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  • Covering for Rad Onc at our hospital

    Posted by danielle.nagel7_998 on August 3, 2023 at 10:02 am

    Has anyone else ever encountered this?  We were asked by our hospital administration to cover the radiology oncology department when rad onc cannot be physically present.  This would entail seeing a patient if they are sick or have symptoms and deciding if radiation should or should not be cancelled after the rad onc doctor confirms the need for cancellation from another site.  I find this request to be unusual.  Apparently oncologists or interns would not suffice and it needs to be radiology.

    mariacardei7_785 replied 1 year, 2 months ago 30 Members · 38 Replies
  • 38 Replies
  • reza800p_368

    Member
    August 3, 2023 at 10:38 am

    Talk to your IRs.

    IR has become a clinical field and may be able to help

  • lisbef3_453

    Member
    August 3, 2023 at 10:58 am

    Quote from miller24

    Has anyone else ever encountered this?   I find this request to be unusual. 

    Never.  It is.
    If something goes south with a patient they will find a line of busses to throw you under.

    • lisa.kipp_631

      Member
      August 3, 2023 at 11:33 am

      This is not a normal or appropriate suggestion afaik. You should ask why it has to be radiology, possibly some regulation. Regardless there is a large chasm between radiology and rad onc that admin probably doesnt appreciate. They just see a similar name and cost savings. Please update, Im curious how this situation arose.

      • smfst7_929

        Member
        August 3, 2023 at 11:41 am

        haha. this hospital is just trying to push it off onto you on the cheap.  The correct and proper thing for them to do is hire locums for any weeks that the radonc is on vacation etc.  And any afterhours stuff either falls on the existing radonc or on his/her locums replacement.
         
        Do not accept this under any circumstances in my opinion. It does not even seem ethical for radiology to be making decisions like that. I would play that tactic if you want to get them to drop it. The buzzwords of “patient care”, “outside scope of practice” “ethical and medicolegal issues” should suffice.
         
        I wouldn’t do this and I don’t care if they pay me $1000 an hour. I’m not putting myself in a situation outside of my scope of practice for money.  

  • JohnnyFever

    Member
    August 3, 2023 at 11:46 am

    Not a reasonable request.   Hard no

    • Unknown Member

      Deleted User
      August 3, 2023 at 11:48 am

      LOL
       
      That’s like saying that since “Neurologist” sounds like “Urologist,” one can cover for another. 

      • danielle.nagel7_998

        Member
        August 3, 2023 at 11:56 am

        They want us to supervise their deparmtment when they are gone on vacation or working at different sites.  Below are the expectations.  Rad onc and the hospital also do not think we should be payed for this.  I sensed this was an inappropriate request, but always want to check to make sure.  Thank you for all the responses.
         

        Other than being available for direct supervision for all treatments, the actual expertise and decision making on your part if you are called to the machine is not challenging.  
        [ul][*]If you are called to a machine during treatment, the straight-forward decision that is yours is whether to proceed with treatment or hold it that day.  You don’t have to change the setup or treatment (you shouldn’t be doing that), you don’t have to know the physics, you don’t have to know how to operate the machine.  You just have to say yes/no to the simple question of whether to proceed as planned, or not.[*]In order to decide whether to proceed, you just keep in mind that a plan has been carefully created based on the patient’s positioning and anatomy at the time of simulation–if the plan can’t be executed for any reason that day, you make the call to hold treatment.  That’s it.[*]Some examples of why a treatment should be held include  [ul][*]a patient’s change in medical status that prevent them from reclining into planned position due to pain or shortness of breath[*]a patient’s change of mind about getting treatment at all, or desire to enter Hospice[*]changes in anatomy that have made the plan no longer accurate.  Weight loss of a few pounds and variations of a 5-10 mm in setup are built into the treatment planning typically, and are acceptable.  But occasionally there is a drained seroma, a new hematoma, an unexpected surgical procedure, or other change that will require replanning. Then hold treatment. [/ul] [*]The therapists and nurses in the department are very experienced and know that you don’t have a radiation background. They will undoubtedly have opinions/advice on what to do.  You can take it or leave it based on your best judgment. [/ul]
         

        • mircea.cg_544

          Member
          August 3, 2023 at 12:17 pm

          Hahahahahayou are not credentialed in rad onc = no.

        • nicolasvg.1003

          Member
          August 3, 2023 at 12:18 pm

           
          Rad Onc is a different field. 
           
          Maybe we should merge back however as Rad Onc is struggling as field currently. 
           
          Dx Rad/Rad Onc/Nuc med/IR all offered by one group would be formidable. 

        • alex.nieto_484

          Member
          August 3, 2023 at 12:19 pm

          Quote from miller24

          They want us to supervise their deparmtment when they are gone on vacation or working at different sites.  Below are the expectations.  Rad onc and the hospital also do not think we should be payed for this.  I sensed this was an inappropriate request, but always want to check to make sure.  Thank you for all the responses.

          Other than being available for direct supervision for all treatments, the actual expertise and decision making on your part if you are called to the machine is not challenging.  
          [ul][*]If you are called to a machine during treatment, the straight-forward decision that is yours is whether to proceed with treatment or hold it that day.  You don’t have to change the setup or treatment (you shouldn’t be doing that), you don’t have to know the physics, you don’t have to know how to operate the machine.  You just have to say yes/no to the simple question of whether to proceed as planned, or not.[*]In order to decide whether to proceed, you just keep in mind that a plan has been carefully created based on the patient’s positioning and anatomy at the time of simulation–if the plan can’t be executed for any reason that day, you make the call to hold treatment.  That’s it.[*]Some examples of why a treatment should be held include  [ul][*]a patient’s change in medical status that prevent them from reclining into planned position due to pain or shortness of breath[*]a patient’s change of mind about getting treatment at all, or desire to enter Hospice[*]changes in anatomy that have made the plan no longer accurate.  Weight loss of a few pounds and variations of a 5-10 mm in setup are built into the treatment planning typically, and are acceptable.  But occasionally there is a drained seroma, a new hematoma, an unexpected surgical procedure, or other change that will require replanning. Then hold treatment. [/ul] [*]The therapists and nurses in the department are very experienced and know that you don’t have a radiation background. They will undoubtedly have opinions/advice on what to do.  You can take it or leave it based on your best judgment. [/ul]

           
          What the actual f*ck. That is an insane request from admin.

          • mircea.cg_544

            Member
            August 3, 2023 at 12:41 pm

            Sounds like a military hospital with a nurse hospital commander.

            • mircea.cg_544

              Member
              August 3, 2023 at 12:43 pm

              Although I think it would be easy enoughjust cancel all patients. Problem solved

              • radiologistkahraman_799

                Member
                August 3, 2023 at 12:53 pm

                “never let a crisis go to waste”.  Use this for leverage

                • mwakamiya

                  Member
                  August 3, 2023 at 1:29 pm

                  This administrator is dumb AND dangerous — AND he/she does not realize it.  Radiology or Radiology – IR are not RadOnc. That is like the general surgeon being asked to cover for the neurosurgeon or viceversa (they are both surgeons and both use the ORs right?).

                  • Unknown Member

                    Deleted User
                    August 3, 2023 at 1:35 pm

                    Seriously one of the most ridiculous requests Ive ever heard. Your admin is completely inept for asking and pardon my frankness but you also should know better and not have to come onto a forum to get advice on this.

                    • danielle.nagel7_998

                      Member
                      August 3, 2023 at 1:45 pm

                      I appreciate your frankness and understand your sentiment.  We already gave a hard unanimous no.  We then received a letter from our CEO stating that we should understand team dynamics, etc.  He even used examples of other doctors covering contrast at outside sites for radiologists as a counterexample.  If this goes any further (which it shouldn’t), it is useful for me to confirm that no one else provides a service like this.

                • rgiles912_432

                  Member
                  August 3, 2023 at 1:34 pm

                  Those poor combined Diagnostic and therapeutic Board certified Radiologists in their 80’s and older are all struggling now to answer this hospital administrator’s call. All of my old attendings from the late 1980’s would have jump at this request.

  • 22002469

    Member
    August 3, 2023 at 1:49 pm

    Pure comedy.
     
    Definitely a “we don’t want to bump up our locums rates, let’s start thinking outside the box” idea from a clueless admin.
     
    Maybe they sent a similar request to Rad Onc to read radiology cases when you guys are on vacation. 
     

    • mircea.cg_544

      Member
      August 3, 2023 at 2:30 pm

      Tell the ceo that you/dept chief are happy to go with him/her/both (dont want to offend Chiro) to patient safety hospital meeting and a credentials committee meeting to further discuss. This is not about teamwork as contrast is (many physicians are trained to treat allergic rxns vs only rad onc is trained to cover rad onc).

      You could also grab the rad oncs by the balls and tell them you will be calling the state licensing board and the ABR to discuss and get further opinions..

      • mircea.cg_544

        Member
        August 3, 2023 at 2:31 pm

        Are you group president?

        • mario.mtz30_447

          Member
          August 3, 2023 at 2:45 pm

          Youre an engineer, cant you drive this train?

  • ruszja

    Member
    August 3, 2023 at 2:50 pm

    Quote from miller24

    Has anyone else ever encountered this?  We were asked by our hospital administration to cover the radiology oncology department when rad onc cannot be physically present.  This would entail seeing a patient if they are sick or have symptoms and deciding if radiation should or should not be cancelled after the rad onc doctor confirms the need for cancellation from another site.  I find this request to be unusual.  Apparently oncologists or interns would not suffice and it needs to be radiology.

    Nuts.

    • mircea.cg_544

      Member
      August 3, 2023 at 2:59 pm

      Gen McAuliffe.love it.

      • btomba_77

        Member
        August 3, 2023 at 3:04 pm

        “Dear administrator:
         
        Diagnostic radiology and radiation oncology are two different specialties.
         
        No.
         
        Go find yourself some rad onc locums.
         
        Signed,
         
        radiology”

        • Unknown Member

          Deleted User
          August 3, 2023 at 3:51 pm

          Inform them that your medical indemnity provider will not cover you for work outside your scope of practice. That should put an end to it quickly and easily.

          • ebshanon

            Member
            August 3, 2023 at 4:06 pm

            Do you work in the boonies?  This is one of the most outlandish requests I ever heard coming from a hospital admin.  Please post what the CEO of your hospital makes to come up with ideas like this. 
             
            10 bucks they turn to a midlevel to staff this dumpster fire rather than hiring proper rad onc locums

            • abananarest

              Member
              August 3, 2023 at 5:22 pm

              I honestly thought this was a troll post

  • aldoctc

    Member
    August 3, 2023 at 7:01 pm

    “I prefer not to.” has been my knee jerk reaction to inane administration requests for years.

    • romacs8ae

      Member
      August 3, 2023 at 9:08 pm

      tell them to hire a licensed PA for pennnies to supervise.  Cheaper then locums and the hospital can provide the PA the malpractice insurance.
      See if they bite.
       

      • amyelizabethbarrett28_711

        Member
        August 3, 2023 at 10:32 pm

        I thought this was a joke also.

        Its like asking the ER doc to do trauma surgery when the trauma surgeon is off

        • ruszja

          Member
          August 4, 2023 at 3:10 am

          This is not about you making any decisions about therapy. This is about listing someone as ‘supervising physician’ for the department. It’s all good until someone gets fried with your name on the chart.

          I don’t think it’s a troll post. I can totally see how this can happen. There is some crazy stuff out there.

          • vanevela49

            Member
            August 4, 2023 at 3:23 am

            Better to have the hospitalists cover this.

            • gabriella.ruffato.ext_635

              Member
              August 5, 2023 at 1:50 pm

              Back in the days of pneumoencephalography diagnostic and therapy were part of radiology training.
              This is totally insane in 2023!  Do I smell a troll?

              • benoit.elens

                Member
                August 5, 2023 at 2:21 pm

                The bigger problem here is the complete lack of thought about the patients.  Imagine if you were one of them and having radiation treatments and decision-making directed by a radiologist or even hosptialist.

                • g.giancaspro_108

                  Member
                  August 5, 2023 at 3:08 pm

                  Health care workers (you) and patients are the only people that give any thought to the patients.
                  Hospital administrators do not care about patients beyond their ability to generate funds for the taking.
                   
                   

                  Quote from ChuckI

                  The bigger problem here is the complete lack of thought about the patients.  Imagine if you were one of them and having radiation treatments and decision-making directed by a radiologist or even hosptialist.

                  • sarah.r.huntington

                    Member
                    August 5, 2023 at 3:34 pm

                    Hell no. You are on the hook for liability during these treatments.
                     
                    It’s frankly an insult that they aren’t even willing to pay you to as enticement (but even then you should decline).

                    • DanielQuilli

                      Member
                      August 5, 2023 at 4:41 pm

                      Excellent example of a case where No. is a complete sentence.

                    • mariacardei7_785

                      Member
                      August 7, 2023 at 8:19 pm

                      Involve TJC, CMS, State Board, Credentially Committee AND Hospital Risk Management