Discussion about this post

User's avatar
Aston's avatar

Lurking SDN brought me here as I can no longer use that forum due to a few toxic posters that dominate the conversation. I appreciate your substack and commentary with an alternative to share thoughts in our field.

Unpopular opinion: Practicing medicine through a screen on wheels cheapens our profession. I support eliminating the E&M codes for telehealth "visits." I have thoughts on WFH in general, but won't go there. There's a sad reality about the real reason why so many want to cling on to the temporary covid measures (which were widely regarded to be extreme measures at the time in a time of emergency) in work, education, healthcare, social freedoms, etc and drag them out for as long as possible if not completely normalize them.

We already have this problem with scope creep of midlevels and the now prevalent use of the term "provider" instead of physician. Amazon is providing medical care now. You can get basically anything you want prescribed online by a "provider" that has never even met you. The QuikTrip gas stations in the midwest literally have their own "QuikMed" doctors offices with MDs wearing gas station polos and name badges. When is it enough?

Of course, a 77427 is not an E&M code. There is no documentation of a physical exam. There are plenty of rad onc specific codes that do not need in-person interaction (77014... my precious). This is a gray area and general supervision is the right answer. In person is always preferable. However, we all know that many of these visits are completely pointless from a purely medical standpoint. Other ones are critical.

There was a comment on SDN I agree with regarding locums in rural areas. This is a huge problem in our field and I would love to see you discuss it more in depth. I have spent most of my career in rural centers so am very familiar with it. I have seen it all: legally blind rad oncs who require a driver, rad oncs with parkinsons that take 3 minutes to shuffle to the machine to check films, felons, bottles of jack daniels in the file cabinet, pathologic personality disorders, dosimetrists seeing patients with a white coat on and drawing target volumes for locums to sign off on, sexual harrassment, and of course the ubiquitous "never got around to taking my boards because I was too busy working." So many rad oncs never want to fully retire, so we end up with these 70, 80, and 90+ year olds (seen it) continuing to take these short term assignments at daily rates far less than the median full-time employed daily compensation (a totally unique feature of rad onc). The only winner in this scenario is the locums agency middleman. This results in flat out bad care. There are so many rural hospitals that refuse to properly compensate to recruit and retain in an undesirable location (75%-tile + MGMA, <5 day workweek, 8+ weeks PTO, technical profit sharing/joint venture, 1099/PSA. etc) and would rather overpay a locums agency than deviate even a single word in a contract from the standard W2 median MGMA, RVU-capped, 5 day week, 6 weeks PTO, press ganey quality "bonus" job offered in metro areas. These hospitals get away with it because the 70+ yo locums pool with 8 figures in the bank but still working for $1600/day are enabling them to do so. Doing locums is generally a backup option for people who need to make a living in a pinch. Anybody considering rad onc as a career needs to understand that their backup option in this field is going to require traveling far away and competing for bids at $1600/day or less from people who don't need the money.

Expand full comment
NopeNoWay's avatar

Bridge Oncology has entered the chat.

Expand full comment

No posts