A Modest Proposal
By Michael J. Katin, MD
We have now had additional time to absorb the effects of the events of the previous year and it is obvious that life as we know will not be returning in its familiar form. This includes changes such as inconvenience from enhanced security, the potential for religious and ethnic discrimination, or even fear of the mail. Unfortunately, the most signficant is the potential for disruption of the practice of Radiation Oncology.
The December, 2001, column lamented the recent decrement in reimbursement
for nearly all of our procedures, with some hope that the money saved by
not being given to us goes to a worthy cause, such as the 37th decontamination
of the Hart
Senate Office Building. Unfortunately, there are even more important
trends evolving that could require a change in practice as we know it.
As of now there are far too few Radiation Therapists and it is easy to
envision that the increased desire to serve our country, combined with the
really neat jobs that will become increasingly available in the military,
will draw off many young people who otherwise might decide to make a career
in this field. This trend might be set back temporarily by the film, Black
Hawk Down, but certainly the ranks of Radiation Therapists will not
be increasing anytime soon.
It is also inevitable that government regulatory forces will be in hog
heaven. Considering that soon you will need to undergo a cavity search
to be allowed to take a flight from Dayton to St. Louis, few people will
want to seem uncooperative with our public servants in any way whatever.
This may be the time that the OIG can become more rigid in the interpretation
of guidelines that so far have been generally overlooked, such as the need
for physician presence at the time of treatment.
There is an obvious solution that would reduce expenses, make up for the shortage of Radiation Therapists, and fulfill the physician presence requirement, all at the same time.
Starting as soon as possible, the actual treatments need to be administered
by Radiation Oncologists. It would be a challenge, but not an insurmountable
one, to get physicians to be able to get a linear accelerator to do its
thing when they might have trouble programming a VCR, but it can be done.
It would also be very difficult to claim that a patient was not seen frequently
enough by a physician when, in fact, that was the person who just spent
35 minutes every day trying to set up that patient for palliative AP-PA
fields. In fact, the patients would probably run out of things to talk about
with the physician.
The number of fields per treatment would probably decrease markedly as well as the number of fractions. Repeat simulations would probably decrease, as would be number of block trims.
This would seem to be one of a very small number of win-win
situations that we would ever see in our lifetime. In this column, we will
continue to explore further ways to keep our specialty solvent.
Next month: 10 things you can do with used bolus material.