Protection of?

[CurbYourExpectations]

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Interested in why there is support of mid level encroachment?

 

[drowsy12]

Who is this directed to?

Did the accelerators fire Anna? Is it just the two dudes now?

 

[CurbYourExpectations]

Who is this directed to?

Did the accelerators fire Anna? Is it just the two dudes now?

Accelerators podcast crew and those that put down early career RadOncs/residents on here. People that seem to be in support of encroachment, but also complain about oversupply.

Not sure, haven't listened to it in forever.

 

[Ray D. Ayshun]

Accelerators podcast crew and those that put down early career RadOncs/residents on here. People that seem to be in support of encroachment, but also complain about oversupply.

Not sure, haven't listened to it in forever.

put down early career docs and residents? What is this in reference to?

 

[CurbYourExpectations]

Sorry, it actually hasn't been much recently tbh. I'm off twitter so idk if the anonymous people are still attacking residents/med students. The most recent thing I can think of was the board failing.

Just frustrating to me that there is all this negativity about medstudents and residents, but some people that complain about that apparently support the midlevel encroachment. Doesn't make sense to me.

 

[medgator]

Sorry, it actually hasn't been much recently tbh. I'm off twitter so idk if the anonymous people are still attacking residents/med students. The most recent thing I can think of was the board failing.

Just frustrating to me that there is all this negativity about medstudents and residents, but some people that complain about that apparently support the midlevel encroachment. Doesn't make sense to me.

Agreed. Makes to no sense to be anti residency expansion and then pro APRT/APP encroachment in rad onc.

I believe the board failing comment was in support of the residents actually.

 

[CurbYourExpectations]

That thread was great, first time reading it. Good reasons to question people and how questioning can hurt people that don't have power. I meant the comments from earlier in the year from this years failing

 

[Ball1029]

Interested in why there is support of mid level encroachment?

What are you even referring to?

 

[NotMattSpraker]

In case people are interested, "The Accelerators" do not support anything in particular. We are not an activist podcast trying to achieve anything other than elevating voices and topics we find interesting.

Here is probably what Curb thinks is the "pro" APRT episode, which based on the PhD work of a single therapist at MD Anderson: “Taking Care of Our Patients”: Advanced Practice Radiation Therapy With Cam and Shaun - The Accelerators Podcast

Here is probably what most people would call the "anti" APRT episode, which came directly from our guests desire to respond to Shaun's episode and the ASRT publications: “What Workforce Challenges Exist”: APRT Revisited With Marsha and Join - The Accelerators Podcast

If had to pick one to support, it is the "anti" episode. Join and Marsha make excellent points, the most important being that the APRT concept is pretty much a solution in search of a problem.

Interested in why there is support of mid level encroachment?

I don't honestly see much in the US beyond a small group at MD Anderson, Mt. Sinai, and the ASRT. Can you give some examples of where physicians have supported mid-level encroachment?

If you are a member, why dont you ask the ASTRO and ACRO boards? They have been silent on this issue, which seems disappointing if you are paying them to support you.

If you want my personal opinion, I am anti-APRT for my own practice. I have no opinion or ability to impact anything beyond that. I would suggest you talk to your own practice leadership if you are anti-APRT, it is a pretty easy argument to make. Its very unclear how an APRT helps most practices.

Sorry, it actually hasn't been much recently tbh. I'm off twitter so idk if the anonymous people are still attacking residents/med students. The most recent thing I can think of was the board failing.

Just frustrating to me that there is all this negativity about medstudents and residents, but some people that complain about that apparently support the midlevel encroachment. Doesn't make sense to me.

I have no idea what this really means, but I think you are conflating opinions here. I never post anonymously and have always supported residents and med students.

If you are frustrated with this field, join the club! It is a way better life to just be the best doctor you can for your patients, work on your practice, and ignore the societies. At least in my opinion.

Hopefully in the future we can make some episodes that are compelling enough to have you back 🙂

Edited: to fix link.

 

[maxxor]

Radiology went through a similar bad faith leadership push by ACR a couple years ago (maybe 2021?) where there was an attempt to create radiology midlevels through a backdoor few lines in the MACRA bill.

I believe someone making huge noise about it on the ACR engage forums helped kill the ACR support for MACRA that year and we don’t have midlevels (phew).

It’s not just radonc that have these brain dead decisions. I firmly believe that all professional membership societies reach a point where they realize they can create more people who have to pay dues and suddenly their raison d etre becomes scope expansion.

 

[CurbYourExpectations]

It would be nice if anyone, literally anyone was sticking up for the average physician in radiation oncology.
This is why I don't give any of my money to any societies and don't listen to any podcasts anymore.

 

[CurbYourExpectations]

It all stems from a lack of work. Won't go into too much detail about this right now. But the unnecessary radiology midlevel encroachment came from Pennsylvania, the unnecessary radonc midlevel encroachment is coming from new york, it seems.

You know why this is happening? Because they're just are so super busy that they can't hire enough physicians to do the work...

Nope, that's not why. It's not because it is beneficial and necessary, it is because these areas are over supplied and have no work and dilute time to these types of movements. It's an attack on physicians.

 

[CurbYourExpectations]

In case people are interested, "The Accelerators" do not support anything in particular. We are not an activist podcast trying to achieve anything other than elevating voices and topics we find interesting.

Here is probably what Curb thinks is the "pro" APRT episode, which based on the PhD work of a single therapist at MD Anderson: “Taking Care of Our Patients”: Advanced Practice Radiation Therapy With Cam and Shaun - The Accelerators Podcast

Here is probably what most people would call the "anti" APRT episode, which came directly from our guests desire to respond to Shaun's episode and the ASRT publications: “What Workforce Challenges Exist”: APRT Revisited With Marsha and Join - The Accelerators Podcast

If had to pick one to support, it is the "anti" episode. Join and Marsha make excellent points, the most important being that the APRT concept is pretty much a solution in search of a problem.



I don't honestly see much in the US beyond a small group at MD Anderson, Mt. Sinai, and the ASRT. Can you give some examples of where physicians have supported mid-level encroachment?

If you are a member, why dont you ask the ASTRO and ACRO boards? They have been silent on this issue, which seems disappointing if you are paying them to support you.

If you want my personal opinion, I am anti-APRT for my own practice. I have no opinion or ability to impact anything beyond that. I would suggest you talk to your own practice leadership if you are anti-APRT, it is a pretty easy argument to make. Its very unclear how an APRT helps most practices.



I have no idea what this really means, but I think you are conflating opinions here. I never post anonymously and have always supported residents and med students.

If you are frustrated with this field, join the club! It is a way better life to just be the best doctor you can for your patients, work on your practice, and ignore the societies. At least in my opinion.

Hopefully in the future we can make some episodes that are compelling enough to have you back 🙂

Edited: to fix link.

I'm biting. You don't support anything in particular? I don't support you. This silence from so many groups in our field is deafening.

You yourself have made multiple public endorsements about mid level encroachment in your podcasts.
"At Wash U.... we had this method"

Building on this, elevating voices? You think you're reporters? The first podcast about encroachment and the blog.
I was very unhappy with the podcast of Marsha and Join, the one podcast I listened to recently. Let's hear your thoughts about what mid level encroachment should be allowed? It shouldn't be any, it's not needed.

Hopefully in the future you can make some episodes that are compelling to have me back. 🙂
edited: smiley face and I do enjoy the podcast in general. Remember when you and simul had takes that weren't shock takes attacking physicians (blog)? Maybe run it through chatGPT and we figure out what a really motivated person thinks?

 

[Radonky]

I'm biting. You don't support anything in particular? I don't support you.

You yourself have made multiple public endorsements about mid level encroachment in your podcasts.
"At Wash U.... we had this method"

Building on this, elevating voices? You think you're reporters?
I was very unhappy with the podcast of Marsha and Join, the one podcast I listened to recently. Let's hear your thoughts about what mid level encroachment should be allowed? But you're a reporter?

Hopefully in the future you can make some episodes that are compelling to have me back. 🙂
edited: smiley face

remember when you and simul had takes that weren't shock takes attacking physicians? Maybe run it through chatGPT and we figure out what a really motivated person thinks?

Maybe you need to...

🥁curb your expectations🥁

 

[CurbYourExpectations]

Definitely true, my bad. Frustrating no societies or anyone else trying to prevent this. But I'm probably an idiot for expecting that.

And sorry if I'm wrong and misinterpreting the podcasts and blog posts.

 

[NotMattSpraker]

I'm biting. You don't support anything in particular? I don't support you. This silence from so many groups in our field is deafening.

You yourself have made multiple public endorsements about mid level encroachment in your podcasts.
"At Wash U.... we had this method"

Building on this, elevating voices? You think you're reporters? The first podcast about encroachment and the blog.
I was very unhappy with the podcast of Marsha and Join, the one podcast I listened to recently. Let's hear your thoughts about what mid level encroachment should be allowed? It shouldn't be any, it's not needed.

Hopefully in the future you can make some episodes that are compelling to have me back. 🙂
edited: smiley face and I do enjoy the podcast in general. Remember when you and simul had takes that weren't shock takes attacking physicians (blog)? Maybe run it through chatGPT and we figure out what a really motivated person thinks?

If you want to consider TAP a "group", which you shouldnt, it seems like we are the only ones that have hosted an argument against the APRT role. You're angry at the wrong people man.

My opinion is that I agree with the arguments made by Marsha and Join. I am not a reporter, I am a full time doctor that has a hobby podcast haha.

Also, I have no affiliation with Simul's blog other than the single guest post that I did. You should give him feedback, I bet hed appreciate it.

Id ask you again: what support are you referring to? Can you point us to anything where physicians are arguing that APRTs should be doing traditional physician roles?

 

[CurbYourExpectations]

I was considering it a group and thanks for hosting people speaking up for RadOnc physicians.

 

[Mandelin Rain]

It's more a "cartel," or even "cabal," IMO.

 

[communitydoc13]

their raison d etre becomes scope expansion

You know why this is happening? Because they're just are so super busy that they can't hire enough physicians to do the work...

Nope, that's not why. It's not because it is beneficial and necessary, it is because these areas are over supplied and have no work and dilute time to these types of movements. It's an attack on physicians.

I can't speak to any of these groups, not a member and not a joiner.

I can say that the markets and work/doc numbers for radonc and radiation oncology are not comparable (at least in my region).

Radiology has a remarkable remote market that is flexible as hell (I personally couldn't stand this type of work, but it is a great option for someone needing flexibility of location or flexibility for family obligations). It is exceptionally hard to recruit radiologists outside of marquee locations.

Radonc is still the worst market among specialties IMO. Docs still have to go to where the jobs are. Recruitment is still easier than for almost any other specialty.

IMO, the idea of promoting mid-level niches in radonc is laughable and only makes sense for two kinds of people (both of whom exist IRL).

1. The academic who basically wants to minimize all clinical obligations to focus on research/leadership/organizational service. The latter being how they ascend in their careers.

2. The PP capitalist, who wants to minimize in person physician coverage and maximize footprint per doc for revenue purposes.

I frankly do not work that hard. I do not want the work I do offered to a less credentialed person. However, there is a third type of person. This is the efficiency/evidence acolyte, for whom anything that can be done with less physical effort, less face-to-face time, less personal intimacy and in a less bespoke fashion, should be done so. Call me a luddite, but I don't agree with this. A little intimacy, a little human decision making, a little thoughtfulness actually makes my day better.

 

[maxxor]

I can't speak to any of these groups, not a member and not a joiner.

I can say that the markets and work/doc numbers for radonc and radiation oncology are not comparable (at least in my region).

Radiology has a remarkable remote market that is flexible as hell (I personally couldn't stand this type of work, but it is a great option for someone needing flexibility of location or flexibility for family obligations). It is exceptionally hard to recruit radiologists outside of marquee locations.

Radonc is still the worst market among specialties IMO. Docs still have to go to where the jobs are. Recruitment is still easier than for almost any other specialty.

IMO, the idea of promoting mid-level niches in radonc is laughable and only makes sense for two kinds of people (both of whom exist IRL).

1. The academic who basically wants to minimize all clinical obligations to focus on research/leadership/organizational service. The latter being how they ascend in their careers.

2. The PP capitalist, who wants to minimize in person physician coverage and maximize footprint per doc for revenue purposes.

I frankly do not work that hard. I do not want the work I do offered to a less credentialed person. However, there is a third type of person. This is the efficiency/evidence acolyte, for whom anything that can be done with less physical effort, less face-to-face time, less personal intimacy and in a less bespoke fashion, should be done so. Call me a luddite, but I don't agree with this. A little intimacy, a little human decision making, a little thoughtfulness actually makes my day better.

100%

My whole point of the anecdote is radonc isn’t alone in idiotic leadership trying to push midlevels when they are not necessary.

What is a midlevel going to do for a radiologist? I’d rather spent the equivalent of a midlevel’s salary and benefits on software that makes my day better and more productive. It’s an entirely pointless creation.

Similarly for Radonc, what exactly is a midlevel providing? Linac coverage? Where an entire army of semi retired Radoncs depress the wages of this work to functional midlevel pay anyway? When the system is pushing hard to remove this requirement?

Its a pointless move which really is to sell more ASTRO or equivalent licensing authority memberships and grift the employer CME funds.

 

[maxxor]

Speaking of radonc remote gigs…

Is it a thing for a radonc MD to do their own planning / dosimetry? Could you do them for others? Remotely? Better than the RTT or Physicists?

In a prior job, Nuc Rad did all the Y90
Planning. I honestly kind of hated it cuz our software wasn’t set up right and it was a time suck and messed with the flow, but if it were my full time thing where I controlled the software etc, maybe I could bang em out fast and at higher quality than a non physician.

 

[HolySmokes]

I do a lot of my own planning because my dosimetry/physics team is... not uniformly stellar. I would not want to do the planning for other MDs (or have other MDs do mine). The urge to nitpick contours and treatment volumes/doses/etc would be strong.

 

[Doctorer]

Speaking of radonc remote gigs…

Is it a thing for a radonc MD to do their own planning / dosimetry? Could you do them for others? Remotely? Better than the RTT or Physicists?

In a prior job, Nuc Rad did all the Y90
Planning. I honestly kind of hated it cuz our software wasn’t set up right and it was a time suck and messed with the flow, but if it were my full time thing where I controlled the software etc, maybe I could bang em out fast and at higher quality than a non physician.

No, not really a thing in radonc, at least in America.

 

[evilbooyaa]

I read the OP and thought "what is this I don't even"

Then I read more posts from OP and thought the same

Curb, you OK dude/dudette?