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fiji128 said:
I’m definitely getting Cartel vibes here.
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elementaryschooleconomics said:
Look.

You didn't hear it from me.

But the SCAROP report is, in fact, the most obvious case of antitrust that I've seen in medicine.

Submit a Healthcare Competition Complaint

www.justice.gov www.justice.gov

The government loves to hear about these things.

(from multiple people)
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When the great unemployment of RadOncs happens I hope it's understood: RadOncs promoted unfettered expansion of residency positions, RadOncs promoted virtual supervision, RadOncs ran bad noninferiority trials, RadOncs thought the business men would let them profit with them, RadOncs did this to ourselves.
 
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CurbYourExpectations said:
View attachment 385705

When the great unemployment of RadOncs happens I hope it's understood: RadOncs promoted unfettered expansion of residency positions, RadOncs promoted virtual supervision, RadOncs ran bad noninferiority trials, RadOncs thought the business men would let them profit with them, RadOncs did this to ourselves.
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Obviously, I'm 90% with you on this statement...

But Mayo can literally reach into far-flung communities and pull patients into their machine for proton treatments, regardless of supervision laws, they told us themselves:


Mayo and the SCAROP Institutions:

We will use our residents to conduct telehealth consults because you saw our advertisements on the internet, and convince you to fly to Rochester (or elsewhere) because it's sooooooooooooo easy to do our 5 fraction proton treatments! We'll connect you with our travel agents, standing by, RIGHT NOW!

Meanwhile...LOOK OVER THERE! IT'S THE EVILS OF VIRTUAL SUPERVISION! GO GET THAT JORDAN GUY! THE DEVIL!
 
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elementaryschooleconomics said:
Obviously, I'm 90% with you on this statement...

But Mayo can literally reach into far-flung communities and pull patients into their machine for proton treatments, regardless of supervision laws, they told us themselves:


Mayo and the SCAROP Institutions:

We will use our residents to conduct telehealth consults because you saw our advertisements on the internet, and convince you to fly to Rochester (or elsewhere) because it's sooooooooooooo easy to do our 5 fraction proton treatments! We'll connect you with our travel agents, standing by, RIGHT NOW!

Meanwhile...LOOK OVER THERE! IT'S THE EVILS OF VIRTUAL SUPERVISION! GO GET THAT JORDAN GUY! THE DEVIL!
Click to expand...
For those who don't want to read the whole paper:

1713580473951.png


IPP = in person patients, VP = virtual patients

(in the context of E&M virtual, not supervision virtual)
 
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Yes, these studies being produced are very business friendly. Poach patient studies are effectively being performed by RadOncs. All of the negative aspects are being done by RadOncs. Whether it's poaching or whether it's promoting virtual RadOncs. It's all being done by RadOncs that think they will somehow benefit from it. But at the end of the day it's just RadOncs tearing down RadOncs and RadOncs racing RadOncs to the bottom in hopes that a few of them benefit over the downfall of others. No matter what it will be a net loss.

PS no one cares about that guy. There are real threats out there. Tigers in the tall grass, they aren't the ones being loud replying to every post on twitter :rofl:.

That publication should be an alarm for everyone here and for any RadOncs that read it. Blue prints are being shown of how to get patients to come get more expensive treatments without proven benefit. It should be worrisome to everyone that VIRTUAL PATIENTS ARE 2.5 AND 2.2 TIMES MORE LIKELY TO GET PROTON THERAPY BECAUSE THEY ARE VIRTUAL VISITS.

Animated GIF
 
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CurbYourExpectations said:
PS no one cares about that guy. There are real threats out there. Tigers in the tall grass, they aren't the ones being loud replying to every post on twitter :rofl:.
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Well

You and I completely agree on that

Unfortunately, and for some absolutely bizarre and insane reason I cannot come close to understanding, many, MANY of the people "inside" ASTRO and ACRO do not agree with us

I can't tell what's happening, honestly. I suspect that SCAROP and peers know a little medicine startup isn't a threat (duh). They can rob the country blind regardless of any of this.

But the people not within the true circle of control/power/whatever you want to call it, starting literally at the next rung down, think Bridge is the harbinger of the apocalypse.

At this point I think it's just a giant, circular game of echo chamber telephone, and they're ramping themselves up more and more and more

I base this on the personal conversations I'm having with these people, and it feels like the tone/tenor of the anxiety over Bridge in particular has stepped up over the last few weeks.

Just...as always: there's a reason that only a half dozen people acting on behalf of ASTRO have weighed in on the topic of ROCR and Supervision.

The 100 SCAROP organizations don't care about any of this, or know that ROCR and Direct Supervision will force further consolidation and therefore, make them even more money.

You can submit antitrust complaints to the DOJ anonymously.
 
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I suspect that small group is nothing but a red herring/scape goat, that is not going to be an issue. If that small business is even remotely successful it will immediately be eaten up by a much more well funded, bigger name institution. Consolidation is going to happen no matter what anyone thinks. People are going to go unemployed just due to numbers, even in a best case scenario. There is not a singular way to stop this without a snap of a genie saying we can start doing medical oncology care without threats for liability.
 
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elementaryschooleconomics said:
For those who don't want to read the whole paper:

View attachment 385707

IPP = in person patients, VP = virtual patients

(in the context of E&M virtual, not supervision virtual)
Click to expand...

Ha what a clever paragraph. Like saying “we used this a lot to recruit prostates for protons, but we’re not saying that, understand?”
 
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CurbYourExpectations said:
Poach patient studies are effectively being performed by RadOncs.
Click to expand...

Tangential, but it is hilarious to me that both ESTRO and ASTRO are doing the green treatment thing.

Yet, only ESTRO talks about how driving to treatment is a huge contributor to carbon monitor units. Im not sure what they are calling them or whatever.

Caveat I have not read these US groups green papers in a while, so please correct me if that has changed.
 
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CurbYourExpectations said:
That publication should be an alarm for everyone here and for any RadOncs that read it. Blue prints are being shown of how to get patients to come get more expensive treatments without proven benefit. It should be worrisome to everyone that VIRTUAL PATIENTS ARE 2.5 AND 2.2 TIMES MORE LIKELY TO GET PROTON THERAPY BECAUSE THEY ARE VIRTUAL VISITS.

Animated GIF
Click to expand...
Correct

And to be clear

THIS IS NOT VIRTUAL SUPERVISION

NOT

VIRTUAL SUPERVISION

THIS IS NOT VIRTUAL SUPERVISION

This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.

Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?

An existing incumbent.

Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.

Want to do a lung cancer screening outreach event?

It better be outside normal business hours!

Want to go have lunch with a referring?

Oh man, hope your therapists and patients are willing to move around the schedule.

Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.

And publish about it, no less!

This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".

I would....again...just highlight the anonymous antitrust complaint link posted above...
 
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elementaryschooleconomics said:
Correct

And to be clear

THIS IS NOT VIRTUAL SUPERVISION

NOT

VIRTUAL SUPERVISION

THIS IS NOT VIRTUAL SUPERVISION

This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.

Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?

An existing incumbent.

Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.

Want to do a lung cancer screening outreach event?

It better be outside normal business hours!

Want to go have lunch with a referring?

Oh man, hope your therapists and patients are willing to move around the schedule.

Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.

And publish about it, no less!

This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".

I would....again...just highlight the anonymous antitrust complaint link posted above...
Click to expand...
I am certain rad oncs as a group are not actually as smart as they think they are because I know a significant proportion have not, and never will, sussed any of the above

I can’t trust you to grasp fully an ITV concept if you can’t grasp the above reality eg
 
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elementaryschooleconomics said:
Correct

And to be clear

THIS IS NOT VIRTUAL SUPERVISION

NOT

VIRTUAL SUPERVISION

THIS IS NOT VIRTUAL SUPERVISION

This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.

Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?

An existing incumbent.

Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.

Want to do a lung cancer screening outreach event?

It better be outside normal business hours!

Want to go have lunch with a referring?

Oh man, hope your therapists and patients are willing to move around the schedule.

Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.

And publish about it, no less!

This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".

I would....again...just highlight the anonymous antitrust complaint link posted above...
Click to expand...
i watched the town hall.
Dr. Michalski thinks that physicians should be in clinic nearly all the time (maybe have an exemption 1 day every 2 weeks).
In my experience more senior faculty at my residency training institution were in clinic like 2 days a week. The rest of the days were academic and post-COVID, many were at home.
I highly doubt that the ASTRO chair is in clinic 9 days out of 10. But maybe some from WashU can correct me.
 
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radoncftw said:
i watched the town hall.
Dr. Michalski thinks that physicians should be in clinic nearly all the time (maybe have an exemption 1 day every 2 weeks).
In my experience more senior faculty at my residency training institution were in clinic like 2 days a week. The rest of the days were academic and post-COVID, many were at home.
I highly doubt that the ASTRO chair is in clinic 9 days out of 10. But maybe some from WashU can correct me.
Click to expand...
For those chairs to be off, somebody else has to be present to see patients.
 
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radoncftw said:
i watched the town hall.
Dr. Michalski thinks that physicians should be in clinic nearly all the time (maybe have an exemption 1 day every 2 weeks).
In my experience more senior faculty at my residency training institution were in clinic like 2 days a week. The rest of the days were academic and post-COVID, many were at home.
I highly doubt that the ASTRO chair is in clinic 9 days out of 10. But maybe some from WashU can correct me.
Click to expand...
Of course

This is do as I say not as I do

It’s really not far off from a well fed person telling the hungry they should eat more food, an employed person telling an unemployed person they should have a job, or a person who can walk telling a paraplegic they need to get their legs moving
 
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TheWallnerus said:
Of course

This is do as I say not as I do

It’s really not far off from a well fed person telling the hungry they should eat more food, an employed person telling an unemployed person they should have a job, or a person who can walk telling a paraplegic they need to get their legs moving
Click to expand...
So many other specialties have real leadership (think gu, rads, derm, plastics).

They don't overtrain, they don't create a long-standing civil war between the private and academic folks within their respective specialties, and some of them are smart enough to create professional/lobbying groups that absolutely blow organizations like ASTRO out of the water when the rubber hits the road (urorads 1, ASTRO PAC 0)

Instead we get folks like Dennis hallahan, L Potters, Jeff Michalski, Steinberg etc. that managed to bring Rad Onc from first to worst in a decade in terms of preference by US medical students

 
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elementaryschooleconomics said:
Correct

And to be clear

THIS IS NOT VIRTUAL SUPERVISION

NOT

VIRTUAL SUPERVISION

THIS IS NOT VIRTUAL SUPERVISION

This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.

Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?

An existing incumbent.

Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.

Want to do a lung cancer screening outreach event?

It better be outside normal business hours!

Want to go have lunch with a referring?

Oh man, hope your therapists and patients are willing to move around the schedule.

Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.

And publish about it, no less!

This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".

I would....again...just highlight the anonymous antitrust complaint link posted above...
Click to expand...
One of your all time great posts...and there are a lot. Make no mistake-the attack on virtual supervision is an attack on private practice. The salary scale is already tipped towards employed positions, but these arrogant pricks like Sameer and Jeff could never humble themselves to allow their docs to run clinics on their own terms. Yes, there are shady private practices, but there are still some good ones that offer their docs tremendous flexibility and autonomy...and the academics still can't compete with that. This is all about imposing burdensome regulations on private docs to squeeze them out of practice.
 
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elementaryschooleconomics said:
Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.
Click to expand...
I'm not sure here. There is no doubt that any supervision requirements at present mean nothing for places like MAYO. Their scale and staffing make the most stringent requirements moot.

But they could still take advantage of direct virtual (which could create an enhanced market for their existing remote services) …also, I doubt they are considering the little community radonc at all.

The deeply ingrained assumption of many academic radoncs is that they provide a differential value over the community, to the point where they advertise their proton treatment as "standard of care for patients under 40" directly to patient's far, far away from their facility. They believe that the diminution of community radonc is in fact ethical.

Meanwhile, this is hardly supported by data ...and it is of course just rationalizing how one should best serve an institution when what you do is both very profitable and, except in rare occasions, equivalently and more affordably provided by the community.

If radonc were a loss leader, nobody would believe in their differential value in most circumstances, protons would remain scarcely disseminated and we would be training roughly 60% of the docs that we are presently.

Reaganite said:
Sameer and Jeff could never humble themselves to allow their docs to run clinics on their own terms
Click to expand...
Is there a notable training program out there that takes pride in producing community docs? Serious question. Mine sure as hell didn't.

Reaganite said:
to squeeze them out of practice.
Click to expand...
Could work either way. Consolidation will come at the hospital level (although history shows that radonc departments may be among the first integrated in a merger). Owning or at least having a very lucrative PSA with a distant community hospital, which you staff remotely regarding multiple specialty services, is happening now and will benefit from virtual direct in terms of staffing radonc and institutional bottom line.
 
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elementaryschooleconomics said:
Obviously, I'm 90% with you on this statement...

But Mayo can literally reach into far-flung communities and pull patients into their machine for proton treatments, regardless of supervision laws, they told us themselves:


Mayo and the SCAROP Institutions:

We will use our residents to conduct telehealth consults because you saw our advertisements on the internet, and convince you to fly to Rochester (or elsewhere) because it's sooooooooooooo easy to do our 5 fraction proton treatments! We'll connect you with our travel agents, standing by, RIGHT NOW!

Meanwhile...LOOK OVER THERE! IT'S THE EVILS OF VIRTUAL SUPERVISION! GO GET THAT JORDAN GUY! THE DEVIL!
Click to expand...

Mayo trainees are basically telemarketers
 
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drowsy12 said:
View attachment 385755
Click to expand...
Interesting take. Of course IMGs have been the backbone of much of community medicine for 40 years. They are certainly the backbone of medical oncology in the community presently.

Per the rural health information hub, "J-1 visa waivers allow rural facilities in or near Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs) to recruit IMGs for vacancies which have been difficult to fill."

This could be DEI, or it could be anti-DEI.

J-1 is one of the best tools that underserved places have to get docs. Is academia underserved?
 
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Academia is not underserved

But many locations are underserved (and really when I say underserved, what I really mean is 'hard to recruit US MDs to'.). Some of these locations have 'academic' name hospitals, some standard non-academic name hospitals, and rarer, free-standing. in rad onc and med onc. they go hand in hand.
 
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drowsy12 said:
Academia is not underserved

But many locations are underserved (and really when I say underserved, what I really mean is 'hard to recruit US MDs to'.). Some of these locations have 'academic' name hospitals, some standard non-academic name hospitals, and rarer, free-standing. in rad onc and med onc. they go hand in hand.
Click to expand...
Yeah...I can only speak from my point of view.

I have no problem with facilitating the most academically ambitious IMGs getting real academic positions.

However, if really what is going on is a push to hire J1 candidates at satellite facilities, this is another example of the scale of consolidation likely hurting access (and value).

J1 candidates have one overwhelming concern....the effectual processing of their visa. This makes total sense, as the consequences of not getting the proper processing are profound. It will be difficult for smaller community places to offer the same assurances as a large center with a large legal team.

I have seen the change in availability of J1 candidates in real time.

Also, certainly hoping that these docs are not getting leveraged into bad contracts.
 
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Agree there is no doubt that visa concerns drive people into certain kinds of jobs and locations. The one I am aware of recently is someone signing a job more than a year in advance to secure their protected status. It wasn’t an academic name hospital, but we should not think that academic names have a monopoly on large systems. There are many non academic corporations that benefit from the same advantages.

My posting of that wasn’t necessarily an endorsement of course, just found it interesting how this is being framed by ASCO
 
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drowsy12 said:
Agree there is no doubt that visa concerns drive people into certain kinds of jobs and locations. The one I am aware of recently is someone signing a job more than a year in advance to secure their protected status. It wasn’t an academic name hospital, but we should not think that academic names have a monopoly on large systems. There are many non academic corporations that benefit from the same advantages.
Click to expand...
Time in advance will be typical for J1 candidates. There is a clock ticking and a lot of work to be done. Early commitment is necessary. A model where an institution puts the work in to secure a J1 slot, pays legal counsel for services and lets candidates commit in March of their graduating year is not tenable (particularly for smaller places).
 
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drowsy12 said:
the youngest boomer is 60 (ends in 1964). there are def some chairs that are still boomers (oldest one is Ralph who is probably bordering on the greatest generation rather than boomer) but I think a lot of chairs these days are Gen X
Click to expand...
Everyone I've referenced previously is a boomer and I imagine the majority of chairs causing a lot of problems for the specialty are Boomer.

Definitely some good Gen X chairs out there but people like Dan spratt and Jerry Jaboin are few and far between and aren't the driving force of what is happening at ASTRO and scarop now
 
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Dan Spratt is a millennial.

Look at that SCAROP picture. lot of Gen X.

My only point was that it’s funny how these generational terms get thrown around but people are old now. Millennials aren’t young and Boomers are less relevant every day.
 
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elementaryschooleconomics said:
For those who don't want to read the whole paper:

View attachment 385707

IPP = in person patients, VP = virtual patients

(in the context of E&M virtual, not supervision virtual)
Click to expand...

GU Malignancies accounted for the largest absolute number of VP treatments

I presume all/mostly prostates

What a poor use of protons.

Protons for CNS in anything besides the non-reirradiation setting? Do GBM outcomes matter whether given by photons or protons???

Meningioma I could potentially see a use for

Craniopharyngiomas/pituitary adenomas would be great if it wasn't for all that darn inability to model the proton accurately

Brainstem gliomas/meningiomas would be great if it wasn't for all that DARN BRAINSTEM NECROSIS (due to inability to model the proton accurately)
 
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evilbooyaa said:
GU Malignancies accounted for the largest absolute number of VP treatments

I presume all/mostly prostates

What a poor use of protons.

Protons for CNS in anything besides the non-reirradiation setting? Do GBM outcomes matter whether given by photons or protons???

Meningioma I could potentially see a use for

Craniopharyngiomas/pituitary adenomas would be great if it wasn't for all that darn inability to model the proton accurately

Brainstem gliomas/meningiomas would be great if it wasn't for all that DARN BRAINSTEM NECROSIS (due to inability to model the proton accurately)
Click to expand...

I don't send GBM's (?where is the NRG trial publication that completed enrollment years ago? )but I have sent some low grade gliomas with favorable biology or complex large meningiomas.

I don't send for brainstem gliomas (and in fact St. Jude sent me someone not long ago and rec'd photons).
 
why are you guys all assuming it is negative? let's wait.
 
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Where is the bone met section?
Arthritis and duputyren's section?
Non-melanoma skin cancer?

All more common than lymphoma referrals in the community.
 
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