Rad Onc - Supply & Demand

[Gfunk6]

Any particular talk/presentation at astro this year where we can all make a scene?

No need, I am my own boss. If I'm not happy with things then I have only myself to blame


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[fiji128]

"or the physicist who exclusively performs vaginal HDRs, and who knows what the rest of the time."

hahaha we totally had one of those guys at my residency.

 

[winstonfoot5]

Any particular talk/presentation at astro this year where we can all make a scene?

saw this in the online planner. from the survey that came up in here

The ASTRO 2017 Radiation Oncologist Workforce Study: Past, Present, Future
EDU 36
Date:
9/26/2017
Time:
4:45 p.m. - 6:15 p.m.
Location:
San Diego Convention Center
Room Number:
1 A/B

Results of the ASTRO 2017 Workforce Study - Past, Present, Future

Learning Objectives:
After this session, attendees should be able to:
Learn about the ASTRO 2017 radiation oncologist workforce study, which examines the demographics, workload, practice structure, employment and compensation models, and perceived supply and demand of U.S. radiation oncologists.
Define shifting workforce trends relative to the ASTRO 2012 workforce study and other historical data, as well as drivers of change and implications for the future.

DESCRIPTION:
This session presents the ASTRO 2017 radiation oncologist (RO) workforce study, a survey-based analysis of the RO workforce in the United States. Topics to be presented include, demographics and practice characteristics such as urban vs suburban vs rural, hospital vs free standing, academic vs non-academic; the workload such as patient volume, hours and time allocation to patient care, electronic health record management, and administrative and other duties; Prevalence of ROs seeking new employment, employment change, and job vacancies; and finally, RO’s perception of supply and demand of radiation oncologists in the U.S. The discussion will provide a comparison of the current study with the ASTRO 2012 workforce survey and other historical data to identify shifting trends and offer insights into the drivers of change and implications for the future of the workforce. Other topics to be discussed include availability of a wide range of radiation therapy technologies across practice types and geography and hypofractionation adoption for various disease sites.

 

[canadianoutlaw]

I remember this one brash, young resident being appointed to a "Dermatology WorkForce TaskForce" (or some similarly named BS) at the AAD who was ultimately silenced but not before angering several balding old jackasses. 15 years later and he was spot on; that's the funny thing about mathematics, equilibrium dynamics, and non-politically (or financially) driven "analysis" or projections. Oops.

can you elaborate? what was he "spot on" about? would be interesting to hear more about the Derm experience

 

[LightSABR]

Any particular talk/presentation at astro this year where we can all make a scene?

Yes, I think the appropriate time is right when the president walks up to the podium at 1:45 on Monday at the plenary keynote. Try to yell really loud. We'll be standing with you I swear!

 

[MOHS_01]

can you elaborate? what was he "spot on" about? would be interesting to hear more about the Derm experience

That the massive increase in residency slots being pushed would have a disproportionate impact on the job market. It's all about equilibrium dynamics; small increases in a system in relative balance leads to large dislocations. For example, one of the metrics used was the number of practices in a locale wishing to add a provider; this was backed up by wait times, etc. The idea pushed was that 7 practices looking to hire somehow equated to 7 positions going unfilled; this was insanely ignorant analysis, for this might only translate into 1-2 needed FTE's before reaching the equilibrium again. It was painful to listen to the anecdotal BS being sold as reasoning. We increased the number of dermatology slots from less than 200 per annum to over 350 in a single decade, an increase that overlapped with the concurrent explosion of midlevel providers. In short, the job market went from picking your place out on the map to jockeying for positions, if any were available, in the state you wanted to practice in.

 

[seper]

so what did Derm exactly do to balance supply/demand?

 

[nkmiami]

One thing to consider about derm is that patient demand is more elastic in the sense that they can always offer lower cost/out of pocket/cosmetic procedures. For us, it is not just the increased residency slots, but the increasing utilization of hypofractionation- which ASTRO pushes without addressing physician supply. Most radonc practices could easily cut the on treat pts in half if all mets were 8 Gy x 1, prostates 20 x 3 Gy (edit) or stereo and breasts 15 fractions or less.

 

[seper]

hang on here, prostate 20 Gy X 3

 

[evilbooyaa]

hang on here, prostate 20 Gy X 3

Imagine it's a typo and nkmiami meant 3Gy x 20. But the general point still stands. Strong push to hypofractionate everything from the ivory towers (with all people who don't aggressively hypofractinoate being money grubbing idiots who are a disgrace to the field) regardless of any evidence that suggests hypofrac is worse (see 8Gy x 1 vs 30 in 10 re-treatment rates, the prostate hypofrac data we've discussed before) with lots of hand-waving to explain away those issues.

You can't push to hypofractionate everything (meaning less patients on treat at any given time) from one side of your mouth while discussing the woes of doctor shortage and how we need 50% more residents (for the patients, not for academic attendings who would be unable to function equally well without them) from the other side of your mouth. But they will anyways.

 

[BobbyHeenan]

hang on here, prostate 20 Gy X 3

I think it's just a typo. He meant 3 Gy X 20.

One thing to consider about derm is that patient demand is more elastic in the sense that they can always offer lower cost/out of pocket/cosmetic procedures. For us, it is not just the increased residency slots, but the increasing utilization of hypofractionation- which ASTRO pushes without addressing physician supply. Most radonc practices could easily cut the on treat pts in half if all mets were 8 Gy x 1, prostates 20 Gy x 3 or stereo and breasts 15 fractions or less.

At my clinic, we have seen very similar total number of consults and CT sims as compared to 10 years ago, but we now have about 1/2 to 2/3 of the overall fractions treated.

I use hypofrac on pretty much 90% of all whole breast patients, do some HDR partial breast, use 70 Gy in 28 for probably 1/2 of my prostate patients, and use 8 X 1 for bone-only mets (I don't use this for soft tissue mets) probably about 20-30% of the time. I don't begrudge anyone for standard fractionation (in fact my partners use it much more than I do), it's just the way I was trained and the way I practice and interpret the data.

The biggest travesty of all of this is that initial JCO paper that "justified" expansion was so flawed in that it didn't even take into account hypofractionation....and it's arguably one of the biggest reasons why the whole landscape is radically different now.

 

[MOHS_01]

so what did Derm exactly do to balance supply/demand?

They have not; as was pointed out above, "demand" is elastic and relative to "supply" for general dermatology. The real dislocation is with the subspecialists such as myself and pathologists, who represent one off derivatives. We, like yourselves, are overtraining in number and more delimited in demand by real disease incidence. Compounding the issue is the rise of in office XRT, increased competition in general derm (making people cut out things that they once would have referred out), and some craziness with ED&C followed by imiquimod. The response to this has been predictable -- increased utilization. It is a procycylical phenomena, entirely predictable, and resultant from willful and poorly thought out policy.

 

[medgator]

Regarding hypofractionation at the "ivory tower." Despite sending some representatives to formulate ASTRO position statements for initiatives like "choosing wisely," anecdotally, these programs are not adopting much hypofraction (except for breast) nor are they encouraging observation for low risk prostate.

Not to bring the other thread topic into this one, but the data for breast is far more compelling, robust and has longer follow up compared to prostate in regards to hypoFx.

In terms of AS/WW vs treatment, kinda surprised about that

 

[thecarbonionangle]

Please don't pollute this thread with that snoozer of a topic. Take that to the other thread.

I need to have my uncluttered safe space to bash all the the ivory tower filth and greed. thanks

 

[Krukenberg]

saw this in the online planner. from the survey that came up in here

The ASTRO 2017 Radiation Oncologist Workforce Study: Past, Present, Future
EDU 36
Date:
9/26/2017
Time:
4:45 p.m. - 6:15 p.m.
Location:
San Diego Convention Center
Room Number:
1 A/B

Results of the ASTRO 2017 Workforce Study - Past, Present, Future

Learning Objectives:
After this session, attendees should be able to:
Learn about the ASTRO 2017 radiation oncologist workforce study, which examines the demographics, workload, practice structure, employment and compensation models, and perceived supply and demand of U.S. radiation oncologists.
Define shifting workforce trends relative to the ASTRO 2012 workforce study and other historical data, as well as drivers of change and implications for the future.

DESCRIPTION:
This session presents the ASTRO 2017 radiation oncologist (RO) workforce study, a survey-based analysis of the RO workforce in the United States. Topics to be presented include, demographics and practice characteristics such as urban vs suburban vs rural, hospital vs free standing, academic vs non-academic; the workload such as patient volume, hours and time allocation to patient care, electronic health record management, and administrative and other duties; Prevalence of ROs seeking new employment, employment change, and job vacancies; and finally, RO’s perception of supply and demand of radiation oncologists in the U.S. The discussion will provide a comparison of the current study with the ASTRO 2012 workforce survey and other historical data to identify shifting trends and offer insights into the drivers of change and implications for the future of the workforce. Other topics to be discussed include availability of a wide range of radiation therapy technologies across practice types and geography and hypofractionation adoption for various disease sites.

Someone please report back about this session for those of us who can't be there


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[bronx43]

That the massive increase in residency slots being pushed would have a disproportionate impact on the job market. It's all about equilibrium dynamics; small increases in a system in relative balance leads to large dislocations. For example, one of the metrics used was the number of practices in a locale wishing to add a provider; this was backed up by wait times, etc. The idea pushed was that 7 practices looking to hire somehow equated to 7 positions going unfilled; this was insanely ignorant analysis, for this might only translate into 1-2 needed FTE's before reaching the equilibrium again. It was painful to listen to the anecdotal BS being sold as reasoning. We increased the number of dermatology slots from less than 200 per annum to over 350 in a single decade, an increase that overlapped with the concurrent explosion of midlevel providers. In short, the job market went from picking your place out on the map to jockeying for positions, if any were available, in the state you wanted to practice in.

Well said MOHS.

Was it the ivory tower academics in your field that pushed this increased number of trainees? My specialty just came out with a "workforce study" last year that "discovered" a severe impending shortage in the number of providers in my field of rheumatology, and are now pushing heavily for massive increase in training numbers. The problem with this is that they are assuming a much higher number of rheumatologists needed in the general population compared to the actual prevalence of autoimmune diseases. Increasing training slots may be catastrophic for the majority of us, but the academics rule the land... so my question to you is if you can go back and try to change the tide, how would you approach it?

 

[MOHS_01]

Well said MOHS.

Was it the ivory tower academics in your field that pushed this increased number of trainees? My specialty just came out with a "workforce study" last year that "discovered" a severe impending shortage in the number of providers in my field of rheumatology, and are now pushing heavily for massive increase in training numbers. The problem with this is that they are assuming a much higher number of rheumatologists needed in the general population compared to the actual prevalence of autoimmune diseases. Increasing training slots may be catastrophic for the majority of us, but the academics rule the land... so my question to you is if you can go back and try to change the tide, how would you approach it?

It was interesting... the young ambitious faculty pushing the narrative like nice little zealots as well as the aged who have used their residencies as referral farm systems, making money off of junior faculty and expanding their referral empires.

It's politics, and politics is not about who's correct in fact or analysis, unfortunately. Dissent is always marginalized and silenced at every opportunity, math be damned. Better analysis and presentation in venues that are not as throttled (i.e., peer reviewed propaganda process) is likely your best bet (something not nearly as readily found 15 years ago).