Rad Onc Twitter

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Radonc90 said:
If you don't have time to write a medical neccesity note (peer-to-peer etc.) for your pt, ChatGPT can help lol...

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If Med Onc can do it, so can we. You're welcome:

"Dear [United Health],

I am writing to appeal the recent denial of coverage for intensity modulated radiation therapy (IMRT) for my patient [Patient Name], who has been diagnosed with rectal cancer. I strongly believe that this treatment is medically necessary and crucial to the patient's recovery and well-being.

I have reviewed the denial of coverage and am disappointed to see that it was based on a misunderstanding of the patient's medical history and the severity of their condition. IMRT is widely recognized as a leading treatment for rectal cancer and has been proven to provide improved outcomes compared to traditional radiation therapy.

Furthermore, the patient has already undergone a comprehensive evaluation by multiple healthcare providers, including a specialist in radiation oncology, and all have recommended IMRT as the best course of treatment. It is imperative that this treatment be covered in order to provide the patient with the best chance of recovery and improved quality of life.

I understand that coverage decisions are based on a variety of factors, but I strongly urge you to reconsider this decision and grant coverage for IMRT for my patient. I have attached supporting medical documentation to this letter for your review.

I appreciate your attention to this matter and look forward to a prompt resolution. I am available to discuss the case further and provide any additional information that may be necessary.

Sincerely, [Your Name]"
 
Gfunk6 said:
If Med Onc can do it, so can we. You're welcome:

"Dear [United Health],

I am writing to appeal the recent denial of coverage for intensity modulated radiation therapy (IMRT) for my patient [Patient Name], who has been diagnosed with rectal cancer. I strongly believe that this treatment is medically necessary and crucial to the patient's recovery and well-being.

I have reviewed the denial of coverage and am disappointed to see that it was based on a misunderstanding of the patient's medical history and the severity of their condition. IMRT is widely recognized as a leading treatment for rectal cancer and has been proven to provide improved outcomes compared to traditional radiation therapy.

Furthermore, the patient has already undergone a comprehensive evaluation by multiple healthcare providers, including a specialist in radiation oncology, and all have recommended IMRT as the best course of treatment. It is imperative that this treatment be covered in order to provide the patient with the best chance of recovery and improved quality of life.

I understand that coverage decisions are based on a variety of factors, but I strongly urge you to reconsider this decision and grant coverage for IMRT for my patient. I have attached supporting medical documentation to this letter for your review.

I appreciate your attention to this matter and look forward to a prompt resolution. I am available to discuss the case further and provide any additional information that may be necessary.

Sincerely, [Your Name]"
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Need to be more specific on doses and send some planning images to have a shot in rectal IMRT appeal. I think they contract actual Radonc's to review appeals
 
FindMeOnTheLinks said:


Lmao

They want a full-time bowel contouring monkey
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This is rich. Dr Steinberg stated in public at an ASTRO panel years ago that "cheap labor" was not the explanation for the resident expansion> another panelist brought up a RAND study concluding that resident expansion in many specialties (especially in "more lucrative" programs) was an attempt to increase revenues with lower wages.

www.rand.org

Does It Cost More to Train Medical Residents or to Replace Them?

If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.
www.rand.org www.rand.org

"If the hospital has service needs, there is a marginal benefit to adding a resident, particularly in the more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare GME-related revenues."
 
Chartreuse Wombat said:
This is rich. Dr Steinberg stated in public at an ASTRO panel years ago that "cheap labor" was not the explanation for the resident expansion> another panelist brought up a RAND study concluding that resident expansion in many specialties (especially in "more lucrative" programs) was an attempt to increase revenues with lower wages.

www.rand.org

Does It Cost More to Train Medical Residents or to Replace Them?

If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.
www.rand.org www.rand.org

"If the hospital has service needs, there is a marginal benefit to adding a resident, particularly in the more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare GME-related revenues."
Click to expand...

Steinberg is another boomer grifter who fits nicely into the category of “I got mine now let’s see how many people I can hoodwink”. The only thing this guy deserves is a CVA
 
Chartreuse Wombat said:
This is rich. Dr Steinberg stated in public at an ASTRO panel years ago that "cheap labor" was not the explanation for the resident expansion> another panelist brought up a RAND study concluding that resident expansion in many specialties (especially in "more lucrative" programs) was an attempt to increase revenues with lower wages.

www.rand.org

Does It Cost More to Train Medical Residents or to Replace Them?

If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.
www.rand.org www.rand.org

"If the hospital has service needs, there is a marginal benefit to adding a resident, particularly in the more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare GME-related revenues."
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This is really bad. So shameful and exploitative.
 
Gfunk6 said:
Also waaaaaay cheaper that hiring an RTT or Physicist to do the same
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Is it really? This is a genuine question. I don't really know the RTT market, but could imagine an "advanced" RTT that is contouring for adaptive might make the same as a clinical fellow?

Physicists do make more yes.
 
NotMattSpraker said:
Is it really? This is a genuine question. I don't really know the RTT market, but could imagine an "advanced" RTT that is contouring for adaptive might make the same as a clinical fellow?

Physicists do make more yes.
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It depends on what Steinberg is paying the fellow. Fellowships can be PGY-6 (what is it, 80K now at UCLA?) or "junior faculty" which is mid 100,000s
 
seper said:
It depends on what Steinberg is paying the fellow. Fellowships can be PGY-6 (what is it, 80K now at UCLA?) or "junior faculty" which is mid 100,000s
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Nah this will be for FMGs looking to get a foot in the door; probably 50ish my guess.
 
temujim said:
Nah this will be for FMGs looking to get a foot in the door; probably 50ish my guess.
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PGY salaries are set by hospital GME office. They are higher in places like LA. I think it's $89,575 now for PGY-6
 
NotMattSpraker said:
Is it really? This is a genuine question. I don't really know the RTT market, but could imagine an "advanced" RTT that is contouring for adaptive might make the same as a clinical fellow?

Physicists do make more yes.
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It really depends heavily on your market. My eyes were opened when I looked at RTT comp across the country. No joke, what they pay starting RTTs in Arkansas is what Chipotle in California pays their local burrito "artists." A lot of times when we post RTT comp, the out of state guys get very excited because it is WAY more than what they are making. The enthusiasm stops after they look at the cost of living via Zillow.

But yes, in CA a fellow would get paid WAY less than an experienced RTT that can adaptively contour on MR.
 
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RealSimulD said:
I'm not a supporter of fellowships, but this is not a clinical fellowship, it's not trying to recruit US MDs. It's a research fellowship funded by Viewray and the target population is international/foreign physicians.

They are hiring 2 physicians for faculty jobs.

I want to hate this as much as the next guy and don't go around defending academic chairmen, but this is not the one to get all worked up about.
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International fellows won’t benefit from this crap either. More likely, they are using it as a back door into the profession.
 
RealSimulD said:
I'm not a supporter of fellowships, but this is not a clinical fellowship, it's not trying to recruit US MDs. It's a research fellowship funded by Viewray and the target population is international/foreign physicians.

They are hiring 2 physicians for faculty jobs.

I want to hate this as much as the next guy and don't go around defending academic chairmen, but this is not the one to get all worked up about.
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The original general #radonc tweet says nothing about that they’re only looking for non US residency grads. And if you click on the link for a further description it specifically states eligibility includes completion of an acgme residency. I know nothing about UCLA rad onc and can only go by with what they publicly post.

Bottom line is just about anyone would agree this is a garbage position for anyone who has completed training and is BE. In reality you are going to learn a whole heck of a lot more in general practice rad onc one year out of residency then doing this fellowship. Not to mention the $100k’s in lost potential income.
 

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fiji128 said:
The original general #radonc tweet says nothing about that they’re only looking for non US residency grads. And if you click on the link for a further description it specifically states eligibility includes completion of an acgme residency. I know nothing about UCLA rad onc and can only go by with what they publicly post.

Bottom line is just about anyone would agree this is a garbage position for anyone who has completed training and is BE. In reality you are going to learn a whole heck of a lot more in general practice rad onc one year out of residency then doing this fellowship. Not to mention the $100k’s in lost potential income.
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RealSimulD said:
In our esteemed Red Journal, recently.

"RadOncs follow guidelines"

"Jail is bad for cancer patients"

"Being poor is bad for cancer patients"

"Experiencing homelessness is bad for cancer patients"

"Socially disadvantaged patients have a hard time completing trials"

"People that don't read/understand the language need more resources to understand RT"
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I still get it for free at my current place. It moves from the mail to my desk. I read the TOC and from there straight into the garbage. Even if the title sounds even mildly interesting I usually throw it away.
 
RealSimulD said:
In our esteemed Red Journal, recently.

"RadOncs follow guidelines"

"Jail is bad for cancer patients"

"Being poor is bad for cancer patients"

"Experiencing homelessness is bad for cancer patients"

"Socially disadvantaged patients have a hard time completing trials"

"People that don't read/understand the language need more resources to understand RT"
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The conclusion of most of these types of studies are “Further interventions to optimize cancer diagnosis and treatment in [group] are urgently needed.”

How many of the researchers who publish on this stuff actually work on any of the interventions they call for?

I’m not saying these topics aren’t worth publishing on at all, but it should be in no more than Advances. Sad that they’re displacing quality research that will end up in a non-flagship journal.
 
There is nothing inherently wrong with DEI per se, and those who vigorously oppose it, for oppositions sakes, aren't the kind of folks I would want to socialize with for very long, and furthermore, I have a high degree of suspicion about their motivations.

Calling out the absurdities of DEI on their own standing, when they are being substituted for high quality scientific research, is reasonable.

Being thoughtful towards marginalized groups is something that should be routine.
 
RealSimulD said:
it's an industry funded opportunity for international docs
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Is this sort of thing helpful? The international applicant views it as helpful to them, but is it helpful to the field? Is it an optimal opportunity to offer a bright person aspiring to be a U.S doc (or would a medicine residency spot be better)? Would Steinberg or any of us recommend this opportunity for their children?

Is it a necessary position for anybody? Does anybody need a year to do this?

Just not seeing it as a defensible thing. Very business motivated. The thinking is, this position will help present docs who have markedly better opportunities than the applicant and it will be filled by a desperate applicant due to global inequity.

Looks like migrant labor for poultry processing to me.
 
sirspamalot said:
There is nothing inherently wrong with DEI per se, and those who vigorously oppose it, for oppositions sakes, aren't the kind of folks I would want to socialize with for very long, and furthermore, I have a high degree of suspicion about their motivations.

Calling out the absurdities of DEI on their own standing, when they are being substituted for high quality scientific research, is reasonable.

Being thoughtful towards marginalized groups is something that should be routine.
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If you’ve gotten through college, accepted into medical school, accepted into rad onc and thus are on track to make hundreds of thousands a year… when do you “ease out” of a marginalized group and just be, like, in a group. Eventually “marginalized” is more state of mind than actual reality at a per person basis. Being thoughtful… sure, ok. James said faith without works is dead. Shakespeare said “my words fly up, my thoughts remain below; words without thoughts never to heaven go.” Words (in RedJ) trick people into thinking you’re harboring deep thoughts. Most people’s deep thoughts on this are Jack Handeyian.
 
RealSimulD said:
You know, you make good points. I don’t know what to tell you. Some international doc may or may not take the position. It’s just the responses seem to want to continue the anger, even though now we know - it’s not targeting Americans, it’s not clinical, there is no RVU generation and exploitation, no state money is being used. We have a lot to be upset about. And MS does a lot of things to cause people to be upset.
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This is exploitation because you could easily hire a true junior faculty and train them on the clinical use of the Viewray while they work. It could likely be done in one or a few days. This is how every single non-resident clinician who is "proficient" on Viewray has been trained to date.

Viewray and UCLA are free to spend their money however they like, but it's easy to think of many other ways this money could be used in more productive ways. Funding an advanced therapist to improve the workflow or a clinical trial are good examples.

Certainly I can see the upside of funding a training position for the company. It's not like they are charitably making MRgRT education better.
 
RealSimulD said:
I'm in favor of Safety, Quality and Huge Bonuses. SQH. I think most of you are also SQH fans. What if my way of promoting Safety was to say that physicians cannot have more than 15 patients on beam at any time. I feel that this is the way to do it. And it will be safer. I will show retrospective data showing that having >15 patients on beam leads to an excess of medical errors. The data will be shoddy, but my buddies in editorial agree with me and will publish this. My way of promoting quality is to make everyone do everything the same way. MDACC has a great way of doing things. My research says their outcomes are better than yours. So, you should do it their way. In fact, we will all do it their way. You will have to buy their network affiliation. In addition, if you don't buy it, then you are also not meeting the safety standard. If you are having difficulty with either of these, then we offer a reasonably priced consultancy that has 1, 2 and 3 year programs that will help you meet our safety and quality standards. Wait - you can't? Don't you like Quality and Safety? Lest we forget about the H. Huge Bonuses go to those administrators that are able to meet our metrics.

It's not D E I that anyone has a problem with. It's DEI,Inc / Big DEI. It's that departments and journals and the third party leeches that are involved. It's the completely inactionable research findings that always conclude "more work is needed blah blah blah". It self perpetuates dismal science.

I am pro diversity. I am pro equity. I am pro inclusiveness. But, there ought not be groupthink on how to get there.
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In my opinion, there is an optimal volume that is busy but not excessive. Lower volume such as less than 15 on beam may result in inefficiency with plenty of online shopping and streaming video consumption but not actually practicing the craft.

Surgical data suggests that quality is related to skill. Longer operations, although a blunt measuring tool, was linked to lower skill. Could there be a similar association in radiation management?


Slowing down is a symptom of bureaucratic bloat that has plagued to construction industry. Anyone see a similar parallel to the health industry and particularly hospitals?

www.nytimes.com

Opinion | The Story Construction Tells About America’s Economy Is Disturbing (Published 2023)

Why was America — and not just America — better at building in the 1970s?
www.nytimes.com www.nytimes.com
 
communitydoc13 said:
Is this sort of thing helpful? The international applicant views it as helpful to them, but is it helpful to the field? Is it an optimal opportunity to offer a bright person aspiring to be a U.S doc (or would a medicine residency spot be better)? Would Steinberg or any of us recommend this opportunity for their children?

Is it a necessary position for anybody? Does anybody need a year to do this?

Just not seeing it as a defensible thing. Very business motivated. The thinking is, this position will help present docs who have markedly better opportunities than the applicant and it will be filled by a desperate applicant due to global inequity.

Looks like migrant labor for poultry processing to me.
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Specifically, per their own posted requirements, the only eligible applicants must have completed an accredited ACGME/RCPSC (which is the Royal College of Physicians and Surgeons of Canada) Radiation Oncology program. So its not even really that international. Its not for pre/post med school research type of stuff. Just US and Canadian rad onc grads can apply. They are looking to fill 1 to 2 positions for July 2023, lol! This type of egregious grift needs to be called out when it is seen.

www.uclahealth.org

Magnetic Resonance Imaging-Guided Radiotherapy Fellowship Program

www.uclahealth.org www.uclahealth.org
 
RealSimulD said:
Questioning anything leads to being labeled an -ist.
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Hyperbole. The questions that get raised sometimes should provoke further insight as to why they are being asked, that in of itself, is not necessarily bad. Everyone will see the line slightly differently.

What should not happen is castigation for raising a question assuming it is made in good faith. OTOH certainly speaking up when punishment is handed out without due investigation is warranted.
 
sirspamalot said:
15 on treatment with a nice mix of patients for an experienced doc is totally fine for practicing the craft.

You don't have to drown to learn how to swim, much less swim to stay fit.
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Doing this for 3 days/week sounds like a great way to wind down a career
 
theradiator said:
In my opinion, there is an optimal volume that is busy but not excessive. Lower volume such as less than 15 on beam may result in inefficiency with plenty of online shopping and streaming video consumption but not actually practicing the craft.

Surgical data suggests that quality is related to skill. Longer operations, although a blunt measuring tool, was linked to lower skill. Could there be a similar association in radiation management?
Click to expand...

I dont think the surgical data can be ported over to Rad Onc for many reasons. Probably most important is that the final "quality" relies on a whole team of people, not the dexterity of one surgeon and a small number of recovery physicians/nurses. A lot of people probably assume "the craft" means contouring as its an easy analogy to operating, but Id argue a skilled rad onc needs to do a lot more than define targets and OARs. Or maybe not. Our field has done a very poor job of defining quality. The quality efforts of ASTRO compared to the American College of Surgeons is a complete joke.

Sometimes people incorrectly look at timing of the end to end RO workflow and incorrectly identify contouring as the "most inefficient" because it takes the longest. I've seen this declared in two different clinics. In one of them, I watched admins blame physicians outright and implement one of the most disastrous policies I've ever seen to "penalize" physicians that contoured "slowly". Considering we all work in healthcare, it is a feat to hold the crown of most disastrous policy.

Too bad the case mix has a huge impact on contouring speed and contouring is an activity that many don't block time to do, so it is impacted by your clinical schedule as well. Busy physicians doing complex cases might have the most skill, but if you pick the wrong metric they are deemed inefficient. Ridiculous.

My guess is many self-proclaimed disease site experts actually carry very few cases because they hold <80% clinical appointments. Are they skilled? If not, how can one be an unskilled expert in a technical field?

I agree with your opinion, but would love data here because I dont think anyone is making a good faith argument on this topic out in the real world. The only people that have ever told me it's important to be busy in order to be a good Rad Onc are people that directly or indirectly benefitted from me taking on a big case load.

If you believe the data, were all getting less busy over time as well. Is the entire field becoming less skilled?

Important questions.
 
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