Radiation Oncology Physician

Radiation Oncology Physician

Essential Duties and Responsibilities

• Services shall include evaluation and treatment of transported inpatient and outpatient clinical services for both palliative and curative cancer patients; follow-up, re-evaluation, and treatment visit; and perform prostate seed implants (if applicable) in the OR.
• Contract Radiation Oncologist shall provide evaluation and a treatment plan; follow patients for treatment management, continuing monitoring and follow-up evaluations. Contract Radiation Oncologist shall complete any documentation associated with the treatment provided to VA patients treated by them
• Conventional Radiation Treatment: Use of the following advanced modalities:IMRT, IGRT, Stereotactic Radiosurgery, and Stereotactic Radiotherapy, shall be fully justified in accordance with the appropriateness criteria promulgated by the American College of Radiology, American Society for Radiation Oncology, and American Association for Physicist in Medicine.
• Patient Consultation/Pretreatment Evaluation: A radiation therapy consultation is defined as a comprehensive patient evaluation provided at the request of the referring physician. A consultation shall consist of a meeting of the patient and a radiation oncologist within the timeframes established by VA Rules and Regulations, a history and physical examination, and a review of pertinent x-rays and laboratory results as well as the patient’s medical record.
• Review previous history, radiographic and lab studies.
• Order any other test required for workup; and 
• Discuss with patient and perform examination.
• Document the evaluation in CPRS, including at least:
• Name of Attending Physician.
• Radiation treatment type (e.g., conventional, IMRT).
• Curative or Palliative radiation treatment
• Dose amount and duration of radiation treatment, and 
• Discussion of evaluation with patient.
• Treatment Planning: When it is determined radiation therapy is appropriate, a goal-oriented treatment plan from supporting data shall be developed by the Contract physician(s) for each patient, discuss treatment plan with patient and obtain patient’s signed consent, and made a part of the VA medical record. The treatment plan shall include the type of radiation to be administered, prescribed dose, treatment site location, Dose Volume (DV) based planning to include DV Histograms (DVH), designation of Organs at Risk (OAR) for radiation injury, DV based radiation delivery goals for each OAR.
• Treatment plans shall be altered as necessary during the course of the patient’s treatment.
• Contract physician(s) shall document initial consultation and full plan of care that includes name of attending physician on all clinical notes, indicate radiation treatment type (i.e., conventional, IMRT), date of simulation or procedure date, curative or palliative radiation treatment, dose amount and duration of radiation treatment and signed patient consent for treatment.
• Treatment Management: Includes weekly examination of the patient under radiation therapy by attending physician. Weekly examination includes review of the daily and/or weekly port films by the attending physician, monitoring all therapy for side effects or complications, prescribed dose changes and other adjustment in treatment as needed, review of all cases at weekly case conferences or chart rounds and documented encounters and clinical progress notes in CPRS. 
• Prior to beginning radiation treatment, contract physician(s) shall instruct the patient and care givers on the risks involved including symptom management and symptoms requiring immediate intervention. This instruction must be documented in the medical record within 24 hours. The patient shall be given names and telephone numbers of persons to contact to report these symptoms. Informed consent shall be completed prior to implementation of initial treatments.
• Contract physician(s) shall evaluate each patient for treatment management at a minimum of once per five treatments. These treatment management evaluations, addressing tumor response and side effects of therapy and medications prescribed, include pertinent laboratory and imaging studies. Patient’s progress shall be reported to the referring physician using the electronic medical record, Computerized Patient Record System (CPRS), to include name of attending physician, treatment date, radiation treatment type, radiation dose amount and duration of treatment, radiation treatment dose to date and remaining dose to be provided, skin check of treated area, plan of care and number of treatments left to complete.
• Contract physician(s) shall provide the patient with written guidelines regarding their rights and responsibilities. This includes keeping the patient informed of all issues affecting care and inviting full participation in planning and implementing care. Patient expectations of contract physician(s) should also be outlined. The patient must be advised of their right to submit complaints and procedures concerning such. This instruction must be documented in the medical record within 24 hours. 
• Contract physician(s) shall maintain written policies and procedures that clearly define guidelines for protecting patients and employees from all unnecessary radiation exposure, provisions for the safe use, removal, handling and storage of radiation and other radioactive elements.
• Contract physician(s) shall monitor all therapy for side effects or complications; prescribe dose changes as needed; and review all cases at physician conference. 
• Treatment Discharge: Contract physician(s) shall document treatment discharge summary (End of Treatment Note) in CPRS to include total radiation treatment doses, patient’s condition at completion of treatment, discharge instructions to patient and a follow-up appointment with 30-60 days post treatment.
• Follow-up Evaluations: A board certified radiation oncologist must see each patient at least one (1) time following the radiation therapy treatment series within thirty (30) to sixty (60) calendar days of the end of a treatment series. The follow-up examination shall consist of a physical examination of the patient and a review of the current medical record including x-rays. The purpose of this examination is to evaluate the patient’s response to therapy and a written evaluation shall be completed for the patient’s medical record within 48 hours.
• Peer Review Conferences: Contract Staff shall attend and participate in weekly peer review conferences to discuss the appropriateness of treatment decisions, treatment goals and expected results related to Facility Radiation Oncology patients. These conferences may be joint conferences at which Contractor’s Radiation Oncology Service patients are also presented. 
• Documentation Requirements: All patient care documentation including, but not limited to consultations, encounters, weekly progress notes, treatment discharge notes, follow-up notes, continuing physics consultation which covers weekly chart review checks, special physics consultation notes, and other required documentation, shall be recorded in CPRS in accordance with VA Rules and Regulations (see Section D, page 83 for CPRS User Guide and By-Laws and Rules of the Medical Staff of the VA RADIATION ONCOLOGY), including, but not limited to: 
• Inclusion of correct Current Procedural Terminology (CPT) and diagnoses codes, and service connection of condition being treated on encounters.
• Resident supervision documentation.
• Electronic signature on all entries; timeframes for electronic signing, completion and closing of entries and encounters.
• COMMUNICATING TEST RESULTS TO PROVIDERS AND PATIENTS: In accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients, all test results requiring action must be communicated by the ordering provider, or designee, to patients no later than 7 calendar days from the date on which the results are available. For test results that require no action, results must be communicated by the ordering provider, or designee, to patients no later than 14 calendar days from the date on which the results are available. The Contractor shall provide the VA with the name, pager, and telephone numbers of a LIP (physician, nurse practitioner, or physician assistant) at the Outpatient Site of Care to accept critical test results discovered on tests done by the VA. For critical results, the LIP must respond back to the VA within forty-five (45) minutes of the initial page or telephone call. The receiving LIP will document the results in the record and conduct a “read back” procedure to ensure accuracy of transmission and translation of all verbal results. The contractor shall determine a plan to fulfill critical test result procedures, per VA policy. VA will not be responsible for the failure of the Contractor to receive critically abnormal test results. Critical results must be reported to the clinician by the radiologist by telephone. Documentation of this notification, “who, when” must appear in the radiology report. For critical results that represent an imminent danger to the patient, the Contractor shall notify the patient immediately. Mechanisms must be in-place to provide notification of test results for patients receiving care in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients.

Minimum Qualifications

• Minimum of five (5) years of experience excluding Residency.
• Minimum of three (3) years of experience in Intensity Modulated Radiation Therapy (IMRT)
• Minimum of three (3) years of experience with Eclipse treatment planning system; ARIA record & verify system, including the following treatment modalities: 2D/3D conformal, SRS, SRT, SBRT, and IMRT/VMAT (following standars of TG-53).
• Minimum of 10 documented cases in the past two (2) years of both Stereotactic Body Radiation Therapy (SBRT) and Sterotactic Radiosurgery (SRS)
• MD or DO degree 
• Completion of a Radiation Oncology Residency
• Board Certification through the American Board of Radiology
• BLS / ACLS Certifications
• Proven ability to speak, understand, read, and write English fluently
• Authorized to work in the U.S. indefinitely without sponsorship (all jobs)
• Basic computer skills
• Type at least 50 WPM
• Ability to obtain a public trust