So you area saying that wasting a million dollars has no impact on the greater good?
I wouldn’t say corrupt
It’s funny, you never hear a med onc saying such things about their colleagues when they give adjuvant Durva for a patient with PDL-1 negative NSCLC after CRT.
Which rad oncs have been driving the bus over the cliff? That's probably the question you should really be asking yourself....
The sin of academia was, after IMRT, we have had a failure to improve quality. We just sat back, satisfied with our brilliance.
In terms of attaching $ to years of life, this is done in most health systems in Europe. If durva is being used in Britain in such pts then i assume it meets the metric.
Why is that the question I should be asking?
or Temodar for GBM with unmethylated MGMT
What fraction of radoncs in an ever expanding academic network are spending most of their time or even a significant minority of their time trying to improve quality?
Expansion impacts the job market, not the worth of the field.
Improving the job market will improve the caliber of student applying, will it not? Isn't that first step to getting better people into the field to actually improve the field? Because right now it's just about finding warm bodies to run departments, not actually expand the field
Ooof. No human values here.
We had decades of the creme of the crop… clearly this isn’t sufficient.
I support drastically cutting residency spots. I want job security, just like you.
Serious question.
...and perception by colleagues. If they see us as booger eaters treating 8 patients each, you can bet that directly impacts the value of radiation oncology.
At the large academic center where I work, my medonc colleagues think it’s remarkable that I can get any research done being in clinic 3 days a week. Most of them are in 1 day (2 days max). While I am sure this is different in different practice settings, I don’t necessarily think patients-on-treatment is an underlying problem with regards to be respected by other specialties.
I think this is part of the solution. Two tracks for radonc in academics. Clinical and research (much like medonc). Clinical makes more money. Research has low volume clinical load and some coverage responsibility. Chair and leadership positions should be rotating but if not, preferably should go to clinical folks. Stop the vanity labs. Let researchers geek out for their whole career.
high technical reimbursements are what led to proliferation of satellites and residencies. Most docs salaries are largely disconnected from technical reimbursement and have everything to do with supply and demand.
does diversity research count as improving qaulity?
It fits the "do better" request.
And those that do have a piece of technical are rapidly losing them. I have had multiple hospitals agree to buy in a small portion of the technical revenue only to change their mind. The "fair market value" analyses don't include technical revenue for rad onc, although I have yet to hear anyone explain to me how offering a rad onc 5-10% of technical revenue in addition to salary to recruit them to an undesirable area explicitly violates Stark law. So that leaves us with the professional component, which you will work hard for, if the volume is even available.
Medoncs earn more and are a lot more imprortant to the hospital yet their technical/value fees are much less. Our value to the hospital is almost entirely set by supply and demand. Many of the hospitals with the highest technical reimbursements pay their radoncs the least. Upenn w/ 10x cms, is not known for high salaries.
This isn't universal. Where I work, I make more than the medoncs -even those who have been in practice > 10 years.
A 340b hospital infusion center would be stratospheric technical medonc revenue, but would it equal RadOnc technical charges?
Pscych bills almost nothing, but heard they are starting in the mid 3s in desirable locations. Do you think if upenn billed 5x cms vs 10 or 20 x cms, this would change their faculty salaries?
There is a HUGE difference between hospital employed med onc and private med onc who own their own infusion centers and imaging, moreso than rad onc. The numbers the latter can pull down are truly mind-boggling.
Our hospital pays medoncs (100$/ rvu) and psych huge salaries (no cash paying pts-) because of market forces and turnover. At the very least, addressing supply and demand is a much bigger priority for the average radonc than technical fees.
Pharmacy! Oral oncolytics are becoming more common and can be very lucrative with not nearly the overhead needed vs infusing chemo or io. Just write a script to your own specialty pharmacy and as long as you have the contract, ka-ching!
I misread and edited my post before you replied, but to be fair you have argued that most rad oncs are earning mid 6 figures in the past. At least you recognize this is not common starting.
I can’t say it often enough. If you read the APM verbiage from the feds, IMRT was the fire and protons were gasoline plus maybe that film stock stuff from Inglorious Basterds.
They make movies about guys/med oncs making sub 300? 😉
The free market was letting docs take too much according to the chair at wash U a decade ago and the rest as they say, is history
I'm talking about a hospital making a >50% profit margin on the TC and using it to make up for shortfalls elsewhere (or something like chemo with 340b). That guy's argument was flooding the market and taking a hefty chunk of the pro too without anyone being the wiser. Academic centers generally don't discuss their billing and collections, they say here is your base salary, RVU target, and scheme for dividing up RVUs over target. We can change it at any time with no notice as required to support the financial health of the institution. Attempts to negotiate are unprofessional and will be met with withdrawal of the offer.
The only reason they are able to do that though is because of supply and demand the way they are. Same issue is how hospitals are able to get away with it as well.
That's this year's thing... and it is pretty boring. Don't get me wrong, it is important work... but is underwhelming in terms of innovation.
