Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
radoncftw said:
I think the most frustrating thing is that no-one every engages @RealSimulD on the twitter when he posts very reasonable things. all i see is radiosilence.
Click to expand...

It's Twitter. For #radonc its all about echo chambers and virtue signaling. Just like the nearly zero activity ROHub, it is not the forum for against the academic narrative type of discussions and engagement. But I do appreciate the effort.
 
Moonbeams said:
I know someone who interviewed for one of the Avera jobs (there are multiple posted). They have somehow acquired rad onc staffing for a few rural hospitals in the area. The amount of WTF involved in the offer is too long to even list here. I can't imagine who actually ends up in the roles as a permanent hire when hospitals in marginally more populated areas are offering contracts with only a little bit of WTF and still can't fill for years.
Click to expand...
Details please!
 
radoncftw said:
rural places do some shady things. some places i interviewed at openly told me that they would have med onc NPs serve as coverage when i was on vacation. I noped out of that very quickly.
edit: I don't want to paint rural places with broad strokes. It is not their fault always. But yes, some places want to even avoid paying locums coverage if they can get away with it if they have a full time Rad Onc on staff.
Click to expand...
Is it really that problematic to have an NP you trained cover the clinic as compared to a random locums? I just reviewed a 72/40 H&N plan done last year to a T0N3 CUP with no elective nodal volumes below level 2ish. Seeing me about a recurrence. I don't want that doctor locumsing for me.
 
Ray D. Ayshun said:
Is it really that problematic to have an NP you trained cover the clinic as compared to a random locums? I just reviewed a 72/40 H&N plan done last year to a T0N3 CUP with no elective nodal volumes below level 2ish. Seeing me about a recurrence. I don't want that doctor locumsing for me.
Click to expand...
Agreed. I'm assuming the NP is just there to handle on treatment issues, not consult patients and draw contours. That's a great role for an oncology knowledgeable NP. I also assume either you, or some other rad onc doc within the same site is approving images remotely.
 
Mandelin Rain said:
Agreed. I'm assuming the NP is just there to handle on treatment issues, not consult patients and draw contours. That's a great role for an oncology knowledgeable NP.
Click to expand...
That too. I was just outta town. My locums checked imaging and saw nobody. I'll never be gone more that 6 days anyway as otv day = retirement.
 
Ray D. Ayshun said:
Is it really that problematic to have an NP you trained cover the clinic as compared to a random locums? I just reviewed a 72/40 H&N plan done last year to a T0N3 CUP with no elective nodal volumes below level 2ish. Seeing me about a recurrence. I don't want that doctor locumsing for me.
Click to expand...

Certainly there are locums rad oncs out there that are worse than NPs.

Yes, it theoretically may be possible in PP to train an NP to be a fully independent rad onc over a period of many years (I have never seen or heard of it done, but I suppose it's possible).

But an NP should not be covering a rad onc clinic for a week at a time alone, The NP is going to staff simulations, check images, make decisions about whether to hold or re-plan treatments, do emergent sim and treats, start new patients, approve SBRT, electron set ups, deal with any dosimetry issues that come up (hey, this boost wasn't approved yet and there is only a GTV drawn yet, can you make a PTV and approve it, etc). You know, things any minimally competent rad onc who completed residency should be able to do. In reality, physics and dosi will make the decisions and the NP will just nod, the same way they do for incompetent octogenarian locums.

Are you serious?

If you are talking about having an NP on site to deal with patient issues and having a rad onc available remotely for general supervision, that's one thing (and I agree that concern over this is way overblown -- no issues to let rad onc cover Friday remotely and be available by phone if needed), but what we're talking about here is the NP is flying solo and the rad onc is scuba diving in Australia. That was the hospital's plan.
 
Last edited by a moderator:
Moonbeams said:
Certainly there are locums rad oncs out there that are worse than NPs.

Yes, it theoretically may be possible in PP to train an NP to be a fully independent rad onc over a period of many years (I have never seen or heard of it done, but I suppose it's possible).

But an NP should not be covering a rad onc clinic for a week at a time alone, The NP is going to staff simulations, check images, make decisions about whether to hold or re-plan treatments, do emergent sim and treats, start new patients, approve SBRT, electron set ups, deal with any dosimetry issues that come up (hey, this boost wasn't approved yet and there is only a GTV drawn yet, can you make a PTV and approve it, etc). You know, things any minimally competent rad onc who completed residency should be able to do. In reality, physics and dosi will make the decisions and the NP will just nod, the same way they do for incompetent octogenarian locums.

Are you serious?

If you are talking about having an NP on site to deal with patient issues and having a rad onc available remotely for general supervision, that's one thing (and I agree that concern over this is way overblown -- no issues to let rad onc cover Friday remotely and be available by phone if needed), but what we're talking about here is the NP is flying solo and the rad onc is scuba diving in Australia. That was the hospital's plan.
Click to expand...
Is this really happening though? I can't imagine a rad onc signing off on this. Looking the other way, sure, but I'm not sure how the staffing rad onc would be off the hook for the med mal cases.
 
Ray D. Ayshun said:
Is this really happening though? I can't imagine a rad onc signing off on this. Looking the other way, sure, but I'm not sure how the staffing rad onc would be off the hook for the med mal cases.
Click to expand...

Exactly.

Sure. We will give you 10 weeks of vacation. The med onc's NP will take care of your patients and see new consults if you choose to use any of your PTO. The choice is yours. Don't think that's appropriate, well then I guess don't leave. There's plenty to do in northern Iowa anyway.

Places like this roll out the red carpet to try and bring a subspecialist surgeon in. Rad onc? They're annoyed they have to hire one at all because they know they can technically move the meat on the linac with physics and dosi making decisions with spotty NP and locums involvement in clinic rubber stamping their name.
 
Moonbeams said:
Certainly there are locums rad oncs out there that are worse than NPs.

Yes, it theoretically may be possible in PP to train an NP to be a fully independent rad onc over a period of many years (I have never seen or heard of it done, but I suppose it's possible).

But an NP should not be covering a rad onc clinic for a week at a time alone, The NP is going to staff simulations, check images, make decisions about whether to hold or re-plan treatments, do emergent sim and treats, start new patients, approve SBRT, electron set ups, deal with any dosimetry issues that come up (hey, this boost wasn't approved yet and there is only a GTV drawn yet, can you make a PTV and approve it, etc). You know, things any minimally competent rad onc who completed residency should be able to do. In reality, physics and dosi will make the decisions and the NP will just nod, the same way they do for incompetent octogenarian locums.

Are you serious?

If you are talking about having an NP on site to deal with patient issues and having a rad onc available remotely for general supervision, that's one thing (and I agree that concern over this is way overblown -- no issues to let rad onc cover Friday remotely and be available by phone if needed), but what we're talking about here is the NP is flying solo and the rad onc is scuba diving in Australia. That was the hospital's plan.
Click to expand...

We have used this set up during the pandemic and use it here and there on Fridays or Mondays - an NP to babysit, and one of the off site partners checking films and coming to the clinic prn should there be a more pressing issue (ie inpatient consult that needs seen/sim'd).

If we're going to be gone a full week we have another partner or "semi retired" partner rad onc covering the clinic the majority of the days. But for a random day here or there the NP set up works really well with an off site physician assigned as the supervision doc.

This works if you have other docs in your group, but for a solo rad onc obviously wouldn't work.
 
BobbyHeenan said:
We have used this set up during the pandemic and use it here and there on Fridays or Mondays - an NP to babysit, and one of the off site partners checking films.
Click to expand...

And that's completely appropriate in a hospital or in a freestanding clinic where another MD is in the building somewhere.
You really don't even need the NP.
The shocking thing to me was hospital admin trying to use NP for vacation coverage without any rad onc oversight. They really are that clueless.
 
Moonbeams said:
And that's completely appropriate in a hospital or in a freestanding clinic where another MD is in the building somewhere.
You really don't even need the NP.
The shocking thing to me was hospital admin trying to use NP for vacation coverage without any rad onc oversight. They really are that clueless.
Click to expand...
The covering MD is not in the building though - they are off site at another one of our hospital based clinics (all our sites are hospital based).

Yes - NP coverage with no assigned MD I agree is not appropriate...especially if billing image guidance.
 
medgator said:
That's a "bring your ottoman to work to kick back and snooze through lunch checking igrts" wage
Click to expand...

BobbyHeenan said:
The covering MD is not in the building though - they are off site at another one of our hospital based clinics (all our sites are hospital based).

Yes - NP coverage with no assigned MD I agree is not appropriate...especially if billing image guidance.
Click to expand...
i disagree. Supervision was suspended for pandemic
 
RickyScott said:
i disagree. Supervision was suspended for pandemic
Click to expand...

I don't necessarily mean illegal.

I just don't think it's great care to have an NP with no back up rad onc for a week (or no rad onc checking films remotely at all for a week). I think of all the times I get called to the machine to check alignment or make a rad onc specific decision. A day or two here or there or one day a week with solo NP seems reasonable, but a whole week I'm just not there yet. I understand though that a solo rad onc in a rural location may not have a choice.

Hospital admin is dying to have the NP with no back up rad onc coverage...I just thnk that's a slippery slope and not great care.

Just my opinion though.
 
BobbyHeenan said:
The covering MD is not in the building though - they are off site at another one of our hospital based clinics (all our sites are hospital based).

Yes - NP coverage with no assigned MD I agree is not appropriate...especially if billing image guidance.
Click to expand...

What say you gator and walrus?
 
jondunn said:
What say you gator and walrus?
Click to expand...

Would value their input.

I’m not talking about an MD checking films from home or on vacation. I think that is ok.

Im saying unless you ?credential? that NP for IGRT if no doc is checking the CBCTs for a week you surely can’t bill them, correct?

Like the other poster said if he/she is in Australia (?presumably not checking films?) I don’t see how an NP can cover to charge IGRT…unless I guess you had trained and credentialed them.
 
BobbyHeenan said:
Would value their input.

I’m not talking about an MD checking films from home or on vacation. I think that is ok.

Im saying unless you ?credential? that NP for IGRT if no doc is checking the CBCTs for a week you surely can’t bill them, correct?

Like the other poster said if he/she is in Australia (?presumably not checking films?) I don’t see how an NP can cover to charge IGRT…unless I guess you had trained and credentialed them.
Click to expand...
I think this is not incorrect. In any of these discussions you have to be very very specific about the hypothetical scenario being proposed. That said, as we all know, CMS has now expressly allowed NPs and PAs to direct supervise IGRT in the hospital. We all have our guesses about how much, or if any, credentialing (there is no “formal” credentialing afaik that CMS does or does not accept) the NPs would have to have to directly supervise. There is wording about “state scope of practice” in the regulations. Hospitals like to credential. Do hospitals “credential” therapists to deliver RT. Dosimetrists to do radiation plans. Physicists to do physics consults. If a hospital had a policy where it *would not* credential an NP for IGRT, would be problematic. But if they were neither credentialed nor uncredentialed (ie no policy) would be OK. Consult your local fraud attorney.

I just haven’t had to dive deep into this. I think one day we may all have to accept that when CMS sets a new supervision policy that is very different from a previous policy, the policy more than likely exists to be taken at face value rather than as an entrapment.
 
TheWallnerus said:
I just haven’t had to dive deep into this. I think one day we may all have to accept that when CMS sets a new supervision policy that is very different from a previous policy, the policy more than likely exists to be taken at face value rather than as an entrapment.
Click to expand...
Yup. You definitely want to consult an attorney and have the system you work for do the same, but just because things may have been one way 5 years ago (and it's not all that clear that they were), doesn't mean it's still that way.
 
TheWallnerus said:
I think this is not incorrect. In any of these discussions you have to be very very specific about the hypothetical scenario being proposed. That said, as we all know, CMS has now expressly allowed NPs and PAs to direct supervise IGRT in the hospital. We all have our guesses about how much, or if any, credentialing (there is no “formal” credentialing afaik that CMS does or does not accept) the NPs would have to have to directly supervise. There is wording about “state scope of practice” in the regulations. Hospitals like to credential. Do hospitals “credential” therapists to deliver RT. Dosimetrists to do radiation plans. Physicists to do physics consults. If a hospital had a policy where it *would not* credential an NP for IGRT, would be problematic. But if they were neither credentialed nor uncredentialed (ie no policy) would be OK. Consult your local fraud attorney.

I just haven’t had to dive deep into this. I think one day we may all have to accept that when CMS sets a new supervision policy that is very different from a previous policy, the policy more than likely exists to be taken at face value rather than as an entrapment.
Click to expand...

Thanks, and I agree.

I think if I was in a situation where I needed or wanted NP coverage without backup MD then I would have formal documenation about how I trained the NP on image guidance. Would also get hospital credentialing to approve it.

It's kind of dumb to think of a hospital credentialing committee signing off on radiation supervision/image guidance (I can almost guarantee you they don't know what that means), but in the legal world some hospital committee approving the NP to review and bill for IGRT is a really good CYA idea. At least it shows you were cognoscente of their scope of practice and other people signed off on it after appropriate training for an area that is a " gray area" by CMS.
 
medgator said:
I would say no go if there isn't a doc available in real time to check via an audiovisual app with the image guidance able to be pulled up.

You can't supervise when you're on vacation
Click to expand...

What is the difference between checking films at the end of the day when all the patients have gone home vs checking the images on a PTO day off site? I think @medgator is one of the last people I know that says direct supervision means you go to the machine when the imaging takes place, but for the reality based crew, what is the difference?
 
RealSimulD said:
What is the difference between checking films at the end of the day when all the patients have gone home vs checking the images on a PTO day off site? I think @medgator is one of the last people I know that says direct supervision means you go to the machine when the imaging takes place, but for the reality based crew, what is the difference?
Click to expand...
Definition came straight from CMS... "Real time audiovisual capability" , "able to furnish assistance" etc during the procedure
 
Mandelin Rain said:
Audio = iPhone in my pocket
Visual = images on ARIA

done
Click to expand...
"Furnish assistance" = call the therapist and shift 0.2cm superior.

So, re-read Todd's lovely feature in the NY Times. Simon Powell does not sound like a man that understands the field that he is a chairman in. Also, they make it sound SOOOOO bad to have remote supervision, when people are doing that left and right. In 2022, the article doesn't make a whole lot of sense. The patient that may have had their intestines turn to mush - wtf ?
 
RealSimulD said:
What is the difference between checking films at the end of the day when all the patients have gone home vs checking the images on a PTO day off site? I think @medgator is one of the last people I know that says direct supervision means you go to the machine when the imaging takes place, but for the reality based crew, what is the difference?
Click to expand...

I don't think the films need to be checked in real time.

But should therapists need you in real time to help them, you are available to assist. I can assist in the office or at home by looking at images in real time with our computer set up.

Or at least that's how I interpret it.
 
BobbyHeenan said:
I don't think the films need to be checked in real time.

But should therapists need you in real time to help them, you are available to assist. I can assist in the office or at home by looking at images in real time with our computer set up.

Or at least that's how I interpret it.
Click to expand...

Okay, that is a reasonable interpretation.
 
TheWallnerus said:
Thirsty? Or doing the Lord’s work?
@Astro boothing it at the American Medical Student Association meeting…

Click to expand...

Unless Astro can address the value of rad onc residency not being what it used to be, probably not much point to the exercise.
 
RealSimulD said:
#METOO.
2600 followers, many of them academics who should be able to have a discussion. But, they refuse to engage. It is so frustrating.
Click to expand...
Is this really that surprising? As reasonable as you often are on Twitter, any contrary response gets reposted and ripped here. It is stifling opinions that may be different than your own
 
grenz said:
Is this really that surprising? As reasonable as you often are on Twitter, any contrary response gets reposted and ripped here. It is stifling opinions that may be different than your own
Click to expand...

I do agree. KO is the only fool that hasnt figured this out, but I am certain there are many that are afraid to get 'cancelled' on here. I actually give credit to KO for posting his opinions.
 
RickyScott said:
No one is cancelled on here, unless you count engagement as cancelling.
Click to expand...

I used cancelling in quotes - but I am certain people don't want to be roasted on here for twitter posts. Just stating the obvious.

Simul should not be any more surprised that a public name on Twitter doesn't want to get into some of these topics than he should be surprised that you don't publicly post your tweets on Twitter.

Simul is a rare breed who posts whatever he wants - both here and there.
 
I love reading this editorial, it's peak Boomer RadOnc:

1649511804556.png


"People said mean things about me on the internet and I suffered absolutely no consequences. WHY ARE YOU CANCELING ME?"

*shakes fist at Millennials*

"...all they care about is work/life balance...back in my day, we knew how to work hard!"
 
The famous UK chairmen essay. Plenty of tone deaf things in that editorial to quibble with. But the crux of it for me is why did you not need any data to expand a bottom tier residency from 4 to 6 spots (except for a desire to exploit cheap labor). But when valid questions are being asked about over supply formal scientific data is a must.
 
fiji128 said:
The famous UK chairmen essay. Plenty of tone deaf things in that editorial to quibble with. But the crux of it for me is why did you not need any data to expand a bottom tier residency from 4 to 6 spots (except for a desire to exploit cheap labor). But when valid questions are being asked about over supply formal scientific data is a must.
Click to expand...
How many things do we, or even as individual rad oncs, do just because “it feels right” or “makes sense.” Things we may never mention. But if another rad onc does something that pings our own individual Disagree-ometer, we run to “Do you have any objective data for that approach?”
 
EX: When Columbia PD came here to defend Lisa Kachnic expanding her residency, no one "cancelled" him. Sure there is going to be debate about the wisdom of the policy but he was not attacked personally. While personal attacks can happen, they are actually quite rare. I suppose if you consider calling Columbia or Kentucky a lower tier residency a "personal attack," but this just reflects choices of matching medical students.
 
Fully agree people can roast public figures for
Public opinions

But also don’t be surprised when some smart public figures keep thoughts close to the vest in public

Same reason we all say stuff here that we wouldn’t say on our public accounts.
 


For a European, this is America in one picture.

Hard-To-Grasp sauce (?) „Great on everything“
Huge bottle of medication (we don‘t have those „eat-that-bottle-and-win-dialysis„ sizes over here)
Peanut butter
 
Palex80 said:


For a European, this is America in one picture.

Hard-To-Grasp sauce (?) „Great on everything“
Huge bottle of medication (we don‘t have those „eat-that-bottle-and-win-dialysis„ sizes over here)
Peanut butter
Click to expand...

Tony Chachere's is actually pretty bomb and worth getting if you are able to across the pond.
 
jondunn said:
I do agree. KO is the only fool that hasnt figured this out, but I am certain there are many that are afraid to get 'cancelled' on here. I actually give credit to KO for posting his opinions.
Click to expand...
He seems to be surrounded by a reality distortion field (in the worst way possible) however, so not sure if that credit is really deserved?
 
jondunn said:
AKA 'We can't keep having old white guys like Todd Scarborough on':

Click to expand...

he is doing rural rad onc. i hear there's a need. wonder if anyone who doesn't do it knows what it's like. in any case, i'm sure there's no need to discuss as it's only the main justification for residency expansion.
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
18
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
3K
RickyScott
R
M
Rad Onc Oral Boards: To quote or not quote studies?
Replies
4
Views
548
alwaysbeIMRTing
A
Top