Definitely. Becoming an academic chair takes a career's worth of work, and then they hold that position for 20+ years. It's not a position you take when your back is against the wall.
I've done consulting work for insurance companies and the sheer number of bogus requests for treatment is breathtaking. It's a bubble here on SDN with everyone hypofractionating every breast and prostate, single fraction palliation, etc. That's not what happens in the real world. I've seen networks without Evicore-type oversite and the boomers and academic docs were going ham with IMRT. Obviously I can't get too specific, but there was one reasonably well known breast person who was IMRTing every single breast cancer 30+ fractions even low risk, right-sided, >70 types. Majority of palliative cases were getting 20 fraction IMRT. One of my favorites was a lymphoma expert at a very expensive academic center getting 7-10x medicare who insisted on IMRT for boom boom palliation.
A decent chunk of the ones I've talked to are no longer active clinically, usually not by choice, despite Dr Spratts insinuations. The one thing evilcore offers above all else is geographic flexibility.
You've stated your position well, and I understand where you are coming from. However, I still 100% have Dan's back on this. I also appreciate your honesty about valuing your own family's life over those of strangers. That's rare for someone to say what we all know to be true in this age of virtue signalling.
We have all undoubtedly watched Evicore shave precious months and years off our patients' lives unnecessarily to save insurance a few bucks. My position that it is not conscionable to work for them under any circumstance. There is a difference between simply putting food on your family's table and trying to maintain your current lifestyle of spending $200k+/year and not having to move somewhere less desirable to do it. A licensed MD can make $100k a year through MANY different avenues in a large city. Sure, it may be harder to make the $200k+ level that Evicore will pay, but that is exactly why people do it. They don't want some clinic oversight babysitting job because it only pays $100k. That's why it's not ok.
In my experience with Evicore docs, they are often part or full-time employed at academic centers and schedule the peer review calls around THEIR workday to pad their income. Revolting. And to the other point above, sometimes it is appropriate to do >10 fraction IMRT palliation. A recent pancreatic met I had comes to mind. As did a rare case of colorectal brain mets, which has evidence for dose escalating with conventional frac. On the other hand, I have seen people give 0.5 Gy/day for prostate over a period of many many months. That does happen, but it's not as common as the above comment suggests I think. I am confident the counter scenario (Evicore denying care inappropriately) is far more common that fraudulent fractionation schemes.
The reality that a lot of you are not going to like to hear is that your plight is not going to garner much sympathy in the eyes of the general public. Your choices are to stay in an exploitative job in southern California making $250k/year with no opportunity for advancement or have to uproot your family and move to whoever's hiring in rural Wyoming/Kansas/Nebraska or one of the perma-hiring rural places in Wisconsin and bring in $700k/year.
I do hear what you all are saying about Dan's bias, and I will fully admit that I am coming at this as a position of bias as well with no family of my own and total freedom to go whereever and do whatever I want. However, I am also aware that there are many thousands of FMGs practicing overseas for well under $100k chomping at the bit to come and take literally any other job in America knowing full well that it means they will get to see their family across the world once every two years via a 40 hour $5000 round trip.
Something to think about. Hope Dan comes here to engage.
Clearly a bachelor and very out of touchYou've stated your position well, and I understand where you are coming from. However, I still 100% have Dan's back on this. I also appreciate your honesty about valuing your own family's life over those of strangers. That's rare for someone to say what we all know to be true in this age of virtue signalling.
We have all undoubtedly watched Evicore shave precious months and years off our patients' lives unnecessarily to save insurance a few bucks. My position that it is not conscionable to work for them under any circumstance. There is a difference between simply putting food on your family's table and trying to maintain your current lifestyle of spending $200k+/year and not having to move somewhere less desirable to do it. A licensed MD can make $100k a year through MANY different avenues in a large city. Sure, it may be harder to make the $200k+ level that Evicore will pay, but that is exactly why people do it. They don't want some clinic oversight babysitting job because it only pays $100k. That's why it's not ok.
In my experience with Evicore docs, they are often part or full-time employed at academic centers and schedule the peer review calls around THEIR workday to pad their income. Revolting. And to the other point above, sometimes it is appropriate to do >10 fraction IMRT palliation. A recent pancreatic met I had comes to mind. As did a rare case of colorectal brain mets, which has evidence for dose escalating with conventional frac. On the other hand, I have seen people give 0.5 Gy/day for prostate over a period of many many months. That does happen, but it's not as common as the above comment suggests I think. I am confident the counter scenario (Evicore denying care inappropriately) is far more common that fraudulent fractionation schemes.
The reality that a lot of you are not going to like to hear is that your plight is not going to garner much sympathy in the eyes of the general public. Your choices are to stay in an exploitative job in southern California making $250k/year with no opportunity for advancement or have to uproot your family and move to whoever's hiring in rural Wyoming/Kansas/Nebraska or one of the perma-hiring rural places in Wisconsin and bring in $700k/year.
I do hear what you all are saying about Dan's bias, and I will fully admit that I am coming at this as a position of bias as well with no family of my own and total freedom to go whereever and do whatever I want. However, I am also aware that there are many thousands of FMGs practicing overseas for well under $100k chomping at the bit to come and take literally any other job in America knowing full well that it means they will get to see their family across the world once every two years via a 40 hour $5000 round trip.
Something to think about. Hope Dan comes here to engage.
Ah yeah, we're wandering into economic territory where emotions get hot (what is a "good" salary etc).
You've stated your position well, and I understand where you are coming from. However, I still 100% have Dan's back on this. I also appreciate your honesty about valuing your own family's life over those of strangers. That's rare for someone to say what we all know to be true in this age of virtue signalling.
We have all undoubtedly watched Evicore shave precious months and years off our patients' lives unnecessarily to save insurance a few bucks. My position that it is not conscionable to work for them under any circumstance. There is a difference between simply putting food on your family's table and trying to maintain your current lifestyle of spending $200k+/year and not having to move somewhere less desirable to do it. A licensed MD can make $100k a year through MANY different avenues in a large city. Sure, it may be harder to make the $200k+ level that Evicore will pay, but that is exactly why people do it. They don't want some clinic oversight babysitting job because it only pays $100k. That's why it's not ok.
In my experience with Evicore docs, they are often part or full-time employed at academic centers and schedule the peer review calls around THEIR workday to pad their income. Revolting. And to the other point above, sometimes it is appropriate to do >10 fraction IMRT palliation. A recent pancreatic met I had comes to mind. As did a rare case of colorectal brain mets, which has evidence for dose escalating with conventional frac. On the other hand, I have seen people give 0.5 Gy/day for prostate over a period of many many months. That does happen, but it's not as common as the above comment suggests I think. I am confident the counter scenario (Evicore denying care inappropriately) is far more common that fraudulent fractionation schemes.
The reality that a lot of you are not going to like to hear is that your plight is not going to garner much sympathy in the eyes of the general public. Your choices are to stay in an exploitative job in southern California making $250k/year with no opportunity for advancement or have to uproot your family and move to whoever's hiring in rural Wyoming/Kansas/Nebraska or one of the perma-hiring rural places in Wisconsin and bring in $700k/year.
I do hear what you all are saying about Dan's bias, and I will fully admit that I am coming at this as a position of bias as well with no family of my own and total freedom to go whereever and do whatever I want. However, I am also aware that there are many thousands of FMGs practicing overseas for well under $100k chomping at the bit to come and take literally any other job in America knowing full well that it means they will get to see their family across the world once every two years via a 40 hour $5000 round trip.
Something to think about. Hope Dan comes here to engage.
Yip. Favorite twitter geezer almost certainly graduated with no debt, was an attending with a lab by his late 20s, bought a house in desirable metro for 50k. Now screams “greed” at anyone with 300k debt, and in late 30s who is not willing to be his post doc.
Doc can just come out one day a week and do the rest remotely.
Because we made too many rad oncs.
Dennis Hallahans master plan
It's not the length that relegates it to drivel. It's the content.
My dude, you are literally defending working for Evicore. Don't lecture about drivel.
I agree. I don't know how you got that from what I wrote, but seeing as you somehow did (to your credit at least you read it and attempted some sort of actual reply unlike the above poster), then yes that makes no sense. You might want to read it again, but I am not saying that most people make less than $100k therefore rad oncs should not whine about having to deal with their being some imaginable scenario with a non-zero probability of occuring in the future where they don't have a guaranteed $30-50k/month paycheck coming in. That is a strawman -- that is not my argument. What I'm saying is that if you're not making the money you want to in the location you want to because of unfavorable market dynamics and you choose to work for Evicore to bring in money so you don't have to move, then you suck. If you choose to do it on the side to pad your existing income, then you especially suck. Have some principles and grow a spine.
This is the silver spoon mentality I was referring to that plagues medicine, especially in multi-generational doctor families. This expectation that you are somehow entitled to a certain paying job and lifestyle. If the market where you want to live is oversupplied because too many rad oncs were trained, that doesn't justify doing things like opening a pill mill or working for obstructionist companies like Evicore that harm patients. What happened to our oath? Do no harm?
I have no issues with rad oncs making large amounts of money treating patients. We should. We should not sell our souls to try and have our cake and eat it too even if the reasoning is that our leaders threw us under the bus. So yeah, go ahead and call it "Evilcore" again.
Isn’t this just another type of virtue signaling?My dude, you are literally defending working for Evicore. Don't lecture about drivel.
I agree. I don't know how you got that from what I wrote, but seeing as you somehow did (to your credit at least you read it and attempted some sort of actual reply unlike the above poster), then yes that makes no sense. You might want to read it again, but I am not saying that most people make less than $100k therefore rad oncs should not whine about having to deal with their being some imaginable scenario with a non-zero probability of occuring in the future where they don't have a guaranteed $30-50k/month paycheck coming in. That is a strawman -- that is not my argument. What I'm saying is that if you're not making the money you want to in the location you want to because of unfavorable market dynamics and you choose to work for Evicore to bring in money so you don't have to move, then you suck. If you choose to do it on the side to pad your existing income, then you especially suck. Have some principles and grow a spine.
This is the silver spoon mentality I was referring to that plagues medicine, especially in multi-generational doctor families. This expectation that you are somehow entitled to a certain paying job and lifestyle. If the market where you want to live is oversupplied because too many rad oncs were trained, that doesn't justify doing things like opening a pill mill or working for obstructionist companies like Evicore that harm patients. What happened to our oath? Do no harm?
I have no issues with rad oncs making large amounts of money treating patients. We should. We should not sell our souls to try and have our cake and eat it too even if the reasoning is that our leaders threw us under the bus. So yeah, go ahead and call it "Evilcore" again.
At least they are getting treatment, albeit financially toxic
True but unseen macroscopic damage to society. Less jobs, teachers, fire fighter and homeless services because health care averages out to something like 12k per person in the USA.
Not to get too political, but this is the price we pay for capitalism. When there is no cap, the rich become richer while the poor becomes poorer. Now if the rich were to give back to society, things wouldn’t be so bad.
similar experience here. If I were to lose my job, I would have no issue working for Evicore or a center that charges 20 x cms rates vs having to move away from my kids. If circumstances force a doc to evercore, why is the doc anymore “at fault” than the chairs responsible for residency expansion? Does Dan Spratt share some responsibility if his grads can’t get jobs in 5 years for not shutting down his program?
Not a single criticism of the chairs and PDs that created this problem to begin? Ridiculous. I'm not going to blame people for trying to stay employed when chairs have basically farked the market for everyoneIf the market where you want to live is oversupplied because too many rad oncs were trained, that doesn't justify doing things like opening a pill mill or working for obstructionist companies like Evicore that harm patients.
I'll admit the hypocrisy on my part that I can find empathy for eviCore employees yet am mostly angry at departmental Chairs.
Pretty sure evilcore would have never had the oxygen to get started without the boomers giving 20+ fx Palliative and ongoing 33+ fx breast for everyone for years.
The oxygen for Evicore was the boom of IMRT (which sidestepped insurance review for a long time) and then the BOOM of IGRT and then IMRT/IGRT tech slowly boom boomed into all the boomers’ clinics. (And academics got on the IMRT and IGRT train too; it took some time in some places.) Over a ten year period Rad onc spending must have tripled or so. From afar it looked like chicanery. But on the ground, we were all just (rightly) using the new toys. I think I had my first Evicore peer to peer around 2013. Evicore came along to say “playtime is over.” The really onerous 20 fraction palliative cases stick out as anecdotes, but (as always) IMRT and IGRT were the meat. The 20 fraction palliatives are now just completely pre screened before it even hits a peer to peer. Peer to peer is like when we are arguing for SBRT to spine for an oligomet nowadays.
10 years ago, even some academic centers would conventionally fractionated breast followed by balloon brachy boost
It's lazy to condemn a person about whom you know very little who does something unsavory. I wonder if there isn't a small portion of your life that could be called out on an anonymous forum... maybe you are that guy who goes 2 mph above the speed limit in the left lane
The UPMC system is particularly bad in many ways. They have been buying up PPs and make everyone an employee. “Only 3-5 hours from this city” say their ads. Let’s just say they are not offering 700k+ For these hellpit locations (not even low quality biryani). These jobs used to offer that kind of money in rural areas now they have dried up. The biggest enemies are these academic systems which want everyone to work for them and monopolize cancer care. Choose wisely folks!!!
