Union for radiation oncologists?

[Purplethread]

In light of the changes to the current supply/demand of radiation oncologists and the trend of corporations acquiring more and more radiation centers across the country, I wanted to gauge interest and get some input on forming a union for radiation oncologists. Anti-trust laws dictate that only employees can join unions, so this won't apply to partnerships, but it can apply to academic centers and corporations.

It might offer a solution to many of problems we face now. If we unionize, radiation centers might look less attractive to corporations, so it might slow down the rate their acquisition if we can keep wages higher. It might also allow us to accumulate more bargaining power to put pressure on academic centers to reverse the short sighted policies they have adopted.

Any input would be appreciated.

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Members don't see this ad.

 

[seper]

private practitioners cannot unionize by definition, but I guess they may be a minority now.

 

[Purplethread]

private practitioners cannot unionize by definition, but I guess they may be a minority now.

Exactly.

 

[RickyScott]

Whether its called a union or not, we need a professional society that actually represents ours and public interests, is what you are getting at, even if doesnt meet the legal definition of a union,

ASTRO actually works against/harms us, as detailed in many posts. Residency expansion in spite of declining demand is a "tragedy of the commons" affecting the vast majority of practioners in and out of training. Lobbying against medicare cuts to protons for prostate certainly isnt in mine (or society's) interest. Neither is focusing on utilization, not the real culprit, "prices" with "choosing wisely:" Bills payed by pts and insurance companies to MDACC/MSCKC or large regional university systems are disgusting.

I would love to support an organization that cares about our future whether we call it a union or not. In the meantime consider not renewing astro dues.

 

[seper]

A "union" of salaried RadOnc's.. May be a viable idea.

 

[medgator]

If you work at a SUNY facility in NY, I believe you are mandated to be in a public sector union anyways.

Then again, a timely SCOTUS decision came out today....

Supreme Court ruling deals major blow to public worker unions

 

[Purplethread]

Professional organizations have failed us. The leaders are out of touch and they are doing a disservice to the profession, the patients, the tax payers (Overcapacity leads to increased cost). Since most of us are/will be employees, a union would be better suited to carry negotiations directly on behalf of it's member, rather than the quasi-leadership we have in place now that doesn't have any leverage against the people expanding residency spots and hiring junior rad oncs

 

[Purplethread]

If you work at a SUNY facility in NY, I believe you are mandated to be in a public sector union anyways.

Then again, a timely SCOTUS decision came out today....

This ruling wouldn't be as important for us as membership in the union/paying union dues will be optional

 

[deleted18755]

In light of the changes to the current supply/demand of radiation oncologists and the trend of corporations acquiring more and more radiation centers across the country, I wanted to gauge interest and get some input on forming a union for radiation oncologists. Anti-trust laws dictate that only employees can join unions, so this won't apply to partnerships, but it can apply to academic centers and corporations.

It might offer a solution to many of problems we face now. If we unionize, radiation centers might look less attractive to corporations, so it might slow down the rate their acquisition if we can keep wages higher. It might also allow us to accumulate more bargaining power to put pressure on academic centers to reverse the short sighted policies they have adopted.

Any input would be appreciated.

I literally have no idea if you are serious or joking, if this is feasible or just an over enthusiastic but unrealistic endeavor, or honestly how or why I or anybody would join and/or what the pros and cons may be (but I do know that ASTRO is not only worthless but detrimental to me and my patients/society).

Perhaps you could briefly outline exactly what it is that you are proposing, how we might make it come to fruition, and and how/why you think it would benefit us and our patients.

 

[Purplethread]

I literally have no idea if you are serious or joking, if this is feasible or just an over enthusiastic but unrealistic endeavor, or honestly how or why I or anybody would join and/or what the pros and cons may be (but I do know that ASTRO is not only worthless but detrimental to me and my patients/society).

Perhaps you could briefly outline exactly what it is that you are proposing, how we might make it come to fruition, and and how/why you think it would benefit us and our patients.

So I am by no means an expert regarding this topic, but the research I have done so far appears promising.

The first link I have here discusses the legality of doctors organizing, and conditions under which it's legal or if violates anti-trust laws:
(Apparently I'm not allowed to post links, so google medicaljustice can doctors form a union)

"In summary: Physicians who are hospital employees (or collective employees of a different large organization) may unionize. Physicians still in training now have an enforceable right to unionize under the National Labor Relations Act. Independent physicians who attempt to unionize will likely violate anti-trust laws."

The second link is from the AFL-CIO, with actual instructions on how to go about building a union. They are also willing to provide a union organizer to help with the process
(Still can't post links, so check the AFL-CIO's website on how to form a union)

"4 Steps to Form a Union
When you and your co-workers come together to form a union, you get the right to negotiate with your employer over wages, benefits and working conditions.

No matter what the industry you are in, or the labor law that covers it, the process for forming a union is similar.

1. Get together with your co-workers who may share a common interest in organizing a union.
2. Talk to a union organizer in order to strategize and to learn the next steps.
3. Talk to your co-workers to build support for the union.
4. Show that support through an election or a card-check once you have a strong majority.

Once your union is official, you’ll choose your leaders and negotiate a contract. The process is democratic, and the more inclusive you can be, the stronger your union will be."

Using that as starting point, I thought I would gauge interest in the idea, and if people would like to provide insight into the applicability of such union to our field, challenges they anticipate and benefits they think we might glean from this.

 

[Purplethread]

I literally have no idea if you are serious or joking, if this is feasible or just an over enthusiastic but unrealistic endeavor, or honestly how or why I or anybody would join and/or what the pros and cons may be (but I do know that ASTRO is not only worthless but detrimental to me and my patients/society).

Perhaps you could briefly outline exactly what it is that you are proposing, how we might make it come to fruition, and and how/why you think it would benefit us and our patients.

The most immediate benefit we would experience comes from contract negotiations, including non-compete clauses, salaries, working conditions...etc
If residents elect to form a union as well, that might be the mechanism which we use to halt expansion of rad onc programs and push them to actually hire graduated residents...etc
Limiting residency spot expansion is an important part of tacking the issue of capacity utilization in the rad onc field ( too many rad oncs, Linacs...etc would increase the cost merely because doctors will do whatever they can to bring RVUs in)
Opportunities for improvement to help our field as a whole can come from membership dues, I have some possibilities in mind, but it's premature to talk about at this point

 

[scarbrtj]

Unionized rad onc residents: scary... but promising.

 

[Fpg1245]

Sounds delusional. Unions won’t make a difference. Rad Onc has so many other structural issues that pose a bigger threat to its viability that unionizing cannot solve. Focusing your energies attempting to unionize will only push you further in the hole faster. If you haven’t noticed, everybody from payors to other medical specialties (med Onc) have an axe to grind with rad onc. I would focus elsewhere.

 

[seper]

AFAIK residents in UK have unionized, with positive outcome.

 

[Fpg1245]

AFAIK residents in UK have unionized, with positive outcome.

By positive outcome you mean what exactly? I have no idea what that means. I guess if the residents felt good about unionizing that could count as a positive outcome. Also, don’t you need to actually offer some kind of essential service that cannot be substituted in order to be an effective organization? As much as it pains me to say this, the future of oncology has a far smaller role for RT. So while we go around stopping our feet for X, Y, and Z from the big bad admins and their army of bean counters, everyone else in the oncology world has found a way to bypass us entirely. Tell it to all those factory workers at the plant who thought the union had it all figured out and their jobs were secure. Human progress can be a real drag especially if you are on the wrong side of history.

 

[seper]

No, I think "junior doctors" in UK have to work less, but get paid more, compared to US residents.

 

[OTN]

I don't think it would work:

They've made too many radonc residents, so we have a glut of highly-trained, highly-intelligent, hard-working people who are either unemployed (there's a graduate from a radonc residency in my city right now who simply isn't working) or underemployed. Let's say you create a union and try to organize to help with hospital-based employment. What's stopping an unemployed radonc from not joining the union and getting the job a union member is trying to negotiate for? Why would a hospital ever want to hire a unionized doc when non-unionized docs are available? Wouldn't a union immediately put its members at a disadvantage with respect to employment?

You can say "well, if we get enough radoncs to join the union they wouldn't be able to do that" - do you really think that's possible? Imagine going to medical school, going through residency, and then telling yourself you're going to limit your employment opportunities at age 31 (finally!) because there's a union being formed that may help your employment in the future. No chance at ALL I would do it, and I imagine many others would feel the same way.

I also don't see the leverage a union would have over residency spots. There are enough MD/PhDs who were sold on radonc academic careers to fill academic positions for a very, very long time, and I can't imagine very few of them would be willing to hinder their academic career to protect the field as a whole. Private-practice docs (either free-standing or hospital-based) have zero leverage with academic programs, which a union wouldn't change.

I do think that if enough of us stopped being ASTRO members they would take notice. I let my membership lapse a year ago and will not renew until ASTRO addresses unbridled residency expansion and site payment parity. I'm not holding my breath.

 

[Purplethread]

I don't think it would work:

They've made too many radonc residents, so we have a glut of highly-trained, highly-intelligent, hard-working people who are either unemployed (there's a graduate from a radonc residency in my city right now who simply isn't working) or underemployed. Let's say you create a union and try to organize to help with hospital-based employment. What's stopping an unemployed radonc from not joining the union and getting the job a union member is trying to negotiate for? Why would a hospital ever want to hire a unionized doc when non-unionized docs are available? Wouldn't a union immediately put its members at a disadvantage with respect to employment?

You can say "well, if we get enough radoncs to join the union they wouldn't be able to do that" - do you really think that's possible? Imagine going to medical school, going through residency, and then telling yourself you're going to limit your employment opportunities at age 31 (finally!) because there's a union being formed that may help your employment in the future. No chance at ALL I would do it, and I imagine many others would feel the same way.

I also don't see the leverage a union would have over residency spots. There are enough MD/PhDs who were sold on radonc academic careers to fill academic positions for a very, very long time, and I can't imagine very few of them would be willing to hinder their academic career to protect the field as a whole. Private-practice docs (either free-standing or hospital-based) have zero leverage with academic programs, which a union wouldn't change.

I do think that if enough of us stopped being ASTRO members they would take notice. I let my membership lapse a year ago and will not renew until ASTRO addresses unbridled residency expansion and site payment parity. I'm not holding my breath.

I think there is an important point to highlight here. Employed rad oncs (especially those who got the short end of the stick during contract negotiations) can choose to organize together and attempt to renegotiate their contracts with their employers. It would be illegal for the employer to fire them or retaliate just because they did organize. You don't actually need to be a part of the union before getting hired. With a market glut, the only negotiating power any of us can get is with organization. That's essentially how our healthcare system works in general. Big hospital systems, insurance companies, drug companies negotiate with one another. Typically, the smaller you are the more of a disadvantage you will be at.

As residents, we don't have any real representation or anyone who actually advocates for us. You either accept residency as is or you quit. With organization, it at least formalizes the process and creates a platform for long term negotiations. The idea here is attempt to mitigate some of the damage that has happened and see if the ship can be turned around. I personally don't see any other alternatives for us.

 

[Fpg1245]

I think there is an important point to highlight here. Employed rad oncs (especially those who got the short end of the stick during contract negotiations) can choose to organize together and attempt to renegotiate their contracts with their employers. It would be illegal for the employer to fire them or retaliate just because they did organize. You don't actually need to be a part of the union before getting hired. With a market glut, the only negotiating power any of us can get is with organization. That's essentially how our healthcare system works in general. Big hospital systems, insurance companies, drug companies negotiate with one another. Typically, the smaller you are the more of a disadvantage you will be at.

As residents, we don't have any real representation or anyone who actually advocates for us. You either accept residency as is or you quit. With organization, it at least formalizes the process and creates a platform for long term negotiations. The idea here is attempt to mitigate some of the damage that has happened and see if the ship can be turned around. I personally don't see any other alternative to be honest for us.

I’m sorry but who are we trying to unionize again? It’s confusing. Residents? Attendings? Both?

 

[Purplethread]

By positive outcome you mean what exactly? I have no idea what that means. I guess if the residents felt good about unionizing that could count as a positive outcome. Also, don’t you need to actually offer some kind of essential service that cannot be substituted in order to be an effective organization? As much as it pains me to say this, the future of oncology has a far smaller role for RT. So while we go around stopping our feet for X, Y, and Z from the big bad admins and their army of bean counters, everyone else in the oncology world has found a way to bypass us entirely. Tell it to all those factory workers at the plant who thought the union had it all figured out and their jobs were secure. Human progress can be a real drag especially if you are on the wrong side of history.

Part of the reason RT is playing less of a role in oncology is the fact that not enough substantive research is being made into finding new indications for radiation or incorporate them in clinical trials. There are also other non-onc indications for RT that are not being pursued aggressively to increase volumes. Also, another important point is that rad onc jobs cannot be outsourced. Board certification requirements can actually protect us. Demand for RT is relatively inelastic on the short term. Many of the reasons that make unions ineffective for industry don't actually apply in medicine. The people who we will be negotiating against are not other specialists or even insurance companies, it's actually the administrators and senior radiation oncologists who are causing all the problems for us at this juncture because they have all the power

 

[Purplethread]

I’m sorry but who are we trying to unionize again? It’s confusing. Residents? Attendings? Both?

Residents, attending or both. Obviously it would be better to do both. Some settings might be easier to for residents and others might be easier for employed rad oncs. I would imagine it would be better to setup a separate union for residents and another for attendings

 

[Purplethread]

I do think that if enough of us stopped being ASTRO members they would take notice. I let my membership lapse a year ago and will not renew until ASTRO addresses unbridled residency expansion and site payment parity. I'm not holding my breath.

I don't think anything will send a better message to ASTRO than another competing organization forming, even though a union won't necessarily be at odds with ASTRO

 

[scarbrtj]

Also, another important point is that rad onc jobs cannot be outsourced.

They absolutely could be. Any doctor of any specialty, MD or DO, can be the supervising physician whilst XRT is administered. In a hospital, it can even be a PA or NP. Why enterprising (unscrupulous) sorts have not taken advantage of this is unknown. Theoretically, one rad onc and 4 other whatever-MDs could run 5 clinics. Theoretically, one rad onc and X number of NPs could run X-1 hospital-based rad onc clinics. In the era of broadband and remote access, rad oncs could do more remote stuff à la radiology. The only way rad onc can't be outsourced is for radioactive sources; yet even then, non-rad oncs (with experience) can be authorized users.

 

[seper]

Since no one is doing it, it must be illegal. Instead hospitals are paying 250K+ for BS RadOncs to babysit clinics.

They absolutely could be. Any doctor of any specialty, MD or DO, can be the supervising physician whilst XRT is administered. In a hospital, it can even be a PA or NP. Why enterprising (unscrupulous) sorts have not taken advantage of this is unknown. Theoretically, one rad onc and 4 other whatever-MDs could run 5 clinics. Theoretically, one rad onc and X number of NPs could run X-1 hospital-based rad onc clinics. In the era of broadband and remote access, rad oncs could do more remote stuff à la radiology. The only way rad onc can't be outsourced is for radioactive sources; yet even then, non-rad oncs (with experience) can be authorized users.

 

[Purplethread]

They absolutely could be. Any doctor of any specialty, MD or DO, can be the supervising physician whilst XRT is administered. In a hospital, it can even be a PA or NP. Why enterprising (unscrupulous) sorts have not taken advantage of this is unknown. Theoretically, one rad onc and 4 other whatever-MDs could run 5 clinics. Theoretically, one rad onc and X number of NPs could run X-1 hospital-based rad onc clinics. In the era of broadband and remote access, rad oncs could do more remote stuff à la radiology. The only way rad onc can't be outsourced is for radioactive sources; yet even then, non-rad oncs (with experience) can be authorized users.

With CMS rule changes, you don't need to babysit machines every day. A rad onc still has to do the consult and plan treatments

 

[medgator]

They absolutely could be. Any doctor of any specialty, MD or DO, can be the supervising physician whilst XRT is administered. In a hospital, it can even be a PA or NP. Why enterprising (unscrupulous) sorts have not taken advantage of this is unknown. Theoretically, one rad onc and 4 other whatever-MDs could run 5 clinics. Theoretically, one rad onc and X number of NPs could run X-1 hospital-based rad onc clinics. In the era of broadband and remote access, rad oncs could do more remote stuff à la radiology. The only way rad onc can't be outsourced is for radioactive sources; yet even then, non-rad oncs (with experience) can be authorized users.

Until you get the OIG/CMS on your back for violating IGRT supervision rules. Afaik, there are no igrt fellowships for NP/PAs

 

[nkmiami]

Until you get the OIG/CMS on your back for violating IGRT supervision rules. Afaik, there are no igrt fellowships for NP/PAs

well unfortunately, there are plenty of igrt fellowships for radiation oncologists, which is probably the point of this thread.

For hospitals: "...either a physician or a non-physician practitioner may directly supervise hospital outpatient therapeutic services.1 However, the supervising physician or non-physician practitioner must have within his or her State scope of practice and hospital-granted privileges the ability to perform the service or procedure that he or she supervises."

Trained advanced practioners (np/PA) are explicity allowed to cover inpatient radiation facilities. In terms of IGRT, a physician can approve that at the end of the day before the next treatment.

For freestanding centers, cms stipulates just an md. There is no language qualifying the type of training or practice: "Regarding clinical qualifications for the supervising provider of freestanding radiation therapy services, CMS only indicates that direct personal supervision by a physician is required."

 

[medgator]

well unfortunately, there are plenty of igrt fellowships for radiation oncologists, which is probably the point of this thread.

For hospitals: "...either a physician or a non-physician practitioner may directly supervise hospital outpatient therapeutic services.1 However, the supervising physician or non-physician practitioner must have within his or her State scope of practice and hospital-granted privileges the ability to perform the service or procedure that he or she supervises."

Trained advanced practioners (np/PA) are explicity allowed to cover inpatient radiation facilities. In terms of IGRT, a physician can approve that at the end of the day before the next treatment.

For freestanding centers, cms stipulates just an md. There is no language qualifying the type of training or practice: "Regarding clinical qualifications for the supervising provider of freestanding radiation therapy services, CMS only indicates that direct personal supervision by a physician is required."

So is the ASTRO white paper on supervision requirements out of date?

https://www.astro.org/uploadedFiles...tice/Content_Pieces/SupervisionWhitePaper.pdf

"While CMS does not explicitly state that a radiation oncologist must supervise radiation therapy, it is ASTRO’s opinion that a board-certified/board-eligible Radiation Oncologist is the clinically appropriate physician to supervise radiation treatments."

"Direct supervision means that the physician must be immediately available, meaning physically present, interruptible and able to furnish assistance and direction throughout the performance of the procedure. The physician is not required to be present in the room during the procedure or within any other physical boundary as long as he or she is immediately available"

(77014 - Computed tomography guidance for placement of radiation therapy fields and 77421 or G60029 - Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy10)

I guess you're kind of right but you're forgetting about the requirement to be able to assist in furnishing IGRT if necessary. I'm guessing the np or PA isn't going to be doing that.

I am sure the lawyers would have a field day with it if anything happened though since Medicare suggests the person needs to be qualified to assist during IGRT if any questions come up, since direct supervision is mandated.

Personally, I think there are enough qui tam lawsuits (and multi-million dollar settlements) in the papers and on the books (esp in FL), to make anyone think twice about using a non-RO to cover IGRT.

 

[Purplethread]

As there has been some confusion with the way I presented the topic, I thought it might be helpful to create another thread discussing viability of unionizing for residents specifically

To unionize or not to unionize-resident edition

 

[nkmiami]

why would you want to unionize as opposed to just forming an organization that actually represent the interests of radiation oncologists and the public good. That would be much easier to do, better received, and less controversial.

 

[Purplethread]

why would you want to unionize as opposed to just forming an organization that actually represent the interests of radiation oncologists and the public good. That would be much easier to do, better received, and less controversial.

Simple answer: leverage. ASTRO for example doesn't have any power over what rad onc programs can or cannot do. The controversy regarding unions stems for politics, not pragmatism. We can brand it differently to avoid the controversy I suppose, but you need actual clout to change things

 

[nkmiami]

Simple answer: leverage. ASTRO for example doesn't have any power over what rad onc programs can or cannot do. The controversy regarding unions stems for politics, not pragmatism. We can brand it differently to avoid the controversy I suppose, but you need actual clout to change things

I would strongly advise not calling it a "union" Leverage would come from having a large, inclusive membership, some of whom would definitely be turned off by the concept of unionization, and legally, it may not even be attainable. There is certainly space for an organization that represents my professional interests and that of the general public.

I disagree that ASTRO has no "power" over programs. They certainly can influence them as "the programs senior members/chairmen" are who ASTRO is. That is like saying ASTRO can not affect radiation reimbursement by CMS because ASTRO is not, in fact, the federal government. True, but that doesnt stop ASTRO from having a PAC and organizing means to influence policy/rates. Collective voice carries a lot of influence. If you think that forming a union, will somehow give you the clout/power to force through what you want, that is simply not how things work.

Radiation is not going to disappear in the next 10 years, but its utilization certainly may decrease, so everyone should be concerned by expanding the supply of docs/

 

[Purplethread]

I would strongly advise not calling it a "union" Leverage would come from having a large, inclusive membership, some of whom would definitely be turned off by the concept of unionization, and legally, it may not even be attainable. There is certainly space for an organization that represents my professional interests and that of the general public.

I disagree that ASTRO has no "power" over programs. They certainly can influence them as "the programs senior members/chairmen" are who ASTRO is. That is like saying ASTRO can not affect radiation reimbursement by CMS because ASTRO is not, in fact, the federal government. True, but that doesnt stop ASTRO from having a PAC and organizing means to influence policy/rates. Collective voice carries a lot of influence. If you think that forming a union, will somehow give you the clout/power to force through what you want, that is simply not how things work.

Radiation is not going to disappear in the next 10 years, but its utilization certainly may decrease, so everyone should be concerned by expanding the supply of docs/

I am certainly not opposed to considering that. However, I believe that there are some resident-run organizations that exist currently which have not done anything to resolve this problem, and as you said, ASTRO has been hijacked by the few people who actually benefit from the status quo. How would you suggest we go about changing that without a union. Who will listen to some obscure newly formed organization? How will such an organization be funded? Who will be willing to pay the dues?

Chairmen and bean counters have a direct financial incentive to maintain the status quo, and are likely experiencing pressure from the administration to continue with the current policies. It will take more than an organization crying foul to alter that behavior

there is nothing illegal about organizing. Essentially if you have a W-2 you can organize

 

[OTN]

I would strongly advise not calling it a "union" Leverage would come from having a large, inclusive membership, some of whom would definitely be turned off by the concept of unionization, and legally, it may not even be attainable. There is certainly space for an organization that represents my professional interests and that of the general public.

I disagree that ASTRO has no "power" over programs. They certainly can influence them as "the programs senior members/chairmen" are who ASTRO is. That is like saying ASTRO can not affect radiation reimbursement by CMS because ASTRO is not, in fact, the federal government. True, but that doesnt stop ASTRO from having a PAC and organizing means to influence policy/rates. Collective voice carries a lot of influence. If you think that forming a union, will somehow give you the clout/power to force through what you want, that is simply not how things work.

Radiation is not going to disappear in the next 10 years, but its utilization certainly may decrease, so everyone should be concerned by expanding the supply of docs/

"Certainly" may decrease? I'm not 100% sure about this. I'm still very hopeful, once the academics actually start doing interesting research rather than ****ty fractionation trials over and over, we may start playing a larger role in treating synergistically with immunotherapy, and I'm very bullish on radiocardiology, although we're still in the early phases of things. Of course, I'm the guy with a tiny, tiny prostate practice (thanks, urorads), so hypofractionation in that space isn't going to effect me at all.

 

[evilbooyaa]

Not to completely hijack the thread, but the amount of SBRT we do for oligometastatic or oligoprogressive disease is much much higher than it would've been in the past. The stimulation of the abscopal effect in IT is also a favorite of certain med-oncs, and we're happy to oblige.

To have an ontopic aspect: Even as a resident who is concerned about the residency expansion, I don't think unionizing is the right idea. I wish ACRO was willing to take a strong, public stance against residency expansion, because I think that would increase their membership significantly and potentially let them try to compete for real with ASTRO.

 

[Purplethread]

I don't think unionizing is the right idea.

Why not? I'm trying to get a better feel for what other residents think about that

 

[evilbooyaa]

Because the age-old adage still holds to this day: They can always hurt you more. That applies to all residents regardless of field.

 

[Purplethread]

Because the age-old adage still holds to this day: They can always hurt you more. That applies to all residents regardless of field.

Please check out this article: pubmed 21646972. I have attached it just in case

 

[DebtRising]

I had a long post but deleted it.

Very simply, the data points all clearly show this field supply and new graduates are being abused by a power structure no one can really firmly identify and the job market for a career that takes 9 years after college is pretty dismal. It's basically ACGME saying 'oh we don't care if society needs more of this doctor type, not our job, besides we don't pay for it anyway', ABR saying 'we want more dues and fees', SCAROP saying nothing, and ASTRO saying 'not our fight, who knows what will happen, please join our membership and pay dues'. Everyone points a finger somewhere else - no one is taking responsibility to say 'this is good for society, this is a good use of financial Medicare resources, this is a good use of intelligent human capital'. Because none of those organizations apparently have that as their mission. Insane when you think about in the pipeline of using tax payer dollars to train physicians, there is no entity charged with evaluating if society actually needs those physicians in the first place.

So when you have no clear responsible party, you obviously can't hurt them. If you unionized - I could just see a chair saying 'oh we'll just expand more to spread out the work' - and next thing you know there is another tax payer funded residency spot, another note writing / scut working / paper writing body, with minimal if any cost to the department itself. Then that's another new body for the fellowship they open to keep the cycle going.

The solution is to get out. I didn't, my hypocrisy on full display, I was too deep in. Regret it. The published data are very clear where this field is going, and you can't fight it. Just educate the next wave, and if they ignore you and believe ASTRO and chairs, let their rude awakening be directed at the parties who failed to give them honest information about what is going on.

 

[evilbooyaa]

Please check out this article: pubmed 21646972. I have attached it just in case

The people who benefit from a residents union (which was done amongst residents at one hospital) is not in dispute here. What you are suggesting is unionization of ALL rad onc residents. There is a stark difference between the residents at one institution unionizing (similar to the workers at one company or factory unionizing) and multiple residency programs that do not have collaborative arrangements to unionize (this would be similar to all department store workers unionizing as one cohesive group, for example).

In addition, all of the concerns that sparked the unionization were in-house things: " At our institution, low salaries, threats of increased premiums for resident health insurance benefits, and the presence of a few key resident leaders likely led to the unionization."

I think my salary is reasonable for a resident. Premiums for resident health care are reasonable. Everything about my program, my institution, itself, is good and I have no strong complaints about my actual program. I love the hospital I work at and have no complaints about the hospital. A union would be helpful if me and everybody else who was in residency in the whole hospital had an axe to grind with the HOSPITAL. Without full buy-in of all residents (across programs) it wouldn't really work.

You notice that the authors of that commentary are across specialties, right? Meaning that EM, IM, and Peds all came together to unionize as one resident cohort. How would that work in Rad-onc? Most places have 1-3 residents a year. Other specialties residents aren't going to give 2 ****s if the rad onc residency is expanding. Most specialties would probably think residency expansion is a good thing that we would want since it leads to less call responsibilities.

 

[thecarbonionangle]

Quixotic thinking here. As much as I would like to see this work, it would never happen. The biggest obstacle is that you would not be able to convince a significant amount of people to join such a risky thing. As long as there are people who do not buy into it because of fear, caution, politcs, opportunism, whatever, Chairs and other bean counters will use our differences to devide us. I don’t know what we can do. I sometimes think about getting out due to anxiety this is causing me but im too much of a coward to leave a field ive invested so much into

 

[RickyScott]

Quixotic thinking here. As much as I would like to see this work, it would never happen. The biggest obstacle is that you would not be able to convince a significant amount of people to join such a risky thing. As long as there are people who do not buy into it because of fear, caution, politcs, opportunism, whatever, Chairs and other bean counters will use our differences to devide us. I don’t know what we can do. I sometimes think about getting out due to anxiety this is causing me but im too much of a coward to leave a field ive invested so much into

Thats why it shouldnt be a union, but just an alternative organization to supplement ASTRO , much less controversial and inclusive.For example, I know a lot of junior faculty who are fed up with ASTRO, but would never join a union.

 

[medgator]

Thats why it shouldnt be a union, but just an alternative organization to supplement ASTRO , much less controversial and inclusive.For example, I know a lot of junior faculty who are fed up with ASTRO, but would never join a union.

That's what ACRO had has trying to do afaik, but to be fair I haven't gone to their meetings lately. Traditionally they are more geared towards community/private practice

 

[Herehere]

Is it time to revive this thread, especially after programs essentially used SOAP as a backdoor draft? 2 years later things have only gotten worse...The only silver lining is that most med students now know to stay clear of rad onc, and for those who inexplicably choose to match, it's now a buyer's market for US seniors when it comes to their choice of residency program

 

[deleted941485]

Is it time to revive this thread, especially after programs essentially used SOAP as a backdoor draft? 2 years later things have only gotten worse...The only silver lining is that most med students now know to stay clear of rad onc, and for those who inexplicably choose to match, it's now a buyer's market for US seniors when it comes to their choice of residency program

Yeah I’m sure all those ophthalmology and Derm rejects don’t know the deal with rad onc. They’ll have plenty of time to build up their resume once they start the RO residency so they can reapply. Hopefully that’s their plan and not actually to complete the residency.

 

[Herehere]

Yeah I’m sure all those ophthalmology and Derm rejects don’t know the deal with rad onc. They’ll have plenty of time to build up their resume once they start the RO residency so they can reapply. Hopefully that’s their plan and not actually to complete the residency.

I wouldn't count on it... the sunk cost fallacy still reigns supreme. Maybe it's time we relied on each other to defend our collective well-being rather than hope that others will merely choose to abandon ship.

 

[scarbrtj]

They absolutely could be. Any doctor of any specialty, MD or DO, can be the supervising physician whilst XRT is administered. In a hospital, it can even be a PA or NP. Why enterprising (unscrupulous) sorts have not taken advantage of this is unknown. Theoretically, one rad onc and 4 other whatever-MDs could run 5 clinics. Theoretically, one rad onc and X number of NPs could run X-1 hospital-based rad onc clinics. In the era of broadband and remote access, rad oncs could do more remote stuff à la radiology. The only way rad onc can't be outsourced is for radioactive sources; yet even then, non-rad oncs (with experience) can be authorized users.

Am I a prophet?!

 

[thecarbonionangle]

I wouldn't count on it... the sunk cost fallacy still reigns supreme. Maybe it's time we relied on each other to defend our collective well-being rather than hope that others will merely choose to abandon ship.

the field is doomed. You’re too late, sorry brotha.
There are a lot of people in our field who are just dead weight, even the young ones, many people who stand for nothing. It drives me crazy many of the personalities we attract, lots of passivity.

this past match was a disgrace.

 

[Herehere]

the field is doomed. You’re too late, sorry brotha

That's another fallacy. Just because things are bad doesn't mean we shouldn't intervene in any way we could. The more we wait the worse things will become. The reality is that we really don't know the point of no return for the job market.

The trend in medicine is that more and more MDs are becoming employees. We can wield a lot of power, but that's not a given, it's a choice.

 

[thecarbonionangle]

That's another fallacy. Just because things are bad doesn't mean we shouldn't intervene in any way we could. The more we wait the worse things will become. The reality is that we really don't know the point of no return for the job market.

The trend in medicine is that more and more MDs are becoming employees. We can wield a lot of power, but that's not a given, it's a choice.

id say the real fallacy is believing that things can change. Momentum and inertia are powerful things. Im actually on your side but many people are just apathetic and unwilling to stick neck out of shell. We are the turtle catfishes of oncology, at the very least surrounded by them in our field.