European Supervision Rules

[scarbrtj]

There is need for radiation oncologists in rural areas too. Not rural-rural in the meaning of towns with a couple hundred people, but there are radiation oncology clinics in cities in the range of 20k-50k inhabitants.
However, not everyone wants to live there, true.

Palex, some around here may want to know what "supervision" means in Europe/your country. What's the medical take? Is there a legal take over there? Feel free to avoid a sticky wicket if you so choose

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[Palex80]

A radiation oncologist needs to be present in the department when treating. It cannot be a resident.

I am not aware of anyone trying to challenge this.

Some countries have rather strict „radiation protection“ legislation, dictating the number of physicians who need to be on contract per site based on operating hours/patients to treat.

For example in Germany you will need around 3 radiation oncologists and 3 physicists to be able to operate a department with around 70–80 patients on beam. You need at least 1 physician per linac + 1 more if you choose to treat > 8 hours per day + 1 more if you choose to utilize IMRT/IGRT (which everyone does nowadays) and to cover for vacations/sickness. Theoretically you could run a machine with just 1.5 physicians but you would only be allowed to treat with simple techniques and perhaps 30 patients / day, which will not be enough to cover costs.

 

[medgator]

A radiation oncologist needs to be present in the department when treating. It cannot be a resident.

I am not aware of anyone trying to challenge this.

Some countries have rather strict „radiation protection“ legislation, dictating the number of physicians who need to be on contract per site based on operating hours/patients to treat.

For example in Germany you will need around 3 radiation oncologists and 3 physicists to be able to operate a department with around 70–80 patients on beam. You need at least 1 physician per linac + 1 more if you choose to treat > 8 hours per day + 1 more if you choose to utilize IMRT/IGRT (which everyone does nowadays) and to cover for vacations/sickness. Theoretically you could run a machine with just 1.5 physicians but you would only be allowed to treat with simple techniques and perhaps 30 patients / day, which will not be enough to cover costs.

Sounds like it is more strict than here, technique and time restricted per radonc is certainly a unique thing, have never heard of that

 

[deleted1002574]

Wow, so this pushes back against my contention that the Europeans do it. So, at lunch, you can’t leave the building to go get some .. idk .. whatever you eat for lunch (not sure where you live)? Have to stay in hospital like us?

A radiation oncologist needs to be present in the department when treating. It cannot be a resident.

I am not aware of anyone trying to challenge this.

Some countries have rather strict „radiation protection“ legislation, dictating the number of physicians who need to be on contract per site based on operating hours/patients to treat.

For example in Germany you will need around 3 radiation oncologists and 3 physicists to be able to operate a department with around 70–80 patients on beam. You need at least 1 physician per linac + 1 more if you choose to treat > 8 hours per day + 1 more if you choose to utilize IMRT/IGRT (which everyone does nowadays) and to cover for vacations/sickness. Theoretically you could run a machine with just 1.5 physicians but you would only be allowed to treat with simple techniques and perhaps 30 patients / day, which will not be enough to cover costs.

 

[medgator]

Wow, so this pushes back against my contention that the Europeans do it. So, at lunch, you can’t leave the building to go get some .. idk .. whatever you eat for lunch (not sure where you live)? Have to stay in hospital like us?

Worse actually. They have stricter labor laws even for rad onc, can't cover 40 pts on a single linac with a single doc if you read his post in detail

 

[scarbrtj]

A radiation oncologist needs to be present in the department when treating. It cannot be a resident.

I am not aware of anyone trying to challenge this.

Some countries have rather strict „radiation protection“ legislation, dictating the number of physicians who need to be on contract per site based on operating hours/patients to treat.

For example in Germany you will need around 3 radiation oncologists and 3 physicists to be able to operate a department with around 70–80 patients on beam. You need at least 1 physician per linac + 1 more if you choose to treat > 8 hours per day + 1 more if you choose to utilize IMRT/IGRT (which everyone does nowadays) and to cover for vacations/sickness. Theoretically you could run a machine with just 1.5 physicians but you would only be allowed to treat with simple techniques and perhaps 30 patients / day, which will not be enough to cover costs.

And how's it handled with one MD only when there's the inevitable unplanned sickness, or just a need to leave the dept for whatever reason. Does the dept shut down?

 

[deleted1002574]

And how's it handled with one MD only when there's the inevitable unplanned sickness, or just a need to leave the dept for whatever reason. Does the dept shut down?

They probably don’t have many single doc sites like we do in America ? I think they or someone said they were shocked at how many sites we have that don’t treat 20 patients or more

So always more than one doc around?

 

[radiaterMike]

GrubHub (or Just Eat or Takeaway) can delivery Biryani throughout most of the populated areas in Europe.

verage.

Wow, so this pushes back against my contention that the Europeans do it. So, at lunch, you can’t leave the building to go get some .. idk .. whatever you eat for lunch (not sure where you live)? Have to stay in hospital like us?

 

[RickyScott]

GrubHub (or Just Eat or Takeaway) can delivery Biryani throughout most of the populated areas in Europe.

Radiation in Europe is probably concentrated in large cities. While European docs don’t earn as much, in places like Germany .Free college, med school, ( kids don’t have to go private) health care, 45 weeks vacation a year make medicine quite appealing.

 

[evilbooyaa]

They probably don’t have many single doc sites like we do in America ? I think they or someone said they were shocked at how many sites we have that don’t treat 20 patients or more

So always more than one doc around?

Much smaller geographically = less treatment facilities compared to the US

 

[scarbrtj]

This was interesting to hear re: Germany, supervision, etc. Everything is supposition 'til you can know first-hand. I still think, as best as I can tell, they do not have the (strict) direct supervision rule in Canada:

Treating Patients without On-Site Radiation Oncologist

 

[w00tz]

This was interesting to hear re: Germany, supervision, etc. Everything is supposition 'til you can know first-hand. I still think, as best as I can tell, they do not have the direct supervision rule in Canada:

Treating Patients without On-Site Radiation Oncologist

I think you are right. I remember some Canadian rad onc on Twitter got defensive last week when a US rad onc (I want to say KO) said it was unsafe.

 

[deleted1002574]

This was interesting to hear re: Germany, supervision, etc. Everything is supposition 'til you can know first-hand. I still think, as best as I can tell, they do not have the (strict) direct supervision rule in Canada:

Treating Patients without On-Site Radiation Oncologist

That's from the Canadian version of ASTRO, not any regulating authority. Our supervision "rule" comes from the federal government, specifically CMS, not ASTRO. And it's from 2003. Not sure if relevant any longer. But, I don't think they do have a direct supervision rule, in any case.

 

[Gfunk6]

This was interesting to hear re: Germany, supervision, etc. Everything is supposition 'til you can know first-hand. I still think, as best as I can tell, they do not have the (strict) direct supervision rule in Canada:

Treating Patients without On-Site Radiation Oncologist

I think we need a Phase III randomized trial to establish this. I would be happy to volunteer my services for the non-supervised treatment arm.

 

[Palex80]

Wow, so this pushes back against my contention that the Europeans do it. So, at lunch, you can’t leave the building to go get some .. idk .. whatever you eat for lunch (not sure where you live)? Have to stay in hospital like us?

Well our LINACS mostly don't run during lunch time so that all of our radiotherapists can have lunch together.

But indeed, in the unfortunate event that we have to treat someone over lunch, one doctor has to stay in the building.
We do have a cafeteria however here and you can be at the Linac within 1 minute if you get a call, so it works well.

In other departments it's common practice however that one person comes earlier in the morning, stays over lunchtime or stays later during evening hours, when patients are treated. It happens in our department too in case of machine breakdown or when heavy maintenance work has to be carried out so that patients from two LINACS are treated at one machine.

And how's it handled with one MD only when there's the inevitable unplanned sickness, or just a need to leave the dept for whatever reason. Does the dept shut down?

The authorities will tolerate short-term leaves.
But they expect you to find solutions in case of planned vacations or for example if one doctor is away on maternal leave. They will not tolerate not enough physicians being on site.
They can inspect you and they can shut down the site if they want to. I have seen them checking monthly work schedules and contracts to make sure the people are actually working there.
It is strict.

Radiation in Europe is probably concentrated in large cities. While European docs don’t earn as much, in places like Germany .Free college, med school, ( kids don’t have to go private) health care, 45 weeks vacation a year make medicine quite appealing.

Certainly most centers are in big cities and in some countries (for example Holland or Denmark, if I am not mistaken) there are no private practices with radiation oncology. Holland for example has radiation oncology mainly concentrated in big hospitals with some of them running up to 10 LINACs. But Holland is also a very densely populated area.

On the other hand, for example in Germany, you will find quite a lot of smaller cities with radiation oncology departments usually running 1 LINAC with 3 doctors and something like 70 patients on beam. And I am talking about cities with around 40k-60k inhabitants. Adding surrounding smaller cities / villages you end up with something like 100-200k of inhabitants being "served" by one LINAC, which is fairly good.