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My issue with San Antonio isn't just that it's an uninteresting place to have a conference, there are not a lot of flight options so it's hard to get in and out of. Houston and Dallas are also boring places to have conferences but at least there are lots of direct flights.
That's where Vegas and Orlando absolutely crush it for flights unless we are talking the big hubs like hotlanta, chi town, NYC, LA etc

ACRO does Orlando quite often and iirc used to do Vegas, so did abs or ars, can't remember.
 
West coast: Vegas
Central: Chicago
East coast: Miami

Just rotate between those three and call it a day. If you have to substitute San Diego for Vegas, I guess ok, but SD is tremendously more boring than Vegas.

Edit: Sorry about Chicago in October, Simul, some us live on the surface of the sun and like to wear our coats every now and then.
 
West coast: Vegas
Central: Chicago
East coast: Miami

Just rotate between those three and call it a day. If you have to substitute San Diego for Vegas, I guess ok, but SD is tremendously more boring than Vegas.

Edit: Sorry about Chicago in October, Simul, some us live on the surface of the sun and like to wear our coats every now and then.
I love Vegas but ASTRO would rate third class status (maybe appropriate but...)

The data is precovid but check out the conference attendees in the Top 10 in Vegas

 
I'm not cross referencing conference attendance vs conference/hotel space available in each locale but I'd love to visit some new places that I wouldn't ordinarily go. Like Palm Springs, Asheville, Salt Lake City, Charleston, Bozeman, etc...
ASTRO has been to SLC...the others are way too small for ASTRO (I have been all of them as it turns out and each is worth a visit; at the right time of year)
 
The exhibitors (see what i did there) are diverse. About 50% were technologies (trying to get as much information into a small file) and the remainder were generalists or niche companies; think obese porn, dwarf porn, etc...

What happens in Vegas.....
 
The exhibitors (see what i did there) are diverse. About 50% were technologies (trying to get as much information into a small file) and the remainder were generalists or niche companies; think obese porn, dwarf porn, etc...

What happens in Vegas.....
Dwarf on obese porn is also a genre
 
I'm not cross referencing conference attendance vs conference/hotel space available in each locale but I'd love to visit some new places that I wouldn't ordinarily go. Like Palm Springs, Asheville, Salt Lake City, Charleston, Bozeman, etc...
Some of those cities probably couldn't support a conf honestly... Asheville traffic is bad enough as it is, not sure where the infrastructure would be to have thousands upon thousands of attendees.

Chicago Orlando and Vegas have the 3 biggest convention centers in the country (in that order iirc)
 
But honestly, does ASTRO need to be as big as it is? We're a relatively tiny specialty. Does it really need one of the 3 largest convention centers?

15 simultaneous rooms presenting garbage retrospective reviews. A massive exhibit hall with countless shills harassing you; at least they used to offer parties to attend. Untold number of unread abstracts. Even the plenaries are typically lackluster.

So many resources utilized to say so little.

Seems like a convenient opportunity to pad a CV and little else at this point.
 
But honestly, does ASTRO need to be as big as it is? We're a relatively tiny specialty. Does it really need one of the 3 largest convention centers?

15 simultaneous rooms presenting garbage retrospective reviews. A massive exhibit hall with countless shills harassing you; at least they used to offer parties to attend. Untold number of unread abstracts. Even the plenaries are typically lackluster.

So many resources utilized to say so little.

Seems like a convenient opportunity to pad a CV and little else at this point.
ASTRO needs to get bigger!! Haven't you been paying attention? It is a membership business. The more people we can claim then the more vendors will pay to exhibit. Growth is always the answer..(e.g GME)
 
ASTRO the organization could grow by making astro, the annual conference more meaningful.

4 rooms
1. Clinical Research
2. Bench Research
3. Contouring/Tough Case seminars
4. Practice Development/Job Market issues

Presentations done by 2:00 PM each day.

Max 250 abstract posters accepted. Have an actual rounds where people read the posters.

Fit the conference in a much smaller footprint to save money but also make it more intimate. Connect people with each other and vital information.
 
ASTRO the organization could grow by making astro, the annual conference more meaningful.

4 rooms
1. Clinical Research
2. Bench Research
3. Contouring/Tough Case seminars
4. Practice Development/Job Market issues

Presentations done by 2:00 PM each day.

Max 250 abstract posters accepted. Have an actual rounds where people read the posters.

Fit the conference in a much smaller footprint to save money but also make it more intimate. Connect people with each other and vital information.
Sounds like ACRO.... Minus the bench stuff
 
ASTRO the organization could grow by making astro, the annual conference more meaningful.

4 rooms
1. Clinical Research
2. Bench Research
3. Contouring/Tough Case seminars
4. Practice Development/Job Market issues

Presentations done by 2:00 PM each day.

Max 250 abstract posters accepted. Have an actual rounds where people read the posters.

Fit the conference in a much smaller footprint to save money but also make it more intimate. Connect people with each other and vital information.
The quality may be better but ASTRO isn't interested in quality (the best stuff goes to ASCO anyway). ASTRO is interested in quantity. For every poster that is accepted the registration number increases. All about the Benjamins.
 
ASTRO the organization could grow by making astro, the annual conference more meaningful.

4 rooms
1. Clinical Research
2. Bench Research
3. Contouring/Tough Case seminars
4. Practice Development/Job Market issues

Presentations done by 2:00 PM each day.

Max 250 abstract posters accepted. Have an actual rounds where people read the posters.

Fit the conference in a much smaller footprint to save money but also make it more intimate. Connect people with each other and vital information.
If you only have 250 posters, that probably means about 1000-1500 med students and residents who aren’t going to the conference in any given year…missing a lotta registration dollars right there
 
Yeah, I guess I don’t know how much of the operating budget comes from meeting registration/industry/profit vs basic membership dues.

Feels like needing to turn a huge profit on a meeting is a recipe for disaster.
 
Yeah, I guess I don’t know how much of the operating budget comes from meeting registration/industry/profit vs basic membership dues.

Feels like needing to turn a huge profit on a meeting is a recipe for disaster.
I think the time is ripe for some of the contents of such meetings to be moved into an online platform. Having ten session running in parallel is not really useful if there is no interaction between speakers and viewers. Some of these presentation can be moved to an online platform and viewed on demand (or whatever).
 
I think the time is ripe for some of the contents of such meetings to be moved into an online platform. Having ten session running in parallel is not really useful if there is no interaction between speakers and viewers. Some of these presentation can be moved to an online platform and viewed on demand (or whatever).
this would be correct IMO if the pupose of a meeting was TRULY just for sharing abstracts

it's not
it's for networking, meeting with industry, seeing friends, serving as a vacation/excuse to use CME money

this is true for ASTRO same as it is for any other medical conference.

for many of the smaller conferences - CME money exists, so conferences exist as a means to capture it.
 
Yeah, I guess I don’t know how much of the operating budget comes from meeting registration/industry/profit vs basic membership dues.

Feels like needing to turn a huge profit on a meeting is a recipe for disaster.
ASTRO made it clear they had real budgetary issues when the in person meeting wasn't going to happen with covid in 2020.. iirc weren't they essentially trying to charge the same registration for virtual in the beginning which resulted in a huge uproar?

At the same time they changed the career center so you had to be a member to see newly posted jobs the first 3 days
 
Yup, I can't remember which talk it was but I remember someone from ASTRO discussing the annual meeting and it's a substantial portion of yearly revenue.

These meeting dates/locations get planned out years in advance, so hope Chicago is a bit warmer in 2023!
 
Yup, I can't remember which talk it was but I remember someone from ASTRO discussing the annual meeting and it's a substantial portion of yearly revenue.

These meeting dates/locations get planned out years in advance, so hope Chicago is a bit warmer in 2023!
All the more reason to stay away when it is in a 2nd tier location.
 
It’s in Chicago again in 2023?

Def not going if so, went to Chicago in 2019, not going to Astro again until it’s on a coast in a warm place (Miami or Cali)
 
It’s in Chicago again in 2023?

Def not going if so, went to Chicago in 2019, not going to Astro again until it’s on a coast in a warm place (Miami or Cali)
Trying to pretend it's as important as asco maybe...

Agree, won't be going again until we see SD or Miami Beach. Maybe beantown (beats Chicago imo, and they don't do it as often there either)
 
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Radiation Oncology Anticipates More Payment Cuts Going into 2023

This evening, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare Physician Fee Schedule proposed rule for 2023, with policy changes that would reduce payments for radiation oncology services by approximately 4% next year. This reduction is due to the expiration of the 3% increase associated with Protecting Medicare and American Farmers from Sequester Cuts Act, as well as the Medicare and CHIP Reauthorization Act statutory required update of 0%, and a budget neutrality adjustment of 1.55%. Additionally, 2023 marks the second year of the four-year phase in of the Clinical Labor Price update which lowers payments to specialties that use expensive equipment, such as radiation oncology, in the budget neutral environment for practice expense. ASTRO will provide members with a summary and detailed analysis of the proposal in coming days and will submit comments to the Agency later this summer.


All is well folks! See you beautiful people at the BLs!
 

Medicare_Updates_Compared_to_InflationV2.png
 
I'm stuck somewhere right between wanting to fight like hell for doctors and wanting to quietly work out my string until I can retire and enjoy a nice life.

I imagine many docs are in the same space.

If the first step for "fighting like hell" was obvious, I believe more of us would do it.
 
I'm stuck somewhere right between wanting to fight like hell for doctors and wanting to quietly work out my string until I can retire and enjoy a nice life.

I imagine many docs are in the same space.

If the first step for "fighting like hell" was obvious, I believe more of us would do it.
Isn’t that why we have organizations like the AMA? As a disclosure, I pretty much let all of my professional organization memberships lapse despite having reimbursement funds due to lack of alignment.
 
From one of my connections on LinkedIn

View attachment 357086
To adequately combat >8% inflation, the fed will have to raise rates substantially beyond their current levels. There is presently $30 trillion of federal debt, which cost nearly 600 billion in interest even when rates were near zero last year. To service the debt, what kind of drastic cuts will be required to medicare, defense, etc if the fed raises rates to even half of what they need? This will not happen, and we will get a crap sandwich resulting from trying to have it both ways because anything else is political suicide. Persistent high inflation with persistent moderate cuts for a long time to come. We will get paid less for doing more work, and the value of the dollars we are paid in will be less.

The future looks bleak, someone please convince me otherwise. Please?
 
Looking at these facts, how can one not conclude that the US government bureaucracy picks winners and losers but not the private physician.

Pharma and Big Rad Onc over small private practices
Early pandemic Target and Costco stay open while mainstreet mom and pops are shuttered
Global financial crisis Wall Street banks get bailed out while the people paying the mortgages do not
etc etc etc
 
Looking at these facts, how can one not conclude that the US government bureaucracy picks winners and losers but not the private physician.

Pharma and Big Rad Onc over small private practices
Early pandemic Target and Costco stay open while mainstreet mom and pops are shuttered
Global financial crisis Wall Street banks get bailed out while the people paying the mortgages do not
etc etc etc
Global financial crisis 2008-2009 leads to rampant underbuilding of SFH/multifamily housing creating the current environment for private equity and banks (including everyone's fave GS) to swoop in and invest in residential real estate (and crowd out first time homebuyers) for "the average Joe" screw part deux over a decade later


But yes, individually RO is totally screwed as a specialty with residency expansion the quintessential cherry on top of the **** sundae
 
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Global financial crisis leads to underbuilding SFH/multifamily housing creating a great environment for private equity and banks (including everyone's fave GS) to swoop in and invest in residential real estate (and crowd out first time homebuyers) for part deux over a decade later

Housing all becomes corporate owned, supply is artificially constrained deBeers style to drive up rents and corporate profits. Not only can you not buy a home, you can't rent any form of a roof over your head due to marketplace competition. If it is difficult (really, an understatement) for me as a subspecialist physician to find a reasonable place to live, I cannot imagine what others are going through.

I suppose they will just keep on going until the head choppers come out. Or more likely until they get themselves in trouble with derivatives on real estate investments again during a recession and are subsequently bailed out of insolvency through more money printing and the cycle starts again. Poor get poorer. Rich gets richer. This is a depressing conversation.
 
To adequately combat >8% inflation, the fed will have to raise rates substantially beyond their current levels. There is presently $30 trillion of federal debt, which cost nearly 600 billion in interest even when rates were near zero last year. To service the debt, what kind of drastic cuts will be required to medicare, defense, etc if the fed raises rates to even half of what they need? This will not happen, and we will get a crap sandwich resulting from trying to have it both ways because anything else is political suicide. Persistent high inflation with persistent moderate cuts for a long time to come. We will get paid less for doing more work, and the value of the dollars we are paid in will be less.

The future looks bleak, someone please convince me otherwise. Please?
The end game will be as follows:

1. Private practice RO (already at death's door) will shutter completely within the next couple of years. Hospitals in rural and semi-rural areas with disproportionately high percentage of Medicare and Medicaid patients will go under as well.

2. Private practices will likely be bought out by academic health systems/big hospital consortiums and all physicians will be employed. These institutions are still getting crap rates from Medicare and Medicaid patients but they are offset by (a) truly exorbitant rates paid by private insurers, (b) government programs that are used to manipulate costs [e.g. 403b], (c) wealthy cash patients who will pay out of pocket (e.g. protons for right sided breast cancer), and (d) wealthy mega-donors who want their name on something.

3. Eventually even the large hospitals will begin to suffer from the never ending cuts to Medicare and Medicaid. They will be getting less revenue in the face of inflation and increased costs. They can't stop taking these patients as that would be a death knell for them. Instead they will start paying physicians less and less and pass the blame to the government. There is nowhere else for physicians to go (doubly so for Rad Onc) and if you try to resist they will replace you with one of 50 new grads who would kill their firstborn for your spot.

There are two ways out of the death spiral above and both require actions by the federal government:

a. The Feds realize that private practice physicians provide comparable care to hospitals and at a fraction of the cost. They decide to pay them fairly to provide these services for their beneficiaries.

b. Medicare for all - private insurance is eliminated

Unlike gun violence or airline safety, there will not be a single, spectacular healthcare adverse event that shocks the nation that will prompt legislative action. It will be death by a thousand cuts. Any legislator who proposes a solution (and all who support it) will effectively be falling on their swords because the consequence of such a major shift in policy will rock the core of the US.

My advice is to start saving your money and diversify your skill set. Better to jump off a sinking ship rather than to go down with it.
 
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