Radiation Oncology Metrics

[Tryigntopass2]

Looking to join a practice that i've been working at for two years. Was wondering how I would go about figuring if my offer is appropriate ie is there a way to find the average collections or pay for someone in a similar situation? Thanks.

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[Mandelin Rain]

If you've been working there for 2 years and making partner, they should probably open the books for you to see what everyone is making. In fact, it's best if they do that from day 1.

 

[evilbooyaa]

Looking to join a practice that i've been working at for two years. Was wondering how I would go about figuring if my offer is appropriate ie is there a way to find the average collections or pay for someone in a similar situation? Thanks.

You mean as a partner? As a partner you should have equal access to the books.

 

[Mandelin Rain]

I'd have a hard time joining any practice where I didn't know exactly how much everyone was making.

 

[deleted1002574]

Sounds like they were working maybe as locums/temp and now joining the practice and is now getting an initial offer - my reading. No mention of partnership. I don't know if they owe you that much information, other than basics, if not currently an associate.

 

[evilbooyaa]

Oh yeah if you were a locums and they're bringing you on as full-time you're not going to know if they're screwing you in regards to collections in your name vs salary until you make partner. Reference MGMA data if you can otherwise it's a matter of whether you feel well compensated or not. If there is a bonus structure it is reasonable to ask those who work there whether others are meeting their bonuses.

 

[msuxrt]

Is there a good way to access MGMA data. I know there is another parallel thread regarding FMV but do we believe the available MGMA numbers are accurate?

 

[medgator]

Is there a good way to access MGMA data.

Pay for it?

 

[scarbrtj]

Is there a good way to access MGMA data. I know there is another parallel thread regarding FMV but do we believe the available MGMA numbers are accurate?

The last time I looked at MGMA data in-depth (7y ago?) it was based on the salary data from approximately 40 radiation oncologists nationwide and rad onc had the fewest respondents of any specialty. Would mean rad onc data comprises about 0.03% of MGMA’s overall data, so it does make you question its accuracy. However, in the eyes of admin, it’s the only data that matters.

 

[Neuronix]

However, in the eyes of admin, it’s the only data that matters.

Academics likes AAMC. Salary numbers are lower than MGMA.

I don't have access to MGMA either. I usually end up using random screenshots from people who have access to it or stuff you can Google.

 

[deleted1002574]

This is why I’m trying to help collect data in the FMV thread. The powers that be and rad oncs themselves are quite secretive about these things.

 

[radoncgrad2019]

anyone who has it available in their local academic library (should be available if you work in academics) - please post pictures publically here on SDN of the 2019 MGMA for Rad Onc.

 

[Chartreuse Wombat]

I don't know whether this is 2018 or 2019.

Don't know what FPSC is either.

Provided by my business office with EOY review

 

[Neuronix]

My experience in hunting for academic jobs is that everything is based on some permutation of FPSC and AAMC. I inquired at my academic library about MGMA and they don't seem to have it.

I'm not secretive about much of anything. There is just a lot of information asymmetry when it comes to these benchmarks. As a peon, I'm usually kept in the dark about this stuff. When they were working on adjusting benchmarks and salaries in our department, I got a very stern talking to for asking too many questions about these benchmarks and what's most appropriate.

Still, there's plenty of information out there using Google.

Regarding FPSC, SCAROP posted a talk here: http://www.scarop.org/documents/BBrown.pdf . If I understand correctly FPSC is specific to academics and is in conjunction with AAMC. Their wRVU benchmarks have always been higher than the private practice benchmarks (MGMA and AGMA) which I find kind of odd.

If the numbers are to believed, there is a spreadsheet with MGMA and AGMA numbers (and median salaries) here: https://www.med.unc.edu/fbo/files/2018/08/Funds-Flow-Benchmark-Request-Form.xlsx

The AAMC salary data for 2017 is found in this spreadsheet: https://jfr.uams.edu/help/JFR_Business_Plan.xlsm . I don't have access to those numbers in print form currently, but it is congruent with my memory of the data for 2017 when I had access.

So most academic institutions use the FPSC with higher wRVU benchmarks than the private benchmarks and with AAMC total compensation numbers that have lower salaries than private benchmarks. Neat huh?

 

[Chartreuse Wombat]

Thanks.

Weird how the intro slides discuss large sample size etc and the breakdown according to %FTE indicates only 140 physicians included in the survey.

Is it possible that the administrators are skewing the numbers? /sarc

 

[Neuronix]

Is it possible that the administrators are skewing the numbers? /sarc

I was wondering the same thing but didn't want to type it. No /s needed on this side.

 

[JustAdocInBox]

 

[Burt Radnolds]

Their wRVU benchmarks have always been higher than the private practice benchmarks (MGMA and AGMA) which I find kind of odd.

My best guess on this is that it pertains to most academics being designated a certain percentage clinical such as 70%. Your wRVUs are then divided by your FTE equivalent to generate what would be attributable to one full FTE. Meanwhile, those in PP would be more likely to be at 100% clinical and the numbers would be more directly attributable to the amount of wRVUs they are actually doing.

I could be off base on this, but it would be important for those in academics to know this distinction as it could be used to fudge the numbers pretty hard against you.

 

[radoncgrad2019]

based on 400 providers, that's not that bad

 

[seper]

10% of the workforce - good. Do you know if it is self-reported by docs? I like the AAMC survey because it's employer-reported.

based on 400 providers, that's not that bad

 

[Neuronix]

My best guess on this is that it pertains to most academics being designated a certain percentage clinical such as 70%. Your wRVUs are then divided by your FTE equivalent to generate what would be attributable to one full FTE. Meanwhile, those in PP would be more likely to be at 100% clinical and the numbers would be more directly attributable to the amount of wRVUs they are actually doing.

I could be off base on this, but it would be important for those in academics to know this distinction as it could be used to fudge the numbers pretty hard against you.

I agree with you.

Let's imagine an academic physician who is full time clinical. I have never seen an academic job that didn't at least on paper have a non-clinical day. So they're immediately 0.8 FTE. But what do all academic people complain about? Their academic day isn't protected or they spend the day catching up contours and notes. I know a number of people in private who have a similar arrangement with no scheduled patients on one day, though they may see add ons, do other admin tasks, provide coverage, etc on that day.

So MGMA median is ~9000. There is nothing to normalize for private practice. That's just a median full-time rad onc. If you divide that by 0.8, you get approximately the FPSC median of 11,250. So there's your academic equivalent full-time clinical rad onc. Indeed, the FPSC presentation I linked earlier has an average clinical effort of 0.73 FTE.

But you're right here--if the thresholds for salaries, bonuses, etc are set to 11,000+ wRVUs based on FPSC medians, that's setting an unrealistic target. Full-time clinical has to be more like 0.8 x FPSC to be more in line with MGMA/AGMA and salaries/bonuses adjusted according to other effort.

Sure enough, when I was 0.7 FTE my RVUs were about 9,000 per year. I knew something was off because I was pretty busy, seeing the same number of consults as my private practice buddies, despite being told I had "1.5 days academic time". It's all a matter of understanding (and fudging) the numbers.

 

[JustAdocInBox]

I agree with you.

Let's imagine an academic physician who is full time clinical. I have never seen an academic job that didn't at least on paper have a non-clinical day. So they're immediately 0.8 FTE. But what do all academic people complain about? Their academic day isn't protected or they spend the day catching up contours and notes. I know a number of people in private who have a similar arrangement with no scheduled patients on one day, though they may see add ons, do other admin tasks, provide coverage, etc on that day.

So MGMA median is ~9000. There is nothing to normalize for private practice. That's just a median full-time rad onc. If you divide that by 0.8, you get approximately the FPSC median of 11,250. So there's your academic equivalent full-time clinical rad onc. Indeed, the FPSC presentation I linked earlier has an average clinical effort of 0.73 FTE.

But you're right here--if the thresholds for salaries, bonuses, etc are set to 11,000+ wRVUs based on FPSC medians, that's setting an unrealistic target. Full-time clinical has to be more like 0.8 x FPSC to be more in line with MGMA/AGMA and salaries/bonuses adjusted according to other effort.

Sure enough, when I was 0.7 FTE my RVUs were about 9,000 per year. I knew something was off because I was pretty busy, seeing the same number of consults as my private practice buddies, despite being told I had "1.5 days academic time". It's all a matter of understanding (and fudging) the numbers.

Did you have expectations for academic productivity as well?

The sense I get from colleagues is academic 80% clinical tends to have the same clinical work load as private practice but with 30% less pay and expectations of academic production added on top.

 

[Neuronix]

Did you have expectations for academic productivity as well?

You have to be academically productive to get promoted because the promotion pathway (here at least) is heavily based on publications and other academic metrics.

You won't get fired for not being academic in any academic shop that I've seen. But if you're a new grad or otherwise not well established in academics, you'll usually hang out as an underpaid assistant professor indefinitely if you're not academically productive.

So if you're not able or willing to be academically productive, it doesn't make sense to stay and make your employer lots of money if you're making less than fair market value with limited opportunities for advancement. Though we have some posters floating around who may not really have any choice... Such is the rad onc job market.

 

[Doctorer]

Anyone have those academic numbers?

 

[Becquerel]

I'm not sure what to make of the MGMA RVU data. 9,000 wRVUs seems quite low for a full-time private practice MD, regardless whether one is employed or a physician partner. I've seen data from 21C suggesting that their MDs are generally exceeding 18-20K wRVUs per year, though that is clearly higher than the average practice environment. 9K wRVUs seems about right for a typical main-site academic job, though that is very disease-site specific (with significant institutional variability).

What do you all feel is the average number of new consults and follow-ups seen per week by a typically busy (but not 21C style), community-based private practice MD working 5 days per week in a mid-sized multi-doc practice? 8-9 consults? 30 followups?

 

[Burt Radnolds]

I'm not sure what to make of the MGMA RVU data. 9,000 wRVUs seems quite low for a full-time private practice MD, regardless whether one is employed or a physician partner. I've seen data from 21C suggesting that their MDs are generally exceeding 18-20K wRVUs per year, though that is clearly higher than the average practice environment. 9K wRVUs seems about right for a typical main-site academic job, though that is very disease-site specific (with significant institutional variability).

What do you all feel is the average number of new consults and follow-ups seen per week by a typically busy (but not 21C style), community-based private practice MD working 5 days per week in a mid-sized multi-doc practice? 8-9 consults? 30 followups?

I think people probably see less true consults than they think. 8-9 consults a week would be ~400 new patients a year which is much higher than most metrics suggest is normal. I think if you average it out over a year the number of a moderately busy rad onc us ~250 new patients a year which comes out to 5ish a week. That could be some weeks with 8-9 and some with 2-3.

 

[medgator]

I think people probably see less true consults than they think. 8-9 consults a week would be ~400 new patients a year which is much higher than most metrics suggest is normal. I think if you average it out over a year the number of a moderately busy rad onc us ~250 new patients a year which comes out to 5ish a week. That could be some weeks with 8-9 and some with 2-3.

In private practice, I would think it is higher. I've seen some practices routinely carry 30-35/doc, which I would think averages out to 300-350 consults/year

 

[Burt Radnolds]

In private practice, I would think it is higher. I've seen some practices routinely carry 30-35/doc, which I would think averages out to 300-350 consults/year

I treat 30+, 15k wRVUs, and do a ton of hypofx. I feel like I work my tail off. I don't see more than 300 new pts a year. Perhaps a better metric is CT simulations for new treatment courses.

 

[deleted1002574]

In private practice, I would think it is higher. I've seen some practices routinely carry 30-35/doc, which I would think averages out to 300-350 consults/year

Doing over that number of consults - about 30 a month (360 a year), and it doesn’t translate to 30-35. It’s about 15-17 usually on beam. I hypo a lot, I omit breast RT for the over 70 crowd, a lot of 8/1 and etc. 9000-10000 wRVU a year.

If you’re doing 18000 and practicing similarly, then you’re either seeing 700 consults or you’re treating everyone and there’s a lot of >10 fx for mets, 30 for N0 intact breast, and 40+ fx prostate. I don’t see how you do otherwise unless I’m missing something.

 

[deleted1002574]

I treat 30+, 15k wRVUs, and do a ton of hypofx. I feel like I work my tail off. I don't see more than 300 new pts a year. Perhaps a better metric is CT simulations for new treatment courses.

I don’t get it!! Wonder how you do that.

If I did 15k I’d make nearly a mil. Maybe you do and that’s awesome!

 

[Becquerel]

It is interesting to see how variable the ratio is for consults / # on treat. This of course makes sense given how much room there is for clinical variation within guidelines / traditional paradigms (e.g. 8/1 for mets versus 30/10 makes a big difference or whether you hypofx/SIB your high risk prostates requiring nodal coverage).

In taking this all in, seems like 8-9 consults/week on average might be a bit high. Perhaps more like 6.5-7/week for the typical 5-day-per-week private practice community doc in a reasonably busy (but not 21C-esque) multi-doc setup. If the average community MD is converting 85% of these consults (seems like ROFallingDown may be at a lower % with radmonckey at a higher %) then we're looking at 5.5-6 new starts a week on average - maybe 3-ish definitive cases and 2.5-3 palliative cases.

Assuming a traditional/modest amount of brachy and SBRT, wRVUs are going to correlate more with number of patients on treatment (according to your fractionation style) and IMRT utilization (which depends heavily on style and payer permissiveness). For this reason, I've never loved wRVUs as a metric to determine how hard someone is actually working (e.g. seems like ROFallingDown is working his butt off but with quite modest RVU generation). To me, consult numbers, sim numbers, and follow-up numbers are a better proxy for physician time commitment.

It's interesting that nobody has commented on followups. They generate virtually no wRVUs but the non-routine (non-breast/non-prostate) ones can be time consuming, especially if you care to do things right (review all the scans, compare to priors, call rads if needed, coordinate with other MDs). I'm curious how many followups you all think an average, community rad onc working 5 days per week is seeing? 25-30? More?

 

[medgator]

I don’t get it!! Wonder how you do that.

If I did 15k I’d make nearly a mil. Maybe you do and that’s awesome!

Don't most of the rvu/employed contracts pretty much top you out at a certain Max salary/%ile of MGMA?

 

[medgator]

Doing over that number of consults - about 30 a month (360 a year), and it doesn’t translate to 30-35. It’s about 15-17 usually on beam. I hypo a lot, I omit breast RT for the over 70 crowd, a lot of 8/1 and etc. 9000-10000 wRVU a year.

If you’re doing 18000 and practicing similarly, then you’re either seeing 700 consults or you’re treating everyone and there’s a lot of >10 fx for mets, 30 for N0 intact breast, and 40+ fx prostate. I don’t see how you do otherwise unless I’m missing something.

I'm thinking simulations more than consults. Depends on what your percentage of converted consults are too. Sims is probably a better number

 

[xrthopeful]

I treat 30+, 15k wRVUs, and do a ton of hypofx. I feel like I work my tail off. I don't see more than 300 new pts a year. Perhaps a better metric is CT simulations for new treatment courses.

absolutely agree.

ultimately number of CT sims (Especially as we do more and more SBRT) is going to be a better marker of physician productivity. 'On beam' is soon going to be a less relevant concept.

 

[Neuronix]

9,000 wRVUs seems quite low for a full-time private practice MD

I think a lot of this confusion comes from many of the private shops (not all) reporting to their providers total RVUs, while the academic shops only report professional wRVUs. When I talk to my private practice buddies we almost always have this confusion.

The MGMA table breaks it down nicely. 15096 median total RVUs vs 9079 median professional wRVUs, which are the sorts of numbers being thrown around here.

There will always be outliers of course. Someone at 21c recently told me they routinely have 70-80 on beam and have been in the 90s!

 

[medgator]

There will always be outliers of course. Someone at 21c recently told me they routinely have 70-80 on beam and have been in the 90s!

1 doc???

 

[Neuronix]

1 doc???

Yup!

 

[medgator]

Yup!

I once saw 65 pts under treatment for coverage at a highly malignant and shady practice a year out of training. You literally don't have time to pee, let alone provide any kind of patient care

 

[deleted1002574]

Ah, maybe that’s why those numbers are different wRVUs vs total?

Am employed, no cap. But don’t really want to go over 10k. We usually hire before staff averages more than that.

 

[deleted1002574]

Right - consults / sims are a better number of productivity, but they don’t correlate to monetary value. wRVUs do.

APM can work on fixing that or capitation, but that’s messy. In areas where Kaiser doesn’t have its own facility (like Colorado I think) and contract out, they give a flat fee per patient and it gets things way out of wack. I heard they pay the same fee for a 8 Gy in 1 bone met or a 40 fraction prostate with daily cone beam.

 

[deleted1002574]

Follow ups are a drain on the system. Both your time and the medical system, because we charge more than a PCP but get so little. Hardly ever follow up very long unless head neck, anorectal, gyn. Lung and esophagus don’t really allow you to follow up very long due to nature of disease, and same with GBM or brain mets.

Most things after a follow up or two should go back to referring doc who should probably send back to the Pcp.

Young rad oncs tend to learn this the hard way when they are about 3-4 years out and can’t understand why they can’t get a lunch break or take a leak since the schedule shows 1 consult, 9 follow ups and they have to see their weeklies.

It is interesting to see how variable the ratio is for consults / # on treat. This of course makes sense given how much room there is for clinical variation within guidelines / traditional paradigms (e.g. 8/1 for mets versus 30/10 makes a big difference or whether you hypofx/SIB your high risk prostates requiring nodal coverage).

In taking this all in, seems like 8-9 consults/week on average might be a bit high. Perhaps more like 6.5-7/week for the typical 5-day-per-week private practice community doc in a reasonably busy (but not 21C-esque) multi-doc setup. If the average community MD is converting 85% of these consults (seems like ROFallingDown may be at a lower % with radmonckey at a higher %) then we're looking at 5.5-6 new starts a week on average - maybe 3-ish definitive cases and 2.5-3 palliative cases.

Assuming a traditional/modest amount of brachy and SBRT, wRVUs are going to correlate more with number of patients on treatment (according to your fractionation style) and IMRT utilization (which depends heavily on style and payer permissiveness). For this reason, I've never loved wRVUs as a metric to determine how hard someone is actually working (e.g. seems like ROFallingDown is working his butt off but with quite modest RVU generation). To me, consult numbers, sim numbers, and follow-up numbers are a better proxy for physician time commitment.

It's interesting that nobody has commented on followups. They generate virtually no wRVUs but the non-routine (non-breast/non-prostate) ones can be time consuming, especially if you care to do things right (review all the scans, compare to priors, call rads if needed, coordinate with other MDs). I'm curious how many followups you all think an average, community rad onc working 5 days per week is seeing? 25-30? More?

 

[OTN]

Follow ups are a drain on the system. Both your time and the medical system, because we charge more than a PCP but get so little. Hardly ever follow up very long unless head neck, anorectal, gyn. Lung and esophagus don’t really allow you to follow up very long due to nature of disease, and same with GBM or brain mets.

Most things after a follow up or two should go back to referring doc who should probably send back to the Pcp.

Young rad oncs tend to learn this the hard way when they are about 3-4 years out and can’t understand why they can’t get a lunch break or take a leak since the schedule shows 1 consult, 9 follow ups and they have to see their weeklies.

I actually disagree. While it certainly makes things more difficult to follow up patients for the long-term, I follow most of my patients up to 5 years out, with the exception of my rectal cancer patients who undergo resection. I also don't follow GBM patients for quite as long, as there's not much I can do to help moving forward.

Especially with respect to NSCLC, however, I've found a big benefit in keeping an eye on things. It's helped me advocate for SBRT for oligomets if those patients do progress. I've been in several situations where a patient clearly was eligible for that, but if I weren't following up, I might not have seen the referral from medonc. They're getting better now that I've been talking about this with them for awhile, but I have no doubt my continuing to follow up has helped them adopt the technique/strategy.

For me as well, seeing patients do well in follow-up for the long term helps me keep my head up and not get discouraged. Helps to reinforce that some of our definitive patients really are cured, and their gratitude when expressed really lifts me up.

Finally, I've treated a few of my follow-up patients now for arthritis, skin cancers, prostate cancers (only way to get them away from urorads in this town) as well.

To each their own, however. No exact way to do it in radonc.

 

[medgator]

Follow ups are a drain on the system. Both your time and the medical system, because we charge more than a PCP but get so little. Hardly ever follow up very long unless head neck, anorectal, gyn. Lung and esophagus don’t really allow you to follow up very long due to nature of disease

Definitely have had some long term survivors with both of those disease sites post concurrent chemo radiation, esp with stage III lung. I've ended up catching new areas/primaries on my lung pts that have turned into sbrt cases

Moreover, most of my lung pts appreciate my going through their scans (vs reading the radiologist reports, which is what most med oncs do)

 

[deleted1002574]

You’ve said you like to be quite busy with 35 on beam. How do you see all those follow ups, as well?

Not a knock. Just asking. I’d be working 50+ hours a week...

I actually disagree. While it certainly makes things more difficult to follow up patients for the long-term, I follow most of my patients up to 5 years out, with the exception of my rectal cancer patients who undergo resection. I also don't follow GBM patients for quite as long, as there's not much I can do to help moving forward.

Especially with respect to NSCLC, however, I've found a big benefit in keeping an eye on things. It's helped me advocate for SBRT for oligomets if those patients do progress. I've been in several situations where a patient clearly was eligible for that, but if I weren't following up, I might not have seen the referral from medonc. They're getting better now that I've been talking about this with them for awhile, but I have no doubt my continuing to follow up has helped them adopt the technique/strategy.

For me as well, seeing patients do well in follow-up for the long term helps me keep my head up and not get discouraged. Helps to reinforce that some of our definitive patients really are cured, and their gratitude when expressed really lifts me up.

Finally, I've treated a few of my follow-up patients now for arthritis, skin cancers, prostate cancers (only way to get them away from urorads in this town) as well.

To each their own, however. No exact way to do it in radonc.

 

[Burt Radnolds]

Thinking more about it I can see more reasons why my number of my legitimate new patients doesn't fully translate to the high wRVUs and patients on treatment that I tend to have. We have a large group and patients get shuffled around to get them closer to home, and just by the nature of locations I think I receive more than I send out. I also see a lot of lung and head and neck who have long treatment courses. I tend to see less palliative cases than I think some rad oncs do, which I'm not 100% sure why as I feel like our med oncs do a good job of getting us who we need to see. Additionally I have been in practice long enough to get patients coming back around for second malignancy, recurrence, etc, and depending on timing etc these are just high level follow ups. Our urologists have a robust surveillance program and I rarely see prostate patients that don't convert to treatment. I don't think I've seen a low risk in years TBH.

However, I do hypofractionate nearly everything. 15-20 for EVERY tangential breast (sometimes 5-10 partial breast), 20-28 for prostate, usually 5 for bone mets, sometimes 1, never more than 10 outside of compelling reason.

Regarding follow ups, I see less than I used to. Maybe 20 a week, or less. I am in a large integrated group and have essentially been told that the med oncs can follow the patient long term and get them back to me if needed. I certainly have a collection of patients I follow long term though, but if its straightforward with low risk of recurrence/morbidity and/or my group is already following them, I let them go.

I work 7-6 most days and drive my wife insane with the amount of work I do at home, on vacation, on the weekends. I am at the limits of what I can comfortably oversee being the control freak that I am.

 

[seper]

Has it been a recent change how follows are reimbursed? I recall some solo docs claiming that their follow revenue was very respectable, > 5% of their collections.

Follow ups are a drain on the system. Both your time and the medical system, because we charge more than a PCP but get so little. Hardly ever follow up very long unless head neck, anorectal, gyn. Lung and esophagus don’t really allow you to follow up very long due to nature of disease, and same with GBM or brain mets.

Most things after a follow up or two should go back to referring doc who should probably send back to the Pcp.

Young rad oncs tend to learn this the hard way when they are about 3-4 years out and can’t understand why they can’t get a lunch break or take a leak since the schedule shows 1 consult, 9 follow ups and they have to see their weeklies.

 

[deleted941485]

I honestly hate the multi year follow up and I try to get them to see either the referring med Onc or surgeon after a certain window of time.

You wanna follow an respected ACC for 10 years be my guest but I’m sending them back to the surgeon.

Head and neck tumors outside the 2 year window and no recurrence...see Med Onc or surgeon. Even the NPLs at visit aren’t worth the hassle.

Breast patients I’ve cut back to 3 years from 5 and I haven’t even been out that long. Most are still on hormones anyway

As my threshold for this stuff has waned , I’ve been basically tried to get a lot of these follow ups off my schedule so o can focus on getting in new blood and new on treats.

 

[medgator]

I honestly hate the multi year follow up and I try to get them to see either the referring med Onc or surgeon after a certain window of time.

You wanna follow an respected ACC for 10 years be my guest but I’m sending them back to the surgeon.

Head and neck tumors outside the 2 year window and no recurrence...see Med Onc or surgeon. Even the NPLs at visit aren’t worth the hassle.

Breast patients I’ve cut back to 3 years from 5 and I haven’t even been out that long. Most are still on hormones anyway

As my threshold for this stuff has waned , I’ve been basically tried to get a lot of these follow ups off my schedule so o can focus on getting in new blood and new on treats.

I've been cutting back on F/u as well as my new consult volume has been growing annually the last few years.

I still find some patients want to fu, esp my anal, h&n, and lung pts. Skin pts get a one time fu to document response and no morbidity and then go straight back to the referring dermatology group.

Breast pts I let go of as well if surgeon/med onc is following, but sometimes I get early stage invasive or ER- dcis where they aren't candidates or refuse endocrine therapy so I'm the only one following them long term.

Ditto for most GI if they are seeing med onc and GI. I usually send lymphoma back to med onc for fu as well.

Prostates alternate fu between myself and gu but sometimes they just want to deal with our office sometimes for what is essentially PSA surveillance

 

[OTN]

You’ve said you like to be quite busy with 35 on beam. How do you see all those follow ups, as well?

Not a knock. Just asking. I’d be working 50+ hours a week...

I'm pretty efficient, and lots of those follow-ups are pretty quick. I only have 4 clinic days, but those days, including SBRT and SRS before and after clinic, can be from as early as 6:30 am to as late as 7:30 pm. Usually at least 7-6. I probably work close to 50 hours a week most weeks.

Including SBRTs, I had 45 on treatment yesterday and today. 14 follow-ups today and three consults, which I'd say is fairly typical, so I'm doing probably 60 follow-ups a week. The reimbursement isn't bad and does add a small bump in income.

I work substanially harder as a pp radonc now than I did in residency, fyi. Order of magnitude more, as my services then usually had 15-20 pts on treatment at any given time. Helpful in training, though, as it gives you time to study/read/etc.

 

[Mandelin Rain]

I've been cutting back on F/u as well as my new consult volume has been growing annually the last few years.

I still find some patients want to fu, esp my anal, h&n, and lung pts. Skin pts get a one time fu to document response and no morbidity and then go straight back to the referring dermatology group.

Breast pts I let go of as well if surgeon/med onc is following, but sometimes I get early stage invasive or ER- dcis where they aren't candidates or refuse endocrine therapy so I'm the only one following them long term.

Ditto for most GI if they are seeing med onc and GI. I usually send lymphoma back to med onc for fu as well.

Prostates alternate fu between myself and gu but sometimes they just want to deal with our office sometimes for what is essentially PSA surveillance

This is pretty much exactly what I do.

Feel bad for breast patients following with surgery and med onc having to come see me, and take ANOTHER day off work and pay ANOTHER co-pay for me to glance at their skin.