Where is the ASTRO response/guidance on how clinics should be operating amid the coronavirus outbreak?

[medgator]

so here's the thing

1) ASTRO has rationale to support supervision rules because this keeps the job market afloat. If supervision rules did not exist, jobs would disappear. this is what ASTRO is supposed to do.
2) Makes sense from CMS perspective to have allowed for the rural exception in interest of public health and access to care
3) all sorts of rules are out the window in the COVID era. this is true for way more important and widespread things than rad onc supervision, but it is true for supervision as well.

none of this (to me) is controversial or confusing. Some of you are playing a constant game of GOTCHA!, when there's nothing to be got.

1) is stupid, the job market would have been fine at 100-120/year. It's not ASTROs responsibility to artificially inflate the job market. Direct supervision didn't exist prior to the last couple of decades. Ct sim, Sbrt, hdr maybe, but that's about it and Astro looks disingenuous trying to continue to support a two tiered approach.

---

Members don't see this ad.

 

[deleted1002574]

so here's the thing

1) ASTRO has rationale to support supervision rules because this keeps the job market afloat. If supervision rules did not exist, jobs would disappear. this is what ASTRO is supposed to do.
2) Makes sense from CMS perspective to have allowed for the rural exception in interest of public health and access to care
3) all sorts of rules are out the window in the COVID era. this is true for way more important and widespread things than rad onc supervision, but it is true for supervision as well.

none of this (to me) is controversial or confusing. Some of you are playing a constant game of GOTCHA!, when there's nothing to be got.

You lost me at 1. ASTRO has made it clear that the job market is not their concern. Since when is that part of their platform? Since when do they speak about it?

Regulations should be in response to a problem. Direct supervision is a solution to a problem that does not exist.

 

[radoncgrad2019]

‘The last couple of decades’ as if anything before the past couple of decades in rad onc and the way we practice is relevant anymore.

But whatever the point is this isn’t about safety so people should stop bringing it up because we all know this is about a perceived need to protect the field

 

[radoncgrad2019]

this is all funny because just like 2 months ago when CMS changed the rules there were threads and threads here about the impact on the job market and how ASTRO has to ACT blah blah blah and now some of you act like you've been pissed about supervision rules the whole time.

please.

for some of you you're just happy now that you realized you don't have to pay locums

it's all about YOU YOU YOU always.

cannot possible be more transparent.

sad!

 

[deleted1002574]

this is all funny because just like 2 months ago when CMS changed the rules there were threads and threads here about the impact on the job market and how ASTRO has to ACT blah blah blah and now some of you act like you've been pissed about supervision rules the whole time.

please.

for some of you you're just happy now that you realized you don't have to pay locums

it's all about YOU YOU YOU always.

cannot possible be more transparent.

sad!

No. I've been consistent and so have some others that direct supervision does not do anything in terms of patient safety. It just props up a weak job market that was created by ASTRO/ABR/academic centers.

I don't know of any data showing ANY benefit of direct supervision. Please feel free to show it to me. I'd be happy to continue the charade of linac babysitting = patient safety benefit.

 

[radoncgrad2019]

No. I've been consistent and so have some others that direct supervision does not do anything in terms of patient safety. It just props up a weak job market that was created by ASTRO/ABR/academic centers.

I don't know of any data showing ANY benefit of direct supervision. Please feel free to show it to me. I'd be happy to continue the charade of linac babysitting = patient safety benefit.

Stop bringing this up. No one actually thinks this is a safety issue. READ.

 

[deleted1002574]

Stop bringing this up. No one actually thinks this is a safety issue. READ.

ASTRO wrote a letter saying it was a patient safety issue. READ

 

[scarbrtj]

Stop bringing this up. No one actually thinks this is a safety issue. READ.

So you're saying when ASTRO says "We contend that reducing the supervision of a patient during therapeutic treatment could potentially endanger patients due to the irreversible nature of radiation treatment delivery" it's more of a wink-wink, we-are-jk sorta thing. Neat. They think something but say something else. Had to read their mind for that one. Some say that being able to READ other people's minds is a sign of psychic ability. Or schizophrenia. Pick!

 

[evilbooyaa]

And just like that supervision became ashes in ASTRO's mouth.

Because a temporary change in policy in the middle of an international pandemic?

No.

I'm not blaming ASTRO for this position, at this time.

We get it, you think supervision is dumb. Totally no bias there /s.

But to say "lol they changed their position, what scrubs they're so inconsistent" in the midst of an international pandemic is to lose the forest for the trees.

 

[medgator]

‘The last couple of decades’ as if anything before the past couple of decades in rad onc and the way we practice is relevant anymore.

But whatever the point is this isn’t about safety so people should stop bringing it up because we all know this is about a perceived need to protect the field

Trolling? That's exactly what ASTRO used to justify continuing it to CMS

 

[medgator]

Because a temporary change in policy in the middle of an international pandemic?

No.

I'm not blaming ASTRO for this position, at this time.

We get it, you think supervision is dumb. Totally no bias there /s.

But to say "lol they changed their position, what scrubs they're so inconsistent" in the midst of an international pandemic is to lose the forest for the trees.

Do you agree with them opening it up to non BC and physicians from other specialties to supervise?

 

[evilbooyaa]

Do you agree with them opening it up to non BC and physicians from other specialties to supervise?

I personally think direct supervision is unnecessary regardless of the setting except in cases of SBRT/Brachy. I could be convinced that for free standing, somebody who can provide medical assistance should be available on-site at all times.

So to answer your question, yes I'd be fine with the questino as posed.

However, ASTRO disagrees with this prior to this, (which they are allowed to do) and those using a statement created during a national crisis as a 'gotcha, hypocrites' need to be called out on it.

 

[RickyScott]

so here's the thing

1) ASTRO has rationale to support supervision rules because this keeps the job market afloat. If supervision rules did not exist, jobs would disappear. this is what ASTRO is supposed to do.
2) Makes sense from CMS perspective to have allowed for the rural exception in interest of public health and access to care
3) all sorts of rules are out the window in the COVID era. this is true for way more important and widespread things than rad onc supervision, but it is true for supervision as well.

none of this (to me) is controversial or confusing. Some of you are playing a constant game of GOTCHA!, when there's nothing to be got.

I've heard similar things from other groups as well along those lines

Supervision much less impact on job market by order of magnitude than residency expansion which Astro tacitly has supported. Same people wearing different hats.

 

[medgator]

I personally think direct supervision is unnecessary regardless of the setting except in cases of SBRT/Brachy. I could be convinced that for free standing, somebody who can provide medical assistance should be available on-site at all times.

So to answer your question, yes I'd be fine with the questino as posed.

However, ASTRO disagrees with this prior to this, (which they are allowed to do) and those using a statement created during a national crisis as a 'gotcha, hypocrites' need to be called out on it.

Why not just leave it at general supervision and keep the other specialists and non-BC ROs out of the equation? That helps no one once we've made it through this crisis.

Once again, ASTRO provides another example of its inept and capricious leadership of our specialty

 

[deleted1002574]

I personally think direct supervision is unnecessary regardless of the setting except in cases of SBRT/Brachy. I could be convinced that for free standing, somebody who can provide medical assistance should be available on-site at all times.

So to answer your question, yes I'd be fine with the questino as posed.

However, ASTRO disagrees with this prior to this, (which they are allowed to do) and those using a statement created during a national crisis as a 'gotcha, hypocrites' need to be called out on it.

No, it's not "Gotcha", Evil. It's showing that they are not being fully honest about this.
It is hypocrisy.
Is it safe or unsafe? That is a reasonable question we should all be asking.

Are we saying that the danger of unsupervised treatment is far, far less than the danger of contracting a virus? What about the flu? Similar problem, different in scope.

I think you're calling out the wrong people.

 

[evilbooyaa]

No, it's not "Gotcha", Evil. It's showing that they are not being fully honest about this.
It is hypocrisy.
Is it safe or unsafe? That is a reasonable question we should all be asking.

Are we saying that the danger of unsupervised treatment is far, far less than the danger of contracting a virus? What about the flu? Similar problem, different in scope.

I think you're calling out the wrong people.

A virus that is an international pandemic leading to shutdown of multiple countries, including every major sports league in the US and European football leagues? We're back to comparing it to the flu?

Yes I expect that ASTRO is worried about the following things right now:
1) Their own membership (many of which are older and/or with medical co-morbidities) contracting the virus from 'direct supervision' requirements as currently written
2) If 1) was to happen, especially in rural freestanding centers, then the facility would have to close and patients would have to stop treatment even by no fault of their own
3) If 2) happens, this is bad, so take steps to minimize 1).

This is NOT the flu. If a Rad Onc has the flu they can still come to work, if not with it, then within a few days. If a Rad Onc has corona virus they will be on a minimum 14 day quarantine. Especially for free standing centers where there may be only one doctor, is it not prudent to minimize risk to the physician staff?

Right now, at any given center that is running lean, if any 1 person is lost, some steps can be taken to work around it, except for the physician and the physicist (and some would argue dosimetry).

While I don't agree with them, I imagine that ASTRO's position is that it IS unsafe, but in a time of crisis, they will live with it being slightly unsafe, as opposed to how unsafe it will be when a Rad Onc is required to be on a 14-day quarantine, and thus patients are completely unable to be treated for a 14 day period. Enjoy your higher rates of recurrence H&N and Cervix patients!

You are allowed to disagree with their premise (as we both do), while still understanding their argument and not calling them hypocrites (as I, alone, am capable of)

I get that most have significant beef with ASTRO, but to equate their normal policy stance with what they are OK doing in times of crisis and call them hypocrites is completely non-sensical.

Do you think that radiation oncologists (or pathologists, or psych, or derm, or ophtho, or other non-hospital specialties) should be doing inpatient hospital admissions? I'd argue that's extremely unsafe compared to the standard of care. However, in a time of crisis, it's something that is allowed for the greater good.

 

[Mandelin Rain]

"We contend that reducing the supervision of a patient during therapeutic treatment could potentially endanger patients due to the irreversible nature of radiation treatment delivery"

It seems that a global pandemic is the last moment you'd want to endanger patients by putting them in the path of irreversible harm.

But ASTRO....?

"Hold my beer."

There's literally no coming back from this for ASTRO re: supervision. CMS will laugh at them. You either believe it's too unsafe to do, or you don't.

 

[evilbooyaa]

Why not just leave it at general supervision and keep the other specialists and non-BC ROs out of the equation? That helps no one once we've made it through this crisis.

Once again, ASTRO provides another example of its inept and capricious leadership of our specialty

Because I imagine some would argue that SOMEBODY should be on site at a free-standing center, similar to how chemotherapy administration has to be 'supervised' but can be supervised by a midlevel or non med onc.

That being said, I'd totally be fine with saying it should be just general supervision except for special procedures, during this time of crisis, similar to what hospital-based facilities now are allowed to do per CMS.

 

[deleted1002574]

"We contend that reducing the supervision of a patient during therapeutic treatment could potentially endanger patients due to the irreversible nature of radiation treatment delivery"

It seems that a global pandemic is the last moment you'd want to endanger patients by putting them in the path of irreversible harm.

But ASTRO....?

"Hold my beer."

There's literally no coming back from this for ASTRO re: supervision. CMS will laugh at them. You either believe it's too unsafe to do, or you don't.

Safe or unsafe. That's it.

Why would we put patients at risk during pandemic ? That's the right questions to ask.

We want them to do something MORE dangerous to their health?

 

[Mandelin Rain]

Whatever you believe about supervision, Astro’s efforts are done. It was a long shot to begin with. Now, it’s dead. Move on to protecting our reimbursement please.

 

[Gfunk6]

It is somewhat amazing to me that people have chosen to take such a polarizing "black or white" view. We are living through a unique, exceptional time. Normal rules of conduct don't apply. On the one hand we have a global pandemic which is a significant threat to everyone but especially our patients who are frequently immunocompromised with a potentially poor reserve to fight off infections. On the other hand, we are delivering life saving treatments to the same patients.

We don't want to take the extreme position that all cancer treatments are cancelled for four weeks. We also don't to take the position to operate as normal without regard to COVID-19 transmission.

In the absence of either extreme position, compromise is required. What do you instead propose ASTRO suggest if an RO MD has to go into 14 day quarantine? Cancel all patients? Show up to work anyway and infect everyone?

I agree that ASTRO is on the wrong side of history with this supervision issue, but saying that "pulling it back during an unprecedented global pandemic is hypocrisy" is asinine.

 

[radoncgrad2019]

Whatever you believe about supervision, Astro’s efforts are done. It was a long shot to begin with. Now, it’s dead. Move on to protecting our reimbursement please.

You shouldn’t talk out of both sides out of your mouth, my friend! What ASTRO knows, and you should learn, is that they go hand in hand.

Look - either what we do matters, or it doesn’t matter. Pick one. ASTRO has taken the overall approach of protecting our role and our importance in cancer care for our patients, which is used to justify our excellent reimbursement.

Are you on that side or the Side of scarb who posts here on a daily basis that what we do doesn’t matter at all?

Because if it doesn’t matter then why the FRACK, pray tell, would CMS pay us anything?

 

[RickyScott]

I give out ibuprofen and Mobic like water to prostate pts. Going to ask them to stop taking?

 

[taserlaser]

I give out ibuprofen and Mobic like water to prostate pts. Going to ask them to stop taking?

As an aside, I’ve never Rx’d Mobic. Do you like it/how do patients do with it?

 

[Mandelin Rain]

It is somewhat amazing to me that people have chosen to take such a polarizing "black or white" view. We are living through a unique, exceptional time. Normal rules of conduct don't apply. On the one hand we have a global pandemic which is a significant threat to everyone but especially our patients who are frequently immunocompromised with a potentially poor reserve to fight off infections. On the other hand, we are delivering life saving treatments to the same patients.

We don't want to take the extreme position that all cancer treatments are cancelled for four weeks. We also don't to take the position to operate as normal without regard to COVID-19 transmission.

In the absence of either extreme position, compromise is required. What do you instead propose ASTRO suggest if an RO MD has to go into 14 day quarantine? Cancel all patients? Show up to work anyway and infect everyone?

I agree that ASTRO is on the wrong side of history with this supervision issue, but saying that "pulling it back during an unprecedented global pandemic is hypocrisy" is asinine.

Again. It’s now a dead issue.

We haven’t seen the American Society of Anesthesiologists requesting non opt out states to relax their supervision standards for CRNAs during surgery (nor will we [and they may actually be needed to fight COVID]), but if they did, they’d do so understanding that genie would never go back in the lamp.

 

[RickyScott]

As an aside, I’ve never Rx’d Mobic. Do you like it/how do patients do with it?

It’s once a day so convenient. Also combine it with narcotics for nsaid/ narcotic synergy. Like the way its name sounds as well.
Btw- just as with nsaids and ace, took parents off ace blockers today

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

 

[Mandelin Rain]

Is astro going to mandate that all unmanned clinics post a sign saying “Unsafe Treatment Within”?

If you honestly believe it’s unsafe, you NEED (as in ethical obligation) to inform your patients of such and offer “safer” alternatives.

 

[radoncgrad2019]

Is astro going to mandate that all unmanned clinics post a sign saying “Unsafe Treatment Within”?

If you honestly believe it’s unsafe, you NEED (as in ethical obligation) to inform your patients of such and offer “safer” alternatives.

There you go again! Bringing up safety.

That’s. Not. The. Point.

 

[medgator]

There you go again! Bringing up safety.

That’s. Not. The. Point.

Have you read the ASTRO letter to CMS protesting their supervision decision? Honest question

 

[Mandelin Rain]

I understand what ASTRO was trying to do. I understand it was entirely disingenuous. But... they chose “patient safety” as the justification for their argument.

Once you do that, there’s no going back. Are they now requesting patients be placed in (by their own words) “unsafe” situations? Or... are they admitting that their original argument was full of ****?

It’s obviously the latter.

I repeat. This is now a dead issue. Focus efforts on something else.

 

[scarbrtj]

It is somewhat amazing to me that people have chosen to take such a polarizing "black or white" view. We are living through a unique, exceptional time. Normal rules of conduct don't apply. On the one hand we have a global pandemic which is a significant threat to everyone but especially our patients who are frequently immunocompromised with a potentially poor reserve to fight off infections. On the other hand, we are delivering life saving treatments to the same patients.

We don't want to take the extreme position that all cancer treatments are cancelled for four weeks. We also don't to take the position to operate as normal without regard to COVID-19 transmission.

In the absence of either extreme position, compromise is required. What do you instead propose ASTRO suggest if an RO MD has to go into 14 day quarantine? Cancel all patients? Show up to work anyway and infect everyone?

I agree that ASTRO is on the wrong side of history with this supervision issue, but saying that "pulling it back during an unprecedented global pandemic is hypocrisy" is asinine.

It was ASTRO that always took the polarizing "black or white" view though. Nuance was 100% disallowed. Now it, general supervision, seems reasonable. What about a solo doc who gets sick in "normal times" and needs to be out for a day or two? Or someone has an emergency and has to go pick up the kids from school? Cancel all treatments then? The direct supervision hell-or-high-water mandate didn't allow for any of this, any leeway. To pull it back only during a global pandemic, now that the direct supervision mandate is inconvenient for everyone and not just a select few, is what I'm pointing out. Direct supervision for thee but not for me. That was bad policy regardless of global catastrophes.

Are you on that side or the Side of scarb who posts here on a daily basis that what we do doesn’t matter at all?

You're not being honest. No one's got "sides." I'm not rallying folks to a cause yeesh.

 

[deleted1002574]

As usual, purveyor of truth, vanquished of hypocrisy. Agree or disagree with The Scarb, he is exceedingly consistent. And, this is actually important when making important decisions.

GFunk, come on. Their whole premise has been safety. Safety, safety, safety. It hasn’t ever been about anything else. Read the stuff they put out. Anything other than that is completely an about-face.

Like the ABR, there is never nuance and there is never an explanation of reversals and NEVER an apology. Do you know people’s careers were ruined by the supervision laws? Do they get their money back? Their reputation back?

I FULLY agree with Astro’s request. I just think they are full of it.

It was ASTRO that always took the polarizing "black or white" view though. Nuance was 100% disallowed. Now it, general supervision, seems reasonable. What about a solo doc who gets sick in "normal times" and needs to be out for a day or two? Or someone has an emergency and has to go pick up the kids from school? Cancel all treatments then? The direct supervision hell-or-high-water mandate didn't allow for any of this, any leeway. To pull it back only during a global pandemic, now that the direct supervision mandate is inconvenient for everyone and not just a select few, is what I'm pointing out. Direct supervision for thee but not for me. That was bad policy regardless of global catastrophes.

You're not being honest. No one's got "sides." I'm not rallying folks to a cause yeesh.

 

[scarbrtj]

As usual, purveyor of truth, vanquished of hypocrisy. Agree or disagree with The Scarb, he is exceedingly consistent. And, this is actually important when making important decisions.

GFunk, come on. Their whole premise has been safety. Safety, safety, safety. It hasn’t ever been about anything else. Read the stuff they put out. Anything other than that is completely an about-face.

Like the ABR, there is never nuance and there is never an explanation of reversals and NEVER an apology. Do you know people’s careers were ruined by the supervision laws? Do they get their money back? Their reputation back?

I FULLY agree with Astro’s request. I just think they are full of it.

Every single... and I mean every single one... rad onc case along these lines has been about safety and supervision being completely dovetailed. Because without the safety element you can't "shock the conscience" as the lawyers say.

“Without a properly trained radiation oncologist supervising the delivery of radiation, there could be burns,” said John Yanchunis, an attorney with Morgan & Morgan who represented Montejo. “There could be treatment of a body part that doesn’t need radiation. A radiation oncologist goes through years of training on just that discipline.“

Despite all that one thinks one can glean from the Google, regular Columbos we are, experiences I witnessed in my neck of the woods were regarding personal supervision... not direct. Personal means "in the room with the patient," not just in the same building. This was back in the days when there was a "normal rule of conduct" that 1) no one knew about because it was unfathomable yet 2) mandated an MD had to stand at the treatment console all day long. Yeah, that existed. And ASTRO said it did. Not for CBCT but for plain kV films. So there's that, not for nothin'.

 

[ProtonElectronNeutron]

Anybody else dealing with administration who still has their head stuck in the sand pretending this isn't a big deal?
I am encountering a lot of resistance trying to take steps that mimic responses in other clinics because "we don't have a case here yet." At the same time, they admit there is not widespread testing and a backlog on available testing.

They are more worried about losing revenue from cancelled follow-ups (LOL!). My suggestion to minimize RTTs was met with "What are they going to do at home? We can't justify paying them if they are home doing nothing."

Great, lets keep everyone together in the office, that way everyone gets sick and the LINAC gets shut down. How much lost revenue is that? Not to mention, you know, the curative cancer patients metting out because they had a one month break in RT.

I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey wooo!!!!) outweighs the risk of infection.

I'm basically being looked at like I'm insane conspiracy theorist. Anyone else dealing with this level of simple thinking and focus on keeping business as usual because of $$$? Focus is on how we can bill for telephone calls. Seriously?

The "I-told-you-sos" are going to be bittersweet.

You are not alone!!

 

[radoncgrad2019]

‘I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey’


INSANITY

Idk where you live but those admins are going to get slapped in the face by reality very soon

 

[RickyScott]

Do we agree that once supervision requirements are lifted, it will be very hard to return to status quo? Go 6 month or year without them and it will be clear as day that they were bs to begin with.

 

[radoncgrad2019]

Do we agree that once supervision requirements are lifted, it will be very hard to return to status quo? Go 6 a year without them and it will be clear as day that they were bs to begin with.

Lot of things will be hard to go back to. standard frac, seeing follow up patients in person etc

 

[RickyScott]

Lot of things will be hard to go back to. standard frac, seeing follow up patients in person etc

So you agree job market will be beyond forever f—d?

 

[radoncgrad2019]

So you agree job market will be beyond forever f—d?

Yeah not forever but short term yeah

 

[medgator]

Yeah not forever but short term yeah

Try 5-10 years minimum, esp at the current level of residency slots

 

[RickyScott]

Yeah not forever but short term yeah

Why not forever? Changes in supervision and hypofrac permanently decrease demand in xrt. Changes in residency numbers next year, which likely won’t happen and be inadequate on the off chance that they did, would take a generation to have an impact.

 

[RickyScott]

And as things worsen and become more obvious,
the masks will come off and you will see just base greed on part of chairmen and twitterati like in pathology.

Again pathology is road map here. They reached a point where frking JAMA called them out and they still defend their actions

 

[KHE88]

Why not forever? Changes in supervision and hypofrac permanently decrease demand in xrt. Changes in residency numbers next year, which likely won’t happen and be inadequate on the off chance that they did, would take a generation to have an impact.

I'll be honest, I've started doing 30/5 breast since the virus became a threat, and if it works well, I'm not sure I'll go back. After the situation with admin and the fact that they fudge how my RVU bonus is calculated so that it's basically impossible to get, I have little incentive to go back. I'm trying to move to 5 fraction prostate as well.

It appears the programs don't care and took people out of the SOAP who were desperate to match in any field (lets be honest, anybody who applied for rad onc initially got it this year), and given all these people coming out in 5-6 years, the widespread adoption of extreme fractionation, and the loss of coverage requirements, I think not only will there be no jobs in cities, my impossible-to-recruit-for rural position where I can get away with telling admin they are stupid will suddenly have competing interests from rad onc grads willing to work anywhere for peanuts just trying to put food on the table.

The only hope was that there wasn't widespread interest in taking people out of the SOAP, which obviously didn't happen and should be shocking to exactly nobody. Now we will continue to see lots of desperate US, DO, Caribbean grads, FMGs going into this field willing to do anything for a paycheck making it impossible for the rest of us to negotiate fair deals.

This specialty is dead. PGY-2s should seriously consider retraining in a different field.

 

[RickyScott]

I'll be honest, I've started doing 30/5 breast since the virus became a threat, and if it works well, I'm not sure I'll go back. After the situation with admin and the fact that they fudge how my RVU bonus is calculated so that it's basically impossible to get, I have little incentive to go back. I'm trying to move to 5 fraction prostate as well.

It appears the programs don't care and took people out of the SOAP who were desperate to match in any field (lets be honest, anybody who applied for rad onc initially got it this year), and given all these people coming out in 5-6 years, the widespread adoption of extreme fractionation, and the loss of coverage requirements, I think not only will there be no jobs in cities, my impossible-to-recruit-for rural position where I can get away with telling admin they are stupid will suddenly have competing interests from rad onc grads willing to work anywhere for peanuts just trying to put food on the table.

The only hope was that there wasn't widespread interest in taking people out of the SOAP, which obviously didn't happen and should be shocking to exactly nobody. Now we will continue to see lots of desperate US, DO, Caribbean grads, FMGs going into this field willing to do anything for a paycheck making it impossible for the rest of us to negotiate fair deals.

This specialty is dead. PGY-2s should seriously consider retraining in a different field.

Historically, academics have always criticized those in private practice with being too motivated by money while ignoring that their own motivations often stem from prestige and recognition, not the pursuit of knowledge. Cutting residencies and residents is cutting prestige/cutting their audience.

 

[evilbooyaa]

Let's not turn this into another job market discussion. Focus on the here and now, please. Posts after this continuing off-topic discussion will be deleted and warnings handed out.

To @ROFallingDown @Mandelin Rain @scarbrtj we'll just have to agree to disagree on this topic. I'm pretty sure ASTRO could say "free-standing centers get paid more than hospitals" and you guys would still find something to complain about. Clearly I think the things being done in response to COVID-19 will be temporary. Telehealth follow-up is not going to 'become the future' - the modifiers for it getting paid will be temporary. Telehealth consults as are frequently being done will not be the future.

Some folks may feel more comfortable with more hypofractionated schemes yes, and may make individual changes to their practice that persist, but I do not foresee a systematic change in how radiation oncology is practiced BECAUSE of COVID-19, once this passes.

As always - please avoid being an ass to other folks even if you disagree with them. 1 post deleted, user warned.

 

[evilbooyaa]

‘I am being told that we can't ban visitors because the benefit of the psychological impact on the patients (patient satisfaction! Press Ganey’


INSANITY

Idk where you live but those admins are going to get slapped in the face by reality very soon

Agree - @KHE88 save those e-mails securely so that you can defend yourself against potential lawsuits in the future. And throw admin under the bus. 2 birds 1 stone.

 

[evilbooyaa]

It was ASTRO that always took the polarizing "black or white" view though. Nuance was 100% disallowed. Now it, general supervision, seems reasonable. What about a solo doc who gets sick in "normal times" and needs to be out for a day or two? Or someone has an emergency and has to go pick up the kids from school? Cancel all treatments then? The direct supervision hell-or-high-water mandate didn't allow for any of this, any leeway. To pull it back only during a global pandemic, now that the direct supervision mandate is inconvenient for everyone and not just a select few, is what I'm pointing out. Direct supervision for thee but not for me. That was bad policy regardless of global catastrophes.

Big difference between being out for a day or two and cancelling treatments for that long and cancelling treatments for 14 days. ASTRO is OK with the risk of the former, as one or 2 days treatment break will not negatively affect 99.9% of patients oncologic outcome. 14 days, not the same, and at this time, they are picking the lesser of two evils (in their mind).

 

[Mandelin Rain]

Big difference between being out for a day or two and cancelling treatments for that long and cancelling treatments for 14 days. ASTRO is OK with the risk of the former, as one or 2 days treatment break will not negatively affect 99.9% of patients oncologic outcome. 14 days, not the same, and at this time, they are picking the lesser of two evils (in their mind).

Like you said, agree to disagree.

"Patient Safety" is not really an area where you compromise. Either unstaffed treatments are unsafe or they're not. If they honestly believe that (hint: they don't, nor should you), they should be mobilizing resources to get patients transported to "safe" (read: staffed) clinics. If there is a run on surgeons, acute appys won't be done by surgical techs.

For whatever it's worth, CMS was unlikely to entertain ASTRO's position anyway. Now.... ASTRO has requested that the rule actually be EXPANDED for an indeterminate time. There isn't a snowball's chance in hell.

ASTRO, I beg you, move on to defending our reimbursement. APM is the next threat to the specialty. The supervision ship has sunk.

 

[scarbrtj]

Let's not turn this into another job market discussion. Focus on the here and now, please. Posts after this continuing off-topic discussion will be deleted and warnings handed out.

To @ROFallingDown @Mandelin Rain @scarbrtj we'll just have to agree to disagree on this topic. I'm pretty sure ASTRO could say "free-standing centers get paid more than hospitals" and you guys would still find something to complain about. Clearly I think the things being done in response to COVID-19 will be temporary. Telehealth follow-up is not going to 'become the future' - the modifiers for it getting paid will be temporary. Telehealth consults as are frequently being done will not be the future.

Some folks may feel more comfortable with more hypofractionated schemes yes, and may make individual changes to their practice that persist, but I do not foresee a systematic change in how radiation oncology is practiced BECAUSE of COVID-19, once this passes.

As always - please avoid being an ass to other folks even if you disagree with them. 1 post deleted, user warned.

Temporarily disagreeing. As your understanding grows more fulsome the disagreement will disappear Just like the direct supervision mandate disappeared... which I recall folks 'round here saying would never happen. But we were a supervision island in an ever more turbulent river so it wasn't hard to read the tea leaves. It's tough to predict the future, but if things are already happening (supervision relaxations, "telehealth," etc.) doesn't it become easier? No one can be sure anything currently underway today will be temporary or that previously reliable things will continue to exist. Telehealth and general supervision streamlines healthcare delivery in positive ways. CMS told ASTRO general supervision never damaged a single DNA base pair as far as they could tell (much to ASTRO's chagrin). From my limited experience thus far, telehealth seems to be a net positive too.

I no longer have to ask "use your imagination." Now I can say use your eyes.

 

[Mandelin Rain]

Temporarily disagreeing. As your understanding grows more fulsome the disagreement will disappear Just like the direct supervision mandate disappeared... which I recall folks 'round here saying would never happen.

They were literally ardently arguing that until the moment the announcement was made.

One of my favorite threads ever here.

Poster 1: An NP can handle all of the daily issues in a rad onc clinic.

Poster 2: You're self hating. There's no way an NP can supervise. I trained for 4 years to sit at my desk.

-15 minutes later-

CMS: The janitor can supervise. Or not. We don't care.