Unsolicited Jobs Thread

[Gfunk6]

In case any of you were hoping to stay in academics, I present the following for your consideration:

The Radiation Oncology Department at Eastern Virginia Medical School (EVMS), in the Norfolk-Virginia Beach region of Virginia, seeks a Radiation Oncologist for a full-time faculty position.

Not only will you enjoy a wide variety of cases, but you'll also live and work in highly desirable Coastal Virginia.

Hampton Roads is an iconic waterfront region in southeastern Virginia and a vibrant community of 1.7 million residents across nine cities and five counties. It is home to Virginia Beach, Newport News, Norfolk, and Chesapeake Bay.

Opportunity Highlights​

• Beautiful Hampton Roads area and a 20-minute drive to Virginia Beach 
• Rated No. 3 on the index of Emerging Creative Hubs in the US (WeTransfer's 2022)
• No. 9 Best City for US doctors (The Darwinian Doctor 2021) 
• Affordable housing, including Colonial-inspired townhomes, waterfront condos, and downtown lofts  
• Nearby historic district (Ghent) walkable from the medical center, with many amenities
• A lower cost of living than the national average   
• Virginia is a 2022 Best Place to Practice (Medscape)
• Enjoy a biking/pedestrian culture and a plethora of outdoor activities afforded by 144 miles of shoreline  
• Indulge in a world-class culinary scene starring fresh seafood, Spanish tapas, and Southern-fried chicken and biscuits  
• Explore countless recreational options, including golf, local wineries and breweries, museums, zoos, gardens, and performing arts venues  
• Easy access to Washington, DC, and the Shenandoah/Blue Ridge Mountains
• General radiation oncology opportunity
• Treat a wide variety of cancers and have a subspecialty, if desired
• Position is clinically oriented with the benefits of being in a medical school with access to clinical trials, conferences, CME, and possible research opportunities

---

Members don't see this ad.

 

[medgator]

In a different era, i think evms used to even have a residency that got shut down.

 

[fiji128]

In a different era, i think evms used to even have a residency that got shut down.

EVMS rad onc 1977 to 2006. 5 total resident positions.

 

[TheWallnerus]

EVMS rad onc 1977 to 2006. 5 total resident positions.

Gotta be weird to have done a residency at a program that no longer exists. I think this happens a little more commonly in rad onc, relative percent wise, than other specialties (a place in Carolina, Vandy lost theirs for a while as did Emory, Cal Pacific)…

 

[medgator]

Gotta be weird to have done a residency at a program that no longer exists. I think this happens a little more commonly in rad onc, relative percent wise, than other specialties (a place in Carolina, Vandy lost theirs for a while as did Emory, Cal Pacific)…

So many defunct programs... Howard, MCG, Drexel, nymc and St Barnabas to name some others

 

[TheWallnerus]

So many defunct programs... Howard, MCG, Drexel, nymc and St Barnabas to name some others

Maybe a failure of leadership. Or just the random hard knocks of life.

 

[evilbooyaa]

Know a guy at EVMS and he's ag ood dude, not sure I would call EVMS academics under any definition of that word....

 

[Gfunk6]

 

[Doctorer]

View attachment 370885

I was tempted to e-mail Terri to ask if the salary was a mistake.

 

[sirspamalot]

Welcome to Hell. No Amenities. Horrible Pay. Far from any major airport. You have arrived. Please prepare the next victim..

 

[udrag14]

View attachment 370885

I got the same one!

Wow I didn't realize it was 18 to 22 on treatment. That is such a terrible salary for that volume.

 

[medgator]

Welcome to Hell. No Amenities. Horrible Pay. Far from any major airport. You have arrived. Please prepare the next victim..

 

[sirspamalot]

Re-using my (recently posted) GIF... I'll allow it. This job sucks.

#

ps. just for fun.. I would only consider working there if they paid min 1M as a 1099 and it was a 3.5 day work week. And even then, I'd still say no right now.

 

[TheWallnerus]

View attachment 370885

I wonder if that’s 22 a day with 9 week prostates and 6.5 week breast patterns. One can’t know until one interviews! A well trained, hypofractionating new grad should be able to lower those numbers real nice like. Also I know several recent grads doing this volume, or more, for which this salary would be a raise.

 

[yesmaster]

When academic papers cite the geographic distribution problem of physicians and difficulty recruiting physicians to rural locations, what they are actually saying in rad onc is—

“Wouldn’t it be great if rad onc’s had no choice but to work for below MGMA pay in a middle of nowhere, tiny town USA? That’s one of many reasons we need to maintain our residency program quota.”

Author: Chair in NYC, LAX, Chicago

Rural gigs would actually be decent if they were 1-2 days on-site, otherwise fully remote, and well paid. Nope, rural hospitals don’t have to offer anything decent because of overtraining.

 

[medgator]

“Wouldn’t it be great if rad onc’s had no choice but to work for below MGMA pay in a middle of nowhere, tiny town USA? That’s one of many reasons we need to maintain our residency program quota.”

Author: Chair in NYC, LAX, Chicago

The chair at WUSTL said EXACTLY that a decade ago in the red journal, immortalized for everyone to see.

So then did rad onc begin its long and steady fall from the top echelon of specialties to the abyss/dumpster fire it is today.

Thank you, Dr Hallahan!

 

[Fpg1245]

I wonder if that’s 22 a day with 9 week prostates and 6.5 week breast patterns. One can’t know until one interviews! A well trained, hypofractionating new grad should be able to lower those numbers real nice like. Also I know several recent grads doing this volume, or more, for which this salary would be a raise.

I had someone tell me straight out they won’t hire new grads for positions for this reason. They either need to be told straight away how it’s done or their volumes start to dip and admin starts asking questions.

 

[TheWallnerus]

I had someone tell me straight out they won’t hire new grads for positions for this reason. They either need to be told straight away how it’s done or their volumes start to dip and admin starts asking questions.

To be a rad onc you have to be smart, learn science, learn medicine, and then pass your boards. After that you need to not make any mistakes so as to never be sued, never upset your therapists, keep great patient review scores… and never, ever, never have admin start asking questions.

 

[sirspamalot]

 

[Ray D. Ayshun]

To be a rad onc you have to be smart, learn science, learn medicine, and then pass your boards. After that you need to not make any mistakes so as to never be sued, never upset your therapists, keep great patient review scores… and never, ever, never have admin start asking questions.

Radoncs need to understand division: 27/5=5, 28/5=6. Once you understand that and cord tolerance you'll be just fine...

 

[fiji128]

View attachment 370885

These type of jobs were advertising the exact same thing in 2015 (meaning similar salary and remoteness of the location). However, $492k in 2015 is equivalent to $621k in 2023. I can easily imagine you will be able to get the exact same deal in nominal terms in 2028 as well. Always loosing ground at this point in rad onc.

 

[sirspamalot]

Loosing.. Loosening.. Losing... its all the same in the end. Madness.

 

[deleted1111261]

Imma go Sir spam on this

492 for 18-22 on beam in Farmington is a GD joke

 

[fiji128]

Imma go Sir spam on this

492 for 18-22 on beam in Farmington is a GD joke

Not disagreeing, but since you have been on the job trail somewhat recently what would you think would be a reality based number given current market dynamics?

 

[RadOncDoc21]

Not disagreeing, but since you have been on the job trail somewhat recently what would you think would be a reality based number given current market dynamics?

In that location and avg 20, I would expect at least 750k but honestly can see someone taking home 1 mil.

 

[sirspamalot]

 

[fiji128]

In that location and avg 20, I would expect at least 750k but honestly can see someone taking home 1 mil.

One might be able to get close that if you’re ortho or something but current market realities in rad onc do not suggest you can just name your price and have takers (outside of maybe some rare circumstances).

 

[RadOncDoc21]

One might be able to get close that if you’re ortho or something but current market realities in rad onc do not suggest you can just name your price and have takers (outside of maybe some rare circumstances).

Of course with more supply, there is less demand but just saying what the going rate was in 2021. Ortho would start off at one mil.

 

[deleted1111261]

Well

Base should be above median - 550-600
And rvu rate should be $60+

18-22 on treatment with hypo should get you to 11-12k. 700 easily achievable

But base should be close to 600 in that location and workload

 

[seper]

At a remote location, without local competition, a hire would usually be expected to over-utilize: prostate x 9 weeks, daily CBCT on WBRT, etc

 

[medgator]

At a remote location, without local competition, a hire would usually be expected to over-utilize: prostate x 9 weeks, daily CBCT on WBRT, etc

9 weeks of prostate might be reasonable in 2023. Not sure the same can ever have been said for daily cbct on a wbrt patient

 

[Mandelin Rain]

Here's the thing, this is an isolated, rural/reservation center with associated payor mix. Take solace in knowing that your salary sacrifice is the only thing that allows the C-suite to get multimillion dollar bonuses.

 

[sirspamalot]

... like I said, if you are taking anything less than 1M.. its like playing poker.

Consider this like playing poker :

If you don't know who the chump is.. ITS YOU.

# under 20, 1M over for fykville nowheretown USA.

 

[medgator]

... like I said, if you are taking anything less than 1M.. its like playing poker.

Consider this like playing poker :

If you don't know who the chump is.. ITS YOU.

# under 20, 1M over for fykville nowheretown USA.

I'd take away an increment of $100k for every day I get to tele-cover that clinic

 

[sirspamalot]

I'd take away an increment of $100k for every day I get to tele-cover that clinic

Make it 5 days a week and I'd consider it for 650k

 

[Ray D. Ayshun]

Imma go Sir spam on this

492 for 18-22 on beam in Farmington is a GD joke

Can probably negotiate up a little today

https://www.cnn.com/2023/05/16/us/farmington-new-mexico-shooting-tuesday/index.html

Gunmen roaming the streets should be worth at least a 100K bump.

 

[sirspamalot]

 

[elementaryschooleconomics]

I had someone tell me straight out they won’t hire new grads for positions for this reason. They either need to be told straight away how it’s done or their volumes start to dip and admin starts asking questions.

The current reality of the system that has been built is actually quite hilarious (in an insane sort of way).

All residency programs in RadOnc are at academic institutions. And not even all of them - mostly the biggest ones in urban areas.

ASTRO is basically God-Emperor in terms of societies. Sure, there's some "others", but there's usually a lot of overlap and they don't hold much sway.

ASTRO is and has always been run by faculty at monster academic institutions.

Because creativity died in RadOnc in the late 1990s or so, along with any level of backbone, we've spent 20 years trying to minimize our footprint.

Which, you know, is fine for monster academic shops with protons or PPS-exempt status or whatnot. They'll make it work.

But...that's not the actual reality for the majority of Radiation Oncologists. While the actual "RadOnc census" is hotly debated, I'm pretty certain there's around 5000 RadOncs working and 1000 of those are academic faculty (well, in the "pre rollup" sense, everyone is "academic" now...but I digress).

So what did we create here? 80% of the workforce are out in places where the margin contribution from RadOnc is critical. Often, those shops have been staffed by the same Boomers since the 1990s. Things are done a certain way.

And now we're deep into the Silver Tsunami. Retirements. New grads.

New grads that have been indoctrinated in the era of hypofrac and omission.

On interview day it's all "we're excited for young energy, this place has been stagnant for too long!"

Dear residents: that is a lie. No one is excited for change. God help you if you fall for it.

Head down. Conventional. Happy therapists. Happy Press-Ganey.

$400k.

 

[sirspamalot]

Depends on where you're living. 400k W2 to work in Farmington, NM?

 

[Fpg1245]

The current reality of the system that has been built is actually quite hilarious (in an insane sort of way).

All residency programs in RadOnc are at academic institutions. And not even all of them - mostly the biggest ones in urban areas.

ASTRO is basically God-Emperor in terms of societies. Sure, there's some "others", but there's usually a lot of overlap and they don't hold much sway.

ASTRO is and has always been run by faculty at monster academic institutions.

Because creativity died in RadOnc in the late 1990s or so, along with any level of backbone, we've spent 20 years trying to minimize our footprint.

Which, you know, is fine for monster academic shops with protons or PPS-exempt status or whatnot. They'll make it work.

But...that's not the actual reality for the majority of Radiation Oncologists. While the actual "RadOnc census" is hotly debated, I'm pretty certain there's around 5000 RadOncs working and 1000 of those are academic faculty (well, in the "pre rollup" sense, everyone is "academic" now...but I digress).

So what did we create here? 80% of the workforce are out in places where the margin contribution from RadOnc is critical. Often, those shops have been staffed by the same Boomers since the 1990s. Things are done a certain way.

And now we're deep into the Silver Tsunami. Retirements. New grads.

New grads that have been indoctrinated in the era of hypofrac and omission.

On interview day it's all "we're excited for young energy, this place has been stagnant for too long!"

Dear residents: that is a lie. No one is excited for change. God help you if you fall for it.

Head down. Conventional. Happy therapists. Happy Press-Ganey.

$400k.

400 in shiprock NM while your friends in Derm get to live in you know actual places

🤮

 

[sirspamalot]

Is Ohio an actual place? Asking for a friend..

 

[medgator]

Depends on where you're living. 400k W2 to work in Farmington, NM?

F not even $600k for that honestly

 

[Gfunk6]

Can probably negotiate up a little today

https://www.cnn.com/2023/05/16/us/farmington-new-mexico-shooting-tuesday/index.html

Gunmen roaming the streets should be worth at least a 100K bump.

Wow, I saw that news report too but didn't associate it with this place.

"In the grim dark future of Farmington, NM . . . there is only war."

 

[RadOncMegatron]

How much can you make from locums if you work half the year? Just curious.

 

[IonsAreOurFuture]

The current reality of the system that has been built is actually quite hilarious (in an insane sort of way).

All residency programs in RadOnc are at academic institutions. And not even all of them - mostly the biggest ones in urban areas.

ASTRO is basically God-Emperor in terms of societies. Sure, there's some "others", but there's usually a lot of overlap and they don't hold much sway.

ASTRO is and has always been run by faculty at monster academic institutions.

Because creativity died in RadOnc in the late 1990s or so, along with any level of backbone, we've spent 20 years trying to minimize our footprint.

Which, you know, is fine for monster academic shops with protons or PPS-exempt status or whatnot. They'll make it work.

But...that's not the actual reality for the majority of Radiation Oncologists. While the actual "RadOnc census" is hotly debated, I'm pretty certain there's around 5000 RadOncs working and 1000 of those are academic faculty (well, in the "pre rollup" sense, everyone is "academic" now...but I digress).

So what did we create here? 80% of the workforce are out in places where the margin contribution from RadOnc is critical. Often, those shops have been staffed by the same Boomers since the 1990s. Things are done a certain way.

And now we're deep into the Silver Tsunami. Retirements. New grads.

New grads that have been indoctrinated in the era of hypofrac and omission.

On interview day it's all "we're excited for young energy, this place has been stagnant for too long!"

Dear residents: that is a lie. No one is excited for change. God help you if you fall for it.

Head down. Conventional. Happy therapists. Happy Press-Ganey.

$400k.

I absolutely lived this scenario recently, almost word for word.

I staffed a small "academic network" satellite in a small city, where the prior doc had been there about 20 years, with little change in practice patterns or fraction sizes. Eventually he was asked to leave over quality concerns, and they wanted somebody who believed in "lifelong learning."

So I joined and started doing 3-4 week hypofrac for breast CA, brain SRS instead of whole brain; lung, prostate and breast SBRT. I advised some 70+ year old women that they likely didn't need radiation for their DCIS that was tiny and 100% ER positive.

I heard from the nurses that in the past, no patient had ever been told that they didn't need radiation, or got fewer than 44 fractions for prostate or 7 weeks for breast. Bone mets all got 3+ weeks, never SBRT even for spine mets, no 1-5 fx for hospice-y patients.

Eventually the administration and rad onc leadership from the main center started to call and ask me "Why are volumes down by half on the machine?" All I could say was that there was a lot of overtreatment before and I was using the modern techniques that I was recruited to bring.

It isn't 1999 anymore, and you and I know it, but maybe that's all a small center has ever known. Many community hospitals have built their long-term goals and budgets on the historical trend line of 40 patients on beam. They are not mentally or financially ready for the hypofrac, SBRT, SRS era. They may buy a new Truebeam but expect you to use it like the old one.

 

[RickyScott]

I absolutely lived this scenario recently, almost word for word.

I staffed a small "academic network" satellite in a small city, where the prior doc had been there about 20 years, with little change in practice patterns or fraction sizes. Eventually he was asked to leave over quality concerns, and they wanted somebody who believed in "lifelong learning."

So I joined and started doing 3-4 week hypofrac for breast CA, brain SRS instead of whole brain; lung, prostate and breast SBRT. I advised some 70+ year old women that they likely didn't need radiation for their DCIS that was tiny and 100% ER positive.

I heard from the nurses that in the past, no patient had ever been told that they didn't need radiation, or got fewer than 44 fractions for prostate or 7 weeks for breast. Bone mets all got 3+ weeks, never SBRT even for spine mets, no 1-5 fx for hospice-y patients.

Eventually the administration and rad onc leadership from the main center started to call and ask me "Why are volumes down by half on the machine?" All I could say was that there was a lot of overtreatment before and I was using the modern techniques that I was recruited to bring.

It isn't 1999 anymore, and you and I know it, but maybe that's all a small center has ever known. Many community hospitals have built their long-term goals and budgets on the historical trend line of 40 patients on beam. They are not mentally or financially ready for the hypofrac, SBRT, SRS era. They may buy a new Truebeam but expect you to use it like the old one.

The department is a team and when you make changes and the staff are uncomfortable, that is when mistakes happen… administrator (first job out of academics) in respose to treating bone met 8 Gy x 1 and treating lung all field every day vs ap/pa until 41 and then off cord.

 

[Fpg1245]

I absolutely lived this scenario recently, almost word for word.

I staffed a small "academic network" satellite in a small city, where the prior doc had been there about 20 years, with little change in practice patterns or fraction sizes. Eventually he was asked to leave over quality concerns, and they wanted somebody who believed in "lifelong learning."

So I joined and started doing 3-4 week hypofrac for breast CA, brain SRS instead of whole brain; lung, prostate and breast SBRT. I advised some 70+ year old women that they likely didn't need radiation for their DCIS that was tiny and 100% ER positive.

I heard from the nurses that in the past, no patient had ever been told that they didn't need radiation, or got fewer than 44 fractions for prostate or 7 weeks for breast. Bone mets all got 3+ weeks, never SBRT even for spine mets, no 1-5 fx for hospice-y patients.

Eventually the administration and rad onc leadership from the main center started to call and ask me "Why are volumes down by half on the machine?" All I could say was that there was a lot of overtreatment before and I was using the modern techniques that I was recruited to bring.

It isn't 1999 anymore, and you and I know it, but maybe that's all a small center has ever known. Many community hospitals have built their long-term goals and budgets on the historical trend line of 40 patients on beam. They are not mentally or financially ready for the hypofrac, SBRT, SRS era. They may buy a new Truebeam but expect you to use it like the old one.

So the center closed? And it was a victory for healthcare spending that day.

my first year, I got a “what’s what” talk from my boss. This is the dose and fractionation we use for breast, prostate etc. I felt no need to be butting heads with my boss or the admin or the nurses or anybody really. And I just did what I was told because honestly it’s not like I had a million offers or any other real prospects for an actual paying job out of residency. Patient still send me cards and admin is friendly. No one ever got me in a corner and grilled me about overtreatment and honestly after a while I stopped caring and if patients didn’t like what I wanted to do then they could go elsewhere.

 

[elementaryschooleconomics]

I absolutely lived this scenario recently, almost word for word.

I staffed a small "academic network" satellite in a small city, where the prior doc had been there about 20 years, with little change in practice patterns or fraction sizes. Eventually he was asked to leave over quality concerns, and they wanted somebody who believed in "lifelong learning."

So I joined and started doing 3-4 week hypofrac for breast CA, brain SRS instead of whole brain; lung, prostate and breast SBRT. I advised some 70+ year old women that they likely didn't need radiation for their DCIS that was tiny and 100% ER positive.

I heard from the nurses that in the past, no patient had ever been told that they didn't need radiation, or got fewer than 44 fractions for prostate or 7 weeks for breast. Bone mets all got 3+ weeks, never SBRT even for spine mets, no 1-5 fx for hospice-y patients.

Eventually the administration and rad onc leadership from the main center started to call and ask me "Why are volumes down by half on the machine?" All I could say was that there was a lot of overtreatment before and I was using the modern techniques that I was recruited to bring.

It isn't 1999 anymore, and you and I know it, but maybe that's all a small center has ever known. Many community hospitals have built their long-term goals and budgets on the historical trend line of 40 patients on beam. They are not mentally or financially ready for the hypofrac, SBRT, SRS era. They may buy a new Truebeam but expect you to use it like the old one.

Ah. Yes.

If you're a current resident, you should memorize this post. Burn it into your soul.

The next decade is going to be A LOT of this. Until the "Silver Tsunami" is over, and the last of the docs practicing in the same clinic since 1999 (or earlier) retires...this story will play out over, and over, and over.

My advice, not necessarily to @IonsAreOurFuture but just to current/future residents, is to not IMMEDIATELY go "full hypofrac", unless you know the clinic has already been doing that before you got there.

This plays somewhat into the "3 A's of private practice" but not only are budgets built around "conventional", it's also what your referring docs and staff will expect.

And, lurking resident reading this in the future, since no one has told you this, allow me: it's actually OK to conventionally fractionate. How can I say such a thing?

Well, none of the hypofrac regimens have really been shown to be superior. Mostly, at best, non-inferior. Breast is sort of the exception from a cosmetic standpoint, but a lot of Boomers adopted "Canadian fractionation" a while back, so just make sure you do a boost on 'em all, it'll be OK.

On balance, we provide way more value than the Keytruda-wielding MedOncs now. Keep the lights on with your margin contribution. You're not the villain of this story.

 

[sirspamalot]

Ah. Yes.

If you're a current resident, you should memorize this post. Burn it into your soul.

The next decade is going to be A LOT of this. Until the "Silver Tsunami" is over, and the last of the docs practicing in the same clinic since 1999 (or earlier) retires...this story will play out over, and over, and over.

My advice, not necessarily to @IonsAreOurFuture but just to current/future residents, is to not IMMEDIATELY go "full hypofrac", unless you know the clinic has already been doing that before you got there.

This plays somewhat into the "3 A's of private practice" but not only are budgets built around "conventional", it's also what your referring docs and staff will expect.

And, lurking resident reading this in the future, since no one has told you this, allow me: it's actually OK to conventionally fractionate. How can I say such a thing?

Well, none of the hypofrac regimens have really been shown to be superior. Mostly, at best, non-inferior. Breast is sort of the exception from a cosmetic standpoint, but a lot of Boomers adopted "Canadian fractionation" a while back, so just make sure you do a boost on 'em all, it'll be OK.

On balance, we provide way more value than the Keytruda-wielding MedOncs now. Keep the lights on with your margin contribution. You're not the villain of this story.

And lettuce say...

Amen.

Hail #

 

[metallica81788]

I absolutely lived this scenario recently, almost word for word.

I staffed a small "academic network" satellite in a small city, where the prior doc had been there about 20 years, with little change in practice patterns or fraction sizes. Eventually he was asked to leave over quality concerns, and they wanted somebody who believed in "lifelong learning."

So I joined and started doing 3-4 week hypofrac for breast CA, brain SRS instead of whole brain; lung, prostate and breast SBRT. I advised some 70+ year old women that they likely didn't need radiation for their DCIS that was tiny and 100% ER positive.

I heard from the nurses that in the past, no patient had ever been told that they didn't need radiation, or got fewer than 44 fractions for prostate or 7 weeks for breast. Bone mets all got 3+ weeks, never SBRT even for spine mets, no 1-5 fx for hospice-y patients.

Eventually the administration and rad onc leadership from the main center started to call and ask me "Why are volumes down by half on the machine?" All I could say was that there was a lot of overtreatment before and I was using the modern techniques that I was recruited to bring.

It isn't 1999 anymore, and you and I know it, but maybe that's all a small center has ever known. Many community hospitals have built their long-term goals and budgets on the historical trend line of 40 patients on beam. They are not mentally or financially ready for the hypofrac, SBRT, SRS era. They may buy a new Truebeam but expect you to use it like the old one.

So the center closed? And it was a victory for healthcare spending that day.

my first year, I got a “what’s what” talk from my boss. This is the dose and fractionation we use for breast, prostate etc. I felt no need to be butting heads with my boss or the admin or the nurses or anybody really. And I just did what I was told because honestly it’s not like I had a million offers or any other real prospects for an actual paying job out of residency. Patient still send me cards and admin is friendly. No one ever got me in a corner and grilled me about overtreatment and honestly after a while I stopped caring and if patients didn’t like what I wanted to do then they could go elsewhere.

I'm in a somewhat similar situation right now with my new job. Caveat that there has been part time newer grad presence for a few years working with the long term old doc so there are some more updated standards present.

I'm keeping the standard frac prostate to keep local urologists happy, but doing some other things differently and moving along slowly.

It's shocking to show up and see what has been done to these patients the last few years. Every follow up is an adventure and usually disappointing to see the old plans. Mostly not bad medicine, but just really outdated techniques and questionable decision making. Nobody here knows any differently and it will take a while to change. Very tempting to try and force it all at once but that's not the way. Luckily admin is supportive of me taking ownership (at least for now haha).