Rad Onc Twitter

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TheWallnerus said:
On paper, brachy. IRL scuttlebutt was it was a couldn’t-find-a-job fellowship.
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I know a few people that did "brachy" fellowships in NY with Lou H and at sloane who did them for the same reason. One of them still does a fair amount of brachy though.

In this day and age, brachy skills are falling by the wayside, so being well trained with a fellowship may open doors in some practices that would otherwise be closed
 
Recently heard of hellpit grad within last 3 years, did a fellowship at well known place, got multiple offers, got good job in academic dept known to pay above average and well in a big city. Just saying it works out for some people. If you got your stuff in storage and are just locuming around and unhappy, it doesnt sound like a terrible option, assuming no help from home program, no connections, go there to network basically. Anything is a gamble, but you can make it work out.
 
thecarbonionangle said:
Recently heard of hellpit grad within last 3 years, did a fellowship at well known place, got multiple offers, got good job in academic dept known to pay above average and well in a big city. Just saying it works out for some people. If you got your stuff in storage and are just locuming around and unhappy, it doesnt sound like a terrible option, assuming no help from home program, no connections, go there to network basically. Anything is a gamble, but you can make it work out.
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In radiology, locums is faaaar more offensive than doing multiple fellowships.
 
maxxor said:
In radiology, locums is faaaar more offensive than doing multiple fellowships.
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Speaking of which
E85EA5C6-9251-4024-B7D6-E075E49A99A5.jpeg
 
medgator said:
Yeah because in radiology, fellowships are acgme accredited, not the unaccredited bull**** we have in rad Onc
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The vast majority are not actually. Most IR, most Peds, some Neuro, and some Nuclear are. But abdominal, msk, breast, and cardiothoracic are usually not.

The reason radiology programs opt against ACGME is that moonlighting as an attending is banned by CMS.
 
maxxor said:
The vast majority are not actually. Most IR, most Peds, some Neuro, and some Nuclear are. But abdominal, msk, breast, and cardiothoracic are usually not.

The reason radiology programs opt against ACGME is that moonlighting as an attending is banned by CMS.
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At least accreditation creates some kind of standard, vs Miami cancer institute and inova trying to get cheap labor for a year with doc of the day and call coverage schilling it as a "proton fellowship"
 
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TheWallnerus said:
On paper, brachy. IRL scuttlebutt was it was a couldn’t-find-a-job fellowship.
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This forum is a great resource and community but something it should do away with is the frequent gossiping/hearsay about individuals going nearly as far as calling them out by name.
It’s the second time this person has been referenced on this forum so I feel compelled to say something.

I know you don’t mean it personally (likely more of an attack on the state of things) but It’s one thing to name drop Lisa Kachnic and entirely another to gossip about a new grad’s situation and put them down like that. Knowing that individual personally, I can tell you they are very strong clinically (anecdotally way stronger than most of the grads from mdacc, Harvard etc I’ve encountered), and that the whole “couldn’t get a job” thing was actually due to pandemic-related factors essentially pulling the rug out from under them after they had all but signed on the dotted line.
 
FindMeOnTheLinks said:
This forum is a great resource and community but something it should do away with is the frequent gossiping/hearsay about individuals going nearly as far as calling them out by name.
It’s the second time this person has been referenced on this forum so I feel compelled to say something.

I know you don’t mean it personally (likely more of an attack on the state of things) but It’s one thing to name drop Lisa Kachnic and entirely another to gossip about a new grad’s situation and put them down like that. Knowing that individual personally, I can tell you they are very strong clinically (anecdotally way stronger than most of the grads from mdacc, Harvard etc I’ve encountered), and that the whole “couldn’t get a job” thing was actually due to pandemic-related factors essentially pulling the rug out from under them after they had all but signed on the dotted line.
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Fair enough, but i know someone nearly a decade ago who did the same thing from a decent mid tier place... Brachy fellowship to wait the job market out a year because of a fiance who was living in a certain area.

It just goes to show that the rad onc job market has never been truly "wide open" and unfortunately the trend has only been getting worse since then
 
medgator said:
Fair enough, but i know someone nearly a decade ago who did the same thing from a decent mid tier place... Brachy fellowship to wait the job market out a year because of a fiance who was living in a certain area.

It just goes to show that the rad onc job market has never been truly "wide open" and unfortunately the trend has only been getting worse since then
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I agree with you, the presence of predatory fellowships is absolutely a growing and concerning trend in our field. 100%

Just felt the need to call attention to singling out of individuals and reframe the discussion to not be so personal.
 
FindMeOnTheLinks said:
I agree with you, the presence of predatory fellowships is absolutely a growing and concerning trend in our field. 100%

Just felt the need to call attention to singling out of individuals and reframe the discussion to not be so personal.
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It wasn’t personal at all esp re clinical acumen
 
Well said and thanks for saying it.

FindMeOnTheLinks said:
This forum is a great resource and community but something it should do away with is the frequent gossiping/hearsay about individuals going nearly as far as calling them out by name.
It’s the second time this person has been referenced on this forum so I feel compelled to say something.

I know you don’t mean it personally (likely more of an attack on the state of things) but It’s one thing to name drop Lisa Kachnic and entirely another to gossip about a new grad’s situation and put them down like that. Knowing that individual personally, I can tell you they are very strong clinically (anecdotally way stronger than most of the grads from mdacc, Harvard etc I’ve encountered), and that the whole “couldn’t get a job” thing was actually due to pandemic-related factors essentially pulling the rug out from under them after they had all but signed on the dotted line.
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Sounds like it’s in west va. Damn, you literally beat me to the punch! Still a no for me becuse I’m a sucker for biryani!
 
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You’ll see stuff that says Chicago or Pittsburgh and it’s 90 miles away. Rockford, IL was a good example. Why even do this? When you interview you’ll figure it out pretty easily.

Tho the 3 ROs that work in Port Huron where I do all live in metro D, we would not say it’s a metro D job.
 
RealSimulD said:
You’ll see stuff that says Chicago or Pittsburgh and it’s 90 miles away. Rockford, IL was a good example. Why even do this? When you interview you’ll figure it out pretty easily.

Tho the 3 ROs that work in Port Huron where I do all live in metro D, we would not say it’s a metro D job.
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Probably should just state that it is commutable
 
$550K for Cumberland, MD or Charleston / Elkins, WV - sounds about right
 
medgator said:
Probably should just state that it is commutable
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Yup. If you have a 4 day/week job with no call that’s 90 minutes outside the city you could live in the fancy suburb that’s a half hour out and commute the hour. Not so much with call or even 5/week gets rough.
 
DoctwoB said:
Yup. If you have a 4 day/week job with no call that’s 90 minutes outside the city you could live in the fancy suburb that’s a half hour out and commute the hour. Not so much with call or even 5/week gets rough.
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These are 5 days / week
 
I think the 4 day work is even coming to RO.
People in non-hospital sites taking advantage of Covid waiver and that is until end of 2023 right now. Stay tuned! I’ve heard that off site may be here to stay.
 
RealSimulD said:
I think the 4 day work is even coming to RO.
People in non-hospital sites taking advantage of Covid waiver and that is until end of 2023 right now. Stay tuned! I’ve heard that off site may be here to stay.
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Tele will become a permanent thing. Covid isn't going to be eliminated by then
 
communitydoc13 said:
Will have to dig deep on RADICALS-HD. Just seems to me that 2 years ADT so much more of a lifestyle impact than 6 mos based on my patient experience.
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Extended ADT for salvage RT sinply prolongs time to PSA progression and metastases development. It does not cure more patients, at least not based on the available data.
 
seper said:
These are 5 days / week
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i think while some of these are "5 days/week" jobs, there is wiggle room. I think some of this may depend on coordination between the rad oncs working in the dept. I interviewed for one of these jobs and the each rad onc had 1 day off per week where the other rad onc covered. they also took much more than the "allowed" vacation because they would cover for each other.

of course none of this was stipulated in the contract, so as soon as some RN MBA BA MOC (member of costco) hospital admin catches word and cares enough im sure it would dissapear.
 
radoncftw said:
i think while some of these are "5 days/week" jobs, there is wiggle room. I think some of this may depend on coordination between the rad oncs working in the dept. I interviewed for one of these jobs and the each rad onc had 1 day off per week where the other rad onc covered. they also took much more than the "allowed" vacation because they would cover for each other.

of course none of this was stipulated in the contract, so as soon as some RN MBA BA MOC (member of costco) hospital admin catches word and cares enough im sure it would dissapear.
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Wow, actually allow the folks who are working to make decisions… crazy world we’re living in!
 
medgator said:
Big difference between being a hospital employed vs PP doc in this field. One big distinction is how supervision rules are interpreted
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2/3 of hospitals I’ve been employed at okay with off site since 2020.

Another place I interviewed at in chicago land - employment / hospital based was okay with off site.

My old single specialty practice in Maryland - the hospitals they worked at were super strict.

I don’t think it has to do with private Vs hospital. The academic guys are the most strict, from what I’ve seen.

Florida is not the world 🙂
 
RealSimulD said:
2/3 of hospitals I’ve been employed at okay with off site since 2020.

Another place I interviewed at in chicago land - employment / hospital based was okay with off site.

My old single specialty practice in Maryland - the hospitals they worked at were super strict.

I don’t think it has to do with private Vs hospital. The academic guys are the most strict, from what I’ve seen.

Florida is not the world 🙂
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Forgot to add ymmv, may not apply to your locale etc.

Intuitively though, supervision decisions seem like something up to the docs if private and hospital if not.

At this point, acr and Astro apex accreditation process doesn't seem to care about physical presence either
 
it is possible to negotiate a day off if 2+ RadOncs are working for a hospital. The 550K ad from this thread is most surely for a single doc site.
 
RealSimulD said:
2/3 of hospitals I’ve been employed at okay with off site since 2020.

Another place I interviewed at in chicago land - employment / hospital based was okay with off site.

My old single specialty practice in Maryland - the hospitals they worked at were super strict.

I don’t think it has to do with private Vs hospital. The academic guys are the most strict, from what I’ve seen.

Florida is not the world 🙂
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Yeah, I absolutely don't think the classic labels ("private", "community", "academic", etc) matter at all in this regard.

The only thing that matters is who's in charge, and what do they think. I obviously don't mean a Chair. With a few notable exceptions, they're not really in charge. If you're in a big department, academic or others, who runs billing? That person is the one actually in charge.

So if you have admin willing to look the other way or even encourage a physician-leaning interpretation of the regulations, great. If you have someone who is absolutely rigid and cannot interpret regulations in any way but with the utmost severity/strictness, GOOD LUCK.

While there are some clear-cut definitions, many things are left up to interpretation. And most of these interpretations will never get tested until and unless some crazy audit or whistleblower case takes place.

Whistleblower cases generally tend to have national "precedents" and can...clarify...regulations, but those are rare for RadOnc. Conversely, an audit in one geographic territory might have different results than if the same practice was audited by a different RAC contractor.

Just from personal experience, I can say that what my academic residency program really cared about (as in, strict policy) was very different than my private practice...but the hospitals staffed by the practice all act differently. It depends on the personalities of the staff who...do the billing.
 
I hope nobody reading this thinks that a 550k salaried job in the west virginia panhandle is a good deal. Especially if you are trying to justify it to yourself by hoping to negotiate a 4 day workweek (which you can probably do) and commute in an hour each way so you get the privilege of living in a suburb in one of the most congested and highest cost of living areas in the entire country. Also, from my experience, in more difficult-to-recruit areas, you should expect to be able to negotiate total comp up between 50 - 100k from their first offer. So you can probably get 625 from this. Still, pass. This is an 800k job, and they should compensate out of tech to fill it, and their consultant should sign off on fair market value due to location.

A_DeMichele said:
it is possible to negotiate a day off if 2+ RadOncs are working for a hospital. The 550K ad from this thread is most surely for a single doc site.
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Yes. You can (and should) for a solo doc site too, either by convincing them to let you provide general supervision remotely on Fridays or having an NP/PA in clinic if they want a body there. Once you have done 4 day weeks and see how stupidly do-able it is, even with a busy load, it's really painful to go back.
 
Moonbeams said:
I hope nobody reading this thinks that a 550k salaried job in the west virginia panhandle is a good deal. Especially if you are trying to justify it to yourself by hoping to negotiate a 4 day workweek (which you can probably do) and commute in an hour each way so you get the privilege of living in a suburb in one of the most congested and highest cost of living areas in the entire country. Also, from my experience, in more difficult-to-recruit areas, you should expect to be able to negotiate total comp up between 50 - 100k from their first offer. So you can probably get 625 from this. Still, pass. This is an 800k job, and they should compensate out of tech to fill it, and their consultant should sign off on fair market value due to location.


Yes. You can (and should) for a solo doc site too, either by convincing them to let you provide general supervision remotely on Fridays or having an NP/PA in clinic if they want a body there. Once you have done 4 day weeks and see how stupidly do-able it is, even with a busy load, it's really painful to go back.
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Two day a week totally doable as well. Don’t take my word for it. Google Medicare’s local carrier determination for almost half the country.
 
TheWallnerus said:
Two day a week totally doable as well. Don’t take my word for it. Google Medicare’s local carrier determination for almost half the country.
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I did 3 day weeks (Tues-Thurs) at a locums gig once. I was the only doc, and we were treating about 25, and I was out of there by 2-3 every day. It was awesome (well except the part where I only got paid for 3 days a week -- doing that fulltime would have been an awesome set up, of course that was only safe when you were paying a locums a daily rate, the fulltime hire had to be there 5 days otherwise not safe).
 
Moonbeams said:
I did 3 day weeks (Tues-Thurs) at a locums gig once. I was the only doc, and we were treating about 25, and I was out of there by 2-3 every day. It was awesome (well except the part where I only got paid for 3 days a week -- doing that fulltime would have been an awesome set up, of course that was only safe when you were paying a locums a daily rate, the fulltime hire had to be there 5 days otherwise not safe).
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I am once again reiterating to any CMMS employees browsing this thread that these are outlier cases and not indicative of the time, energy, and effort it takes to provide the excellent radiotherapeutic cancer care patients deserve to receive.
 
OTN said:
I am once again reiterating to any CMMS employees browsing this thread that these are outlier cases and not indicative of the time, energy, and effort it takes to provide the excellent radiotherapeutic cancer care patients deserve to receive.
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Supervision train left the station and CMS actually started up the locomotive at the beginning of 2020 pre pandemic iirc @TheWallnerus

No one should be surprised. CMS decided the rural critical access hospital (CAH) exemption wasn't killing patients over the last decade+ so they went ahead and made everyone exempt
 
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medgator said:
Supervision train left the station... CMS actually started up the locomotive at the beginning of 2020 pre pandemic iirc @TheWallnerus
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That’s true. And I repeat, federal govt LCDs say radiation doctors should be in the clinic two days a week.
 
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