5 Pieces of Advice for Your First Years in Radiation Oncology Administration

By Ron DiGiaimo, MBA, FACHE, John Montville, MBA, FACHE, FACMPE, FACCC, COA, Marc Gelinas, MHA, CMPE, FACHE, and Bri Driggers

Whether you started as a radiation therapist or nurse and worked your way up to management or you are coming into the role from the business and healthcare administration side, accepting a role in radiation oncology administration is a huge career step. Every patient who steps into your office is dealing with immense physical, emotional, and potentially financial difficulties, and they are counting on you to ensure they get the best care available.

We understand that this can be quite a daunting undertaking for anyone. As a result, we sat down with some of the industry’s most experienced radiation oncology administrators to ask them what they wished they had known at the start of their careers. Ron DiGiaimo (CEO of RCCS), John Montville (executive director of Oncology Service Line at Bon Secours Mercy Health/Lourdes Hospital), and Marc Gelinas (VP of The Oncology Group) have five pieces of advice to help new administrators thrive during their first few years in the role.

Figure Out What You Don’t Know

No matter your background, it’s impossible to know everything you have to know about the job on the first day. Often, new administrators can feel an immense amount of pressure to have all the answers and avoid asking for help. However, the best way to be successful in radiation oncology administration is to acknowledge that you still have a lot to learn.

Coming from a business background, John assumed that it would be fairly straightforward to apply business administration practices to a radiation oncology practice. However, he quickly realized that without an understanding of radiation therapy, he was never going to be able to support his team to the best of his ability.

Take advantage of continuing education, including online courses, webinars, and conferences. But John and Marc agree that your most important lessons in those early years will be the ones that you learn on the job. “Books are great; applying it is a different story.” It’s important to take the time to periodically conduct an honest assessment of where there might be gaps in your knowledge.

Learn to See Yourself as a Partner, Not an Authority

When Marc first started his career as an administrator, he believed “managing physicians is like herding cattle.” Today, he acknowledges just how big of a mistake that was. “They are human beings with whom we need to partner and collaborate. They provide the essential services to patients, and a significant part of your role is ensuring their success.”

On paper, administrators are a level above practitioners in the hierarchy. New administrators may feel that if they are not completely in control, they are “failing” at their job. Unfortunately, it is not uncommon for administrators to adopt an “us vs. them” mentality with physicians. Marc encourages all new administrators to let go of their egos and acknowledge that the entire office is on one team with one goal: to provide excellent care to cancer patients. Rather than trying to hold onto their sense of authority, administrators need to prioritize the collective success of the entire practice.

At the end of the day, the physicians are the ones working one-on-one with patients to treat their cancer. A truly successful administrator makes their job as easy as possible so patients can have the best experience. In this regard, Marc has some humbling advice for administrators: “As an administrator, the fact of the matter is that you are more dispensable. It is in your best interest to support [the physicians].”

Expect Challenges and Embrace Complexity

“The level of difficulty can surpass people’s expectations,” Marc says. From a medical perspective, cancer is a complicated disease to treat. The care team has to figure out how to kill the mutated cells without causing excessive damage to healthy cells. Because of this intricacy, treatment plans tend to vary from individual to individual. However, the emotional toll of the disease adds an extra layer of complexity. When managing patient care, the entire team—including administrators—needs to remember that the patient’s mental, physical, and emotional well-being are paramount. It is natural for conflict to arise among providers. Each provider brings different experiences to the table that can influence their perspective on what’s best for the patient, and those ideas may not always align.

Radiation oncology does not work in isolation, and the most challenging part of the role is learning how to balance multiple programs against each other to achieve the best outcome for the patient. Patients don’t get to radiation oncology without at least one referral.  More often, they have seen several other providers before they get to your clinic and will continue to see them throughout their treatment program. It is important to understand the chain of referrals that got the patient to you—such as gynecology, internal medicine, and surgery—and recognize how each specialty complements and competes with the others to help make this process as stress-free as possible for the patient.

One of an administrator’s primary responsibilities includes managing the billing cycle. Before a patient can begin treatment, you need to verify their insurance and get authorization from the insurance company. Your practice or clinic cannot cover or exceed expenses unless the patients’ insurance company agrees to reimburse you for the services. However, delaying the start of treatment can create immense anxiety for the patient. It is up to you to navigate this intricate landscape in an efficient and timely manner. This includes a detailed knowledge of referral patterns and patient care requirements.

Seek Out Connection

Learning on the job is about more than learning from experience through trial and error. It is also important to learn from other people who have more experience than you outside of formal learning environments. John, Marc, and Ron all agree that it is important to seek out mentorship early on in your radiation oncology career.

When looking for a mentor, you may be tempted to find someone who is a perfect fit for your personality, values, and career goals. While this situation would be ideal, there is also value in working with a mentor who isn’t the best fit. At the very least, they can teach you what not to do and how not to treat members of your team or patients, which is just as valuable as learning what you should do. Also, what you need from your mentor may change over time. You may need to work with more than one mentor over the course of your evolving career to ensure you are able to perform your job to the best of your abilities.

In addition to mentorship, build a network with other colleagues in the field. You can make these connections through organizations like the Society for Radiation Oncology Administrators (SROA), the Association of Cancer Executives (ACE), and the Association of Community Cancer Centers (ACCC). Try to build relationships with administrators working in a wide range of settings, such as university hospitals, community clinics, private practices, and rural clinics. Learn from each other and adopt the best practices you see others implement.

Get Detail Oriented

Your main goal as an administrator in radiation oncology is to ensure that your team has the support they need to deliver the highest quality of care possible to each patient. Part of this is emotional support, but you also need to ensure they have the physical resources necessary to do their job effectively. Financial management will be one of your primary responsibilities. As soon as you start, learn as much as you can about the budget situation you have inherited from your predecessor and create a detailed inventory of all equipment, supplies, and facility details. Then, develop a financial plan that will help you maximize revenue and control costs. You can help build a more cohesive team by including the physicians in these conversations and asking for their input. This shows them that you see them as an equal and valuable member of the practice or clinic.

A career in radiation oncology administration comes with challenges, but it can also be incredibly rewarding. Your success is measured by how well you meet challenges. You may not know everything on your first day, but you can set yourself up for success by establishing yourself as an honest, forward-thinking team player with a willingness to listen and learn.