Lost my job and can't move . . . now what?

[BobbyHeenan]

I'm not really seeing a change in autonomy in transitioning from PSA to employed. Corporate let's me do my thing. The autonomy issues I have are a product of our medical system, which is independent of how I'm paid.

Like Simul is saying there is a lot of variability in employed autonomy.

It's good for now, but you're one administration change away from bigger issues. It happened at our place for med onc....a new admin came in and completely restructured their contracts and there was massive exodus.

Being PSA isn't for everyone. Like I said above, there are lots of hassles.

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[BobbyHeenan]

Autonomy to me is treating how I want, when I want, and making my own schedule (within reason) but there are lots of ways to define it that I am probably not even aware of with different tiers of importance

Yes. Within our group we have docs that take just 2-3 weeks of vacation and docs that take up to 8-10. We have some that want to work more or work less days a week. Some that want NP's/PA's and some that don't. Some that want to do certain procedures in certain hospitals, etc.

A lot of that flexibility isn't there if you're employed in some situations.

 

[thecarbonionangle]

I feel like autonomy is somewhat of a fantasy just like free will. There is always a way to things. Even if you are in a 10 doc group, you still have to figure out coverage. You cannot all be out when you want. If you have to “submit” vacation how is that truly different than having to run it by your group/partners?

its definitely a word which means all sort of things to many people.

 

[jondunn]

How is everyone defining autonomy: is this in terms of billing, or in terms of treating the way you want to treat (or both?)

For me it’s

Number one - my time is my time and I decided how it’s gonna be done. No admin telling me that I did not have enough ‘slots’

Number two - no one telling me I can’t do the things I like to do - like hypofrac routinely

 

[jondunn]

I feel like autonomy is somewhat of a fantasy just like free will. There is always a way to things. Even if you are in a 10 doc group, you still have to figure out coverage. You cannot all be out when you want. If you have to “suit” vacation how is that truly different than having to run it by your group/partners?

its definitely a word which means all sort of things to many people.

Yes you can’t all be out at the same time, of course. But you MDs and you MDs only will figure it out.

Not MBA Jones saying ‘well we need you to do this and that’

 

[Ray D. Ayshun]

For me it’s

Number one - my time is my time and I decided how it’s gonna be done. No admin telling me that I did not have enough ‘slots’

Number two - no one telling me I can’t do the things I like to do - like hypofrac routinely

I agree and have autonomy in both regards. I recognize situations vary, and see a lot of advantages to a psa. If I were a 2+ group, I'd probably prefer it. As is, in my obviously limited experience, a psa doesn't make a ton of sense for a single doc, and only seems to have the potential to be a greater headache given the needs of managing a business and finding coverage.

Edit: re hypofrac, I will say I'm conventionally fractionating my first intact prostate since being out of residency and wish I could do it every time. It is nice having a good volume foundation for 8 weeks.

 

[deleted1116990]

Autonomy to me is treating how I want, when I want, and making my own schedule (within reason) but there are lots of ways to define it that I am probably not even aware of with different tiers of importance

I can't explain what a gut punch it is, after a decade of post-graduate training and probably $1M or so in opportunity costs to become a skilled professional to walk into your first "job" in your mid 30s at a hospital as an employee, and have some buffoon who thinks he's your boss come into your office tell you what your schedule is going to be, what your "hours" are going to be, how they treat patients there, and force you to participate in endlessly pointless meetings. For perspective, when dentists graduate dental school, they get a loan, buy a practice and do literally whatever they want.

Big picture: single specialty freestanding has most autonomy, employed at hospital has least, but at individual level, there are many very autonomous hospital employed docs, and constrained freestanding docs.

I made my own autonomy at the hospital by refusing to cooperate with the above. It was not worth the fight. When you say "no" you make enemies, and I'm fairly confident I would have been non-renewed.
Now at freestanding. More autonomy in terms of treating patients, but zero autonomy over schedule, time off, etc due to a toxic partner who has been here forever.

So I agree being able to set your own schedule, control how much time off you take and when you take it, and not have your clinical decision making infringed upon outweighs total autonomy over the billing.

 

[theradiator]

I have had 3 hospital jobs.

The one affiliated with the big center had least autonomy.

The most recent has the most autonomy, even more than my freestanding life.

Big picture: single specialty freestanding has most autonomy, employed at hospital has least, but at individual level, there are many very autonomous hospital employed docs, and constrained freestanding docs.

The existential question is how much agency does a practicing radiation oncologist have to create autonomy. Is there something a radiation oncologist can do in terms of practice building, workflow, patient satisfaction that can make an administrator say "nothing to see here" and focus on putting out other fires? Also what are predictors or correlates of autonomy, including factors listed on this thread?

If the answer is truly no agency and its all predestined, then we are truly in dystopian times.

 

[deleted1116990]

The existential question is how much agency does a practicing radiation oncologist have to create autonomy. Is there something a radiation oncologist can do in terms of practice building, workflow, patient satisfaction that can make an administrator say "nothing to see here" and focus on putting out other fires? Also what are predictors or correlates of autonomy, including factors listed on this thread?

If the answer is truly no agency and its all predestined, then we are truly in dystopian times.

In my experience, the lack of autonomy does not directly come from the C-suite. They have little interest in micromanaging your little corner in the basement. The problem is the low level admin idiot they put "in charge" of the department who views you as a threat. If the C-suite would simply clarify that you are in charge and everyone else's job is to support your vision, there would be no problem.

 

[temujim]

In my experience, the lack of autonomy does not directly come from the C-suite. They have little interest in micromanaging your little corner in the basement. The problem is the low level admin idiot they put "in charge" of the department who views you as a threat. If the C-suite would simply clarify that you are in charge and everyone else's job is to support your vision, there would be no problem.

That useless layer of middle management is usually the first on the chopping block when financial issues crop up. From experience, this process can be accelerated if necessary.

 

[thecarbonionangle]

Why is there even a need for these admins? Why are healthcare systems growing this layer of lard? What is their incentive?

 

[deleted1111261]

Yeah, so some places really seem to let the RO fly and others have plans coming from the top and you just carry out orders. Both options are good for people, depending on personality. I think on SDN, autonomy/independence is crucial. In Twitter/academia, they have ceded this completely and don't care at all. The new grads tend to have the idea that autonomy is a vestige of the past - very few comment on it, and they suddenly quiet down shortly afterwards if they do comment on it.

Agree about the middle-man admin person. At a tiny hospital like man, we are all doing everything. Admin middle man is the dosimetrist and also and RT. I'm RO, but do tumor board and being asked to do other activities. Our success is intertwined and we really help each other. The doc I replaced fostered a high-trust environment, so it was natural when I got here to continue "open door" communication. If anyone has an issue, they literally walk in the office and let me know. And after all these years of thinking I know what's best, I've learned to listen more. It seems to work .. today, at least.

C suite is very busy, we are one part of hospital that happens to be innovating and growing, so the leash is long. If we grow a lot, then we suddenly become more interesting and that's when we may lose control. That's probably issue w RO most places - it is a cash cow, and so people want to make sure it stays that way.

 

[deleted1116990]

That useless layer of middle management is usually the first on the chopping block when financial issues crop up. From experience, this process can be accelerated if necessary.

In my experience, the only way to get an admin fired is to walk out citing admin incompetence/toxicity as a reason for your departure. It was somewhat satisfying to find out the problematic admins had been sacked a few months later. But why not solve the problem before losing a rad onc? They did the same thing with multiple med oncs. Revolving door of med oncs, would fire the med onc manager afterwards, hire someone else equally awful and then repeat the process. Stupid.

 

[Mandelin Rain]

The existential question is how much agency does a practicing radiation oncologist have to create autonomy. Is there something a radiation oncologist can do in terms of practice building, workflow, patient satisfaction that can make an administrator say "nothing to see here" and focus on putting out other fires? Also what are predictors or correlates of autonomy, including factors listed on this thread?

If the answer is truly no agency and its all predestined, then we are truly in dystopian times.

If you treat the staff and patients well, show up on time, do what you say you'll do, and only complain/make requests when you really need to (and encourage those around you to do the same), they'll mostly just ignore you. Obviously, ymmv on this, but "ignored" is the absolute best place to be. Never give them a reason to look at you.

 

[BobbyHeenan]

I feel like autonomy is somewhat of a fantasy just like free will. There is always a way to things. Even if you are in a 10 doc group, you still have to figure out coverage. You cannot all be out when you want. If you have to “submit” vacation how is that truly different than having to run it by your group/partners?

its definitely a word which means all sort of things to many people.

Yes you can’t all be out at the same time, of course. But you MDs and you MDs only will figure it out.

Not MBA Jones saying ‘well we need you to do this and that’

Exactly. I feel like we (the docs) see problems and drama through a lens that is different than an MBA. We have skin in the game with regard to patient care and outcomes. They (admin) do not.

There will always be compromise ...but it's easier in my experience to compromise with docs than admin.

 

[OTN]

If I were stuck in a situation where a low-level admin was making my life hell, one option would be to go nuclear: Get an executive MBA, join hospital committees, work your way up enough to where you truly have the ear of the C suite execs, then get the low-level admin fired. That's a lot of work, but spite can be very motivating.

 

[deleted1111261]

Examples of lack of autonomy (some mentioned above):

1) Not being able to take time off when you want / for as long as you want. This is a problem for me. But, that's because I'm solo and I chose that.
2) Not being able to choose which treatment you want to give a patient.
3) Not being able to see the number of patients as you want.
4) Not being able to leave if there is no work to be done.
5) Not being able to say no to things that you are not contractually obligated to do.
6) Not being able to be in control of the "template" of your schedule (presuming you have staffing)

But a lot of these things are not b/c of the hospital. 1 can be due to the group's policies and coverage issues. 3 can be due to structural issues in community. 6 might be because you overwork your staff.

 

[deleted1116990]

1) Not being able to take time off when you want / for as long as you want. This is a problem for me. But, that's because I'm solo and I chose that.

One thing I have found surprising in recruiting is the absolute unwillingness of most hospitals to negotiate on PTO. They will negotiate back and forth on compensation but if you were to say, instead of your standard 30 days, I would like 50 days. Locums cost to the hospital is $3k/day, so reduce the salary offer by $60k, and I will sign, and they will refuse and lose the hire. Bizarre and frustrating how they insist on all employed doctors across the entire system having the exact same PTO without exception. They have no problem individualizing compensation for doctors, but all employed clinic physicians regardless of specialty are only given 30 days, end of discussion. Even if that is plenty for you, it's pretty demoralizing feeling like it's out of your control -- makes you feel owned. It would make more sense to base you assuming you are working 52 weeks rather than 46, then substract locums cost from your paychecks as you choose to utilize them.

 

[seper]

don't forget wRVU targets!!

 

[deleted1111261]

One thing I have found surprising in recruiting is the absolute unwillingness of most hospitals to negotiate on PTO. They will negotiate back and forth on compensation but if you were to say, instead of your standard 30 days, I would like 50 days. Locums cost to the hospital is $3k/day, so reduce the salary offer by $60k, and I will sign, and they will refuse and lose the hire. Bizarre and frustrating how they insist on all employed doctors across the entire system having the exact same PTO without exception. They have no problem individualizing compensation for doctors, but all employed clinic physicians regardless of specialty are only given 30 days, end of discussion. Even if that is plenty for you, it's pretty demoralizing feeling like it's out of your control -- makes you feel owned. It would make more sense to base you assuming you are working 52 weeks rather than 46, then substract locums cost from your paychecks as you choose to utilize them.

So true. I wonder why this is.

 

[deleted1116990]

So true. I wonder why this is.

The explanation given is they can't given certain doctors more PTO than others because the other doctors would complain about it not being fair.
However, obviously it is fine for compensation to vary widely. I suppose that's because how much PTO you take is transparent, whereas your compensation is explicitly to be kept secret by the terms of the contract you signed. Stupid.

 

[medgator]

Examples of lack of autonomy (some mentioned above):

1) Not being able to take time off when you want / for as long as you want. This is a problem for me. But, that's because I'm solo and I chose that.
2) Not being able to choose which treatment you want to give a patient.
3) Not being able to see the number of patients as you want.
4) Not being able to leave if there is no work to be done.
5) Not being able to say no to things that you are not contractually obligated to do.
6) Not being able to be in control of the "template" of your schedule (presuming you have staffing)

But a lot of these things are not b/c of the hospital. 1 can be due to the group's policies and coverage issues. 3 can be due to structural issues in community. 6 might be because you overwork your staff.

7) not being able to implement supervision rules as you see fit and interpret from CMS.

Some admins will not allow their employed ROs to do telesupervision at all from what I'm hearing. In a true PP, you decide what is billed, treatment fx and supervision

 

[medgator]

One thing I have found surprising in recruiting is the absolute unwillingness of most hospitals to negotiate on PTO. They will negotiate back and forth on compensation but if you were to say, instead of your standard 30 days, I would like 50 days. Locums cost to the hospital is $3k/day, so reduce the salary offer by $60k, and I will sign, and they will refuse and lose the hire. Bizarre and frustrating how they insist on all employed doctors across the entire system having the exact same PTO without exception. They have no problem individualizing compensation for doctors, but all employed clinic physicians regardless of specialty are only given 30 days, end of discussion. Even if that is plenty for you, it's pretty demoralizing feeling like it's out of your control -- makes you feel owned. It would make more sense to base you assuming you are working 52 weeks rather than 46, then substract locums cost from your paychecks as you choose to utilize them.

That's where PP wins imo... I want more time off? I pay more for my locums coverage and take as much as i need

 

[Chartreuse Wombat]

Why is there even a need for these admins? Why are healthcare systems growing this layer of lard? What is their incentive?

Managerialism

Predicted in 1941

Amazon product

 

[TheWallnerus]

Some admins will not allow their employed ROs to do telesupervision at all from what I'm hearing

And some admins building and staffing centers now based on the rule (telesup kind of, but definitely facility gen sup for MD/NP IGRT sup). Also let us not forget that for a large geographic swath of country Medicare only requires direct sup for MDs at two days per week now. It’s written, unambiguous “law.”

 

[Mandelin Rain]

Got an email today looking for med oncs at 3-4k per day with OT available if hospital work.

 

[jondunn]

One thing I’ve noticed my friends in PSA PP groups - which are good jobs all things considered - the younger partners have less say than the senior partners - and how do you fix that?

 

[medgator]

And some admins building and staffing centers now based on the rule (telesup kind of, but definitely facility gen sup for MD/NP IGRT sup). Also let us not forget that for a large geographic swath of country Medicare only requires direct sup for MDs at two days per week now. It’s written, unambiguous “law.”

Could go either way there, very true

 

[medgator]

One thing I’ve noticed my friends in PSA PP groups - which are good jobs all things considered - the younger partners have less say than the senior partners - and how do you fix that?

Not an equal vote partnership? Is that truly "partnership"?

 

[jondunn]

And some admins building and staffing centers now based on the rule (telesup kind of, but definitely facility gen sup for MD/NP IGRT sup). Also let us not forget that for a large geographic swath of country Medicare only requires direct sup for MDs at two days per week now. It’s written, unambiguous “law.”

This change at scale will have the biggest impact on the job market compared to anything else - by far.

So yeah I’m glad medgator stays home seeing OTVs by phone with his hands down his pants, but it’s undeniable that the downstream effects on the future are not good from this.

This is a ‘good for me, sucks for you’ thing

 

[jondunn]

Not an equal vote partnership? It's that truly "partnership"?

Well equal vote on paper but there is soft power that someone that has been there for ten years longer has

 

[Ray D. Ayshun]

All animals are equal, but some animals are more equal than others.

 

[Mandelin Rain]

One thing I’ve noticed my friends in PSA PP groups - which are good jobs all things considered - the younger partners have less say than the senior partners - and how do you fix that?

All about culture. Not that way everywhere. Younger partners can change that culture overtime as the old guys age out, if they want to.

 

[jondunn]

All about culture. Not that way everywhere. Younger partners can change that culture overtime as the old guys age out.

Agree - that’s what I tell them. Just hard to take sometimes in the short term

 

[Mandelin Rain]

Agree - that’s what I tell them. Just hard to take sometimes in the short term

If they truly have an equal voting rights, some of it may just be a self-assuredness issue too. I think a lot of recent grads think of the older partners as academic chairmen who can crush you. They are typically just colleagues who have different needs/wants based on the stage of their career. Younger partners need to feel confident to voice their needs as well, while also understanding they'll be the old guy one day.

 

[jondunn]

If they truly have an equal voting rights, some of it may just be a self-assuredness issue too. I think a lot of recent grads think of the older partners as academic chairmen who can crush you. They are typically just colleagues who have different needs/wants based on the stage of their career. Younger partners need to feel confident to voice their needs as well, while also understanding they'll be the old guy one day.

Agree - definitely true that some people perceive that they’re lesser than when they aren’t truly or don’t have to be

But if you’re a first year partner it’s hard to go against what the senior ones want to do. Have to wait not to be outnumber

 

[medgator]

This change at scale will have the biggest impact on the job market compared to anything else - by far.

So yeah I’m glad medgator stays home seeing OTVs by phone with his hands down his pants, but it’s undeniable that the downstream effects on the future are not good from this.

This is a ‘good for me, sucks for you’ thing

 

[jondunn]

Not hate. Just the stone cold truth

 

[Gfunk6]

Autonomy is a tricky proposition as many posters have cited. I am in a large, multi-specialty, physician-owned practice that would appear to easily pass the "sniff test" of being autonomous. But we have long since passed the days of a single doc practice being able to do whatever you want, whenever you want it. Just by way of example, let's look at the rules of autonomy Simul cited above:

1) Not being able to take time off when you want / for as long as you want. This is a problem for me. But, that's because I'm solo and I chose that.
In our practice, you can generally do it. However, what happens when all the docs with kids want off for Spring Break? What about high-demand holidays like Thanksgiving, Christmas and New Years? Are we going to pay for locums coverage? Some compromise is required.

2) Not being able to choose which treatment you want to give a patient.
Mostly true, but subject to audit and peer review in Chart Rounds. A doc will be crucified in chart rounds, for instance, if they try to give a > 70 woman with early-stage, low-risk breast cancer 33 fractions of treatment.

3) Not being able to see the number of patients as you want.
Again this is a yin and yang type situation. We incentivize productivity and profitability so if you turn away patients it can potentially (a) damage your reputation in the community and (b) eat into your personal bottom line.

4) Not being able to leave if there is no work to be done.
We strongly believe in this, but you still need to be fully available by phone/text during business hours if you are working.

5) Not being able to say no to things that you are not contractually obligated to do.
Depends on what this entails but we would ask nicely, not compel.

6) Not being able to be in control of the "template" of your schedule (presuming you have staffing)
We give physicians full control of this (within reason).

What it boils down to in the end is that we still need consensus, SOPs, and rules to do things. However, when there are problems the person who comes and talks to you is a peer physician in your specialty, not an administrator.

 

[jondunn]

There has to be honor among thieves. 33 fractions to a 70 year old with that kind of breast cancer breaks that rule. Deserves to be questioned.

 

[medgator]

Not hate. Just the stone cold truth

Hint: i didn't make the tele rules

 

[deleted1111261]

If I were stuck in a situation where a low-level admin was making my life hell, one option would be to go nuclear: Get an executive MBA, join hospital committees, work your way up enough to where you truly have the ear of the C suite execs, then get the low-level admin fired. That's a lot of work, but spite can be very motivating.

It gives me great satisfaction to know that you would an could actually do this. It is truly inspiring.

 

[deleted1111261]

Autonomy is a tricky proposition as many posters have cited. I am in a large, multi-specialty, physician-owned practice that would appear to easily pass the "sniff test" of being autonomous. But we have long since passed the days of a single doc practice being able to do whatever you want, whenever you want it. Just by way of example, let's look at the rules of autonomy Simul cited above:

1) Not being able to take time off when you want / for as long as you want. This is a problem for me. But, that's because I'm solo and I chose that.
In our practice, you can generally do it. However, what happens when all the docs with kids want off for Spring Break? What about high-demand holidays like Thanksgiving, Christmas and New Years? Are we going to pay for locums coverage? Some compromise is required.

2) Not being able to choose which treatment you want to give a patient.
Mostly true, but subject to audit and peer review in Chart Rounds. A doc will be crucified in chart rounds, for instance, if they try to give a > 70 woman with early-stage, low-risk breast cancer 33 fractions of treatment.

3) Not being able to see the number of patients as you want.
Again this is a yin and yang type situation. We incentivize productivity and profitability so if you turn away patients it can potentially (a) damage your reputation in the community and (b) eat into your personal bottom line.

4) Not being able to leave if there is no work to be done.
We strongly believe in this, but you still need to be fully available by phone/text during business hours if you are working.

5) Not being able to say no to things that you are not contractually obligated to do.
Depends on what this entails but we would ask nicely, not compel.

6) Not being able to be in control of the "template" of your schedule (presuming you have staffing)
We give physicians full control of this (within reason).

What it boils down to in the end is that we still need consensus, SOPs, and rules to do things. However, when there are problems the person who comes and talks to you is a peer physician in your specialty, not an administrator.

Oh yeah - I didn't mean hospital vs free. Just in general. Prior auth is killing all of us. Freestanding guys may have independent billing company on their throats about supervision. Hospital may force you to be the radiation safety person. Hospital may consistently place 3pm follow ups on your scheddy, even though you're done treating at 1.30p that day. Freestanding guys may have senior partner that will side eye you for single fx bone met treatment.

 

[elementaryschooleconomics]

I think a lot of recent grads think of the older partners as academic chairmen who can crush you. They are typically just colleagues who have different needs/wants based on the stage of their career.

I'm trying to figure out if this has always been the case, or is a recent phenomenon.

Observations:

1) Completely agree that new grads/early career docs view senior partners (or colleagues, if employed) as having "Chair-over-resident" power, even if there's no objective difference in rank.

2) Assuming you can't practice medicine without board certification (or eligibility). There's fundamental confusion about a state medical license and board eligibility/certification.

3) Assuming being a "W2 employee" is the natural state of things.

4) Assuming if you weren't trained or exposed to a technique in residency, you can't do it without special training/certification/attending a course etc.

The world is so different now compared to even 20 years ago, and I don't mean that in a "old man yells at clouds" way. I mean the rise and prevalence of the internet and social media, globalization, and the formation of gigantic academic health systems which have obliterated the concept of "private practice".

So when I see these things in my friends and colleagues, I am often left wondering if I would be observing the same trends if I had a time machine and could go back to 1980. I can't tell anymore.

 

[jondunn]

Hint: i didn't make the tele rules

i know - again - not blaming anyone. just saying it clearly has an impact if adopted at scale - especially if smart admins figure this out.

 

[Mandelin Rain]

I'm trying to figure out if this has always been the case, or is a recent phenomenon.

Observations:

1) Completely agree that new grads/early career docs view senior partners (or colleagues, if employed) as having "Chair-over-resident" power, even if there's no objective difference in rank.

2) Assuming you can't practice medicine without board certification (or eligibility). There's fundamental confusion about a state medical license and board eligibility/certification.

3) Assuming being a "W2 employee" is the natural state of things.

4) Assuming if you weren't trained or exposed to a technique in residency, you can't do it without special training/certification/attending a course etc.

The world is so different now compared to even 20 years ago, and I don't mean that in a "old man yells at clouds" way. I mean the rise and prevalence of the internet and social media, globalization, and the formation of gigantic academic health systems which have obliterated the concept of "private practice".

So when I see these things in my friends and colleagues, I am often left wondering if I would be observing the same trends if I had a time machine and could go back to 1980. I can't tell anymore.

Everything needs to be fully accredited by some onerous process and reviewed 10 times. I need to know that I know what I know! GIVE ME A GRADE!!!! PLEASE!!!

 

[Ray D. Ayshun]

If I were stuck in a situation where a low-level admin was making my life hell, one option would be to go nuclear: Get an executive MBA, join hospital committees, work your way up enough to where you truly have the ear of the C suite execs, then get the low-level admin fired. That's a lot of work, but spite can be very motivating.

 

[thecarbonionangle]

Im gonna build the biggest spite house next to my chair in retirement. I will blast indian temple music all day

 

[Lamount]

Yeah, so some places really seem to let the RO fly and others have plans coming from the top and you just carry out orders. Both options are good for people, depending on personality. I think on SDN, autonomy/independence is crucial. In Twitter/academia, they have ceded this completely and don't care at all. The new grads tend to have the idea that autonomy is a vestige of the past - very few comment on it, and they suddenly quiet down shortly afterwards if they do comment on it.

Agree about the middle-man admin person. At a tiny hospital like man, we are all doing everything. Admin middle man is the dosimetrist and also and RT. I'm RO, but do tumor board and being asked to do other activities. Our success is intertwined and we really help each other. The doc I replaced fostered a high-trust environment, so it was natural when I got here to continue "open door" communication. If anyone has an issue, they literally walk in the office and let me know. And after all these years of thinking I know what's best, I've learned to listen more. It seems to work .. today, at least.

C suite is very busy, we are one part of hospital that happens to be innovating and growing, so the leash is long. If we grow a lot, then we suddenly become more interesting and that's when we may lose control. That's probably issue w RO most places - it is a cash cow, and so people want to make sure it stays that way.

Where I work... I personally have a ton of autonomy -largely my own boss. This is not necessarily true of my colleagues in other disease sites. It is very division-specific. As you said, some like having train-tracks ahead, and some like to go off-roading. I was a little nervous with having so much autonomy at first, but have since grown into it.

 

[Mandelin Rain]

I was a little nervous with having so much autonomy at first.

This seems to be a feature, not a bug of radiation oncology residencies.