Too many tumor conferences!

[coroner]

At my current hospital (non-academic) we are now up to 8 tumor conferences, 10 total if you count placenta and M&M! What’s next…toenail conference? At some of these, they’re presenting 10+ patients. Granted, some are bi-weekly or monthly; and, it’s divided between my colleagues, but it’s been ramping up in frequency and subspecialty over the years. I think money is a factor i.e. being an accredited breast, thoracic, etc. center = grants/state funding. Whatever happened to the days when there was only one weekly general tumor conference with 2 cases…?

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[SunBakedTrash]

Whatever happened to reading the report and calling if they have a question?

I suppose there is value in QA, there are rare occasions when the diagnosis changes. I agree with you though, it’s excessive.

 

[gbwillner]

Hey, don't scoff at toenail conference. You know they are doing molecular testing on toenail cuttings at some places now? Those may need consultation! Cha-ching.

 

[Alteran]

At my current hospital (non-academic) we are now up to 8 tumor conferences, 10 total if you count placenta and M&M! What’s next…toenail conference? At some of these, they’re presenting 10+ patients. Granted, some are bi-weekly or monthly; and, it’s divided between my colleagues, but it’s been ramping up in frequency and subspecialty over the years. I think money is a factor i.e. being an accredited breast, thoracic, etc. center = grants/state funding. Whatever happened to the days when there was only one weekly general tumor conference with 2 cases…?

You have a "placenta" conference? Seriously!!!???

All joking aside at the absurdity of that, my group has 4 tumor boards we participate in where the goal is to cram 15+ patients into 1 hour of discussion which is about as in depth - and useful - as you can imagine. I heard somewhere that you can't charge for your participation in tumor boards if you're going to get CME out of it. But if you're not going to get CME, could you theoretically charge for your professional time? Just asking because I don't know out of ignorance.

 

[ScubaV]

You nailed it. It's all about the accreditation which I believe for most requires a regular conference with participation from multiple specialties. A lot depends on if the clinicians or pathologists want to do some hand-holding or do some professorial bloviating with a stage. At least covid pushed most of these online for us. Then you can call in from home or in the car especially for the dreaded 7am'ers. And try reducing pathology participation to only "unusual cases" under the guise of not taking up too much precious time.

 

[Dave1980]

At my current hospital (non-academic) we are now up to 8 tumor conferences, 10 total if you count placenta and M&M! What’s next…toenail conference? At some of these, they’re presenting 10+ patients. Granted, some are bi-weekly or monthly; and, it’s divided between my colleagues, but it’s been ramping up in frequency and subspecialty over the years. I think money is a factor i.e. being an accredited breast, thoracic, etc. center = grants/state funding. Whatever happened to the days when there was only one weekly general tumor conference with 2 cases…?

How many per week are you actually doing though? I do 0-2 a week but it's usually just 1. It's not bad, I get to meet my colleagues and learn something about how they think,

I'm in rads and have always been jealous of the path people who take part in the conference. They want to see rads on every case but only ask for path on like 20% of the cases. When it is paths turn they say "the diagnosis is xyz because there are these findings here" and that's it. Occasionally someone will say "well could it be abc?" and the path will say "no, because of this marker".

For rads they literally want to see multiple scans and then throw curveballs at you also asking about unrelated things.

 

[deleted314957]

y’all would be wise to never say a word about any case that is not in your report. Bloviation= potential misunderstanding and liability.

 

[coroner]

How many per week are you actually doing though? I do 0-2 a week but it's usually just 1. It's not bad, I get to meet my colleagues and learn something about how they think,

As I said, it is divided between my colleagues and I. To your question specifically, it only amounts to 1 or 2 per week for myself and each colleague. But either way, do the math and it's more time out of our day(s) overall: 10 different types of conferences divided by 6 partners vs 1 general tumor conference (in the old days) divided by 6 partners = less frequency per month/week/day = more time to get work done.

I'm in rads and have always been jealous of the path people who take part in the conference. They want to see rads on every case but only ask for path on like 20% of the cases. When it is paths turn they say "the diagnosis is xyz because there are these findings here" and that's it.

Yeah, as one of my friends from medical school who went into rads once said, when a radiologic image is looked at by pulmologists, oncologists, surgeons, etc., everyone likes to play "armchair radiologist". When path shows a slide, everyone shuts the hell up and takes what the pathologist says as gospel because no one knows (or remembers) histology.

The door swings both ways though on the jealousy part. I get miffed when I had already took photos of the pathology to present, and for the sake of time, or absent-mindedness, the presenter of the case completely ignores the Pathology. Then why should I bother taking photos and reviewing the path report beforehand if you're going to skip me?!? That never happens to rads in tumor conference...

y’all would be wise to never say a word about any case that is not in your report. Bloviation= potential misunderstanding and liability.

That is good in theory if and when there is confusion or a discrepancy. The problem is, clinicians will hold you or any pathologist present at that conference accountable for all the pathologists in your group; regardless if you were or were not the one signing out the case.

 

[LADoc00]

At my current hospital (non-academic) we are now up to 8 tumor conferences, 10 total if you count placenta and M&M! What’s next…toenail conference? At some of these, they’re presenting 10+ patients. Granted, some are bi-weekly or monthly; and, it’s divided between my colleagues, but it’s been ramping up in frequency and subspecialty over the years. I think money is a factor i.e. being an accredited breast, thoracic, etc. center = grants/state funding. Whatever happened to the days when there was only one weekly general tumor conference with 2 cases…?

cherry picking what hospitals to cover is almost as important as practice structure.

If you get a high maintenance hospital contract you really have to evaluate how much the pain is worth.

There is SOOOOO MUCH money being made in OP molecular now, we can really be choosey about doing hospital based AP.

I can easily clear in 1 day in OP molecular what I can pull down in 1-2+ weeks signing out general surg path. With multiples of that level, not sure why I even still have a microscope in my office.

The other option would be hire a grad straight out of training and just make him/her the conference bitch.

 

[Dave1980]

y’all would be wise to never say a word about any case that is not in your report. Bloviation= potential misunderstanding and liability.

have you been in a lot of tumor boards? that's not how tumor boards work in my experience.

 

[Dave1980]

As I said, it is divided between my colleagues and I. To your question specifically, it only amounts to 1 or 2 per week for myself and each colleague. But either way, do the math and it's more time out of our day(s) overall: 10 different types of conferences divided by 6 partners vs 1 general tumor conference (in the old days) divided by 6 partners = less frequency per month/week/day = more time to get work done.

You can always decline to go to MDC if your workload is overwhelming. I never thought of path as a field that gets overworked or pulled in a bunch of different direction though.

 

[deleted314957]

have you been in a lot of tumor boards? that's not how tumor boards work in my experience.

Decades worth.

 

[Med Director New England]

I don’t mind tumor boards, so long as they are run efficiently. Good way to get to know your colleagues and a good way to learn the treatment decisions/ algorithms that hinge on our diagnoses.

 

[Napoleon1801]

cherry picking what hospitals to cover is almost as important as practice structure.

If you get a high maintenance hospital contract you really have to evaluate how much the pain is worth.

There is SOOOOO MUCH money being made in OP molecular now, we can really be choosey about doing hospital based AP.

I can easily clear in 1 day in OP molecular what I can pull down in 1-2+ weeks signing out general surg path. With multiples of that level, not sure why I even still have a microscope in my office.

The other option would be hire a grad straight out of training and just make him/her the conference bitch.

What OP molecular testing is paying out this good? The COVID gravy train is going to end at some point.

 

[univlad]

What OP molecular testing is paying out this good? The COVID gravy train is going to end at some point.j

Maybe the molecular you can do off pap smears, although I suppose that depends on finding a source of pap smears. All the primary care docs here are employed one of the major health systems.

We have three tumor boards a week--general, lung mass, and breast. Being able to work in my office during the tumor boards has been helpful. Taking pictures is of sort of a time sink, but I just put the slide up and take the first picture that comes up that's reasonable and at least somewhat in focus. Half the time they don't ask for pathology and most of the people don't care or don't know what they are looking at anyway. Some of my colleagues spend a half hour taking pictures--I spend less than 5 minutes usually and then more throughly look through the reports, etc. while everyone is looking at the radiology.

 

[LADoc00]

What OP molecular testing is paying out this good? The COVID gravy train is going to end at some point.

Multiplex PCR for urine, STI, vaginitis, nail fungal analysis, wound culture replacement.
Liquid Biopsy, CTC assay, actionable mutation analysis by NGS.

now that can plug and play this stuff for sub 250k in capital, not sure why the dogs are still fighting over the scraps of AP with CMS reimbursement circling the drain...

 

[deleted314957]

Multiplex PCR for urine, STI, vaginitis, nail fungal analysis, wound culture replacement.
Liquid Biopsy, CTC assay, actionable mutation analysis by NGS.

now that can plug and play this stuff for sub 250k in capital, not sure why the dogs are still fighting over the scraps of AP with CMS reimbursement circling the drain...

My God, people do pcr DNA analysis on TOE NAIL FUNGUS??! They are all dermatophytes and the tx is all the same unless one hell of a lot has changed since 2013. We would just look at a section of nail with a PAS fungal stain and described their presence or absence. Why in the world would anybody need DNA analysis? I am seriously asking because it sounds really weird.

 

[gbwillner]

My God, people do pcr DNA analysis on TOE NAIL FUNGUS??! They are all dermatophytes and the tx is all the same unless one hell of a lot has changed since 2013. We would just look at a section of nail with a PAS fungal stain and described their presence or absence. Why in the world would anybody need DNA analysis? I am seriously asking because it sounds really weird.

People do all kinds of dumb and unnecessary things.

 

[WEBB PINKERTON]

In office lab people been targeting podiatrists for a while. You only need 80 to 150 toenail clippings a month to turn some profit!

https://www.podiatrym.com/pdf/2016/12/MDCProfile117web.pdf

Whatever happened to them just trying to talk you into useless shoe inserts or excessive xrays in office?
After I got my first stress fracture when I was pounding out 100 mile weeks of running, they wanted to xray my foot every 2 weeks. I told the guy no thanks. That seems pretty extreme.

 

[deleted314957]

Damn, I feel old sometimes.

 

[Guest8]

My God, people do pcr DNA analysis on TOE NAIL FUNGUS??! They are all dermatophytes and the tx is all the same unless one hell of a lot has changed since 2013. We would just look at a section of nail with a PAS fungal stain and described their presence or absence. Why in the world would anybody need DNA analysis? I am seriously asking because it sounds really weird.

Fee for service leads to more services for more fees. Some of those fees are insane, like molecular testing on toenails.

 

[LADoc00]

Fee for service leads to more services for more fees. Some of those fees are insane, like molecular testing on toenails.

And flat W-2 pay in healthcare leads to less care, less engagement, more waiting, lower quality care.

Im not saying there is a perfect answer in healthcare economic models, but I can tell you fee for service directly aligns the interests of patients and providers in a way salaried providers could never touch.

I have practiced in every imaginable model of healthcare and can say without any reservations whatsoever that "fee for service" produces the most hustle/customer service oriented behavior.

Salaried docs do the bare minimum, rough to admit that, but its absolutely the truth. And they will constantly push the boundaries in terms of minimal effort.