Radiation oncology now offered lowest locum rates in "radiology"?

[scarbrtj]

will try to copy the entire email (from a large national locums staffing firm) below.

Daily pay rates
Low range locums for rad onc, diagnostic/general, breast imaging, neurointerventional, interventional:
$1500 vs $1700 vs $1800 vs $2000 vs $2200 (r-sq: 0.98, p=0.0004)
High range locums for rad onc, diagnostic/general, breast imaging, interventional, neurointerventional:
$2500 vs $2500 vs $2800 vs $3200 vs $5000 (r-sq: 0.74, p=0.06)

----------------------------

My name is Daniel and I'm on the Radiology Staffing team at ASR. We're currently working with 200+ facilities with active opportunities throughout the U.S. Below, I listed our most active (aggressively seeking facilities) locum tenens jobs. *We can activate new state licenses for most of these jobs.* Please feel free to reply with your specialty preferences so I can follow-up with more applicable options. Staffing Every Radiology Service-line: General / Diagnostic Breast Imaging Interventional NeuroInterventional NeuroRadiology Nuclear Medicine MSK Radiology Body Imaging Cardiac Imaging & Radiation Oncology Hottest Jobs: ​ Neurointerventional - 3 Active Jobs - MO, TX, GA Compensation - Industry Avg. Range = $2000 - $5000 per day Hottest Jobs: Texas - Houston - 4 Locations All Star Recruiting is seeking a Radiologist for NIR Locum call coverage in Texas. Some details include: Daily patient volume: Avg. 2 Primary Stroke Center Meditech EMR Board Certification required TX License Required Seeking Physicians for 3-5 day assignments, flexible scheduling Coverage needed for vacations, holidays, etc... California - Southern CA… close to Los Angeles All Star Recruiting is seeking Radiologists for Stroke-Call coverage in California. Board Certified Inpatient 24hr call High-Quality Facilities Stroke Coverage / Light Rounding Low - Moderate Volume Specializing in stroke-related procedures EMR: Epic 1-2 Weeks Per Month Multiple Locations - avg. approx. 100 strokes per year at each facility  Locums physician will cover one facility per assignment. Group of Radiologists, covering multiple facilities. NeuroRadiology - 1 Active Job - FL Florida - Gulf Coast All Star Recruiting is seeking a Neuroradiologist for locum coverage in Florida. Board Certified Outpatient M-F No call 100% Neuroradiology Full-Time Coverage April - August Locums to permanent opportunity High Quality Imaging Center Founded and operated by Radiologists This is a very established outpatient facility that is founded and operated by Radiologists. They've been growing in the community for over 40 years. They pride themselves on high-quality care and they're seeking a skilled physician to fill a full-time position. Breast Imaging - 14 Active Jobs Compensation - Industry Avg. Range = $1800 - $2800 per day Hottest Jobs: New York - Westchester County All Star Recruiting is seeking a Fellowship-trained Breast Imaging Radiologist for Locum coverage in New York. Some details include: Outpatient based practice; 60% breast imaging; balance in MR, CT, US, bone densitometry; Expect 3D, Diagnostics and Breast MR; No biopsies or interventions; Volume averages 25-28 patients per day; Coverage is needed these dates: 4/14-17 5/28 and 5/29 6/1-6/5 6/8-6/12 9/7-11 Future dates to be determined 8-hour day, typically 8-5, with an hour for lunch; Hologic Mammo, Powerscribe, GE PACS, and MedQ RIS; Massachusetts - Boston Area All Star Recruiting needs a Breast Imaging Radiologist for Locum coverage in Massachusetts. Some details include: Start as soon as you are credentialed; Ongoing need; Flexible to week blocks (M-F); Expect Breast US, digital mammo including Tomo, screening and diagnostic mammo, and FNA's; 100% Mammo Optional to perform Breast MR and stereotactic biopsies; Equipment is Hologic and GE, with Mckesson PACS; Typical day is 8-5, M-F; Massachusetts' largest network of hospitals and doctors with a market share of 22% in the eastern part of the state. Diagnostic / General - 31 Active Jobs Compensation - Industry Avg. Range = $1700 - $2500 per day Hottest Jobs: South Dakota - Southeast SD - Rapid City All Star Recruiting is seeking a Radiologist for Locum coverage in South Dakota. Some details include: Proficiency needed in reading MR, CT, US, plain films and Nuc Light IR (occasional biopsies/drains, etc...) needed 8a-5p No call Full support of staff: techs, nurses, etc... Board Certification not required Coverage needed April 27 through May 1 Future dates to be determined When can you start and what availability can you offer, ongoing? Pennsylvania - Philadelphia AREA All Star Recruiting is seeking a Body Imaging-based Radiologist for Locum coverage in Pennsylvania. Some details include: Focus will be Body Imaging-based reads; Average is 23-25 studies per day, mostly CT, some MR; (low volume do to complexity - Cancer center) Likely also some (10 or so) plain films as well; Biopsies not required, but helpful; Neuro is optional; No IR or Mammo; Full support staff: techs, nurses, etc... Board Certification required; Typically 8a-5p daily; Pennsylvania license needed due to quick start date; Typically multiple weeks (M-F) need each month; Known dates needing coverage 3/3 -6 (Tues-Fri) 3/11-13 (Wed-Fri) Future dates TBD What availability do you have ongoing? Interventional Radiology - 15 Active Jobs Compensation - Industry Avg. Range = $2200 - $3200 per day Hottest Jobs: Missouri & Illinois - …1.5 hours south of St. Louis. Radiology > Interventional All Star Recruiting is seeking an Interventional Radiologist for Locum coverage. Some details include: Expect 100% IR; Perform the majority of VIR, including oncologic IR, PVD, vein work, etc... Aortic Stent Grafts would be a plus; but, are not required; The practice covers multiple hospitals, although you would be focused at one at a time; ABR board-certified and IR certification needed; MO and/or IL licensed preferred, but willing to license if needed; 5 day (M-F) or 7-day (M-M) blocks preferred, multiple blocks available monthly; This is an ongoing need; When can you start and what availability can you offer? Dates Needed: 3/10 (7AM) to 3/14 (5PM) 4/20 (7AM) to 4/24 (5PM) 5/18 (7AM) to 5/22 (5PM) 6/8 (7AM) to 6/26 (5PM) Michigan - Approx. 1.5 hours from Detroit All Star Recruiting is seeking a Radiologist for locum coverage in Michigan. Board Certified Radiology Monday - Friday 8a-5p MI license required March 2 start with ongoing for several weeks 100% Interventional Radiology EMR: Cerner Seeking physician with full-time or part-time availability Preferably at least two weeks per month This is a practice that covers a local hospital Daily volume is 5-12 with vast majority of days under 10. Radiation Oncology - 5 Active Jobs Compensation - Industry Avg. Range = $1500 - $2500 per day Hottest Jobs: New York - Upstate NY - close to Albany All Star Recruiting is seeking a Radiation Oncologist for Locum coverage in New York. Some details include: Skills needed: external beam, IMRT, IGRT, Rapid Arc but no specialized procedures Volume: 8 new patients per week Typically 10-15 patients on treatment The schedule is M-F, 8a to 5p Coverage needed ongoing Will consider Locum-to-Perm if you are interested Staff includes 2 RTTs, 1 RN, Scheduler, Patient Care Tech, and a manager Site is a newer center with ARIA 13.5 being upgraded in January When can you start and what availability can you offer Dates Needed March 9 - April 24th Pennsylvania - Southern PA - 2 Cancer Centers All Star Recruiting is seeking a Radiation Oncologist for Locum coverage in Pennsylvania. It is a one physician Radiation Oncology practice, seeking vacation coverage for one week at a time. Some details include: 7:30am until 4pm, M-F No overnight call Avg 18 pts/ day on treatment Known dates: Start Date: 4/27 - 5/1 (Mon-Fri) Start Date: 5/5 - 5/8 (Tues-Fri) Second Location Start Date: 5/18 - 5/22 (Mon-Fri) Future dates TBD Pennsylvania license and ABR Certification required ​

​

My job is to help you find - ADDITIONAL REVENUE STREAMS $$$ Feel free to reply with your assignment preferences so I can follow-up with more applicable options. ​

---

Members don't see this ad.

 

[Neuronix]

I haven't been offered over $1000/day for locums in my state for years, even around holidays.

 

[scarbrtj]

I haven't been offered over $1000/day for locums in my state for years, even around holidays.

I have seen 1500 but 2500 sounded like a stretch, but it’s high end in this email

 

[medgator]

Will be interesting (in a sad way) to see where this thread is in 2025+

I have seen 1500 but 2500 sounded like a stretch, but it’s high end in this email

I could see that in happening around ASTRO time in a place that's biryani-free.

Going rate in our neck of the woods for the local retired ROs is $1200/day.

 

[radiaterMike]

I’ve never done locums. Is it often just babysitting a LINAC, IGRT and doing OTVs? If so, that could account for the lower pay. I’m assuming the locums radiologists are reading films and the IR docs doing procedures.

 

[xrthopeful]

I’ve never done locums. Is it often just babysitting a LINAC, IGRT and doing OTVs? If so, that could account for the lower pay. I’m assuming the locums radiologists are reading films and the IR docs doing procedures.

most def

 

[scarbrtj]

most def

Most times: 95% babysitting, 5% end of day IGRTs (~30 seconds per patient, 15 patients for the day) and note signing. Most times they try to keep you away from patients except when you have to cover more than 4 days in one place. And you're right: it ain't very productive and money making for the practice. But it sure as heck prevents money loss. And in most other specialties, locums have to be paid more or equal what the usual doctor would make per day (ie >100% pay rate). In other words, if we had a "good market," the ~$500K annual salary so often talked about would translate into ~$2000/day locums low end, $2500-3000 high end. Instead what we hear (what we all seem to hear) is that almost all rad onc locums are paid <100% rates.

 

[Haybrant]

always ask them for 3.5k min. Never have gotten it.

sometimes I ask for 5k for fun, never really have an intention on doing it. Basically everyone should be asking for a very high sum so they think twice

 

[Palex80]

Excuse me if I sound stupid, but:

"8 new patients per week
Typically 10-15 patients on treatment "

How does that work?
Is it normat to have 10-15 patients on treatment if you have 8 new patients per week?

Our usual mix of patients includes around 30% breast cancer , which means 30% will come to RT for a minimum of 3 weeks and a maximum of 6, so probably the average is around 4.5 weeks for them. Add another 20% prostate cancer that will get 4 weeks (primary) to 7 weeks (postoperative), so that's 5.5 weeks average for them. Add another 10% H&N-patients who get 6.5-7 weeks, add another 15% primary NSCLC, neoadjuvant rectal, GBMs, sarcomas that get an average of 5 weeks of RT (some GBMs are hypofractionated). The rest (around 25%) are indeed, hypofractionated one-week treatments on average: bone, brain mets other palliative treatments and a few benign diseases.

I thought that maybe they are doing a lot of single-shot radiosurgery-like procedures, but it says:

Skills needed: external beam, IMRT, IGRT, Rapid Arc but no specialized procedures

So probably they have a lot of 1 x 8 Gy bone mets?

Just my thoughts...

 

[scarbrtj]

Excuse me if I sound stupid, but:

"8 new patients per week
Typically 10-15 patients on treatment "

How does that work?
Is it normat to have 10-15 patients on treatment if you have 8 new patients per week?

Our usual mix of patients includes around 30% breast cancer , which means 30% will come to RT for a minimum of 3 weeks and a maximum of 6, so probably the average is around 4.5 weeks for them. Add another 20% prostate cancer that will get 4 weeks (primary) to 7 weeks (postoperative), so that's 5.5 weeks average for them. Add another 10% H&N-patients who get 6.5-7 weeks, add another 15% primary NSCLC, neoadjuvant rectal, GBMs, sarcomas that get an average of 5 weeks of RT (some GBMs are hypofractionated). The rest (around 25%) are indeed, hypofractionated one-week treatments on average: bone, brain mets other palliative treatments and a few benign diseases.

I thought that maybe they are doing a lot of single-shot radiosurgery-like procedures, but it says:

Skills needed: external beam, IMRT, IGRT, Rapid Arc but no specialized procedures

So probably they have a lot of 1 x 8 Gy bone mets?

Just my thoughts...

my opinion: un-savvy recruiters writing un-savvy emails
the math: P = N * W
P = avg number of patients on beam/day
N = avg number of new pts/week
W = avg length of patient treatment, in weeks (1 fx = 0.2 weeks)

 

[Mandelin Rain]

always ask them for 3.5k min. Never have gotten it.

sometimes I ask for 5k for fun, never really have an intention on doing it. Basically everyone should be asking for a very high sum so they think twice

Agreed. I have told them I'm available but won't work for less than I make without leaving my family, driving 3-5 hours across the state to some rural locale where there's nothing to do or see. When they ask what that is, the conversation ends.

 

[seper]

Locum opportunities are very locale-dependent. In some cities, 99% of opportunities are word-of-the mouth (a major East Coast metro I used to live in). I think scarb's point is that the prevailing rates will go down some more due to over-supply and hospital supervision rules.

 

[elementaryschooleconomics]

Locum opportunities are very locale-dependent. In some cities, 99% of opportunities are word-of-the mouth (a major East Coast metro I used to live in). I think scarb's point is that the prevailing rates will go down some more due to over-supply and hospital supervision rules.

I wonder if there's some way to analyze and compare the number of locums opportunities for sort of a pre/post general supervision analysis.

Because of the oversupply of physicians, rates were naturally going to go down anyway - unclear if general supervision will have a tremendous effect.

What I think is more likely to happen is hospital outpatient practices with several docs just aren't going to use locums anymore. If you have 5 docs in a practice and one goes on vacation, all you need is to have one (or more) of the other 4 docs available by phone. I imagine the APEx practices will still use locums to retain accreditation.

But man, huge score for these practices who will take advantage of general supervision. Now docs can go on vacation/whatever and you don't need to 1) coordinate locums and 2) pay locums, only make sure your other docs have working cell phones and a pulse.

 

[Pointless]

I wonder if there's some way to analyze and compare the number of locums opportunities for sort of a pre/post general supervision analysis.

Because of the oversupply of physicians, rates were naturally going to go down anyway - unclear if general supervision will have a tremendous effect.

What I think is more likely to happen is hospital outpatient practices with several docs just aren't going to use locums anymore. If you have 5 docs in a practice and one goes on vacation, all you need is to have one (or more) of the other 4 docs available by phone. I imagine the APEx practices will still use locums to retain accreditation.

But man, huge score for these practices who will take advantage of general supervision. Now docs can go on vacation/whatever and you don't need to 1) coordinate locums and 2) pay locums, only make sure your other docs have working cell phones and a pulse.

Perhaps I'm being naive, but I think that most reputable practices will continue to maintain physician presence. IMO it is unbecoming to leave a department empty while patients are on beam, not a good look for a specialty that is already fighting against the "all you do is push a button" narrative.

It does make sense that the truly rural sites will likely be staffed part-time, but the rest I would expect to have a doc on site.

And I expect the ACR to revise their accreditation supervision requirements any time now to absolutely require physician presence. No way they are going to take responsibility for the first serious error caused by lack of oversight from an "accredited" facility.

Just my two cents anyway...

 

[Pointless]

Actually, just looked it up. It won't take much tweaking of their existing language to make direct supervision required:

While CMS does not specify that radiation therapy services should be supervised by a radiation oncologist; it is the opinion of the ACR that a board-certified/board-eligible radiation oncologist is the clinically appropriate physician to supervise these procedures. This position is supported by guidance from the Conference of Radiation Control Program Directors (CRCPD) training requirements for therapeutic radiation machines , which closely mirrors the U.S. Nuclear Regulatory Commission’s regulations for teletherapy, sealed source therapy and HDR after loading brachytherapy. Further, ACR Radiation Oncology Practice Accreditation program requirements specify that “a radiation oncologist should be available for direct care and quality review and should be on the premises whenever radiation treatments are being delivered. The radiation oncologist, facility, and support staff should be available to initiate urgent treatment within a medically appropriate response time on a 24-hour basis or refer to a facility that is available to treat on a 24-hour basis. When unavailable, the radiation oncologist is responsible for arranging appropriate coverage.”

 

[evilbooyaa]

Perhaps I'm being naive, but I think that most reputable practices will continue to maintain physician presence. IMO it is unbecoming to leave a department empty while patients are on beam, not a good look for a specialty that is already fighting against the "all you do is push a button" narrative.

It does make sense that the truly rural sites will likely be staffed part-time, but the rest I would expect to have a doc on site.

And I expect the ACR to revise their accreditation supervision requirements any time now to absolutely require physician presence. No way they are going to take responsibility for the first serious error caused by lack of oversight from an "accredited" facility.

Just my two cents anyway...

Med-onc practices can (and do) give chemo without a medical oncologist there for direct supervision.

Which therapy causes more acute toxicity (in the first day after treatment) requiring immediate clinical evaluation and treatment, chemotherapy or radiation?

 

[elementaryschooleconomics]

Perhaps I'm being naive, but I think that most reputable practices will continue to maintain physician presence. IMO it is unbecoming to leave a department empty while patients are on beam, not a good look for a specialty that is already fighting against the "all you do is push a button" narrative.

It does make sense that the truly rural sites will likely be staffed part-time, but the rest I would expect to have a doc on site.

And I expect the ACR to revise their accreditation supervision requirements any time now to absolutely require physician presence. No way they are going to take responsibility for the first serious error caused by lack of oversight from an "accredited" facility.

Just my two cents anyway...

You're far more optimistic than I am - and I desperately want you to be right!

 

[Pointless]

Med-onc practices can (and do) give chemo without a medical oncologist there for direct supervision.

Which therapy causes more acute toxicity (in the first day after treatment) requiring immediate clinical evaluation and treatment, chemotherapy or radiation?

But med oncs, as least as far as I know, literally have no role in the administration of chemotherapy aside from writing the order. Rad oncs however... one mistreated SRS and that will be the end of the little "no doctor" party for any practice that wants to remain on the right side of being sued.

 

[evilbooyaa]

But med oncs, as least as far as I know, literally have no role in the administration of chemotherapy aside from writing the order. Rad oncs however... one mistreated SRS and that will be the end of the little "no doctor" party for any practice that wants to remain on the right side of being sued.

I don't think anyone is advocating for SRS/SBRT/Brachytherapy to be given without direct supervision, myself included.

As an attending if we're not mandating direct supervision I would stack my stereo cases and do remote review for all the plain films/CBCT as necessary assuming I work at a hospital-based practice. In the era of declining reimbursements this is likely how either folks will 1) maintain salary and/or 2) improve lifestyle by maintaining 4 day work weeks.

 

[Bequerel]

But med oncs, as least as far as I know, literally have no role in the administration of chemotherapy aside from writing the order. Rad oncs however... one mistreated SRS and that will be the end of the little "no doctor" party for any practice that wants to remain on the right side of being sued.

They have more role then we do. I don’t think anyone is suggesting that we not be present for SBRT, SRS, HDR or simulations procedures/verifications. A Med onc is much more likely to be needed during and adverse chemo reaction than I’ll ever be needed for a breast tangent treatment. If set up responsibly (proper departmental policies in place and patients scheduled appropriately) I think it’s very reasonable that a radiation oncologist could leave an hour before machines are done or show up in the morning after the first patient is treated.

 

[Mandelin Rain]

The ACR is not of the opinion that a board certified radiologist is the only appropriate physician to supervise diagnostic xrays being delivered to patients, but therapeutic xrays need a rad onc?

 

[Pointless]

The ACR is not of the opinion that a board certified radiologist is the only appropriate physician to supervise diagnostic xrays being delivered to patients, but therapeutic xrays need a rad onc?

Just directly quoting their current statement.

 

[scarbrtj]

But med oncs, as least as far as I know, literally have no role in the administration of chemotherapy aside from writing the order. Rad oncs however... one mistreated SRS and that will be the end of the little "no doctor" party for any practice that wants to remain on the right side of being sued.

I don't understand your distinction, but even if I did/could it would be a distinction without a difference. I submit that one CAN NOT cause or witness immediate death (ie within an hour of irradiation) from outpatient administered irradiation. I also submit it's never even happened in the history of medicine. As such, the risk of immediate death from the other cancer therapy (chemotherapy)--and the possibility of it happening without a "chemo doctor" in the building--is a million times greater. The only mandate for supervision there (freestanding outpatient) is an NP or PA must be present. Think of a radiation oncology situation where a bad event were to happen... and whatever that event were... the mere physical presence of a radiation oncologist would be immunizing to a lawsuit. Because I can't think of one. (I would also submit that 100% of radiation oncology malpractice cases were brought where a rad onc was present in the building during the XRT.) If it's a malpractice case, it's a malpractice case. Who cares if the doc was back in the back office watching the Criterion Channel.

 

[Burt Radnolds]

The only mandate for supervision there (freestanding outpatient) is an NP or PA must be present.

Is this true? I've been told by our group that this is state dependent and our state requires MD radiation oncologist supervision.

 

[RickyScott]

Hospital is hiring a locum dosimetrist. Company wants 130$ an hour!

 

[scarbrtj]

Is this true? I've been told by our group that this is state dependent and our state requires MD radiation oncologist supervision.

When I said "The only mandate for supervision there (freestanding outpatient) is an NP or PA must be present" I was speaking re: chemotherapy admin and supervision, which has been no MD needed for a long time.

 

[dieABRdie]

We are an outpatient hospital facility in a very remote location. In order for me to take ANY time off I used to take entire week of vacation because it is impossible to get someone to make the trek out here for just one or two days of locums.

The regular locums doc we use just got the notification... "Your services are no longer be required...."

 

[Mandelin Rain]

Just directly quoting their current statement.

Understand. I just wanted to demonstrate how entirely incongruent their stance is re: delivering XRays to patients. Given that, I think the hope that they'll white knight the cause to artificially buoy the job market is likely misguided.

 

[RadDoc11]

Can you bill for IGRT if no rad onc is present to supervise? Can the rad onc just check the films before the next fraction in order to bill?

Also, my understanding is that direct supervision is still required at freestanding centers.

I find not having direct supervision concerning. I feel l have good radiation therapists, but I still get called to the machine regularly to check setups and daily imaging when questions arise. Seems like it's in the best interests of patients to have a rad onc around during treatment. Patients have questions that come up on non-OTV days all the time too that my nurses aren't always comfortable answering.

 

[scarbrtj]

Can you bill for IGRT if no rad onc is present to supervise? Can the rad onc just check the films before the next fraction in order to bill?

Also, my understanding is that direct supervision is still required at freestanding centers.

I find not having direct supervision concerning. I feel l have good radiation therapists, but I still get called to the machine regularly to check setups and daily imaging when questions arise. Seems like it's in the best interests of patients to have a rad onc around during treatment. Patients have questions that come up on non-OTV days all the time too that my nurses aren't always comfortable answering.

There are two types of supervision in the mind of MDs: supervision which is necessary to bill something, and supervision which is necessary for good care. And then there's supervision which is not really supervision in the usual English language definition of the word. E.g., is commander-in-chief Donald Trump "supervising" the troops in Afghanistan today? I guess in one way, yes, in another way, not really. In the eyes of Medicare, supervision always just amounted to one thing: billing concerns. And there were/are three CMS supervision levels: personal (in the room), direct (in the building or very nearby), and general (available by phone). So I quibble with your statement re: "present to supervise." General supervision is supervision; the presence is simply non-onsite. So now that ALL of (hospital) outpatient therapy is general supervision per Medicare, and IGRT is under the umbrella of outpatient therapy, use your own brain and judgment to make that call re: "can you bill for IGRT if no rad onc is present to supervise." You are always present (ie by telephone) to supervise in the CMS "general" parlance. Your freestanding assessment is correct. Re: your other concerns (presence to answer questions, etc), now we're in that other sense of supervision... the sense which is not concerned with billing at all and is instead clinical/administrative in nature. EDIT: IMHO things like answering patient questions ("can I go on a 3-day cruise next weekend and miss a day?"), checking setups/images, etc., can as easily be handled with a telepresence as an actual presence.

 

[radiaterMike]

I doubt that you could bill the professional component for IGRT if you or a partner are not there to review it. I do not know if virtually there (i.e. remotely) would count (I would think that it would) and yes you can check the next day as long as it is before the next fraction. I believe that the technical IGRT component can now be billed for 3D treatments regardless of physician presence (it is bundled with IMRT).

 

[scarbrtj]

I doubt that you could bill the professional component for IGRT if you or a partner are not there to review it. I do not know if virtually there (i.e. remotely) would count (I would think that it would) and yes you can check the next day as long as it is before the next fraction. I believe that the technical IGRT component can now be billed for 3D treatments regardless of physician presence (it is bundled with IMRT).

Again I think we are conflating a few things here. And first and foremost, professional codes have no associated supervision levels per se. I.e., what is the supervision level for a consult? Well either you personally do it or you don't (even then, it can be "remote" ie telemedicine, but I digress). Medicare doesn't care where you sit, geographically speaking, when you check a film. CMS supervision is related to two things: where is the patient and where is the MD. When I check films, 99.99% of the time the patient is at home (or maybe in an airplane, or on the ocean, or in a motel, who knows). Thus "supervision" can't apply: literally can't be in the building with the patient, so literally I almost never, ever "directly supervise" (ie in building with patient) IGRT professional. And neither do you. Carl Bogardus had good explanations about why remote IGRT review was kosher way back when, and of course radiologists check films "remotely." We're not held to higher standards than they are.

 

[PhotonBomb]

if you want to keep your nose clean, be mindful of who you take advice from of what counts as appropriate or inappropriate.

 

[scarbrtj]

if you want to keep your nose clean, be mindful of who you take advice from of what counts as appropriate or inappropriate.

An old email from Bogardus, circa 2015. Images can be checked "from any location..." and this was of course antecedent to today's general supervision "laxity" I guess you could call it.

 

[Pointless]

Understand. I just wanted to demonstrate how entirely incongruent their stance is re: delivering XRays to patients. Given that, I think the hope that they'll white knight the cause to artificially buoy the job market is likely misguided.

Got it. To be clear, I don't think the ACR gives a flying $hit about our job market, but if they are going to lend their name to a practice, it makes logical sense to me that they would err on the side of conservatism. What downside is there for them to require supervision? Zero that I can think of. Conversely, if something bad were to happen at one of their accredited sites, and a physician was not present (and I understand that this would be extremely unlikely to be a relevant point, as wtf would we do anyway) how would that look to them?

Just trying to think like administrators do. Low hanging fruit = engorge.

 

[scarbrtj]

Got it. To be clear, I don't think the ACR gives a flying $hit about our job market...
Just trying to think like administrators do. Low hanging fruit = engorge.

True. They may not care about our rad onc job market, but I think they care a lot about radiology and would never countenance something as disruptive/pitfallish as inane "presence" mandates. To wit, when you quoted what they say...

While CMS does not specify that radiation therapy services should be supervised by a radiation oncologist; it is the opinion of the ACR that a board-certified/board-eligible radiation oncologist is the clinically appropriate physician to supervise these procedures.

re: "these procedures," it's notable that "procedures" can mean a great many things. I, personally, have never thought of "simple" EBRT as a procedure, but, OK, it's a procedure. But then so too is everything radiology does: a CT is a procedure, an MRI is, an X-ray is, a mammogram is, etc etc. To Mandelin Rain's point, we can get more radiation dose to (some cells in) the patient's body in some radiographic procedures (ie can get ~6-12 Gy in fluoro) than in some radiation therapy procedures. But the ACR isn't perseverating over radiology-physician-are-you-there?-or-not as far as I know.

 

[Pointless]

True. They may not care about our rad onc job market, but I think they care a lot about radiology and would never countenance something as disruptive/pitfallish as inane "presence" mandates. To wit, when you quoted what they say...

re: "these procedures," it's notable that "procedures" can mean a great many things. I, personally, have never thought of "simple" EBRT as a procedure, but, OK, it's a procedure. But then so too is everything radiology does: a CT is a procedure, an MRI is, an X-ray is, a mammogram is, etc etc. To Mandelin Rain's point, we can get more radiation dose to (some cells in) the patient's body in some radiographic procedures (ie can get ~6-12 Gy in fluoro) than in some radiation therapy procedures. But the ACR isn't perseverating over radiology-physician-are-you-there?-or-not as far as I know.

Fair enough, but I think that radiation therapy has a different place in the medical zeitgeist then diagnostic x-rays. There is a stigma and fear attached to them and I think most would readily draw a distinction about the cavalierness (that a word? Cavalierity?) with which they can be appropriately delivered.

 

[Pointless]

Maybe somebody should just email the damn ACR and ask them what their position is... anyone know anybody on the inside?

 

[RickyScott]

Maybe somebody should just email the damn ACR and ask them what their position is... anyone know anybody on the inside?

we are ACR, but I think it is becoming less and less important with emergence of satellites etc. MDACC/MSKCC/university affiliation has 100x name recognition for patient than ACR. Never heard of pt say I chose x center because they are ACR.

 

[Mandelin Rain]

ACR accreditation may have had noble beginnings, but like anything likely now exists as a revenue stream for ACR. Will they close the door on many revenue pathways by continuing to mandate supervision in the face of CMS rule? Including delivery of X-ray beams? A "procedure" that is performed hundreds of thousands of times in diagnostic departments with absolutely no supervision? You certainly can't upset the radiology apple cart if you're the ACR.

 

[RickyScott]

ACR accreditation may have had noble beginnings, but like anything likely now exists as a revenue stream for ACR. Will they close the door on many revenue pathways by continuing to mandate supervision in the face of CMS rule? Including delivery of X-ray beams? A "procedure" that is performed hundreds of thousands of times in diagnostic departments with absolutely no supervision? You certainly can't upset the radiology apple cart if you're the ACR.

If your center is going to go with mdacc etc who are going to tell you how to pee and where to put the water cooler, what is the point in getting acr? As radonc coalesces into these large institutions, acr becoming totally irrelevant.

 

[deleted941485]

If your center is going to go with mdacc etc who are going to tell you how to pee and where to put the water cooler, what is the point in getting acr? As radonc coalesces into these large institutions, acr becoming totally irrelevant.

The whole thing was a farce to begin with a way for institutions to make money solely off their name and charge a pretty penny for it.

 

[Neuronix]

Noticed this thread today in Pathology. Same discussion. Same oversupply issues: Crazy Pathology Wage Inversion, this is unsustainable

$1,000/day for locums with new hires starting at ~$350k/year is the situation in my state, assuming you can find a job in the state at all. Basically the same as the discussion in path.

 

[medgator]

Can just smell the desperation through the email...

 

[TheWallnerus]

Can just smell the desperation through the email...

A chairman needs to resign and offer this kid a job.

 

[seper]

An old email from Bogardus, circa 2015. Images can be checked "from any location..." and this was of course antecedent to today's general supervision "laxity" I guess you could call it.

remote simple sim is kosher. good. I've run into serious RVU disputes over this

 

[deleted941485]

Can just smell the desperation through the email...

I saw something similar a few weeks ago. I have no idea why they think I’d want to give them a job when it risks replacing me

 

[medgator]

I saw something similar a few weeks ago. I have no idea why they think I’d want to give them a job when it risks replacing me

There's enough networking between SDN ROHub etc and enough rad oncs looking, I'm guessing even the locums agencies are hurting

 

[deleted941485]

There's enough networking between SDN ROHub etc and enough rad oncs looking, I'm guessing even the locums agencies are hurting

Recruiters are some of the biggest scum out there. How do these firms even exist when so much of there functioning has been brought in house?

 

[TheWallnerus]

Quo vadis rad onc.