ROCR

[Rad Onc SK]

Thanks for coming on here and engaging with this group! Much appreciated.

Thank you!

Oh yeah As you know, I’m not afraid to talk to people with differing opinions. In fact, I like doing it because it makes me think differently. Sometimes, I realize that I am wrong or could see the issue better. So I want to engage, especially with the forum that is largely distrustful of ASTRO. I’m trying to better understand why.

As I told you, Todd, Jason and Simul, I’m happy to do this. I truly am. The one thing I cannot put up with, however, is a lack of respect and professionalism. If I do hear ASTRO staff, or myself being personally attacked, I’m going to have to exit stage left. That’s the only big rule I have and I think it’s a fair one.

I really want to understand where people are coming from in the entire Radiation Oncology community. I do think we’re stronger together. That sounds incredibly cheesy as I see it dictating itself on the screen 🙂

We may not always agree on issues. That’s OK. As long as we can respect each other at the end of the discussion, then it’s all good.

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Members don't see this ad.

 

[Rad Onc SK]

To play devils advocate, suppose that the ROCR doubles or even triples reimbursement vs fee for service. Selfishly this may be a negative for employed doctors - most of us- because the hypofractionation that would follow could easily put a lot of docs on the job market and when it comes time to renew my contract, the hospital will have tremendous leverage. And btw, we hypofrac more than most. There has been almost no study of how many jobs are “unnecessary” taking into account hypofract and supervision.

This is a VERY, VERY, VERY good point.

VERY

Did I mention that this is a very good point?

 

[RickyScott]

This is a VERY, VERY, VERY good point.

VERY

Did I mention that this is a very good point?

It’s cliche to state that we all bring our own biases, experiences to the table, but as a well regarded senior Mayo faculty, I think it would be hard for you to conceive waking up one day unemployed. It happened to me several years out of residency due to political machinations involving a well regarded private practice and hospital. (No drugs, no sex, no personality issues, and typical resume for the field. In medschool, I was taught it took one of those 3 things to loose your job) I more than landed on my feet, but there were so many opportunities back then. Supply is our only defense against a storm. The very idea of a “profession” dating back to the guilds of Germany in the Middle Ages is predicated on this notion.

 

[deleted1111261]

My turn, my turn!

Few years ago I said the way the APM was written meant the end of OTVs and the end of supervision. I was told because of the data collection aspect, it was not, bc you were still sending all the same codes (extra work) to measure.

Well, what about in this model?

Are we submitting 77427s, 77295s, etc or just the ICD code of the cancer ?

Is this the end of supervision and weekly visits? Because this + massive increase in hypofractionation will destroy the job market. 30% unemployment. Decreased salaries. Ioniqs instead of Teslas. End times, my dude.

Thoughts?

 

[Rad Onc SK]

It’s cliche to state that we all bring our own biases, experiences to the table, but as a well regarded senior Mayo faculty, I think it would be hard for you to conceive waking up one day unemployed. It happened to me several years out of residency due to political machinations involving a well regarded private practice and hospital. (No drugs, no sex, no personality issues, and typical resume for the field. In medschool, I was taught it took one of those 3 things to loose your job) I more than landed on my feet, but there were so many opportunities back then. Supply is our only defense against a storm. The very idea of a “profession” dating back to the guilds of Germany in the Middle Ages is predicated on this notion.

You are correct. I am in as safe as harbors as you can find in all of medicine.

While I was in PP for only 4 years, those 4 years shaped my thinking far more than the rest of my career combined. I learned how dollars flow, how relationships matter, and how taking great care of patients is ALWAYS the best way to build a practice, regardless of setting. I also saw what happens with payment turbulence. My group has missed payroll and drawn down on a LOC to pay staff (while skipping our own paychecks). I know what that feels like.

 

[NotMattSpraker]

Thank you!

Oh yeah As you know, I’m not afraid to talk to people with differing opinions. In fact, I like doing it because it makes me think differently. Sometimes, I realize that I am wrong or could see the issue better. So I want to engage, especially with the forum that is largely distrustful of ASTRO. I’m trying to better understand why.

As I told you, Todd, Jason and Simul, I’m happy to do this. I truly am. The one thing I cannot put up with, however, is a lack of respect and professionalism. If I do hear ASTRO staff, or myself being personally attacked, I’m going to have to exit stage left. That’s the only big rule I have and I think it’s a fair one.

I really want to understand where people are coming from in the entire Radiation Oncology community. I do think we’re stronger together. That sounds incredibly cheesy as I see it dictating itself on the screen 🙂

We may not always agree on issues. That’s OK. As long as we can respect each other at the end of the discussion, then it’s all good.

Agreed. One issue, though, is that professionalism is a squishy and often weaponized term in medicine. As you know, power imbalances make it kind of tough.

You and others have stated that you want to better engage radiation oncologists. I hope ASTRO, especially the paid staffers, recognize the need for respect and professional behavior in their interactions with rank and file radiation oncologists. In my opinion, it starts with honest discussion and transparency, even in the hard conversations.

 

[Reaganite]

My turn, my turn!

Few years ago I said the way the APM was written meant the end of OTVs and the end of supervision. I was told because of the data collection aspect, it was not, bc you were still sending all the same codes (extra work) to measure.

Well, what about in this model?

Are we submitting 77427s, 77295s, etc or just the ICD code of the cancer ?

Is this the end of supervision and weekly visits? Because this + massive increase in hypofractionation will destroy the job market. 30% unemployment. Decreased salaries. Ioniqs instead of Teslas. End times, my dude.

Thoughts?

On site supervision probably over irrespective of ROCR. CMS proposal for 2024 extends virtual supervision to end of 2024 with solicitation of comments regarding extending it essentially permanently. Hospitals already have general supervision; hard to see them going back now even on the freestanding site. Anyone expanding their program in the face of hypofx, end of supervision, declining reimbursement, etc. deserves a punch in the face at this point.

 

[temujim]

Q: Payment stability. A: ROCR is going through Congress. More stable than CMS with rises more likely to happen since PC linked to MEI and TC linked to HIPPS.

Q/C: “ASTRO only spends $150k a year on PAC”. A: ASTRO spends quite a bit on lobbying and advocacy activities. I believe it’s between 12 and 15%. The number is on the annual dues statement, which may be why few people in this forum see it (relax, it’s just a joke) ASTRO PAC has about $150k in hard money each year.

Some haven't forgotten a political position ASTRO PAC took in 2021. What makes you think those politicians in congress forgot? And why would they help the specialty now? Unless ASTRO has identified a small group of congressmen who are willing to spend political capital on an bit of esoterica slipped into a bill for a completely different purpose, this whole thing is DOA as a legislative matter.

 

[Chartreuse Wombat]

From OpenSecrets.

 

[Chartreuse Wombat]

Here is ASTRO PAC

Not sure why there are different numbers. I am not wise about giving money to pols

 

[Mandelin Rain]

If things are going to burn down anyway, we should see to it that protons are included, otherwise just setting favorable conditions for consolidations and takeovers, firesales to the “winners”

This is a perk, not a bug.

 

[Mandelin Rain]

Unless ASTRO has identified a small group of congressmen who are willing to spend political capital on an bit of esoterica slipped into a bill for a completely different purpose

I don't purport to know regarding this situation specifically, but yes. This is how business is done.

 

[Mandelin Rain]

My chief complaint with this bit of legislation and ASTRO more generally is that there's never a sense of, "We're all in this together. We'll suffer and/or gain together."

There's always winners and losers. There's always hidden agendas. There's always secret backdoor meetings and HUGE nuggets of business altering policy made without comment outside the chosen few. Urorads taking all the academic centers' prostate patients? We must fight them, never mind the rad onc there is happily making >1million. Concerns about the job market? Attack junior faculty in Red Journal. Antitrust, antitrust, antitrust. Circle the wagons to protect the business of the select few (typically, large academic centers).

I hope this changes. I hold little hope it'll change. Only has gotten worse over the past 2 decades.

 

[Mandelin Rain]

There’s no guarantees anywhere, but if there’s a tornado coming, I’d rather be in a brick building with no windows, as opposed to a tent on an open field

And yet, the PPSE and proton/adaptive owning facilities see the tent as the better option? (note: I understand PPSE are also protected by long standing legislation. It's just very low hanging fruit if cost savings/stabilization is a goal here)

Brick buildings with no windows?

 

[thecarbonionangle]

@Rad Onc SK congrats on your election! As far as I know you are the first Astro president to come here and engage. I like that you arent afraid to discuss opinions and aren’t “offended” when someone has a different take or perspective. I hope you stick around.

 

[deleted1111261]

My chief complaint with this bit of legislation and ASTRO more generally is that there's never a sense of, "We're all in this together. We'll suffer and/or gain together."

There's always winners and losers. There's always hidden agendas. There's always secret backdoor meetings and HUGE nuggets of business altering policy made without comment outside the chosen few. Urorads taking all the academic centers' prostate patients? We must fight them, never mind the rad onc there is happily making >1million. Concerns about the job market? Attack junior faculty in Red Journal. Antitrust, antitrust, antitrust. Circle the wagons to protect the business of the select few (typically, large academic centers).

I hope this changes. I hold little hope it'll change. Only has gotten worse over the past 2 decades.

ASTRO will continue to become more academic and thus you’re right - unless SK is a revelation - the same issues will continue to occur.

 

[elementaryschooleconomics]

Here is ASTRO PAC

View attachment 374274
Not sure why there are different numbers. I am not wise about giving money to pols

They're different numbers because they're different entities.

The IRS 990 form is public record. ASTRO is a 501c6 nonprofit and required to file.

ASTRO gives $100-$150k per year to ASTRO PAC. Since ASTRO is a 501c6 (not 501c3) it technically can engage in unlimited lobbying, but they appear to consistently stick with the $100k-$150k.

The "rest" of the lobbying amount from ASTRO is what Sameer and I were discussing since it shows up on the dues statement. They're not required to disclose the details of the $600-$800k they're reporting, just that the organization is reporting that amount as being spent on political efforts which has tax ramifications.

The ASTRO PAC numbers are coming from the money received from ASTRO and the money received from other donors. As a PAC the records are much more granular.

The ASTRO PAC likes to donate $10,000 to get Mitch McConnell re-elected, for example.

But regarding the numbers for ASTRO, not ASTRO PAC - things like travel grants given for Advocacy Day are likely tallied in that reported amount. The dinners and stuff as well.

 

[Chartreuse Wombat]

They're different numbers because they're different entities.

The IRS 990 form is public record. ASTRO is a 501c6 nonprofit and required to file.

ASTRO gives $100-$150k per year to ASTRO PAC. Since ASTRO is a 501c6 (not 501c3) it technically can engage in unlimited lobbying, but they appear to consistently stick with the $100k-$150k.

The "rest" of the lobbying amount from ASTRO is what Sameer and I were discussing since it shows up on the dues statement. They're not required to disclose the details of the $600-$800k they're reporting, just that the organization is reporting that amount as being spent on political efforts which has tax ramifications.

The ASTRO PAC numbers are coming from the money received from ASTRO and the money received from other donors. As a PAC the records are much more granular.

The ASTRO PAC likes to donate $10,000 to get Mitch McConnell re-elected, for example.

But regarding the numbers for ASTRO, not ASTRO PAC - things like travel grants given for Advocacy Day are likely tallied in that reported amount. The dinners and stuff as well.

Excellent thanks for information.

 

[temujim]

I don't purport to know regarding this situation specifically, but yes. This is how business is done.

For sure. But if I was a politician (to many margaritas and/or poor choices), would 100% keep a list of PACs who crossed the line. And torpedo every one of their initiatives come hell or high water until they came begging. Double when it's a penny-ante org like ASTRO (PAC).

 

[Rad Onc SK]

For sure. But if I was a politician (to many margaritas and/or poor choices), would 100% keep a list of PACs who crossed the line. And torpedo every one of their initiatives come hell or high water until they came begging. Double when it's a penny-ante org like ASTRO (PAC).

Politicians have a thick skin. Many groups with held money from the 147. ASTRO PAC was not alone.

I am on the Committee board for the pac. I can tell you is that the decision to withhold money was not unanimous (I voted against it) but it did pass with a solid majority.

Ultimately, the people on the PAC board made the decision. The ASTRO staff had to execute it. The ASTRO lobbying staff had many meetings with the offices, especially the key players in health, who were in the 147, to explain our position.

The 147 needs us. It’s not just us. There were a lot of association lobbying groups that withheld money. They can’t hold grudges against everyone.

The ASTRO lobbying staff is very well respected on the Hill. Dave Adler is very well known. He has excellent personal relationships with many members on both sides of the aisle. These relationships have helped us many times.

To succeed in Washington DC, you have to be pragmatic and have a short memory, despite all the posturing you see on TV and in the media.

 

[temujim]

Politicians have a thick skin. Many groups with held money from the 147. ASTRO PAC was not alone.

I am on the Committee board for the pac. I can tell you is that the decision to withhold money was not unanimous (I voted against it) but it did pass with a solid majority.

Ultimately, the people on the PAC board made the decision. The ASTRO staff had to execute it. The ASTRO lobbying staff had many meetings with the offices, especially the key players in health, who were in the 147, to explain our position.

The 147 needs us. It’s not just us. There were a lot of association lobbying groups that withheld money. They can’t hold grudges against everyone.

The ASTRO lobbying staff is very well respected on the Hill. Dave Adler is very well known. He has excellent personal relationships with many members on both sides of the aisle. These relationships have helped us many times.

To succeed in Washington DC, you have to be pragmatic and have a short memory, despite all the posturing you see on TV and in the media.

kudos to you for voting against. But the best way to maintain political power is to reward your friends and punish your enemies. ASTRO might be small potatoes and slip away unscathed hiding behind "patients", but counting on politician's good will is a dicey business.

ASTRO had an opportunity to side step a stupid issue that has nothing to do with radiation oncology and come out clean. Instead, the decision was to perhaps alienate 50% (?) of potential donors and potential decision makers. I chuckle at the requests for money from ASTRO PAC. And like many others on this board, questioning why I should maintain ASTRO membership. ASTRO has to explain, like the AMA, why many should ever support them. Btw "fighting for the field" is not a winning slogan in this context. I urge you to return ASTRO to simply a focused professional association.

In any case, I like many others, appreciate your engagement on this board.

 

[RadOncDoc21]

@Rad Onc SK

Thank you for coming on here and for sharing your perspective and insight on what goes on behind the scenes.

It’s good to see you engaging on this forum as you already know why a lot of us have significant issues and resentment against ASTRO.- skepticism and erosion of trust and that they only support the interests of big time academia.

I believe that in order to rebuild trust, there needs to be transparency, accountability, and ethical leadership within the political sphere and I hope you continue to engage and represent all of us.

 

[sirspamalot]

For those of us who aren't ASTRO members.. Can you fill us in on what 147 is all about?

 

[medgator]

For those of us who aren't ASTRO members.. Can you fill us in on what 147 is all about?

After Jan. 6, hundreds of corporations vowed to not donate to Republicans who voted to overturn the election. Many haven't kept their promise.

Tracking corporate donations to the 147 Republicans who objected to 2020 presidential election.

www.wgbh.org

I didn't have a problem with it, personally. I think SKs explanation was correct. Many felt that what happened on 1/6 was historic and demanded accountability. ASTRO was far from the only organization that did this and memories are short

 

[deleted1111261]

Politicians have a thick skin. Many groups with held money from the 147. ASTRO PAC was not alone.

I am on the Committee board for the pac. I can tell you is that the decision to withhold money was not unanimous (I voted against it) but it did pass with a solid majority.

Ultimately, the people on the PAC board made the decision. The ASTRO staff had to execute it. The ASTRO lobbying staff had many meetings with the offices, especially the key players in health, who were in the 147, to explain our position.

The 147 needs us. It’s not just us. There were a lot of association lobbying groups that withheld money. They can’t hold grudges against everyone.

The ASTRO lobbying staff is very well respected on the Hill. Dave Adler is very well known. He has excellent personal relationships with many members on both sides of the aisle. These relationships have helped us many times.

To succeed in Washington DC, you have to be pragmatic and have a short memory, despite all the posturing you see on TV and in the media.

This is not a personal attack and shouldn’t be taken as one. But the personal relations you speak of from the lobby arm - this is the same person that told us staffers were not allowed to go on our show. If that’s how they behave towards their own members, I have my opinions on how good they are with forging strong and useful relationships. In addition, when talking to former staffers (one we both know personally), even after they quit, “why are you still associating with him?”

I’m just one person - If this is the sort of thing that the staff is doing on their own, it is cancerous. If they are being directed to behave like that, it’s a failure of leadership.

Matt can attest - there is a brittleness that is either the organization or the people - and it is not fruitful for healthy relationships. Here’s to hoping that changes. But culture is like tree rot, it’s from within and can destroy the organism over time.

 

[deleted1111261]

After Jan. 6, hundreds of corporations vowed to not donate to Republicans who voted to overturn the election. Many haven't kept their promise.

Tracking corporate donations to the 147 Republicans who objected to 2020 presidential election.

www.wgbh.org

I didn't have a problem with it, personally. I think SKs explanation was correct. Many felt that what happened on 1/6 was historic and demanded accountability. ASTRO was far from the only organization that did this and memories are short

Reasonable people can disagree. Almost every elected official is a POS. Your POS may be my hero. And vice versa. The position I would hope for is - “does this person care about RO”? Because I didn’t elect them, I don’t care about any other values they have (or don’t have).

 

[sirspamalot]

Reasonable people can disagree. Almost every elected official is a POS. Your POS may be my hero. And vice versa. The position I would hope for is - “does this person care about RO”? Because I didn’t elect them, I don’t care about any other values they have (or don’t have).

To what end. If a fringe right politician who subtly hints at violence against POC and antisemitism but loves RO we should funnel dollars to them?

There has to be a line.

 

[RickyScott]

To what end. If a fringe right politician who subtly hints at violence against POC and antisemitism but loves RO we should funnel dollars to them?

There has to be a line.

Moderate here, but If MTG, desantis or Rick Scott was going to advocate for radonc, I would probably support them

 

[RadOncDoc21]

To what end. If a fringe right politician who subtly hints at violence against POC and antisemitism but loves RO we should funnel dollars to them?

There has to be a line.

Definitely has to be a line

 

[NotMattSpraker]

This is not a personal attack and shouldn’t be taken as one. But the personal relations you speak of from the lobby arm - this is the same person that told us staffers were not allowed to go on our show. If that’s how they behave towards their own members, I have my opinions on how good they are with forging strong and useful relationships. In addition, when talking to former staffers (one we both know personally), even after they quit, “why are you still associating with him?”

I’m just one person - If this is the sort of thing that the staff is doing on their own, it is cancerous. If they are being directed to behave like that, it’s a failure of leadership.

Matt can attest - there is a brittleness that is either the organization or the people - and it is not fruitful for healthy relationships. Here’s to hoping that changes. But culture is like tree rot, it’s from within and can destroy the organism over time.

I agree with this, I suspect this is a cultural issue that starts with the CEO. I have very little to base that on except personal experience and stories that I have heard.

However, I’d be curious to hear why a rank and file member should believe that Dave and Anne are very effective on the hill. We get very little from them in terms of info or communication. We keep getting cut and don’t really seem to get what we want as a group. That may be out of their hands, but they communicate very little with the membership and are not welcoming when it comes to follow up questions or requests for information.

All one really has to go on is the information available. It’s an interesting contrast if you look at what Jason and ACRO provides it’s members in terms of information and communication, especially given their much smaller size and budget.

I’ve moved my money around to different orgs, trying to find who makes me feel like they will be most effective lobbying for my future. This year it is the state/city medical society and ACRO.

Even personal conflicts aside, there is not a lot out there for me to even understand what Dave and Anne are doing with the money and I get very little back in terms of updates. Layer on the weird/bad culture and it’s a non starter.

Just some thoughts.

 

[RickyScott]

I agree with this, I suspect this is a cultural issue that starts with the CEO. I have very little to base that on except personal experience and stories that I have heard.

However, I’d be curious to hear why a rank and file member should believe that Dave and Anne are very effective on the hill. We get very little from them in terms of info or communication. We keep getting cut and don’t really seem to get what we want as a group. That may be out of their hands, but they communicate very little with the membership and are not welcoming when it comes to follow up questions or requests for information.

All one really has to go on is the information available. It’s an interesting contrast if you look at what Jason and ACRO provides it’s members in terms of information and communication, especially given their much smaller size and budget.

I’ve moved my money around to different orgs, trying to find who makes me feel like they will be most effective lobbying for my future. This year it is the state/city medical society and ACRO.

Even personal conflicts aside, there is not a lot out there for me to even understand what Dave and Anne are doing with the money and I get very little back in terms of updates. Layer on the weird/bad culture and it’s a non starter.

Just some thoughts.

At the end of the day, Astro, Dave and Anne feel their mission is to advocate for cms payment and government support for radonc. Philosophically, they seem to believe that we are all better off if there is increased cms/gov support for radonc and SK seems partial to this view.

But the vast majority of radoncs are now employed and are impacted 10x more by supply/demand issues than cms reimbursement, and Astro seemingly could give a flying f abt the central supply issue facing this specialty.

As I mentioned before, The ROCR could increase payment 3x over traditional fee for service, but still severely hurt the professional interests of the vast majority of Astros members. All those docs/practices who overly rely on extended conventional fract will hit the job market and impact all our mobility opportunities and contract negotiations. My hospital will never hire again if Mets are one fraction and prostate/breast 5, even if we are getting 3x more with the ROCR. (They recently inquired if we really need locums when one of us is on vacation, given the telehealth supervision) The hospital will just take the money and smile. My own salary would go down because a bunch of recently unemployed go getters from 21c will now be available and ready to jump in if I threatened to leave.

Is Astros mission to advocate for the interests of its members or increased payments by cms? Astro staff seem to react poorly to those who point out that they don’t really give a sh— abt the actual proffesional interests of most members, but this is the honest truth.

 

[NotMattSpraker]

At the end of the day, Astro, Dave and Anne feel their mission is to advocate for cms payment and government support for radonc. Philosophically, they seem to believe that we are all better off if there is increased cms/gov support for radonc and SK seems to partial to this view.

But the vast majority of radoncs are now employed and are impacted 10x more by supply/demand issues vs cms reimbursement, and Astro seemingly could give a flying f abt the central supply issue facing this specialty.

As I mentioned before, The ROCR could increase payment 3x over traditional fee for service, but still severely hurt the professional interests of the vast majority of Astros members. All those docs/practices who overly rely on extended conventional fract will hit the job market and impact all our mobility opportunities and contract negotiations. My hospital will never hire again if Mets are one fraction and prostate/breast 5 even if we are getting 3x more with the ROCR. My hospital will just take the money and smile. My own salary would go down because their would be so many others now available and ready to jump in if I threatened to leave.

Is Astros mission to advocate for the interests of its members or increased payments by cms. They seem to react poorly to those who point out that they don’t really give a sh— abt the actual proffesional interests of most members, but this is the honest truth.

Yea, I actually like being employed (don’t cancel me) and I totally agree with you.

This isn’t that complicated. ASTROs policy mission should be to advocate for the what the membership thinks is important. You do this through transparent education of current events, collecting feedback in an open way, and holding democratic elections of board members.

They took the opposite route with ROCR. They have a chance to turn it around, very interested to see how this “town hall” goes on Friday.

I hope people from this forum attend the session, there have been so many excellent comments here.

 

[sirspamalot]

Yea, I actually like being employed (don’t cancel me) and I totally agree with you.

This isn’t that complicated. ASTROs policy mission should be to advocate for the what the membership thinks is important. You do this through transparent education of current events, collecting feedback in an open way, and holding democratic elections of board members.

They took the opposite route with ROCR. They have a chance to turn it around, very interested to see how this “town hall” goes on Friday.

I hope people from this forum attend the session, there have been so many excellent comments here.

Link?

Is membership required? If so, oh well.

Will there be a real Q & A or just more South Park "we're sorry" stuff?

 

[NotMattSpraker]

Link?

Is membership required? If so, oh well.

Will there be a real Q & A or just more South Park "we're sorry" stuff?

Advocacy Radiation Oncology Case Rate Program - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

The ASTRO-proposed Radiation Oncology Case Rate (ROCR) program represents a bold initiative to reverse disastrous payment trends that are expected to continue.

www.astro.org

I do not have high hopes for this session because they have not advertised this at all that I have seen.

 

[RickyScott]

Was Astro simultaneously working on the ROCR and workforce report?

 

[elementaryschooleconomics]

Was Astro simultaneously working on the ROCR and workforce report?

Ah...what a pesky question...

So ASTRO hired independent consultants for both projects. HMA for workforce, Wakely for ROCR.

The technical document for ROCR states that it used the HMA workforce data for the model.

The workforce paper dropped early March 2023. The Excel files for ROCR that are on the website were first created in February.

I'm not sure how far in advance ASTRO was given the HMA report before publishing that paper, at least a couple months (they did the interim presentation at the 2022 conference if you recall).

So the short answer is yes absolutely. These were being worked on simultaneously.

The question is...who knew about it. ROCR was a surprise to a lot of people. Workforce paper authors found out when the rest of us did. Some very senior/inner circle people were aware of ROCR only shortly (weeks) before it was released.

But other knowing that it was a thing that existed, it really, really sounds like only a small handful of people actually knew the details of ROCR.

If I had to guess, I would bet A LOT of money that the 4 people you see in the 12 minute webinar were probably the only ones. Maybe CEO Laura. But...yeah.

 

[elementaryschooleconomics]

Hahaha I just noticed -

That's hilariously sleezy. I would like to rescind my previous statements.

Wakely is a subsidiary of HMA.

Cool.

 

[DireMoose]

I agree with this, I suspect this is a cultural issue that starts with the CEO. I have very little to base that on except personal experience and stories that I have heard.

However, I’d be curious to hear why a rank and file member should believe that Dave and Anne are very effective on the hill. We get very little from them in terms of info or communication. We keep getting cut and don’t really seem to get what we want as a group. That may be out of their hands, but they communicate very little with the membership and are not welcoming when it comes to follow up questions or requests for information.

All one really has to go on is the information available. It’s an interesting contrast if you look at what Jason and ACRO provides it’s members in terms of information and communication, especially given their much smaller size and budget.

I’ve moved my money around to different orgs, trying to find who makes me feel like they will be most effective lobbying for my future. This year it is the state/city medical society and ACRO.

Even personal conflicts aside, there is not a lot out there for me to even understand what Dave and Anne are doing with the money and I get very little back in terms of updates. Layer on the weird/bad culture and it’s a non starter.

Just some thoughts.

Very basic questions - but what is the scope of the ASTRO president’s powers? I imagine they can’t come in and clean house on the employees of the organization, but perhaps they have more sway than just picking the theme of the annual meeting?

Who can make changes if there is a bad egg who’s prickly with the rank and file membership, as has been the case? The CEO?

Perhaps, along with other members of the board, can the ASTRO president apply influence on the CEO?

Who is in charge of the CEO?

 

[RickyScott]

Very basic questions - but what is the scope of the ASTRO president’s powers? I imagine they can’t come in and clean house on the employees of the organization, but perhaps they have more sway than just picking the theme of the annual meeting?

Who can make changes if there is a bad egg who’s prickly with the rank and file membership, as has been the case? The CEO?

Perhaps, along with other members of the board, can the ASTRO president apply influence on the CEO?

Who is in charge of the CEO?

I just hope for a president who presents ideas and advocates for our interests . Can’t really expect him to effect major changes by himself.

 

[sirspamalot]

I just hope for a president who presents ideas and advocates for our interests . Can’t really expect him to effect major changes by himself.

Nah.. In the end.. it'll be more of the same "thank you sir may I have another" in all likelihood..

 

[RadOncDoc21]

Nah.. In the end.. it'll be more of the same "thank you sir may I have another" in all likelihood..

Unfortunately, I agree.

 

[elementaryschooleconomics]

Who is in charge of the CEO?

In any nonprofit, the board of directors is in charge of the CEO.

ASTRO became independent, breaking free of the management services agreement with the ACR, in 1998.

The current CEO has been CEO for nearly that entire time.

Either her performance is what the board wants, the "status quo" is easier than replacing her, maybe a mixture of both - who knows.

Can someone check if there's a Greek God of Retirement, and we can build a temple to pray in?

 

[Lamount]

Can someone check if there's a Greek God of Retirement, and we can build a temple to pray in?

Bacchus (Dionysus)? Close enough, as far as I am concerned.

 

[DireMoose]

Either her performance is what the board wants, the "status quo" is easier than replacing her, maybe a mixture of both - who knows.

Exactly.

To tie in another thread here, how much “skin is in the game?” Have salaries at ASTRO been getting cut by 2-3% per year? It’s tough to feel the crunch of the masses when the status quo is accepted. Just survive the revolving door of board members and move it along till next year.

I’m a fan of carrots as well as sticks:

I’d pay double the dues to ASTRO if they successfully cut training spots in half. We could even have an incentive program. Each year that total available training slots are cut, dues go up by an equivalent percentage. In the short run, the people in charge could be in line for significant raises as the total doctors belonging to ASTRO wouldn’t decrease right away. In fact more may join!
That changes the time horizon of the goals for decision makers.

Might as well tie *The Thing* that is the existential threat to incentives that shape decisions.

 

[RickyScott]

What is her name and total compensation?

 

[elementaryschooleconomics]

What is her name and total compensation?

 

[RadOncDoc21]

View attachment 374372

Damn, not a bad gig at all.

 

[deleted1111261]

View attachment 374372

That’s the real 750orGTFO

 

[elementaryschooleconomics]

Just to really reinforce how recent this all is, from ASTRO's website:

1) ASTRO decided to leave the ACR in 1998
2) Since 1998, there have been a grand total of two chief executives - with the current CEO holding the position since 2002
3) THERE WASN'T EVEN FORMAL GOVERNMENT RELATIONS UNTIL 2004

The fact that Radiation Oncology did "well" at all was a complete accident. IMRT took off around 2002/2003. The government noticed. In 2007, ASTRO decided to fight UroRads/self-referral with a team that was formed...3 years prior.

Can someone dust off the management services agreement with ACR and see if we can go back?

 

[TheWallnerus]

#nosnark

As an aside SDN has really matured these last 5 or 6 years and is now clearly a space for high level and important discussions about rad onc as a whole. ASTRO and every rad onc could learn a lot from coming on here occasionally. If one is not checking in on SDN in rad onc, one is not getting the full story and/or at risk of getting caught with one’s professional pants down.

#resumesnark