The True Enemy

[RadOncDoc21]

I don't know if it's been said enough, but seriously: kudos to all of you on this board for what you've done.

You’re welcome, I’m just a great person!

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[Xander Cruz]

Yale treats you well, but a clinically poor program. On interview day they said they barely see any patients. Just sit behind computers and crank out NCDB garbage

Yale resident here - I know this was/is the narrative about the program from years past - from what I can gather, this sentiment was nurtured by prior generations to give a sense of greater research time and work-life balance. Sort of off-topic for this thread, but our attendings generally stack all of their consults/follow-ups etc into 1-2 "clinic days" a week, and we generally average 8-14 consults a week depending on the service. The rest of our time is spent doing notes, contours, patient problem visits, research (though the heyday of "NCDB garbage" is long past), etc.

Happy to chat via PM if anyone's interested - just couldn't let the original post go down in history without refute.

 

[medgator]

Busy/clinically strong residencies see more than double that.

Per attending per week? If most of those are translating to external volume, that's a pretty busy service imo

 

[Xander Cruz]

8 consults / week. LOL - You think that’s dispelling the stereotype?

Busy/clinically strong residencies see more than double that.

I mean, obviously some weeks are slower than others, depending on the rotation. I was under the impression from talking to friends in other programs and this thread, for example, that 8-14 consults a week was an average range. Is that not correct? To my recollection, I remember a single program that blew those numbers away when I was interviewing, and I was told by literally everyone on interview day to go anywhere else if I had the option.

To quote you from this thread, I'm not sure you have the best perspective on what is a normal number of consults:

"Nobody should have to go through what I and my co-residents did. Broke ACGME limit on contours every year (by a LOT and were pressured to underlog), all double or triple coverage with at best a half day of academic time per week, constant cross-coverage, highly malignant call, constant barrage of pages to deal with scut and administrative BS from a poorly organized clinic, barely any faculty teaching to speak of, staff who treated us like children... We were coached on what to write on our ACGME surveys, coached and policed on what to say to applicants. It brought out the worst in everyone. "

Additionally, busy =/= clinically strong.

 

[deleted1002574]

I mean, obviously some weeks are slower than others, depending on the rotation. I was under the impression from talking to friends in other programs and this thread, for example, that 8-14 consults a week was an average range. Is that not correct? To my recollection, I remember a single program that blew those numbers away when I was interviewing, and I was told by literally everyone on interview day to go anywhere else if I had the option.

To quote you from this thread, I'm not sure you have the best perspective on what is a normal number of consults:

"Nobody should have to go through what I and my co-residents did. Broke ACGME limit on contours every year (by a LOT and were pressured to underlog), all double or triple coverage with at best a half day of academic time per week, constant cross-coverage, highly malignant call, constant barrage of pages to deal with scut and administrative BS from a poorly organized clinic, barely any faculty teaching to speak of, staff who treated us like children... We were coached on what to write on our ACGME surveys, coached and policed on what to say to applicants. It brought out the worst in everyone. "

Additionally, busy =/= clinically strong.

Man .. it's one of those, damned if you see too many consults, damned if you don't see enough.

8 curative cases on a service per week, if you are getting taught, getting to do H&P, work-up, contours, and management - think about it - 4 weeks off a year - 8 x 48 = 384 patients. And that's if 8 is MAX per week.

Jeez. If it is 8 to 14, and majority is 10, we are talking 480 consults a year. That's plenty.

Let's not cannibalize ...

 

[deleted1002574]

Gimme a break.

Sound like surgeons talking about “the worst thing about q2 call is you miss half the cases”

 

[Lamount]

We had 16 consults a day, 6 days a week, plus we had to run the radiation machines ourselves.

 

[deleted1002574]

We didn’t have dosimetrists, pinnacle, or velocity. Had to print out axial images on transparent film, overly to create fusions, and then hand calced IMRT plans. But, I knew what I was doing at the end and could handle anything.

 

[xrthopeful]

Are you kidding me?

4 clinic days of 2 patient am and 2 patient pm is not a hard schedule...

That’s barely a 9-5.

8 consults a week also means tons of coordination of care/patient phone calls/emails, the OTVs, the associated sims, all the associated follow-ups, plus all the research and academic requirements of a resident in training..... I don't know how long it's been since you trained, but 8 consults weekly is not 'a joke' in residency. I think it's what most residents would call 'a busy service'

I think people that have been out in PP for a long time also forget there's a difference between the patients we see in general practice and the neediness of patients that choose to go to an academic center.

 

[medgator]

I think people that have been out in PP for a long time also forget there's a difference between the patients we see in general practice and the neediness of patients that choose to go to an academic center.

Pretty sure my 2-3 weekly h&n consult pts need as much TLC now as they did in residency, I just have less support to do it

 

[xrthopeful]

I agree, Medgator, head and neck patients need TLC wherever they are.

but rememeber being on a service of all head and neck? Or imagine instead that all of your breast and prostate patients send you MyChart messages in EPIC every 2 days? just saying. Residency is still pretty nice compared to most specialties, just like attendinghood is, but it's not the Club Med to see 8 consults a week.

 

[medgator]

I agree, Medgator, head and neck patients need TLC wherever they are.

but rememeber being on a service of all head and neck? Or imagine instead that all of your breast and prostate patients send you MyChart messages in EPIC every 2 days? just saying. Residency is still pretty nice compared to most specialties, just like attendinghood is, but it's not the Club Med to see 8 consults a week.

Oh I agree. 360+/year easy and most will convert to cases

 

[SubserviantToABR]

8 consults a week also means tons of coordination of care/patient phone calls/emails, the OTVs, the associated sims, all the associated follow-ups, plus all the research and academic requirements of a resident in training..... I don't know how long it's been since you trained, but 8 consults weekly is not 'a joke' in residency. I think it's what most residents would call 'a busy service'

I think people that have been out in PP for a long time also forget there's a difference between the patients we see in general practice and the neediness of patients that choose to go to an academic center.

Holy smokes, 8 consults a week is busy?!?! I am four months and 1 day out of residency, and if you think 8 a week is busy, you're in for a rude awakening when you graduate. You see whoever comes through your door, plus inpatients plus add-on consults whenever your referring providers want you to see patients. Plus, all of the coordination of care/patient phone calls/emails, OTVs, sims, and follow ups. There's no residents to help out, and I see a variety of patients. I still try to do some research on the side as the local PI on our trials. You should probably considering SOAPing into more busy program this next year (I hear there's going to be some openings this upcoming year ) to get the training you need to prepare for the real world.

I think people that have been residency for a short time also don't realize there's a difference between the patients we see in training and the realities of the real world.

 

[xrthopeful]

ugh. you missed the point.

 

[medgator]

Holy smokes, 8 consults a week is busy?!?! I am four months and 1 day out of residency, and if you think 8 a week is busy, you're in for a rude awakening when you graduate. You see whoever comes through your door, plus inpatients plus add-on consults whenever your referring providers want you to see patients. Plus, all of the coordination of care/patient phone calls/emails, OTVs, sims, and follow ups. There's no residents to help out, and I see a variety of patients. I still try to do some research on the side as the local PI on our trials. You should probably considering SOAPing into more busy program this next year (I hear there's going to be some openings this upcoming year ) to get the training you need to prepare for the real world.

I think people that have been residency for a short time also don't realize there's a difference between the patients we see in training and the realities of the real world.

Also true, but in residency, I'd say 8/week is decently busy. You'll go over your maximums at that volume in some cases.

My personal best was 18 consults one week, a mix of outpatient and inpatient consults at 2 different hospitals, and a Saturday one . It was not fun and I start to feel overwhelmed when I start getting inpatients while the outpt consult/tx volume is high. Of course, a few months later, I'll be pulling my hair out with boredom at 4/week.

I definitely have worse hours in practice than residency and see way more per year. There are no maximums, and in PP, no cap to your production.

 

[Mandelin Rain]

8 patients is neither busy nor slow. In residency, almost all your patients become sims opposed to community practice where maybe 2/3 of my consults become sims.

When I was a resident (before wide spread hypo adoption), 8 sims per week would probably be a 35-40 otv service. That’s pretty busy.

I doubt many residents would call that “slow”.

 

[RadOncDoc21]

This is starting to sound like a pissing contest.... if so just know I’m the best, smartest and hardest worker there is...believe me!

 

[OTN]

8 consults a week also means tons of coordination of care/patient phone calls/emails, the OTVs, the associated sims, all the associated follow-ups, plus all the research and academic requirements of a resident in training..... I don't know how long it's been since you trained, but 8 consults weekly is not 'a joke' in residency. I think it's what most residents would call 'a busy service'

I think people that have been out in PP for a long time also forget there's a difference between the patients we see in general practice and the neediness of patients that choose to go to an academic center.

In my practice, my patients are far more sick and far poorer than those who can go to the academic center, as said center does not see it their mission to treat the impoverished.

 

[medgator]

In my practice, my patients are far more sick and far poorer than those who can go to the academic center, as said center does not see it their mission to treat the impoverished.

I forgot... My local NCI designated CC does not accept Medicaid! Much easier to take care of the well-insured high ECOG prostate and breast patients I guess

 

[Mandelin Rain]

In my practice, my patients are far more sick and far poorer than those who can go to the academic center, as said center does not see it their mission to treat the impoverished.

Agreed. Nearest academic center will see these patients but they schedule them out months typically. If the mean time they crump, and come to see me. Breast and prostates though, they get them right in and on beam for 6/9 weeks.

 

[BobbyHeenan]

Pretty sure my 2-3 weekly h&n consult pts need as much TLC now as they did in residency, I just have less support to do it

My closest academic center also doesn’t take many forms of our states medicaid.

Sometimes I can do an appeal (like if they need interstitial brachy for gyn), but other times no luck.

 

[medgator]

My closest academic center also doesn’t take many forms of our states medicaid.

That's what they pump out graduates for...

 

[evilbooyaa]

~10 consults a week in residency is a very reasonable number, IMO. I agree that let's not turn this into a pissing contest of who does more patients. Doing an extra 8 palliative bone met consults a week is NOT educational.... which is what residency should be for. Education.

If I was routinely seeing 15+ consults a week in residency I would tell perspective applicants to run, not walk, away from my program. Sure, some services are busier but if they're averaging 15+ consults, there needs to be another attending or there is minimal education happening in my experience.

 

[Mandelin Rain]

I see myself as a pretty efficient doc, but after about 12 consults in a week I feel like I'm struggling to remember patients' names and what my plan is for each of them is. It's definitely doable to see 15+ new patients per week, particularly if all straightforward cases, but at some point are you really giving enough of the "cognitive portion" of what we do to each?

FWIW, I once saw 14 consults in a day during residency.

 

[evilbooyaa]

I see myself as a pretty efficient doc, but after about 12 consults in a week I feel like I'm struggling to remember patients' names and what my plan is for each of them is. It's definitely doable to see 15+ new patients per week, particularly if all straightforward cases, but at some point are you really giving enough of the "cognitive portion" of what we do to each?

FWIW, I once saw 14 consults in a day during residency.

14 in a day? That's dangerous IMO.

 

[Mandelin Rain]

14 in a day? That's dangerous IMO.

I wouldn't recommend.

 

[seper]

Happens routinely for RadOncs that attend "Breast center" or 'Prostate center" when patients see all 3 specialties in 1 day.

I wouldn't recommend.

 

[Mandelin Rain]

Happens routinely for RadOncs that attend "Breast center" or 'Prostate center" when patients see all 3 specialties in 1 day.

Agreed. In those multidisciplinary clinics you can see A LOT of patients very quickly. But in my experience, it's usually very superficial meet and a greet with a predetermined plan from a tumor board that immediately preceded.

"Hi, I'm Dr. X. I recommend radiation for you after your lumpectomy surgery. This will entail 3-4 weeks of daily treatents that you will likely tolerate very well. But first we need to get that tumor out. Dr. Y will inform you all about the surgery and Dr. Z will discuss systemic therapies. I will plan to meet with you about 3 weeks after surgery to discuss further. For now, best of luck on a speedy recovery post-op, and call if you have any questions. Bye."

 

[Chartreuse Wombat]

Agreed. In those multidisciplinary clinics you can see A LOT of patients very quickly. But in my experience, it's usually very superficial meet and a greet with a predetermined plan from a tumor board that immediately preceded.

"Hi, I'm Dr. X. I recommend radiation for you after your lumpectomy surgery. This will entail 3-4 weeks of daily treatents that you will likely tolerate very well. But first we need to get that tumor out. Dr. Y will inform you all about the surgery and Dr. Z will discuss systemic therapies. I will plan to meet with you about 3 weeks after surgery to discuss further. For now, best of luck on a speedy recovery post-op, and call if you have any questions. Bye."

Level V Consult correct? Assuming the documentation is pristine.

 

[medgator]

Assuming the documentation is pristine.

That's what the resident is for

 

[xrthopeful]

I see myself as a pretty efficient doc, but after about 12 consults in a week I feel like I'm struggling to remember patients' names and what my plan is for each of them is. It's definitely doable to see 15+ new patients per week, particularly if all straightforward cases, but at some point are you really giving enough of the "cognitive portion" of what we do to each?

FWIW, I once saw 14 consults in a day during residency.

agree 12/week is pushing it, especially if more than half of them are not straight forward breast/prostate.