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Anecdotally, I'm seeing a lot more GG4-5, N+ prostate cancer than I did in training. I've seen some mention on the MedNet that others have anecdotally been seeing more node+ and retroperitoneal spread from prostate cancer.

Makes you wonder how much the patterns really are changing as we see less GG1 prostates just getting observed.
The combo of MRI fusion biopsy and PSMA PET has led to major risk group migration without us really knowing how dangerous a lot of this disease is.

Pretty typical consult today. 74 y/o on AS for GG1 disease diagnosed by TRUS bx 2 years ago. No concerning PSA kinetics. Repeat MRI fusion bx shows GG4 disease now.
 
Wish folks would stop putting patients on AS after just a sextant biopsy, no MRI showing Gleason 3+3=6 disease.
It's like people HATE making money and helping patients simultaneously. Lotta urologists who can't or won't do TP biopsy as well.
 
Wish folks would stop putting patients on AS after just a sextant biopsy, no MRI showing Gleason 3+3=6 disease.
It's like people HATE making money and helping patients simultaneously. Lotta urologists who can't or won't do TP biopsy as well.
What I see a lot of is standard TRUS 12 core based on PSA. Then, the radiologists don't want an MRI for at least 6 months due to blood products/hematoma so uro waits until 1 year at time of rebiopsy. Invariably find higher PIRADS lesion and do targeted biopsy revealing higher grade group.
 
I recommend treatment for 90+% of patients, but work with experienced medoncs and surgeons. I almost never see an inappropriate consult. The only pts I dont treat consistently are prostates that desire surveillance after I take the time to explain the natural hx.

I don’t have a big issue with treating a high % of consults - just those who say they don’t and then they do
 
oh yeah smile GIF by Collider
 
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Mri fusion/transperineal biopsies pay more?
Not sure if MRI Fusion TP biopsies pay more. They certainly should, probably, IMO.

What I meant was-
MRI to identify a lesion and then fusion biopsy will lead to upgrading which means the recommendation becomes treatment more frequently than just AS'ing a Gleason 6. More money in treating than AS at least in the short-term. I guess long-term for Uro if they can AS x 5 years then RP they've made more money per patient than just RPing off the bat though...
 
as long as programs are hiring for instructor positions/fellowships then market is not on fire. i know academic institutions are still offering PGY5s instructor positions instead of true asst professor jobs. that is complete bs. heres 100k, hope you like having 30 on treat.

sounds kinda like a self fulfilling prophecy from that response to the bloodbath red j 2013

Not sure if MRI Fusion TP biopsies pay more. They certainly should, probably, IMO.

What I meant was-
MRI to identify a lesion and then fusion biopsy will lead to upgrading which means the recommendation becomes treatment more frequently than just AS'ing a Gleason 6. More money in treating than AS at least in the short-term. I guess long-term for Uro if they can AS x 5 years then RP they've made more money per patient than just RPing off the bat though...
Or if the urologists own the MRI machine....then AS with MRI q1-2 years is way more $ than treatment.
 
Not sure if MRI Fusion TP biopsies pay more. They certainly should, probably, IMO.

What I meant was-
MRI to identify a lesion and then fusion biopsy will lead to upgrading which means the recommendation becomes treatment more frequently than just AS'ing a Gleason 6. More money in treating than AS at least in the short-term. I guess long-term for Uro if they can AS x 5 years then RP they've made more money per patient than just RPing off the bat though...

Or if the urologists own the MRI machine....then AS with MRI q1-2 years is way more $ than treatment.
There was study that came out within the last year or two, maybe was posted on SDN even suggesting more cost to AS once you got to more than 1-2 years out between imaging, biopsies etc
 
Or if the urologists own the MRI machine....then AS with MRI q1-2 years is way more $ than treatment.
Naive question -- how is it that Urologists can own everything downstream but other docs don't seem to be able to?

Is it just a capital thing? What about Stark?
 
Naive question -- how is it that Urologists can own everything downstream but other docs don't seem to be able to?

Is it just a capital thing? What about Stark?
Med oncs, ortho/neurosurg can too. In office ancillary exemption. I've heard of big Ortho/pain groups owning MRI machines
 
Med oncs, ortho/neurosurg can too. In office ancillary exemption. I've heard of big Ortho/pain groups owning MRI machines
Are there things we can buy and own as Rad Oncs?
 
Med oncs, ortho/neurosurg can too. In office ancillary exemption. I've heard of big Ortho/pain groups owning MRI machines

If Zap is successful in the US, I would guess a lot will be neurosurg owned. One of the biggest selling points is you don't need a shielded room so you can put it a lot of places.
 
Are there things we can buy and own as Rad Oncs?
Sure. The same things as everyone else. The question is where will you get the referrals from? The days of rad onc only practices with ownership are numbered, many have already gone away
 
Are there things we can buy and own as Rad Oncs?
Linear accelerators, PET/CT machines, labs, CT scanners would be the big ones. The economics of an MRI machine don't make sense unless you are ordering many, many scans- far more than oncology would normally order.

The writing has been on the wall for radonc-only groups for at least 15 years now. Multispecialty is the only way to be safe if you're interested in private practice.
 
If Zap is successful in the US, I would guess a lot will be neurosurg owned. One of the biggest selling points is you don't need a shielded room so you can put it a lot of places.
In many major markets, neurosurgeons can earn a lot more when employed by a hospital than working for themselves. Had quite a few discussions abt this.
 
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Sure you can own in office imaging and in office path. But not enough volume to make it worth it for a rad Onc. You could also do in office radiopharmaceutical instead of via the hospital but not a lot of ROs doing that
 
In many major markets, neurosurgeons can earn a lot more when employed by a hospital than by working for themselves. Had quite a few discussions with them abt this.
Because like everything else. CMS doesn’t value physician work but will pay hospitals handsome fees.
 
It’s like they think if they send the NE job to me enough times I’ll somehow reply
 
It’s like they think if they send the NE job to me enough times I’ll somehow reply
Anyone try responding with a decent locums rate? I can be convinced to see Nebraska.
 
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It’s like they think if they send the NE job to me enough times I’ll somehow reply

Anyone try responding with a decent locums rate? I can be convinced to see Nebraska.
Recruiter seemed open to a number. Just reply with @sirspamalot 's daily rate
 
Got multiple emails about two $15k/week locums jobs recently (New Mexico and Indiana).
 
I've seen $4500 opportunities with extra pay for weekend call, 15-20 pts a day in the office. BFE though. Definitely a far healthier locums market than ours
If instead of a Jun-Dec gig for 4K a day you got yourself that gig for a year, you’ve got a $1M a year 1099 rad onc job. In other words like maybe a one in 200 job in rad onc.
 
On East Coast (populated areas), Comphealth RO is currently paying $2000 - 2100 per day
 
At what point is it harassment? Because I hate getting those calls. Same with morristown TN
Well we’re living here in Morristown
And they’re closing all the accelerators down
Out in Knoxville they’re killing time
Enrolling in APM, standing in line

So our ABR certifications hang on the wall
But they never really helped us at all
No they never taught us what was supreme
Tech and pro, vaults with proton beam
 
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Well we’re living here in Morristown
And they’re closing all the accelerators down
Out in Knoxville they’re killing time
Enrolling in APM, standing in line

So our ABR certifications hang on the wall
But they never really helped us at all
No they never taught us what was supreme
Tech and pro, vaults with proton beam

At least chat GPT gets it lol!
 
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Correction: that's what desperate local radoncs are taking. Or those who are naive.

You get what you negotiate.

My area it's $1500/day. I used to tell them to talk to me when the rate is higher and they never came back to negotiate with me, not even once.

I stopped bothering. I can make more seeing more patients in my day job.
 
Correction: that's what desperate local radoncs are taking. Or those who are naive.

You get what you negotiate.

My area it's $1500/day. I used to tell them to talk to me when the rate is higher and they never came back to negotiate with me, not even once.

I stopped bothering. I can make more seeing more patients in my day job.
Supply and demand, not desperation @sirspamalot even the med onc locums paying $4k+ are in the Midwest well away from populated metros
 
even the med onc locums paying $4k+ are in the Midwest
Nope. Well, hard for me to tell exactly what doc gets through the contract, but coastal community hospitals have been paying more than this per day to agencies for awhile.
 
Nope. Well, hard for me to tell exactly what doc gets through the contract, but coastal community hospitals have been paying more than this per day to agencies for awhile.
Doc isn't getting even close to that, the agencies take a big cut. Hopefully the smart ones will figure this out and go directly to the hospital in the future....
 
Seeing a decent number of GG1s that come back at GG3 or GG4 and require more intensive therapy than what they would've lead to.
Some GG1s are slowly progressing to GG2s as is expected and can be treated without additional toxicity.

But man, if AS is leading to N+ disease, something real messed up has happened IMO.
Very rare, but AS very slightly increasing N+ is bore out at least by PROTECT. 2.6% in AS vs. <1% in treatment groups.
 
If anyone has ever dreamed of working in Platte County, Nebraska DM me and I will hook you up
Kearney, NE is in Buffalo county.....

I'm only aware of one center in Platte County, NE. I believe it was 100% physician owned.

If not... they're doomed finding coverage.
 
Supply and demand, not desperation @sirspamalot even the med onc locums paying $4k+ are in the Midwest well away from populated metros

Whenever the agency calls you and says we'll pay you "X" just add 30% and start negotiating. Seriously. If enough radoncs did this, we wouldn't see job postings for 2100$ any more. Perhaps 5 years ago, I got a call about a job posting saying it was 'only' paying 1400 a day. I told them I hadn't seen that kind of number since 2000.

If you're a good candidate and they want quality, they'll pay. If they're looking for a 'warm body' then its a race to the bottom. If thats the gig you want, so be it.
 
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