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Really nice thread from SimulD
Jobs up, but probably pay down, more so than would be expected otherwiseSatellite positions on this board often get denigrated, but would be curious to see if anybody has done the formal analysis to see what happens to net number of jobs after a academic center takes over a private practice or opens new satellite.
My impression is that, even in community satellites, academics have less pts on beam per attending, thus usually have more attendings per center than a pure private practice would. Theoretically satellite docs are given an academic day, so that may play into it. But would interesting to see if academic satellites have a net plus/minus on jobs overall
MDACC needs to explain why their phase II data trumps RCTs that show 5FU and MMC is better than Cis/5FU.
MDACC needs to explain why their phase II data trumps RCTs that show 5FU and MMC is better than Cis/5FU.
My issue with the recent satellite center PR push is that when an academic satellite center opens up in a location, they use their state tax dollars and (in MDACC’s case, their selective exclusion from billing experiments) as a kind of crony capitalism to overwhelm any practices already in the market. Then, what happens to the docs who were already there? If they lose their jobs, will MDACC hire them? Probably not, as they don’t know the “MDACC way.” Will they have to uproot their family and move? Probably? Will they find a job in today’s market? Maybe.
My issue with the recent satellite center PR push is that when an academic satellite center opens up in a location, they use their state tax dollars and (in MDACC’s case, their selective exclusion from billing experiments) as a kind of crony capitalism to overwhelm any practices already in the market. Then, what happens to the docs who were already there? If they lose their jobs, will MDACC hire them? Probably not, as they don’t know the “MDACC way.” Will they have to uproot their family and move? Probably? Will they find a job in today’s market? Maybe.
MDACC does some goofy stuff for sure, but I actually think there is some potential rationale for cisplatin. This post by CC sums it up nicely (theMednet - Login)
but basically ACT II showed no difference, and 98-11 muddied the waters by adding in the induction chemotherapy part which is believed to have worsened outcomes, as also seen in the ACCORD trial.
Since ACT II showed equal outcomes, but it was NOT a non-inferiority trial, MMC is SOC. But I think if you're not doing the induction cis part, you can probably safely assume that it works about as well.
I've never done it, but if I had a frail patient and the med onc wanted to do it, I wouldn't have an issue.
This is spot on. ACT II essentially showed equivalence but cis did not usurp mmc as standard of care due to trial design. Cis actually had much less hematologic toxicity but it's a 4 hour infusion with the need for hydration etc instead of 15 mins MMC push so would be more chair time/ more resources in a nation with socialized medicine. I have no problem with anyone giving cis.
Anal cancer regimen? It’s reasonable and some people use it and it’s NCCN allowed. A lot of people here do things that are seem odd, but are still considered “a standard of care (not even 5 years ago, STILL had long standing, respected members of this board saying they would not hypofx DCIS)
Out of state satellites are not exempt and fall under regular hospital / freestanding billing rule. At least the way MDACC has done it, they bill under the hospital - be it Scripps, Cooper, Banner, Baptist. None of those are PPS exempt. All of them are possibly going to be lottery losers of APM, I’m predicting 40%
They absorb those that are there, let them have the option of learning “the way”. No firing goes on... You guys sound kind of tin hat... Even some of the usually more reasonable posters.
Affiliates don’t get to bill under mothership but satellites do.Anal cancer regimen? It’s reasonable and some people use it and it’s NCCN allowed. A lot of people here do things that are seem odd, but are still considered “a standard of care (not even 5 years ago, STILL had long standing, respected members of this board saying they would not hypofx DCIS)
Out of state satellites are not exempt and fall under regular hospital / freestanding billing rule. At least the way MDACC has done it, they bill under the hospital - be it Scripps, Cooper, Banner, Baptist. None of those are PPS exempt. All of them are possibly going to be lottery losers of APM, I’m predicting 40%
They absorb those that are there, let them have the option of learning “the way”. No firing goes on... You guys sound kind of tin hat... Even some of the usually more reasonable posters.
Affiliates don’t get to bill under mothership but satellites do.
My *$$hole would prefer MMC assuming I'm in decent shapeYeah didn’t want to wade into this debate, because MMC people will be intolerable about it. Try cis for your next 5 patients, I overwhelmingly think you and your med onc will rue the day you used MMC. No matter... it’s a SOC, and if you don’t do it, I don’t think you’re a meanie for giving more toxicity
Probably overlaps with this list a lotTotally.
Also should publicize who doesn’t take Medicaid and shame them
When Duke and UNC bought up all the primary care practices in Raleigh, I don’t remember them hiring any of the USON docs after that practice went down...Anal cancer regimen? It’s reasonable and some people use it and it’s NCCN allowed. A lot of people here do things that are seem odd, but are still considered “a standard of care (not even 5 years ago, STILL had long standing, respected members of this board saying they would not hypofx DCIS)
Out of state satellites are not exempt and fall under regular hospital / freestanding billing rule. At least the way MDACC has done it, they bill under the hospital - be it Scripps, Cooper, Banner, Baptist. None of those are PPS exempt. All of them are possibly going to be lottery losers of APM, I’m predicting 40%
They absorb those that are there, let them have the option of learning “the way”. No firing goes on... You guys sound kind of tin hat... Even some of the usually more reasonable posters.
Simuls post is a good example of the type of introspection that’s allows one to adapt well to the situation they find themselves in. It’s looking at the bright side of a situation bc one could easily look at this and easily find the negatives too. Rad onc has become a field where you increasingly can not control your narrative any longer and that’s precisely the reason why med students should not enter the field or do so at your own peril. Not only will you be justifying your job situation (no offense but the idea of Banner MDACC sounds terrible) youre at extreme risk of having to do a similar thing w all aspects of your life as well. It’s a hard way to live but many of us, lots and lots and lots of us, are in this exact situation w our lives - sure we adapt bc that’s what humans do and sometimes it’s not so bad- but you don’t have to settle for something like that, just going where the winds decide to blow you. Choose something else for your own self preservation
I mean his entire point is that the concept of ‘terrible’ as you describe is all relative.
If making 500k plus living in an metro area while getting to be a radiation oncologist but you have to deal with the disgrace of being ‘employed’ rather than your own guy is ‘terrible’ but you still would take it over being some other field, many fields which a lot of us think would suck to do, that’s the decision you have to make. That’s why his input was good.
If making 500k plus living in an metro area while getting to be a radiation oncologist
I've never been offered this kind of money. YMMV.
Also, a metro is possible. Which metro? You may not get to choose.
With non competes, single employers buying up whole metros, and the oversupply of new grads, it makes it a lot harder for people to switch jobs or have any bargaining power at all in their position as well.
Super easy to get on Twitter and rah rah rah I love my employer. You aren't going to see anyone bad-mouth their employer in public. I see it in other specialities, but rad onc is too small and the job market is too tight.
you are a physician scientist with grant funding with a non-full time clinic schedule. You are in a different category. You see that, right? Plus you have indicated that associate profs where you are make around 450. not bad. congrats on your successful academic career thus far.
Separately, doesn't MMC improve colostomy-free survival, which is arguably the most important endpoint?
My memory banks from a decade ago during oral boards prep still recalls a 20% vs 10% benefit in avoiding colostomy in that regard per the rtog which was ss.Separately, doesn't MMC improve colostomy-free survival, which is arguably the most important endpoint?
Non-MMC regimens continue to be 2B in nccn?Only in 98-11, which was tainted due to changing two variables (induction plus cisplatin). In ACT II, a larger and more modern trial, which had a 2 x 2 randomization, (cis vs MMC, adjuvant vs no adjuvant), there was no difference in any disease control endpoint.
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Depends... If pay was productivity based and I had autonomy, I'd be ok with itAgree that the job may be fine for some.
I have to admit, however, that if you would have told me while applying for residency that the most likely job I would get would be an academic satellite job, I would have chosen another specialty.
Agree that the job may be fine for some.
I have to admit, however, that if you would have told me while applying for residency that the most likely job I would get would be an academic satellite job, I would have chosen another specialty.
Eh even now being at a good academic satellite with a bonus structure is something I'd be OK with. It's when it's straight salary and/or without a reasonable production incentive that I have a sour taste in my mouth.
I think I would prefer a straight (Cush) salary because these bonus metrics are never easily feasible and continue to get harder.
Not saying you shouldn’t get rewarded for your work but I rather not worry about it personally.
I think I would prefer a straight (Cush) salary because these bonus metrics are never easily feasible and continue to get harder.
Not saying you shouldn’t get rewarded for your work but I rather not worry about it personally.
Anybody on here that would be willing to send me the 2019 MGMA compensation data for academics and pp? One of the hardest things for residents is the information asymetry. Hard to try to negotiate when you are a tool-less baby monkey
Linked document is hard to interpret. Is incentive bonus included in MGMA totals for non-academic practices? I thought it was.