Rad Onc Twitter

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jondunn said:
Pure math is math. Getting the x,y, and the Z of it is the nuance.
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X = number of americans needing rt
Y = number of new starts/on treats per rad onc
Z = number of rad oncs needed
The exact right number is a nuance. Recognizing we're way past it is not.
 
RealSimulD said:
It’s extremely complicated. All of us feel that way.
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Would love for you guys to do another podcast all about the changing working model, with 4 days a week, job shares etc, I feel like you could only get to the surface of a lot of stuff given time constraints. Same goes for Todd’s fraction stuff.

Also as someone who has recently been in the position of hiring, would have loved to hear more about your persoective
 
jondunn said:
Pure math is math. Getting the x,y, and the Z of it is the nuance.
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Maybe agreeing what the x,y,z should be BEFORE you measure it perhaps is nuance. It seems sometimes people get the x,y,z and say "we are under-supplied," then get a new x,y,z later and say "Nah, you know what, this is fine, nothing to see, we are over-supplied but this is very complicated." If no one can agree on what the base truth should even look like... chaos. Does 12 on beam/day, on average, for the average RO sound like where we should be in RO? I have seen people on Twitter argue "I treat 30 a day! No one I know has 12!" I hope the people who say such things can honestly circle back later and admit that... if the x,y,z data shows we are averaging 12/day/RO... that 12 is too low, and the only way to fix it is decrease RO number.
 
Ray D. Ayshun said:
X = number of americans needing rt
Y = number of new starts/on treats per rad onc
Z = number of rad oncs needed
The exact right number is a nuance. Recognizing we're way past it is not.
Click to expand...

1) no one said that there isn’t a problem. Some of you need to stop making up arguments in your head. Not good for you.

2) agree that new starts is a better metric than number on beam, as Chirag points out. We have to move forward with new way of looking at it
 
jondunn said:
2) agree that new starts is a better metric than number on beam, as Chirag points out. We have to move forward with new way of looking at it
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Now this is nuance.

I tend to think that number on beam is still of high importance. Fractions are fluctuating, admittedly; one day, they won't be. At that time, the "number on beam" and its temporal trend will again just be another way of saying "new starts." The two are highly correlated, especially at the individual practitioner level. Oh, and another thing, for now anyways, when it comes to "money talks and bulls**t walks," number on beam is money and new starts is bulls**t. I'm not being glib or greedy, just stating a fact.
 
TheWallnerus said:
Now this is nuance.

I tend to think that number on beam is still of high importance. Fractions are fluctuating, admittedly; one day, they won't be. At that time, the "number on beam" and its temporal trend will again just be another way of saying "new starts." The two are highly correlated, especially at the individual practitioner level.
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Some form of combination of the 2, Y = CPT 7726X + (H&N X pi/3) - (prostate x avg AUA/12) + (DCIS x 4)
 
TheWallnerus said:
The two are highly correlated, especially at the individual practitioner level.
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I disagree. I think they may be highly correlated at an institutional or society level than at an individual level. As Spraker said, he does a ton of SBRT, so he may only have very few 'on beam' at any given time. it can fall apart at an individual level.

number needed on a machine to keep a machine profitable ALSO falls apart at an individual level. Simul pointed out that at his last practice, a number of the sites only needed 6 patients a day to financially make sense
 
jondunn said:
I disagree. I think they may be highly correlated at an institutional or society level than at an individual level. As Spraker said, he does a ton of SBRT, so he may only have very few 'on beam' at any given time. it can fall apart at an individual level.
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No I am saying if you drill down on an individual practitioner, her or his number of new starts will correlate very closely with number on beam. I bet Spratt's, or yours, or my, number on beam, and new pts/week, doesn't fluctuate wildly over time. At a society level, I can make a very good guess at the number of new starts per year (about 1.1m) and the number of fractions (about 16); this means we have about 3.2m under beam per day in the US; divide by ~5750 ROs... simple (not complicated!!!) math means 11.7 RT pts/day/RO under beam. But at the individual level? It's going to be HUGE variation. I need know only Spratt's new starts for year and sample about 20-30 of his cases (for fraction number) and I can nail pretty closely how many on avg he'll have under beam per day. And it won't change a lot over time (~3-5y periods). It *has* changed a lot over time per RO over the last 30y.
 
TheWallnerus said:
No I am saying if you drill down on an individual practitioner, her or his number of new starts will correlate very closely with number on beam. I bet Spratt's, or yours, or my, number on beam, and new pts/week, doesn't fluctuate wildly over time. At a society level, I can make a very good guess at the number of new starts per year (about 1.1m) and the number of fractions (about 16); this means we have about 3.2m under beam per day in the US; divide by ~5750 ROs... simple (not complicated!!!) math means 11.7 RT pts/day/RO under beam. But at the individual level? It's going to be HUGE variation. I need know only Spratt's new starts for year and sample about 20-30 of his cases (for fraction number) and I can nail pretty closely how many on avg he'll have under beam per day. And it won't change a lot over time (~3-5y periods). It *has* changed a lot over time per RO over the last 30y.
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'It *has* changed a lot over time per RO over the last 30y.'


yes, yes it has. the question is how much that matters as a metric.

the metrics that matters to me are: salary and jobs.

assuming all assumptions are correct in your analysis, we have roughly 12/beam for roughly MGMA median (havent looked in a while) of 550-600k. I treat more than that and make more than that, but that's pretty darn good. I think the hospital-based charges increasingly make the math work.

we are less and less of a freestanding field and more and more a corporate and academic field. that's the reality, so we also have to keep that in mind as we evaluate the math.

If the number on beam per doc went from 12 to 15 magically overnight by cutting the number of ROs, I bet a lot of the extra number would concentrate in the hands of high charging academic places, actually. but hell, that's where the jobs are I guess

it's all very interesting
 
TheWallnerus said:
I agree; I think it is complicated. However, the complication is the gathering of the data. If we had accurate data, it wouldn't be complicated AT ALL (yes, I just shouted). The approaches so far have been so superficial and unthorough they've almost always (always?) looked silly through the retrospectoscope. Probably a lot of analogies I could use, but figuring out how to compute pi seemed ridiculously complicated (one guy spent his whole lifetime brute forcing it) until Isaac Newton came along and tried a more thorough and reliable and much quicker approach.
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Three drunk statisticians go to the shooting range. The first misses the target 5 ft to the left; the second misses 5 ft to right; the third throws his hands in the air, and shouts "bullseye".

I think it's knowable macroscopically, but hitting the target for every local market is a little different. That being said, if we could decrease resident numbers with a flexible mechanism, we would be able to course-correct at a later date if we overshoot.
 
RealSimulD said:
The economics are really opaque, but yah, 12 on beam is a “magic” number of a community practice where you’re going to make about the median. When you run pro formas of HOPD, many times 6-7 patients will be plenty to make admins happy at smaller centers.
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Question from the academic bubble:
12 on beam a week, assuming 15-16fx per patient, means approx 4 sims a week (assuming I am doing the math correctly)…are there a lot of folks out there who want to be that busy, but aren’t?
 
jondunn said:
MGMA median (havent looked in a while) of 550-600k
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Even THAT number is hard to pin down. I believe, just because I believe in math and know Medicare "reimbursement spreads" per RO plummeted over 2014-19, that number HAS to fall. It's gravity. We will see.

d8NyrAn.png
 
Lamount said:
Question from the academic bubble:
12 on beam a week, assuming 15-16fx per patient, means approx 4 sims a week (assuming I am doing the math correctly)…are there a lot of folks out there who want to be that busy, but aren’t?
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Definitely.

But I don’t know that those people will get much busier if they are in a situation where they are competing against an academic network site, even if there were less rad oncs. It seems very location dependent.
 
RealSimulD said:
The economics are really opaque, but yah, 12 on beam is a “magic” number of a community practice where you’re going to make about the median. When you run pro formas of HOPD, many times 6-7 patients will be plenty to make admins happy at smaller centers.
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6-7 with good insurance on the technical side. The problem is that while technical fees can be 3-5 x cms, hospitals don’t negotiate similar increase for the prof charges. In fact, I have heard rumors that they will raise tech and quid pro quo with insurer to lower prof. (Adventist health supposedly)
 
forums.studentdoctor.net

Radiation Oncology Metrics

Looking to join a practice that i've been working at for two years. Was wondering how I would go about figuring if my offer is appropriate ie is there a way to find the average collections or pay for someone in a similar situation? Thanks.
forums.studentdoctor.net forums.studentdoctor.net

this is a decent source for metrics. I am sure Simul has the most up to date MGMA numbers given his recent role
 
RealSimulD said:
The economics are really opaque, but yah, 12 on beam is a “magic” number of a community practice where you’re going to make about the median. When you run pro formas of HOPD, many times 6-7 patients will be plenty to make admins happy at smaller centers.
Click to expand...
Totally region and payor dependent. Those numbers aren't going to hold up in socal or sfl. Socal is a pretty brutal market with lots of capitated and Medicaid patients and plenty of providers competing for them
 
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medgator said:
Totally region and payor dependent. Those numbers aren't going to hold up in socal or sfl. Socal is a pretty brutal market with lots of capitated and Medicaid patients and plenty of providers competing for them
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king of the distraction. I said HOPD.
 
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medgator said:
You said "community practices".... I'm sure under HOPPS hospital billing you're correct, under Medicare PFS freestanding probably not
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Freestanding it’s not going to work. Agreed. If wasn’t clear, I meant hospital outpatient department. I don’t have good understanding about break-even for freestanding, but I presume that’s what explains some of the reliance on protracted schedules (as the data shows, freestanding tend to treat longer).
 
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thecarbonionangle said:
Anybody have a list of the programs at risk with recent ACGME changes? Has this work been done?
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There are 6 programs that might close. Maybe. Another 38 that might have to contract. Maybe. Just based on attending/resident ratios. The rotation location restriction changes and subsite numbers are obviously a little more opaque.
 
temujim said:
There are 6 programs that might close. Maybe. Another 38 that might have to contract. Maybe. Just based on attending/resident ratios. The rotation location restriction changes and subsite numbers are obviously a little more opaque.
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What 6- musc?
 
temujim said:
There are 6 programs that might close. Maybe. Another 38 that might have to contract. Maybe. Just based on attending/resident ratios. The rotation location restriction changes and subsite numbers are obviously a little more opaque.
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Post the list. The market has already priced these news
 
No one is closing because of the rule changes. It’s actually going to lead to maybe more programs because they know that there will be no changes for a while. If you meet criteria, you can open / add spots. Pessimistic mood today.
 
anyone know of any place trying to open a program right now? name and shame!
 
RickyScott said:
Let’s just pivot, and drop the whole residency contraction thing. DEI and grievances should be our focus.
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It is the era of the no-answer answer.

How many residents should there be. “This is very complicated.”

How many programs will close after changing program requirements. “It’s more than you might think.”

I don’t think we are very serious people. If we were fighting Russia, we’d get shellacked. If fighting Ukraine, vaporized.
 
TheWallnerus said:
It is the era of the no-answer answer.

How many residents should there be. “This is very complicated.”

How many programs will close after changing program requirements. “It’s more than you might think.”

I don’t think we are very serious people. If we were fighting Russia, we’d get shellacked. If fighting Ukraine, vaporized.
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i used to know a ukranian guy. He was in the russian military. He said that if you pissed someone off they sometimes slice your throat in the middle of the night and be found dead next day and thrown in some bottomless hellpit. Bottomline, never piss off a Ukrainian or a Russian. They know a good hell pit. Rad onc does too.
 
Didnt NY medical college or something post a chair job 1-2 years ago clearly stating they wanted to start a program?
 
TheWallnerus said:
How many residents should there be. “This is very complicated.”
Click to expand...

It's not complicated at all, just depends on what side you're on. You either believe the fee-for-service model means the service provider should get the intended fee or else you believe the company should get all of the fees and pay the physician whatever they want. If you believe the latter, having a huge supply of early career radiation oncologists isn't really a problem, you just hire more than you need and pay them a low salary accepting the fact they will likely not be treating many patients.

The problem is the faction that believes in having a lot of non-busy low-paid staff vs. fewer numbers of busy and appropriately higher paid staff. The former group will necessarily believe that all of the concerns about the job market are nonsense, because coming up with a $300k/year low volume job for someone isn't really difficult. That's all fine, but the problem is that those are truly part time jobs; however they will still require 40 hours a week with a lot of downtime in the office where they are made to do other things they'd probably rather not be doing (most of us went to medical school to practice medicine, after all, and that's all we really want to do). That's how you end up with a lot of very (and appropriately so) disgruntled people posting about their awful experiences and career dissatisfaction on online forums. Seems like a bad idea.
 
Moonbeams said:
It's not complicated at all, just depends on what side you're on. You either believe the fee-for-service model means the service provider should get the intended fee or else you believe the company should get all of the fees and pay the physician whatever they want. If you believe the latter, having a huge supply of early career radiation oncologists isn't really a problem, you just hire more than you need and pay them a low salary accepting the fact they will likely not be treating many patients.

The problem is the faction that believes in having a lot of non-busy low-paid staff vs. fewer numbers of busy and appropriately higher paid staff. The former group will necessarily believe that all of the concerns about the job market are nonsense, because coming up with a $300k/year low volume job for someone isn't really difficult. That's all fine, but the problem is that those are truly part time jobs; however they will still require 40 hours a week with a lot of downtime in the office where they are made to do other things they'd probably rather not be doing (most of us went to medical school to practice medicine, after all, and that's all we really want to do). That's how you end up with a lot of very (and appropriately so) disgruntled people posting about their awful experiences and career dissatisfaction on online forums. Seems like a bad idea.
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Problem with the idea that you can hire large contingent of low paid radoncs who are not clinically productive (model of many academic centers) is that they can also be be fired when times are tough and they will be totally unemployable. To fill up 40 hours, I have notice a lot of these centers have ever increasing documentation requirements and qa committees etc
 
RickyScott said:
To fill up 40 hours, I have notice a lot of these centers have ever increasing documentation requirements and qa committees etc
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Also linac babysitting across the network and of course academic expectations. All of that added together does not a happy rad onc make. Nobody likes to feel like their time away from their home, family, hobbies, etc. isn't maximally productive and efficient. It was actually a big reason I went to med school because I saw my peers going to work for major corporations where they had to go sit in their cubicles from 8-5 even if they, often, literally had nothing to do other than figure out how to look like they were doing something (fluff publications, anybody?). That looked miserable, albeit easy. I think most of us want to be busy at work and leave when we are done.

If you said, hey we don't have a lot of work for you. You can schedule all your patients in the morning and leave at noon if you want or work M-W or something, then that's fine. That's a part time job. It's a bit of a trick to take that same clinical workload, make the person stay until 5, and call that a 1.0 "FTE." And then you will also call the person who treats 30-40 at a time in clinic 4 days a week with one protected admin day 0.8 FTE. Huh? How is the second person less than? Seems suspicious.
 
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