The High Number of Unfilled Positions in the 2019 Radiation Oncology Residency Match: Temporary Variation or Indicator of Important Change?

[Mandelin Rain]

Seemed apropos that it ended with "Palliative Care" as a suggestion. This article feels like the 6th line of chemo for our specialty before the inevitable referral to Hospice.

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[medgator]

Seemed apropos that it ended with "Palliative Care" as a suggestion. This article feels like the 6th line of chemo for our specialty before the inevitable referral to Hospice.

Depending on our practice environment, many of us are practicing "palliative care" whether we chose to, or not, no fellowship needed.

Tone deaf is a great description of this article

 

[OTN]

Meanwhile in the new Merrit Hawkins review of residents' job prospects:

-------------------------------------------------------------
Treated Like "Blue Chip Athletes"
Satisfied or not, though, there are plenty of available jobs. The residents who responded to the survey said they were being inundated with recruiting offers. Two thirds of them had received 51 or more recruiting offers, and 45% had received more than 100.

"Physicians coming out of training are being recruited like blue chip athletes," said Travis Singleton, executive vice president of Merritt Hawkins, in a news release. "There are simply not enough new doctors to go around."

Geographic location was the number one priority of residents who were considering a practice opportunity, followed by a good financial package and the availability of personal time. Only 1% of the respondents (compared to 3% in 2015) said they preferred to practice in a town of 25,000 people or less.
--------------------------------------------------------------

Look at all three paragraphs, ESPECIALLY the last one, which to me is the most telling. Study after study keeps showing that geographic preference is becoming more and more important as time goes on.

 

[Lamount]

Ugh, that was pretty grim. Don't get me wrong, I know people who are happily pursuing most of -if not every option- on that list... but for most of us, those really aren't the sub-specialties that piqued our interests when this all started.

 

[seper]

"Certified palliative care physician" is actually a legitimate career path. I know 2 former general surgeons who took some palliative care training and then got full-time jobs, as bridge to retirement, overseeing hospice/palliative operations at a large hospital.

Depending on our practice environment, many of us are practicing "palliative care" whether we chose to, or not, no fellowship needed.

Tone deaf is a great description of this article

 

[medgator]

"Certified palliative care physician" is actually a legitimate career path. I know 2 former general surgeons who took some palliative care training and then got full-time jobs, as bridge to retirement, overseeing hospice/palliative operations at a large hospital.

I know, just saying that palliative care is under our purvey if we do general RO and really should not be looked at a potential option for the residency oversupply considering there are actually fellowship trained physicians in that specialty who would be more appropriate for it

 

[evilbooyaa]

Big difference between Palliative Care (the medical specialty) and Palliative Radiation Oncology (which we all do).

I mean I personally don't want to be forced to do inpatient rounds as a HPM attending. I don't want to do any of the nonsense from that article. I want to be a radiation oncologist. You know, the guy who uses radiation, to treat cancer. Why is that seen as 'not enough' by the authors of that article? Maybe we should expand the denominator by increasing the indication for radiation, thus requiring more doctors? Maybe we should push for office-based skills like prostate biopsy that will allow us to go directly to PCPs for patients? Maybe we should push to allow delivery of concurrent chemotherapy, like the Europeans?

But no, those would be hard. Better to just recommend we go into things completely unrelated to radiation oncology.

Frontier medicine? In Rad Onc? WTF does that even mean?

This is the exact opposite of JFK's "Why we do things speech". "We do things not because they are hard, but because they are easy".

 

[RadOncG]

This article popped up in my inbox today:

Enhancing Career Paths for Tomorrow’s Radiation Oncologists

Enhancing Career Paths for Tomorrow’s Radiation Oncologists

www.sciencedirect.com

In summary--we should use the oversupply of rad oncs to work in global health, "frontier medicine" (indian reservations? Rural?), policy/FDA, government, industry, epidemiology, informatics/biology (i.e. research), and palliative care.

I have experience in many of these areas myself and I find the article tone deaf. There are careers for a single digit number of rad oncs in most of these areas, at best, or stiff competition with other, larger medical specialties or degree programs (PhD, etc). Also, most of these positions are far less lucrative than clinical radiation oncology, or indeed clinical medicine at all. An oversupply of rad onc grads certainly would help a handful of established people in those alternate areas who have a hard time recruiting people for the low salaries or fellowships offered.

The article is suggesting that we should have flexible residencies to train our rad onc residents for these alternative careers. I find it very difficult to believe that such alternative pathway training will happen outside of a small number of programs. I also find it very difficult to believe that these non-clinical careers will put a dent in the radiation oncology job market issues given that we are currently probably training several dozen rad oncs per year more than we actually need. Further, why train MD radiation oncologists for jobs that are currently typically filled with MBAs, MHAs, MPHs, PhDs, etc...

I read this as the academics saying "Let them eat cake"

There are plenty of jobs in Cambodia or in training Russian oncologists how to contour. So why so much complaining?

Just go practice palliative care or go do "Biology" as one of their alternative careers suggestions.

These academics must not have very many patients either if they sit around and write this hot pile of garbage. Maybe their residents are busy managing their patients.

 

[deleted941485]

I’m a member of the AMA and go to meetings so I can fill in you in on how the process actually works.

AMA members from state and specialty societies propose policies (such as increased funding for GME), voting delegates debate the issue in the open, and then vote on the issue. It’s an open and democratic process. Membership is a mix of private and academic docs and Med students/residents also have a block of voting rights.

So it’s not some secret cabal of power brokers in the AMA who don’t care about doctors and want to increase supply. It really is the membership which pretty accurately reflects what most physicians believe.

AMA is the most powerful physician lobby in DC and has been critical in reducing burdensome reporting requirements (a lot more to do on this), keeping payment rates higher than would be otherwise (ie overturning the SGR), etc. Having more rad oncs involved is important if we don’t want to be steamrolled

Yeah...about overturning that SGR. Which was replaced by what exactly? Because those 0.5% increases minus sequestration cuts amounts to basically nothing.

 

[deleted941485]

Dr. Vapiwala has received speaker honoraria from Varian Medical Systems.
Dr. Goldwein is a full-time employee of Elekta AB.
Dr. Kupelian is an employee of Varian Medical Systems.
Dr. Weidhaas reports other from MiraDx, outside the submitted work, and a patent KRASvariant in cancer with royalties paid to MiraDx.
Dr. Fuller has received industry-funded institutional grant support, speaker honoraria, and travel funding from Elekta AB.
Dr. Okunieff is an inventor and founder of a company that markets biomarker technologies, DiaCarta.com.
Dr. Formenti reports grant/research support from Bristol Myers Squibb, Varian, Janssen, Regeneron, Eisai, Merck, Celldex and honoraria form Bristol Myers Squibb, Varian, Elekta, Janssen, Regeneron, GlaxoSmithKline, Eisai, Dynavax, AstraZeneca, Merck, Viewray, Bayer.
Dr. Mitin reports personal fees from UpToDate, Inc. and Janssen and grants from Novocure, Inc.

I step away for a few days and wham more garbage.

What A bunch of industry ******.

 

[bluebubbles]

Academics like those writing this article are free to do palliative care, epidemiology, research, industry consulting, policy, etc., as "radiation oncologists" because their incomes and protected time are SUBSIDIZED by junior faculty and residents TAKING CARE OF PATIENTS. At the end of the day, these "enhanced career paths" are only possible in the context of a thriving clinical program. If academic & free-standing clinical programs become anemic (low patient volume compared to the # of trained radiation oncologists), then yes, some may be forced to phase out of clinical radiation oncology (part-time or full-time) and make a career change. Just call it what it is.

Addendum: Contrary to the other replies, I believe it can be a good thing for some in academics to work with industry. Collaborations between forward-thinking radiation oncologists and industry can benefit the field as a whole. As deeply upsetting as the residency expansion issue is, I wouldn't take cheap shots at the authors and their industry ties, which are quite modest compared to several other medical specialties.

 

[deleted941485]

Academics like those writing this article are free to do palliative care, epidemiology, research, policy, etc., as "radiation oncologists" because their incomes and protected time are SUBSIDIZED by junior faculty and residents TAKING CARE OF PATIENTS. At the end of the day, these "enhanced career paths" are only possible in the context of a thriving clinical program. If academic & free-standing clinical programs become anemic (low patient volume compared to the # of trained radiation oncologists), then yes, some may be forced to phase out of clinical radiation oncology (part-time or full-time) and make a career change. Just call it what it is.

And for the love of god, if we ever do make that career change, don't work as a lab monkey or whatever else you want to call it for one of the academics on these papers.

If i wanted to do palliative care or epidemiology research then why the F*** would I go through a RO training program first?

What these *****s have failed to grasp is that you are training clinicians to practice Rad Onc not slaves for projects, perpetual students, MPH or MBA candidates, not podium presenters, data entry clerks, or professional asskissers. They are clinicians that will practice on their own. What these dinguses want is an open ended residency that blurs the line between clinical training and a post doc that goes on and on and on.

I feel like these hospital admin should really put the screws to these academic ROs. Start adding in some aggressive RVU targets and cutting their research time. if they threaten to leave then they can draw from the oversupply that they helped to create. I’m pretty sure whatever the hell they were working on is not so esoteric or ground breaking.

 

[scarbrtj]

Ah, "enhancing career paths." Hope this is not like the oxygen enhancement ratio where past a certain linear energy transfer there can be no more enhancement; actually produce de-enhancement. Wasted effort, flogging a dead horse, et cetera. Paths, roads... two roads diverged in a wood, and I, I took the one less traveled by. We all did, yes? In retrospect, the less traveled path is probably that way for a reason!

 

[DebtRising]

So how is not Medicare fraud to use government funds for training if in order to find employment training is needed in completely different specialities?

 

[deleted941485]

So how is not Medicare fraud to use government funds for training if in order to find employment training is needed in completely different specialities?

Definitely a question worth asking.

 

[deleted774703]

This was a pad your stats publication for the 31 authors. No merit or substance provided. Interestingly, this was a continuation of Paul Wallner and Anthony Zietman's nonsensical suggestions a few months ago.

 

[deleted941485]

This was a pad your stats publication for the 31 authors. No merit or substance provided. Interestingly, this was a continuation of Paul Wallner and Anthony Zietman's nonsensical suggestions a few months ago.

I wonder what kind of cognitive contortions you need to do to be able to convince yourself that what you are doing is helpful to the field.

No wait I know! A fat paycheck completely from industry and academia. Someone or some entity really needs to hit these people where it hurts and continue to squeeze them until they scream.

 

[imhopeful432]

I think its fine to write an article about alternative careers in radiation oncology (I think its good for our field to have smart radiation oncologists in industry, government, etc). I found the multiple alternative careers in the article interesting and I think residency programs should welcome residents who want to branch out (top residency programs in other specialties and medical schools also similarly encourage their residents to participate in organized medicine, work for government, do an MBA/MPH, etc)

But...that should certainly not be the focus of residency training. As many posters, have mentioned, these types of careers will be full time or even 50% for less than 2% of rad oncs. And to even mention the job market in relationship to alternative careers in this article comes across as tone deaf.

 

[deleted941485]

I think its fine to write an article about alternative careers in radiation oncology (I think its good for our field to have smart radiation oncologists in industry, government, etc). I found the multiple alternative careers in the article interesting and I think residency programs should welcome residents who want to branch out (top residency programs in other specialties and medical schools also similarly encourage their residents to participate in organized medicine, work for government, do an MBA/MPH, etc)

But...that should certainly not be the focus of residency training. As many posters, have mentioned, these types of careers will be full time or even 50% for less than 2% of rad oncs. And to even mention the job market in relationship to alternative careers in this article comes across as tone deaf.

A suggestion that benefits a single digit number of Rad oncs is a non starter. And the only ones it probably really helps are those residents that are at places like MSKCC or Stanford where their faculty already Have ties to major industries and global health and can help slip one of their own in.

 

[Mandelin Rain]

Should have mentioned Evicore peer reviewer/IMRT preventer as option.

 

[deleted774703]

Rereading the paper now. It’s clear the authors are pushing their interests down our throats.

Maybe a few want nontraditional careers; however, I’m not sorry that I want a conventional job and majority feel that way.

Instead of expanding residencies, these “leaders” should work on expanding faculty rosters

 

[GapCalc]

To be fair, I would like to give the authors credit for a couple points they make:

1) They are acknowledging an oversupply. Perhaps not overtly in the text of the manuscript, but it is at least being alluded to in the keywords. This is a change from lots of other prior Red Journal articles, which had lots of hand waving about 'maldistribution' but didn't really directly address that yes, we have too many new ROs.

2) They bring up expanding our domain within clinical oncology (although this point is buried). This includes the option of giving immunotherapies, which I think could be particularly helpful. The authors also mention dual-boards with nuclear medicine (not a path I would choose, but sure, maybe someone is interested).

3) I do think it is important that ROs in the US help both at home and abroad with improving access to care, but I do not think this is really the solution to the problem of too many graduating residents.

4) I think working with industry is just fine. Compared with physicians who require ongoing consumption of pricey medical equipment (i.e. orthopedic surgeons with prostheses) or those who prescribe expensive drugs (i.e. med oncs and immunotherapy), I think our ability to 'get rich'/sell out from working with industry is actually relatively small. You can only purchase so many linacs for your practice, and new devices like SpaceOAR aren't going to make up a huge part of anyone's practice.

But yes, overall, I think the proposed pathways to "increasing the denominator" might account for somewhere on the order of 5-10 jobs annually. I just don't think anyone is matching into RO because they've always dreamed of being a fellowship-trained hospice doctor. There are faster and cheaper ways to do that, which require fewer years of training.

 

[deleted774703]

I’m sorry but I sincerely disagree with you.

The way US medical training is set up there is absolutely no way radonc will be prescribing immunotherapy. I have no idea why that is constantly being brought up.

It would require a radical change in requirements for that to happen and considering we can’t even decrease number of residents it is essentially impossible to make that change.

Let’s stop wasting time.

 

[deleted947887]

Why not just do residency again? Two years and you become board certified in internal medicine. Or just do away with rad onc residency and add it as a fellowship to internal medicine or pathology.

 

[Ray D. Ayshun]

There's a wet bear on the cover of the red journal. They obviously recognize the direction of the market. They're just ****ing with us.

 

[RadOncMegatron]

Why not just do residency again? Two years and you become board certified in internal medicine. Or just do away with rad onc residency and add it as a fellowship to internal medicine or pathology.

If the leadership is going to sell us short than ...

I think (don't kill me now!) that a 6 year residency that double boards in IM & Rad Onc (like med/peds) would've been way better than a 5 year residency where you do a retrospective report for 6 months and random electives for 6 months ie cut out that unnecessary 12 months they mention for something worthwhile. The 5 year pure rad onc residency, like it is now, can be for Holman pathway candidates or MD/PhDs going into academics.

 

[CaliXRT]

Revisiting the quintessential question: does size really matter?

A different type of size (or lack thereof) may be why we're all in this predicament.

 

[thecarbonionangle]

Wet bear cracked me up! The “leaders” are basically flinging poop down our way, laughing at us. Anyone remember that Reagan “trickle down” meme? i picture that at the moment with people laughing. You guys better save money in your Salina Kansas jobs and live TIGHT, FIRE, who knows what nonsense is being worked out in the bushes. Beware of the WET BEAR

 

[Haybrant]

If the leadership is going to sell us short than ...

I think (don't kill me now!) that a 6 year residency that double boards in IM & Rad Onc (like med/peds) would've been way better than a 5 year residency where you do a retrospective report for 6 months and random electives for 6 months ie cut out that unnecessary 12 months they mention for something worthwhile. The 5 year pure rad onc residency, like it is now, can be for Holman pathway candidates or MD/PhDs going into academics.

This right here is the best solution, 2 years medicine then 3 years Rad onc. These authors don’t realize it but they are trying to figure out ways to solidify their hold over residents bc that is how they have always done things. They and nobody owns you despite their desire to do so and if you have IM first then they don’t control you, can always work in IM instead of Rad Onc if you want. The idea that we should do some international fellowship is some backwater asinine BS that clueless physicians who have made bad life decisions themselves would recommend

 

[ramsesthenice]

If the leadership is going to sell us short than ...

I think (don't kill me now!) that a 6 year residency that double boards in IM & Rad Onc (like med/peds) would've been way better than a 5 year residency where you do a retrospective report for 6 months and random electives for 6 months ie cut out that unnecessary 12 months they mention for something worthwhile. The 5 year pure rad onc residency, like it is now, can be for Holman pathway candidates or MD/PhDs going into academics.

IM residency is 3 years
Hemeonc fellowship is 3-4
Rad onc is 4

Even if you cut off as many years as possible it would realistically be closer to 7-8 years minimum to get boarded in both in an integrated program. Not saying that’s a deal breaker. Thats in line with a number of existing specialties. But it’s doubtful it would be as easy as just get rid of the research year and add an extra year for onc.

 

[deleted947887]

This right here is the best solution, 2 years medicine then 3 years Rad onc. These authors don’t realize it but they are trying to figure out ways to solidify their hold over residents bc that is how they have always done things. They and nobody owns you despite their desire to do so and if you have IM first then they don’t control you, can always work in IM instead of Rad Onc if you want. The idea that we should do some international fellowship is some backwater asinine BS that clueless physicians who have made bad life decisions themselves would recommend

Agree with this. Best solution is dual certification in IM in 6 years. If we're lucky, maybe they can finagle chemo and immunotherapy into it.

 

[Ray D. Ayshun]

IM residency is 3 years
Hemeonc fellowship is 3-4
Rad onc is 4

Even if you cut off as many years as possible it would realistically be closer to 7-8 years minimum to get boarded in both in an integrated program. Not saying that’s a deal breaker. Thats in line with a number of existing specialties. But it’s doubtful it would be as easy as just get rid of the research year and add an extra year for onc.

Most academic places do med onc in a combined 3ish for those on research track, and Holman pathway folks get like 24 months of clinic. 6 years for everything seems reasonable.

 

[deleted941485]

I’m sorry but I sincerely disagree with you.

The way US medical training is set up there is absolutely no way radonc will be prescribing immunotherapy. I have no idea why that is constantly being brought up.

It would require a radical change in requirements for that to happen and considering we can’t even decrease number of residents it is essentially impossible to make that change.

Let’s stop wasting time.

pharma just wants a warm body to push drugs they may not nessesarily care whose doing it.

 

[deleted941485]

Why not just do residency again? Two years and you become board certified in internal medicine. Or just do away with rad onc residency and add it as a fellowship to internal medicine or pathology.

If RO gets crappy enough, the opportunity costs won’t be as high and it would be worth retraining

 

[scarbrtj]

IM residency is 3 years
Hemeonc fellowship is 3-4
Rad onc is 4

Even if you cut off as many years as possible it would realistically be closer to 7-8 years minimum to get boarded in both in an integrated program. Not saying that’s a deal breaker. Thats in line with a number of existing specialties. But it’s doubtful it would be as easy as just get rid of the research year and add an extra year for onc.

Agree with this. Best solution is dual certification in IM in 6 years. If we're lucky, maybe they can finagle chemo and immunotherapy into it.

Most academic places do med onc in a combined 3ish for those on research track, and Holman pathway folks get like 24 months of clinic. 6 years for everything seems reasonable.

Keeping in mind the pathway of training e.g. in the UK, how one can become an IM or FP physician 6 years after graduating college in some accelerated programs, and the very shortened clinical exposure in the Holman pathway (I assume those guys are competent rad oncs too), a 5-6 year postgraduate path to become IM/Rad Onc boarded is rational and very feasible. The research year is dumb. The vast majority of MDs' raison d'etre is *primarily* money-making, aka patient care, nowadays. Not to be flippant but they don't need a research year in welding school.

Even more so, and I wish someone would do this, is a true hybrid med onc/rad onc. A 7-year program is endured to become a CT surgeon e.g. and it takes some NSG guys this long too. It's not crazy. Imagine that job security.

I have known of several rad oncs who formerly did IM, and then med onc fellowship, who subsequently left that for rad onc; Charles Thomas at OHSU and Andrew Turrisi come to mind. Those guys seem to have awesome depths and breadths of knowledge vs your typical rad onc. (I know of no rad onc that ever left rad onc and then did IM/med onc fellowship.) If some University somewhere could innovate and adapt just a little outside the rad onc box, integrate med onc or IM, I bet demand for that training program would be sky high.

 

[OTN]

If neurologists and gynecologists don't have to do a medicine residency to deliver chemotherapy/systemic agents, then neither should we. Given that the six months to a year of research most training programs require is worthless to those not interested in academic careers (it was for me at least), it's safe to say most radonc residents receive 3-3.5 years of clinical training in residency in radiation oncology.

Subtract benign hematology and heme tumors from heme/onc fellowship, and 1-2 years of training should work to be able to deliver systemic agents. So, it seems perfectly reasonable to me that a clinical oncology residency (radonc + solid tumor oncology) would be at most 4-5 years of training after internship.

I would LOVE to have been trained this way. It also works really well at the societal level, as it takes care of two problems: oversupply of radiation oncologists and undersupply of medoncs.

 

[deleted947887]

If neurologists and gynecologists don't have to do a medicine residency to deliver chemotherapy/systemic agents, then neither should we. Given that the six months to a year of research most training programs require is worthless to those not interested in academic careers (it was for me at least), it's safe to say most radonc residents receive 3-3.5 years of clinical training after residency in radiation oncology.

Subtract benign hematology and heme tumors from heme/onc fellowship, and 1-2 years of training should work to be able to deliver systemic agents. So, it seems perfectly reasonable to me that a clinical oncology residency (radonc + solid tumor oncology) would be at most 4-5 years of training after internship.

I would LOVE to have been trained this way. It also works really well at the societal level, as it takes care of two problems: oversupply of radiation oncologists and undersupply of medoncs.

It also solves the treatment bias for certain sites/stages where either modality can be used.

 

[deleted774703]

pharma just wants a warm body to push drugs they may not nessesarily care whose doing it.

Pharma doesnt set national standards of how to become a prescriber of immunotherapy.

Stop drinking the Kool Aid that this is a legitimate avenue

 

[Krukenberg]

If you started prescribing immunotherapy, your friendly referring med oncs would suddenly become not so friendly. They could put you out of business if there’s a competing practice in town

 

[medgator]

If you started prescribing immunotherapy, your friendly referring med oncs would suddenly become not so friendly. They could put you out of business if there’s a competing practice in town

It's not a model that will work for everyone. Personally, I wouldn't have any interest. It's certainly nice to have the option though given recent changes in the specialty, and will be best suited for those coming out into practice imo where referral politics don't exist yet

 

[deleted941485]

Pharma doesnt set national standards of how to become a prescriber of immunotherapy.

Stop drinking the Kool Aid that this is a legitimate avenue

What standards? This nation thinks DNP = MD. So let the Med oncs Throw up a stink about it. It’s not like they ever respected what we do anyway.

Med oncs don’t control referrals anymore. A.) because Med onc private practice is basically extinct B.) Hospital systems tacitly dictate referral patterns. An RO that gives systemic therapy? Guess that’s one less person they have to hire.

If GYNs can give cis for their SCC cervix patients I don’t see why we can’t do the same for our H&N patients

It’s clear that we aren’t gonna get anywhere if we follow the rules and play nice with others. That ship has sailed. The midlevels and nurses figured that out a while ago and despite all the huffing and puffing physicians and are doing they are here to stay.

 

[medgator]

.

Med oncs don’t control referrals anymore

In any good employed or PP situation, they never should have to begin with, at least outside of Mets and lymphoma.

I mean seriously what's a med onc going to do with an early stage glottic, a BCC of the nasal tip, or a Gleason 7 prostate CA?

 

[Lamount]

Rad oncs giving concurrent chemo seems like a reasonable ask (and something that would save hospitals money in a 'bundled care' model), but anything more than that would be threatening the entire institution of medical oncology... and will probably be met with all sorts of resistance. I can see medical oncology giving up ground specifically on gyn/onc and neuro/onc, but if we are trying to push them out of the way on targeted therapies, they will fight tooth and nail... they would be more likely to acquiesce with concurrent Xeloda, or carbo/taxol.

 

[medgator]

Rad oncs giving concurrent chemo seems like a reasonable ask (and something that would save hospitals money in a 'bundled care' model), but anything more than that would be threatening the entire institution of medical oncology... and will probably be met with all sorts of resistance. I can see medical oncology giving up ground specifically on gyn/onc and neuro/onc, but if we are trying to push them out of the way on targeted therapies, they will fight tooth and nail... they would be more likely to acquiesce with concurrent Xeloda, or carbo/taxol.

Immunotherapy is as easy, if not easier, to give than concurrent chemo. Of course it is all about the margins and those branded drugs generate higher ones

 

[bronx43]

What standards? This nation thinks DNP = MD. So let the Med oncs Throw up a stink about it. It’s not like they ever respected what we do anyway.

Med oncs don’t control referrals anymore. A.) because Med onc private practice is basically extinct B.) Hospital systems tacitly dictate referral patterns. An RO that gives systemic therapy? Guess that’s one less person they have to hire.

If GYNs can give cis for their SCC cervix patients I don’t see why we can’t do the same for our H&N patients

It’s clear that we aren’t gonna get anywhere if we follow the rules and play nice with others. That ship has sailed. The midlevels and nurses figured that out a while ago and despite all the huffing and puffing physicians and are doing they are here to stay.

What incentive is there for a large hospital system to hire rad onc to prescribe immunotherapy? Large systems exist mostly in large metros where hiring med onc on the cheap isn’t exactly difficult. Also, they much rather hire a gaggle of midlevels to “augment” their existing med onc than to hire new Rad Onc. Midlevels make them money.

At the end of the day, they don’t necessarily get value from a rad onc that can prescribe immunotherapy. If the job market is really bad enough for you, they can either squeeze more productivity out of existing rad onc or hire part time/locums.

In areas without cancer center monopoly, the referral patterns are completely dictated by primary care. I don’t see internists and family docs referring to anyone but med onc.

 

[Lamount]

Immunotherapy is as easy, if not easier, to give than concurrent chemo. Of course it is all about the margins and those branded drugs generate higher ones

Not a question of easy... it's a question of future of their entire field. If we can do our job and their job, and they can only do their job... why would they agree to that. Let them keep non-concurrent therapies... and my impression is that they wouldn't be heartbroken to give up the patients who are getting radiation toxicities.

 

[deleted774703]

What standards? This nation thinks DNP = MD. So let the Med oncs Throw up a stink about it. It’s not like they ever respected what we do anyway.

Med oncs don’t control referrals anymore. A.) because Med onc private practice is basically extinct B.) Hospital systems tacitly dictate referral patterns. An RO that gives systemic therapy? Guess that’s one less person they have to hire.

If GYNs can give cis for their SCC cervix patients I don’t see why we can’t do the same for our H&N patients

It’s clear that we aren’t gonna get anywhere if we follow the rules and play nice with others. That ship has sailed. The midlevels and nurses figured that out a while ago and despite all the huffing and puffing physicians and are doing they are here to stay.

I’m looking forward to you leading the charge on this unrealistic motion.

Or maybe it will be another scenario where radonc “leaders” feed us nonsensical information and ultimately we all end up back in this thread talking about the same things over and over.

 

[deleted941485]

I’m looking forward to you leading the charge on this unrealistic motion.

Or maybe it will be another scenario where radonc “leaders” feed us nonsensical information and ultimately we all end up back in this thread talking about the same things over and over.

I mean let’s start with something pretty small. Don’t you think it’s a little ridiculous that for your early stage ER + breast ca patients that aren’t getting systemic chemo but need adjuvant RT and hormone blockade that they are seeing 3 separate oncology physicians? I always found those med Onc consults ridiculous we know they don’t need chemo we can do genetic testing with the 21 gene assay and if they need hormone therapy we already know the indications. Oh but what about side effects? I don’t think you need a fellowship in Med Onc to manage the side effects of Hormone blockade.

 

[medgator]

I mean let’s start with something pretty small. Don’t you think it’s a little ridiculous that for your early stage ER + breast ca patients that aren’t getting systemic chemo but need adjuvant RT and hormone blockade that they are seeing 3 separate oncology physicians? I always found those med Onc consults ridiculous we know they don’t need chemo we can do genetic testing with the 21 gene assay and if they need hormone therapy we already know the indications. Oh but what about side effects? I don’t think you need a fellowship in Med Onc to manage the side effects of Hormone blockade.

I typically send them to avoid stepping on toes, but you're correct. Sometimes the med onc will also give prolia if osteoporosis on dexa, check labs etc, but those could fall under rad onc. Many of us give lupron already with xrt. I will sometimes order an oncotype DX as well to save time for the med onc so they have that info when they eventually see the patient from the surgeon.

 

[deleted774703]

Yes we prescribe ADT and how far have we gotten with receiving prostate consults? Vast majority of US has to scrounge to get those referrals based on percentage of pts who actually receive RT vs RP.

Ordering gene tests makes no difference. Whoever does it first just makes it more convenient for the patient but doesn’t change anything else.

Being a speciality so dependent on referring providers makes it smarter not to make med oncs an enemy for marginal profit gain