"Big Rad Onc" thought leader who wants direct supervision any time beam is on to fix job market for unnecessary number of trainees = bad guy
Private practice owner who wants virtual direct forever to maximize profits with minimal staffing and rarely come in = bad guy
Private equity who wants to employ a couple of doctors to cover a dozen rural sites at a time = bad guy
There are different kinds of bad guys.
I think this is the core of it - though would zoom out even further and start sorting the "good guy/bad guy" camps on the "oversupply" question itself.
There are still many RadOncs who think oversupply is a myth, and I can think of a few people I know in real life who think oversupply isn't real and direct supervision is needed for safety.
While I disagree with that camp, it's hard for me to say they're "bad" for believing those things.
My own stance on supervision comes down to unintended consequences.
In the "permanent virtual direct exploitation scenario", a PE firm can't just snap their fingers and drop linacs in new areas and create this "one RadOnc/10 linac nightmare" situation.
There are other significant hurdles to that exploitation scenario, namely, acquiring capital, staying solvent, CON laws, additional staff shortages, etc etc.
In the "return to direct supervision everywhere exploitation scenario", all it takes is one disgruntled employee/colleague to fly off the handle and start pointing fingers, and a whistleblower case can be built.
It's not a short road to a successful whistleblower case conviction/settlement, of course - but all it takes is one person with an axe to grind to get things in motion.
In my neck of the woods, there are no PE owned/affiliated hospitals or practices. I know of a US Oncology site a few hours from here, but it's old at this point.
We don't even have enough mid-levels for their regular roles, let alone anyone tossing around an "Advanced RTT" idea or whatnot.
What I do have is a lot of people driving 45-60 minutes each way to get to me. There's no way I could get a CON approved to build a new linac in this state and, even if I did, the sparse population means I would struggle to break even.
But, maybe there's a future where a refurbished linac can be installed in one of the points where it would enhance access to care. In this hopeful future, I could break even by virtually supervising it much of the week.
Would oddball entities like Bridge be a threat? Sure. But so would MD Anderson, Sloan, Mayo, etc and their expanding "networks".
We can't regulate ourselves out of oversupply. You won't fix distribution problems by producing so many RadOncs you force them to go to rural areas they don't want to be.
The truth is that problems like maldistribution will likely NEVER be fixed. Oversupply won't be fixed. General/virtual supervision will stay.
I see more value in trying to adapt the specialty into the most likely future, not go totally rogue asking for unique supervision rules in some noble but misguided desire to reduce the harm of oversupply.
For us, the doctors with the liability, more regulations almost always means increased risk of lost malpractice cases or whistleblower charges. But - that's just my opinion, and maybe I'll be proven wrong someday.
