Rural Rad Onc

[radoncgrad2019]

Anyone sign a rural job for high pay only to have COVID screw everything up? Happened to a friend of mine who is my year. Guy is pissed. No way he gets a bonus this year, and he still has to live in a state with so few electoral votes it would make a grown man cry

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[w00tz]

I think many people's bonuses are going to be lower this year. I just going to assume I'm not getting a bonus this year and hope that I'm pleasantly surprised. Potentially, investing in the stock market during this downturn could be my consolation prize IF things get better. Otherwise, just more tears.

Just be glad you're not my friend who's practice is 90% elective procedures (bariatric surgery).

Edit: How was he screwed? No job? Lowered salary?

 

[radoncgrad2019]

I think many people's bonuses are going to be lower this year. I just going to assume I'm not getting a bonus this year and hope that I'm pleasantly surprised. Potentially, investing in the stock market during this downturn could be my consolation prize IF things get better. Otherwise, just more tears.

Just be glad you're not my friend who's practice is 90% elective procedures (bariatric surgery).

Edit: How was he screwed? No job? Lowered salary?

He’s expecting no bonus Which was huge part of the apppeal

 

[w00tz]

Yea, I don't this is going to be unique to rad onc or being rural.

I know ortho, ophtho, derm people that are very concerned about their jobs.

 

[KHE88]

Is your friend me? I didn't think I had any left after I dropped off the face of the earth.

Even before COVID, I learned pretty quickly they had pulled a bait and switch regarding the lucrative RVU bonus.

The first trick is that the bonus is calculated quarterly and extrapolated to be as if it were for a full year. And any deficit in terms of not making up your salary is CARRIED FORWARD to the next quarter. So if you take a vacation that quarter, you can forget about it. Take a vacation early in the year, you're always playing catch up. Basically what this means is that suppose you need 9500 wRVUs to make up your salary and enter bonus territory. Due to their tricks, you can have over 9500 wRVUs for the year but still not bonus.

The second trick is that I don't get to do my own billing. I don't know what's being charged. I tried to audit it myself and got nowhere. Stuff gets billed months and months later, and of course thrown on whatever corner benefits the hospital in terms of not having to pay a bonus. I have to take them at their word that the wRVU numbers (which are comically low for 25 patients on treatment - like extrapolating to 5000 wRVU/year or something) are truthful. I received a report in my first quarter than I earned 50 wRVU (yes, fifty for 3 months of work) because the bills hadn't come through yet.

Other physicians, excuse me providers, have quit over this. I am considering have a lawyer review the situation.

Bottom line, if you want one of these jobs, demand a very high salary guarantee for 5 years rather than a lucrative bonus structure. If your friend accepted a low salary guarantee with the promise of making a huge bonus, I feel sorry for him.

 

[thecarbonionangle]

Is your friend me? I didn't think I had any left after I dropped off the face of the earth.

Even before COVID, I learned pretty quickly they had pulled a bait and switch regarding the lucrative RVU bonus.

The first trick is that the bonus is calculated quarterly and extrapolated to be as if it were for a full year. And any deficit in terms of not making up your salary is CARRIED FORWARD to the next quarter. So if you take a vacation that quarter, you can forget about it. Take a vacation early in the year, you're always playing catch up. Basically what this means is that suppose you need 9500 wRVUs to make up your salary and enter bonus territory. Due to their tricks, you can have over 9500 wRVUs for the year but still not bonus.

The second trick is that I don't get to do my own billing. I don't know what's being charged. I tried to audit it myself and got nowhere. Stuff gets billed months and months later, and of course thrown on whatever corner benefits the hospital in terms of not having to pay a bonus. I have to take them at their word that the wRVU numbers (which are comically low for 25 patients on treatment - like extrapolating to 5000 wRVU/year or something) are truthful. I received a report in my first quarter than I earned 50 wRVU (yes, fifty for 3 months of work) because the bills hadn't come through yet.

Other physicians, excuse me providers, have quit over this. I am considering have a lawyer review the situation.

Bottom line, if you want one of these jobs, demand a very high salary guarantee for 5 years rather than a lucrative bonus structure. If your friend accepted a low salary guarantee with the promise of making a huge bonus, I feel sorry for him.

you should have taken Carlsbad job instead! Sounds like they screwed you and you aren’t gonna get paid for it.

 

[Mandelin Rain]

Umm.... yes. If they tell you 25 patients = 5000 RVU, I have a bridge to sell you

 

[radoncgrad2019]

Sorry KHE, seems like you know what’s up now so you got them over a barrel

At least your base is likely high as most rural jobs I had seen had nice base.

My friend fell for the okey doke and took normal base with promise of a higher bonus based salary if he played ball, trucka style. Now he’s hosed

 

[evilbooyaa]

Umm.... yes. If they tell you 25 patients = 5000 RVU, I have a bridge to sell you

Yeah seriously @KHE88. I don't care if your payer mix is straight medicaid you are getting fleeced on 25 patients under treatment = 5k RVUs for the year.

You are getting bent over on your billing right now.

 

[KHE88]

you should have taken Carlsbad job instead! Sounds like they screwed you and you aren’t gonna get paid for it.

Salary guarantee is ~75% MGMA, which is good but should be better given the sacrifices I made. So I tolerate. But stupid for them not to incentivize me to produce more. But this level of simple thinking has really come to light in the COVID pandemic. I am being treated with zero respect, and actually disdain and ridicule, for raising concerns about the situation. I am being called "paranoid" and "out of control" in closed door meetings I am not invited to, when I am simplying stating exactly what rad oncs in academic centers are stating. Talked down to by non-physician administrators who are threatened by medical doctors exposing their lack of knowledge and medical background to make policy decisions. It is absolutely, 100% a power struggle. You want to know how I know? Because they told me it wasn't. I am their employee, their property, their "provider."

Yours is not to question why yours is but to do and die. Back to the front! Bill those OTVs, capture all follow-ups, N95s be damned!

I could very easily overwhelm them and put 30+ patients on the machine all getting standard frac and conventional imaging. But I'm doing the right thing for my patients because I care and you know, want to sleep at night. And guess what? Yep, already taking flack for using more hypofrac.

 

[radoncgrad2019]

Salary guarantee is ~75% MGMA, which is good but should be better given the sacrifices I made. So I tolerate. But stupid for them not to incentivize me to produce more. But this level of simple thinking has really come to light in the COVID pandemic. I am being treated with zero respect, and actually disdain and ridicule, for raising concerns about the situation. I am being called "paranoid" and "out of control" in closed door meetings I am not invited to, when I am simplying stating exactly what rad oncs in academic centers are stating. Talked down to by non-physician administrators who are threatened by medical doctors exposing their lack of knowledge and medical background to make policy decisions. It is absolutely, 100% a power struggle. You want to know how I know? Because they told me it wasn't. I am their employee, their property, their "provider."

Yours is not to question why yours is but to do and die. Back to the front! Bill those OTVs, capture all follow-ups, N95s be damned!

I could very easily overwhelm them and put 30+ patients on the machine all getting standard frac and conventional imaging. But I'm doing the right thing for my patients because I care and you know, want to sleep at night. And guess what? Yep, already taking flack for using more hypofrac.

Hey we haven’t always agreed and you have a terrible taste in food - but respect to you.

 

[deleted1002574]

Is your friend me? I didn't think I had any left after I dropped off the face of the earth.

Even before COVID, I learned pretty quickly they had pulled a bait and switch regarding the lucrative RVU bonus.

The first trick is that the bonus is calculated quarterly and extrapolated to be as if it were for a full year. And any deficit in terms of not making up your salary is CARRIED FORWARD to the next quarter. So if you take a vacation that quarter, you can forget about it. Take a vacation early in the year, you're always playing catch up. Basically what this means is that suppose you need 9500 wRVUs to make up your salary and enter bonus territory. Due to their tricks, you can have over 9500 wRVUs for the year but still not bonus.

The second trick is that I don't get to do my own billing. I don't know what's being charged. I tried to audit it myself and got nowhere. Stuff gets billed months and months later, and of course thrown on whatever corner benefits the hospital in terms of not having to pay a bonus. I have to take them at their word that the wRVU numbers (which are comically low for 25 patients on treatment - like extrapolating to 5000 wRVU/year or something) are truthful. I received a report in my first quarter than I earned 50 wRVU (yes, fifty for 3 months of work) because the bills hadn't come through yet.

Other physicians, excuse me providers, have quit over this. I am considering have a lawyer review the situation.

Bottom line, if you want one of these jobs, demand a very high salary guarantee for 5 years rather than a lucrative bonus structure. If your friend accepted a low salary guarantee with the promise of making a huge bonus, I feel sorry for him.

That is some F'd up business. I work for a large system in my RVUs for February come to be on March 15. And, almost always if we are short, it's because I didn't submit a charge.

But, for real, have you yet tried biryani? Maybe the group oughtta send some over to you.

 

[KHE88]

My friend fell for the okey doke and took normal base with promise of a higher bonus based salary if he played ball, trucka style. Now he’s hosed

The way that this usually works is they give you a 1-2 year fat salary guarantee and tell you that you will be switched to production after year 2, which you will make more money with as you will have built your practice by then. Usually some vague "quality" component tied to it.

I wouldn't believe any of it, especially in this environment. Admin's job exists for one reason: to keep the lights on as cheaply as possible. I would say, thanks no thanks I need protection so lets just keep the high base. If they balk, say fine, no probs I got a PSA here my lawyer drafted, I'll see your patients so you can bill your technical fees and I'll take care of my own professional fee billing, benefits, and vacation coverage. Oh, what's that? You want a share of my pro charges? hahhahahahhaha....

I laugh when I get these papers each quarter that have a (xxx,xxx) bottom line that says I have lost the hospital 6 figure sums just by employing me. Sure...

 

[dieABRdie]

Is your friend me? I didn't think I had any left after I dropped off the face of the earth.

Even before COVID, I learned pretty quickly they had pulled a bait and switch regarding the lucrative RVU bonus.

The first trick is that the bonus is calculated quarterly and extrapolated to be as if it were for a full year. And any deficit in terms of not making up your salary is CARRIED FORWARD to the next quarter. So if you take a vacation that quarter, you can forget about it. Take a vacation early in the year, you're always playing catch up. Basically what this means is that suppose you need 9500 wRVUs to make up your salary and enter bonus territory. Due to their tricks, you can have over 9500 wRVUs for the year but still not bonus.

The second trick is that I don't get to do my own billing. I don't know what's being charged. I tried to audit it myself and got nowhere. Stuff gets billed months and months later, and of course thrown on whatever corner benefits the hospital in terms of not having to pay a bonus. I have to take them at their word that the wRVU numbers (which are comically low for 25 patients on treatment - like extrapolating to 5000 wRVU/year or something) are truthful. I received a report in my first quarter than I earned 50 wRVU (yes, fifty for 3 months of work) because the bills hadn't come through yet.

Other physicians, excuse me providers, have quit over this. I am considering have a lawyer review the situation.

Bottom line, if you want one of these jobs, demand a very high salary guarantee for 5 years rather than a lucrative bonus structure. If your friend accepted a low salary guarantee with the promise of making a huge bonus, I feel sorry for him.

So if you are only earning 50 wRVU in the first quarter because "the bills hadn't come through yet" then you will be getting a check long after your contract is over as the bills come in? I'm guessing no....

My impression has been that RVU based contracts can be much more lucrative than professional fee only PSA because you should be getting paid for "what you do" not "what gets collected." If I treat 25 patients and the hospital billing department collects nothing then that is their problem (or it should be). Maybe I'm wrong... I haven't reviewed a hospital employed base vs. RVU contract yet. The only one I've come close to so far wouldn't make a reasonable base offer and was uber rural... so I told them to suck it.

I've learned over the last year that the best defense a good doc has in this environment is to be willing to pack up and leave. Maybe they won't budge but you don't have to take it. And I know the inevitable response is "but how can you do that if there's just another grad waiting to take the job?" Honestly... I have investigated many of these "rural jobs" and you would be over-estimating how many people are chomping at the bit to work there.

So if you quit.... just make sure you do it in August when nearly all the grads have signed. Maybe there will be a desperate one out there but they will definitely be in a bigger bind to replace you.

 

[Mandelin Rain]

I mean, if the honestly told you you had 50 RVUs in a quarter, you need to find an attorney. They are clearly in breach of contract.

 

[scarbrtj]

I received a report in my first quarter than I earned 50 wRVU (yes, fifty for 3 months of work) because the bills hadn't come through yet.

One of the reasons the whole pay-docs-based-on-RVUs thing came to be is that it was illegal-ish to base bonuses on collected money amounts. Had to be a more arbitrary thing like RVUs. And the whole idea of that was: an RVU happened or it didn't, and an RVU on a total homeless person who never paid anything was just as good as an RVU on Bill Gates with double insurance coverage and Medicare as primary. If they link "bills hadn't come through yet" to your RVU production... I'm no lawyer but I'm pretty sure that is illegal?

 

[Mandelin Rain]

One of the reasons the whole pay-docs-based-on-RVUs thing came to be is that it was illegal-ish to base bonuses on collected money amounts. Had to be a more arbitrary thing like RVUs. And the whole idea of that was: an RVU happened or it didn't, and an RVU on a total homeless person who never paid anything was just as good as an RVU on Bill Gates with double insurance coverage and Medicare as primary. If they link "bills hadn't come through yet" to your RVU production... I'm no lawyer but I'm pretty sure that is illegal?

That's always been my understanding as well. It's based on codes billed, and has nothing to do with collections or receivables.

 

[KHE88]

That's always been my understanding as well. It's based on codes billed, and has nothing to do with collections or receivables.

This is very interesting. The issue as they claimed was that they couldn't count the RVUs until they submitted the bills, and it took a while for me to get on all the insurance policies. I'm looking through my paperwork, and they did run a re-calc of the numbers after everything was supposedly submitted, and I earned about 870 wRVUs for the first quarter. Granted, I wasn't as busy then, but I was told I was talking into a practice that averaged 8k-9k wRVU. That's not even close.

I've learned over the last year that the best defense a good doc has in this environment is to be willing to pack up and leave. Maybe they won't budge but you don't have to take it. And I know the inevitable response is "but how can you do that if there's just another grad waiting to take the job?" Honestly... I have investigated many of these "rural jobs" and you would be over-estimating how many people are chomping at the bit to work there.

In reply to this, I'd like to quote Joe Pesci's line from Casino:

I think in all fairness, I should explain to you exactly what it is that I do. For instance tomorrow morning I'll get up nice and early, take a walk down over to the bank and... walk in and see and, uh... if you don't have my money for me, I'll... crack your ****in' head wide-open in front of everybody in the bank. And just about the time that I'm comin' out of jail, hopefully, you'll be coming out of your coma. And guess what? I'll split your ****in' head open again. 'Cause I'm ****in' stupid. I don't give a **** about jail. That's my business. That's what I do.

In my case, the hospital is my Nicky Santoro. A seasoned med onc just quit because of the wRVU bonus bait-and-switch scheme. The hospital's response? See highlighted above. They'd rather pay millions for locums than pay out an extra cent in an earned wRVU bonus, which of course they waited until the last minute to line up because they knew the other med oncs would suck it up.

I'm beginning to realize it's no surprise that everyone they are hiring is a new grad who they hope knows nothing about the business and won't bat an eye when they are told they are losing the system money with their salary. I suppose they figure we will be passive out the gates. I learned very quickly you have to be the bad guy and fight them literally every day on everything. I haven't gotten to the point of threatening to quit, because if I do, I will mean it, but we are quickly going that route with the COVID-denial nonsense. And this is in an extremely-difficult-to-recruit-for-area. I can't imagine the abuse that goes with admins to their "providers" in competitive areas.

 

[Mandelin Rain]

Is it a large system? National?

 

[scarbrtj]

This is very interesting. The issue as they claimed was that they couldn't count the RVUs until they submitted the bills, and it took a while for me to get on all the insurance policies.

The reason this is bad is because employed physicians can't be paid on basis of volume or value of "referrals." So the RVU rubric gets laid over top of the MD remuneration as a way to shield parties from Stark.* Now if the hospital after the fact comes in and says "Well we can't collect $$$ on some of your RVUs so some of your RVUs are now worthless depending on whether or not we get paid," it now ties your compensation to the value of the referrals. (And strangely a lot of times non-collection becomes a write-off for the hospital and a bit of a financial plus for them; bad for you but good for them.) As obviously some of your referrals--depending on collections--can have a value that is now either zero or positive depending on the hospital's collection efforts. In short, you could MAYBE make more money by suing your hospital on a False Claims or some such than you could from being a radiation oncologist. At least in the short term. Maybe. Please give me 10% of your profits if so.

*Don't ask me why this also doesn't violate volume/value

 

[CaliXRT]

The reason this is bad is because employed physicians can't be paid on basis of volume or value of "referrals." So the RVU rubric gets laid over top of the MD remuneration as a way to shield parties from Stark.* Now if the hospital after the fact comes in and says "Well we can't collect $$$ on some of your RVUs so some of your RVUs are now worthless depending on whether or not we get paid," it now ties your compensation to the value of the referrals. (And strangely a lot of times non-collection becomes a write-off for the hospital and a bit of a financial plus for them; bad for you but good for them.) As obviously some of your referrals--depending on collections--can have a value that is now either zero or positive depending on the hospital's collection efforts. In short, you could MAYBE make more money by suing your hospital on a False Claims or some such than you could from being a radiation oncologist. At least in the short term. Maybe. Please give me 10% of your profits if so.

*Don't ask me why this also doesn't violate volume/value

In terms of Stark, I am confident that initiating RT yourself is not considered a DHS referral as long as the initial consultation was requested by another physician .

(2) Does not include a request by a pathologist for clinical diagnostic laboratory tests and pathological examination services, by a radiologist for diagnostic radiology services, and by a radiation oncologist for radiation therapy or ancillary services necessary for, and integral to, the provision of radiation therapy, if -

(i) The request results from a consultation initiated by another physician (whether the request for a consultation was made to a particular physician or to an entity with which the physician is affiliated); and

(ii) The tests or services are furnished by or under the supervision of the pathologist, radiologist, or radiation oncologist, or under the supervision of a pathologist, radiologist, or radiation oncologist, respectively, in the same group practice as the pathologist, radiologist, or radiation oncologist.

Thus from a Stark standpoint, I don't see why using RVU compensation structure is necessary (may be a result of administrators wanting a way to set/ monitor compensation across various specialties).

However, if a medical oncologist receives a bonus for radiation treatment (related to RVUs or collections), this is most certainly problematic (see Florida Hospital System Agrees to Pay the Government $85 Million to Settle Allegations of Improper Financial Relationships with Referring Physicians).

 

[scarbrtj]

In terms of Stark, I am confident that initiating RT yourself is not considered a DHS referral as long as the initial consultation was requested by another physician ... Thus from a Stark standpoint, I don't see why using RVU compensation structure is necessary (may be a result of administrators wanting a way to set/ monitor compensation across various specialties).

100% true, and I don't know why the RVU thing came to be but the admin types and lawyer types always say it's somehow tied into Stark and money and compensation etc. Making it about "productivity" versus a dollars and cents discussion. It's stupid in other words.

 

[RadRadRad]

psa sounds like the way to go. Do your own billing, more write offs, usually better retirement plan. And it’s a win for the hospital since they are “losing” money on you anyway (their words not yours). [This assumes covid cleared up....obviously being on guaranteed salary during pandemic is beneficial]

The way that this usually works is they give you a 1-2 year fat salary guarantee and tell you that you will be switched to production after year 2, which you will make more money with as you will have built your practice by then. Usually some vague "quality" component tied to it.

I wouldn't believe any of it, especially in this environment. Admin's job exists for one reason: to keep the lights on as cheaply as possible. I would say, thanks no thanks I need protection so lets just keep the high base. If they balk, say fine, no probs I got a PSA here my lawyer drafted, I'll see your patients so you can bill your technical fees and I'll take care of my own professional fee billing, benefits, and vacation coverage. Oh, what's that? You want a share of my pro charges? hahhahahahhaha....

I laugh when I get these papers each quarter that have a (xxx,xxx) bottom line that says I have lost the hospital 6 figure sums just by employing me. Sure...

 

[dieABRdie]

I'm going to start another thread in the Business of Rad Onc area because I'd like to get some more numbers on this from other members. Probably better to keep that info to ourselves.

Edit: Thanks! Deleted the post. Please discuss in the other forum.

 

[Mandelin Rain]

Fair. I deleted my post, if you want to delete the quote of my post.

 

[radoncgrad2019]

I’ve said it before and I’ll say it again - but all the self bashing that goes on here in public space about how little we have to offer and little we have to do and how unimportant our presence is does nothing to help justify the continuation of the inflated salaries we have enjoyed for the past 2-3 decades.

I hope people understand that, but they never seem to.

 

[RadRadRad]

Agree. And still don't understand where this comes from. I barely sit down most days at work. If you continue to see your follow ups, that schedule alone becomes hard to manage after a few years in practice. With this comes a lot of additional revenue for the hospital that we don't give ourselves credit for...MRIs, PETS, CTs, etc.

I’ve said it before and I’ll say it again - but all the self bashing that goes on here in public space about how little we have to offer and little we have to do and how unimportant our presence is does nothing to help justify the continuation of the inflated salaries we have enjoyed for the past 2-3 decades.

I hope people understand that, but they never seem to.

 

[Burt Radnolds]

Agree. And still don't understand where this comes from. I barely sit down most days at work.

Concur, I go nonstop all day every day. Supervision rules are irrelevant for me because I would be in clinic anyways. Some people who shall remain nameless who have promoted this line of thinking that we do nothing are doing us a major disservice, and are not reflecting everyone's reality.

 

[PhotonBomb]

Concur, I go nonstop all day every day. Supervision rules are irrelevant for me because I would be in clinic anyways. Some people who shall remain nameless who have promoted this line of thinking that we do nothing are doing us a major disservice, and are not reflecting everyone's reality.

Well said.

 

[scarbrtj]

Concur, I go nonstop all day every day. Supervision rules are irrelevant for me because I would be in clinic anyways. Some people who shall remain nameless who have promoted this line of thinking that we do nothing are doing us a major disservice, and are not reflecting everyone's reality.

Well said.

And re: reflecting reality. Yours may not match everyone else's. Your I-go-nonstop-all-day might be accomplished by another in half or quarter the time. But the logic of "It's a law that never affects me, so it's a good law" is awfully bad logic. Could rephrase "Some people who shall remain nameless who have promoted this line of thinking that we do nothing" as "Some people who shall remain nameless who have promoted physician autonomy." Doctors should have the final say in what is something, and what is nothing. I have never said "we do nothing." We is also me. If anything I go off into the pedantic, hair-splitting weeds about what exactly to do most times. I have said there's so many rad oncs, and disappearing XRT indications, we're all just mathematically doing less over time. Just glance at the recent MSKCC breast/corona guidelines. There's a lot that could/should be whittled down in rad onc.

Sometimes I mention painful truths. I know it seems inconceivable, but if I talk about things it has literally zero effect on how things are in this field or what happens in this field. So if it appears my words have an effect on things, it reflects a neurosis or a paranoia in another person. CMS changes the supervision rules, and in the coronavirus outbreak the first thing ASTRO says to the government is: "abolish supervision." But if another rad onc says any of that, it's a "disservice."

 

[deleted1002574]

The nerve to essentially try to Doxx someone about a case that was reported in such nebulous detail ... and that’s your justification for we shouldn’t have supervision??

ASTRO has pretty much come out and said it, without saying it. Much of this supervision talk has zero to do with safety and much to do about many other things. And, it’s hypocritical but because other leadership has been so dismal, it’s necessary.

Again, going after the person, not the arguments. Will someone that is so pro-supervision please provide some evidence that it is adding safety? The reason it was waived for HOP was because it wasn’t shown to improve safety. End of story.

And, yes, many of us can do the work faster. I don’t have your job, so I don’t know. But, I don’t get this non-stop bit. But, instead of going after you as a person that is inefficient / lazy / whatever (which is a useless point to try to make because we will never work together), I can chalk it up to different working styles. I’ve seen people that work 8a-6p non stop, and I’ve seen people that work shorter hours and just get way more done. Everyone is different.

But, no, to our new young people - if you think different or behave different, you should be attacked (not your words, thoughts, or actions).

(This is who we have to hire .. thank goodness when supervision ends, we can hire so many fewer)

 

[RickyScott]

Concur, I go nonstop all day every day. Supervision rules are irrelevant for me because I would be in clinic anyways. Some people who shall remain nameless who have promoted this line of thinking that we do nothing are doing us a major disservice, and are not reflecting everyone's reality.

This is so dependent on the doctor and the practice dynamics.

 

[Mandelin Rain]

Going nonstop for me would be running about 40+ patients on beam. In which case, yes you should be present because you're probably seeing 10-15 consults per week, plus sims, plus follow ups, plus SBRTs, plus implants, etc...

I've run this practice before. It feels like you're really doing SOMETHING.

I've also run the 15-20 patient practice and there is plenty of time where you're literally doing NOTHING (except perhaps compulsively checking SDN). I think a lot, perhaps the majority, of rad oncs find themselves in this situation.

 

[Mandelin Rain]

re: supervision

To me, there are are a lot more acute things that require a lot less supervision.

Example, a vascular surgeon can cut out a diseased aorta, sew a graft into it's place, write an op-note, give some orders, and then walk out of the hospital leaving nurses to handle the administration of those orders.

You're telling me that's somehow safer than me walking out of the sim room, drawing some circles, giving some orders, and letting radiation therapists handle the administration of those orders?

Come on.

 

[Burt Radnolds]

One of these days a bunch of you ladies are gonna have to have a mud wrestle or knit-off or something and settle who's gonna marry me. PhotonBomb: prurient, Enquirer-y. Other than taxes I have never paid a dime to the government, and any other people that did didn't "have" to. You're unsophisticated and naive and an unintentional (I hope) liar. Here's hoping you learn stuff by other means than just Google.

And re: reflecting reality. Yours may not match everyone else's. Your I-go-nonstop-all-day might be accomplished by another in half or quarter the time. But the logic of "It's a law that never affects me, so it's a good law" is awfully bad logic. Could rephrase "Some people who shall remain nameless who have promoted this line of thinking that we do nothing" as "Some people who shall remain nameless who have promoted physician autonomy." Doctors should have the final say in what is something, and what is nothing. I have never said "we do nothing." We is also me. If anything I go off into the pedantic, hair-splitting weeds about what exactly to do most times. I have said there's so many rad oncs, and disappearing XRT indications, we're all just mathematically doing less over time. Just glance at the recent MSKCC breast/corona guidelines. There's a lot that could/should be whittled down in rad onc.

Sometimes I mention painful truths. I know it seems inconceivable, but if I talk about things it has literally zero effect on how things are in this field or what happens in this field. So if it appears my words have an effect on things, it reflects a neurosis or a paranoia in another person. CMS changes the supervision rules, and in the coronavirus outbreak the first thing ASTRO says to the government is: "abolish supervision." But if another rad onc says any of that, it's a "disservice."

Heh. You give yourself a bit too much credit. Thanks for lumping in my mostly benign nebulous quote in with a much more directed malignant one, not cool. I was not supporting supervision, just saying it didn't really matter to me right now, you really like to put words in people mouths sometimes. I think its stupid and would prefer it to completely go away as it would help with a few scheduling dilemmas. I'm well aware my situation is different than many, but yeah its pretty in line with Mandelin Rain's 40 complicated patients on beam scenario and its tough. My wife doesn't like it. However, I completely agree with you that there are way too many rad oncs and if you look back, I was one of the early ones who saw the bad math.

Honestly, this gets down to the crux of why this expansion business bothers me so much. We have all put so much into our education, training, and careers, and to slowly find out we are expendable commodities is very unpleasant, but I'm not one to put my head in the sand, I've been screaming it from the start. However, I question whether it is helpful to create these back of the envelope calculations portraying us as perhaps even more expendable than I think is reality. I get you are trying to get across what you see as unpleasant truth, but I think you may take it too far sometimes.

 

[dieABRdie]

This is very interesting. The issue as they claimed was that they couldn't count the RVUs until they submitted the bills, and it took a while for me to get on all the insurance policies. I'm looking through my paperwork, and they did run a re-calc of the numbers after everything was supposedly submitted, and I earned about 870 wRVUs for the first quarter. Granted, I wasn't as busy then, but I was told I was talking into a practice that averaged 8k-9k wRVU. That's not even close.



In reply to this, I'd like to quote Joe Pesci's line from Casino:

I think in all fairness, I should explain to you exactly what it is that I do. For instance tomorrow morning I'll get up nice and early, take a walk down over to the bank and... walk in and see and, uh... if you don't have my money for me, I'll... crack your ****in' head wide-open in front of everybody in the bank. And just about the time that I'm comin' out of jail, hopefully, you'll be coming out of your coma. And guess what? I'll split your ****in' head open again. 'Cause I'm ****in' stupid. I don't give a **** about jail. That's my business. That's what I do.

In my case, the hospital is my Nicky Santoro. A seasoned med onc just quit because of the wRVU bonus bait-and-switch scheme. The hospital's response? See highlighted above. They'd rather pay millions for locums than pay out an extra cent in an earned wRVU bonus, which of course they waited until the last minute to line up because they knew the other med oncs would suck it up.

I'm beginning to realize it's no surprise that everyone they are hiring is a new grad who they hope knows nothing about the business and won't bat an eye when they are told they are losing the system money with their salary. I suppose they figure we will be passive out the gates. I learned very quickly you have to be the bad guy and fight them literally every day on everything. I haven't gotten to the point of threatening to quit, because if I do, I will mean it, but we are quickly going that route with the COVID-denial nonsense. And this is in an extremely-difficult-to-recruit-for-area. I can't imagine the abuse that goes with admins to their "providers" in competitive areas.

Sorry to hear what's going on at your shop with this whole COVID situation. Looks like I got fortunate the admins at my previous place refused my offer of 75% MGMA and I walked so I'm not dealing with this nonsense.

I would recommend you go ahead and take that sweet 2 year guaranteed fat rural base salary and make sure you pay of those loans so you can pack your sh-- and leave once its up. Honestly.... if an administrator told me "they are losing money on my salary" I would feel all warm and fuzzy inside. They can call me "paranoid"... call me "provider" or even "paranoid provider"... as long as I know that I'm eating into their technical revenue I would be filled with glee.

I would also get a lawyer to look into the way they are compensating your RVUs. I would definitely save all email correspondence between admin. And I don't know what state you are in but if its legal I would also record conversations. Some states allow it and some states do not Recording Phone Calls and Conversations - 50 State Survey :: Justia

Once your contract is up you can offer that PSA contract... or there is another option that the other locums doc did at my last gig. He basically had his own LLC and his own malpractice. But rather than having a PSA where he had to do his own billing... he had a locums contract with the hospital so they did all the billing and he just charged a flat rate. Guess what rate? $2750 per day... which comes out to an annual salary of $660,000. Not too bad for average 10 patients on beam. They probably wouldn't fall for that but I thought it was pure genius, and might be a better option if the payer mix sucks in your area.