Why I think Rad/Onc has a secure career and bright future

[elementaryschooleconomics]

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Just saw the AMA is considering or has already dumped us? Wtf?

Oh yeah I forgot about this:

It's just such classic RadOnc and par for the course. I know the AMA is a polarizing subject for people, but regardless of what you think about it, it does have power.

The theme of the last 20 years is hubris. The people in charge watched the field become ultra-competitive through the serendipity of the fee-for-service system of American medicine and the perception that we're a "lifestyle" specialty. Anyone who says anything else is either lying to themselves or selling you something.

Hubris played a part in our disengagement with the ACR. Hubris played a part in the AMA putting our main specialty society on probation.

Now, after 10 years of reimbursement cuts, bundled payment models are being implemented for half of us and the cuts are continuing for all of us. ASTRO's $300k in lobbying money is barely enough to cover a few dinners for Senators; we have no one to blame but ourselves.

But don't forget, low unemployment for new grads per a survey sent out by the resident subdivision of the society that is currently on probation, and 50% of academic chairs said they might hire in the next 2-3 years per a different survey sent out by a chair to his buddies, so everything is fine, and we're just a bunch of toxic misanthropes for even bringing this up.

 

[RickyScott]

It seems like one of the many toxic personalities has found his/her way to SDN. Look at derm practices. They prescribe superficial RT like crazy, and they haven’t spent a single day learning about physics or rad bio. You can do better bud.”

“ It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.”

Very bizzare. Not so implicitly acknowledge oversupply, and then complain that others are alerting medstudents to it? Wouldn’t surprise me if you were a program director at some gutter residency like Kentucky, musc, Columbia or Dartmouth?

 

[Volfo]

In a vacuum, the actual medicine and practice of Radiation Oncology is amazing, and I have rarely (if ever) heard anyone say otherwise, here or elsewhere.

But life doesn't happen in a vacuum. A living, breathing person, with hopes and dreams and desires, has to choose to practice Radiation Oncology. The opportunity cost of becoming a specialty-trained physician in America is so high that you're essentially committing to that path for life.

The "solution for oversupply" is largely in the hands of a small group of senior people, and consists of reducing the number of residents trained per year. Barring that, the "toxic hyperbole" to which you're referring mostly serves to remind medical students that they are, in fact, people too (despite an educational system which tries to get them to forget it). If someone falls in love with the medicine and practice of Radiation Oncology, and is aware of and understands the potential significant limitations pursuing the specialty might place on their life outside of work, then I look forward to meeting them at a future ASTRO meeting.

Speaking of hyperbole - there are no technical or knowledge barriers making it "impossible" for mid-levels or non-RadOnc physicians to use ionizing radiation therapeutically. This thread alone has multiple examples, the most glaring of which is the Dermatologists and skin cancer.

If anyone lurking in this thread thinks the ABR and residency training in Radiation Oncology builds an impenetrable fortress around radiation therapy, please go Google "dermatology superficial radiation". Take a look at how many practices are advertising it on their websites. See the machines that are for sale.

Here's a fun passage to consider, from a paper published in 2015:

View attachment 346424

As always, the therapeutic use of ionizing radiation is an incredible way to practice medicine, and if that's the only thing someone needs to have a fulfilling life as a doctor, great. If you have other things to balance in your life, such as geographical considerations for your spouse, children, family, community, etc - perhaps a different specialty would be just as rewarding and won't result in divorce.

Oh I see I got you I can also do that check this out man:

1- PAs are already replacing expensive surgeons without even having M.D degree and they procure hearts and lungs independently without supervision not to mention cholecystectomy!! RIP surgeons💀

 

[Volfo]

2- And since we are talking about Dermatology they are now being overrun by NPs and PAs and it's actually quite scary thing for them, and sooner or later the dermatology will collapse with the rise of midlevels. I guess RIP Dermatology???☠️



Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015

• "In 2012, NPs and PAs performed and billed independently for more than 4 million procedures (Table 1) at our cutoff of 5000 paid claims per procedure. Most (54.8%) of these procedures were performed in the specialty area of dermatology."
• "Most of the approximately 2.6 million dermatologic procedures performed in the office setting in 2012 were destruction of premalignant lesions, which requires correct distinction of a premalignant lesion from a benign one. Inappropriate cryotherapy of these lesions may lead to scarring, dyspigmentation, and unnecessary costs."
• " A review of 2014 Medicare data revealed that 824 NPs and 2083 PAs independently billed Medicare $59,438,802 and $171,645,943, respectively. Only 3% of these nonphysician clinicians (NPCs) practiced in counties without a dermatologist, decreasing the possibility that they were the sole source of dermatologic care for underserved populations"

Also check this:
Characterization of Biopsies by Dermatologists and Nonphysician Providers in the Medicare Population: A Rapidly Changing Landscape

and this:
Geographic Distribution of Nonphysician Clinicians Who Independently Billed Medicare for Common Dermatologic Services in 2014

and this:
Biopsy Use in Skin Cancer Diagnosis: Comparing Dermatology Physicians and Advanced Practice Professionals

I guess I have proved my point there is no barrier to dermatology and it's dead field??

 

[Volfo]

3- BTW did i ever tell you about EM? and how it's dead? what about the 10K surplus of EM Physicians in 2030? and what about the NPs and PAs that are invading the EM? and they call themselves residents now loool
I guess EM is dead now RIP








I guess I won the hyperbole game. WasEz😎

 

[seper]

Oh yeah I forgot about this:

View attachment 346439

It's just such classic RadOnc and par for the course. I know the AMA is a polarizing subject for people, but regardless of what you think about it, it does have power.

The theme of the last 20 years is hubris. The people in charge watched the field become ultra-competitive through the serendipity of the fee-for-service system of American medicine and the perception that we're a "lifestyle" specialty. Anyone who says anything else is either lying to themselves or selling you something.

Hubris played a part in our disengagement with the ACR. Hubris played a part in the AMA putting our main specialty society on probation.

Now, after 10 years of reimbursement cuts, bundled payment models are being implemented for half of us and the cuts are continuing for all of us. ASTRO's $300k in lobbying money is barely enough to cover a few dinners for Senators; we have no one to blame but ourselves.

But don't forget, low unemployment for new grads per a survey sent out by the resident subdivision of the society that is currently on probation, and 50% of academic chairs said they might hire in the next 2-3 years per a different survey sent out by a chair to his buddies, so everything is fine, and we're just a bunch of toxic misanthropes for even bringing this up.

I don't get it, are attending physicians expected to be paying members of AMA?

 

[elementaryschooleconomics]

3- BTW did i ever tell you about EM? and how it's dead? what about the 10K surplus of EM Physicians in 2030? and what about the NPs and PAs that are invading the EM? and they call themselves residents now loool
I guess EM is dead now RIP

I guess I won the hyperbole game. WasEz😎

EM is also facing massive oversupply issues which is being aggressively addressed by their own specialty societies, and Derm is facing issues not necessarily from mid-levels, but from private equity and venture capitalists - though APPs might be playing a role in their issues too. The surgeons will be fine.

But these are independent issues from Radiation Oncology, and have nothing to do with anything.

I understand formulating a logical argument can be difficult, so to frame this for you:

1) The claim is that Radiation Oncology is "safe" as a field because the therapeutic use of ionizing radiation is "restricted" by our residency training and board certification through the ABR

2) The evidence is that, in America, any licensed physician can use a device which produces electrons and/or photons for therapeutic purposes

3) The most widespread application of this phenomenon is Dermatology and skin cancer, which is so prevalent a group of Dermatologists published their own consensus guidelines on using radiation for skin cancer

4) The restrictions on the use of unsealed sources and brachytherapy are tighter, and residency training in Radiation Oncology is one of the "easiest" paths to becoming an authorized user for these techniques

5) It is not the only path to become an authorized user

6) Unsealed sources and brachytherapy are the minority modalities of therapeutic radiation in the modern era

7) Therefore, the belief that RadOnc is "protected" because the medical use of ionizing radiation is "off limits" to anyone but us is not evidence-based

Your counterargument to this is...other specialties have their own problems, ergo, RadOnc is fine? Yes, you did win the hyperbole game.

 

[elementaryschooleconomics]

I don't get it, are attending physicians expected to be paying members of AMA?

Yeah - to my understanding, ASTRO as a specialty society is a delegate of the AMA. In order for a specialty society to have this designation (and the benefits of the collective power of the AMA as an institution), a certain percentage of the society's members must also be members of the AMA. If the society falls below whatever threshold is set, it can lose its status within the AMA.

I assume the AMA is designed like this to prevent groups from trying to take advantage of the lobbying/legislative power of the AMA without giving anything in return. So, this doesn't mean that 1) any individual Radiation Oncologist can't choose to be an AMA member regardless of what's going on with ASTRO, 2) other RadOnc-focused specialty societies (like ACRO) can't also be a delegate (though I am unsure if ACRO is a delegate, I suspect there might be a lot of hoop jumping to get your society in as a delegate).

What it does mean is that ASTRO is (obviously) RadOnc's main professional society, and if it loses its delegate status with the AMA, it means that it loses a potentially significant ally in lobbying the government when things like APM happen (for all the good it has done us).

Folks have some strong opinions on the AMA, so I assume there are some who want this to happen. To me, even if the AMA is not a perfect institution, its power dwarfs ASTRO, and I think we need it (I am a dues-paying member of both ASTRO and the AMA).

 

[communitydoc13]

I guess I won the hyperbole game. WasEz😎

No hyperbole. Nobody sh...ing on field (except for maybe me). Most of us grateful for our jobs.

No idea what your position in the field is, but I would ask the following questions (to either your senior colleagues, junior colleagues, recent predecessors in training or peers out in the community).

1. How easy is it for recent graduates to move from one job to another comparable job? How does this compare to their colleagues in medical oncology?

2. How hard is it for hospital based practices in non-major metropolitan areas to recruit radiation oncologists vs other specialties, including medical oncology?

3. In terms of intellectual excitement, how much has the standard of cancer care regarding radiation treatment changed in the last 10 years in a direction that makes radiation oncologists a more prominent component of solid tumor care? How does this compare to medical oncology?

4. In terms of compensation, are any established community radiation oncologists expecting a significant increase in professional revenue over their lifetime? Are they at a minimum expecting a cost of living decrease in wages over the foreseeable future?

5. If you had a child in medical school, who was not remarkably connected to a prominent academic physician, and this child communicated that location of practice was among the most important things to them in terms of QOL, would you recommend radiation oncology?

 

[RickyScott]

The schtick that everyone has it bad, but us less so- and we should be thankful- is directly lifted from North Korean propaganda. Heard a number of IYI make it, which is why I am suspicious this guy is from LIJ, kentucky, Columbia etc and frustrated about sifting through the resumes of ex cons. Any 4th year medical student can just take note of the tens of job interviews and unsolicited offers, seniors in other specialties recieve.

 

[deleted941485]

The schtick that everyone has it bad, but us less so- and we should be thankful- is directly lifted from North Korea propaganda. Heard a number of IYI make it, which is why I am suspicious this guy is from LIJ, kentucky, Columbia etc frustrated over sifting through resumes of ex cons. Any 4th year medical student on specialty rotations just has to take note of the tens of job interviews and unsolicited offfers those in others specialties recieve.

My colleagues always tell me that and to some extent I agree with them. Gas and Rads specifically even Derm. But honestly they’re is still a demand for the service. This field is unique in that it’s greatest feat has been placing itself into increasing irrelevance. I hate that I fell for it and I wish I could go back and tell those miserable faculty memebers to shove it. But I can’t and now I just have to be “thankful”

 

[RickyScott]

I like Harvey a lot, but the net result of this type of research is only to eliminate/narrow xrt. So much of our focus is on contracting indications. Whatever happens with mid levels in derm, er, rads, nobody predicts there will be less indications/utilization.

 

[communitydoc13]

So much of our focus is on contracting indications.

Which is fine. This is good work and meaningful work. In a non-synthetic specialty, this makes sense and I'm not blaming academics for this.

But...as you meaningfully contract indications, you should also contract the workforce.

 

[jondunn]

Which is fine. This is good work and meaningful work. In a non-synthetic specialty, this makes sense and I'm not blaming academics for this.

But...as you meaningfully contract indications, you should also contract the workforce.

yes.

 

[elementaryschooleconomics]

I like Harvey a lot, but the net result of this type of research is to only to eliminate xrt. So much of our focus is on contracting indications. Whatever happens with mid levels in seem, er, rads, nobody predicts there will be less indications/utilization.

Exactly.

It's potentially great for patients and should absolutely be pursued. It could be great for the RadOnc physicians, as well, if we adjusted our workforce accordingly.

For anyone still on the fence about this, ask yourself: if a significant portion of our "high impact" faculty at major intuitions are engaged in research and trials aimed at reducing or omitting radiation therapy, especially in our primary disease sites of breast and prostate - should we be producing two new Radiation Oncologists for every one that retires, every single year?

Folks get all riled up and argue on Twitter/SDN/real life any time a paper comes out showing an OS benefit without a PFS benefit, or some confounder isn't addressed, or a drug is approved based on some soft endpoint. Why isn't that same level of critical thinking applied here?

 

[jondunn]

For anyone still on the fence about this

are there really significnant numbers of people on the other side of this at this point? seems like most people are on the same page, on SDN, on Twitter.

 

[elementaryschooleconomics]

are there really significnant numbers of people on the other side of this at this point? seems like most people are on the same page, on SDN, on Twitter.

There were some Tweets which garnered a few dozen "likes" after the ARRO survey came out this year, the guy from Dartmouth really went all-in during the ACR presentation a couple weeks ago, and since it's interview season, I'm hearing stories of faculty saying everything is fine.

But I do feel like the general sentiment has shifted towards "maybe this is an issue".

 

[Volfo]

No hyperbole. Nobody sh...ing on field (except for maybe me). Most of us grateful for our jobs.

No idea what your position in the field is, but I would ask the following questions (to either your senior colleagues, junior colleagues, recent predecessors in training or peers out in the community).

1. How easy is it for recent graduates to move from one job to another comparable job? How does this compare to their colleagues in medical oncology?

2. How hard is it for hospital based practices in non-major metropolitan areas to recruit radiation oncologists vs other specialties, including medical oncology?

3. In terms of intellectual excitement, how much has the standard of cancer care regarding radiation treatment changed in the last 10 years in a direction that makes radiation oncologists a more prominent component of solid tumor care? How does this compare to medical oncology?

4. In terms of compensation, are any established community radiation oncologists expecting a significant increase in professional revenue over their lifetime? Are they at a minimum expecting a cost of living decrease in wages over the foreseeable future?

5. If you had a child in medical school, who was not remarkably connected to a prominent academic physician, and this child communicated that location of practice was among the most important things to them in terms of QOL, would you recommend radiation oncology?

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver Mets/HCC and cutting off TACE/RFA.

4- I don't know about everyone here but what I see in this forum a lot of people are one trick pony that can't even give radioactive iodine and they gave it up to nuc med. In term of compensation I'm VERY happy.

5- If location is the only thing he care about I will tell him to be family physician or just be a nurse.

 

[medgator]

are there really significnant numbers of people on the other side of this at this point? seems like most people are on the same page, on SDN, on Twitter.

Clearly haven't heard the nonsense from people like KO, potters, chair at Kentucky or the schtick from the recent ACR webinar etc

Seems to be a generational issue, mainly boomers still in denial (actively benefitting from the system as it currently stands)

 

[RickyScott]

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver mets/HCC and cutting off TACE/RFA.

4- I don't know about everyone here but what I see in this forum a lot of people are one trick pony that can't even give radioactive iodine and they gave it up to nuc med. In term of compensation I'm VERY happy.

5- If location is the only thing he care about I will tell him to be family physician or just be a nurse.

Location is the primary concern of most medstudents and attainable in almost every specialty (job may not be great). In fact in 2007-10, almost every location was doable in radonc.

 

[jondunn]

Clearly haven't heard the nonsense from people like KO, potters, chair at Kentucky etc

I mean even if they denied that there were issues, my point was significant numbers. but anyways, at least for KO and Potters, they say some annoying stuff, but IM fairly certain neither is blank denying the oversupply issues at this point?

 

[elementaryschooleconomics]

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver Mets/HCC and cutting off TACE/RFA.

I assume from this statement that you're not in America?

Unless by "we" you mean you're in a multispecialty group with Medical Oncologists? Or do you mean the Radiation Oncologists give chemo? If you're a Radiation Oncologist in America and you're routinely giving chemo, I'm very interested in the structure of your practice.

 

[communitydoc13]

At our center we give radiosensitizing chemotherapy, HT,

Rare. I'm a contracted community radonc (better than employed IMO) and fully integrated into the hospital system.

I would be willing to be the prescribing physician for these things but would require buy-in from all the other players. I am the first referral for a minority of patients and even when I am, the goal is to make use of the resources available to me to provide the best possible care. (It would be a poor clinical decision to ask my nursing staff to administer chemo when infusion nurses are down the hall and are integrated with the medical oncologists).

How did you end up giving these things? Sincerely curious. A historical peculiarity with a double boarded doc who integrated systemic therapy into clinic decades ago? Urologist and medical oncologists who are not possessive of these interventions?

Admittedly, if recruitment of medical oncologists continues to be a problem, I might float something like comprehensive management of early stage breast cancer patients by radonc. In that case, buy-in from my colleagues might end up being the barrier.

 

[TheWallnerus]

3- BTW did i ever tell you about EM? and how it's dead? what about the 10K surplus of EM Physicians in 2030? and what about the NPs and PAs that are invading the EM? and they call themselves residents now loool
I guess EM is dead now RIP








I guess I won the hyperbole game. WasEz😎

I like to mention the themes of rad onc being doable by non-rad oncs occasionally because it adds a little spice to the "main dish" (commiseration is a coping mechanism), to bust commonly held myths, and to shake people awake. The main dish is that over the last 20 years on average rad oncs are seeing less new patients per year. And there are significantly less treatments per patient. Nationally there are ~50%+ more rad oncs and ~-10% less rad onc patients in the last 20 years. And with relaxed supervision regulations, this means going forward even fewer rad oncs are required to do the same (or more) amounts of work as compared to the past. (Let us all be honest that the direct-to-general supervision change was a huge shock to the ASTRO/Ivory Tower system when it happened.) Finally, there are imminent downward reimbursement pressures from Medicare unique to our specialty. (All this data is available on request.)

In term of compensation I'm VERY happy.

I know so many young rad oncs that aren't. Newly graduated rad onc residents get on average only two firm job offers. Imagine how few job offers you might land if you were unhappy later years in practice and wanted to switch. So there but for the grace of God may we all find ourselves unhappy too one day.

 

[TheWallnerus]

3- At our center we give radiosensitizing chemotherapy

Unless by "we" you mean you're in a multispecialty group with Medical Oncologists?

What do you mean "we," rad onc?
- a med onc

 

[elementaryschooleconomics]

I like to mention the themes of rad onc being doable by non-rad oncs occasionally because it adds a little spice to the "main dish" (commiseration is a coping mechanism), to bust commonly held myths, and to shake people awake.

I've been running into this a lot lately (mostly related to items from my favorite post on SDN).

It's so fascinating where doctors choose to apply critical thinking vs falling into a pattern of opinion/anecdote/cognitive bias etc. We're all guilty of it, obviously, but I have seen people who can pick apart the tiniest details of a trial basically turn their brain off when they want to.

 

[Lamount]

Yeah - to my understanding, ASTRO as a specialty society is a delegate of the AMA. In order for a specialty society to have this designation (and the benefits of the collective power of the AMA as an institution), a certain percentage of the society's members must also be members of the AMA. If the society falls below whatever threshold is set, it can lose its status within the AMA.

I assume the AMA is designed like this to prevent groups from trying to take advantage of the lobbying/legislative power of the AMA without giving anything in return. So, this doesn't mean that 1) any individual Radiation Oncologist can't choose to be an AMA member regardless of what's going on with ASTRO, 2) other RadOnc-focused specialty societies (like ACRO) can't also be a delegate (though I am unsure if ACRO is a delegate, I suspect there might be a lot of hoop jumping to get your society in as a delegate).

What it does mean is that ASTRO is (obviously) RadOnc's main professional society, and if it loses its delegate status with the AMA, it means that it loses a potentially significant ally in lobbying the government when things like APM happen (for all the good it has done us).

Folks have some strong opinions on the AMA, so I assume there are some who want this to happen. To me, even if the AMA is not a perfect institution, its power dwarfs ASTRO, and I think we need it (I am a dues-paying member of both ASTRO and the AMA).

To distill this down, would it be beneficial for the specialty if we all became AMA members?

 

[deleted941485]

I like Harvey a lot, but the net result of this type of research is only to eliminate/narrow xrt. So much of our focus is on contracting indications. Whatever happens with mid levels in derm, er, rads, nobody predicts there will be less indications/utilization.

at best it wont have any effect. RT and Surgery as a local therapy. I mean if they ran this on patients with DCIS and didnt find any tumor cells floating around then what? No RT?

It seems to me that in the 21st century RO academics and maybe MO academics that RT is merely a placeholder treatment until they can find a drug that does the same thing.

 

[RO28]

The opportunity cost of becoming a specialty-trained physician in America is so high that you're essentially committing to that path for life.

YES! This point exactly.

 

[medgator]

It seems to me that in the 21st century RO academics and maybe MO academics that RT is merely a placeholder treatment until they can find a drug that does the same thing.

Nails it. Saddest part is all of those rad onc academics with Stockholm syndrome trying to help that process along

 

[DrZap]

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver Mets/HCC and cutting off TACE/RFA.

4- I don't know about everyone here but what I see in this forum a lot of people are one trick pony that can't even give radioactive iodine and they gave it up to nuc med. In term of compensation I'm VERY happy.

5- If location is the only thing he care about I will tell him to be family physician or just be a nurse.

We do iodine, Xofigo, Y90... all a drop in the bucket compared to external beam. It's not enough to overcome the decreasing indications combined with residency expansion

 

[medgator]

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver Mets/HCC and cutting off TACE/RFA.

4- I don't know about everyone here but what I see in this forum a lot of people are one trick pony that can't even give radioactive iodine and they gave it up to nuc med. In term of compensation I'm VERY happy.

5- If location is the only thing he care about I will tell him to be family physician or just be a nurse.

Do you know how much radiopharm contributes to the average person's practice either in terms of pt volume or salary? Gonna guess no on that one

 

[elementaryschooleconomics]

Do you know how much radiopharm contributes to the average person's practice either in terms of pt volume or salary? Gonna guess no on that one

I would love to hear if anyone out there has a booming radiopharm practice. I imagine it would have to be in a very large metro area with some sort of established referral patterns from a big network of frontline docs?

My practice has made sure we can offer Xofigo, Iodine (high and low), and Lutathera. We are very clear to the hospital bean counters that, at best, these are revenue neutral when considering manpower and overhead, and we're offering it as a service to the community, not because it will keep the doors open.

 

[Palex80]

There is no inherent reason why UroRad couldn't show up as PulmoRad.

Indeed. A full circle.
Less than 60 years ago, gynecologists used to give brachytherapy in Europe on their own. I assume it was the same in the US too?

 

[Krukenberg]

I would love to hear if anyone out there has a booming radiopharm practice. I imagine it would have to be in a very large metro area with some sort of established referral patterns from a big network of frontline docs?

My practice has made sure we can offer Xofigo, Iodine (high and low), and Lutathera. We are very clear to the hospital bean counters that, at best, these are revenue neutral when considering manpower and overhead, and we're offering it as a service to the community, not because it will keep the doors open.

Same. I’ve heard the hospital makes a lot off radiopharm infusions, so it keeps them happy with our services

 

[madchemist89]

Radiopharm compensation is not great from what I've heard. If the patient doesn't show up for infusion, you are out tens of thousands potentially.

 

[maxxor]

I would love to hear if anyone out there has a booming radiopharm practice. I imagine it would have to be in a very large metro area with some sort of established referral patterns from a big network of frontline docs?

My practice has made sure we can offer Xofigo, Iodine (high and low), and Lutathera. We are very clear to the hospital bean counters that, at best, these are revenue neutral when considering manpower and overhead, and we're offering it as a service to the community, not because it will keep the doors open.

Rad/Nuc Rad:

You can only make money in this from the technical side, especially if you are a 340b hospital. The professional reimbursement is basically nothing. It’s like the chemo business model.

1 treatment of lutathera is 50k cost and CMS reimbursed ASP+6%. My professional component is the initial E&M consult and a 1 rvu or so administration charge.

Now if 340b, then the drug costs 77.5% but still gets reimbursed at 50k +6%. That’s the only place there’s any money.

——————

I fully expect uroRads to go hard on LuPSMA. They might not even need a Radonc for that; they could get a Nuc Med for cheaper.

I at least can go read other scans. Nuc Med only guys are toast.

 

[maxxor]

Radiopharm compensation is not great from what I've heard. If the patient doesn't show up for infusion, you are out tens of thousands potentially.

Yes. If you are lucky, the manufacturer will accept a return for a partial credit, but it’s still very easy to lose a lot of money very quickly if you have even a few no shows.

 

[RickyScott]

Have heard from multiple sources that lutathera is neutral to loss leader. Also have to factor in that hospital buys drug for 50k and then waits months for reimbursement. One no show or denial and any meager profit erased.

 

[TheWallnerus]

Rad/Nuc Rad:

You can only make money in this from the technical side, especially if you are a 340b hospital. The professional reimbursement is basically nothing. It’s like the chemo business model.

1 treatment of lutathera is 50k cost and CMS reimbursed ASP+6%. My professional component is the initial E&M consult and a 1 rvu or so administration charge.

Now if 340b, then the drug costs 77.5% but still gets reimbursed at 50k +6%. That’s the only place there’s any money.

If the patient doesn't show up for infusion, you are out tens of thousands potentially.

I was going to say what @maxxor said; his numbers are perfect (you can probably tack a 77263 on). You basically become a very poor doctor if you decided to become a radiopharm doctor. I don't know how the companies ever expect radiopharm really to "become hot" (pardon the pun). The hospitals make good money on the newer agents, but they decline over time. The calculus on the technical side is not as great in freestanding. You could do ten of these and if one patient cancels then the profit you made on the ten other patients is gone. Radiopharm is a bit of sucker's game IMHO. But yeehaw! I offer it. Because I'm a conscientious rad onc. I should be a conscientious radiopharm objector, I just don't have the nerve.

 

[TheWallnerus]

Indeed. A full circle.
Less than 60 years ago, gynecologists used to give brachytherapy in Europe on their own. I assume it was the same in the US too?

The gyn oncs are an industrious bunch! In the US they give their own chemo (and immunotx). Yes gyn oncs, as well as some surgeons, used to do their own brachy. People forget the "pigs" lol. There was pretty good radiation exposure to a brachytherapist in the old days. I'm sure the "radiologists" were glad to let the surgeons be the source placers. Reminds me of the GammaTile situation now: the neurosurgeons are the actual brachytherapists (and get the radiation exposure) in the O.R. But it is done under the "watchful eye" of a rad onc! Rad oncs: legally mandated moral supporters in the GammaTile O.R.

 

[medgator]

Rad/Nuc Rad:

You can only make money in this from the technical side, especially if you are a 340b hospital. The professional reimbursement is basically nothing. It’s like the chemo business model.

1 treatment of lutathera is 50k cost and CMS reimbursed ASP+6%. My professional component is the initial E&M consult and a 1 rvu or so administration charge.

Now if 340b, then the drug costs 77.5% but still gets reimbursed at 50k +6%. That’s the only place there’s any money.

——————

I fully expect uroRads to go hard on LuPSMA. They might not even need a Radonc for that; they could get a Nuc Med for cheaper.

I at least can go read other scans. Nuc Med only guys are toast.

Lutathera even worse than simple xofigo or iodine because it basically kills your whole day and ties up physics for longer, infusion is done over several hours, requires premedication with antiemetics and amino acids,pt needs their own bathroom etc

 

[maxxor]

Lutathera even worse than simple xofigo or iodine because it basically kills your whole day and ties up physics for longer, infusion is done over several hours, requires premedication with antiemetics and amino acids,pt needs their own bathroom etc

The radioactive portion is 30 minutes. What takes hours is the amino acid infusion plus other infusions to keep the dose acceptable to kidneys.

The way we have it set up is we use actual inpatient beds for this, like the old inpatient thyroid days. We do 7-9 infusions a week.

Another place I worked did lutathera in the oncology infusion area but that space also had shielded “inpatient” rooms for inpatient thyroid therapy as it was mysteriously built with them but they were never used until we needed to do lutathera.


This is one thing it’s probably better to just turf to academics unless you have a positively amazing payer mix which you don’t want to leak anywhere. Or you somehow can get a break on dose pricing.

 

[madchemist89]

We did a lot of radiopharm including lutathera in residency. I agree with the above. In addition, there is a lot of work by physics as well. If the patient has an accident on the way to the toilet, it involves even more of their time. They would put chucks(absorbent pads) on the floor and in the bathroom to make clean up easier.

 

[evilbooyaa]

I guess I won the hyperbole game. WasEz😎

That is an impressive amount of whataboutism in your last few posts there.

Giving me these vibes (disclaimer- I am not calling you an idiot, I am saying what you said as a 'gotcha' make me feel similar to this guy):

 

[evilbooyaa]

3- At our center we give radiosensitizing chemotherapy, HT, and also all kinds of radiopharmaceuticals for years. We also moving aggressively with SBRT for liver Mets/HCC and cutting off TACE/RFA.

4- I don't know about everyone here but what I see in this forum a lot of people are one trick pony that can't even give radioactive iodine and they gave it up to nuc med. In term of compensation I'm VERY happy.

5- If location is the only thing he care about I will tell him to be family physician or just be a nurse.

OK, so you clearly practice outside of the US and want to have a strong pro opinion on the US Job market for Radiation Oncologists? Why do you think your opinion holds any weight in this space?

 

[elementaryschooleconomics]

View attachment 346509

I deeply appreciate you using this meme. I say this often in real life, and there's a sharp divide between people who get the reference and those who don't.

The divide seems to be "birthday before or after 1990".

 

[TheWallnerus]

US Job market for Radiation Oncologists

Good news on the job market

The unemployment rate in radiation oncology is now lower than the unemployment rate in the Cuomo family

 

[radoncftw]

I deeply appreciate you using this meme. I say this often in real life, and there's a sharp divide between people who get the reference and those who don't.

The divide seems to be "birthday before or after 1990".

Hey now - I am 1992 and Billy Madison was my favorite movie growing up. Had the Billy Madison / Happy Gilmore DVD box set.

 

[elementaryschooleconomics]

Hey now - I am 1992 and Billy Madison was my favorite movie growing up. Had the Billy Madison / Happy Gilmore DVD box set.

Ah I have two nurses in my department born around that year and they get none of my references...wait. Perhaps I'm the problem? No! That can't be true.