out of the basement / radiation medicine

For years, the "white whale" of Medicare reimbursement has created many "Captain Ahab" impressions among policymakers and professional societies.

In a movie script written in the style of George A. Romero, the Radiation Oncology Case Rate Program (ROCR) was unexpectedly published on June 28th, generating significant buzz among the RadOnc (RadMed) community.

The model projects $212 million dollars in savings for CMS over a 5-year period but...how? On this "hot take" episode of OOTB, we discuss how one private consulting firm uses the data from another private consulting firm to make some...interesting...economic forecasts.

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Who knew that using liquid radiation could be so complicated and confusing?

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What does it mean to talk about "on beam" numbers in a Radiation Oncology clinic?

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What has prevented open and in-depth analysis of the RadOnc workforce over the last decade?

To paraphrase Fight Club - you are not your job.

Does the 2023 ASTRO/HMA study make sense in terms of the existing data? Do we even know how many linear accelerators there are in America?

Spoiler alert: we do (sort of) know!

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On a recent, LIVE episode of The Accelerators, the question of "what happened to RadOnc" was answered, in part, by referencing the unusually high failure rate of board certification exams. It has now been 5 years since those events, and medical students/junior residents are unlikely to know "the story". This is my version of a documentary/editorial on "the 2018 exams", which starts with a 2012 CNN report, exam restructuring, NRMP reports, ARRO letters, PRO papers - all of it. Though impossible for me to tell the story utterly objectively, I have tried to include all major milestones should folks feel inclined to "check my sources".

Then, in a twist worthy of M. Night Shyamalan, I discuss why hitting this "rock bottom" has brought out some of the most inspiring people our field has, and why I think there's a bright light at the end of this tunnel.

It's easy to lose hope, but remember the ACROpolis and...Rome wasn't built in a day.

***ERRATA*** I realized after uploading this that the "trending downward" paper was published prior to the 2018 exams. I'll leave this as-is, because my error demonstrates the purpose of this project.

Relevant papers:

https://doi.org/10.1148/radiol.12120251

https://doi.org/10.1016/j.prro.2020.04.010

https://doi.org/10.1016/j.prro.2018.03.005

https://doi.org/10.1016/j.ijrobp.2018.12.046

http://dx.doi.org/10.1016/j.ijrobp.2013.05.027

https://doi.org/10.1016/j.prro.2018.04.005

https://doi.org/10.1016/j.prro.2018.04.005

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Twitter: @drbeckta

Crawling Out of the Basement for the first time in 2023 with The Accelerators, The Todd, and Birkenstock Beckta (now based on the set of Super Troopers, looking for Bernie's mittens).

The ASTRO Workforce Taskforce paper, the final version, dropped last Wednesday. In terms of "ambitious projects", forecasting supply and demand is akin to eating not one but TWO elephants. We discuss almost exclusively the concept of supply, hiring consultants, and the folly of forecasting the past instead of just, you know, using data.

Join me as I meld prior ASTRO abstracts, Red Journal publications, CMS Medicare Part B data, and phone pics of slides live-Tweeted from San Antonio...to discuss the job market. No, I don't have "regular" hobbies, why do you ask? 

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My Twitter feed is an explosion of posts about airports and hotels and registrations and...it's that time of year again. The ASTRO conference. Which means senior residents gearing up for the legendary "ASTRO Job Interview" marathon. Employers are gearing up for new grad prospecting and "the arbitrage of talent".

This episode is 30 minutes of advice I wish I could give to my younger self on the first day of med school. 15 years of painful lessons. One podcast.

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Twitter: @drbeckta

You're a doctor, not a writer! Stop pretending your consult note needs to cite the PACIFIC trial and join me to talk about Evaluation and Management CPT codes, wRVUs, time-based billing, and how I write my notes: BEAM-IT.

The most innovative acronym in medicine.

Here are the slides/figures from the episode

https://figshare.com/articles/figure/BEAM-IT/21334053?file=37860630

https://figshare.com/articles/figure/BEAM-IT/21334053?file=37860627

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General societal opinion says doctors + $$ = bad. This attitude means non-clinicians command American healthcare.

Ignoring the business of medicine doesn't mean we’ve taken the ethical highroad.

It means we have surrendered an essential component of caring for the sick.

I want to learn more about the nuts and bolts of the Healthcare Machine. Do you?

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Twitter: @drbeckta