Rad Onc Twitter

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At least on the West Coast, there is a shortage of RTTs and RTT schools. They get to dictate what they want and, if we want to continue to treat patients with radiation, we have to compromise. With that in mind, we have entertained all types of request from 30 hours/week of work to having them work 4 days per week. Schedules and RTT rotational shifts need to be modified to allow for patient treatment but what can you do?

Locums RTTs cost a fortune.
 
Gfunk6 said:
At least on the West Coast, there is a shortage of RTTs and RTT schools. They get to dictate what they want and, if we want to continue to treat patients with radiation, we have to compromise. With that in mind, we have entertained all types of request from 30 hours/week of work to having them work 4 days per week. Schedules and RTT rotational shifts need to be modified to allow for patient treatment but what can you do?

Locums RTTs cost a fortune.
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Did not see that one coming. Two years ago I predicted there would be a major oversupply of RTTs. That was assuming APM was implemented and everything moved to hypofractionation, and there would be less patients on treatment. I guess rad onc is not immune to the Great Resignation.
 
Moonbeams said:
I have never met an RTT that would voluntarily work a late/2nd shift. Literally, of the ~100 RTTs I have encountered in my life I have never met a single one who would have preferred to come in later and stay later or even stay later for additional $$. In your above scenario, they would fight to death over the 7AM-3PM slot.
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Same here. It is mind boggling. I wanted to start treating at 730 since that is when the building officially opens. I met so much resistance. The resistance wasn't direct either. They argued that starting at 630 was better for our patients.
 
w00tz said:
Did not see that one coming. Two years ago I predicted there would be a major oversupply of RTTs. That was assuming APM was implemented and everything moved to hypofractionation, and there would be less patients on treatment. I guess rad onc is not immune to the Great Resignation.
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Long term will still happen imo. Just like locums market for us improved this year also
 
medgator said:
Post covid, I've had a couple of leave for traveling jobs making in the mid to high 4 figures every week. Obviously that's prior to the locums middleman taking their generous cut
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It's interesting. In my (many) conversations with locums RTTs, it is not the money from their hourly rate that entices them but rather the lump sum they get for lodging, food, and transportation because that amount is apparently tax privileged. They take an assignment: live cheap, eat cheap and ride a bicycle to work and then pocket the delta.
 
radoncle said:
Is he saying virtual supervision is illegal? Haven’t we been through this? This is what Genesiscare is doing at all of their centers. What is he talking about? Maybe I’m misunderstanding?
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Good practice vs legal standard. I'm not sure what JJ is smoking but tele is legal and afaik you don't have to be covid+ to document using it.

Hell i used it yesterday because i had a uri with a negative covid test but didn't want to risk infecting my staff and my oxygen dependent patients if i turn + a couple days into s, BA5 variant is circulating robustly around the country
 
medgator said:
Good practice vs legal standard. I'm not sure what JJ is smoking but tele is legal and afaik you don't have to be covid+ to document using it.

Hell i used it yesterday because i had a uri with a negative covid test but didn't want to risk infecting my staff and my oxygen dependent patients if i turn + a couple days into s, BA5 variant is circulating robustly around the country
Click to expand...
It seems like just a useful tool to have for emergencies, if you have to leave to go see a patient in the hospital and you’re at a freestanding center, you need to step out for 10 mins, etc.
 
Uh...

1660419910188.png


So, yeah, freestanding centers have different rules, and I guess if someone was REALLY motivated to push it through, perhaps there are some private payors that stipulate direct supervision in a hospital outpatient department?

But to invoke the word "fraud" in 2022 for this...yikes. Maybe he means 10 years ago?
 
elementaryschooleconomics said:
Uh...

View attachment 358398

So, yeah, freestanding centers have different rules, and I guess if someone was REALLY motivated to push it through, perhaps there are some private payors that stipulate direct supervision in a hospital outpatient department?

But to invoke the word "fraud" in 2022 for this...yikes. Maybe he means 10 years ago?
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Grifters gonna grift. JJ is an "expert" the "science is settled".
 
Chartreuse Wombat said:
Grifters gonna grift. JJ is an "expert" the "science is settled".
Click to expand...

In general my approach to someone that is not an MD but makes a living via business associated with practicing medicine and/or regulations related to practicing medicine is to approach with caution.

Just too many horror stories from colleagues over the years letting “consultants” or “billing experts” come a calling around your clinic.

I have found that when in doubt then pick up the phone or email friends about how they handle it. Or post it on here. Seriously.
 
BobbyHeenan said:
I have found that when in doubt then pick up the phone or email friends about how they handle it. Or post it on here. Seriously.
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I don't know how to say this in a way that doesn't sound crazy, but: reading and posting on SDN has given me a fund of knowledge that I would have been unable to attain in residency/early career alone.

Talking to my peers vs folks 15-20 years out of residency, there is a level of "practical" knowledge that SDN gave me a shortcut to which is...remarkable.

Now, sure. It's probably easier to pay some guy in a textured wool suit who uses a shiny hair product to present his PPT deck and throw some fancy words around vs spending years of your life haunting an internet forum to talk about "episodes of care in the APM" or whatever...but man, the people who avoid the misanthropes of SDN are doing themselves a disservice.

I really want to emphasize the word "haunting". The soft glow SDN emits from my monitor in an otherwise pitch black room at 12:34AM on a random Tuesday - it's like a nerd version of "The Ring".

SO BACK TO THE NUANCES OF CRITICAL ACCESS HOSPITALS AS IT PERTAINS TO CMS...
 
I truly believe the anonymous nature of the forum makes it even more genuine vs. the need for approval attached to a real name. It’s amazing how a community of experts in an area can volunteer to give free, solid unsolicited advice without the need for a middleman.

I’ve also gained a great deal of knowledge in both the clinical and business side of our field that has served me well without the formalities and fees for these services by coming on here.
 
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RickyScott said:
Selling fear.
Click to expand...

His agency exists because the physicians of Radiation Oncology have internalized a deep shame regarding the "F word" (Finances). Take that shame and then hide all the economics of practicing American medicine in a convoluted system of ICD, CPT, RVU, RAC, OIG, HOPPS...

...wait maybe I'll start my own competing agency now that I think about it.

Siri, where's the nearest Brooks Brothers? I need this tie!

1660496399731.png
 
elementaryschooleconomics said:
I really want to emphasize the word "haunting". The soft glow SDN emits from my monitor in an otherwise pitch black room at 12:34AM on a random Tuesday - it's like a nerd version of "The Ring".
Click to expand...
Before Rad Onc dies, you see the ring
 
Not a popular take here of course but I also think the Hallahan theory is way overblown here.
 
I know people think of me being a MDACC/Ben Smith apologist, but let's at least attempt objectivity - nobody batted an eye in 2010. We certainly know that everybody likes a villain. The stuff with that department pushing out of town visitors to get treatment in Houston is icky. Saying that @OTN can't handle left sided breast treatment is reprehensible (I have no reason to believe he would make this up). Etc. etc. But, in 2009-2010, things were looking good. Whoever graduated around that time and stayed in community practice is probably still doing pretty well (I would say I'm in that group).

I graduated that year. We read it in the resident's office. It made sense to us, from what we saw in clinic. Even after 2004 CALGB publication, omission was quite uncommon. I presented Whelan at our faculty meeting as a resident and the vast majority of staff were not comfortable with 16 Fx treatment. Everyone (>99% of patients) were still giving 44 fx for prostate (even after 28 fx was shown to be a potential option; I think @Gfunk6 was one of the earlier adopters in my orbit). Many centers could not see patients fast enough and centers were opening up like crazy. People were doing very well and there was no thought that the bottom was going to fall out.

Not one person said anything at the time. "Anonymous" people on Twitter keep saying "we knew it, we knew it". Did you? Why would you hold back this information? If you had such certainty about this, why not post? I've been on SDN since undergrad probably. So have many other posters. They just forgot to say "The world is actually burning, Ben has it wrong"? We talk about everything important in RO here, but just ignored that completely?

Hypo, surveillance, omission, consolidation - we all knew this was possible, but based on clinical practice at the time, not a soul pushed back on the paper. In the last 6-8 years, history has been revised that "Everyone knew there was an issue, what a flawed article, blah blah blah, Ben Smith ruined the world and made airline travel, terrible, too!" Come on - look at the threads from 2010 here - we saw a lot coming, but no one said anything at the time of the publication of how bad it could even potentially get.

I will concede: in retrospect, that article had many flaws that no one pointed out and at the end of the day was WILDLY incorrect.

Yet, nobody published a rebuttal or a re-do - except ... the author himself in 2016. OOPS. We can't get people to admit they are full of **** on this forum when they make an error or a lie (even when caught). He publicly says, "I bungled this - we really need to re-evaluate". Yes, this is of little value to many of you and that's fine. But, think about what it takes to do that. What would be the motivation to correct an error? Nobody does that in this day and age.

It is very easy to play Monday Morning Quarterback, 5 years after the game, after you studied the tapes and media reports and interviewed the players.

HOT TAKE: Prediction of past events has high likelihood of accuracy.
 
RealSimulD said:
I know people think of me being a MDACC/Ben Smith apologist, but let's at least attempt objectivity - nobody batted an eye in 2010. We certainly know that everybody likes a villain. The stuff with that department pushing out of town visitors to get treatment in Houston is icky. Saying that @OTN can't handle left sided breast treatment is reprehensible (I have no reason to believe he would make this up). Etc. etc. But, in 2009-2010, things were looking good. Whoever graduated around that time and stayed in community practice is probably still doing pretty well (I would say I'm in that group).

I graduated that year. We read it in the resident's office. It made sense to us, from what we saw in clinic. Even after 2004 CALGB publication, omission was quite uncommon. I presented Whelan at our faculty meeting as a resident and the vast majority of staff were not comfortable with 16 Fx treatment. Everyone (>99% of patients) were still giving 44 fx for prostate (even after 28 fx was shown to be a potential option; I think @Gfunk6 was one of the earlier adopters in my orbit). Many centers could not see patients fast enough and centers were opening up like crazy. People were doing very well and there was no thought that the bottom was going to fall out.

Not one person said anything at the time. "Anonymous" people on Twitter keep saying "we knew it, we knew it". Did you? Why would you hold back this information? If you had such certainty about this, why not post? I've been on SDN since undergrad probably. So have many other posters. They just forgot to say "The world is actually burning, Ben has it wrong"? We talk about everything important in RO here, but just ignored that completely?

Hypo, surveillance, omission, consolidation - we all knew this was possible, but based on clinical practice at the time, not a soul pushed back on the paper. In the last 6-8 years, history has been revised that "Everyone knew there was an issue, what a flawed article, blah blah blah, Ben Smith ruined the world and made airline travel, terrible, too!" Come on - look at the threads from 2010 here - we saw a lot coming, but no one said anything at the time of the publication of how bad it could even potentially get.

I will concede: in retrospect, that article had many flaws that no one pointed out and at the end of the day was WILDLY incorrect.

Yet, nobody published a rebuttal or a re-do - except ... the author himself in 2016. OOPS. We can't get people to admit they are full of **** on this forum when they make an error or a lie (even when caught). He publicly says, "I bungled this - we really need to re-evaluate". Yes, this is of little value to many of you and that's fine. But, think about what it takes to do that. What would be the motivation to correct an error? Nobody does that in this day and age.

It is very easy to play Monday Morning Quarterback, 5 years after the game, after you studied the tapes and media reports and interviewed the players.

HOT TAKE: Prediction of past events has high likelihood of accuracy.
Click to expand...
From what I heard of Ben Smith, he is an upstanding person and overall great guy.

However, just to be neutral, there was a prediction, from a high profile person (MDACC attending) in a high profile journal (JCO).

This prediction was just flat out wrong and caused problems.

If people were asked, there would have been, a many more voices to point out the simple investing adage "past performances are not indicative of future performance." All of us here probably invest and are not putting 100% into stocks due to the risk inherent in such an endeavor.

It doesn't matter if people did not respond appropriately, there really is no accountability, except a mea culpa in 2016 - too little too late.

Just like the financial advisor who takes a cut of your money and then when things go sour and loses your money, we take the brunt of the consequences. This asymmetry is undeniable, even if he is a genius breast oncologist and genuine nice guy.
 
RadOncMegatron said:
From what I heard of Ben Smith, he is an upstanding person and overall great guy.

However, just to be neutral, there was a prediction, from a high profile person (MDACC attending) in a high profile journal (JCO).

This prediction was just flat out wrong and caused problems.

If people were asked, there would have been, a many more voices to point out the simple investing adage "past performances are not indicative of future performance." All of us here probably invest and are not putting 100% into stocks due to the risk inherent in such an endeavor.

It doesn't matter if people did not respond appropriately, there really is no accountability, except a mea culpa in 2016 - too little too late.

Just like the financial advisor who takes a cut of your money and then when things go sour and loses your money, we take the brunt of the consequences. This asymmetry is undeniable, even if he is a genius breast oncologist and genuine nice guy.
Click to expand...
I agree
 
Ray D. Ayshun said:
Speaking of therapist complaints, how commonly are therapists salaried and not hourly?
Click to expand...
I've looked into this extensively. By CA law, all employees are hourly with two exceptions:

  1. People that are in a managerial capacity; this includes "working" Lead or Chief RTTs with some admin role, even if it is ~ 20%
  2. Positions where it is the "community norm" to be exempt rather than hourly (e.g. engineers, dosimetrists, physicists)

The second one is a bit tricky - as you sometimes have to ask your competitors what they are doing. Based on the above, only "Lead" and "Chief" RTTs can be exempt/salaried.
 
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RealSimulD said:
I know people think of me being a MDACC/Ben Smith apologist, but let's at least attempt objectivity - nobody batted an eye in 2010. We certainly know that everybody likes a villain. The stuff with that department pushing out of town visitors to get treatment in Houston is icky. Saying that @OTN can't handle left sided breast treatment is reprehensible (I have no reason to believe he would make this up). Etc. etc. But, in 2009-2010, things were looking good. Whoever graduated around that time and stayed in community practice is probably still doing pretty well (I would say I'm in that group).

I graduated that year. We read it in the resident's office. It made sense to us, from what we saw in clinic. Even after 2004 CALGB publication, omission was quite uncommon. I presented Whelan at our faculty meeting as a resident and the vast majority of staff were not comfortable with 16 Fx treatment. Everyone (>99% of patients) were still giving 44 fx for prostate (even after 28 fx was shown to be a potential option; I think @Gfunk6 was one of the earlier adopters in my orbit). Many centers could not see patients fast enough and centers were opening up like crazy. People were doing very well and there was no thought that the bottom was going to fall out.

Not one person said anything at the time. "Anonymous" people on Twitter keep saying "we knew it, we knew it". Did you? Why would you hold back this information? If you had such certainty about this, why not post? I've been on SDN since undergrad probably. So have many other posters. They just forgot to say "The world is actually burning, Ben has it wrong"? We talk about everything important in RO here, but just ignored that completely?

Hypo, surveillance, omission, consolidation - we all knew this was possible, but based on clinical practice at the time, not a soul pushed back on the paper. In the last 6-8 years, history has been revised that "Everyone knew there was an issue, what a flawed article, blah blah blah, Ben Smith ruined the world and made airline travel, terrible, too!" Come on - look at the threads from 2010 here - we saw a lot coming, but no one said anything at the time of the publication of how bad it could even potentially get.

I will concede: in retrospect, that article had many flaws that no one pointed out and at the end of the day was WILDLY incorrect.

Yet, nobody published a rebuttal or a re-do - except ... the author himself in 2016. OOPS. We can't get people to admit they are full of **** on this forum when they make an error or a lie (even when caught). He publicly says, "I bungled this - we really need to re-evaluate". Yes, this is of little value to many of you and that's fine. But, think about what it takes to do that. What would be the motivation to correct an error? Nobody does that in this day and age.

It is very easy to play Monday Morning Quarterback, 5 years after the game, after you studied the tapes and media reports and interviewed the players.

HOT TAKE: Prediction of past events has high likelihood of accuracy.
Click to expand...

I too was an upper level resident then and we looked at this paper and discussed this amongst our program. In retrospect, I/we should have spoken up earlier but who goes against a professor at MDA on a study like this?

A couple of things we talked about amongst the residents:
1. Our academic center was already hypofrac nearly every prostate and tangent breast at that time. We were a little bit ahead of other places but you could see it coming (canadian data maturing, UK studies, etc). Kupelian prostate data looking promising, etc.
2. A big private group I was interviewing with had already told me they planned on replacing retiring docs with NP/PAs to help extend the docs. I don't believe this variable was covered at all . I was starting to see it on the interview trail.

Of course it was 3 years later, but I had posted about issues with the study back in the 2013 blood bath thread.

Your main point does stand - in 2010/2011 there wasn't a ton of push back. By 2013 there is though (at least on SDN).

I don't see intentional malice with Smith on it though, could have just been an error of interpretation. Where I took/take issue with smith is the railing against breast IMRT then treating (and publishing) about proton APBI.

forums.studentdoctor.net

Bloodbath in Red Journal

Anyone catch the beat down this kid at Wash U took in the most recent Red Journal? When your department is expanding it's residency, probably best not to call out the process in the specialty's primary journal. Especially if you graduated last year.
forums.studentdoctor.net forums.studentdoctor.net
 
RadOncMegatron said:
From what I heard of Ben Smith, he is an upstanding person and overall great guy.

However, just to be neutral, there was a prediction, from a high profile person (MDACC attending) in a high profile journal (JCO).

This prediction was just flat out wrong and caused problems.

If people were asked, there would have been, a many more voices to point out the simple investing adage "past performances are not indicative of future performance." All of us here probably invest and are not putting 100% into stocks due to the risk inherent in such an endeavor.

It doesn't matter if people did not respond appropriately, there really is no accountability, except a mea culpa in 2016 - too little too late.

Just like the financial advisor who takes a cut of your money and then when things go sour and loses your money, we take the brunt of the consequences. This asymmetry is undeniable, even if he is a genius breast oncologist and genuine nice guy.
Click to expand...
RealSimulD said:
I agree
Click to expand...
Ben Smith is a great guy who did a bad analysis of rad onc supply/demand that looked good at the time and which got a lot of play in the popular medical press. He came back later with an analysis that completely negated the other analysis.

He committed a Type 1 error. Or what is the type of error when you find a difference and not only does the difference not exist, it exists in the opposite direction? A Type Negative One error??? Not great, but not a shootable offense.

HOWEVER. Ben Smith. Breast IMRT. He has been terrible on this too.

He may be a great guy but he keeps being wrong about things that negatively affect the PP rad oncs *a lot.* So he needs to do what Howard Stern's dad was always telling him to do.


jondunn said:
Click to expand...

actually i would be a little worried about a guy in a bikini on twitter
 
jondunn said:
Click to expand...

Sorry I realize this is a relatively old post in the thread but I did not think it made much sense so I looked into it more.

It appears to most definitely NOT be a list of the "top 5 specialties by revenue generated" although I could see how someone would get that impression. It appears to be a random sampling of 5 specialties as far as I can tell and it is not very clearly worded in the report.

Rad Onc isn't on there of course.
 
HemeOncHopeful19 said:
Sorry I realize this is a relatively old post in the thread but I did not think it made much sense so I looked into it more.

It appears to most definitely NOT be a list of the "top 5 specialties by revenue generated" although I could see how someone would get that impression. It appears to be a random sampling of 5 specialties as far as I can tell and it is not very clearly worded in the report.

Rad Onc isn't on there of course.
Click to expand...
Which kinda makes you wonder why it was posted in this thread in the first place 💡
 
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