Tom Mullen

SC*31+MA*1+WA*4+OR*5+…. Husband of @TheCircusDoc and father of beta_adventure.dog. I also take care of the best people in the world and kill cancer when I can

[Tom Mullen @mottress]

@SprakerMDPhD Depends on how bad my biopsy experience was, how old I am, and if getting SBRT I would be more in favor

[Jason Beckta @drbeckta]

Alright let's add this one to the timeline:

1) Anti-Kickback Statute gets added to the Social Security Act in 1972 to prohibit anyone "knowingly and willfully receiving or paying anything of value to influence the referral of federal healthcare program business".

Well...you know, any individual, especially physicians, can't pay to influence referrals for federal healthcare business.

But let's say you're one of the PPS-exempt cancer hospitals. Let's say...you're based in Texas. Let's say you spend...at least $14 million per year on advertising (that was in 2016, so, you know - inflation and stuff). Perhaps you have this cute little graphic where you cross out the word "cancer" and slap that shit on billboards, and magazines, and newspapers, and all over the internet.

As long as your army of lawyers makes sure you're in a safe harbor category, well, all the matters is you're following the letter of the law - no one cares about the spirit!

2) The Stark Law Statute became effective in January 1995 and prohibits healthcare service providers from referring Medicare and Medicaid patients for specific services to entities with which they have a “financial relationship".

Because, you know, according to the AHA, we need to protect patients from the evil physicians. Specifically on their Fact Sheet for their Position Statement advocating for strong laws prohibiting physician self-referral to new physician-owned hospitals, the AHA justifies this position with:

- Physician-owned hospitals provide limited or no emergency services, relying instead on publicly funded 911 services when their patients need emergency care.

- Physician self-referral leads to greater utilization of services and higher costs.

- Physician-owned hospitals tend to cherry-pick the most profitable patients, jeopardizing communities’ access to full-service care.

Now, of course, OF COURSE, hospitals owned and operated exclusively by people who went to business school are nothing but altruistic angels, running as lean as humanly possible to provide the best care possible to any and every patient who comes through the door!

Excuse me while I go grab some hospital CEO compensation data to prove my point, because I'm sure they peg their total comp to the average American and...oh. Oh wait. Oh no. Oh, they don't do that at all. Oh...oh no.

3) Speaking of physician-owned hospitals, Section 6001 of the Affordable Care Act banned new physician-owned hospitals when it was passed in 2010. OBVIOUSLY, the kind-hearted politicians and philanthropic lobbyists were SO CONCERNED that doctors who had a financial stake in a hospital would simply refer the most financially lucrative patients to their own facilities, threatening patient safety and driving up cost at the same time.

Now, when these nasty, terrifying, horrific physician-owned hospitals were actually studied...they offered patients comparable or lower costs and higher quality care compared to other hospitals, patients with serious conditions experienced lower in-hospital and/or 30-day mortality rates, and it was not possible to "identify a service market where the data on quality disfavored physician-owned hospitals".

I could go on and on with this list, hitting Certificate of Need laws, the massive consolidation of the healthcare market and the resulting shift of 30% physicians holding W2 employee jobs in 2010/2011 to >70% being employed in 2024...but I'll give it a rest.

My point being that for more than 50 years, America has regulated medicine so drastically that physicians retain all the liability for the life-and-death decisions we are asked to make, while we have been herded into a very narrow path of hoping our Hospital Bosses pay us a small percentage of the revenue they generate from our labor, because owning...oh, basically anything - even our own time - may or may not be illegal, depending on how good your lawyer is and how aggressive the MBAs/politicians want to be.

There is no way, NO WAY that we will see non-competes banned for physicians. They might be banned for everyone else...but not physicians.

The only chance we have is to do what is often considered distasteful, perhaps borderline taboo in certain circles:

Advocating for our own value - in the financial sense.

I know you're supposed to be satisfied with "prestige" and "admiration"...which is how journals tricked our entire profession into paying them billions of dollars to publish a manuscript we did all the work for...

But here's the thing: prestige can't be put into your 401k. Prestige can't pay a mortgage. Prestige can't keep your kids in daycare. Prestige can't help your elderly parents afford their assisted living facility.

Now, if they want to start charging "prestige points" for med school tuition, or you could pay for malpractice insurance with "Prestigecoin"...that would be a different story.

There's only one way to start fixing this trainwreck: and it ain't by staying quiet.

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org I’ll admit I don’t know peds NP billing, but I can say APPs in my community serve much of the FP and peds care because, similarly, Peds and FP MDs/DOs are very hard to come by.

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org ?

[Tom Mullen @mottress]

@radoncodonk @5_utr @srob61 @CMSGov @ASTRO_org (That is, bill Rad Onc)

[Tom Mullen @mottress]

@radoncodonk @5_utr @srob61 @CMSGov @ASTRO_org NPs and PAs can provide Pediatrics. They can’t do Rad Onc.

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org I’m lucky enough to have a larger group with vacay coverage within, but for them to cover it could be a 14-hr day. We’re not doing any virt direct yet but adding for low risk pts on fringe of day.

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org Rad Onc needs to get its head out of its ass when it comes to recruitment

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org Because those residencies don’t recruit MD/Phds who think they’re gonna spend their life in an urban academic practice and then realize it’s BS

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org Also locums is just not a great option if you are trying to cultivate a consistent culture. Haven’t done any virt direct yet but planning to start for lowest risk patients to allow more flexibility for our limited docs

[Tom Mullen @mottress]

@5_utr @radoncodonk @srob61 @CMSGov @ASTRO_org Higher salaries don’t convince a Rad Onc and their also-professional spouse to move to “NoWhere,” away from families and free childcare

[Lucinda Morris @lucindamorris23]

👉 #RadiationTherapy delivers huge bang for 💸 as a cancer treatment
👉#Radiationtherapy accounts for only 6c per $1 spent on cancer treatments whilst contributing to HALF of all cancer cures 🙌
👉 As medical costs skyrocket, #Radiationtherapy remains incredibly cost-effective ⚡️

[Tom Mullen @mottress]

@SprakerMDPhD In 20 years, proton therapy will be remembered as the Bill Cosby of radiation therapy (if anybody remembers Bill Cosby at that point). My question is: how long will they hold onto Radcomp before publishing? So much money at stake…

[Tom Mullen @mottress]

@SprakerMDPhD Like most humans, they believe something strongly, with the strength of believe inversely correlated with its veracity

[Tom Mullen @mottress]

@toddscarbrough @orlandohealth Publish the damn data!

[Tom Mullen @mottress]

@HardenedBeam @SprakerMDPhD The only place a proton plan beats an IMRT plan is in silico

[Scott Eggener @uroegg]

Until someone shows me compelling data otherwise, proton therapy for prostate cancer is yet another black eye for American health care

Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer https://t.co/JUoFAw7z6B

[Todd Scarbrough @toddscarbrough]

One of the more interesting #radonc presentations at the recent European Lung Cancer Congress

Long-term follow-up of CONVERT:
once-daily 66/33 vs twice-daily 45/30 for small cell #LungCancer

Significantly more long-term esophageal toxicity for once-daily (as we might predict since 66/33 is ~50% more BED Gy-3 than 45/30!)

https://t.co/BGZK3rpkja

[Tom Mullen @mottress]

@toddscarbrough Survey was done in 2022. ChatGPT was launched in 11/2022. I bet the radiologists would respond differently now. I can’t speak for the rest of the US, but the RO job market is great in Southern Oregon!