Rad Onc Twitter

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I'm glad the internet was invented, so all the petty drama that used to take place on a local level in individual RadOnc departments has now been set free on a national (international?) scale.

At first I thought, "why are people like this"? But then I remembered the years I spent under the thumbs of faculty with frail egos, and how they treated me and each other, and how their behavior was passed on to the residents and students to emulate for the next generation.

So, in summary:

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Why is she so upset with PP rad onc?

Which one of us burned her
 
Lamount said:
Looks like it was deleted before I could read it. What did it say?
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Surprisingly harsh ad hominem Tweets. I only saw what was directed at Simul and Evan, and heard about the rest in some of my group texts.

I don't want to immortalize it on SDN, because if the doxxing is true then perhaps this person just had some poor judgement this weekend, and if the doxxing is false then I definitely don't want to spread rumors.

Everyone seems on edge these days, so just remember: if you're going to start throwing napalm, make sure you do it from a burner account, because privacy is a myth and the internet is forever.
 
elementaryschooleconomics said:
Surprisingly harsh ad hominem Tweets. I only saw what was directed at Simul and Evan, and heard about the rest in some of my group texts.

I don't want to immortalize it on SDN, because if the doxxing is true then perhaps this person just had some poor judgement this weekend, and if the doxxing is false then I definitely don't want to spread rumors.

Everyone seems on edge these days, so just remember: if you're going to start throwing napalm, make sure you do it from a burner account, because privacy is a myth and the internet is forever.
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He ad hominem'd Simul??? Boo! But like Dave Chappelle just said in "The Closer"... "Man, f*** Twitter, it's not a real place."
 
elementaryschooleconomics said:
Surprisingly harsh ad hominem Tweets. I only saw what was directed at Simul and Evan, and heard about the rest in some of my group texts.

I don't want to immortalize it on SDN, because if the doxxing is true then perhaps this person just had some poor judgement this weekend, and if the doxxing is false then I definitely don't want to spread rumors.

Everyone seems on edge these days, so just remember: if you're going to start throwing napalm, make sure you do it from a burner account, because privacy is a myth and the internet is forever.
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They attacked these guys from their own Twitter account?
 
elementaryschooleconomics said:
Surprisingly harsh ad hominem Tweets. I only saw what was directed at Simul and Evan, and heard about the rest in some of my group texts.

I don't want to immortalize it on SDN, because if the doxxing is true then perhaps this person just had some poor judgement this weekend, and if the doxxing is false then I definitely don't want to spread rumors.

Everyone seems on edge these days, so just remember: if you're going to start throwing napalm, make sure you do it from a burner account, because privacy is a myth and the internet is forever.
Click to expand...

Yikes...

Ashamed to say that I am curious what happened, but I will get over it.

Fear of doxxing is why I only get into heated debates on SDN and not twitter... it's fun to argue without having to worry
 
SubserviantToABR said:
Interesting analysis by Rapp and Amdur: Potential Financial Implications of Substituting Cognitive Medicine for Technical Radiation Oncology Billing Services

I admit, I haven't read the full article and will read it once returning to work tomorrow. Should be good points for discussion here and elsewhere.
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I just did a quick read of the full article, it's a very interesting concept they're exploring here. I'll also read it more thoroughly later.

The actual content of the paper aside...Bob Amdur is great. This guy has just been consistently a positive force for Radiation Oncology. I've read a lot of his work, spent time with him in real life, and I wish we could have 100 more people like him in this specialty.
 
elementaryschooleconomics said:
I just did a quick read of the full article, it's a very interesting concept they're exploring here. I'll also read it more thoroughly later.

The actual content of the paper aside...Bob Amdur is great. This guy has just been consistently a positive force for Radiation Oncology. I've read a lot of his work, spent time with him in real life, and I wish we could have 100 more people like him in this specialty.
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He is really f—ing smart
 
OTN said:
I don’t understand why she thinks she gets an opinion on radonc staffing in a multi-D group.
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My take is that an increasing number of docs outside the field are sensing that “there is something rotten in the state of Denmark” when it comes to radonc, but don’t really understand the dysfunctional dynamics.
 
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OTN said:
I don’t understand why she thinks she gets an opinion on radonc staffing in a multi-D group.
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The implication is that the two rad oncs who hog all the business in her city are greedy and are holding the field back and screwing new grads. Why she feels this strongly about them would be a juicy story!
 
OTN said:
I don’t understand why she thinks she gets an opinion on radonc staffing in a multi-D group.
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From their perspective it doesn’t make sense and bothers them that those two rad oncs are surely killing it and they occasionally have to wait for their patients to be seen. They mad mad mad
 
Some high level surgeons who pride themselves on the highest of high value care hate to see their patients have to go to a random guy/gal in a strip mall. I’ve heard this before.
 
all of medicine has the issue of the same people who sit at the top gobbling all opportunities for others. In our small field, this dynamic is highly amplified. Same crew gobbles up all NRG, ASTRO, ACRO,ACR, ABR, ABS, ARRO opportunities. They also sit at the top in cities and refuse to bring anybody in because it would hurt their bottom line. The best thing that could happen to this field is to have most people over 55 start winding down to retirement. How many more lines do you need on your resume? How many more senior authorships must you gobble up at NRG preventing others from benefitting? How much money do you need?

Greed!
 
I’m looking forward to reading, too! Love idea of a cognitive based payment.
 
Okay, I read it. Was not what I was thinking.

Basically, it was saying that instead of being a 1.0 FTE as an RO, can consider being 0.8 FTE as RO and then 0.2 FTE doing things that a hospitalist, palliative care physician or general internist does. So for 20% of your time, you are doing things that you typically would refer to someone else to do (admitting a patient, managing palliation, tweaking lipid medications).

Those other specialties tend to make lower absolute wRVUs, however, because of downstream capture of revenue, they get paid more $/RVU.

So, they calculate that a RO spending 20% of their time in one of those specialties (considered cognitive rather than technical), they would not lose 20% of their income, it would be more like 8%.

I am not sure of the point of analyzing it this way? My thought was they would consider paying us on management of the patient - i.e. you still earn something if you recommend omission of RT or active surveillance of prostate cancer (not just the E&M, but the cognitive aspect of managing these patients).

I'm going to summarize this in a tweet.
 
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thecarbonionangle said:
The implication is that the two rad oncs who hog all the business in her city are greedy and are holding the field back and screwing new grads. Why she feels this strongly about them would be a juicy story!
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There HAS to be more to that story. Only two RadOncs serving a population that has 40 MedOncs and 8 surgeons?

Just extrapolating from my own experience: I'm usually at one site with another doc. I have a significantly smaller pool of referring docs (5-6 MedOncs who basically exclusively refer to my group) and I personally have around 35 on beam right now, with a mix of everything except Pediatrics. I have no residents or mid-levels, and I stay busy.

If you took my area's practice/referring pattern, and scaled it up ~8 times...that would put me at like 250 patients on beam, which is just a completely fictional workload. Even if you cut it in half, I don't see anyone carrying 100 patients on beam by themselves for a sustained period of time.

However, maybe I'm wrong. Are any of you guys doing that? Thinking of my current experience, and what I would need to go from 35 to 70 on beam (routinely) without losing my mind, perhaps I could do it with a bunch of mid-levels handling all the notes/problem visits/phone calls and a few Dosimetrists who could contour everything, always (except target volumes) and routinely produce plans that require little to no editing prior to approval.

But then that leads us back to the oversupply problem. If there are practices out there that have figured out how to provide radiation therapy services to an area which can support 40 MedOncs with only two RadOncs, then in an era of decreased reimbursement but increased practice consolidation and VC/private equity-backed endeavors, things are even more bleak than I thought.

There absolutely has to be more to that story.
 
jondunn said:
looks like the breast surgeon works in texas

texas is famous for this. it's a weird place for rad onc.
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Yeah that would be the other scenario where I could see this as "reasonable". If you were a breast-only RadOnc, equipped with mid-levels and good Dosimetry/Physics, you could probably handle a pretty high caseload.
 
SubserviantToABR said:
Looks like she was in San Antonio with Texas Oncology before going to Austin? https://www.texasoncology.com/who-we-are/news/2019/breast-cancer-genetic-testing

Looks like there are 4 rad oncs at Texas Oncology in the San Antonio area: https://www.texasoncology.com/cancer-centers/san-antonio-area/cancer-treatments/radiation-oncology
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Maybe the rad oncs told her they were the only rad oncs in the area and she never checked. I actually knew a group that had different offices who would tell docs they were competing docs… kind of misleading but I guess all is fair now a days.
 
RickyScott said:
Q

Bach in day, I always heard Texas oncology was a great practice for radoncs.
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Yup..... Pretty sure it still would be if we were graduating 120/year. Topa likely didn't increase their new jobs to account for all the extra residents coming out.
jondunn said:
well they ain't hiring!
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U jelly?
 
medgator said:
Yup..... Pretty sure it still would be if we were graduating 120/year. Topa likely didn't increase their new jobs to account for all the extra residents coming out.

U jelly?
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Doing some thinking. In the area where I took my first job, and it’s a growing and thriving area with hospital based and freestanding, there’s not been a net add of ROs in 18 years.

If we say that there were 3500 ROs in the US in 2002 and 6000 in 2022, that’s 2500 new ROs (net add 125/year). How many have been added in private practice, non academic?

I would say the number is 500 or less. Which means I am saying America is adding 25 or less PP RO jobs per year. I wager some simple digging would back up my educated guess.

When/if academic job add gravy train stops, the breadlines will commence.
 
‘Which means I am saying America is adding 25 or less PP RO jobs per year’


Are you saying 25 new hires a year or 25 new jobs
 
jondunn said:
‘Which means I am saying America is adding 25 or less PP RO jobs per year’


Are you saying 25 new hires a year or 25 new jobs
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It is the correct conclusion 🙂
(Within a 95% CI)

One way to invalidate my math is look at your state and four nearby states. Look at all the pure PP ROs in practice in those 5 states. Go back in time 5 years. If there are *net* new more 5 ROs today than 5 years ago then America is probably adding/producing the need for more than 25 PP ROs per year. FWIW, this number (25 new PP jobs per year) has almost zero probability being greater than 50.

“Are you saying 25 new hires a year or 25 new jobs”

When I say there are 6000 active ROs today and 3500 20 years ago, what do you think?
 
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TheWallnerus said:
I would say the number is 500 or less. Which means I am saying America is adding 25 or less PP RO jobs per year.
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I think you're right (at least within a factor of 2). I'm just extrapolating from the roughly 1M area where I know every hire.

jondunn said:
Are you saying 25 new hires a year or 25 new jobs
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I'm interpreting as net, meaning there were retirements and other losses that were replaced but don't count towards net job creation. The main point for me is that the dramatic consolidation referenced in the other thread must be almost strictly a function of academic expansion.
 
communitydoc13 said:
I think you're right (at least within a factor of 2). I'm just extrapolating from the roughly 1M area where I know every hire.


I'm interpreting as net, meaning there were retirements and other losses that were replaced but don't count towards net job creation. The main point for me is that the dramatic consolidation referenced in the other thread must be almost strictly a function of academic expansion.
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I like to make my guesses being almost 100% certain not to be wrong within a factor of two 🙂

That said even 50 net new PP jobs per year for the whole country is still a shockingly low number given that we pump out 200 (and growing) grads a year. 25 though I think still better models the data. I have tracked academic job growth and it DWARFS PP job growth.
 
The private practices I know fairly well:

My old firm, inova group and SERO - all are larger than when I applied / interviewed.

There is a lot of variance in this field. That’s why that breast surgeon has her opinion about our numbers. If she says she is having access issues, it’s probably true for her.

Anecdotes don’t work well when this field is as small as it is.
 
RealSimulD said:
The private practices I know fairly well:

My old firm, inova group and SERO - all are larger than when I applied / interviewed.

There is a lot of variance in this field. That’s why that breast surgeon has her opinion about our numbers. If she says she is having access issues, it’s probably true for her.

Anecdotes don’t work well when this field is as small as it is.
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Which is why we have to stick to numbers, not anecdotes. We have added 2000-2500 new RO jobs in America in the last 20 years. All that’s left to “guess” after that is what proportion is academic and what proportion wasn’t. I think the data shows it’s about 80/20.

SERO had 20 ROs in 2003: https://web.archive.org/web/20030203051408/http://www.treatcancer.com/physicians.htm

By my count they have 35 now.

The largest PP group in the southeast, in one of the growing-est regions of the SE, is adding ~0.8 new ROs per year. That is... probably in-line with ~25/year new PP jobs for the whole country IMHO.
 
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RealSimulD said:
The private practices I know fairly well:

My old firm, inova group and SERO - all are larger than when I applied / interviewed.

There is a lot of variance in this field. That’s why that breast surgeon has her opinion about our numbers. If she says she is having access issues, it’s probably true for her.

Anecdotes don’t work well when this field is as small as it is.
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It is not true for her, and she is getting dangerously close to making libelous statements about a practice against which she competes in a regulated marketplace.
 
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