"Science"

[grenz]

It's also attractive for those of us in private practice who realize that, in order to maintain our income in the face of declining cuts, we will need to continue to increase the number of patients treated per radonc moving forward. I welcome both technological and regulatory changes which will allow us to do so.

The effect this could have on the job market for new grads is not my problem.

I could think of a lot of helpful uses of an advanced RTT, but I’m not sure how I could justify the cost. I already see 5 consults a day so I’m not sure how much more they could really enable me to see. At least an APP can bill for follow ups. If you’re paying for an APP out of pocket for QoL reasons, I could see an advanced RTT actually being better for my QoL than an APP.

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[sirspamalot]

You see 5 consults a day, how many days a week?

Man oh man, I hope you are # level

 

[IonsAreOurFuture]

I could think of a lot of helpful uses of an advanced RTT, but I’m not sure how I could justify the cost. I already see 5 consults a day so I’m not sure how much more they could really enable me to see. At least an APP can bill for follow ups. If you’re paying for an APP out of pocket for QoL reasons, I could see an advanced RTT actually being better for my QoL than an APP.

The main purpose of a physician extender (in a way, anyone in a rad onc practice who does what an MD "technically" could - check vitals, answer phones, record billing codes, schedule patients, treat patients, contour, calc dose, write notes, field questions, send out prescriptions, file appeals, see followups, etc) is to let the MD practice at the top of their skillset doing only those thing that legally require a medical license to do.

Even with a little slack in my schedule, it can save me money for anyone lower paid to do something that I "technically" could, even if they aren't totally awesome at it. That is the essence of specialization.

In the one place I practiced where we were fully staffed at every level including scribes and a PA, not only was productivity sky high, but I believe everyone (including patients) was happier and more fulfilled. We all got to practice at the top of our game. We had a very cohesive dept and very little turnover.

Since I didn't see a lot of simple breast or prostate patients, I didn't utilize our PA that much, but my partners did. For me, with complex cases and lots of reirradiation, the scribe was a much better value. Although having a scribe or scribe/MA costs money, they allowed me to see an extra 1-2 consults per day and improved my job satisfaction and on-time departure more than any other person in the dept. They more than made up their "cost."

 

[RadOncDoc21]

The main purpose of a physician extender (in a way, anyone in a rad onc practice who does what an MD "technically" could - check vitals, answer phones, record billing codes, schedule patients, treat patients, contour, calc dose, write notes, field questions, send out prescriptions, file appeals, see followups, etc) is to let the MD practice at the top of their skillset doing only those thing that legally require a medical license to do.

Even with a little slack in my schedule, it can save me money for anyone lower paid to do something that I "technically" could, even if they aren't totally awesome at it. That is the essence of specialization.

In the one place I practiced where we were fully staffed at every level including scribes and a PA, not only was productivity sky high, but I believe everyone (including patients) was happier and more fulfilled. We all got to practice at the top of our game. We had a very cohesive dept and very little turnover.

Since I didn't see a lot of simple breast or prostate patients, I didn't utilize our PA that much, but my partners did. For me, with complex cases and lots of reirradiation, the scribe was a much better value. Although having a scribe or scribe/MA costs money, they allowed me to see an extra 1-2 consults per day and improved my job satisfaction and on-time departure more than any other person in the dept. They more than made up their "cost."

Just use AI

 

[TheWallnerus]

Since I didn't see a lot of simple breast or prostate patients, I didn't utilize our PA that much, but my partners did. For me, with complex cases and lots of reirradiation, the scribe was a much better value. Although having a scribe or scribe/MA costs money, they allowed me to see an extra 1-2 consults per day and improved my job satisfaction and on-time departure more than any other person in the dept

Did the lack of a scribe prevent you from seeing all patients referred to you, or did the addition of a scribe create more patient referrals for you?

 

[RadOncMegatron]

You see 5 consults a day, how many days a week?

Man oh man, I hope you are # level

5 consults a day?!?!?

Man oh man, I hope you are alive!

 

[sirspamalot]

I did 8 (twice) and thought I was a bad ass... Until I met an Asian ALPHA lady... Who did 12.

 

[medgator]

I did 8 (twice) and thought I was a bad ass... Until I met an Asian ALPHA lady... Who did 12.

Could do that with skin and (maybe) prostate i think. Would be hard with head and neck, GI, etc if you're trying to do it right

 

[grenz]

5 consults a day?!?!?

Man oh man, I hope you are alive!

Not 5 days a week, and more like up to 5/day. Probably 12-17 consults/week and a smattering of re-evals.

 

[salubalu]

Not 5 days a week, and more like up to 5/day. Probably 12-17 consults/week and a smattering of re-evals.

Once you create efficiency it’s manageable but still good amount of work. 12-17 very typical schedule here too.

 

[medgator]

Once you create efficiency it’s manageable but still good amount of work. 12-17 very typical schedule here too.

I get a decent amount of skin and those are much less work (with commensurately less reimbursement) than something like a head and neck or a retreat patient with previous RT at other facilities. Depends on the case mix i think. That's why those urorads/dermrads folks can traditionally carry 40-45+ pts with no sweat imo

 

[TheWallnerus]

Not 5 days a week, and more like up to 5/day. Probably 12-17 consults/week and a smattering of re-evals.

Once you create efficiency it’s manageable but still good amount of work. 12-17 very typical schedule here too.

I bet less than 20 radiation oncologists in the country are seeing 600+ new consults a year.

 

[elementaryschooleconomics]

After training and working in multiple types of environments, the measures of "I see XYZ consults per week" or "I have XYZ on beam" have lost a lot of meaning for me.

Objectively, sure, there's no way someone routinely doing 15+ consults per week or carrying 35+ on beam ISN'T busy.

But man, the resources and infrastructure around you matter SO MUCH and it's borderline impossible to communicate it effectively. Just like the old adage of "a change in program director can change an entire residency program", our experience as Radiation Oncologists can hinge on just a couple individuals, or individual factors.

@IonsAreOurFuture absolutely nailed it:

In the one place I practiced where we were fully staffed at every level including scribes and a PA, not only was productivity sky high, but I believe everyone (including patients) was happier and more fulfilled. We all got to practice at the top of our game. We had a very cohesive dept and very little turnover.

Once you get into "not overtly insane" numbers, "work" or "effort" for a certain volume of patients is extremely variable.

I bet less than 20 radiation oncologists in the country are seeing 600+ new consults a year.

Agreed. Depending on billing, type of practice, diseases/treatment schemes - even 300 new starts a year is at least 75th percentile for wRVUs.

300 new starts with inadequate staffing and/or in a low-resource setting can easily require as much (or more) time/effort than 400-500 new starts working in a high-resource, well-oiled machine.

 

[grenz]

I bet less than 20 radiation oncologists in the country are seeing 600+ new consults a year.

it’s a well oiled machine where I pretty much just do doctor stuff. Nurses and APP are heavily utilized. I get relatively few disaster patients with no work-up and/or mismanaged. I completely agree that 8-10 consults in a rural area with poor support would be just as much work.

 

[elementaryschooleconomics]

I completely agree that 8-10 consults in a rural area with poor support would be just as much work.