really small program that shouldn't have residents. Research is all retrospective chart reviews. Job placement is pretty terrible. Do not get a full research year. Clinical coverage is prioritized above all."

 

[drewdog1973]

I don’t doubt the google sheet or Reddit. Just specific outrageousness. Carry on.

 

[Ray D. Ayshun]

I went to a pretty chill program with nice people, but it was non-stop malignancy.

 

[Tumba]

Basically, when a certain member reports about a places purported malignancy, she is wrong about 95% of the details. Just saying...
Not saying MUSC doesn't have significant issues, or that UPMC had in the past. But generally, the details are epitome of "fake news"

Well you could Google the lawsuit, ain’t too hard to find. Or maybe the multiple things said past 3-4 years on spreadsheet, or see that 3 residents and 1 “not rehired” in a 2 year span in a program with 6 residents and 6 attendings.

Or you could just be that guy. To each their own.

 

[elementaryschooleconomics]

I went to a pretty chill program with nice people, but it was non-stop malignancy.

Did you just make a cancer pun?

 

[taserlaser]

Did you just make a cancer pun?

I have it on good authority that oncologists have a good sense of tumor.

 

[Ray D. Ayshun]

Did you just make a cancer pun?

No, but in all seriousness, yeah, he was actually pretty aggressive.

Family Guy (1999) - S05E01 clip with quote No, but in all seriousness, yeah, he was actually pretty aggressive. Yarn is the best search for video clips by quote. Find the exact moment in a TV show, movie, or music video you want to share. Easily move forward or backward to get to...

getyarn.io

This just felt appropriate for some reason.

 

[elementaryschooleconomics]

Y'all are hilarious for a bunch of misanthropes

 

[Tumba]

I don’t doubt the google sheet or Reddit. Just specific outrageousness. Carry on.

Can’t even make this up. Say a department had all these allegations over years brought up, complaints, residents transferring etc etc say just like above example. What do you think leadership did in response

A. Take responsibility, make changes, be better

or

B. Blame the people who transferred/had outspoken complaints about real issues that many others have had but were too afraid of consequence, blow it off as it was all the “bad apples”, but a mini fridge in resident room, and bam course corrected/not malignant.

I wonder which option a malignant program would have done.

 

[metview]

There was a good point brought up about how MUSC has 6 faculty and 6 residents. There should never be a 1:1 faculty:resident ratio for obvious reasons. There really should be a maximum faculty:resident ratio which applies to every program in the country. Why can't this implemented by ACGME and then contract spots at programs which exceed maximum ratio (ie. MUSC, Baylor, etc)? It's not coincidental how programs with a high resident to faculty ratios, are the same ones which provide very poor education and job opportunities.

 

[Tumba]

There was a good point brought up about how MUSC has 6 faculty and 6 residents. There should never be a 1:1 faculty:resident ratio for obvious reasons. There really should be a maximum faculty:resident ratio which applies to every program in the country. Why can't this implemented by ACGME and then contract spots at programs which exceed maximum ratio (ie. MUSC, Baylor, etc)? It's not coincidental how programs with a high resident to faculty ratios, are the same ones which provide very poor education and job opportunities.

6 and 6. Wonder if any of those faculty were md/phd and only in clinic part time or if any of them didn’t have residents for extended period, ratio less than 1:1 no good.

good point

 

[thecarbonionangle]

Can’t even make this up. Say a department had all these allegations over years brought up, complaints, residents transferring etc etc say just like above example. What do you think leadership did in response

A. Take responsibility, make changes, be better

or

B. Blame the people who transferred/had outspoken complaints about real issues that many others have had but were too afraid of consequence, blow it off as it was all the “bad apples”, but a mini fridge in resident room, and bam course corrected/not malignant.

I wonder which option a malignant program would have done.

Poster who casts aspersions and seeds doubt about absolutely true things which are as you said absolutely verifiable with minimal effort, certainly makes you wonder about their agenda, one not hard to discern. Don’t worry, you will find A warm body just like graduates find A job!!! Its all good folks!

 

[medgator]

Basically, when a certain member reports about a places purported malignancy, she is wrong about 95% of the details. Just saying...
Not saying MUSC doesn't have significant issues, or that UPMC had in the past. But generally, the details are epitome of "fake news"

Please proceed. Say more.

2 sides to UPMC story, carbon. Unlike the musc situation where there has been far more resident turnover and badness in general

 

[Ray D. Ayshun]

There was a good point brought up about how MUSC has 6 faculty and 6 residents. There should never be a 1:1 faculty:resident ratio for obvious reasons. There really should be a maximum faculty:resident ratio which applies to every program in the country. Why can't this implemented by ACGME and then contract spots at programs which exceed maximum ratio (ie. MUSC, Baylor, etc)? It's not coincidental how programs with a high resident to faculty ratios, are the same ones which provide very poor education and job opportunities.

Uh, two of those residents obviously busy testing Flash and mrigrt prospectively.

 

[RadRadRad]

There was a good point brought up about how MUSC has 6 faculty and 6 residents. There should never be a 1:1 faculty:resident ratio for obvious reasons. There really should be a maximum faculty:resident ratio which applies to every program in the country. Why can't this implemented by ACGME and then contract spots at programs which exceed maximum ratio (ie. MUSC, Baylor, etc)? It's not coincidental how programs with a high resident to faculty ratios, are the same ones which provide very poor education and job opportunities.

Musc is also managed by alliance oncology and has had a proposed satellite facility blocked for con approval for failure to even acknowledge the jv arrangement of the facility (with alliance) in the application

 

[RadRadRad]

MUSC wanted to open a $9.8M cancer center in Berkeley County; SC judge said no

A dispute over a nearly $10 million cancer center prompted a judge to find the Medical University of South Carolina misrepresented a business deal on an application with health regulators.

www.postandcourier.com

 

[drewdog1973]

Alliance has its hands in a lot of hot garbage

 

[VA Hopeful Dr]

I'm quite unfamiliar with most aspects of radiation oncology practice or training, but I am from SC so the MUSC mention got me curious.

Is it unusual to have 4 PGY-2s, 1 PGY-3, and 1 PGY-5 be your entire program?

They're missing an entire year and have 4X as many PGY-2 positions as the other years. That seems like a bad sign, right?

 

[Ray D. Ayshun]

I'm quite unfamiliar with most aspects of radiation oncology practice or training, but I am from SC so the MUSC mention got me curious.

Is it unusual to have 4 PGY-2s, 1 PGY-3, and 1 PGY-5 be your entire program?

They're missing an entire year and have 4X as many PGY-2 positions as the other years. That seems like a bad sign, right?

Unusual, yes, but not unheard-of. Vanderbilt's program, for instance, is slightly imbalanced as they decided to add their newly approved spots (6-8 residents) all at once, going from a 1-2-1-2 program to 1-4-1-2. In this case, though, your inclination may be right, particularly if there are 0 pgy4s, who may have left and been replaced.

 

[RadRadRad]

Unusual, yes, but not unheard-of. Vanderbilt's program, for instance, is slightly imbalanced as they decided to add their newly approved spots (6-8 residents) all at once, going from a 1-2-1-2 program to 1-4-1-2. In this case, though, your inclination may be right, particularly if there are 0 pgy4s, who may have left and been replaced.

Hard to imagine why you’d add all your new spots in 1 class other than for cheap labor/scut.