ASTRO made our bed with supervision and now APM and evicore. We all get to lay in it, some more than others
The gist I got from the APM final rule was: “Here at CMS, IMRT pre-2010 put us close to the edge but we were willing to let bygones be bygones; after 2010 protons took us over the edge.” As we all know ASTRO is to protons like Linus Pauling was to Vitamin C. ASTRO lobbied hard for protons even as data suggested mediocrity but said IMRT was wrong even when randomized trials proved its worth. “Played yo self” as the kids say. We need to ape that scene from Frankenstein where us townsfolk show up with torches and pitchforks at the ASTRO castle.
I hope he means "not everyone" should be doing that opposed to "not anyone" ... but I think he means the latter.
8-10 hour workday? Geez. I'm hoping that's a max 4 day week 🙂
Theoretically, if someone like you saw 15 consults this week, it also means there has to be a doc out there who saw only one consult.
Fifteen new patients a week equals 750 new patients/year. From a best case scenario of 1.2 million new XRT starts a year and 5000 rad oncs, you're talking 240 XRT consults (all comers: mets, new dx curative, etc.) as the *average* case load per rad onc in the US. It would be close to impossible to maintain 15 new patients/week (ie for one individual rad onc to have 750 new XRT consults over a 1 year period). Not physically impossible... mathematically impossible. Of course, as shown here, one week "blips"/outliers happen. "Theoretically, if someone like you saw 15 consults this week, it also means there has to be a doc out there who saw only one consult"... hmm, more like 2-3 docs who saw only one.
I agree. After 12, it get's into "I'm glad next week isn't as busy" territory. But everyone has their own motivations. Some prefer money, some prefer time away from work. It certainly isn't impossible, or "unsafe." It just requires more of your time focusing on work.
When someone says "I see blah blah a week" I take them to mean they see ~50 times that amount per year. In other words, 2000 consults/year. Not only is it a joke, it's nearly physically impossible and wholly mathematically impossible unless teleportation has been invented and you have the ability/willingness to pay other rad oncs to send you patients (and probably pay patients to drive from long distances to see you).
Or as a medonc for 700k+
Ha true. There are ~1.8 million new cancer cases per year, per ASTRO. However, the dermatologists know there are 3-5 million new non-melanoma skin cancers per year that ARE NOT included in that (paltry) 1.8 million number. And we only get ~1/3 of that ~1.8 million anyways (lots of colon, lymphoma, prostate surgery, mNSCLC or met this and that, etc etc). Or 2/3 of the ~1.8 million, but this is ASTRO's own oft-repeated stat that doesn't even closely jive with what's been published.
First off... you know how much routine hypofractionating is going on in these practices at those WRVUs and those patient numbers??? Rad onc reimbursement is waaayyy artificially elevated right now. Anyways....
Realistically, i take about 2ish or so per year, not sure how i could squeeze in 91.2 consults/month. I'm really curious how you do that scheduling wise with otvs, follow up, planning/procedures etc. Are you seeing 20-25+ consults every week?
Wowie. Let's say "several" months off a year equals just two months. That leaves about 44 weeks a year, i.e. 220 work days... and thus ~4+ consults a day you gotta be seeing. On average. Miss one day, it's gotta be 8 consults the next day, miss two, yada yada. And if 90% of your consults become on-treats, and the average treatment time is 4-5 weeks, that means you're averaging 80-90/day of patients under beam all by yourself. Definitely Wilt Chamberlain-type numbers; places you in the top 25 among 5000 American rad oncs I reckon. (I take long trips driving 80 mph on the interstate but my odometer still keeps saying my average car speed is around 37 mph.) The only thing offensive to me is that almost no rad onc in America can choose to work this hard if he/she so desires.
Hope Tigerstang not offended and don't mean to perseverate over this but it'd be more like the only rad onc in a city of 400K to 500K. The cancer incidence is about 1 in 200, and we only get to see half of those at best, so you could be sole rad onc in city of 400K and have trouble reaching ~1000 consults per year. Which all goes to show, seeing ~1000 consults per year--which I'm sure Tigerstang can ably do--means we only need, like, 600 (1200 max!) or so radiation oncologists in the U.S.
I have a heavier lung/h&n mix, so it would probably be tougher for me to have those kind of days. Definitely can breeze through my prostate/breast service quicker on otv day
This is why, kids, hypofrac is such a big deal. Same patient (consult) load 20y ago would easily equal 90 on treats per day. Now it gets you 60.
" Oh no, @ASTR😵rg for real? Is that what the study found? That's your interpretation? Interesting ... @CShahMD, @Sushilberiwal, thoughts on this? "
This is an absurd amount of work and I will admit that I am incapable of this volume. I see 4-11 consults a week in a diverse community practice with a fair bit of head and neck, lung, gyn, GI and complicated palliative cases (low volume recurrences) and after years of practice have problems culling my follow-ups down to less than 20/week. I try to write good notes. I'm not efficient and probably push 50 hour weeks. Probably 15-20 on beam at a time.
