Rad Onc Twitter

[thecarbonionangle]

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My point is any practice that gets off on weird “prestige” is an absolute turn off for me. Country club culture ruined this field, created a toxic culture of taking advantage of people. Guess what rad onc is a bottom of barrell field now. Nobody cares about your “prestige” and “eliteness”.

 

[deleted1111261]

MCI and INOVA have both posted for “fellowships”. Minesh and Gopal love a good IMG slave.
PPs have tried to open up residencies. It is known!

Which ones have tried to open up residencies ?

 

[deleted1111261]

Long path

King path not far from truth!

 

[TheWallnerus]

I see no reason to believe the median is not lower than 500-550 when that number comes up again and again and again…..and again.

I’m sorry that your machinations of guesses of Medicare payouts per practice don’t jive!

ACRO declares the average rad onc salary is $400K. Their inaccuracy triggers me.

Although I think I might steal “radioeconomics.”

 

[deleted941485]

Very short sighted to concern yourself with early lower salary. But it does take til year 10 to really see the good good.

10 years of being underpaid makes no sense in rad onc. It didn’t even make sense in the early IMRT days. It’s just a tool to string you along and the high risks of just being in a specialty that’s basically slowly going out of bussiness isn’t exactly a receipe for success.

Grads should be trying ti make the best of a ****ty situation that will likely get worse. Take an employed job that pays reasonable and then pivot to admin. If your health system has other retraining programs maybe make in roads there.

 

[deleted941485]

ACRO declares the average rad onc salary is $400K. Their inaccuracy triggers me.

Although I think I might steal “radioeconomics.”


View attachment 351633

I have been paying and yet the cuts still seem to come and not just from CMS! Seemed to be getting stabbed in the back by my own.

 

[deleted1111261]

10 years of being underpaid makes no sense in rad onc. It didn’t even make sense in the early IMRT days. It’s just a tool to string you along and the high risks of just being in a specialty that’s basically slowly going out of bussiness isn’t exactly a receipe for success.

Grads should be trying ti make the best of a ****ty situation that will likely get worse. Take an employed job that pays reasonable and then pivot to admin. If your health system has other retraining programs maybe make in roads there.

In general, maybe so. But an investment in real estate and technology/linac is maybe to you wasteful / inefficient, but to many it makes sense.

 

[deleted941485]

In general, maybe so. But an investment in real estate and technology/linac is maybe to you wasteful / inefficient, but to many it makes sense.

Unless you plan on living like a resident and sinking most of what you make into an already over priced market, this strategy isn’t for you. Most grads aren’t budding real estate gurus and taking a master class on how to get rich in real estate isn’t really a viable strategy. Also they have enough debt to make a banker blush that you cannot discharge in a bankruptcy.

Investing in a linac is nice but let’s be honest…hospitals and old boomers own linacs. Linacs are like anything else they get old need repairs and eventually die. I’m not interested in owning a piece of your Clinac 2100X you bought in 2001 that you convinced a bunch of idiots is the state of the art.

 

[TheWallnerus]

Unless you plan on living like a resident and sinking most of what you make into an already over priced market, this strategy isn’t for you. Most grads aren’t budding real estate gurus and taking a master class on how to get rich in real estate isn’t really a viable strategy. Also they have enough debt to make a banker blush that you cannot discharge in a bankruptcy.

Investing in a linac is nice but let’s be honest…hospitals and old boomers own linacs. Linacs are like anything else they get old need repairs and eventually die. I’m not interested in owning a piece of your Clinac 2100X you bought in 2001 that you convinced a bunch of idiots is the state of the art.

I will buy that linac where is it 🤣

 

[deleted1116990]

Sure, if you've got a doc burning a hole in the chest with 125 Gy, or melting pelvises routinely, that's one thing.

But if you've got someone who can get the radiation in the ballpark of the correct anatomy, and give a dose of radiation that's within a realm of reasonable, and at least talk the talk in a halfway coherent manner - I can 100% guarantee you that doc will have a 30+ year career.

I work closely with someone who has made a long career of similar things to 125 Gy leaving holes to the chest (yet claims high success rates with low toxicity because you can claim that when you don't follow your patients), and he has still managed to make an extremely lucrative 30 year PP career anyway. SOME referrings have finally stopped sending patients, but not all.

The thing that drives me completely insane is the false expectations doctors like him have left in their wake of only caring about patient experience on treatment. They inappropriately hypofractionate and cause late toxicity that nobody in clinic ever sees and they undertreat with tiny volumes (op bed and ipsilateral level 1-2 only for oral tongue, prostate fossa about a 3rd of the size it should be, etc.) to avoid acute toxicity in situations where that is not an option, put on break inappropriately, etc. So when you appropriately treat an anal or vulvar cancer or inflammatory breast cancer or something and cause the expected acute toxicity and treat through it with the appropriate goal of curing their cancer, it is spun that you are harming patients and don't know what you are doing because Dr. Boomer would never burn somebody like that.

 

[Krukenberg]

In general, maybe so. But an investment in real estate and technology/linac is maybe to you wasteful / inefficient, but to many it makes sense.

This is the truth. Some want the higher salary without equity. But, the “capital” in capitalism means the riches go to owners of capital. This is something the surgeons and endoscopists understand.

 

[DoctwoB]

Looks like SERO is living their best life, flush with cash right now!

Anyone else find pictures like that incredibly cringy?

C-suite types and docs who probably have never worked a manual job in their life posing with shovels and bulldozers. .

 

[RadOncDoc21]

10 years of being underpaid makes no sense in rad onc. It didn’t even make sense in the early IMRT days. It’s just a tool to string you along and the high risks of just being in a specialty that’s basically slowly going out of bussiness isn’t exactly a receipe for success.

Grads should be trying ti make the best of a ****ty situation that will likely get worse. Take an employed job that pays reasonable and then pivot to admin. If your health system has other retraining programs maybe make in roads there.

Especially when the first job is unlikely the last job. I say sieze the moments in life!

 

[Mandelin Rain]

Anyone else find pictures like that incredibly cringy?

C-suite types and docs who probably have never worked a manual job in their life posing with shovels and bulldozers. .

Are the hard hats just in case they start hitting each other with the shovels?

 

[deleted941485]

I find even the sight of corporate overloads and their syncophant physicians incredibly nauseating.

 

[thecarbonionangle]

Anyone else find pictures like that incredibly cringy?

C-suite types and docs who probably have never worked a manual job in their life posing with shovels and bulldozers. .

Yup it looks incredibly phony to see old white men in tailored suits holding shovels with single hands with no calluses. May as well take a picture stepping on someone’s neck. That is more representative of what is going on.

 

[elementaryschooleconomics]

they undertreat with tiny volumes (op bed and ipsilateral level 1-2 only for oral tongue, prostate fossa about a 3rd of the size it should be, etc.) to avoid acute toxicity in situations where that is not an option, put on break inappropriately, etc.

This is, in my estimation, the most common "sin" of practicing RadOncs (PP or academic - I have personally witnessed both).

Cancer comes back? Throw hands in air, "cancer is hard to treat".

Press Ganey scores? Through the roof!

Admin? "We're the best, look at our PG scores!"

 

[Mandelin Rain]

I find even the sight of corporate overloads and their syncophant physicians incredibly nauseating.

Imagine white coats on the military men.

 

[RadOncMegatron]

This is, in my estimation, the most common "sin" of practicing RadOncs (PP or academic - I have personally witnessed both).

Cancer comes back? Throw hands in air, "cancer is hard to treat".

Press Ganey scores? Through the roof!

Admin? "We're the best, look at our PG scores!"

This right here. Forget adding ADT or going with SBRT for patients. Most important thing is if they filled a satisfaction survey! Guaranteed 10% absolute OS or is it 10% admin bonus? Same thing I guess...

 

[fiji128]

Which ones?

There were rumors that Willis-Knighton Cancer Center in Shreveport was trying to open up a rad onc residency in conjunction with Tulane. No idea if there was any truth to that. Current RRC rules would make that arrangement basically impossible.

 

[deleted1116990]

I’ve tried really hard to get a bump in salary from my hospital employer. Making about MGMA mean but I’m at a not great location. Seeing about 200 consults/year. Hospital making millions off me at my single physician site but I can’t get a raise. Seriously considering leaving and they can take their chances with whomever they get. Im sure they will be willing to coast by with locums for years as the consult numbers dwindle down.

You are more right than you know. The hospital absolutely will be willing to coast by with locums for years. They don't care. It is very unlikely you will get a pay raise by threatening to resign and likely may end up with the opposite outcome. It is very possible that the hospital has already determined they are paying you above market rate and intends to cut your pay when your contract is up and if you resign, they will accept it and not let you take it back.

I was told (explicitly by the CEO) that it was preferable to lose a rad onc than it was to lose RTTs, dosi, or physics, and they weren't lying. It is far easier to get locums than to make an employed rad onc happy by replacing or correcting insubordinate or incompetent staff (especially in a "not great location"), and the locums doesn't push RTT, dosi, and physics (because they don't care), and then the complaints go away. I have watched it happen. Admin's solution to this problem is to tell the staff they are right and the rad onc is wrong and make the rad onc so miserable that he voluntarily resigns, then bring locums in and try to start over with a more passive new hire.

 

[jondunn]

Which ones have tried to open up residencies ?

I heard Willis Knighton

 

[temujim]

You are more right than you know. The hospital absolutely will be willing to coast by with locums for years. They don't care. It is very unlikely you will get a pay raise by threatening to resign and likely may end up with the opposite outcome. It is very possible that the hospital has already determined they are paying you above market rate and intends to cut your pay when your contract is up and if you resign, they will accept it and not let you take it back.

I was told (explicitly by the CEO) that it was preferable to lose a rad onc than it was to lose RTTs, dosi, or physics, and they weren't lying. It is far easier to get locums than to make an employed rad onc happy by replacing or correcting insubordinate or incompetent staff (especially in a "not great location"), and the locums doesn't push RTT, dosi, and physics (because they don't care), and then the complaints go away. I have watched it happen. Admin's solution to this problem is to tell the staff they are right and the rad onc is wrong and make the rad onc so miserable that he voluntarily resigns, then bring locums in and try to start over with a more passive new hire.

Particularly the RTTs. Easy enough to get remote dosi and contract physics. But in the current RTT locums market they'd have to pay double. Seen it over and over. RTTs are the tail that wags the dog, and heaven forbid you're a doc in a unionized location.

Best locums email for MDs I've seen lately is 2400/d. For a year commitment. Arithmetic is easy for admins.

 

[jondunn]

from what I know, you make a lot salary wise before ten years (3 years to partner salary) but I believe it may be ten years to the extra extra technical money.


the partner salary even without technical is quite good (700-800)

 

[thesauce]

Anyone else find pictures like that incredibly cringy?

C-suite types and docs who probably have never worked a manual job in their life posing with shovels and bulldozers. .

People are still putting in Gamma Knife machines?? Why on earth...

 

[jondunn]

People are still putting in Gamma Knife machines?? Why on earth...

money.

 

[thesauce]

money.

Is there really a financial benefit to a GK over any other linac technology which can all do SRS now?

 

[temujim]

Is there really a financial benefit to a GK over any other linac technology which can all do SRS now?

There's a neurosurgeon ego/referral benefit. Maybe that translates into a financial benefit?

 

[Ray D. Ayshun]

Is there really a financial benefit to a GK over any other linac technology which can all do SRS now?

Linacs have yet to develop the technology to include knife in the name

 

[metallica81788]

Is there really a financial benefit to a GK over any other linac technology which can all do SRS now?

For the neurosurgeons, probably

 

[Neuronix]

Is there really a financial benefit to a GK over any other linac technology which can all do SRS now?

No. Reimbursement is complicated but roughly similar.

GK is a resource hog though. Big time and personnel sink to do a case. Also it's dedicated equipment and space for a machine that most centers do not utilize fully or to the same capacity as a linac that treats anywhere in the body.

There's a neurosurgeon ego/referral benefit. Maybe that translates into a financial benefit?

This is the biggest reason IMO. I have both GK and linac SRS options and some neurosurgeons insist on using GK for no reason other than they said so.

Linacs have yet to develop the technology to include knife in the name

Cyberknife? 😉

 

[temujim]

No. Reimbursement is complicated but roughly similar.

GK is a resource hog though. Big time and personnel sink to do a case. Also it's dedicated equipment and space for a machine that most centers do not utilize fully or to the same capacity as a linac that treats anywhere in the body.



This is the biggest reason IMO. I have both GK and linac SRS options and some neurosurgeons insist on using GK for no reason other than they said so.



Cyberknife? 😉

Had an Elekta sales rep tell the group at one job that GK is a "neurosurgical machine". Needless to say we kindly said GTFO.

 

[metallica81788]

I had an issue with a new neurosurgeon taking cases I could do LINAC SRS and bringing an hour away for Gamma Knife - only because he could bill stuff. Neurosurgeons at mothership will convince patients that live near me to do Gamma Knife instead of sending to me. It's a racket but hospitals love the neurosurgeons, they can do no wrong.

That was a big issue for me and a battle I chose to fight.

 

[thesauce]

Linacs have yet to develop the technology to include knife in the name

Not true - Cyberknife

 

[jondunn]

Surgeons can and do bill on a Linac as well

 

[temujim]

I had an issue with a new neurosurgeon taking cases I could do LINAC SRS and bringing an hour away for Gamma Knife - only because he could bill stuff. Neurosurgeons at mothership will convince patients that live near me to do Gamma Knife instead of sending to me. It's a racket but hospitals love the neurosurgeons, they can do no wrong.

That was a big issue for me and a battle I chose to fight.

They can still do some charges on LINAC, just lose the frame fee.

Hope you won.

 

[deleted941485]

You are more right than you know. The hospital absolutely will be willing to coast by with locums for years. They don't care. It is very unlikely you will get a pay raise by threatening to resign and likely may end up with the opposite outcome. It is very possible that the hospital has already determined they are paying you above market rate and intends to cut your pay when your contract is up and if you resign, they will accept it and not let you take it back.

I was told (explicitly by the CEO) that it was preferable to lose a rad onc than it was to lose RTTs, dosi, or physics, and they weren't lying. It is far easier to get locums than to make an employed rad onc happy by replacing or correcting insubordinate or incompetent staff (especially in a "not great location"), and the locums doesn't push RTT, dosi, and physics (because they don't care), and then the complaints go away. I have watched it happen. Admin's solution to this problem is to tell the staff they are right and the rad onc is wrong and make the rad onc so miserable that he voluntarily resigns, then bring locums in and try to start over with a more passive new hire.

Hospital and health systems have all the leeway. They can make a million financial mistakes and still be ok but as a PP you piss off one person or make one bad decision and your done.

And yeah they absolutely do not care if it’s a revolving door of rad oncs or not. They just need someone to sign off on the plan and go with the flow.

 

[Ray D. Ayshun]

Not true - Cyberknife

Well yes. I guess I just consider that it's own weird thing. I take back the literality of what I said, but stick with the figurality, which is to say, when you have enough things, you start buying gimmicky stuff.

 

[metallica81788]

They can still do some charges on LINAC, just lose the frame fee.

Hope you won.

Hospital and health systems have all the leeway. They can make a million financial mistakes and still be ok but as a PP you piss off one person or make one bad decision and your done.

And yeah they absolutely do not care if it’s a revolving door of rad oncs or not. They just need someone to sign off on the plan and go with the flow.

I mostly won, the surgeon ended up leaving after a year. Before that, we agreed to have him be involved with the LINAC SRS billing and planning process.

However, I'm sure there are countless cases that never even get to me and are absorbed by the mothership before I'm even aware.

 

[thecarbonionangle]

I went to a tumor board once and heard a neurosurgeon argue that anything without a GK and more than one fx was not radiosurgery

 

[udrag14]

You are more right than you know. The hospital absolutely will be willing to coast by with locums for years. They don't care. It is very unlikely you will get a pay raise by threatening to resign and likely may end up with the opposite outcome. It is very possible that the hospital has already determined they are paying you above market rate and intends to cut your pay when your contract is up and if you resign, they will accept it and not let you take it back.

I was told (explicitly by the CEO) that it was preferable to lose a rad onc than it was to lose RTTs, dosi, or physics, and they weren't lying. It is far easier to get locums than to make an employed rad onc happy by replacing or correcting insubordinate or incompetent staff (especially in a "not great location"), and the locums doesn't push RTT, dosi, and physics (because they don't care), and then the complaints go away. I have watched it happen. Admin's solution to this problem is to tell the staff they are right and the rad onc is wrong and make the rad onc so miserable that he voluntarily resigns, then bring locums in and try to start over with a more passive new hire.

This is so stupid to me. Hospitals admins are so short sided. They believe volume will continue regardless of the doctor. They will see the volume drop and blame the doctor for not "being a team player" with no effort on the institutions part.

 

[Mandelin Rain]

I went to a tumor board once and heard a neurosurgeon argue that anything without a GK and more than one fx was not radiosurgery

There should be a term like "mansplaining" specific to neurosurgeons.

 

[brushbeamscanning]

I went to a tumor board once and heard a neurosurgeon argue that anything without a GK and more than one fx was not radiosurgery

Beside the GK part isn't this true? I was told that semantically SRS is 1 fx and anything fractionated is FSRT.

 

[Ray D. Ayshun]

Beside the GK part isn't this true? I was told that semantically SRS is 1 fx and anything fractionated is FSRT.

For insurance srs is 1 fx and sbrt 2-5 right?

 

[Neuronix]

Beside the GK part isn't this true? I was told that semantically SRS is 1 fx and anything fractionated is FSRT.

Per billing rules this is correct. Those are the technical CPT codes 77371 or 77372 (single fraction GK or linac intracranial).

SBRT is 77373 which is 1-5 fractions elsewhere in the body or 2-5 intracranial.

 

[medgator]

Which ones have tried to open up residencies ?

At least residencies have to go through accreditation theater... Unaccredited fellowships are just a cheap labor grab esp if they are advertising to US grads

 

[temujim]

Which ones have tried to open up residencies ?

I think rad onc is saved by the need for a radiation biologist; what private practice admin is going to sign off on that? Well other than Kaiser and Allegheny already.

 

[Neuronix]

People are still putting in Gamma Knife machines?? Why on earth...

Our neurosurgery department said "rad onc either you put in a GK machine or we're buying one and hiring our own rad onc"

 

[temujim]

Our neurosurgery department said "rad onc either you put in a GK machine or we're buying one and hiring our own rad onc"

Where I trained the neurosurgeons tried to do the same to call the shots on GK and when it was being replaced, tried to induce a CK and locate it in their proximity.

All bluffs. Call 'em on it.

 

[medgator]

Our neurosurgery department said "rad onc either you put in a GK machine or we're buying one and hiring our own rad onc"

UAB got rid of theirs with nsg buy in... Doing their TNs on an edge iirc. All about the local politics