Rad Onc Twitter

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drowsy12 said:
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No matter how hard it is to get more RVUs or more patients, or persisting in fee for service, MGMA says rad onc salaries keep going up year after year, and new grads are coming out making three quarter million dollars or more a year.

Let go and let God, Brother Sameer.
 
I don’t know how ROCR helps either other than “stabilize” your pro forma calculations for years and/or avoids any issues like when they cut your IGRT charges or bundle something. It doesn’t “solve” this issue though, I agree.

But it still comes down to pro fees aren’t keeping up with salaries, so hospitals/practices are taking technical revenue to boost salaries. Much like med onc salaries where their $/RVU can be very high though the professional fees they generate are more modest. They're taking chemo/infusion money and giving it to the docs. This just means on the back end the hospitals won’t have as much excess revenue from technical fees to funnel into other service lines.

I actually do believe those MGMA numbers, but I think it’s from more employed docs and some pro fee only groups getting “management fees” from hospitals to boost income above pro fees.

Of course this is all location dependent and in popular areas hospitals may not be willing to pay. Ultimately it’s supply/demand ….but big Medicare cuts can cause shock waves. At some point though when you go to admin and say you want more $/wRVU they will tell you no...we'll find someone else to do it for this...
 
BobbyHeenan said:
I don’t know how ROCR helps either other than “stabilize” your pro forma calculations for years and/or avoids any issues like when they cut your IGRT charges or bundle something. It doesn’t “solve” this issue though, I agree.

But it still comes down to pro fees aren’t keeping up with salaries, so hospitals/practices are taking technical revenue to boost salaries. Much like med onc salaries where their $/RVU can be very high though the professional fees they generate are more modest. They're taking chemo/infusion money and giving it to the docs. This just means on the back end the hospitals won’t have as much excess revenue from technical fees to funnel into other service lines.

I actually do believe those MGMA numbers, but I think it’s from more employed docs and some pro fee only groups getting “management fees” from hospitals to boost income above pro fees.

Of course this is all location dependent and in popular areas hospitals may not be willing to pay. Ultimately it’s supply/demand ….but big Medicare cuts can cause shock waves. At some point though when you go to admin and say you want more $/wRVU they will tell you no...we'll find someone else to do it for this...
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The increases in technical revenue (from the monopolistic leverage employed by growing/consolidating "nonprofit" systems) is an order of magnitude higher than the cuts in prof fees. This is why hospital and departmental profits increase every year. Unfortunately much of the technical increase is hidden behind nondisclosures in insurance contracts. Basically reimbursement is being transferred from prof to technical fees, and supply and demand sets the salaries for employed docs. Samir seems to have a very poor understanding of even the most basic economic realities.
 
BobbyHeenan said:
I actually do believe those MGMA numbers
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So we then have to believe our salaries are truly inversely proportional to how much Medicare reimburses us. Shouldn’t we be welcoming any time Medicare cuts rad onc. Maybe not welcoming, but quit wasting our time trying to stop it. After years and years of MGMA reports giving us irrefutable proof that rad onc salaries have risen proportionally more than about any other specialty over the last decade or so, do we have to fully embrace the counter-intuitiveness? The system is set up to raise MD salaries when MD reimbursement gets notched downward… a paradoxical, but strangely comforting, thought.
 
TheWallnerus said:
So we then have to believe our salaries are truly inversely proportional to how much Medicare reimburses us. Shouldn’t we be welcoming any time Medicare cuts rad onc. Maybe not welcoming, but quit wasting our time trying to stop it. After years and years of MGMA reports giving us irrefutable proof that rad onc salaries have risen proportionally more than about any other specialty over the last decade or so, do we have to fully embrace the counter-intuitiveness? The system is set up to raise MD salaries when MD reimbursement gets notched downward… a paradoxical, but strangely comforting, thought.
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I don’t understand this argument when despite Medicare cuts the medical field continue to make more year over year. Despite cuts there was a rise in physician average compensation overall.
 
BobbyHeenan said:
I actually do believe those MGMA numbers, but I think it’s from more employed docs and some pro fee only groups getting “management fees” from hospitals to boost income above pro fees.
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I think this is definitely the deal. If you are in a 70%+ Medicare area, you are probably not collecting pro-fees to pay your salary, even if you are relatively busy.

Case based doesn't directly solve the RVU issue, but I am an advocate. RVUs are very arbitrary and are a very imperfect way for admin to gauge your productivity. They should be excluded or minimized from contracts in many circumstances IMO (some folks here have a circumstance where RVUs presently help them, but we are seeing in real time how fickle this is).

Case based allows for a very simple establishment of terms with your employer.

@RickyScott has it right for employed docs salaries...although total revenue generated does matter some. Decoupling professional fees from salary is probably for the best for most of us.

My biggest concern is viability of smaller systems going forward. This will provide downward pressure on salaries (and limit high autonomy opportunities).
 
TheWallnerus said:
So we then have to believe our salaries are truly inversely proportional to how much Medicare reimburses us. Shouldn’t we be welcoming any time Medicare cuts rad onc. Maybe not welcoming, but quit wasting our time trying to stop it. After years and years of MGMA reports giving us irrefutable proof that rad onc salaries have risen proportionally more than about any other specialty over the last decade or so, do we have to fully embrace the counter-intuitiveness? The system is set up to raise MD salaries when MD reimbursement gets notched downward… a paradoxical, but strangely comforting, thought.
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I think Ricky Scott hits it. FOR NOW, well run large places have favorable technical rates. It may be serving as a supplement to maintain professional salaries as medicare reimbursement for pro fees are cut.

But like others are mentioning, this may be what is happening at present, but it can change quickly . Money is fungible, so at some point the hospital may want to siphon that technical revenue somewhere else outside of the department.
 
allseasons said:
I don’t understand this argument when despite Medicare cuts the medical field continue to make more year over year. Despite cuts there was a rise in physician average compensation overall.
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A lot of the arguments are extremely Rad Onc centric, and even further centric to niche subsets of Rad Onc, such as the few people that own capital in freestanding centers.

The hardest hitting cuts are to outpatient specialty physicians who are paid off the MPFS and have to buy expensive equipment to do procedures. Other physicians are seeing raises.

I agree with the above RVU emails and there is some concern. However, if you are in a large system, your executives may not be concerned at all. Mine have never heard of ROCR and do not understand how it helps patients. I tend to agree with them.

communitydoc13 said:
My biggest concern is viability of smaller systems going forward. This will provide downward pressure on salaries (and limit high autonomy opportunities).
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Same. I actually like being employed... I know, crazy... and it helps me to have a lot of employers in town. Through this lens, I am pretty anti-ROCR.
 
allseasons said:
I don’t understand this argument when despite Medicare cuts the medical field continue to make more year over year. Despite cuts there was a rise in physician average compensation overall.
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Many large health systems negotiate rates w/ insurers that are much higher than medicare (5-10 x cms!). Because these systems have monopolistic leverage, the rate increases far outpace inflation (and why health insurance is now 30k+ for a family of 4). For example several years ago, upenn was charging some insurance cos 300K+ for IMRT prostate radiation. Centers like MDACC would rather break federal and state laws and pay daily fines than disclose what they are being paid by private payors.
 
TheWallnerus said:
So we then have to believe our salaries are truly inversely proportional to how much Medicare reimburses us. Shouldn’t we be welcoming any time Medicare cuts rad onc. Maybe not welcoming, but quit wasting our time trying to stop it. After years and years of MGMA reports giving us irrefutable proof that rad onc salaries have risen proportionally more than about any other specialty over the last decade or so, do we have to fully embrace the counter-intuitiveness? The system is set up to raise MD salaries when MD reimbursement gets notched downward… a paradoxical, but strangely comforting, thought.
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You seem to live in 2002 still.

This is 2025.

I don’t think you understand that we are all largely employed.
 
drowsy12 said:
You seem to live in 2002 still.

This is 2025.

I don’t think you understand that we are all largely employed.
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Oh no. I live in the employed, eternal now 🙂

Here, rad onc salary is up 12 to 33% over the last 7-8 years per MGMA and Doximity.
Here, rad onc reimbursement is down 25% over the last 12 years.

This is very suggestive that the significant cuts looming to our professional reimbursement next year mean we are all about to, yet again, get another annual pay raise. Just like the one we got this year and last year. (By "we" I mean the "median we." We's mileage may vary.)

And that should make all of us employed rad oncs very happy. If ROCR stabilizes things, past financial history pretty much indicates: our salaries should stagnate, or go down. We should all hate ROCR for that reason alone... it threatens to stabilize reimbursement, threatening our annual significant salary increases which, again, MGMA and Doximity prove have been happening.


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TheWallnerus said:
Oh no. I live in the employed, eternal now 🙂

Here, rad onc salary is up 12 to 33% over the last 7-8 years per MGMA and Doximity.
Here, rad onc reimbursement is down 25% over the last 12 years.

This is very suggestive that the significant cuts looming to our professional reimbursement next year mean we are all about to, yet again, get another annual pay raise. Just like the one we got this year and last year. (By "we" I mean the "median we." We's mileage may vary.)

And that should make all of us employed rad oncs very happy. If ROCR stabilizes things, past financial history pretty much indicates: our salaries should stagnate, or go down. We should all hate ROCR for that reason alone... it threatens to stabilize reimbursement, threatening our annual significant salary increases which, again, MGMA and Doximity prove have been happening.


View attachment 408039View attachment 408040
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If you believe ChatGPT, were actually up less than average over the same time period.

Nominal Salary Growth: 2015–2025​

  • According to Becker’s ASC, physicians experienced a cumulative average pay increase of 40.14% between 2015 and 2025 Becker’s ASC.
  • This equates to an approximate average annual nominal growth of ~3.4% (using compound annual growth rate over 10 years).
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It could be that this is all just market movement related to supply, demand, and COL, and there is no mechanistic relationship to RVU trends at all. If someone is employed, you are making a ton of assumptions about how that institution sets their salary.

Using past economic patterns to predict the future is about as scientific as invoking the invisible hand.

That said, we SCAROP/ASTRO are kind of taunting it, and I hope when we get slapped by the hand it doesnt hurt to bad. For the physicians I mean. Chairs... as we all have heard them say... will be happy.
 
Mandelin Rain said:
Pay can go up when reimbursement goes down, if utilization/volume increase.
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There is an immense amount of data that RT utilization is going down over time. Volume, in terms of raw numbers, is a little more difficult to get a pulse on. My gestalt is volume is mildly increasing over time… offset by rad onc (MD) volume increase however.
 
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Are you aware of inflation?

I really don’t get this hill you’ve carved out that every piece of salary information we have out there is wrong.

It’s strange strange behavior
 
drowsy12 said:
Are you aware of inflation?

I really don’t get this hill you’ve carved out that every piece of salary information we have out there is wrong.

It’s strange strange behavior
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No hill carving. I’m fully prepared to say I’m wrong. It’s one of my better qualities. Every single salary data metric is unassailable. I know this because I’m making 33% more today than 8 years ago 😉

 
alwaysbeIMRTing said:
It is wild when you realize how much the people in the generation before were making per patient, both on an absolute and relative-to-inflation basis.
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Peak rad onc. The ones that got into residency in the late 90s didn't even know what hit them...
 
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Palex80 said:
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1. What is PORT? 😜
2. What do RadOncs have to say about the next quadruple Chemo-IO combination that will be used in neoadjuvant stage III NSCL?
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1) a treatment given in spite of data… because the data is not quite what you think it is on expert close inspection
2) it will only increase the necessity of local control
 
It really shouldn't be "controversial" to not do neoadjuvant systemic treatment before surgical resection in an unresectable tumor, given the complete lack of data supporting it, but I'm not surprised that a surgeon has decided to ignore the data. I'm also not surprised that Drew went waaaayyyyyy too far with his Twitter argument.
 
OTN said:
It really shouldn't be "controversial" to not do neoadjuvant systemic treatment before surgical resection in an unresectable tumor, given the complete lack of data supporting it, but I'm not surprised that a surgeon has decided to ignore the data.
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The surgeon is a PITA on twitter and it doesn’t surprise me that thoracic surgeons seem like they run the table in the northeast. I don’t get why community rad onc’s should be beholden to them though, they never send us patients and try to surgerize everything.

Taking to surgeons in my city: When is chemo/IO plus surgery appropriate for nsclc?

Surgeons: “Yes”

I blame the pharma companies for pushing neoadjuvant for unresectable disease and the surgeons for going along with it
 
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What an oddly specific thing to deny. Insurance trying to regulate energy mixing?

I thought we did 4 board exams including radiation biology and physics in order to gain respect in the house of medicine for what we do.

Haha, jokes on you. Some actuary who knows nothing about what you do will control how you treat patients to save a buck.

ETA: it does make me think our billing and coding has gotten too complex. They can mess with us this thoroughly because we have so many codes to play with. An argument for the simplification --- if they would only value the codes right.
 
yesmaster said:
The surgeon is a PITA on twitter and it doesn’t surprise me that thoracic surgeons seem like they run the table in the northeast. I don’t get why community rad onc’s should be beholden to them though, they never send us patients and try to surgerize everything.

Taking to surgeons in my city: When is chemo/IO plus surgery appropriate for nsclc?

Surgeons: “Yes”

I blame the pharma companies for pushing neoadjuvant for unresectable disease and the surgeons for going along with it
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The last three months I have seen a patient per month who underwent neoadjuvant systemic therapy, was taken to the OR, a thoracotomy was done, and then for various reasons it was aborted/unsuccessful/etc, so I've had to come in and clean up with chemoRT. I had a "way out over our skis" discussion with my main medonc yesterday about it, as he only saw one of those three cases. We'll see if it moves the needle, but while the academicians are getting into a Twitter pissing contest I haven't heard anything about any comparative Phase III trials being developed.
 
OTN said:
The last three months I have seen a patient per month who underwent neoadjuvant systemic therapy, was taken to the OR, a thoracotomy was done, and then for various reasons it was aborted/unsuccessful/etc, so I've had to come in and clean up with chemoRT. I had a "way out over our skis" discussion with my main medonc yesterday about it, as he only saw one of those three cases. We'll see if it moves the needle, but while the academicians are getting into a Twitter pissing contest I haven't heard anything about any comparative Phase III trials being developed.
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Honestly not sure how we got to this point considering what the albain/intergroup lung study showed us about the role of surgery, at least in stage 3
 
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