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Radiation Oncology Physician
Place of Performance: San Juan P.R.

General Description:
Provide services necessary to perform on-site board-certified Radiation Oncology Physician services to eligible beneficiaries of the San Juan Medical Center.

Specific Tasks:
Provide evaluation and treatment of transported inpatient and outpatient clinical services for both palliative and curative cancer patients, follow-up, re-evaluation, and treatment visit.
Provide evaluation and a treatment plan; follow patients for treatment management, continuing monitoring, and follow-up evaluations. You shall complete any documentation associated with the treatment provided to patients.
Conventional Radiation Treatment: Use of the following advanced modalities: 3D- conformal, VMAT, IMRT, IGRT, SBRT, and/or SRS, shall be fully justified in accordance with the appropriateness criteria promulgated by the 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 Rules and Regulations, a history and physical examination, and a review of pertinent x-rays and laboratory results as well as the patients medical record.
1. Review previous history, radiographic and lab studies.
2. Order any other test required for workup.
3. Discuss with patient and perform examination.
4. Document the evaluation in EHR, 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 physician(s) for each patient, discuss treatment plan with patient and obtain patients 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.
1. All treatment plans shall undergo peer review prior to initiation of treatment.
2. Treatment plans shall be altered as necessary during the course of the patients treatment.
3. 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.
4. 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 and ARIA/Eclipse.
5. 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.
6. 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. Patients progress shall be reported to the referring physician using the electronic medical record, Computerized Patient Record System (CPRS) and ARIA/Eclipse, 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.
7. 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.
8. 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.
9. Monitor all therapy for side effects or complications; prescribe dose changes as needed; and review all cases at physician conference.
Treatment Discharge: Document treatment discharge summary (End of Treatment Note) in CPRS and ARIA/Eclipse to include total radiation treatment doses, patients condition at completion of treatment, discharge instructions to patient and a follow-up Appointment with 30-60 days post treatment.
Follow-up Evaluations: 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 patients response to therapy and a written evaluation shall be completed for the patients medical record within 48 hours. Prior to any initiation of new treatment, approval must be obtained from the Medical Center.
Peer Review Conferences: 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 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
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.
Attend service staff meetings (Service Quality Assurance Meetings, chart rounds, peer review conferences, as required by the Chief, Radiation Oncology Service, COS, or designee.
Responsible for assisting in a protected peer review program in compliance with The Joint Commission and practice standards promulgated by ASTRO, and AAPM and to maintain documentation of appropriate peer review statistics as needed for quality management and credentialing.
Attend and participate in the Medical Center Name Tumor Board Conferences.
Follow all established patient safety and infection control standards of care.

License:
Shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia.

Certification:
Shall be board certified, American Board of Radiology (ABR) certified physician in the area of Radiation Oncology.
Current DEA certificate.
BLS
All continuing education courses required for maintaining certification must be kept up to date at all times.