ASTRO panel session on US rad onc labor market

[photonchick]

Nobody went along with it. Everyone is pissed. We sacrificed a new hire, not because we didn't need her, but we needed to make sure that everyone understood that the #struggleisreal. Everywhere you go, you see a radonc. My uber driver was a PGY5 in Louisville, had no idea what he was going to do next. Was like, "well, we need a PA". Even academic centers do incentive pay via RVUs. You think I want some dum dum taking the patients I can easily treat myself?

Wifi at my uncles funeral is a f-cking joke. This took forever to get through.

Yeah... the Louisville residents aren't Uber drivers... Nice try!

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[thesauce]

Yeah... the Louisville residents aren't Uber drivers... Nice try!

Yeah. He must have meant Lyft

Daniel jumped the shark a couple weeks ago. Hard to take him seriously anymore.

 

[Damn_Daniel]

The myth of jumping the shark.

 

[redoitall]

That's a bit too simplistic. Freestanding centers may be down, but they are not out. As hospitals open and consolidate centers, payors are looking for the less expensive option. Many insurance companies preferentially contract with freestanding centers because they deliver care for less $$$. That being said, starting a center in the current environment would be very tough. Freestanding centers these days go with gently used while hospitals are shelling out $$$$ for truebeam and protons. They may hire MAs or LPNs while RNs staff hospital sites. That is how they survive (lower cost structure).
The future may not be as kind to hospital-based radiation oncology as it has been the last decade. Things like bundled payments and payment parity legislation (equalizing pay between freestanding and hospital-based centers) may swing the pendulum back towards freestanding radiation oncology.

Alright then, a freestanding practice may have a shot at "sustaining itself" in the current climate with a good load of patient. And while I do wonder what a "good load of patient" represents, that still doesn't really remove the barrier to entry. Hospital have finance structures that allow them to open up a radiation facility, but if I wanted to do it, broke as I am, I can't see how I could find the few million bucks needed. Even if I did find some financial agreement, not sure I would survive long enough to make the first few payments back... I seriously do not know how those practices started in the first place. If anyone started a practice and want to share some info about it, I'd seriously like to know.

 

[RadOncDoc21]

Alright then, a freestanding practice may have a shot at "sustaining itself" in the current climate with a good load of patient. And while I do wonder what a "good load of patient" represents, that still doesn't really remove the barrier to entry. Hospital have finance structures that allow them to open up a radiation facility, but if I wanted to do it, broke as I am, I can't see how I could find the few million bucks needed. Even if I did find some financial agreement, not sure I would survive long enough to make the first few payments back... I seriously do not know how those practices started in the first place. If anyone started a practice and want to share some info about it, I'd seriously like to know.

In today's current model, it's hard to find primary docs opening up their own shop, much less a radiation oncology department. I think the best option coming out of residency is to get a good feel for a certain area before investing due to so many unknown factors (competition, referral base, reimbursement, etc). I know there is always an option of taking out a loan but coming out of residency is probably the toughest time.

With all that said, there are places and docs that have done this and would be the first to tell you that it is a huge and rewarding challenge. You may either have to give up on (early) compensation and convenience (lack of coverage, more call) for a short duration of time but nothing better than being your own boss with great potential. Another option is to see a practice set up you're interested in to see if any docs are retiring so that you can come in and take over right away versus starting from scratch. You can even work for a group and do a possible buy into the practice as well.

You will see once you get out of training, there are many different potential options in regards to the business model you would like to set up for yourself. I think the most common coming out is an employed position with either a hospital or private group with a partnership track. Most places don't own their own equipment and the ones that currently do use either used or older linacs compared to the big academic hospital up the street which usually has the most latest, most expensive model.

 

[Damn_Daniel]

Alright then, a freestanding practice may have a shot at "sustaining itself" in the current climate with a good load of patient. And while I do wonder what a "good load of patient" represents, that still doesn't really remove the barrier to entry. Hospital have finance structures that allow them to open up a radiation facility, but if I wanted to do it, broke as I am, I can't see how I could find the few million bucks needed. Even if I did find some financial agreement, not sure I would survive long enough to make the first few payments back... I seriously do not know how those practices started in the first place. If anyone started a practice and want to share some info about it, I'd seriously like to know.

I don't know how active the company is, but there was a company called Vantage that gave a talk about what it would take to try to own a center. I think at the time, they helped with some of the capital investment. The old numbers were you needed about $5m to open a center, and needed to have $1m and borrow the rest. Probably a lot more now? And, would be hard to get the lending, in this era. Give Vantage a call and see if they still give this talk.

 

[Reaganite]

Alright then, a freestanding practice may have a shot at "sustaining itself" in the current climate with a good load of patient. And while I do wonder what a "good load of patient" represents, that still doesn't really remove the barrier to entry. Hospital have finance structures that allow them to open up a radiation facility, but if I wanted to do it, broke as I am, I can't see how I could find the few million bucks needed. Even if I did find some financial agreement, not sure I would survive long enough to make the first few payments back... I seriously do not know how those practices started in the first place. If anyone started a practice and want to share some info about it, I'd seriously like to know.

vault: 700k-1mil. Good used linac: 500-700k. Software (Aria/Mosaiq, Eclipse/Pinnacle): 500k+. With other miscellaneous expenses, cheapest you could possibly build a center for would be 2.5-3million. Then you'd have several months with no collections where you'd still have to pay physician, physics, staff, IT, etc. Made a lot more sense when IMRT was reimbursing 50k a pop. Now, even centers with physician investors are struggling.

We all complained our collective asses off when urorads was 'taking' the prostate patients, but we probably wouldn't have seen those patients anyway since they were all getting surgery before the uros had an RT investment. Meanwhile, the hospitals are buying out all the med oncs...a much bigger threat to private practice rad onc these days.

 

[medgator]

vault: 700k-1mil. Good used linac: 500-700k. Software (Aria/Mosaiq, Eclipse/Pinnacle): 500k+. With other miscellaneous expenses, cheapest you could possibly build a center for would be 2.5-3million. Then you'd have several months with no collections where you'd still have to pay physician, physics, staff, IT, etc. Made a lot more sense when IMRT was reimbursing 50k a pop. Now, even centers with physician investors are struggling.

We all complained our collective asses off when urorads was 'taking' the prostate patients, but we probably wouldn't have seen those patients anyway since they were all getting surgery before the uros had an RT investment. Meanwhile, the hospitals are buying out all the med oncs...a much bigger threat to private practice rad onc these days.

The really shady urologists were flying to Cancun to do hifu, or just cryoing everybody.

Imo, the biggest threat isn't losing med oncs, it's losing the breast/general surgeons, pulmonologists, GI, pcps etc. where entire groups are being bought up. They feed both types of oncologists when you really look at it at the end of the day.

And contrary to folklore, pcps can send us patients

 

[RadOncDoc21]

The really shady urologists were flying to Cancun to do hifu, or just cryoing everybody.

Imo, the biggest threat isn't losing med oncs, it's losing the breast/general surgeons, pulmonologists, GI, pcps etc. where entire groups are being bought up. They feed both types of oncologists when you really look at it at the end of the day.

And contrary to folklore, pcps can send us patients

Nothing like being a bottom feeder!

 

[smq123]

And contrary to folklore, pcps can send us patients

Sure, they can...but how many actually do? How many referrals from PCPs have you gotten?

 

[xrthopeful]

Sure, they can...but how many actually do? How many referrals from PCPs have you gotten?

you're not a radiation oncologist.

 

[smq123]

you're not a radiation oncologist.

That's why I ask - I am genuinely curious. I'm a PCP and I can't remember the last time I referred a patient to a radiation oncologist. I tried once, but it didn't go the way that I had hoped. :-/

 

[Damn_Daniel]

That's why I ask - I am genuinely curious. I'm a PCP and I can't remember the last time I referred a patient to a radiation oncologist. I tried once, but it didn't go the way that I had hoped. :-/

Never once have I received a referral from a PCP. Would ruin my established relationships with specialists if I bypassed them.

 

[Neuronix]

you're not a radiation oncologist.

Between smq and I, we have a good idea what PCPs and rad oncs do... I would agree with her. As a resident, I don't think I've ever seen a patient referred directly from a PCP. Most of smq's coworkers don't even know what we do.

Never once have I received a referral from a PCP. Would ruin my established relationships with specialists if I bypassed them.

There's a little more to that story. I'm smq's boyfriend. Because we used to practice about an hour away from each other, I told her to refer to a local rad onc for rising PSA post-prostatectomy for consideration of salvage RT. I don't remember all the details of the case and risk factors, but I do recall the PSA was 0.7 about 5 years after surgery, started rising about 4 years out.

The local rad onc called her to tell her to re-refer when the PSA rose over 1. Patient was then lost to follow-up--no idea what happened to the guy.

 

[xrthopeful]

It's a good thing we never let one bad PCP referral or send-back ruin the process for us.

 

[Damn_Daniel]

I didn't mean anything by the comment about smq, it was a thoughtful thing for her to do. It's just The Gator speaks a lot about basically being "the link" between PCPs and curing cancer and maybe it's his / her practice environment, but seeking it out would probably hurt me a lot, and honestly would hurt a lot of radiation oncologists who's relationships with referrings can be tenuous, and I would say to someone starting out that courting local PCPs is fraught with some danger, and would do it judiciously, utilizing the advice of people with knowledge of local practice patterns.

Have good relationships with everyone, and hopefully most people that should come to you, come to you. Alienate yourself by hassling busy people at your own risk.

Between smq and I, we have a good idea what PCPs and rad oncs do... I would agree with her. As a resident, I don't think I've ever seen a patient referred directly from a PCP. Most of smq's coworkers don't even know what we do.



There's a little more to that story. I'm smq's boyfriend. Because we used to practice about an hour away from each other, I told her to refer to a local rad onc for rising PSA post-prostatectomy for consideration of salvage RT. I don't remember all the details of the case and risk factors, but I do recall the PSA was 0.7 about 5 years after surgery, started rising about 4 years out.

The local rad onc called her to tell her to re-refer when the PSA rose over 1. Patient was then lost to follow-up--no idea what happened to the guy.

 

[smq123]

It's a good thing we never let one bad PCP referral or send-back ruin the process for us.

Who peed in your wheaties?

I asked because I was truly curious. I agree that PCPs can, and, for the appropriate patient, should refer to rad onc. But most PCPs don't, even though it's probably warranted. It's a combination of lack of knowledge on the PCP's part (as residents, we learn from IM subspecialists, med onc, and surg onc, and thats what tends to drive our referral patterns) and poor understanding of what rad onc even is - many of my coworkers say that they feel sorry that my boyfriend spends all of his time in a dark room hunched over a dictaphone, no matter how many times I tell them he's not a radiologist.

My point with asking the question is that relying on people to feed you referrals is tough. PCPs won't feed you referrals when they don't even understand what you guys can treat.

It sounds like you get a LOT of PCP referrals. Good for you. I was just surprised because that is not typical. That has certainly not been my experience as a PCP, throughout 3 years of residency and nearly 4 years of practice in the community.

 

[smq123]

I didn't mean anything by the comment about smq, it was a thoughtful thing for her to do. It's just The Gator speaks a lot about basically being "the link" between PCPs and curing cancer and maybe it's his / her practice environment, but seeking it out would probably hurt me a lot, and honestly would hurt a lot of radiation oncologists who's relationships with referrings can be tenuous, and I would say to someone starting out that courting local PCPs is fraught with some danger, and would do it judiciously, utilizing the advice of people with knowledge of local practice patterns.

Have good relationships with everyone, and hopefully most people that should come to you, come to you. Alienate yourself by hassling busy people at your own risk.

I appreciate your comments. I have griped in the past that rad onc doesn't do a good job of selling itself. I actually kind of wish that they tried harder to do so, at least in my market. For example, maybe we should start sending some of our patients with basal cell cancers on the face straight to rad onc instead of derm/surgery (which is what many PCPs will do).

 

[Damn_Daniel]

Trust me, people love peeing in people's wheaties here. Haha, awesome, love that line.

It's great you did refer. It's not your job. Lot more important things to worry about. I couldn't imagine managing a PCP's panel of patient's, and then trying to learn when during a PSA trajectory post surgery I have to send to radiation. Wtf!!!

Who peed in your wheaties?

I asked because I was truly curious. I agree that PCPs can, and, for the appropriate patient, should refer to rad onc. But most PCPs don't, even though it's probably warranted. It's a combination of lack of knowledge on the PCP's part (as residents, we learn from IM subspecialists, med onc, and surg onc, and thats what tends to drive our referral patterns) and poor understanding of what rad onc even is - many of my coworkers say that they feel sorry that my boyfriend spends all of his time in a dark room hunched over a dictaphone, no matter how many times I tell them he's not a radiologist.

My point with asking the question is that relying on people to feed you referrals is tough. PCPs won't feed you referrals when they don't even understand what you guys can treat.

It sounds like you get a LOT of PCP referrals. Good for you. I was just surprised because that is not typical. That has certainly not been my experience as a PCP, throughout 3 years of residency and nearly 4 years of practice in the community.

 

[Damn_Daniel]

I appreciate your comments. I have griped in the past that rad onc doesn't do a good job of selling itself. I actually kind of wish that they tried harder to do so, at least in my market. For example, maybe we should start sending some of our patients with basal cell cancers on the face straight to rad onc instead of derm/surgery (which is what many PCPs will do).

No, you're fine. Unless you're doing biopsies and then sending to us. If you're not, I'm just going to send them to derm for a biopsy. Being a PCP is like the guy who finally has a chance to have a theeesome. He's got to coordinate like 12 million things, has a clipboard, and a Bluetooth earpiece, and needs to cross a bunch of t's and dot a bunch of i's to make things come together. It's really damn hard. I'm not about to give the threesome planner another task, like "also, can you get a really nice Pinot and make a pot roast?"

 

[Neuronix]

It's a good thing we never let one bad PCP referral or send-back ruin the process for us.

... Ok Mr. Sarcasm. It's the only case that I felt needed a direct rad onc referral (not med onc or surg onc) in smq's practice in the years that smq has been an attending. She runs many cases by me.

 

[RadOncDoc21]

I wouldn't complain if I received a referral from a PCP. Maybe that's the kind of innovation that would be necessary in the future.

It wasn't that long ago when a physician never had to advertise for business. I'm also not a fan of community hospitals paying for academic names. I just saw another MD Anderson hospital.

 

[medgator]

Sure, they can...but how many actually do? How many referrals from PCPs have you gotten?

Ok, reading through this thread, I will assume you're not trolling. I receive a handful every year for different situations. I'll list a few cases I can recall off the top of my head. The jist of it is, that there can be hostile med oncs (that have an interest in supporting a competing xrt center), shady urologists that cut/cryo everything, as well as situations where a patient sees a tertiary referral center for diagnosis and the pcp knows I'm competent to give the xrt locally rather than a 100+ miles away. Hospitalists sometimes call me for symptomatic mets. Other scenarios as well

I got a referral for a symptomatic follicular lymphoma of paraaortic nodes invading the spine as a dual referral along with med onc. Another pcp sent me a h&n case where the pt was seen and diagnosed at an academic place and was potentially going to get xrt there. I occasionally get a high risk prostate ca as well where the pcp knows the surgeon may be more aggressive than for the patients good, and chances are I won't see said patient unless it's postop salvage, if at all, or I'm treating mets at that point :-/

We have the most oncology training in medicine, hands down. Personally, id love to get more fresh lung masses/spn's from primary care, a goal I'm working towards. There is no reason why pcps can't send us patients.

Capiche?

 

[medgator]

Never once have I received a referral from a PCP. Would ruin my established relationships with specialists if I bypassed them.

Can always count on comedic relief from DD. Must be nice to be in the end stage referral cocoon in your "third rate" academic center. PP would be a shock to your system

 

[thecarbonionangle]

a "third rate academic center" with training from "the Harvard of the caribbean" and his dosimetrist is Haitian or something.

 

[xrthopeful]

DD is being legit in this case - most rad oncs have never even SNIFFED a referral from a PCP.

If you have, you're the rarity.

 

[RadOncDoc21]

DD is being legit in this case - most rad oncs have never even SNIFFED a referral from a PCP.

If you have, you're the rarity.

And yet, we wonder why we get last dibs in the referral stream. I got a family to feed also!

 

[Gfunk6]

I have to concur with DD and xrthopeful here. Getting referrals from PCPs is dandy but is surely a product of your location and regional politics.

Our Medical Oncologists, by virtue of their Heme training have a significant "in" with our referring PCPs. They frequently receive texts/calls from PCPs about how to appropriately work up patients with CBCs out of whack. This builds PCP knowledge base, prevents unnecessary referrals and most importantly, builds the relationship.

If you really want direct referrals from PCPs, then employ 'em. That's what we did


Sent from my iPhone using SDN mobile app

 

[Damn_Daniel]

DD is being legit in this case - most rad oncs have never even SNIFFED a referral from a PCP.

If you have, you're the rarity.

a "third rate academic center" with training from "the Harvard of the caribbean" and his dosimetrist is Haitian or something.

Racist. I hold what you say now in very little regard. The Haitians have done nothing to you. What does it mean that my physics staff are from Haiti or not? They aren't. But if they were, is that funny? I'm an obese, difficult to agree with, occasionally flatulent man that most people don't like to hang out with. But no one would expect even me to be racist amongst the most harmed people in the Caribbean. Sorry to read this. Sorry to have you as a co-specialist

 

[Damn_Daniel]

H

Racist. I hold what you say now in very little regard. The Haitians have done nothing to you. What does it mean that my physics staff are from Haiti or not? They aren't. But if they were, is that funny? I'm an obese, difficult to agree with, occasionally flatulent man that most people don't like to hang out with. But no one would expect even me to be racist amongst the most harmed people in the Caribbean. Sorry to read this. Sorry to have you as a co-specialist

He wanted to employ a dosimetrists without borders program for Haitians. Which is stupid. My dosimetrist is stupid. Not Haitian. They aren't the same thing. Racist.

 

[RadOncDoc21]

I have to concur with DD and xrthopeful here. Getting referrals from PCPs is dandy but is surely a product of your location and regional politics.

Our Medical Oncologists, by virtue of their Heme training have a significant "in" with our referring PCPs. They frequently receive texts/calls from PCPs about how to appropriately work up patients with CBCs out of whack. This builds PCP knowledge base, prevents unnecessary referrals and most importantly, builds the relationship.

If you really want direct referrals from PCPs, then employ 'em. That's what we did


Sent from my iPhone using SDN mobile app

You best believe that's what I'm doing. If I relied on my urologists, thoracic surgeons and dermatologists for referals, I would be homeless!

 

[Damn_Daniel]

Can always count on comedic relief from DD. Must be nice to be in the end stage referral cocoon in your "third rate" academic center. PP would be a shock to your system

I bow to you! Even though everyone, even in private practice agrees with me, I'm such comedic relief.

 

[Gfunk6]

Everyone, please cool your jets and stay on topic.


Sent from my iPhone using SDN mobile app

 

[Burt Radnolds]

N

 

[mpdoc2]

This thread seems "straight outta Compton".

 

[Reaganite]

I've spent a HUGE amount of time marketing several private practices, so I'd like to think I'm as well-versed as anyone in this. Marketing to PCPs is mostly a waste of time. Referring directly to Med Oncs is so ingrained in their collective psyche, that it will be almost impossible to change that. Most solo guys are too busy and have little interest in changing the referral trend to some rad onc when the med onc will typically do all the triaging to rad onc and surg onc for them. If you really want to market outside the usual suspects, you might reach out to GI or pulm for some direct referrals. There is also occasionally a benefit to courting large PCP groups. There is one group near an office of mine that literally controls half the primary care in the entire city. Marketing to them has generated many direct referrals to me. Outside of these bigger groups, though, I wouldn't waste my time.

 

[Damn_Daniel]

Knowing nothing in life but to be legit...

Doesn't matter. Hospital based medicine is going to win, they will own the PCPs, med oncs, radoncs and specialists. They will set up the referral chain and put the specialists on salary with cute incentive bonuses. The fees are drastically different now, and they can treat less patients and make more money, while freestanding centers will have to fight and claw (and I guess pander to PCPs) for every single patient left out there. It's the beginning of the end. But, it was lovely while it lasted.

 

[smq123]

I've spent a HUGE amount of time marketing several private practices, so I'd like to think I'm as well-versed as anyone in this. Marketing to PCPs is mostly a waste of time. Referring directly to Med Oncs is so ingrained in their collective psyche, that it will be almost impossible to change that. Most solo guys are too busy and have little interest in changing the referral trend to some rad onc when the med onc will typically do all the triaging to rad onc and surg onc for them. If you really want to market outside the usual suspects, you might reach out to GI or pulm for some direct referrals. There is also occasionally a benefit to courting large PCP groups. There is one group near an office of mine that literally controls half the primary care in the entire city. Marketing to them has generated many direct referrals to me. Outside of these bigger groups, though, I wouldn't waste my time.

If you're interested in changing referral patterns, sometimes giving a good lecture to a local FM residency program can be helpful. You're right, most people who have been out in practice for a while have ingrained referral patterns and a set of specialist buddies that they tend to turn to, repeatedly. But catching PCPs when they're young and relatively moldable might help change that.

You best believe that's what I'm doing. If I relied on my urologists, thoracic surgeons and dermatologists for referals, I would be homeless!

What GFunk's group is doing is incredibly smart. Building their own multi-specialty practice is probably the best way for a privately owned group to survive nowadays. Sad that that's the way things have become....

 

[RadOncDoc21]

If you're interested in changing referral patterns, sometimes giving a good lecture to a local FM residency program can be helpful. You're right, most people who have been out in practice for a while have ingrained referral patterns and a set of specialist buddies that they tend to turn to, repeatedly. But catching PCPs when they're young and relatively moldable might help change that.



What GFunk's group is doing is incredibly smart. Building their own multi-specialty practice is probably the best way for a privately owned group to survive nowadays. Sad that that's the way things have become....

I have a question since this is all new to me... How would Stark Law come into play with doing this? I mean are you able to refer patients within your group, if so is it billed the same?

 

[medgator]

I have a question since this is all new to me... How would Stark Law come into play with doing this? I mean are you able to refer patients within your group, if so is it billed the same?

They're likely all under one tax ID. No stark law issues in that scenario in terms of referring patients. Radiation (and diagnostic imaging if they own scanners) fall under the IOAE (in-office ancillary exemption). The only thing the stark law says is that they can't profit directly as a result of the specific patients/referrals they send. The safe way to play that is that everyone shares in the ancillary/technical revenue equally.

I wouldn't complain if I received a referral from a PCP. Maybe that's the kind of innovation that would be necessary in the future.

Yup. Honestly, do you think a med onc can work up a lung mass better than we can? We look at scans, they look at reports. How do they know the best way to get tissue? Sometimes, a CT-guided approach is the way go, other times, maybe the patient needs EBUS or even ENB (electro-nav. bronchoscopy). Brain mets? Every once in a blue moon, a PCP is asute enough to call me for those too when they diagnose it. As Reaganite alluded to, marketing to the big independent groups is the more efficient way to go, but there's no reason not be friendly with the smaller groups/physicians/hospitalists when you get the opportunity to see/meet them.

 

[Reaganite]

They're likely all under one tax ID. No stark law issues in that scenario in terms of referring patients. Radiation (and diagnostic imaging if they own scanners) fall under the IOAE (in-office ancillary exemption). The only thing the stark law says is that they can't profit directly as a result of the specific patients/referrals they send. The safe way to play that is that everyone shares in the ancillary/technical revenue equally.

Yup. Honestly, do you think a med onc can work up a lung mass better than we can? We look at scans, they look at reports. How do they know the best way to get tissue? Sometimes, a CT-guided approach is the way go, other times, maybe the patient needs EBUS or even ENB (electro-nav. bronchoscopy). Brain mets? Every once in a blue moon, a PCP is asute enough to call me for those too when they diagnose it. As Reaganite alluded to, marketing to the big independent groups is the more efficient way to go, but there's no reason not be friendly with the smaller groups/physicians/hospitalists when you get the opportunity to see/meet them.

I agree. Always buddy up to PCPs whenever you can. I do get direct referrals from smaller PCPs at my hospital-based practice, mostly the ones who attend tumor board and have an opportunity to hear me talk about cases. When PCPs see a rad onc in action against a Med Onc, they realize how much better our grasp of oncology is. In freestanding centers, it's a little tougher. I tried it. Marketed to small docs as a general "oncologist." Actually got several oncology referrals, but most were not radiation cases. Atypical ductal hyperplasia, colon cancer, etc. It became a hassle for me, and the PCPs eventually caught wind that I was just triaging to the med oncs and surgeons, and they stopped sending. Actually pissed off one guy because I presented myself as an oncologist!

 

[RadOncDoc21]

I agree. Always buddy up to PCPs whenever you can. I do get direct referrals from smaller PCPs at my hospital-based practice, mostly the ones who attend tumor board and have an opportunity to hear me talk about cases. When PCPs see a rad onc in action against a Med Onc, they realize how much better our grasp of oncology is. In freestanding centers, it's a little tougher. I tried it. Marketed to small docs as a general "oncologist." Actually got several oncology referrals, but most were not radiation cases. Atypical ductal hyperplasia, colon cancer, etc. It became a hassle for me, and the PCPs eventually caught wind that I was just triaging to the med oncs and surgeons, and they stopped sending. Actually pissed off one guy because I presented myself as an oncologist!

Genius!

 

[DebtRising]

http://www.redjournal.org/article/S0360-3016(16)00233-9/abstract

Just a link to the abstract from what I can tell was essentially discussed / presented earlier. Publishing, in plain language, that the model now projects oversupply is a good start. Unfortunately it appears to be too little too late to save the next decade and a half without action of intelligently regulating supply to meet demand. Regulating positions to ensure graduates can get a job in New York City or Southern California is bad, but so is NOT regulating positions so that graduates who may or may not have significant debt struggle to find meaningful employment (partnership track, true academic, something other than a glamorous locums) and have to do fellowship. Who is in charge of walking this line and both serving societal needs and providing some protection to the very newest entrants in the field, who may have been told (as per ASTROs website) about the growth of the specialty and ability to find employment? From what I can tell no one, as ASTRO, SCAROP, ACGME all seem to abolish any responsibility. Medical students and young residents take note of this.

Biggest question will be when does the line cross from 'can't get a job in a large, very desirable coastal city' to 'either you are in the middle of a small town in the midwest, mid south, or small/remote areas in northeast/west/southwest [no disrespect to smaller locales intended], or are in fellowship'. My guess is 4-5 years, if not sooner.

If this link has previously been posted I apologize completely for the rehash.

 

[medgator]

To help the impending "shortage" in rad onc, sounds like Arkansas will be bringing a program online soon

http://careers.astro.org/jobs/8145430/radiation-oncology-residency-training-program-director

 

[deleted18755]

Something doesn't add up here. How can the center serve 3 million people but only treat 800-1000 new patients per year? I've never been to Arkansas but I can't imagine that the state has some bizarre demographics (only non-smoking young adults) and/or that the incidence of cancer is almost an order of magnitude lower than normal. Or maybe I was too disgusted at this obvious attempt to start a residency program just to provide free labor to an attending (and thus try to attract an attending to Arkansas) to read carefully.

In any event how can a center support a program with 800 patients per year ... One lonely resident per year for a total of 4 seeing 200/year? I'm sure that includes a lot of bone and brain mets so good luck getting a quality education due to lack of cases and inexperienced teaching faculty (who are just using you for free labor). Poor suckers ...

 

[Fpg1245]

Look the bottom line is short of a tremendous disruption on the part of present rad onc residents expect this kind of crap to continue. You've already been fed every line in the book. "The 2008 crisis altered retirement plans" even if it did the new trend is boomers working well past the age of 65 for a variety of reasons. See non http://www.bloomberg.com/news/artic...re-americans-break-record-for-working-past-65

And look no further than than your very own medscape, they are trimming radiation out of every disease or reducing number of fractions for a cancer.

I think the luminaries in this field are leading the charge to over saturation and increasing irrelevance. We may not be able to control the latter but the former well...

 

[Sheldor]

Something doesn't add up here. How can the center serve 3 million people but only treat 800-1000 new patients per year? I've never been to Arkansas but I can't imagine that the state has some bizarre demographics (only non-smoking young adults) and/or that the incidence of cancer is almost an order of magnitude lower than normal. Or maybe I was too disgusted at this obvious attempt to start a residency program just to provide free labor to an attending (and thus try to attract an attending to Arkansas) to read carefully.

In any event how can a center support a program with 800 patients per year ... One lonely resident per year for a total of 4 seeing 200/year? I'm sure that includes a lot of bone and brain mets so good luck getting a quality education due to lack of cases and inexperienced teaching faculty (who are just using you for free labor). Poor suckers ...

I have some familiarity with the department there so I can add some info: So, they've been trying to start this program for quite a while. The mission of the University of Arkansas is to train physicians to serve Arkansans. Something like 60-70% of their students stay in Arkansas to do their residency, and then stay on in the state to work. One of the few residencies not available in the state is Rad Onc, and so their goal has been to add that so that they can help train rad oncs who will want to practice in the state. They are essentially doing what other places have been talking about. Have a hard time getting docs to rural areas? Lets prioritize accepting every med school applicant from rural areas that meets basic eligibiliaty criteria. Then lets train them and send them back home. All that to say, you won't find a more strident critic of the ever expanding residency programs in our field, in fact, I think we need to cut spots! That said, letting a small state where no one wants to move to start a residency so the people that live there can have better access to care makes basic sense. (NB: I think we should cap residency positions and then just redistribute not add.)

As to their catchment area, they are the only academic center in the state, so I guess they are counting the population of the state? Their new chair is going to be Fen Xia from Ohio State and it looks like they are hiring a PD with experience, so it shouldn't be all bad.

 

[deleted18755]

Disregard

 

[DebtRising]

I have some familiarity with the department there so I can add some info: So, they've been trying to start this program for quite a while. The mission of the University of Arkansas is to train physicians to serve Arkansans. Something like 60-70% of their students stay in Arkansas to do their residency, and then stay on in the state to work. One of the few residencies not available in the state is Rad Onc, and so their goal has been to add that so that they can help train rad oncs who will want to practice in the state. They are essentially doing what other places have been talking about. Have a hard time getting docs to rural areas? Lets prioritize accepting every med school applicant from rural areas that meets basic eligibiliaty criteria. Then lets train them and send them back home. All that to say, you won't find a more strident critic of the ever expanding residency programs in our field, in fact, I think we need to cut spots! That said, letting a small state where no one wants to move to start a residency so the people that live there can have better access to care makes basic sense. (NB: I think we should cap residency positions and then just redistribute not add.)

As to their catchment area, they are the only academic center in the state, so I guess they are counting the population of the state? Their new chair is going to be Fen Xia from Ohio State and it looks like they are hiring a PD with experience, so it shouldn't be all bad.

That may all be true about the intention, but starting a perpetually filling / graduating training program to meet the finite needs of a small state is a perfect illustration of the backward and selfish thinking of people more senior in this field.

Arkansas has a population of 3 million, roughly. That's the whole state. How many radiation oncologists do they need? Once the needs of the state are met, assuming they aren't now, is the residency program going to go on hiatus?

A smart solution would be to team up with a larger center, you know like one of the ones in Texas, where the Arkansas institution and the Texas institution 'share' a spot every 2-3 years. They could specifically recruit to fill this spot from Arkanas or local regions- ie people who want to live there long term. The larger Texas institution would get an extra resident every 2-3 years; the requisite, essentially free labor to make their administration / senior docs happy, and this resident could then rotate through Arkanas for periods of time during residency as well to familiarize themselves with system and physicians. And, as pointed out previously, this resident would get superior training with a bigger and more diverse case load from the larger institution - all the while not being that terribly far from the state.

Is something like this really that hard to work out? Seems to be a win for everyone, including those people who would really like to practice in AR, the PDs / Chairs getting their requisite free note-writing doctor, the resident getting a superior training, and the added labor force matched to the true need at a time when models suggest we are already training more radiation oncologists then are needed. Their intentions may be sound, but solving a small, inflexible labor shortage (if there was one) with a continuous, never ending (in theory) new supply is just idiotic, no matter how hard they have been working on it. And that's not even to point out my favorite institution, Wash U, isn't all that far away and if they really wanted to serve the needs of the under-served could have devised / thought up an intervention that took me all of 1 minute.

As I said before, regulating the supply of our labor to ensure we have good jobs at the expense of patients is wrong. But mindlessly expanding the supply of labor / new graduates while ignoring the oversupply, with no official acknowledgement that their may be a problem, and a blatantly self serving interest of having more cheap labor in one of the few fields where mid-levels are particularly limited in their capabilities, is equally wrong and disgusting. But it keeps happening. 'Adjust your expectations'.

 

[xrthopeful]

Yep.

Let's hope this program never gets off the ground.

Same for the ones planned for West Virginia and East Carolina.

Cut them at the knees now.