Turning Off on Vacation

[RadOncBeamer]

Are any of you able to successfully turn off on vacation and not do work? I find it impossible, and probably one of the worst aspects of the specialty. I often find myself spending a considerable amount of time contouring and doing plan review on vacation. I think with prostate/breast patients, it's a no brainer to delay them a week. Some of the others - H&N, GI, lung, CNS or anyone who needs to start in a timely fashion, and have to start with concurrent chemo, so I find myself contouring on vacation. In addition there's emails from billing, peer 2 peers, prior auths, none of which can be put off for a week. For example, today I sent about 10 emails back and forth with dosimetry and billing. My colleagues in radiology, EM, or even IM/surg do not have to really deal with this. Is this just an unavoidable feature of this specialty? Is it practice-dependent? What strategies do you use to minimize work on vacation?

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[Reaganite]

Definitely one of the big, big downsides to this field especially if you're in private practice. The locums pool is a lot of older guys (no offense) who basically expect to babysit your practice and do as little as possible. Its hard to get reliable cross coverage like you might get in an overstaffed academic satellite where 2 docs are covering 20-30 patients total. That kind of staffing just isnt feasible at freestanding rates. The day to day freedom of PP is unbeatable in my opinion, and I'd take it all day every day... but you definitely give up real, turn-your-phone off vacation. I dread the first few days back after "vacation."

 

[RadOncBeamer]

The way I've explained it to my family and friends in the most simplistic terms. If there are 5 steps needed to start a patient's RT treatment and you complete step 1 (consult) or 2 (sim) before vacation, you can't really just put off steps 3-5 (contouring, plan review, approval) for a week, cancer patients and referrings generally do not like delays, so you're bound to spend your vacations working. It makes it near impossible to take any international trips or trips where you'll be truly off the grid for more than a day. For what it's worth, I'm an academic attending in a satellite, but the culture here is that covering docs, even from our network, just babysit, and all work related to a particular attending's patients is to be done by that attending. This leads to situations like me answering a facetime from my lead therapist regarding an IGRT issue while boarding a plane. I actually dread vacation for this reason.

 

[thesauce]

This is a reason to find a good, reliable, and recurring locums that can handle these things. It’s really tough to find but will give you peace and a true vacation.

 

[thecarbonionangle]

I try to manage these issues by planning ahead. Try to find an academic dept with a good culture of support. Find a PP with a similar culture and multiple people so you have support.

Generally try not to schedule any sims week im flying off especially days before. If referring service calls about urgent sim, i tell them im flying off in 3 days is it ok if my colleague takes care of it? Always say sure np. Of course, it has happened that i gotta do some stuff when off like answer a few emails, a referring text or call but generally this strategy has worked well. I tell them im on vacation when they call and they are cool. Im generally able to take time off undisturbed. Select a good academic place or PP. Many of these things new grads do not realize have value in a departmental culture

 

[medgator]

Is your EMR/planning system in the cloud? Double edged sword i know but man does it help on vacation

 

[fiji128]

Are any of you able to successfully turn off on vacation and not do work? I find it impossible, and probably one of the worst aspects of the specialty. I often find myself spending a considerable amount of time contouring and doing plan review on vacation. I think with prostate/breast patients, it's a no brainer to delay them a week. Some of the others - H&N, GI, lung, CNS or anyone who needs to start in a timely fashion, and have to start with concurrent chemo, so I find myself contouring on vacation. In addition there's emails from billing, peer 2 peers, prior auths, none of which can be put off for a week. For example, today I sent about 10 emails back and forth with dosimetry and billing. My colleagues in radiology, EM, or even IM/surg do not have to really deal with this. Is this just an unavoidable feature of this specialty? Is it practice-dependent? What strategies do you use to minimize work on vacation?

Outside of planning for the stuff that you can, which can lead up to busy days before vacation, there is absolutely no reason for any of this if you are in an "academics" satellite type of practice. When reading this, it essentially means the department is not set up well with the burden of all this just being placed on the physician because that is the easiest thing for admin to do. I think you just need to start telling people "no" to at least some of this stuff on your PTO. Boundaries need to be set and support staff need to learn how to deal with this on their own when the main doc isn't there. I 100% never contour on vacation and for sure never deal with billing, done a peer 2 peer or prior auth stuff either. My wRVUs are in the 70% range at a stand alone clinic. Your med oncs and surgery docs aren't doing this while they are on their vacations and no one would ask them to either. Rad Oncs are just so eager to always please and not rock the boat. It is ok to completely unplug while on vacation. You are an employee and do not own the practice.

 

[OTN]

I'm in private practice. I prefer trips where I'm way out there, usually with no cell phone coverage whatsoever. Just took one last week.

I used to unplug completely for a whole week, and even tried for two weeks. I basically found that with the size of my practice, locums more or less couldn't handle the volume effectively. Can't necessarily blame them, as it took me awhile to get efficient enough and dialed enough for it to work.

Stress-wise, as a result, it's just easier for me to try to get work done here and there on vacation, rather than make things really difficult both before and after. Sure, they're still difficult before and after, but it never reaches the unmanageable level. This summer when I'm in the mountains I'm planning on contouring and doing telemedicine to keep things going, but I'm going to take a little more time off to compensate and may fly back in the middle of the family vacation for a few days to get a lot of work done.

It's not as easy as other specialties to unplug, that's for sure, and not something that most in training really know about. It's not a big complaint of mine, though, to be honest, because as a private practice owner it's totally up to me what I want to do when I'm out. Keeping things rolling along smoothly is just easier for me than trying to manage a ton of fires around when I leave.

 

[deleted1111261]

I've been on several long vacations - international and domestic - throughout my career. RadOnc IS in fact situated for this. Private groups typically have 8 - 12 weeks off and people go away for long periods of time. I went to India this January and Japan a few weeks ago. And I'm in solo practice at a small hospital.

The key to this are two things

1) It's 80% workplace culture (EXTERNAL)

2) The more you do, the more that will be asked of you. (INTERNAL)

We really need to get over this idea that everything has to be done this moment. Yes, there are certain cases that are truly urgent. Yes, if you are an administrator, as well as clinician, you may not be able to truly "turn off" non clinical activities. That being said, we've gone so far overboard with being connected (phone, text, email, EPIC inbox) that the blame certainly has to go on many individuals that feel you are indispensable. It is morbid to think about, but if you dropped dead today after work today, yes there would be a hard transition, yes the practice may suffer a bit, but life on Earth goes on. People will manage.

Here is a short list of ways to make vacation great again:

1) Do not check your work email. Just don't do it. I don't even have outlook on my phone. This is not an affectation. I am terrible with my phone and especially work e-mail. In a little over a year of not having it, I realized that there was no patient-related value to having email after hours or on weekends (or on vacation). Just log off. Use your personal email for whatever emailing needs you have.

2A) Locums dependent - figure out which locums are good/useful and use them more; allow them full freedom if they are competent enough. They don't have to be you or as good as you (based on whatever metric you've decided), but you have to be okay with that. They are temporary. Try not to judge harshly. Have a very low bar as to what constitutes successful coverage. Here is mine: 1) Be nice to staff 2) Check all images 3) See all pre-scheduled follow ups 4) See inpatients and write a note. 5) See urgent outpatient consults and let me know the plan. 6) Don't piss off the referrings. This is literally it. I will fix the rest if there is an issue in a week or two. It will be okay. I currently have the greatest locums guy and need to get on of my other friends to help out.

2B) Partners - this needs to be discussed. My first practice we had 10 weeks off. We had a very good culture of taking each others patients. Detailed sign-outs were written up. The early years, the day before vacation was horrible. You stayed til late to get your stuff all done. Then, we talked about it and decided that you sort of stopped on last day and you signed out contours. Yes, this meant occasionally you were taking over a post-op gastric case or some bullsh*t, but it meant when you had the same issue you were not there til 8p the night before your flight. Also, you have to give and receive trust. Do not voice your opinion on a 5% dose difference or a fractionation you would not have used (as long as it is standard of care). Do not judge the decisions. Don't mention the one thing on your list they forgot, if they got the rest done.

3) Be organized - this is not easy for me. But, check the schedule for the next 2 weeks and the prior 2 weeks. Make sure all sim orders are complete and the signout says what to do. If you want people to check imaging report, make sure there is something actionable - otherwise, don't make them follow up. Make sure you have out of office reply on email and EPIC. The signout should start earlier and be as detailed as possible. Highlight who should do what. Even if you have one nurse, it should read "PHYLLIS - check on Mrs. So and So about how her diarrhea is doing and then DR. BOONHAUER can write Lomotil". There is rarely "too much" on a sign out. Set up Epic Inbox forwarding and make it clear who is covering.

4) Train the staff - you should become extremely predictable, like they should know when you leave to take a dump routinely. But, seriously, talk about everything with them. They need to be up in your head and know what you want and how you think. If they can channel you to the coverage and to referrings, then it will help you a lot. Not like clinical stuff, but what types of patients need to be seen right away, what is a "social" emergency that needs to be acted upon or can be placated. They should know you and be unafraid to communicate directly with you. They should feel that same comfort with the locums.

5) Be unavailable - if you get a phone call, but not text or voicemail, let them call you again. If it's a text that is not a medical emergency, wait 4-6 hours at the least before responding. Obviously, no email or EPIC Inbox messages should be responded to.

6) Relieving anxiety about being unavailable - take 1 day maybe mid vacation to quickly look through emails if you think this will make you feel better; once you realize the world moves on without you, you don't need to do this any more.

7) Have a day before you start - I have trouble with this, but it makes for a much better return if you come back on Saturday and check email / Inbox on Sunday so all of that is done before you get to work on Monday.

Maybe I'm not as good as others that are dutifully check email and Inbox and contour on vacation, but it makes for a better QOL and happy family that I don't have to disappear mid day to do work stuff. But, if you don't really like your family / friends anyway, then bring the work laptop and go to town!

 

[BobbyHeenan]

Good posts/discussion.

OP you're not alone. This is a problem for the job. There are some solutions but all of them have trade offs. This is especially tough for those with busy private practices without partners that co-manage patients. (ie solo practice or one doc at each center).

I find I like long weekend vacations more frequently more than big 1-2 week vacations because the before/after work load is tough.

One weeks or plus off I STRONGLY echo making sure you have time the day before you're back in the office to sit down at a computer fo ra few hours to catch up on emails/charting/anything else before the hustle nad bustle of clinic starts. That means don't fly back in Sunday night and go to work monday. Fly in Saturday or Sunday AM and expect to spend some time Sunday catching up. It is what it is.

As an aside, the other thing I deal with is text messages from referring docs. I don't mind it too much, except when on vacation. I too use text to communicate with them. We aren't all on the same EMR, so I can't just do a message in a cerner or epic app either. Is there a way to put all the MD's in a "list" of contacts and create an auto-response text to any messages that come in from them, but not auto-respond to messages I get from other people like my family or friends?

 

[evilbooyaa]

On vacation I don't check work e-mails or EMR. I usually tell all my staff the week before that I am going on vacation and not to bother me. The ones who invariably do with a text I tell them to contact someone who is on-site. We have a DoD system so I encourage them to use it. I do try to make sure my contours and sim orders and plan reviews are done, but

I don't schedule p2ps or any insurance or billing nonsense on my time off.

When my referrings text/call, if it's something quick I may text or call back (rarely, if ever, pick up the phone if there is an initial call). Otherwise I let them know that I'm on vacation, will be back on X date and call them then, and ask if it's urgent enough to see one of my colleagues.

Set up an auto-reply on my e-mail stating that I will be unavailable with resources of who else they can contact for something urgent. List myself in EMR as out with forwarding to someone (resident vs nursing) to triage urgent issues.

I get paid a lot less than most on this forum but this is definitely one of the advantages of being part of academic conglomerate....

A vacation where I spend more than about 2 hours total, logging into work e-mail or EMR, is not really a vacation in my (or my SO's) eyes...

 

[RadOncDoc21]

Great responses and I’ve taken a similar approach to the posted comments above. I just wanted to add that if you don’t allow the system to work without you, it will never work. I refuse to answer emails, texts unless it’s from one of my partners and if we’re on vacation, we rarely ever contact each other and usually handle whatever the situation is at that time to not interrupt one’s vacation time. Everything and everyone else can wait and what’s the use of having colleagues if you don’t allow them to cover for you?

I understand and have experience being solo and relying on a Locums but I’ve learned to take a similar approach in that situation as well. It does make a significant difference to allow yourself to “trust the system.”

 

[Ray D. Ayshun]

As a solo doc I'm mostly able to coordinate sims, planning etc before and after. Otoh, knowing about certain things on vacay beats finding out about them all at once when I return, so I generally talk with people if necessary and not infrequently review images.

 

[NotMattSpraker]

I understand and have experience being solo and relying on a Locums but I’ve learned to take a similar approach in that situation as well. It does make a significant difference to allow yourself to “trust the system.”

I love this and agree with many comments above.

I too have been disappointed with boomer locums. Sometimes you even set them up for success and they still find ways to fail. Bro what you doin! Retire!

 

[Gfunk6]

I appreciate this thread, thanks to RadOncBeamer for starting it. There have also been some great posts - I figured I would throw in my two cents too.

I'm a bit old school on this front - I view being a physician as a calling and being there for my patients 24/7. When I am on vacation, my colleagues cover most routine tasks but I remain available by phone/text for emergencies (or for calls from referring physicians) and I do all of my contouring and treatment planning myself. I know my patients the best and transferring their care to anyone else would result in sub-standard care at least in my view.

Like all people, I am a patient too and it is very frustrating when your doctor is out and you have a simple question or concern which is either deferred for 1-2 weeks or an NP/covering physician gives an opinion that is not particularly relevant or useful.

I do think my views are dying as people view being a physician as "just a job" but I get a lot of fulfillment being available this way. As a private practice physician I also feel that my views will hopefully keep me in business despite consolidation and deep-pocketed competitors.

 

[medgator]

.

I too have been disappointed with boomer locums. Sometimes you even set them up for success and they still find ways to fail. Bro what you doin! Retire!

💯

 

[BobbyHeenan]

I appreciate this thread, thanks to RadOncBeamer for starting it. There have also been some great posts - I figured I would throw in my two cents too.

I'm a bit old school on this front - I view being a physician as a calling and being there for my patients 24/7. When I am on vacation, my colleagues cover most routine tasks but I remain available by phone/text for emergencies (or for calls from referring physicians) and I do all of my contouring and treatment planning myself. I know my patients the best and transferring their care to anyone else would result in sub-standard care at least in my view.

Like all people, I am a patient too and it is very frustrating when your doctor is out and you have a simple question or concern which is either deferred for 1-2 weeks or an NP/covering physician gives an opinion that is not particularly relevant or useful.

I do think my views are dying as people view being a physician as "just a job" but I get a lot of fulfillment being available this way. As a private practice physician I also feel that my views will hopefully keep me in business despite consolidation and deep-pocketed competitors.

This is 100% me. I couldn't like this post enough.

I think my partners are very good but I have a lot of issues with just letting them contour a case I've already thought about. There are also lots of decisions we make on cases which are gut calls I don't want them to have to make. I also think delays matter. I probably over-stress on speed but I swear speed matters in getting treatment started in lots of cases - especially lung cases where post obstructive pneumonias can become disasters.

THis all does weigh on you though. But in the end I love my job and as long as I feel like I'm not compromising my family life too much then I will keep doing it this way. My default is leave the office at a normal time and never miss after school ball games, dances, etc and just ge tthe work done on a weekend day or figure out a way. At least I'm not missing family stuff due to emergency surgeries, etc.

 

[medgator]

This is 100% me. I couldn't like this post enough.

I think my partners are very good but I have a lot of issues with just letting them contour a case I've already thought about. There are also lots of decisions we make on cases which are gut calls I don't want them to have to make. I also think delays matter. I probably over-stress on speed but I swear speed matters in getting treatment started in lots of cases - especially lung cases where post obstructive pneumonias can become disasters.

THis all does weigh on you though. But in the end I love my job and as long as I feel like I'm not compromising my family life too much then I will keep doing it this way. My default is leave the office at a normal time and never miss after school ball games, dances, etc and just ge tthe work done on a weekend day or figure out a way. At least I'm not missing family stuff due to emergency surgeries, etc.

Compared to what the cards stemi guys are going through, we are doing great

 

[deleted1111261]

So, this is it right here -

If your preference is to be available and that makes you feel your care is best, then do that.

But you can work things out so vacation can be vacation.

There are different strokes for different people. I purposely didn’t rhyme, fwiw

 

[BobbyHeenan]

So, this is it right here -

If your preference is to be available and that makes you feel your care is best, then do that.

But you can work things out so vacation can be vacation.

There are different strokes for different people. I purposely didn’t rhyme, fwiw

Also agree strongly with this.
One way is not wrong. People even evolve with time too how they handle things. Even within our group none of us handle vacation duties the same way. We get a long well, but do it differently and we're for the most part happy about how we do it.

 

[NotMattSpraker]

I appreciate this thread, thanks to RadOncBeamer for starting it. There have also been some great posts - I figured I would throw in my two cents too.

I'm a bit old school on this front - I view being a physician as a calling and being there for my patients 24/7. When I am on vacation, my colleagues cover most routine tasks but I remain available by phone/text for emergencies (or for calls from referring physicians) and I do all of my contouring and treatment planning myself. I know my patients the best and transferring their care to anyone else would result in sub-standard care at least in my view.

Like all people, I am a patient too and it is very frustrating when your doctor is out and you have a simple question or concern which is either deferred for 1-2 weeks or an NP/covering physician gives an opinion that is not particularly relevant or useful.

I do think my views are dying as people view being a physician as "just a job" but I get a lot of fulfillment being available this way. As a private practice physician I also feel that my views will hopefully keep me in business despite consolidation and deep-pocketed competitors.

I wish there was more nuance around this calling versus job thing. In my aggressive attempt to never work on vacation, I still give my cell to my team, some patients, and all patients have my work email. People should and do call in an emergency, but emergencies are rare. If my wife is scrolling during some vacation downtime, I might glance at my email. If I can easily help a patient that emailed, I will. If someone calls in an emergency, of course I help. It feels great.

I do not think my partner covering some small aspects of care for my patients is sub-standard. If I did, I wouldn't have joined this practice.

I don't blame anyone for wanting to take ownership (as we all should), but there has to be a line. If patients have access to you at all times, a patient with an unhealthy relationship with their health care will drag you down in to that unhealthy relationship.

While that is rare, the "calling" thing is abused like crazy by admins and bosses. When I push back and try to fight myself and those that want work life balance, the implication is that I am lazy or that my care is poor quality. It's weird how no one wants to take ownership for high levels of addiction, burnout, and suicide though. I think my care quality in the setting of aggressive work-life balance is much higher than the workplace quality most hospital admins are fostering. Just my opinion though. Funny how no one seems to talk about that very much.

At the end of the day, it should be personal for each doctor. But we should start at a place where we put healthy balance way high up on a pedestal and have each doctor titrate balance to what they want from there. This thing where most start with a toxic work-life balance and has to overcome incredible odds to get to what they want is absurd and we should move away from it ASAP.

 

[dieABRdie]

Are any of you able to successfully turn off on vacation and not do work? I find it impossible, and probably one of the worst aspects of the specialty. I often find myself spending a considerable amount of time contouring and doing plan review on vacation. I think with prostate/breast patients, it's a no brainer to delay them a week. Some of the others - H&N, GI, lung, CNS or anyone who needs to start in a timely fashion, and have to start with concurrent chemo, so I find myself contouring on vacation. In addition there's emails from billing, peer 2 peers, prior auths, none of which can be put off for a week. For example, today I sent about 10 emails back and forth with dosimetry and billing. My colleagues in radiology, EM, or even IM/surg do not have to really deal with this. Is this just an unavoidable feature of this specialty? Is it practice-dependent? What strategies do you use to minimize work on vacation?

Could not agree more.... and its always really hard for my friends/family to understand it. ("I mean.... what do you actually DO anyway???, can't someone else just sign the document????)

I've just accepted its part of the life and make sure I have access wherever I go. I make sure that at least once per day (maybe twice) to log in and check emails / sign plans.

If I really need to be completely gone... I take two days of vacation off before I actually leave. Or block my schedule for two days. It really takes some forethought and planning. Much more than any specialty.

 

[Ray D. Ayshun]

Could not agree more.... and its always really hard for my friends/family to understand it. ("I mean.... what do you actually DO anyway???, can't someone else just sign the document????)

I've just accepted its part of the life and make sure I have access wherever I go. I make sure that at least once per day (maybe twice) to log in and check emails / sign plans.

If I really need to be completely gone... I take two days of vacation off before I actually leave. Or block my schedule for two days. It really takes some forethought and planning. Much more than any specialty.

If my family says anything, I say #750orGTFO, and they understand.

 

[seper]

I've worked at 2 relatively large employed groups, and found that Radonc's usually REALLY want to do contouring and plan review during their vacation. That is to maximize their individual wRVU

 

[RO28]

So I kind of do a little of both sides, I don't check my email, or my epic inbox when I am on vacation. Emails should never be urgent (IMO) and I delegate the inbox and patient calls to whomever is covering for me (we do have a really good locums). I never give my cell phone to patients but referring MDs have it and I just let them know I'm on vacation, if its urgent someone else can cover or if its not urgent I'll do it when I come back.

However, I absolutely hate delegating contouring. I do my best to either have those done before/after I go on vacation and work with our CT sim schedule to try and orchestrate that. Maybe I'm a bit of a control freak here, but oh well. I'm okay with this one control freak point and will cede all the other work to someone else to enjoy vacation...because I really value my time off and don't really consider this my "calling".

 

[RadOncDoc21]

There is nothing worst then inheriting contours on a plan you know nothing about.

I’ve also noticed the higher up the food chain, the more willing that person is to dump their contours and consults down on a lower rank member. The worst is when they have already determined the plan for you, including the dose and target volume before anyone has actually done a consultation. This is usually done in the setting of a curbside consult made between the referring doc and the rad onc chair/chief while they are out playing golf or on day 3 of “admin time.”

At first, you’re happy to cover and even see it as a compliment as the higher ups “trust” you with their patients. After awhile, you start to realize they are dumping on you and you become resentful and end up leaving as you mistakenly believed being a workhorse and someone who is reliable would demonstrate how valuable you are to the team. Hell, you may even believe that the admins would consider giving you a raise since 80% of the patients being treated are yours!

Please don’t make the same mistakes I’ve made in the past. Set the tone early and draw a line in the sand. Do what works the best for you and your family because that’s all that matters in the end!

 

[metallica81788]

So I kind of do a little of both sides, I don't check my email, or my epic inbox when I am on vacation. Emails should never be urgent (IMO) and I delegate the inbox and patient calls to whomever is covering for me (we do have a really good locums). I never give my cell phone to patients but referring MDs have it and I just let them know I'm on vacation, if its urgent someone else can cover or if its not urgent I'll do it when I come back.

However, I absolutely hate delegating contouring. I do my best to either have those done before/after I go on vacation and work with our CT sim schedule to try and orchestrate that. Maybe I'm a bit of a control freak here, but oh well. I'm okay with this one control freak point and will cede all the other work to someone else to enjoy vacation...because I really value my time off and don't really consider this my "calling".

Bingo

I don't even mind answering calls texts from referrings while I'm out - they can't all know I'm gone and I'm not texting/calling every single one. I'll let phone calls go to voicemail then text them asking what's going on. My staff will know when I'm out, don't call/text me and if you email me it may take a while. I'll still check my email as habit but it won't stress me out.

Will always leave a detailed OTV list for covering MD and try to predict any problems. Staff should be trained to know the patients, know you, and anticipate needs.

Covering MD can handle inpatients and/or urgent consults. No way am I checking images while gone, that's ridiculous. Now at my new job, locums seem to have historically been given more responsibilities so they can see some old follow ups because I don't know them any better anyway.

I will never leave contours for anyone. Ever. I will control my sim schedule to where that doesn't happen. Complicated more time-sensitive cases like HN, lung, cervix, etc will have to be worked in either before vacation (but with reasonably enough time to plan and approve before leaving) but when I'm gone I'm gone. Prefer to not have sims while I'm out, but it can make things more streamlined when returning. The before and after vacation suck, it is what it is.
Leaving contours/planning for another MD that doesn't know your patient is probably one of the worst things a RadOnc can do. Most of these scenarios had plenty of foresight to avoid handoffs. Nobody will ever convince me otherwise. It's just trash.

 

[deleted1111261]

Not to try to convince you because you already said I practice like trash but, I also can think it’s trash for people to think they are the only one that manage a case.

It is very #radonc to think there is one way to do something and other ways are trash.

 

[medgator]

Not to try to convince you because you already said I practice like trash but, I also can think it’s trash for people to think they are the only one that manage a case.

It is very #radonc to think there is one way to do something and other ways are trash.

When a patient sees a surgical specialist for a whipple, goose-ectomy, RP, radical cystectomy etc. is it usual for a different surgeon to do the operation because someone happened to be out of town that week for or scheduling?

That's not been my experience

 

[elementaryschooleconomics]

I would like to point out, on a meta-level:

The size and intricacy of the posts written in this thread are unusual for SDN. Usually, the "dissertation-style" posts are the domain of myself and @TheWallnerus.

But these are passionate, well-thought-out arguments.

And this is the #1 reason I get furious that there's still the myth out there that "RadOnc is perfect for physician-scientists".

No. No it's not.

The bleeding of work into VACATION for EVERYONE - it's worse during a "normal" week if you're trying to have "protected" lab time.

My eyes were really opened during my Holman and I worked with non-RadOnc physician-scientists. Sure, they had "inpatient responsibilities". It took them totally out of the lab a couple weeks a year.

But when they were in the lab, THEY WERE IN THE LAB.

As medical students have come to see this specialty for what it is, this is a vestigial belief that also needs to end.

 

[deleted1111261]

When a patient sees a surgical specialist for a whipple, goose-ectomy, RP, radical cystectomy etc. is it usual for a different surgeon to do the operation because someone happened to be out of town that week for or scheduling?

That's not been my experience

OB.. ALL THE TIME

Kaiser RadOnc in certain busy regions consistently has the non consulting doc contour the case.

SERO in past had internal locums type situation - and many cases taken care of by others.

Standardization allows for this, not only for efficiency reasons but also quality. Anderson does it all the same way - and it allows for seamless coverage.

Again, just because one way works for you doesn’t mean that’s the only way. It’s a big problem with us when you look at how approach problems.

 

[theradiator]

Inherent in this discussion is the tension between being a replaceable drone to irreplaceable artisan and the second order effects on physician quality of life. Everyone will fall somewhere on this spectrum with the predictable tradeoffs on lifestyle.

 

[metallica81788]

Not to try to convince you because you already said I practice like trash but, I also can think it’s trash for people to think they are the only one that manage a case.

It is very #radonc to think there is one way to do something and other ways are trash.

I certainly don't think I'm the only one that can manage a case. But this isn't OB where things can happen any given moment - we can plan things out.
If I meet the patient and discuss things with them, barring utter emergency, I see things through. I believe in continuity. Can I be there for every weekly visit? Probably not but that point the plan is in motion.

The exception I can think of is if you are in a group (but preferably small partnership) where you know your partner in out and you practice the same way and completely trust one another to do such things. A shared patient model where care is essentially identical and the arrangement works for personal and professional work-life balance.
Your situation may be that way, but we all know most contour-dumping situations are not like that.

 

[medgator]

OB.. ALL THE TIME

A c-section isn't a TORS/Whipple/TME-LAR/radical cystectomy etc.

I've never seen it happen in the surg onc world. The specialist who consults my patients does the surgery. Makes sense to me 🤷‍♂️

Different strokes for different people right? All a matter of perspective

 

[deleted1111261]

A c-section isn't a Whipple/TME-LAR/radical cystectomy. I've never seen it happen in the surg onc world. The specialist who consults my patients does the surgery. Makes sense to me 🤷‍♂️

Different strokes for different people right? All a matter of perspective

You said does someone else do the surgery. You did not ask me to go through complexity.

If you’re going to do it that way, then I’m going to say it’s absurd to make a patient wait for you to come back for their bone met treatment when you’re back from Mackinac or to delay a whole brain or whole breast. As a sole proprietor - that’s poor practice. Am I going to leave a recurrent head and neck? Probably not. If it comes in on Friday, and I brief my coverage on it before a two week trip, I’ll explain and gauge their comfort level. But I’m not cancelling my time off. Life is complicated.

If you don’t have systems in place for when you are out, there may be more dangers than allowing a board certified faculty member from the local academic center to contour your cases.

Practice variation is just variation. It’s not good or bad or trash or angelic.

The graveyard is filled with the irreplaceable.

 

[RadOncDoc21]

Truly is a spectrum. Are there some rad oncs out there I couldn’t trust to provide high quality care, I’m sure there are but I know 95% of the time no matter how great I think I am, the outcomes wouldn’t change regardless if either me or someone else designed the “perfect” plan.

Life is short people, enjoy it while you can. Rad oncs are not special!

 

[metallica81788]

Our experiences and opinions are shaped by our residency and jobs

Some places have great shared patient responsibilities, most don't. Systems in place make the difference.
I've had zero faith in the locums covering me since I've been out in the world - but I'm sure good ones do exist. I'm currently cleaning up some messes from some locums coverage at my current job, 80% was done well but the other 20%...
If a more known quantity covered me I don't want to leave extra work for them to do that I should have handled myself.
I've heard horror stories of unexpected coverage of another site where you're there for one day as a favor and get dumped 3 head necks to contour that have no business being on your plate, most people just can't say no. That's what I'm referring to as trash.

 

[deleted1111261]

Totally.

I think that’s the point - finding coverage or having partners that you trust.

 

[NotMattSpraker]

When a patient sees a surgical specialist for a whipple, goose-ectomy, RP, radical cystectomy etc. is it usual for a different surgeon to do the operation because someone happened to be out of town that week for or scheduling?

That's not been my experience

Did you rotate with OBGYN?

I'm not advocating that people should dump contours on their partners, I don't like that either. But radiation is not surgery, no matter how much Rad Oncs like to pretend.

 

[medgator]

Did you rotate with OBGYN?

I'm not advocating that people should dump contours on their partners, I don't like that either. But radiation is not surgery, no matter how much Rad Oncs like to pretend.

Yes. I think it's best practice to have complicated, definitive cases planned by the doc who saw and will take care of the patient when possible. Maybe that makes me old school. I'm not talking an emergent case like a bad spine met etc. And C sections are usually emergent when they happen outside of normal hours, right?

 

[medgator]

You said does someone else do the surgery. You did not ask me to go through complexity.

If you’re going to do it that way, then I’m going to say it’s absurd to make a patient wait for you to come back for their bone met treatment when you’re back from Mackinac or to delay a whole brain or whole breast. As a sole proprietor - that’s poor practice. Am I going to leave a recurrent head and neck? Probably not. If it comes in on Friday, and I brief my coverage on it before a two week trip, I’ll explain and gauge their comfort level. But I’m not cancelling my time off. Life is complicated.

If you don’t have systems in place for when you are out, there may be more dangers than allowing a board certified faculty member from the local academic center to contour your cases.

Practice variation is just variation. It’s not good or bad or trash or angelic.

The graveyard is filled with the irreplaceable.

Analogous to a c section right?

Vs a nasopharynx or something. What I'm saying is I try to do my own definitive complex cases when possible.

And yes i totally get the last statement. The variation I've heard is "work will never love you back"

 

[deleted1111261]

I don’t think anyone is disagreeing with that.

I think there is confusion between dumping all your work for the coverage vs strategically managing your patients and care to optimize QOL.

I would not pick a partner that would refuse to contour while I was out. I simply wouldn’t hire them - doesn’t jive with my worldview.

 

[medgator]

I would not pick a partner that would refuse to contour while I was out. I simply wouldn’t hire them - doesn’t jive with my worldview.

A lot (all?) of us can't fire the existing partners of practices we are hired into, and it's rare that any of us at this stage were fortunate enough to start a private group from scratch

 

[metallica81788]

I don’t think anyone is disagreeing with that.

I think there is confusion between dumping all your work for the coverage vs strategically managing your patients and care to optimize QOL.

I would not pick a partner that would refuse to contour while I was out. I simply wouldn’t hire them - doesn’t jive with my worldview.

I think my view of a "perfect" practice would be busy enough to support two doctors, everything is interchangeable as you've mentioned
You can take unlimited vacation, work 3-4 days a week and provide seamless coverage for one another with great continuity for the patients

Problem is finding two people with the same goals and mindset in the same location
I've only been solo and will be until I find that scenario, which is increasingly unlikely. So I have to take a defensive and ownership mindset to protect my patients and also my sanity.

 

[RadOncDoc21]

I think my view of a "perfect" practice would be busy enough to support two doctors, everything is interchangeable as you've mentioned
You can take unlimited vacation, work 3-4 days a week and provide seamless coverage for one another with great continuity for the patients

Problem is finding two people with the same goals and mindset in the same location
I've only been solo and will be until I find that scenario, which is increasingly unlikely. So I have to take a defensive and ownership mindset to protect my patients and also my sanity.

This would be ideal and I’m sure there are places like this that exist. My current partners and I don’t always agree on everything but we shrare a desire to have a work life balance which seems to work out.

We literally work independently with our patients but share resources and try to standardize a set way of treating common things but usually only cover in the setting of vacations, conferences, etc.

 

[thecarbonionangle]

A lot (all?) of us can't fire the existing partners of practices we are hired into, and it's rare that any of us at this stage were fortunate enough to start a private group from scratch

True i would imagine people are limited by boomers/Late gen X by how much progressive change can happen. There are people who are just fine with everyone for themselves.

 

[NotMattSpraker]

Yes. I think it's best practice to have complicated, definitive cases planned by the doc who saw and will take care of the patient when possible. Maybe that makes me old school. I'm not talking an emergent case like a bad spine met etc. And C sections are usually emergent when they happen outside of normal hours, right?

Yes, I think we agree more than not. Most complicated, definitive cases, you can work them around a vacation or triage them. My main site of practice has 2 doctors. If I have a vacation coming up and a complicated case that needs to start soon is referred, the other doctor should see it.

I think my original point was that I do not like the culture of keeping that case. Seeing the consult and sim the day before you leave, then contouring for 2 hours during your vacation. There are a lot of self-proclaimed heroes in medicine, and holding the opinion that you don't need to be a hero does not make me a bad doctor.

In my new practice, where all the doctors seem to protect work-life balance, surgeons do this too.

We literally work independently with our patients but share resources and try to standardize a set way of treating common things but usually only cover in the setting of vacations, conferences, etc.

Same here, I like this model.

 

[sirspamalot]

I leave, they get a locums, I say I'm available but they don't call typically, maybe a text. I take an entire week off to the islands (Next up: Sandy Lane) and thats that. Complex new consults are deferred, everything else is "cleaned up" before I leave..

Look, one thing those who complain about "old guys babysitting" is you are paying them to do that. $1500 a day I don't answer the phone. $2000 a day it had damn well better be babysitting you're hoping for.. if you can get me to show up. Which you won't.

You want me to run your 25 on treatment flawlessly? Do everything.. On demand whenever you need me? YOU KNOW the song I'm about to link to.. its $2800-3000 a day or pound sand. Maybe more if its "We need it next week."

Yes there are useless old dudes doing babysitting.. and you can't always know what you're getting. But you generally get what you pay for if you are doing it intelligently.

Oh, and add 25-50% if you go thru an agency. Best plan ahead or be prepared to see 3500/d and up.. for babysitters they are paying 1800/d....

#

ps. if things go my way, I may "retire" in the next 5 years. Perhaps I will be available to fly to your place and work for appropriate compensation, you'll have to cover hard flight costs and housing though....thinking of planning to work quarter time to cover the overhead of lyfe and keep the creds current. I'd enjoy meeting many of you around the country..

 

[RO28]

I will say, to add fuel to the fire, the OB I just happened to be referred to is in solo practice (I have NO EFFING idea why, that's her problem, not mine) but I did really, really appreciate the fact that I knew it would be her regardless. There is/was a level of trust I have with her as a result.

But yeah, I think there is a lot of nuance to be able to trust your partners and have them contour cases. Its not like I don't trust them, but I do see some of them on a weekly basis in chart rounds and have a few quirks that I want done differently that I am okay with. Which is totally different than urgent whole brain or brain mets.