Total Rad Onc Applicants Shoot Back Up To Exceed 2019 Level

[fiji128]

I have a high-volume 4 day/week job. Those 4 days are long and intense, but it's worth it for the extra one off. It helps to be efficient at charting, which is kind of easy once you realize no one cares what we write in our notes.

The shorter you keep the A/P the more likely it is to be read.

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[OTN]

when i type notes i dont even capitalize or do punctuation like this

again, no one cares

 

[DebtRising]

Not a surprise looking at the on paper statistics and backgrounds of the applicants this year. Different universe than 5 years ago, overall down from last year. This is going by the metrics the leaders of the field used when they could.

 

[TheWallnerus]

when i type notes i dont even capitalize or do punctuation like this

again, no one cares

you are the e e cummings of rad onc

 

[deleted1111261]

A/P first

Keep it really simple

Time based, so you don’t have to list all the other stuffs. Was talked about on the bird.

People are reading the recommendations. They do not care that you did a thorough FH or recorded pack years.

@OTN - the capitalization would kill me, man!

 

[RadOncDoc21]

A/P first

Keep it really simple

Time based, so you don’t have to list all the other stuffs. Was talked about on the bird.

People are reading the recommendations. They do not care that you did a thorough FH or recorded pack years.

@OTN - the capitalization would kill me, man!

My issues have always been with the billing folks. I document what they want in the note but the time spent with a patient always confuses me. I can spend an hour talking about football or 30 efficient minutes going over the treatment plan and recommendations but the billing isn’t the same.

 

[deleted1111261]

Time based includes - time spent with patient, time reviewing chart, discussing with referrings and colleagues, and time spent documenting. You’ll hit 60+ Minutes most of the time. It’s a change to move to this and requires re-education.

 

[RadOncDoc21]

Time based includes - time spent with patient, time reviewing chart, discussing with referrings and colleagues, and time spent documenting. You’ll hit 60+ Minutes most of the time. It’s a change to move to this and requires re-education.

Thanks, I’ll add that to my bottom signature. I think my nurse times me in order to be a whistleblower… I’m paranoid like that.

 

[RadOncMegatron]

when i type notes i dont even capitalize or do punctuation like this

again, no one cares

Seriously, when is the last time you read someone else’s (or even your own) ROS?

 

[TheWallnerus]

Seriously, when is the last time you read someone else’s (or even your own) ROS?

If I don’t mention “fever chills night sweats EtOH-intolerance” in a lymphoma patient ROS I feel incomplete. But fortunately I don’t see lymphoma patients anymore!

 

[medgator]

Seriously, when is the last time you read someone else’s (or even your own) ROS?

Nurse is putting that in and it automatically populates in note once we approve it

 

[deleted941485]

Same here… unfortunately I went in hard recently on stocks and it wasn’t a good time to go into the market as it recently took a downhill spiral. I’m still banking on investing to get me through this hellpit. I’m done with medicine overall and wish I would have got a MBA.

Basically I’m at the point where I’m willing to take big risks if it means I can get out of this and support my family while I find something else to do. I gotta say a lot easier said than done.

 

[OTN]

Seriously, when is the last time you read someone else’s (or even your own) ROS?

"As per the pt's history of present illness, the remainder of the 10-pt ROS is negative."

I can say it into my dictaphone in about 2 seconds

Even though we don't have to keep it in, as we can just bill by time, they taught me it was important in medical school to include it, so there you go.

 

[metallica81788]

Time based billing FTW we manage complex stuff don't sell yourself short and lose out on what you worked for

 

[TheWallnerus]

(You can also have the patient fill out an ROS questionnaire. At the bottom there is a signature line “reviewed by MD,” which I sign. And in the dictation I usually say “Full ROS questionnaire reviewed by me and reviewed w patient and signed; no significant positives.” Scan into EMR obv.)

 

[RadOncDoc21]

ROS is such a waste of time. We all have something we can complain about.

 

[TheWallnerus]

Does anyone still put the Sacklers’ fifth vital sign of the 0-10 pain level in their note.

 

[fiji128]

Does anyone still put the Sacklers’ fifth vital sign of the 0-10 pain level in their note.

I think a pain score is still required in new patient notes for some sort of metric? I can't really keep straight all the different rule changes and requirements for how to bill for a level 3, 4 or 5 new patient or follow up encounters/notes. I believe ROS is now out. Pretty sure none of it really makes any difference. Can't stand those super long notes with endless labs, ros, copy and paste results, check box physical exam ect... but somehow no medical decision making or plan.

 

[TheWallnerus]

I think a pain score is still required in new patient notes for some sort of metric? I can't really keep straight all the different rule changes and requirements for how to bill for a level 3, 4 or 5 new patient or follow up encounters/notes. I believe ROS is now out. Pretty sure none of it really makes any difference. Can't stand those super long notes with endless labs, ros, copy and paste results, check box physical exam ect... but somehow no medical decision making or plan.

After reading “Dopesick” and watching it and meeting the author, and now realizing I was the recipient of pharm propaganda as an intern and resident, refuse to record the pain level anymore on principle.

Enduring pain: how a 1996 opioid policy change had long-lasting effects

A recommendation for doctors to treat pain as a ‘fifth vital sign’, coupled with a profit-driven pharmaceutical industry and a consumer culture created a perfect storm

www.theguardian.com

 

[OTN]

After reading “Dopesick” and watching it and meeting the author, and now realizing I was the recipient of pharm propaganda as an intern and resident, refuse to record the pain level anymore on principle.

Enduring pain: how a 1996 opioid policy change had long-lasting effects

A recommendation for doctors to treat pain as a ‘fifth vital sign’, coupled with a profit-driven pharmaceutical industry and a consumer culture created a perfect storm

www.theguardian.com

Pain level out of 10 is an OCM metric. Any pain > 0 must have a plan of care associated with it as well.

 

[RSAOaky]

I have a high-volume 4 day/week job. Those 4 days are long and intense, but it's worth it for the extra one off. It helps to be efficient at charting, which is kind of easy once you realize no one cares what we write in our notes.

Out of curiosity, when you say high volume what are your annual RVUs? I'm essentially 4 days a week too (WFH one day, which means do whatever I want/need to do) at about 12-13k RVUs. I definitely spill into that day off.

 

[RSAOaky]

I think a pain score is still required in new patient notes for some sort of metric? I can't really keep straight all the different rule changes and requirements for how to bill for a level 3, 4 or 5 new patient or follow up encounters/notes. I believe ROS is now out. Pretty sure none of it really makes any difference. Can't stand those super long notes with endless labs, ros, copy and paste results, check box physical exam ect... but somehow no medical decision making or plan.

RO-APM requires a pain score and a plan for pain.

 

[OTN]

Out of curiosity, when you say high volume what are your annual RVUs? I'm essentially 4 days a week too (WFH one day, which means do whatever I want/need to do) at about 12-13k RVUs. I definitely spill into that day off.

I PMd you. Not looking to give the competition info on my bidness.

 

[jondunn]

In rad onc, ASTRO has infiltrated the rad onc resident ‘union’ ARRO

 

[deleted1111261]

In rad onc, ASTRO has infiltrated the rad onc resident ‘union’ ARRO

It hasn’t infiltrated- it IS ASTRO.

We started the prep calls for our Jobs podcast and what makes it hard is essentially every organization that is supposed to be fighting for us is under the ASTRO umbrellaz

 

[medgator]

 

[CurbYourExpectations]

I think it will be higher for RadOnc this year than last year

 

[Fpg1245]

I think it will be higher for RadOnc this year than last year

A return to greatness!!! There’s more interest time to open up 6 more programs with 10 additional spots

 

[RickyScott]

Some of the leadership in arro is there for the explicit purpose of networking and promoting themselves. They will parrot anything that improves their chances of landing a job. Reminds me of the collaborators in Russian occupied Ukraine.

 

[Gfunk6]

 

[thecarbonionangle]

t’was the beginning of ERAS. The usual suspect hellpits are getting ready. Last year’s failures were written off as hiccups or not enough outreach. It all turned out “fine” anyways, they matched anybody on the soap. No introspection to improve the program, blame the internet misanthropes for their failures. Three cheers for another amazing match this year!

 

[medgator]

I think it will be higher for RadOnc this year than last year

The data is less useful without context.... Basically i (and most during peak rad onc) applied to about 2-3x the number listed after the turn of the century and that was basically applying to the vast majority of them.

Now we have way more programs opened since and more training slots but med students are applying to 50-66% less programs

 

[NotMattSpraker]

Really odd thing to only look at absolute total.

FMG tripled since 2018 - 26 to 79
US MD+DO went from 226 to 153

How is this a return to the same?

Im very curious about that data point because I know nothing at all about the FMG ERAS experience. Are they counseled to apply for high probability match fields regardless of interest?

Not sure where the data come from but do they have apps per applicant?

 

[Neuronix]

Does anyone still put the Sacklers’ fifth vital sign of the 0-10 pain level in their note.

An admin emailed me last year because the percentage of patients with a pain score documented in my notes was too low. They were going to set up a one hour training about the pain score's importance and how to document it.

I apologized profusely, and now it's in practically every note. I never scheduled that training.

 

[CurbYourExpectations]

Im very curious about that data point because I know nothing at all about the FMG ERAS experience. Are they counseled to apply for high probability match fields regardless of interest?

Not sure where the data come from but do they have apps per applicant?

ERAS posts statistics in excel format every now and then.

February 2022 RadOnc Stats:
For DOs, IMGs and USMD respectively: Applicants 21, 79, 132. AVG apps per applicant: 24, 30, 39.
Programs received an overall average of 92 apps

 

[RSAOaky]

The data is less useful without context.... Basically i (and most during peak rad onc) applied to about 2-3x the number listed after the turn of the century and that was basically applying to the vast majority of them.

Now we have way more programs opened since and more training slots but med students are applying to 50-66% less programs

250+ Step 1 from a top 50 US allopathic school with decent grades, decent letters, an oral presentation at ASTRO and some abstracts but no pubs, a normal personality. I think there were ~80 programs when I applied. I applied to 75 of them, got interviews at 6-8 hellpits and 3 mid tiers, 1 upper tier. Got interviews at 12 and attended 10. Cancelled UTMB at the end of the season because I was just over it. Cancelled my Mississippi interview after a late night come to Jesus with myself where I decided that as much as I wanted to do radonc, the only thing worse than not matching was matching in Mississippi. Matched 8th on my list. Times have changed.

 

[elementaryschooleconomics]

An admin emailed me last year because the percentage of patients with a pain score documented in my notes was too low. They were going to set up a one hour training about the pain score's importance and how to document it.

I apologized profusely, and now it's in practically every note. I never scheduled that training.

Uh. Yeah.

I use time-based billing for E/M, have deleted most things from my consult notes, and even I still document a pain score because I had a billing person yell at me several years ago.

 

[RSAOaky]

Uh. Yeah.

I use time-based billing for E/M, have deleted most things from my consult notes, and even I still document a pain score because I had a billing person yell at me several years ago.

Nursing documents it at intake. Makes life easy.

 

[thecarbonionangle]

250+ Step 1 from a top 50 US allopathic school with decent grades, decent letters, an oral presentation at ASTRO and some abstracts but no pubs, a normal personality. I think there were ~80 programs when I applied. I applied to 75 of them, got interviews at 6-8 hellpits and 3 mid tiers, 1 upper tier. Got interviews at 12 and attended 10. Cancelled UTMB at the end of the season because I was just over it. Cancelled my Mississippi interview after a late night come to Jesus with myself where I decided that as much as I wanted to do radonc, the only thing worse than not matching was matching in Mississippi. Matched 8th on my list. Times have changed.

I remember the dean meeting and back then it was so competitive, the general wisdom
Or advice was apply very broadly and be happy you get A match, anywhere. Top applicants went to hellpits because there were simply not enough spots. It was not a bad deal because there was the promise of getting 2/3 priorities and high pay. Fast fw to a few years later and Astro president says just be happy you get A job. All of a sudden you have many people who feel they were got. It will only get worst as more “rockstars” graduate and find out there ain’t a pie in the sky.

 

[metallica81788]

Uh. Yeah.

I use time-based billing for E/M, have deleted most things from my consult notes, and even I still document a pain score because I had a billing person yell at me several years ago.

Such bs
Why are all these non-clinical people telling us what to put in our notes

 

[elementaryschooleconomics]

I remember the dean meeting and back then it was so competitive, the general wisdom
Or advice was apply very broadly and be happy you get A match, anywhere. Top applicants went to hellpits because there were simply not enough spots. It was not a bad deal because there was the promise of getting 2/3 priorities and high pay. Fast fw to a few years later and Astro president says just be happy you get A job. All of a sudden you have many people who feel they were got. It will only get worst as more “rockstars” graduate and find out there ain’t a pie in the sky.

I'm trying out some optimism in my life to see if I like it (I doubt it):

The upside we're currently witnessing is the immense weaking of the "culture stranglehold" during the Bubble. Part of the reason our research was driven into the ground (as in, primarily focusing on dose escalation, hypofrac, or omission) was the fear of "stepping out of line". When RadOnc was SO competitive, we all felt lucky just to be let into the club. In such a small specialty, there was concern that upsetting the wrong person would "blacklist" you forever.

So the people in charge wielded tremendous power...to our detriment. There's obviously Freudian-level hang-ups with hierarchy in medicine in general, but we were living it in an extreme sense. Now that we're the most undesirable specialty in medicine, hopefully we can shake things up for the better.

The guy who graduated medical school in the 1960s no longer being in charge is also great.

 

[Neuronix]

Nursing documents it at intake. Makes life easy.

Indeed. Nursing was often not documenting it, so I have reinforced that they need to do so.

Also we use epic so I had to change my template from .vitals to .vitalswithpain .

That was hardly a time consuming fix. Just another annoyance of being an employed rad onc, but that's a very minor issue for me in comparison to other issues.

 

[NotMattSpraker]

ERAS posts statistics in excel format every now and then.

February 2022 RadOnc Stats:
For DOs, IMGs and USMD respectively: Applicants 21, 79, 132. AVG apps per applicant: 24, 30, 39.
Programs received an overall average of 92 apps

That's great for students, number of apps sent should be low right now. Thanks for sharing that.

 

[Fpg1245]

I remember the dean meeting and back then it was so competitive, the general wisdom
Or advice was apply very broadly and be happy you get A match, anywhere. Top applicants went to hellpits because there were simply not enough spots. It was not a bad deal because there was the promise of getting 2/3 priorities and high pay. Fast fw to a few years later and Astro president says just be happy you get A job. All of a sudden you have many people who feel they were got. It will only get worst as more “rockstars” graduate and find out there ain’t a pie in the sky.

You and a lot of people on here were bamboozled. We had to please a lot of dinguses to get to where we are. people that we would have normally told to **** off. It hurts when you get to this point and you realize the endeavor was actually pointless. What a waste.

Apparently at places like Penn, you don’t even function like a doctor you just follow the recipe and that’s it.

 

[medgator]

.

Apparently at places like Penn, you don’t even function like a doctor you just follow the recipe and that’s it.

Anderson and Anderson affiliates same i believe, @RealSimulD

 

[deleted1111261]

Anderson and Anderson affiliates same i believe, @RealSimulD

Lol.

 

[deleted1111261]

You and a lot of people on here were bamboozled. We had to please a lot of dinguses to get to where we are. people that we would have normally told to **** off. It hurts when you get to this point and you realize the endeavor was actually pointless. What a waste.

Apparently at places like Penn, you don’t even function like a doctor you just follow the recipe and that’s it.

What’s wrong with a tried and true recipe?

I’m an amateur cook and occasional caterer for hire.

Winging every prep would cause chaos and inconsistency.

95% of the meals I make, I have a recipe that gets me where I need to know. Kenzji, Sam Sifton, Tejal Rao, Stella Parks, Sho - all these folks have already tested every thing in their test kitchen. I’m just not going to be able to improve on the way chicken is fried or how to get the tadigh perfect.

It would be arrogant of me to say “well, I’ve fried chicken and people seem to like it, so I should ignore the guy that did 1000 versions of it and created a best version”

I know how people that never worked in the system feel about it. I would say that cancer care with guidelines, strict constraints, consistency for 95% of cases improves care. There is need for variation, changes in dose or volumes or constraints. The network’s liaisons recognize that. After a year in, once there is trust, there certainly is flexibility.

I’m not going to convince people who’s minds are made up, but those considering a network site - coming from a guy who loves to be iconoclastic (ahem, a pain in the ass), I think network guidelines are fantastic for high volume places.

 

[OTN]

What’s wrong with a tried and true recipe?

I’m an amateur cook and occasional caterer for hire.

Winging every prep would cause chaos and inconsistency.

95% of the meals I make, I have a recipe that gets me where I need to know. Kenzji, Sam Sifton, Tejal Rao, Stella Parks, Sho - all these folks have already tested every thing in their test kitchen. I’m just not going to be able to improve on the way chicken is fried or how to get the tadigh perfect.

It would be arrogant of me to say “well, I’ve fried chicken and people seem to like it, so I should ignore the guy that did 1000 versions of it and created a best version”

I know how people that never worked in the system feel about it. I would say that cancer care with guidelines, strict constraints, consistency for 95% of cases improves care. There is need for variation, changes in dose or volumes or constraints. The network’s liaisons recognize that. After a year in, once there is trust, there certainly is flexibility.

I’m not going to convince people who’s minds are made up, but those considering a network site - coming from a guy who loves to be iconoclastic (ahem, a pain in the ass), I think network guidelines are fantastic for high volume places.

Even for pp it's important to have guidelines in place. Not only can it help ensure standards of care are being delivered, but payors like to know that our docs won't be way out in left field when we treat their patients, so it can help with payor negotiations. We of course allow flexibility within the guidelines, but having guardrails up is a good idea.

 

[TheWallnerus]

Such bs
Why are all these non-clinical people telling us what to put in our notes

Because JCAHO, essentially

In cahoots with the whole pain cabal

 

[Mandelin Rain]

Because JCAHO, essentially

In cahoots with the whole pain cabal

Yes. And once it was realized the damage it was doing in terms of the national opioid crisis? "Sorry, we can't change. It's doctors' fault."