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A low dose of adjuvant glp1 would probably prevent more recurrences than an AI and probably would provide an os benefit vs radiation.
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Hmmm...
1. I also didn't get to go the Hamptons when I was 25-32.
2. I was also not a partner at age 35.
3. And if I could fill Madison Square Garden with my surgeries, then I must have made some very bad financial decisions, if I had to work until 66 and not be able to FIRE.
Maybe it's just another overdramatic urologist?
Discuss!
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Idk we interviewed a US RO who was towards the end of their career a few years back who was at a high volume academic centre of prominence. It came up during our dinner that that individual had made certain choices so they never ended up getting married implying work got in the way. It can happen anywhere just due to the nature of medicine I think.
Uro here: The key line in this is "All self imposed," which, to the poster's credit, he acknowledged.
Plenty of uro jobs out there (I can't get spam recruiters to stop texting me), many 4 days a week, 830-5 gigs (sure some earlier days when operating). Hospital call is typically optional or relatively light. Sure less work often = less money, but we're doing just fine, and many of those grinding like this are the academics who could work less and make more by not striving to be a chairman.
One more reason to get out earlier? No marriage, no kids, less expenses, more chances to earn serious money?
Just walk away. The world will go on without you doing TURPs.
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There is a quality discussion going on in regards to virtual supervision. I stand closer to Shah than McBride on this though both have excellent points. I don't love filtering things through accreditation but I also absolutely loathe that anything PPS-exempt gets any voice in regulatory discussions, they have less skin in the game and operate in their own set of rules. I have no problem with off line film review or even treatment without a doc in the building, but I think overall more virtual care is a reduction in quality of care in general.
Definitely great contributions from both Shah and McBride. They both make great points, but are somehow talking past each other.
Government control of where I am going to be doing my job and how I do it is god awful.
Devaluing our codes based on this would be awful.
But, big centers using virtual medicine to out compete local centers is concerning, as well, particularly with hypofx/SRS/SBRT.
I think a joint point - counterpoint would have been better - because I think a lot of us agree on broad points and would like both some flexibility and some protection against cuts/AMC competition.
I don't know that I think Sean is saying this b/c it benefits his large center. I think people even in smaller centers have similar viewpoints. But, I am not sure that mandates from the Feds about the percentage of time I'm in my chair is good either.
“Work” can be a convenient excuse but people usually have other reasons for life regret, maybe they have the personality of a toadstool or they enjoy the single life in their 30’s/40’s or they just ugly af.
My sense is that with very little opportunity for ownership and CMS heavily penalizing owners and small shops, that the optimal path is to work a 2-3 day a week job, make above average mgma though without ownership economics, treat patients and staff well, and do not put in extra time or effort into work.
Learn from Odysseus and do not spend your prime years at work away from your family, fighting battles you can’t win anyways
I saw what they did to my former chairman. They tossed him out like garbage despite being one of the biggest names in the field with a well-funded lab, active clinical trials, recent high impact publications, etc. Without any input from the faculty, they replaced him with a nobody from outside of the institution who obviously disrespects him at every opportunity and tries to force him to quit.
After being in academics long enough, I'm not sure it's worth it to even fight within academics. Maybe you're the boss temporarily, but to what end?
After being in academics long enough, I'm not sure it's worth it to even fight within academics. Maybe you're the boss temporarily, but to what end?
Hey that’s my partner !! Who gave him the time off to go to PGH???
Tell El Franco to lose the serifs. Hard to read
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Old heads love the blue background with yellow font powerpoint aesthetic.
Number one indication for XRT has been deescalated over the last 40 years
The number of rad oncs has been escalated
Makes sense
Still my favorite. Also, love the serif font. Hopefully only a few picture graphics (maybe with axis labels inappropriately cropped) and maybe a photo of family in there as well.
Definitely no animation.
This and a few forays away from the podium is all anyone ever needs.
Heh. If that is true then the rate is too high.
I agree with this. Only the professional societies have the resources and expertise to analyze regulatory and legislative changes, educate the membership, and advocate for what is most likely to be beneficial for the specialty. The latter point may not apply universally, but by and large the changes ASTRO advocates for would be better for our practice than most MPFS proposed changes as written. Without the expertise of specialty societies, we are all on the menu for the AHA, AHIP, and PhRMA wolves.
I'm sure the intentions are good (for the most part). The results have been dreadful.
I’m not even sure the intentions are good - or at least not good for everyone. If they are, then the approach shows total incompetence.
lets look at heme/onc as an example. For an employed heme/onc, reimbursement is entirely dependent on e/m rvus and has little to do with drugs and infusion services . $/rvu is set by supply and demand of docs.
If anything, Astro supports increasing the supply of radoncs. If you are employed, Astro is largely there to hurt not help you. If cms increased proffesional reimbursement by 50%, my salary is not increasing. It would still be set by how much it would cost the hospital to replace me.
If anything, Astro supports increasing the supply of radoncs. If you are employed, Astro is largely there to hurt not help you. If cms increased proffesional reimbursement by 50%, my salary is not increasing. It would still be set by how much it would cost the hospital to replace me.
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Well, you know what the road to hell is paved with ...
After engaging with ASTRO for years, my conclusion was that I was essentially paying them to dig my own grave. Hence i cancelled membership. If your goal is political advocacy, there are better choices out there IMO.
Completely false in PP
Yes- this is for employed radoncs.
Not really.
ASTRO has been anti freestanding center/physician ownership for years to decades.
Anti urorads, anti in office ancillary exemption, anti bundled payments through their PAC
It was very clear who has been buttering their bread long term
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For years, I relentlessly posted on Sdn that large nonprofits were charging 5x cms, and most thought was crazy. (I guess they assumed MDACC or UPenn would be a good sport, leave money on the table, and not benefit from the name or market leverage.)
Same is going to be true with supply and demand and employed docs. If you are employed, the proffesional cms fees are largely irrelevant to your salary. Not sure how so many have such a hard time grasping elementary school economics in supposedly technical and data driven specialty.
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The post implies revenue for large departments will fall when in fact it almost certainly will increase faster than inflation. Whatever happens with cms will be far outweighed by price increases from the monopolistic leverage of ever consolidating large non profits. Health care expenditures and college tuition are completely unsusaitanble
(Brian is a good guy btw)
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“yes everyone saw this coming”
Well I am just gonna call BS on that a little bit. I was discussing with Brian late 2025 that this was going to be a disaster for freestanding. He disagreed. Do we not remember the late 2025 ASTRO town hall where they said this was all a “win” for the specialty? There are/were writings on the ASTRO website that payers could no longer deny IMRT eg and that prior auth for that would go away Jan 1 2026. I don’t want to say people were ebullient but there was definitely no sense of doom and gloom leastways not to the extent of doom and gloom that existed in the spring and summer of this year.
It’s all water under the bridge. Now. But as my dad used to say “one of these days we’re all gonna have to get together and be honest.” It’s *OK* to say that the reps we had to RUC and the AMA made some mistakes. That ASTRO didn’t do enough payer feed forward in 2025 etc. If no one admits some mistakes (mispredictions) were made we could never hope to learn from them. Unless everything was perfect stem to stern and “nothing to see here, carry on about your business.”
It’s one thing to get hammered by CMS due to lack of competence, foresight and influence from your professional society. It is another thing to pay for the privilege.
There are plenty of things I can do to damage my professional career for free.
He doesn't get to tell me, or anyone else, who I get to criticize or how. Where he gets the idea that he gets to silence my voice because he disagrees with what I have to say is beyond me. His post goes straight into the evidence bin showing why this board has to exist.
It's especially rich considering radoncs outside the academic cabal have tried to join ASTRO and were told to piss off.
ASTRO did a historically bad job negotiating with CMS this past year, but they don't care because it doesn't affect their centers. This guy can put a camera 6 inches from his face and talk down to everyone as much as he wants, but it doesn't change those basic facts.
Not everyone! I wrote about falling off the cliff in fall of 2025. The analytics showed it was pretty widely read.
It was strictly math. There was no guess work. It was clear that it was going to be a bloodbath.
It was strictly math. There was no guess work. It was clear that it was going to be a bloodbath.
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Same. I circulated that CMS letter and encouraged everyone to send it and was told to let our professional societies handle it.
Hopefully everyone sees now that we need to advocate for ourselves to have any chance.
“Hopefully” doing Herculean heavy lifting in that sentence. About five people nationwide have contributed to challenge Evicore’s sweeping anti LDRT policy that takes effect in a few days. Admittedly zero societies or companies seem to have done so; meetings with Evicore were scheduled and had however. Hopefully those advocacy efforts will work someday.
Hope is not a strategy. However I can’t immediately come up with good evidence that our field thinks it isn’t. Have no pity for a man holding a shovel praying for a hole.
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Very few academic centers care about benign disease- I distinctly remember one resident being excoriated for having the temerity to bring a benign case to teaching rounds one time. How dare he. A relative of mine was treated for prostate cancer at an academic center a few months ago and asked if he could get his OA pain treated. We_don't_do_that_here.wakanda resulted.
If I had my tinfoil hat on, I would say that ASTRO actively doesn't care about benign disease because it's mainly benefitting freestanding centers, which they want to see shut down. If I had that hat on. Which of course I don't. So, I guess we can attribute ASTRO's silence about Evicore's policy to simple ineptitude. It's either that or malice, but that's the tinfoil speaking.
If I had my tinfoil hat on, I would say that ASTRO actively doesn't care about benign disease because it's mainly benefitting freestanding centers, which they want to see shut down. If I had that hat on. Which of course I don't. So, I guess we can attribute ASTRO's silence about Evicore's policy to simple ineptitude. It's either that or malice, but that's the tinfoil speaking.
Whenever an insurance UM doc cites Evicore guidelines like it’s UpToDate or nccn, I just can’t take them seriously. It is as if Regeneron or Pfizer has its internal “experts” write guidelines that Skyrizi can be used to treat hair loss, thank you for the unbiased expert conclusion ya profiteering illiterate gerbils
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Define "better." If better means surgery should be considered first by a surgerizable patient and SBRT considered if the patient refuses surgery (i.e., thoracic surgery should get "right of first refusal"), NCCN guidelines think surgery is better. If forced to make an honest, literature-based case one way or the other for a healthy patient with a long life expectancy, I would give surgery the edge on the probability of maximizing long-term survival. Obviously SBRT gets the edge for immediate post-procedure mortality, overall convenience, and likely cost as well. If I found out I had stage one NSCLC tomorrow I would get surgery.
Agree. I think his post was almost more about it’s weird for Evan to make that post about a specific patient and a specific case we know nothing about
Not a good look ever for rad onc to go full IR
I have questions that I wouldn’t post like I wonder why he got a lobectony rather than a sublobar resection which is the current SOC for small tumors, may have been on the bigger side
Not a good look ever for rad onc to go full IR
I have questions that I wouldn’t post like I wonder why he got a lobectony rather than a sublobar resection which is the current SOC for small tumors, may have been on the bigger side
documented as less than 3cm iirc from some report
But personally I think Evan’s post was fine. The news piece was like Pope got out of hospital 4 days after surgery. It is very true to observe if he’d got SBRT he’d be out the clinic in 5 mins. If that can offend anyone’s delicate sensibilities I fail to see why.
It's fine, but when you have a reputation of fighting every little battle against "the haters", when you're saying getting standard of care is sus ... idk. I think SBRT would have been fine, but it's not SOC for that unless medically inoperable or patient declines. Presume pontiff is a guy that listens to his doctors. Similar to if a patient had a rad cys for T2 bladder cancer. Of course we can say CRT would have preserved his bladder, but SOC is SOC. It's an odd battle, in my opinion, particularly without reviewing the case in detail.
