RO Job? 58% chance it will be "low volume"

[TheWallnerus]

---

Members don't see this ad.

Trump called Jeb "low energy."

If you get a rad onc job, here's some interesting data that there's a 58% chance it will be in a "low energy" (low volume) center... that is if you're open to taking a job at any center anywhere.

Rad onc has a clear patient volume maldistribution problem which could be solved by increasing the incidence of cancer or decreasing the incidence of cancer centers and/or MDs.

 

[Gfunk6]

Rad onc has a clear patient volume maldistribution problem which could be solved by increasing the incidence of cancer or decreasing the incidence of cancer centers and/or MDs.

Well since we know the latter is never going to happen, perhaps we ought to petition ASTRO to consider putting nickel and cadmium into drinking water?

 

[TheWallnerus]

Well since we know the latter is never going to happen, perhaps we ought to petition ASTRO to consider putting nickel and cadmium into drinking water?

Something like this seems like the only thing "they" will sign on to at this point.

 

[RickyScott]

Trump called Jeb "low energy."

If you get a rad onc job, here's some interesting data that there's a 58% chance it will be in a "low energy" (low volume) center... that is if you're open to taking a job at any center anywhere.

Rad onc has a clear patient volume maldistribution problem which could be solved by increasing the incidence of cancer or decreasing the incidence of cancer centers and/or MDs.

But, but, but I heard about a radonc who treats 70 pts a day as well as a very busy big academic center….

 

[hal9k]

But, but, but I know a radonc who treats 70 pts a day as well as a very busy big academic center….

saw more who treat fewer than 10...how is 70 even possible? you need to see 20-30 new consults per week?

 

[TheWallnerus]

saw more who treat fewer than 10...how is 70 even possible? you need to see 20-30 new consults per week?

If the avg tx length is now 16 fractions across all fractions in the US (and there's data that's the case), then you'd need to see 70/3.1 = 23 new consults a week. And you have to AVERAGE that. So if you take a week vacation, you need to hit 46 the next week to make up for it so the math will work out. This is like when Wilt Chamberlain said he slept with 20,000 women in 10 years. Doing the math, he had to be with a new woman having sex like every 6 hours, no breaks, no eating, no sleeping.

 

[Mandelin Rain]

But if you're treating mainly prostates at 44 fractions, much easy to get to 70.

 

[hal9k]

If the avg tx length is now 16 fractions across all fractions in the US (and there's data that's the case), then you'd need to see 70/3.1 = 23 new consults a week. And you have to AVERAGE that. So if you take a week vacation, you need to hit 46 the next week to make up for it so the math will work out. This is like when Wilt Chamberlain said he slept with 20,000 women in 10 years. Doing the math, he had to be with a new woman having sex like every 6 hours, no breaks, no eating, no sleeping.

no wonder I never get close to that number..Wonder whats the average number of new consults rad onc sees each week...I am averaging 10-15 and I thought I am busy

 

[TheWallnerus]

But if you're treating mainly prostates at 44 fractions, much easy to get to 70.

This is why fraction number is so important. If your prostate Rx is 9 weeks in duration, and you see 8 new prostates a week, you will have 72 on beam. If you see 8 new prostates a week and do SBRT on all of them, you will have 8 on beam per day.

Math.

 

[OTN]

Trump called Jeb "low energy."

If you get a rad onc job, here's some interesting data that there's a 58% chance it will be in a "low energy" (low volume) center... that is if you're open to taking a job at any center anywhere.

Rad onc has a clear patient volume maldistribution problem which could be solved by increasing the incidence of cancer or decreasing the incidence of cancer centers and/or MDs.

What metrics did they use to define volume and come up with the groups?

 

[deleted1111261]

I’m really surprised at the numbers.

Did people suddenly go from 6 new patients a week with historic fractionation and 25 on beam to 12 new patients a week with 15 on beam? Or were people seeing 12 a week during historic era and routinely carrying 45-50 patients?

 

[elementaryschooleconomics]

Interestingly, the conclusions from this study is that overall survival is improved at higher volume centers.

Thus, if the data says that ~60% (almost 2/3rds) of radiation practices are "low volume", is the logical conclusion that the majority of people in America are receiving inferior care?

There are a lot of methodological problems I have with this study but that's a provocative conclusion they've reached.

 

[communitydoc13]

I'm having a hard time gleaning anything meaningful from the original referenced tweet. Most centers are still community centers and are by definition going to see less patients per center. I did not see any reference to per provider numbers so small center generalists may still see a reasonable number of patients altogether relative to large center peers (probably more actually).

Regarding the survival curves? I think most would agree that H&N cancer is the site where technical acumen is most likely to be reflected in survival. Essentially overlapping curves for all center sizes here. I'll take this as an indicator that it doesn't really matter where you get your radiation.

I am averaging 10-15 and I thought I am busy

That is very busy

Did people suddenly go from 6 new patients a week with historic fractionation and 25 on beam to 12 new patients a week with 15 on beam?

I know of no one who has done this. More likely to by 6/25 to 5/12-15. I'm sure there are some more remote places that have trimmed staff and increased number of consults per physician markedly but definitely not a trend that I'm aware of.

 

[deleted1111261]

10-15 consults is way high end, compared to National numbers.

 

[RickyScott]

10-15 consults is way high end, compared to National numbers.

Yip, means someone else seeing 2 pts week or less

 

[hal9k]

10-15 consults is way high end, compared to National numbers.

still not that busy to be honest..4-day week and go home by 5 most days

 

[RickyScott]

still not that busy to be honest..4-day week and go home by 5 most days

Depends on mix of pts and hospital vs freestanding. I also assume that you are not reviewing 10 yrs of prior mammograms w/a dcis consult.

 

[medgator]

still not that busy to be honest..4-day week and go home by 5 most days

Not if it's head and neck and gyn

 

[hal9k]

Not if it's head and neck and gyn

lots of lung/prostate/breast with some head and neck/gyn

 

[Music Man Stan]

lots of lung/prostate/breast with some head and neck/gyn

You make me feel very insecure about my intelligence and ability to be able to see 10-15 consults a week and have 4 “normal hour” workdays :-(. I see 8-14 patients a week and I’m routinely working 5 days a week 12+ hours a day. My family hardly sees me. I’m not exaggerating.

I’m really hoping somebody chimes in and says “Music Man Stan, I also see about 8-14 patients a week and I too don’t see my family!” It would really make me feel better. Please. My ego is hurting bad right now.

 

[deleted1111261]

You make me feel very insecure about my intelligence and ability to be able to see 10-15 consults a week and have a 4 “normal hour” workdays :-(. I see 8-14 patients a week and I’m routinely working 5 days a week 12+ hours a day. My family hardly sees me. I’m not exaggerating.

I’m really hoping somebody chimes in and says “Music Man Stan, I also see about 8-14 patients a week and I too don’t see my family!” It would really make me feel better. Please. My ego is hurting bad right now.

everyone is different. In our practice, when we start averaging 10 consults per person, the hours per day shoot way up, close to what you’re saying

 

[hal9k]

You make me feel very insecure about my intelligence and ability to be able to see 10-15 consults a week and have 4 “normal hour” workdays :-(. I see 8-14 patients a week and I’m routinely working 5 days a week 12+ hours a day. My family hardly sees me. I’m not exaggerating.

I’m really hoping somebody chimes in and says “Music Man Stan, I also see about 8-14 patients a week and I too don’t see my family!” It would really make me feel better. Please. My ego is hurting bad right now.

i got 2 NPs and 4-5 dosimetrists...so no note writing or normal structure contouring if that matters

 

[medgator]

i got 2 NPs and 4-5 dosimetrists...so no note writing or normal structure contouring if that matters

That isn't the norm for most of us. Nice gig

 

[hal9k]

That isn't the norm for most of us. Nice gig

rural location....theres always a trade off

 

[communitydoc13]

i got 2 NPs and 4-5 dosimetrists...so no note writing or normal structure contouring if that matters

Holy Sh... Sweet gig. Don't leave that gig. Stay true like Dell Curry should have.

 

[thecarbonionangle]

Perfect fit for all the low energy turtles in this field

 

[RadOncMegatron]

You make me feel very insecure about my intelligence and ability to be able to see 10-15 consults a week and have 4 “normal hour” workdays :-(. I see 8-14 patients a week and I’m routinely working 5 days a week 12+ hours a day. My family hardly sees me. I’m not exaggerating.

I’m really hoping somebody chimes in and says “Music Man Stan, I also see about 8-14 patients a week and I too don’t see my family!” It would really make me feel better. Please. My ego is hurting bad right now.

I have seen >10 new pts week after week before and thought I was going crazy. Would have gone crazy if I didn’t have the ability to contour from home. A > 10 patients per week is doable here or there but back to back with stupid administrative stuff gets tough.

 

[TheWallnerus]

Btw guys this graph...

Really looks like this...

When you make it 1) not semi-log, and 2) look at patients per year per facility.

 

[RadOncDoc21]

Btw guys this graph...

Really looks like this...

When you make it 1) not semi-log, and 2) look at patients per year per facility.

Bad stock!

 

[medgator]

Bad stock!

We're the coal industry of medicine

 

[elementaryschooleconomics]

I have seen >10 new pts week after week before and thought I was going crazy. Would have gone crazy if I didn’t have the ability to contour from home. A > 10 patients per week is doable here or there but back to back with stupid administrative stuff gets tough.

I'm also generally seeing 8-14 patients a week, and am also only able to have my children remember my face because of remote contouring. Though that many consults/sims can definitely be a lot of work, for me, it's the constant stream of vsims, shift approvals, problem visits, P2Ps, and other chicanery that I also get dragged into that destroys my efficiency.

@hal9k, you must be in a "desirable" rural location for your hospital/group to attract 2 NPs and 4-5 dosimetrists. Is your dosi remote or are they actually onsite? My practice is also somewhat rural (though not by Census Bureau definitions) and it took us months to hire a new nurse (though this is probably due to the national nursing shortage as well). I can't imagine trying to recruit one, let alone 2, nurse practitioners!

 

[medgator]

I'm also generally seeing 8-14 patients a week, and am also only able to have my children remember my face because of remote contouring. Though that many consults/sims can definitely be a lot of work, for me, it's the constant stream of vsims, shift approvals, problem visits, P2Ps, and other chicanery that I also get dragged into that destroys my efficiency.

@hal9k, you must be in a "desirable" rural location for your hospital/group to attract 2 NPs and 4-5 dosimetrists. Is your dosi remote or are they actually onsite? My practice is also somewhat rural (though not by Census Bureau definitions) and it took us months to hire a new nurse (though this is probably due to the national nursing shortage as well). I can't imagine trying to recruit one, let alone 2, nurse practitioners!

Definitely a rough week when I'm seeing double digit consult volumes. Templates help as does block scheduling.... Keep your consults scheduled separately from your otvs when possible. Treatment planning system in the cloud has been a really nice thing to have. Can contour at home or wherever....

 

[salubalu]

If the avg tx length is now 16 fractions across all fractions in the US (and there's data that's the case), then you'd need to see 70/3.1 = 23 new consults a week. And you have to AVERAGE that. So if you take a week vacation, you need to hit 46 the next week to make up for it so the math will work out. This is like when Wilt Chamberlain said he slept with 20,000 women in 10 years. Doing the math, he had to be with a new woman having sex like every 6 hours, no breaks, no eating, no sleeping.

Y’all can’t do that?

 

[salubalu]

You make me feel very insecure about my intelligence and ability to be able to see 10-15 consults a week and have 4 “normal hour” workdays :-(. I see 8-14 patients a week and I’m routinely working 5 days a week 12+ hours a day. My family hardly sees me. I’m not exaggerating.

I’m really hoping somebody chimes in and says “Music Man Stan, I also see about 8-14 patients a week and I too don’t see my family!” It would really make me feel better. Please. My ego is hurting bad right now.

You may already do this but one thing that helps me be more efficient is prepping hpis for patients at least one day in advance. That way I already know the patients history and have a game plan in mind. Makes my day flow better.

 

[hal9k]

lol its not that desirable for most ppl I would say but somehow they got enough ppl willing to work there for 20-30 years..everyone is on site

I'm also generally seeing 8-14 patients a week, and am also only able to have my children remember my face because of remote contouring. Though that many consults/sims can definitely be a lot of work, for me, it's the constant stream of vsims, shift approvals, problem visits, P2Ps, and other chicanery that I also get dragged into that destroys my efficiency.

@hal9k, you must be in a "desirable" rural location for your hospital/group to attract 2 NPs and 4-5 dosimetrists. Is your dosi remote or are they actually onsite? My practice is also somewhat rural (though not by Census Bureau definitions) and it took us months to hire a new nurse (though this is probably due to the national nursing shortage as well). I can't imagine trying to recruit one, let alone 2, nurse practitioners!

 

[Lamount]

no wonder I never get close to that number..Wonder whats the average number of new consults rad onc sees each week...I am averaging 10-15 and I thought I am busy

I'm in clinic 60% with 6-9 new consults a week, 6-15 sims, and 15-20 (25 at the most) sick(ish) thoracic patients on treatment most of the time (not counting SBRT), and have zero interest in being ANY busier. More power to those folks who want to have 30-40+ on treatment... just not for me.

 

[dieABRdie]

I'm also generally seeing 8-14 patients a week, and am also only able to have my children remember my face because of remote contouring. Though that many consults/sims can definitely be a lot of work, for me, it's the constant stream of vsims, shift approvals, problem visits, P2Ps, and other chicanery that I also get dragged into that destroys my efficiency.

@hal9k, you must be in a "desirable" rural location for your hospital/group to attract 2 NPs and 4-5 dosimetrists. Is your dosi remote or are they actually onsite? My practice is also somewhat rural (though not by Census Bureau definitions) and it took us months to hire a new nurse (though this is probably due to the national nursing shortage as well). I can't imagine trying to recruit one, let alone 2, nurse practitioners!

That's because all the nurses only did nursing long enough to get their online degree at work and become an NP. Its not surprising you can't find a nurse, but I bet you could get two NPs by tomorrow.

 

[medgator]

That's because all the nurses only did nursing long enough to get their online degree at work and become an NP. Its not surprising you can't find a nurse, but I bet you could get two NPs by tomorrow.

The nurses you can find may have gotten an email to go to az or tx to make five figures a month doing covid work on top of it

 

[elementaryschooleconomics]

The nursing situation is this country right now is crazy, I had no idea how bad/good it was (bad for us, great for the RNs scoring those sweet travel contracts pulling down $8k-$10k per week).

Lest anyone think we're exaggerating:

 

[Gfunk6]

Heard through the grapevine that RN shortage in SE is so acute that they are being offered $500/hr. You have to go into COVID infested regions though so it’s definitely not low risk

 

[medgator]

Heard through the grapevine that RN shortage in SE is so acute that they are being offered $500/hr. You have to go into COVID infested regions though so it’s definitely not low risk

$10k a week in Texas. That's even crazier!

 

[RadOncDoc21]

Heard through the grapevine that RN shortage in SE is so acute that they are being offered $500/hr. You have to go into COVID infested regions though so it’s definitely not low risk

I’m ready!

 

[salubalu]

Heard through the grapevine that RN shortage in SE is so acute that they are being offered $500/hr. You have to go into COVID infested regions though so it’s definitely not low risk

Does that mean they prescribe lupron for those patients then?

 

[RadOncDoc21]

Does that mean they prescribe lupron for those patients then?

I’ve heard Ivermectin or low dose radiation can be very effective. Apparently anything but a vaccine or mask. I’ve learned a lot in the anesthesiology forum.

 

[elementaryschooleconomics]

I’ve heard Ivermectin or low dose radiation can be very effective. Apparently anything but a vaccine or mask. I’ve learned a lot in the anesthesiology forum.

 

[Ray D. Ayshun]

If the avg tx length is now 16 fractions across all fractions in the US (and there's data that's the case), then you'd need to see 70/3.1 = 23 new consults a week. And you have to AVERAGE that. So if you take a week vacation, you need to hit 46 the next week to make up for it so the math will work out. This is like when Wilt Chamberlain said he slept with 20,000 women in 10 years. Doing the math, he had to be with a new woman having sex like every 6 hours, no breaks, no eating, no sleeping.

Unlike wilt we can't (a) do 5 plans at one time (2) operate hi on cocaine.

 

[salubalu]

I’ve heard Ivermectin or low dose radiation can be very effective. Apparently anything but a vaccine or mask. I’ve learned a lot in the anesthesiology forum.

I seriously had a patient with cervical cancer this week ask me to prescribe her ivermectin

 

[elementaryschooleconomics]

I seriously had a patient with cervical cancer this week ask me to prescribe her ivermectin

My OTVs and consults have basically turned into me proselytizing the vaccine and/or other safety measures like masks and social distancing. I'm on call right now and just got paged about one of my patients who was having side effects from her second shot and was concerned about it. At least I talked her into the vaccine?

I'm so tired of this.

 

[SneakyBooger]

I have been spending the past hour looking at the #ESTRO2021 Twitter discussions regarding less and less use of XRT in cancer management.

I suspect the definition of "low volume" will rapidly change...

 

[TheWallnerus]

I have been spending the past hour looking at the #ESTRO2021 Twitter discussions regarding less and less use of XRT in cancer management.

I suspect the definition of "low volume" will rapidly change...

One marker of low volume in this graph: the number of breast pts a center treats. The majority of centers in US are seeing 2 or less breast patients per week. And as the graph shows this (breast) is overwhelmingly the most common patient centers see/treat.

What does that say about a center's total volume (all diagnoses, incl bone mets etc which will be less common than br ca)... and the docs who work in these centers volume?

Residents, and med students, could say "Well I won't wind up at one of these centers."

One of these 772 centers which make up 1331 total centers.