In terms of reimbursement, many medical oncology groups are teaming up with radiation oncologists to create joint ventures. The money now lies in the technical radiation fees as chemo profits have dissipated. Even urology groups have joined in the fray. Google 'urorad'. The NYT has some good articles from the past.
These joint ventures can be sketchy- not sure if many of these will pass Stark 2 rules so be diligent when looking for job. Probably a lot of money passing under the table for these rad facilities to get patients from referring docs. Only way this is legal if all specialties are under one employer, such as academic center, big community hospital, or multispecialty group.
Kind of depressing when I see second opinion prostate cancer patients trying to decide on radiation vs RP in early stage tumors, especially the younger guys. I know of a solo practice urologist who never operates, but instead advocates IMRT on every patient. And oh by the way, who so happens to own a share of the radiation center next door to his office.
These fly-by-night entrepreneurs developing stand-alone radiation centers now becoming more prevalent all across our nation are troubling. Saw a 85yo patient in the hospital recently with advanced dementia, COPD, and CHF, who was diagnosed with squamous cell lung cancer with brain, liver, and bone metastasis. PS of 2-3. I recommended hospice as well as the rad onc employed by the hospital. But the pulmonologist (probably a shareholder)wanted a second opinion and referred the patient to an outside rad onc,who ended up recommending gamma knife along with WBXRT. And they also wanted to radiate the lung and femur. For a total of 4 weeks! This unfortunate man was not competent to make any decisions, and did not even remember his own name. Fortunately, the family cancelled the radiation after a few treatments and decided on hospice. But how much did they bill medicare in a span of a week- probably 20-30K? Such is life in community oncology.
