Rad onc supervision, the epilogue

[dozitgetchahi]

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That's pretty benign compared to the stuff I've seen out West LOL

If you can find worse than that in America, I don’t want to go anywhere near it.

 

[thecarbonionangle]

Oh totally agree with all of this. I didn’t train in the south and thus was seen as an “outsider” for the entire time I was there. Even though I was a demonstrably better physician than almost everyone I encountered. Btw some of the patients (the ones with their heads screwed on straight-er) actually want doctors trained elsewhere because they know the locals totally suck.

Oh, and BTW: several of the senior docs in my practice were members of the local KKK chapter. No joke. At least one doc was drinking and doing drugs while seeing patients, and the state board raided his office shortly after I left. One doc was living out of his office (had a wife and kids in a neighboring state but was working here?) and apparently had used condoms under his desk all the time. Another had been groping patients and had a “gentleman’s agreement” with the practice to see his patients virtually through a robotic camera, because he was one of the biggest billers in the practice and we just can’t let him go, can we? Bless his heart (I hope to never hear that phrase again lol). I seriously wish I was joking about all this. It was a total all American ****show. The practice imploded not long after I left, and I moved back to the Midwest where I belong.

Used condoms under desk? They were sleeping with nurses?

 

[dozitgetchahi]

Used condoms under desk? They were sleeping with nurses?

I think he was bringing random women into his office at night (since it was his “apartment” of sorts, he had a bed in there and was living there)

 

[medgator]

CMS 1, ASTRO circa 2020-2024 0

From the latest CMS 2026 fee schedule:

CMS is also proposing for services that are required to be performed under the direct supervision of a physician or other supervising practitioner, to permanently adopt a definition of direct supervision that allows the physician or supervising practitioner to provide such supervision through real-time audio and visual interactive telecommunications (excluding audio-only). Except for services that have a global surgery indicator of 010 or 090, CMS is proposing that a physician or other supervising practitioner may provide such virtual direct supervision for applicable incident-to services under § 410.26, diagnostic tests under § 410.32, pulmonary rehabilitation services under § 410.47, cardiac rehabilitation and intensive cardiac rehabilitation services under § 410.49.

 

[TheWallnerus]

CMS 1, ASTRO circa 2020-2024 0

From the latest CMS 2026 fee schedule:

Kind of… ironic. I think that’s the right word.

Prior to the 1980s the term “radiation oncologist” didn’t really exist. And the “radiation therapists” definitely definitely definitely didn’t worry about supervision.

In the 1980s the term rad onc was ABR sanctified. And still radiation oncologist supervision definitely definitely was not a worry.

It will still not a worry in the 1990s.

Come -2005, it began to be a HOT worry. The next 15 years were marked by supervision agita and you had people like Ken Olivier saying on Twitter that cancer patients always *deserve* to have a rad onc on site at all times no matter what. And people being shamed for not being on site. Etc etc. Nowadays Ken seems more interested in psychedelics that supervision. How nice.

Fast forward to 2026. Where we are essentially back to the 1990s and decades prior. Makes one very tired.

 

[medgator]

Come -2005, it began to be a HOT worry. The next 15 years were marked by supervision agita and you had people like Ken Olivier saying on Twitter that cancer patients always *deserve* to have a rad onc on site at all times no matter what. And people being shamed for not being on site. Etc etc. Nowadays Ken seems more interested in psychedelics that supervision. How nice.

Must be celebrating

 

[RickyScott]

Must be celebrating

I would sooner be a fellow of NAMBLA than ASTRO

 

[CurbYourExpectations]

I would sooner be a fellow of NAMBLA than ASTRO

dude

 

[drowsy12]

I would sooner be a fellow of NAMBLA than ASTRO

Yo what lol

 

[alwaysbeIMRTing]

South Park circa 2000 offending zoomers. I feel old.

 

[yesmaster]

I hope I have more to celebrate at age 50 than getting a few more capital letters after my name.

 

[CaesarRO]

Kind of… ironic. I think that’s the right word.

Prior to the 1980s the term “radiation oncologist” didn’t really exist. And the “radiation therapists” definitely definitely definitely didn’t worry about supervision.

In the 1980s the term rad onc was ABR sanctified. And still radiation oncologist supervision definitely definitely was not a worry.

It will still not a worry in the 1990s.

Come -2005, it began to be a HOT worry. The next 15 years were marked by supervision agita and you had people like Ken Olivier saying on Twitter that cancer patients always *deserve* to have a rad onc on site at all times no matter what. And people being shamed for not being on site. Etc etc. Nowadays Ken seems more interested in psychedelics that supervision. How nice.

Fast forward to 2026. Where we are essentially back to the 1990s and decades prior. Makes one very tired.

Mostly to be pedantic... But there were some important changes that you kinda gloss over in that timeline.... Namely advent of IMRT and CBCT.

You can (and do) argue we don't need direct supervision anymore for those, but it is a germane reason for Astro to be worried about it circa 2005

 

[RickyScott]

Mostly to be pedantic... But there were some important changes that you kinda gloss over in that timeline.... Namely advent of IMRT and CBCT.

You can (and do) argue we don't need direct supervision anymore for those, but it is a germane reason for Astro to be worried about it circa 2005

Why is imrt germane?

 

[CaesarRO]

It's a little different as far as setup and accuracy goes than seeing up a 2D or 3D field? Having the doc around for therapists to grab if needed would be a valid concern. Especially as doses began increasing dramatically.

Again. We know a lot more now than we did then. But I think it's disingenuous in his narrative to pretend it came out of thin air in 2005

 

[TheWallnerus]

It's a little different as far as setup and accuracy goes than seeing up a 2D or 3D field? Having the doc around for therapists to grab if needed would be a valid concern. Especially as doses began increasing dramatically.

Again. We know a lot more now than we did then. But I think it's disingenuous in his narrative to pretend it came out of thin air in 2005

There has been one IGRT code in the history of rad onc that had a personal supervision requirement. Which was it, when did it appear, and which code did it replace? Anyone who knows that can then rightfully add nuance to my disingenuous timeline 😉

Bonus if you know the legal/CMS status of supervision prior to the IMRT era. (Hint: the IMRT era did not change those requirements. Nor did the CBCT era.)

Of course nothing comes out of thin air. In medicine, in rad onc, it’s usually mostly about… the money.