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this is a tricky one. Virtual supervision is bad for the collective, good for the individual, in my view
this is a tricky one. Virtual supervision is bad for the collective, good for the individual, in my view
I tend to agree.
I think it can very much be a mixed bag for patients too. I do think some patient care is inferior via virtual. But it may also improve access...so mixed bag.
What's the rationale against having the option?Counterpoint: an OTV in the first couple weeks of treatment typically takes 13 seconds whether it's on telemed or in person. The telemed is actually likely more cumbersome to get set up and no vitals/non-verbal communication/miscellaneous doctoring, etc...
It's just worse all around.
Once we become full on technicians, the game is over.
Because Bridge Oncology will put an NP in a site and have a doctor fly in twice a month to see 8 consults/Sims in a day and then fly out.What's the rationale against having the option?
Counterpoint: an OTV in the first couple weeks of treatment typically takes 13 seconds whether it's on telemed or in person. The telemed is actually likely more cumbersome to get set up and no vitals/non-verbal communication/miscellaneous doctoring, etc...
It's just worse all around.
Once we become full on technicians, the game is over.
What's the rationale against having the option?
Because Bridge Oncology will put an NP in a site and have a doctor fly in twice a month to see 8 consults/Sims in a day and then fly out.
I don't think it's in the patients' or specialty's best interest (or really, many individual doctors' best interest) to go this route.
If it's an option for rare occurrences, it's an option for every occurrence. It will be abused if it makes a dollar for someone. Likely immediately and wantonly.
Because Bridge Oncology will put an NP in a site and have a doctor fly in twice a month to see consults/Sim and then fly out.
I don't think it's in the patients' or specialty's best interest (or really many individual doctors' best interest) to go this route.
If it's an option for rare occurrences, it's an option for every occurrence. It will be abused if it makes a dollar for someone. Likely immediately and wantonly.
If you were allowed to be off site, would you do it every day?exactly
Precisely this. Remember, "it's fine until it's not". Are the rules going to be different for higher risk patients, eg the H&N who has already lost 30# before starting treatment and is refusing a feeding tube? What about people getting concurrent chemo? Despite frequently grousing about having to stop whatever I'm doing to go check in with the person who just started and has no complaints, or the person who has the same questions every week like groundhog day, seeing on treatment patients in person for a weekly check is non-negotiable as far as I'm concerned. Employment questions aside the patients need it. Leaving even acute RT toxicity management aside I can't tell you how many times I have caught drug reactions, DVTs, dehydration/renal failure, infections...all kinds of serious stuff...just by getting a set of vitals and checking in with the patient. It's not like the med oncs are doing it. We are just going to roll over and sign away our professional obligations to extenders because we can't be bothered? Whoever upthread said that a center that can't staff a weekly OTV with an MD shouldn't be open is 100% correct. Same with AI. Who does all this benefit? not the MDs and certainly not the patients I assure you.Because Bridge Oncology will put an NP in a site and have a doctor fly in twice a month to see consults/Sim and then fly out.
I don't think it's in the patients' or specialty's best interest (or really many individual doctors' best interest) to go this route.
If it's an option for rare occurrences, it's an option for every occurrence. It will be abused if it makes a dollar for someone. Likely immediately and wantonly.
By your own admission here, don't you treat like 10-12 patients? You really can't find time in the week to spent 5 minutes with each of them?My hospital does general supervision, not direct (we follow Medicare). I take a WFH day maybe once a quarter.
I would never have a sim occur without me on site, we don't treat higher than 4 Gy / Fx without me here.
You want rules to enforce bad behavior, good luck. People are sh*tty, that's the world we live in.
But, for me to not be able to go off site for half a day on OTV day .. this is the height of absurdity.
I understand what you're saying - I'm definitely do. Have not seen people abuse at multiple centers I know that do general supervision.
Sounds like a great topic to discuss openly with members and the field. The secrecy is so damaging.
I think if by and large we were desperately trying to keep up with volume, you would get a different response.If you were allowed to be off site, would you do it every day?
NPs are at infusion centers. Medoncs still are working. Not marginalized.
I do all of mine in person. But the option…By your own admission here, don't you treat like 10-12 patients? You really can't find time in the week to spent 5 minutes with each of them?
I realize that ASTRO is the arch enemy of many, and I understand you personal concerns.
on the other hand - the organization exists to do this. It is like the government. We won't agree with all they do, and may not know it all either, but ultimately the big picture stuff is presented, individual people (many of whom we like, including community folks) are on these panels and are decision makers.
if every decision is voted on, that's how we end up like California where every proposition needs to be voted on.
I'm not pro ASTRO - but this is more to say, like this is sort of their job.... so I guess I can understand why 'they' would do things without running every single thing past every member. that's not how organizations like this work, right?
COLD, BROVirtual for OTN but mandate in-person for Simul. Let's start there.
The field is so small that it lends itself to an authoritarian culture where the few “leaders” oligarchs “know best”. It has been the MO of the field for a long time. How do we change this?
The great part is that they didn't even do it right and that's why it is back in. They simply are not competent.I realize that ASTRO is the arch enemy of many, and I understand you personal concerns.
on the other hand - the organization exists to do this. It is like the government. We won't agree with all they do, and may not know it all either, but ultimately the big picture stuff is presented, individual people (many of whom we like, including community folks) are on these panels and are decision makers.
if every decision is voted on, that's how we end up like California where every proposition needs to be voted on.
I'm not pro ASTRO - but this is more to say, like this is sort of their job.... so I guess I can understand why 'they' would do things without running every single thing past every member. that's not how organizations like this work, right?
Ah yes the “negative” label. This seems to be a very favorite word by these groups. Easy to always character asassinate than engage in ideas. My frustration is that many careerists are always talking about “diversity” but they do not welcome this really. They want minority faces to rubberstamp their views and collective actions. There is no attempt to have diversity of thought. If you had a minority outspokenly going against the group think, they would also be labeled as “negative” and “hard to work with” and cancelled.A nice start would be to stop pretending like people who are just asking for discussion are calling for the "death of ASTRO" or labeling them as misanthropes or negative.
I know nothing about either of your practices, other than what is shared here.COLD, BRO
Wait, do I have a billion dollar idea??I know nothing about either of your practices, other than what is shared here.
I just imagine OTN seeing 16-20 consults a week and single handedly servicing the equivalent of a medium sized city while you see 4 consults a week, have 6 side hustles and are strategizing regarding a wellness clinic that will make you like a billion dollars.
I'm just jelly. Looking for regulation as a form of retribution.
The reality for me is that I do so much SBRT it really doesn't make much of a difference.
Medonc is becoming a significantly APP driven service in the community, because it has to be. Because doc leverage is so great and the supply to demand ratio of docs is so low.
And I hear it from patients. They don't know who their med onc is; only saw them once prior to treatment. And now I get to manage all the concurrent chemo side effects, because the APPs in general don't do a great job or at worst are counter productive with their recommendations.
I tend to believe this.We're about to convenience ourselves right out of a field of medicine.
You're saying "we".We've done more to minimize our presence in front of patients over the last 20 year than any other field in medicine. I think celebrating the ability to eliminate it completely outside of a single initial visit, is VERY shortsighted.
Yeah. I'm not sure that a site should be open if a doctor isn't available to see each patient on treatment once per week.
Jordan Johnson wants it that way because it (now) suits his business model (as opposed to previously when he'd be screaming fraud and fear mongering people into buying his services).
It is quite the sleight of hand for the tertiary referral centers to be so gung ho on telehealth consults (and oh my do the MSKCCs of the world love telehealth consults) but derisive about telehealth OTVs.
Legitimately every single person in VC.Do you all know people that are different than me?
I'm gonna disagree on this one.It is quite the sleight of hand for the tertiary referral centers to be so gung ho on telehealth consults (and oh my do the MSKCCs of the world love telehealth consults) but derisive about telehealth OTVs.
We've done more to minimize our presence in front of patients over the last 20 year than any other field in medicine. I think celebrating the ability to eliminate it completely outside of a single initial visit, is VERY shortsighted.
People here want to rail against the old rad onc "leaders" making decisions to benefit themselves at the detriment of all future rad oncs and the field at large. This is one of those things.