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scarbrtj said:
I tried very hard to get uro guys on board with fiducials, never took hold. SPACE OAR (pinches nose) reps need to re-visit my neck of woods. Also, I think it helps (re: prostate) to live in a region where the avg age older or more retirees.
Click to expand...
I am way too slow. I pop back on and I am >50 posts behind!

What has worked for me may not work for other due to organization structure, payer mix, etc, and I would love to hear success stories from all of you how you increase multi-D care and referrals.

When I started at U of M in 2015 we had a somewhat small prostate radonc program. About 1 radonc cFTE.
What worked for me was:
1. I changed our multi-D clinic to go into the room at the same time as the surgeon. This kept us both honest, but it also let them become educated on what exactly I say. It built a lot of trust and they learned a lot of fiducials, spacers, SBRT, etc. It also allowed us to have professional back and forth in front of the patient, and I learned a lot about how they view things I was never trained about. Made me appreciate different surgeons skill level and bedside manner too. The multi-D clinic grew from 3-5 patients per half day to 9-13 consults per half day (pre-COVID).
2. I gave early on and every few years a talk on the technological advancements of RT. Most non radoncs dont realize that ProtecT data, as good as it was, was 3DCRT. I show them what a 3D plan looks like, what IMRT is, what IGRT is, what SBRT is, spacers, etc. This was huge for not just prostate but also for SBRT for kidney cancers. I also review toxicity data from RCTs, and not cherry picked studies to show consistency.
3. I overbook patients same day or almost any day. I want them to know patients come first.
4. I make sure to keep them in the loop early on while I built up my practice and trust with them. If a patient was leaning towards RT I told them. I never let patients decide they want RT in the office as I want them to think about it without me in front of them.
5. I make sure to tell the patients how fantastic our surgeons are (obviously I wouldnt do this if I didnt believe it...I am lucky to have amazing surgeons to work with). This shows I am not a cars salesman/woman. Patients hate when they see a surgeon and they tell them to get surgery, and then radonc --> get RT, etc. We tell all patients surgery and RT have the same cure rates and have every patient read the PCF.org patient guide they can download for free. It says it right in there. I tell them side effects are different.
6. As I am at an academic center I make sure all Uro Oncology fellows rotate in radonc and they see with their own eyes how patients do. I make sure to give a few lectures to urology every year.
7. I give talks around the state to big urology groups to let them know about what we offer. Every place has guys who are not good surgical candidates or who want to hear about RT.
8. I educate our urologists about the critical need for early salvage for all patients, and adjuvant should rarely be used. We too care about QOL/continence.

What has this done? In 5 years we now have 3.5 cFTE and over quadrupled our prostate RT volume. I think the surgical volume also increased simply because patients really love hearing a surgeon and radonc both agree that cure rates are equal, but the side effects and logistics are different.

I know this works as when I started at U of M I treated CNS mainly and also almost doubled the program in the first 12 months. We have done the same thing from scratch with a new spine program that is very busy (~250+ spine SBRT cases per year now that started at about 5 per year).

So I believe this is an amazing time for radonc, but we cant view ourselves like radiology or a pharmacist. If we simply wait for the order for RT and we act like a technician than that is how we will be treated. All of you are incredibly smart to be radoncs, and have a unique and powerful vantage point that many specialties dont have. I challenge you to think like an oncologists and that you happen to give RT, not the other way around.

Palliative RT, oligomet RT, etc are booming. We now treat at least 300+ patients just because of PET imaging in prostate cancer we wouldnt have treated before. Medoncs need to see the success (and failures) and work together. Most docs want to do what is best, but we all are so sheltered in our specialties we forget that many people have not seen the amazing responses you all know to be true. We also need to own up and share the bad outcomes with them and ask for help.

Would love to hear how some of you have grown your practices as it sounds it is very hit or miss from the thread.

Any pointers?

Thanks!
Best,
Dan
 
Dan Spratt said:
I am way too slow. I pop back on and I am >50 posts behind!

What has worked for me may not work for other due to organization structure, payer mix, etc, and I would love to hear success stories from all of you how you increase multi-D care and referrals.

When I started at U of M in 2015 we had a somewhat small prostate radonc program. About 1 radonc cFTE.
What worked for me was:
1. I changed our multi-D clinic to go into the room at the same time as the surgeon. This kept us both honest, but it also let them become educated on what exactly I say. It built a lot of trust and they learned a lot of fiducials, spacers, SBRT, etc. It also allowed us to have professional back and forth in front of the patient, and I learned a lot about how they view things I was never trained about. Made me appreciate different surgeons skill level and bedside manner too. The multi-D clinic grew from 3-5 patients per half day to 9-13 consults per half day (pre-COVID).
2. I gave early on and every few years a talk on the technological advancements of RT. Most non radoncs dont realize that ProtecT data, as good as it was, was 3DCRT. I show them what a 3D plan looks like, what IMRT is, what IGRT is, what SBRT is, spacers, etc. This was huge for not just prostate but also for SBRT for kidney cancers. I also review toxicity data from RCTs, and not cherry picked studies to show consistency.
3. I overbook patients same day or almost any day. I want them to know patients come first.
4. I make sure to keep them in the loop early on while I built up my practice and trust with them. If a patient was leaning towards RT I told them. I never let patients decide they want RT in the office as I want them to think about it without me in front of them.
5. I make sure to tell the patients how fantastic our surgeons are (obviously I wouldnt do this if I didnt believe it...I am lucky to have amazing surgeons to work with). This shows I am not a cars salesman/woman. Patients hate when they see a surgeon and they tell them to get surgery, and then radonc --> get RT, etc. We tell all patients surgery and RT have the same cure rates and have every patient read the PCF.org patient guide they can download for free. It says it right in there. I tell them side effects are different.
6. As I am at an academic center I make sure all Uro Oncology fellows rotate in radonc and they see with their own eyes how patients do. I make sure to give a few lectures to urology every year.
7. I give talks around the state to big urology groups to let them know about what we offer. Every place has guys who are not good surgical candidates or who want to hear about RT.
8. I educate our urologists about the critical need for early salvage for all patients, and adjuvant should rarely be used. We too care about QOL/continence.

What has this done? In 5 years we now have 3.5 cFTE and over quadrupled our prostate RT volume. I think the surgical volume also increased simply because patients really love hearing a surgeon and radonc both agree that cure rates are equal, but the side effects and logistics are different.

I know this works as when I started at U of M I treated CNS mainly and also almost doubled the program in the first 12 months. We have done the same thing from scratch with a new spine program that is very busy (~250+ spine SBRT cases per year now that started at about 5 per year).

So I believe this is an amazing time for radonc, but we cant view ourselves like radiology or a pharmacist. If we simply wait for the order for RT and we act like a technician than that is how we will be treated. All of you are incredibly smart to be radoncs, and have a unique and powerful vantage point that many specialties dont have. I challenge you to think like an oncologists and that you happen to give RT, not the other way around.

Palliative RT, oligomet RT, etc are booming. We now treat at least 300+ patients just because of PET imaging in prostate cancer we wouldnt have treated before. Medoncs need to see the success (and failures) and work together. Most docs want to do what is best, but we all are so sheltered in our specialties we forget that many people have not seen the amazing responses you all know to be true. We also need to own up and share the bad outcomes with them and ask for help.

Would love to hear how some of you have grown your practices as it sounds it is very hit or miss from the thread.

Any pointers?

Thanks!
Best,
Dan
Click to expand...

The first big hurdle is getting urology to even agree to a multi disciplinary clinic. Believe it or not them refusing to do an equitable clinic (or any clinic at all) is a thing...I’ve seen it in both academics and private groups.
 
Point 1 is really interesting.

I mean, having a MDC with Urologists is a great first step in-and-of-itself, but tag-teaming a patient with 2 docs in the room at the same time is a really interesting way to do it.

I think you, Dr. Spratt, probably could've landed anywhere and worked your tail off to have a somewhat similar outcome.

That being said - do you think there's any hope of coming up with joint AUA/ASTRO/SUO guidelines that say "All patients, prior to deciding upon a definitive treatment option (surgery or radiation) should be offered consultation with both a urologist and a radiation oncologist"?

My experience is similar to Heenan's above at 2 separate facilities. I know it can be done, as I saw it a CCF as a medical student. MDCs lead to higher utilization of radiation compared to Urologist picking and choosing. How do we go about establishing a MDC at our own institutions?
 
Sorry I said a comment earlier about all urologists... what if the ones you work with are unethical?
 
Dan Spratt said:
I am way too slow. I pop back on and I am >50 posts behind!

What has worked for me may not work for other due to organization structure, payer mix, etc, and I would love to hear success stories from all of you how you increase multi-D care and referrals.

When I started at U of M in 2015 we had a somewhat small prostate radonc program. About 1 radonc cFTE.
What worked for me was:
1. I changed our multi-D clinic to go into the room at the same time as the surgeon. This kept us both honest, but it also let them become educated on what exactly I say. It built a lot of trust and they learned a lot of fiducials, spacers, SBRT, etc. It also allowed us to have professional back and forth in front of the patient, and I learned a lot about how they view things I was never trained about. Made me appreciate different surgeons skill level and bedside manner too. The multi-D clinic grew from 3-5 patients per half day to 9-13 consults per half day (pre-COVID).
2. I gave early on and every few years a talk on the technological advancements of RT. Most non radoncs dont realize that ProtecT data, as good as it was, was 3DCRT. I show them what a 3D plan looks like, what IMRT is, what IGRT is, what SBRT is, spacers, etc. This was huge for not just prostate but also for SBRT for kidney cancers. I also review toxicity data from RCTs, and not cherry picked studies to show consistency.
3. I overbook patients same day or almost any day. I want them to know patients come first.
4. I make sure to keep them in the loop early on while I built up my practice and trust with them. If a patient was leaning towards RT I told them. I never let patients decide they want RT in the office as I want them to think about it without me in front of them.
5. I make sure to tell the patients how fantastic our surgeons are (obviously I wouldnt do this if I didnt believe it...I am lucky to have amazing surgeons to work with). This shows I am not a cars salesman/woman. Patients hate when they see a surgeon and they tell them to get surgery, and then radonc --> get RT, etc. We tell all patients surgery and RT have the same cure rates and have every patient read the PCF.org patient guide they can download for free. It says it right in there. I tell them side effects are different.
6. As I am at an academic center I make sure all Uro Oncology fellows rotate in radonc and they see with their own eyes how patients do. I make sure to give a few lectures to urology every year.
7. I give talks around the state to big urology groups to let them know about what we offer. Every place has guys who are not good surgical candidates or who want to hear about RT.
8. I educate our urologists about the critical need for early salvage for all patients, and adjuvant should rarely be used. We too care about QOL/continence.

What has this done? In 5 years we now have 3.5 cFTE and over quadrupled our prostate RT volume. I think the surgical volume also increased simply because patients really love hearing a surgeon and radonc both agree that cure rates are equal, but the side effects and logistics are different.

I know this works as when I started at U of M I treated CNS mainly and also almost doubled the program in the first 12 months. We have done the same thing from scratch with a new spine program that is very busy (~250+ spine SBRT cases per year now that started at about 5 per year).

So I believe this is an amazing time for radonc, but we cant view ourselves like radiology or a pharmacist. If we simply wait for the order for RT and we act like a technician than that is how we will be treated. All of you are incredibly smart to be radoncs, and have a unique and powerful vantage point that many specialties dont have. I challenge you to think like an oncologists and that you happen to give RT, not the other way around.

Palliative RT, oligomet RT, etc are booming. We now treat at least 300+ patients just because of PET imaging in prostate cancer we wouldnt have treated before. Medoncs need to see the success (and failures) and work together. Most docs want to do what is best, but we all are so sheltered in our specialties we forget that many people have not seen the amazing responses you all know to be true. We also need to own up and share the bad outcomes with them and ask for help.

Would love to hear how some of you have grown your practices as it sounds it is very hit or miss from the thread.

Any pointers?

Thanks!
Best,
Dan
Click to expand...

awesome, awesome post. Will take some of these lessons as I start my practice.

in your lectures to other specialists, what is the % mix between presenting data vs. “show and tell” about RT tech advancements?
 
RadOncDoc21 said:
Sorry I said a comment earlier about all urologists... what if the ones you work with are unethical?
Click to expand...
@Dan Spratt ? How do you address a situation where urologists believe in cryo, hifu etc because they have financial incentives to be aligned with it
 
Dan Spratt said:
I am way too slow. I pop back on and I am >50 posts behind!

What has worked for me may not work for other due to organization structure, payer mix, etc, and I would love to hear success stories from all of you how you increase multi-D care and referrals.

When I started at U of M in 2015 we had a somewhat small prostate radonc program. About 1 radonc cFTE.
What worked for me was:
1. I changed our multi-D clinic to go into the room at the same time as the surgeon. This kept us both honest, but it also let them become educated on what exactly I say. It built a lot of trust and they learned a lot of fiducials, spacers, SBRT, etc. It also allowed us to have professional back and forth in front of the patient, and I learned a lot about how they view things I was never trained about. Made me appreciate different surgeons skill level and bedside manner too. The multi-D clinic grew from 3-5 patients per half day to 9-13 consults per half day (pre-COVID).
2. I gave early on and every few years a talk on the technological advancements of RT. Most non radoncs dont realize that ProtecT data, as good as it was, was 3DCRT. I show them what a 3D plan looks like, what IMRT is, what IGRT is, what SBRT is, spacers, etc. This was huge for not just prostate but also for SBRT for kidney cancers. I also review toxicity data from RCTs, and not cherry picked studies to show consistency.
3. I overbook patients same day or almost any day. I want them to know patients come first.
4. I make sure to keep them in the loop early on while I built up my practice and trust with them. If a patient was leaning towards RT I told them. I never let patients decide they want RT in the office as I want them to think about it without me in front of them.
5. I make sure to tell the patients how fantastic our surgeons are (obviously I wouldnt do this if I didnt believe it...I am lucky to have amazing surgeons to work with). This shows I am not a cars salesman/woman. Patients hate when they see a surgeon and they tell them to get surgery, and then radonc --> get RT, etc. We tell all patients surgery and RT have the same cure rates and have every patient read the PCF.org patient guide they can download for free. It says it right in there. I tell them side effects are different.
6. As I am at an academic center I make sure all Uro Oncology fellows rotate in radonc and they see with their own eyes how patients do. I make sure to give a few lectures to urology every year.
7. I give talks around the state to big urology groups to let them know about what we offer. Every place has guys who are not good surgical candidates or who want to hear about RT.
8. I educate our urologists about the critical need for early salvage for all patients, and adjuvant should rarely be used. We too care about QOL/continence.

What has this done? In 5 years we now have 3.5 cFTE and over quadrupled our prostate RT volume. I think the surgical volume also increased simply because patients really love hearing a surgeon and radonc both agree that cure rates are equal, but the side effects and logistics are different.

I know this works as when I started at U of M I treated CNS mainly and also almost doubled the program in the first 12 months. We have done the same thing from scratch with a new spine program that is very busy (~250+ spine SBRT cases per year now that started at about 5 per year).

So I believe this is an amazing time for radonc, but we cant view ourselves like radiology or a pharmacist. If we simply wait for the order for RT and we act like a technician than that is how we will be treated. All of you are incredibly smart to be radoncs, and have a unique and powerful vantage point that many specialties dont have. I challenge you to think like an oncologists and that you happen to give RT, not the other way around.

Palliative RT, oligomet RT, etc are booming. We now treat at least 300+ patients just because of PET imaging in prostate cancer we wouldnt have treated before. Medoncs need to see the success (and failures) and work together. Most docs want to do what is best, but we all are so sheltered in our specialties we forget that many people have not seen the amazing responses you all know to be true. We also need to own up and share the bad outcomes with them and ask for help.

Would love to hear how some of you have grown your practices as it sounds it is very hit or miss from the thread.

Any pointers?

Thanks!
Best,
Dan
Click to expand...
Great post, Dan, and a wonderful example of how we as radoncs can advocate for ourselves within an academic system. Should be required reading for all new academic attendings.

I'm a partner in a large multispecialty private practice group, and I just wanted to describe the prostate ca tx landscape in my neck of the woods (top 15 metro). Urologic care is dominated by a very large urology group which also has it's own radonc. They're treating anywhere between 60-100 patients with radiation for prostate care: All getting long-course, 45-fraction XRT. I have 38 patients on treatment right now, with only 2 prostate patients for example, both getting SBRT.

We've been able to move the needle a little by offering SBRT and hypofractionation, but it's an uphill battle. Direct-to-patient and -PCP advertising can get the message there a bit, but as you know it's tough to interrupt the abnormal PSA --> biopsy --> urology-led treatment plan train. As a result, we've hired our own urologist to try to make a dent in the market. In addition, as the large primary care/multispecialty groups move towards two-sided risk plans, we're planning to help them see how SBRT and hypofx can provide cost-effective care for their patients.
 
Dan Spratt said:
... we cant view ourselves like radiology or a pharmacist. If we simply wait for the order for RT and we act like a technician than that is how we will be treated. All of you are incredibly smart to be radoncs, and have a unique and powerful vantage point that many specialties dont have. I challenge you to think like an oncologists and that you happen to give RT, not the other way around.
Click to expand...
totally agree with you on this Dan
 
OTN said:
Great post, Dan, and a wonderful example of how we as radoncs can advocate for ourselves within an academic system. Should be required reading for all new academic attendings.

I'm a partner in a large multispecialty private practice group, and I just wanted to describe the prostate ca tx landscape in my neck of the woods (top 15 metro). Urologic care is dominated by a very large urology group which also has it's own radonc. They're treating anywhere between 60-100 patients with radiation for prostate care: All getting long-course, 45-fraction XRT. I have 38 patients on treatment right now, with only 2 prostate patients for example, both getting SBRT.

We've been able to move the needle a little by offering SBRT and hypofractionation, but it's an uphill battle. Direct-to-patient and -PCP advertising can get the message there a bit, but as you know it's tough to interrupt the abnormal PSA --> biopsy --> urology-led treatment plan train. As a result, we've hired our own urologist to try to make a dent in the market. In addition, as the large primary care/multispecialty groups move towards two-sided risk plans, we're planning to help them see how SBRT and hypofx can provide cost-effective care for their patients.
Click to expand...
Also in a decent sized multispecialty group in a very large metro. We hired some urologists and that has increased our prostate volume. Our competitor multispecialty group started hiring PCPs to draw the screening PSA, then send to their preferred urologists for biopsy, who will send back to them for radiation. Perhaps some unmarked envelopes being exchanged along that process. It's brutal out there!!!
 
w00tz said:
Also in a decent sized multispecialty group in a very large metro. We hired some urologists and that has increased our prostate volume. Our competitor multispecialty group started hiring PCPs to draw the screening PSA, then send to their preferred urologists for biopsy, who will send back to them for radiation. Perhaps some unmarked envelopes being exchanged along that process. It's brutal out there!!!
Click to expand...
When are these exchanges happening now a days due to the pandemic? I would assume it’s getting harder to launder/wire money these days but I’m just a small time rad onc in this game. Here I am thankful that my med oncs are sending me bone mets again.
 
RadOncDoc21 said:
When are these exchanges happening now a days due to the pandemic? I would assume it’s getting harder to launder/wire money these days but I’m just a small time rad onc in this game. Here I am thankful that my med oncs are sending me bone mets again.
Click to expand...

Have you considered BitCoin?
 
thecarbonionangle said:
Lots of venmos are being sent
Click to expand...

Which emoji do you put as reason for payment?

You're crazy for leaving a digital paper trail. I only accept non-sequential bills in an unmarked bag left surreptitiously in the back of my Bentley's trunk for my referrals to rad onc.

In turn, I ply my PCPs with viagra samples for their referrals. May have to change that once they catch on that it's gone generic.
 
The reality is this is all geographically-dependent. Dan's approach works great in geographies where there isn't a financial incentive for uros to direct their business to a certain entity. In the kind of scenario, the 3 As really matter. That being said, I've been doing this for >10 years and have built multiple practices in very diverse geographies, and I've never met a urologist who hasn't been offered some kind of incentive for their business. I don't mean this in any kind of shady way either. Prostate IMRT pays big bucks and everyone goes after the uros. Even if there's no direct exchange of funds, somebody somehow somewhere is incentivizing the uro to send to them. Hospitals do this in all sorts of ways, including medical directorship stipends, low-end-of-fmv rental agreements, nurse navigators/case managers instructed to preferentially send to loyal groups, encouraging hospital owned PCPs to send to loyal providers, exclusive or at least preferential ER call, etc. Something tells me uros aren't heading over to main campus to do joint consults with Umich rad oncs for nothing...as admittedly awesome as Dan Spratt seems! My group is lucky in that the local payors have forced the uros to choose among a select few value-based providers, and our competitors are a bunch of old-timers who are incapable of bro-ing it out with the boys.
 
Reaganite said:
The reality is this is all geographically-dependent. Dan's approach works great in geographies where there isn't a financial incentive for uros to direct their business to a certain entity. In the kind of scenario, the 3 As really matter. That being said, I've been doing this for >10 years and have built multiple practices in very diverse geographies, and I've never met a urologist who hasn't been offered some kind of incentive for their business. I don't mean this in any kind of shady way either. Prostate IMRT pays big bucks and everyone goes after the uros. Even if there's no direct exchange of funds, somebody somehow somewhere is incentivizing the uro to send to them. Hospitals do this in all sorts of ways, including medical directorship stipends, low-end-of-fmv rental agreements, nurse navigators/case managers instructed to preferentially send to loyal groups, encouraging hospital owned PCPs to send to loyal providers, exclusive or at least preferential ER call, etc. Something tells me uros aren't heading over to main campus to do joint consults with Umich rad oncs for nothing...as admittedly awesome as Dan Spratt seems! My group is lucky in that the local payors have forced the uros to choose among a select few value-based providers, and our competitors are a bunch of old-timers who are incapable of bro-ing it out with the boys.
Click to expand...
I’m not a bro-it out type of person myself so I guess it’s going to be me making illegal transactions until I can get the legal business going. I never completed watching Breaking Bad so I would assume it all works out in the end.
 
Reaganite said:
The reality is this is all geographically-dependent. Dan's approach works great in geographies where there isn't a financial incentive for uros to direct their business to a certain entity. In the kind of scenario, the 3 As really matter. That being said, I've been doing this for >10 years and have built multiple practices in very diverse geographies, and I've never met a urologist who hasn't been offered some kind of incentive for their business. I don't mean this in any kind of shady way either. Prostate IMRT pays big bucks and everyone goes after the uros. Even if there's no direct exchange of funds, somebody somehow somewhere is incentivizing the uro to send to them. Hospitals do this in all sorts of ways, including medical directorship stipends, low-end-of-fmv rental agreements, nurse navigators/case managers instructed to preferentially send to loyal groups, encouraging hospital owned PCPs to send to loyal providers, exclusive or at least preferential ER call, etc. Something tells me uros aren't heading over to main campus to do joint consults with Umich rad oncs for nothing...as admittedly awesome as Dan Spratt seems! My group is lucky in that the local payors have forced the uros to choose among a select few value-based providers, and our competitors are a bunch of old-timers who are incapable of bro-ing it out with the boys.
Click to expand...
It's really common to see this in any business. You see in other non-medical companies/businesses give complimentary wine bottles, free dinners, etc. for loyal customers EVERYWHERE. It's really a game theory situation where you cannot be the only business that doesn't offer thanks and appreciation. Direct kickback like under the table money exchange is one thing and not saying it cannot be abused, but to give thanks (or should I say thank$) is a common business practice.

I am not saying it is right or whatever, just saying it ain't going away, and we should not be surprised to have to play this game.
 
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DoctwoB said:
Which emoji do you put as reason for payment?

You're crazy for leaving a digital paper trail. I only accept non-sequential bills in an unmarked bag left surreptitiously in the back of my Bentley's trunk for my referrals to rad onc.

In turn, I ply my PCPs with viagra samples for their referrals. May have to change that once they catch on that it's gone generic.
Click to expand...
It depends on my mood. Sometimes it is the eggplant+Shower classic. Sometimes the bottle of champaign or wine or a food one. Sometimes a thumbs up. Urologists always know whats up.
 
Reaganite said:
The reality is this is all geographically-dependent. Dan's approach works great in geographies where there isn't a financial incentive for uros to direct their business to a certain entity. In the kind of scenario, the 3 As really matter. That being said, I've been doing this for >10 years and have built multiple practices in very diverse geographies, and I've never met a urologist who hasn't been offered some kind of incentive for their business. I don't mean this in any kind of shady way either. Prostate IMRT pays big bucks and everyone goes after the uros. Even if there's no direct exchange of funds, somebody somehow somewhere is incentivizing the uro to send to them. Hospitals do this in all sorts of ways, including medical directorship stipends, low-end-of-fmv rental agreements, nurse navigators/case managers instructed to preferentially send to loyal groups, encouraging hospital owned PCPs to send to loyal providers, exclusive or at least preferential ER call, etc. Something tells me uros aren't heading over to main campus to do joint consults with Umich rad oncs for nothing...as admittedly awesome as Dan Spratt seems! My group is lucky in that the local payors have forced the uros to choose among a select few value-based providers, and our competitors are a bunch of old-timers who are incapable of bro-ing it out with the boys.
Click to expand...

I view urology fiducial/spaceOAR placement, and urology involvement in brachytherapy as similar incentives.
 
One other factor that will come into play is that more and more urologists (like myself) are employed and as such will be on some form of RVU model. RP gives decent RVUs, but in the time it takes me to do one (and round post op and see them within global) I could easily earn that many RVUs in clinic. Likewise I have no financial reason to HIFU someone. The number of urologists with a strong financial incentive (technical fees from IMRT, HIFU, etc) is declining rapidly as PP declines.

To be fair there are more incentives then just money (secondary gain, we are surgeons and most like operating, etc.) But it’s not like we’re taking out prostates for the big bucks involved.
 
DoctwoB said:
One other factor that will come into play is that more and more urologists (like myself) are employed and as such will be on some form of RVU model. RP gives decent RVUs, but in the time it takes me to do one (and round post op and see them within global) I could easily earn that many RVUs in clinic. Likewise I have no financial reason to HIFU someone. The number of urologists with a strong financial incentive (technical fees from IMRT, HIFU, etc) is declining rapidly as PP declines.

To be fair there are more incentives then just money (secondary gain, we are surgeons and most like operating, etc.) But it’s not like we’re taking out prostates for the big bucks involved.
Click to expand...
How many rvus is an RP? (And space oar)
 
DoctwoB said:
One other factor that will come into play is that more and more urologists (like myself) are employed and as such will be on some form of RVU model. RP gives decent RVUs, but in the time it takes me to do one (and round post op and see them within global) I could easily earn that many RVUs in clinic. Likewise I have no financial reason to HIFU someone. The number of urologists with a strong financial incentive (technical fees from IMRT, HIFU, etc) is declining rapidly as PP declines.

To be fair there are more incentives then just money (secondary gain, we are surgeons and most like operating, etc.) But it’s not like we’re taking out prostates for the big bucks involved.
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scarbrtj said:
Can't even make a good meme when a person who wants to become a rad onc calls other rad oncs "these people."
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I love how it's turned into an "Us vs Them" thing, where either you 1) think RadOnc is amazing and everything is fine and everything ASTRO and the ABR are doing is great and nothing to see here, or 2) You have concerns about how the specialty is being managed and choices major players are making and by voicing these concerns you are automatically a misanthrope who hates Radiation Oncology.

I uh, think there's a few more shades of Gray there friends.
 
elementaryschooleconomics said:
View attachment 325282

From the Google Spreadsheet just now - guys, we're so vicious.

...vicious in our desire to keep this specialty healthy and vibrant?
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Checked radonc SDN for the first time in a few months? An applicant? Good thinking. In any case, if I ever say, "Just Wow," plz have me drawn and quartered.

Edit: I might remember thinking, I hope I never become like that, too. The short answer is, "you will."
 
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elementaryschooleconomics said:
View attachment 325282

From the Google Spreadsheet just now - guys, we're so vicious.

...vicious in our desire to keep this specialty healthy and vibrant?
Click to expand...
There have been more comments now, which seem to "get" what we're trying to do and where we're coming from. Even mention Simul the Great and what happened to someone like him who tried to affect change via Twitter.
 
OTN said:
There have been more comments now, which seem to "get" what we're trying to do and where we're coming from. Even mention Simul the Great and what happened to someone like him who tried to affect change via Twitter.
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TLDR on simul the great pretty please.
 
Tumba said:
TLDR on simul the great pretty please.
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Dr. Simul Parikh The Great (I like to use his full honorific) is a radonc with Banner Health in Arizona, which is 'affiliated' with MDAnderson. He used to post on here a fair amount, then made the leap to Twitter, where he consistently, smartly, and passionately would argue the points about residency expansion and the job market that we frequently make.

Although his posts were respectful, they went against the ASTRO party line and were obviously contrarian to the goals/ideas ASTRO/MDAnderson has about the current state of our field. He was a tremendously valuable voice, as he was able to argue rather effectively on Twitter.

One day, that Twitter account simply disappeared. I don't want to make guesses as to why, but at the same time I don't think I need to.
 
OTN said:
Dr. Simul Parikh The Great (I like to use his full honorific) is a radonc with Banner Health in Arizona, which is 'affiliated' with MDAnderson. He used to post on here a fair amount, then made the leap to Twitter, where he consistently, smartly, and passionately would argue the points about residency expansion and the job market that we frequently make.

Although his posts were respectful, they went against the ASTRO party line and were obviously contrarian to the goals/ideas ASTRO/MDAnderson has about the current state of our field. He was a tremendously valuable voice, as he was able to argue rather effectively on Twitter.

One day, that Twitter account simply disappeared. I don't want to make guesses as to why, but at the same time I don't think I need to.
Click to expand...

ahhhh thank you! Of course, academics = status quo, don’t rock the boat, outdated ivory tower way or the highway. Seems like that’s a common theme and a lot of institutions big and small, people in charge think they are untouchable. That is why they will eventually get theirs.
 
Tumba said:
ahhhh thank you! Of course, academics = status quo, don’t rock the boat, outdated ivory tower way or the highway. Seems like that’s a common theme and a lot of institutions big and small, people in charge think they are untouchable. That is why they will eventually get theirs.
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I'm not sure, I've started to lose hope that "they'll get theirs". I think the system is set up to continue to reward the behavior of your standard Ivory Tower Academic Physician...unless, of course, we hit an "eat the rich" sort of environment.
 
elementaryschooleconomics said:
I'm not sure, I've started to lose hope that "they'll get theirs". I think the system is set up to continue to reward the behavior of your standard Ivory Tower Academic Physician...unless, of course, we hit an "eat the rich" sort of environment.
Click to expand...

I hear ya. Depends on who/what/where for sure. Time will tell.
 
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