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I’m definitely getting Cartel vibes here.
I’m definitely getting Cartel vibes here.
Look.
You didn't hear it from me.
But the SCAROP report is, in fact, the most obvious case of antitrust that I've seen in medicine.
Submit a Healthcare Competition Complaint
www.justice.gov
The government loves to hear about these things.
(from multiple people)
Obviously, I'm 90% with you on this statement...View attachment 385705
When the great unemployment of RadOncs happens I hope it's understood: RadOncs promoted unfettered expansion of residency positions, RadOncs promoted virtual supervision, RadOncs ran bad noninferiority trials, RadOncs thought the business men would let them profit with them, RadOncs did this to ourselves.
For those who don't want to read the whole paper:Obviously, I'm 90% with you on this statement...
But Mayo can literally reach into far-flung communities and pull patients into their machine for proton treatments, regardless of supervision laws, they told us themselves:
Mayo and the SCAROP Institutions:
We will use our residents to conduct telehealth consults because you saw our advertisements on the internet, and convince you to fly to Rochester (or elsewhere) because it's sooooooooooooo easy to do our 5 fraction proton treatments! We'll connect you with our travel agents, standing by, RIGHT NOW!
Meanwhile...LOOK OVER THERE! IT'S THE EVILS OF VIRTUAL SUPERVISION! GO GET THAT JORDAN GUY! THE DEVIL!
WellPS no one cares about that guy. There are real threats out there. Tigers in the tall grass, they aren't the ones being loud replying to every post on twitter .
For those who don't want to read the whole paper:
View attachment 385707
IPP = in person patients, VP = virtual patients
(in the context of E&M virtual, not supervision virtual)
Poach patient studies are effectively being performed by RadOncs.
CorrectThat publication should be an alarm for everyone here and for any RadOncs that read it. Blue prints are being shown of how to get patients to come get more expensive treatments without proven benefit. It should be worrisome to everyone that VIRTUAL PATIENTS ARE 2.5 AND 2.2 TIMES MORE LIKELY TO GET PROTON THERAPY BECAUSE THEY ARE VIRTUAL VISITS.
I am certain rad oncs as a group are not actually as smart as they think they are because I know a significant proportion have not, and never will, sussed any of the aboveCorrect
And to be clear
THIS IS NOT VIRTUAL SUPERVISION
NOT
VIRTUAL SUPERVISION
THIS IS NOT VIRTUAL SUPERVISION
This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.
Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?
An existing incumbent.
Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.
Want to do a lung cancer screening outreach event?
It better be outside normal business hours!
Want to go have lunch with a referring?
Oh man, hope your therapists and patients are willing to move around the schedule.
Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.
And publish about it, no less!
This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".
I would....again...just highlight the anonymous antitrust complaint link posted above...
i watched the town hall.Correct
And to be clear
THIS IS NOT VIRTUAL SUPERVISION
NOT
VIRTUAL SUPERVISION
THIS IS NOT VIRTUAL SUPERVISION
This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.
Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?
An existing incumbent.
Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.
Want to do a lung cancer screening outreach event?
It better be outside normal business hours!
Want to go have lunch with a referring?
Oh man, hope your therapists and patients are willing to move around the schedule.
Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.
And publish about it, no less!
This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".
I would....again...just highlight the anonymous antitrust complaint link posted above...
For those chairs to be off, somebody else has to be present to see patients.i watched the town hall.
Dr. Michalski thinks that physicians should be in clinic nearly all the time (maybe have an exemption 1 day every 2 weeks).
In my experience more senior faculty at my residency training institution were in clinic like 2 days a week. The rest of the days were academic and post-COVID, many were at home.
I highly doubt that the ASTRO chair is in clinic 9 days out of 10. But maybe some from WashU can correct me.
Of coursei watched the town hall.
Dr. Michalski thinks that physicians should be in clinic nearly all the time (maybe have an exemption 1 day every 2 weeks).
In my experience more senior faculty at my residency training institution were in clinic like 2 days a week. The rest of the days were academic and post-COVID, many were at home.
I highly doubt that the ASTRO chair is in clinic 9 days out of 10. But maybe some from WashU can correct me.
So many other specialties have real leadership (think gu, rads, derm, plastics).Of course
This is do as I say not as I do
It’s really not far off from a well fed person telling the hungry they should eat more food, an employed person telling an unemployed person they should have a job, or a person who can walk telling a paraplegic they need to get their legs moving
One of your all time great posts...and there are a lot. Make no mistake-the attack on virtual supervision is an attack on private practice. The salary scale is already tipped towards employed positions, but these arrogant pricks like Sameer and Jeff could never humble themselves to allow their docs to run clinics on their own terms. Yes, there are shady private practices, but there are still some good ones that offer their docs tremendous flexibility and autonomy...and the academics still can't compete with that. This is all about imposing burdensome regulations on private docs to squeeze them out of practice.Correct
And to be clear
THIS IS NOT VIRTUAL SUPERVISION
NOT
VIRTUAL SUPERVISION
THIS IS NOT VIRTUAL SUPERVISION
This is exclusively a telehealth consult. The thing that is already permanent. The thing that ASTRO has never said a word about.
Direct Supervision, the classic edition - it's like a Certificate of Need law. Who has the money and power to get a certificate of need?
An existing incumbent.
Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.
Want to do a lung cancer screening outreach event?
It better be outside normal business hours!
Want to go have lunch with a referring?
Oh man, hope your therapists and patients are willing to move around the schedule.
Meanwhile, Mayo is spending tens of millions of dollars on advertising to steal your patients right from under your nose.
And publish about it, no less!
This is the literal stayed goal of ROCR too. As in, Jeff Michalski literally said with ROCR and 5 fraction treatments, it's "easier for patients to travel away from their homes".
I would....again...just highlight the anonymous antitrust complaint link posted above...
I'm not sure here. There is no doubt that any supervision requirements at present mean nothing for places like MAYO. Their scale and staffing make the most stringent requirements moot.Mayo would LOVE for Direct Supervision to come back. It would lock the little community RadOnc into their single little vault.
Is there a notable training program out there that takes pride in producing community docs? Serious question. Mine sure as hell didn't.Sameer and Jeff could never humble themselves to allow their docs to run clinics on their own terms
Could work either way. Consolidation will come at the hospital level (although history shows that radonc departments may be among the first integrated in a merger). Owning or at least having a very lucrative PSA with a distant community hospital, which you staff remotely regarding multiple specialty services, is happening now and will benefit from virtual direct in terms of staffing radonc and institutional bottom line.to squeeze them out of practice.
Obviously, I'm 90% with you on this statement...
But Mayo can literally reach into far-flung communities and pull patients into their machine for proton treatments, regardless of supervision laws, they told us themselves:
Mayo and the SCAROP Institutions:
We will use our residents to conduct telehealth consults because you saw our advertisements on the internet, and convince you to fly to Rochester (or elsewhere) because it's sooooooooooooo easy to do our 5 fraction proton treatments! We'll connect you with our travel agents, standing by, RIGHT NOW!
Meanwhile...LOOK OVER THERE! IT'S THE EVILS OF VIRTUAL SUPERVISION! GO GET THAT JORDAN GUY! THE DEVIL!
Interesting take. Of course IMGs have been the backbone of much of community medicine for 40 years. They are certainly the backbone of medical oncology in the community presently.
Yeah...I can only speak from my point of view.Academia is not underserved
But many locations are underserved (and really when I say underserved, what I really mean is 'hard to recruit US MDs to'.). Some of these locations have 'academic' name hospitals, some standard non-academic name hospitals, and rarer, free-standing. in rad onc and med onc. they go hand in hand.
Time in advance will be typical for J1 candidates. There is a clock ticking and a lot of work to be done. Early commitment is necessary. A model where an institution puts the work in to secure a J1 slot, pays legal counsel for services and lets candidates commit in March of their graduating year is not tenable (particularly for smaller places).Agree there is no doubt that visa concerns drive people into certain kinds of jobs and locations. The one I am aware of recently is someone signing a job more than a year in advance to secure their protected status. It wasn’t an academic name hospital, but we should not think that academic names have a monopoly on large systems. There are many non academic corporations that benefit from the same advantages.
Everyone I've referenced previously is a boomer and I imagine the majority of chairs causing a lot of problems for the specialty are Boomer.the youngest boomer is 60 (ends in 1964). there are def some chairs that are still boomers (oldest one is Ralph who is probably bordering on the greatest generation rather than boomer) but I think a lot of chairs these days are Gen X
I don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.
Grifters gonna griftI don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.
I don’t understand the relationship between DEI and hating Jews.I don't understand the relationship between IMG advocacy and DEI. DEI lobby seems to put their hands in everything they pass by.
To non oncologists, full body mri and protons for that matter sounds like a great business plan
For those who don't want to read the whole paper:
View attachment 385707
IPP = in person patients, VP = virtual patients
(in the context of E&M virtual, not supervision virtual)
GU Malignancies accounted for the largest absolute number of VP treatments
I presume all/mostly prostates
What a poor use of protons.
Protons for CNS in anything besides the non-reirradiation setting? Do GBM outcomes matter whether given by photons or protons???
Meningioma I could potentially see a use for
Craniopharyngiomas/pituitary adenomas would be great if it wasn't for all that darn inability to model the proton accurately
Brainstem gliomas/meningiomas would be great if it wasn't for all that DARN BRAINSTEM NECROSIS (due to inability to model the proton accurately)
How do you know RT won't double OS?This will end up reducing my post-op panc volume to zero. Oops, I mean this won't change my post-op panc volume.
Treating so much myself these daysBeen saying this for while - when are we going to do away with a gi section for radiation boards?
Been saying this for while - when are we going to do away with a gi section for radiation boards?
Lymphoma needs to go away way before GI imoAs soon as they do away with the lymphoma section.
Because it's in the "oral abstracts session".why are you guys all assuming it is negative? let's wait.
For a long follow-up? Oh, wait. It's pancreas.16 years since inception
Wtf have they been waiting for