Tumor sites-- if you could do it all over again, how would you choose?

[levelsands]

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I'll be starting in an academic position next year and I'm currently in the process of deciding tumor sites. I'm salaried, so there aren't really any financial considerations I need to make--I just need to hit around 180-190 new patient starts a year, RVUs don't matter. I went into radiation oncology to treat breast so that will be my primary site, but I'm struggling to decide between GU (no brachy), lung or thyroid as my second site. Skin or lymphoma may also open up in a few years so those are possible longer term options too. Any thoughts/ personal anecdotes/ reality checks would be greatly appreciated!

 

[radoncftw]

breast and GU sounds great to me.
Mostly good outcomes, healthy-ish patients, contouring/planning relatively straight forward.

thyroid may be a good second site. Probably minimal external beam volume. Not sure if you would also handle RAI but that is fairly straight forward in my experience.

 

[seper]

Do not start off with easy sites. H&N, Gyn brachy, or both simultaneously.

 

[levelsands]

breast and GU sounds great to me.
Mostly good outcomes, healthy-ish patients, contouring/planning relatively straight forward.

thyroid may be a good second site. Probably minimal external beam volume. Not sure if you would also handle RAI but that is fairly straight forward in my experience.

Thanks for the response, GU was high up on my list earlier on in residency, but have you also noticed prostate patients seem to be increasingly anxious? Feel like every clinic I have one or two guys who are terrified and cant make up their minds, makes for some long and tiring conversations when you sometimes have to discuss EBRT,SBRT, brachy AND ADT

 

[levelsands]

Do not start off with easy sites. H&N, Gyn brachy, or both simultaneously.

Thanks for the response, any reason you feel this way? These sites are fully staffed where I'm starting, but curious about your thought process

 

[metallica81788]

Personally I wouldn't do breast and GU - too much anxiety and know-it-all patients between the two, even if "easier."
If you pick something significantly different than breast you'll probably have good variety of complexity, ease, and outcomes within your job.

 

[Bequerel]

I’ve been a generalist for over a decade. I find head and neck the most rewarding. I do a ton of breast and couldn’t imagine only doing it plus we’re going to lose a lot of breast over next 20 years. I agree with GU being too high anxiety!

 

[Doctorer]

I think a mix of something easy (breast) and annoying (H&N/Prostate brachy/Gyn) would be a good balance. Doing something annoying keeps you marketable when you end up wanting to/needing to jump somewhere else. If you solely focus on something like Breast/GU it's a lot harder to stand out.

 

[pikachu]

breast and GU are my nightmare sites - so many worried well patients in whom many times the only tangible manifestation of our treatment is side effects. literally i would take a 100% head and neck service over a 1% breast service.
go ahead and roast me

ETA: SBRT for RCC might be kind of rewarding. Still

 

[communitydoc13]

CNS and H&N are the most rewarding in terms of impact and secure in terms of our role in the near future (10-20 years) IMO. They are also essentially completely (not quite in H&N) external beam sites.

FWIW, I'm a community generalist who is pretty comfortable treating everything. I have on occasion referred out for extraordinary cases in both of these sites.

I have never, ever referred out for an academic breast radonc consult and would have to be convinced of the value of such a thing. I can give 0-5 fractions too.

 

[temujim]

I'll be starting in an academic position next year and I'm currently in the process of deciding tumor sites. I'm salaried, so there aren't really any financial considerations I need to make--I just need to hit around 180-190 new patient starts a year, RVUs don't matter. I went into radiation oncology to treat breast so that will be my primary site, but I'm struggling to decide between GU (no brachy), lung or thyroid as my second site. Skin or lymphoma may also open up in a few years so those are possible longer term options too. Any thoughts/ personal anecdotes/ reality checks would be greatly appreciated!

Think about thyroid. Low acuity patients, no concurrent chemo really (excepting the anaplastic). Rare definitive well differentiated patients as well. Mostly lots of SBRT for mets over the long term natural history, so not much follow up either; just release them back to endo. Only downsides are the patients can also be anxious despite their good long term prognosis in general and endo can be bizarrely anti-RT even though they have a hair trigger for I131.

 

[randomname2018]

I'm salaried, so there aren't really any financial considerations

Regardless of employment type, there are always financial considerations.

just need to hit around 180-190 new patient starts a year, RVUs don't matter.

RVUs do matter. There is systematic reporting of this at the department level without question. If your chair told you this they are lying.

As far as second sites go, any of the above are otherwise reasonable. I would expand your considerations to look at it globally - referring, RVUs, workflow, etc. There is a reason these are available. Why?

 

[ramsesthenice]

I'll be starting in an academic position next year and I'm currently in the process of deciding tumor sites. I'm salaried, so there aren't really any financial considerations I need to make--I just need to hit around 180-190 new patient starts a year, RVUs don't matter. I went into radiation oncology to treat breast so that will be my primary site, but I'm struggling to decide between GU (no brachy), lung or thyroid as my second site. Skin or lymphoma may also open up in a few years so those are possible longer term options too. Any thoughts/ personal anecdotes/ reality checks would be greatly appreciated!

What is expected of your non clinical time/how much academic work do you to do? 180-190 new starts is not a big deal if you are full time clinical. If you are planning on carrying that kind of volume and doing a significant amount of research/education, you will need to be very efficient. It’s doable, and lung and GU are both good options because both can be fairly SBRT heavy. I’d personally recommend finding out more about the referral patterns and other groups. If the GU group only does salvage or gets the medically unwell patients (ie, surgical throw always)…hard pass. My GU group is great. And in my neck of the woods, bladder and RCC volumes have increased exponentially over the last couple years. It’s far more interesting than what I experienced with GU in training. Probably 35-40% of my GU is non prostate.

 

[Lamount]

I like lung… nice mix of easy SBRT and challenging stage III/OMD. Where I work, thoracic sees all thoracic pts (primary lung/thoracic as well as thoracic mets). Seeing metastatic patients with different histologies/kinetics is stimulating -figuring when and if there is a role for RT. Outcomes aren’t always great but patients are wonderful

 

[NotMattSpraker]

Great question and answers.

My favorite:

As far as second sites go, any of the above are otherwise reasonable. I would expand your considerations to look at it globally - referring, RVUs, workflow, etc. There is a reason these are available. Why?

RVUs may "not matter" (they always matter), but fairness is what really will matter to you. Pay, resident coverage, NP coverage, access to non-clinical time, tumor board coverage, average patient/consult load, and call are all things I've seen people perceive to be "unfair".

Hierarchy matters in both positive and negative ways. If you treat thoracic, what is your role and position among the service line? Are you kind of covering all the stuff the service line leadership doesnt want to do?

There is also hierarchy for opening, funding, and enrolling IITs. What is your research? If you are going to do trials, it helps to treat the disease you are studying.

I like complexity so absolutely loved my disease sites of sarcoma and thorax. Then it really started to wear on me emotionally after a year or two, and was way tougher at times than I ever expected. It is easier as a community generalist where my complex/poor expected outcome cases are mixed with some easy wins. Never thought about this once during residency, just something to consider.

 

[Palex80]

Only problem with prostate & breast:
You will always have these patients that you won't lget along with (for any given reason), that you will eventually need to treat and re-treat and re-treat for metastatic disease, and who will refuse to die. So troublesome.

 

[RSAOaky]

Community generalist. The answer is breast and lung.
Breast: well tolerated treatments, simple treatment paradigms, no real need to follow up (most of these patients see medonc every 3-6 months, surgeons once a year, we provide low value in follow ups). They have no side effects for half of treatment, get a bit irritated by the end, you tell them it will all get better, and it does. Sure, you have to deal with the anxiety of a 65 y/o w/ Grade 1 DCIS every once in a while, but overall it's a cush gig.

Lung: well tolerated treatments (really the only acute side effect related to RT that some lung patients get is esophagitis). Easy follow ups. Patients are typically either cured or they do "well enough." Good systemic options for those that recur. Good balance RVU wise for breast, which is lower RVUs.

GU is pretty easy but a bit more annoying. So many treatment options for patients makes for long conversations, especially if you are close to a proton center. Contours are easy but you have more to contour than breast. It does generate more RVUs if that matters. Patients have more side effects that you need to manage, whether they're your fault or not. It's not a hard disease site by any means, there are just things that make it annoying.

H&N sucks. It's time consuming to manage these patients and to do their contours. Patients are extremely high maintenance before, during, and after treatment. Recurrences feel really bad. Some patients just do extremely poorly and you've given them this awful toxicity for them to still recur or even progress through treatment. It's a site that people either love or hate for a reason.

GYN/GI - these sites are ok if you aren't doing T&Os. Somewhere between GU and H&N.

CNS - It's ok, contours aren't bad, GBMs do poorly but you expect them to do poorly. Everyone else mostly does fine.

Sarcoma - also fine

 

[RSAOaky]

Great question and answers.

My favorite:



RVUs may "not matter" (they always matter)

To echo this, RVUs don't matter until they do. It's the issue with breast as a primary site. It's an easy site but you see more patients to generate fewer RVUs than other sites.

Lets say two doctors renegotiate their contract. One treats breast and one treats lung. The breast physician averages 20-25 on treatment and the lung doc averages 15-20 on treatment. The breast doc generates 9000 RVUs and the lung doc generates 13000 RVUs. Breast doc says "I see more patients, I'm busier, I deserve a raise." Lung doc says "I bring in 50% more money than breast doc, why do we get paid the same?"

Who do you think gets paid?

 

[levelsands]

I think a mix of something easy (breast) and annoying (H&N/Prostate brachy/Gyn) would be a good balance. Doing something annoying keeps you marketable when you end up wanting to/needing to jump somewhere else. If you solely focus on something like Breast/GU it's a lot harder to stand out.

That's a great perspective and future portability is something that's on my mind. The issue is that at the large academic center I'm starting at, HN and brachy positions usually require some sort of additional fellowship training. In terms of marketable sites, would you also consider lymphoma or CNS as "marketable"?

 

[levelsands]

CNS and H&N are the most rewarding in terms of impact and secure in terms of our role in the near future (10-20 years) IMO. They are also essentially completely (not quite in H&N) external beam sites.

FWIW, I'm a community generalist who is pretty comfortable treating everything. I have on occasion referred out for extraordinary cases in both of these sites.

I have never, ever referred out for an academic breast radonc consult and would have to be convinced of the value of such a thing. I can give 0-5 fractions

Great points re: impact and security! Do you not feel that thoracic/ lung is fairly secure as well despite the influx of biologics? You'll always need some kind of local therapy for NSCLC and I've seen a huge increase in referrals for SBRT; likely will continue to increase as we catch these earlier and earlier with more LDCT screening implementation

 

[levelsands]

Think about thyroid. Low acuity patients, no concurrent chemo really (excepting the anaplastic). Rare definitive well differentiated patients as well. Mostly lots of SBRT for mets over the long term natural history, so not much follow up either; just release them back to endo. Only downsides are the patients can also be anxious despite their good long term prognosis in general and endo can be bizarrely anti-RT even though they have a hair trigger for I131.

Unfortunately thyroid is lower down on my list as my center splits RAI treatment with endo so we end up doing a LOT of followup which definitely seems to add some drag onto practice efficiency, especially with all the retreatments, etc

 

[RSAOaky]

Great points re: impact and security! Do you not feel that thoracic/ lung is fairly secure as well despite the influx of biologics? You'll always need some kind of local therapy for NSCLC and I've seen a huge increase in referrals for SBRT; likely will continue to increase as we catch these earlier and earlier with more LDCT screening implementation

Lung is stable. There will always be lung patients who are not candidates for surgery. Also, lung patients are living long with the best data for consolidative local therapies. Lot of opportunities to treat mets.

 

[levelsands]

What is expected of your non clinical time/how much academic work do you to do? 180-190 new starts is not a big deal if you are full time clinical. If you are planning on carrying that kind of volume and doing a significant amount of research/education, you will need to be very efficient. It’s doable, and lung and GU are both good options because both can be fairly SBRT heavy. I’d personally recommend finding out more about the referral patterns and other groups. If the GU group only does salvage or gets the medically unwell patients (ie, surgical throw always)…hard pass. My GU group is great. And in my neck of the woods, bladder and RCC volumes have increased exponentially over the last couple years. It’s far more interesting than what I experienced with GU in training. Probably 35-40% of my GU is non prostate.

I'll be around 60% clinical, is 180-190 new starts considered fairly high volume? We have 12 weeks off a year, so that works out to about 4-5 patients a week. The rest of my 40% is going to be mostly education as I've been heavily involved in that during residency. Research expectations are fairly light, just accrue for some trials. In terms of referral patterns, that's a very salient point, I'm surprised 40% of your GU is non prostate and I still do not see many RCCs and bladders in my neck of the woods!

 

[levelsands]

Great question and answers.

My favorite:



RVUs may "not matter" (they always matter), but fairness is what really will matter to you. Pay, resident coverage, NP coverage, access to non-clinical time, tumor board coverage, average patient/consult load, and call are all things I've seen people perceive to be "unfair".

Hierarchy matters in both positive and negative ways. If you treat thoracic, what is your role and position among the service line? Are you kind of covering all the stuff the service line leadership doesnt want to do?

There is also hierarchy for opening, funding, and enrolling IITs. What is your research? If you are going to do trials, it helps to treat the disease you are studying.

I like complexity so absolutely loved my disease sites of sarcoma and thorax. Then it really started to wear on me emotionally after a year or two, and was way tougher at times than I ever expected. It is easier as a community generalist where my complex/poor expected outcome cases are mixed with some easy wins. Never thought about this once during residency, just something to consider.

All excellent points, your last bit on poor outcome sites wearing you down emotionally resonates with me. One of my main points of hesitation about doing thorax is the poor outcomes. I'm hoping balancing it with breast will help, but it is on the back of my mind.

 

[levelsands]

Community generalist. The answer is breast and lung.
Breast: well tolerated treatments, simple treatment paradigms, no real need to follow up (most of these patients see medonc every 3-6 months, surgeons once a year, we provide low value in follow ups). They have no side effects for half of treatment, get a bit irritated by the end, you tell them it will all get better, and it does. Sure, you have to deal with the anxiety of a 65 y/o w/ Grade 1 DCIS every once in a while, but overall it's a cush gig.

Lung: well tolerated treatments (really the only acute side effect related to RT that some lung patients get is esophagitis). Easy follow ups. Patients are typically either cured or they do "well enough." Good systemic options for those that recur. Good balance RVU wise for breast, which is lower RVUs.

GU is pretty easy but a bit more annoying. So many treatment options for patients makes for long conversations, especially if you are close to a proton center. Contours are easy but you have more to contour than breast. It does generate more RVUs if that matters. Patients have more side effects that you need to manage, whether they're your fault or not. It's not a hard disease site by any means, there are just things that make it annoying.

H&N sucks. It's time consuming to manage these patients and to do their contours. Patients are extremely high maintenance before, during, and after treatment. Recurrences feel really bad. Some patients just do extremely poorly and you've given them this awful toxicity for them to still recur or even progress through treatment. It's a site that people either love or hate for a reason.

GYN/GI - these sites are ok if you aren't doing T&Os. Somewhere between GU and H&N.

CNS - It's ok, contours aren't bad, GBMs do poorly but you expect them to do poorly. Everyone else mostly does fine.

Sarcoma - also fine

To echo this, RVUs don't matter until they do. It's the issue with breast as a primary site. It's an easy site but you see more patients to generate fewer RVUs than other sites.

Lets say two doctors renegotiate their contract. One treats breast and one treats lung. The breast physician averages 20-25 on treatment and the lung doc averages 15-20 on treatment. The breast doc generates 9000 RVUs and the lung doc generates 13000 RVUs. Breast doc says "I see more patients, I'm busier, I deserve a raise." Lung doc says "I bring in 50% more money than breast doc, why do we get paid the same?"

Who do you think gets paid?

Thanks for the really thoughtful answers! I think this has helped push me towards lung as my second site. What do you think of skin? That may be an option as well, but I was concerned I would get bored doing breast and skin.

I'm frankly quite naive regarding RVUs for different sites, I know HN and CNS are high value RVU sites, but beyond that, what are the relative "tier lists" if you don't mind me asking?

 

[RSAOaky]

Thanks for the really thoughtful answers! I think this has helped push me towards lung as my second site. What do you think of skin? That may be an option as well, but I was concerned I would get bored doing breast and skin.

I'm frankly quite naive regarding RVUs for different sites, I know HN and CNS are high value RVU sites, but beyond that, what are the relative "tier lists" if you don't mind me asking?

There's nothing magical about it. Lung, GU, H&N are the highest (lots of IMRT, longish courses, high volume). Gyn, GI, and CNS are in the next tier. They have a lot of IMRT (and brachy for gyn) but generally shorter courses and not as high volume as the above (unless you count brain mets as CNS in which case bump it in to the previous list). Lymphoma/Sarcoma are rare disease sites so they don't really count on their own. Breast is the lowest (high volume, shortish courses, very little IMRT).

 

[Doctorer]

That's a great perspective and future portability is something that's on my mind. The issue is that at the large academic center I'm starting at, HN and brachy positions usually require some sort of additional fellowship training. In terms of marketable sites, would you also consider lymphoma or CNS as "marketable"?

Neither would be my first choice in terms of marketability. CNS isn't a super "hard" site to treat, but can generate decent revenue for a department due to SRS, so those positions are often seen as valuable. Lymphoma has the benefit of being esoteric (ie, most people try to think about lymphoma as little as possible) and patients don't get sick (at least while you're treating them), so you're not stuck in clinic/can focus on research, but there are very few places that are going to get excited about hiring a lymphoma specialist, especially since lymphoma is one of those very low RVU sites.

 

[medgator]

All excellent points, your last bit on poor outcome sites wearing you down emotionally resonates with me. One of my main points of hesitation about doing thorax is the poor outcomes. I'm hoping balancing it with breast will help, but it is on the back of my mind.

Disagree in nsclc these days

 

[NotMattSpraker]

Disagree in nsclc these days

Thoracic re-irradiation cases keep me up at night

 

[Chartreuse Wombat]

I'll be around 60% clinical, is 180-190 new starts considered fairly high volume? We have 12 weeks off a year, so that works out to about 4-5 patients a week. The rest of my 40% is going to be mostly education as I've been heavily involved in that during residency. Research expectations are fairly light, just accrue for some trials. In terms of referral patterns, that's a very salient point, I'm surprised 40% of your GU is non prostate and I still do not see many RCCs and bladders in my neck of the woods!

12 weeks off a year? WTF

 

[medgator]

Thoracic re-irradiation cases keep me up at night

Yep. Didn't have this problem when I graduated residency. Now we actually cure a lot more stage 3 and end up having to sbrt stuff nearby or retreat for palliation etc

 

[medgator]

12 weeks off a year? WTF

Sounds like a rads job

 

[ramsesthenice]

I'll be around 60% clinical, is 180-190 new starts considered fairly high volume? We have 12 weeks off a year, so that works out to about 4-5 patients a week. The rest of my 40% is going to be mostly education as I've been heavily involved in that during residency. Research expectations are fairly light, just accrue for some trials. In terms of referral patterns, that's a very salient point, I'm surprised 40% of your GU is non prostate and I still do not see many RCCs and bladders in my neck of the woods!

Well, it depends on your gross volume and catch rate. Breast and prostate patients often come to academic sites to see the surgeon and end up getting referred to community practices for radiation. If you only end up treating 60% of your consults with 3 clinic days per week, 4-5 new starts per week is pretty ambitious. There are a lot of variables which can be hard to appreciate as a resident. My best guess is you vs will be fine, but busy. They wouldn’t give you .6 FTE if they didn’t think you could make your target.

For perspective, I’m in clinic 2 days per week and HDR 2 half days per week doing GI, GU, and some GYN (mostly the ones that need interstitial) and probably average around 150ish new starts per year. We don’t have new start targets but I basically double my RVU targets each year. I’m busy as f***, but manage to write ISTs and 1-2 R01s per year. It’s all doable, but you have to be efficient.

 

[catachip]

12 weeks off a year? WTF

12 weeks here plus 6 holidays (Thanksgiving, Christmas, Labor Day etc).

 

[communitydoc13]

Agree that thoracic a fine site and stable for foreseeable future. Remarkably contingent on surgical culture regarding SBRT volumes.

I'm starting to wonder with these 12 weeks off jobs.

Maybe elite radonc has known what it was doing all along?

Sure, avenues for making bank as a private doc have dried up and if you are at a smaller community place that treats locals and old people and has no bargaining power, you are struggling to pay yourself old MGMA average with pro-fees (indications, fractionation, Medicare compensation etc).

Not to mention that we all matter less and less (academics included).

But if you are at a large institution with a favorable payor mix and regional bargaining power...maybe you are working 3/4 weeks a year with 3 clinic days per week and probably not making much less than many hospital employed docs? (Of course, I am aware of some prestige places that are actually tremendously bottom line driven and underpay/clinically overwork their young faculty).

There are clearly some sweet spot academic jobs out there. Congratulations to the OP for landing one. Clearly with a commitment from an academic place this early, they are valued by the institution.

I would have jumped at an opportunity like this (the breast part aside).

IMO, the best part of a job offer like this is the time...time to make something unique out of it, either from a research or pedagogical standpoint. That's what academics is for after all.

 

[levelsands]

Disagree in nsclc these days

I feel like in our thoracics clinics a solid 1/4 of the new patient consults I see are palliative; it's definitely better than how things used to be as we're seeing lots of early stage SBRT patients and many patients are doing better with IO, but short of GBM heavy CNS clinics, there aren't many sites with worse outcomes on average. Of course this probably hugely varies between practices!

 

[levelsands]

12 weeks off a year? WTF

Quality of life is good (I'm only on call 1-2 weeks a year but always have resident coverage), but the pay is less than even MGMA median, so it comes at a price.

 

[BobbyHeenan]

Quality of life is good (I'm only on call 1-2 weeks a year but always have resident coverage), but the pay is less than even MGMA median, so it comes at a price.

are you allowed to do locums on your off weeks?

In years past our group has had some local-ish academics come do coverage for us. Good way to pick up extra money if you need it and also dip a toe in private practice.

 

[levelsands]

Well, it depends on your gross volume and catch rate. Breast and prostate patients often come to academic sites to see the surgeon and end up getting referred to community practices for radiation. If you only end up treating 60% of your consults with 3 clinic days per week, 4-5 new starts per week is pretty ambitious. There are a lot of variables which can be hard to appreciate as a resident. My best guess is you vs will be fine, but busy. They wouldn’t give you .6 FTE if they didn’t think you could make your target.

For perspective, I’m in clinic 2 days per week and HDR 2 half days per week doing GI, GU, and some GYN (mostly the ones that need interstitial) and probably average around 150ish new starts per year. We don’t have new start targets but I basically double my RVU targets each year. I’m busy as f***, but manage to write ISTs and 1-2 R01s per year. It’s all doable, but you have to be efficient.

Thanks for the response, I apologize as I should have been more clear, but they just require that I see 180-190 patients in consultation--that should hopefully make things more manageable. Wow, impressive level of efficiency on your part if you're doing that much brachy while still being productive in research!

 

[levelsands]

Agree that thoracic a fine site and stable for foreseeable future. Remarkably contingent on surgical culture regarding SBRT volumes.

I'm starting to wonder with these 12 weeks off jobs.

Maybe elite radonc has known what it was doing all along?

Sure, avenues for making bank as a private doc have dried up and if you are at a smaller community place that treats locals and old people and has no bargaining power, you are struggling to pay yourself old MGMA average with pro-fees (indications, fractionation, Medicare compensation etc).

Not to mention that we all matter less and less (academics included).

But if you are at a large institution with a favorable payor mix and regional bargaining power...maybe you are working 3/4 weeks a year with 3 clinic days per week and probably not making much less than many hospital employed docs? (Of course, I am aware of some prestige places that are actually tremendously bottom line driven and underpay/clinically overwork their young faculty).

There are clearly some sweet spot academic jobs out there. Congratulations to the OP for landing one. Clearly with a commitment from an academic place this early, they are valued by the institution.

I would have jumped at an opportunity like this (the breast part aside).

IMO, the best part of a job offer like this is the time...time to make something unique out of it, either from a research or pedagogical standpoint. That's what academics is for after all.

Thank you for the kind words and the congratulations! I agree in that there is something to be said for lifestyle when it comes to some academic (non exploitative/ rotating satellite center) jobs. Of course it comes with tradeoffs in terms of compensation (will be making a little less than MGMA median) but between the vacation, extremely light call, and 2.5-3 days/week of protected/ work from home time, it was worth it for me. As you have said, I definitely intend to make the most of the academic time that I have!

 

[levelsands]

are you allowed to do locums on your off weeks?

In years past our group has had some local-ish academics come do coverage for us. Good way to pick up extra money if you need it and also dip a toe in private practice.

That's a great thought, I considered it as well, but I would have to realistically travel a few hours away for locum opportunities and with babies at home and a wife that's a few years behind me in a different residency program, it would difficult to manage.

 

[temujim]

Thanks for the response, I apologize as I should have been more clear, but they just require that I see 180-190 patients in consultation--that should hopefully make things more manageable. Wow, impressive level of efficiency on your part if you're doing that much brachy while still being productive in research!

Many academic sites consider ~150 new starts for a 1.0 FTE clinical to be the target. That's around 90 for 0.6 FTE, so 180-190 with a 50% conversion rate, particularly for breast which as others have noted in this thread may go closer to home rather than the academic mothership, may be reasonable.

 

[NotMattSpraker]

Thanks for the response, I apologize as I should have been more clear, but they just require that I see 180-190 patients in consultation--that should hopefully make things more manageable. Wow, impressive level of efficiency on your part if you're doing that much brachy while still being productive in research!

What happens to you if you dont see the 180-190?

Are you responsible for getting those on to your schedule or do you have a good idea where they will come from?

 

[ramsesthenice]

Thanks for the response, I apologize as I should have been more clear, but they just require that I see 180-190 patients in consultation--that should hopefully make things more manageable. Wow, impressive level of efficiency on your part if you're doing that much brachy while still being productive in research!

It definitely would make it more manageable. Again, the vast majority of academic sites won't set you up to fail. I would be very clear on what metrics will be used to assess your performance and bonus etc. There has been more of a push post-COVID at many centers to cede power away from the chair and back to the SOM and consequently, it has become more formulaic at many centers. I can't say I have ever seen a situation in which the number of new consults was considered a key metric since as I suggested, it can be fairly removed from revenue generation. Honestly, if they have a good mix of long-term and newer faculty who feel like they are supported and have time to do what they need to do, that is what you really need to know at this point. Academic or PP, there is a reason that high turn over is the single biggest red flag you can have.

 

[evilbooyaa]

I can't imagine 'thyroid' being a sub-site that one would treat. Thyroid gets wrapped into H&N where I am. GU is fine if you can handle the long consults and low conversion rates (or referral to community centers if they come to your institution to see the Uro Onc). Lung would be the best. Most who are referred are going to get treatment (because surgeons will still frequently resect without 'sending to Rad Onc to discuss SBRT' for early stage). If those 3 are what you're between, I'd recommend lung.

If you ever want to switch jobs to potentially being a generalist (or some other disease site), being the 'breast/thyroid' specialist would probably make it pretty hard for someone to be willing to hire you.

 

[pikachu]

I can't imagine 'thyroid' being a sub-site that one would treat. Thyroid gets wrapped into H&N where I am. GU is fine if you can handle the long consults and low conversion rates (or referral to community centers if they come to your institution to see the Uro Onc). Lung would be the best. Most who are referred are going to get treatment (because surgeons will still frequently resect without 'sending to Rad Onc to discuss SBRT' for early stage). If those 3 are what you're between, I'd recommend lung.

If you ever want to switch jobs to potentially being a generalist (or some other disease site), being the 'breast/thyroid' specialist would probably make it pretty hard for someone to be willing to hire you.

I hear parts of the pripyat exclusion zone are now considered safe to farm, so maybe a motivated new grad with an interest in thyroid cancer...