What is the problem...can one define it? Let your voice be heard...

[evilbooyaa]

maybe we need a "rooney rule". I am all about diversity training, but I find it somewhat laughable that we undergo diversity training but then all of the department leadership are essentially old white men (sometimes white women). I think if diversity was a focus, then institutions would actually show this by hiring and retaining a diverse workforce. i don't see that happening often.

Why everyone forgettin' about CRT and JJ all the time?

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[jondunn]

Why everyone forgettin' about CRT and JJ all the time?

How does this change his point though?

 

[deleted1111261]

State of Michigan starting implicit bias training this summer for all health care professionals. Just got the email this week.

 

[RickyScott]

State of Michigan starting implicit bias training this summer for all health care professionals. Just got the email this week.

Reeducation camps?

 

[medgator]

State of Michigan starting implicit bias training this summer for all health care professionals. Just got the email this week.

Hopefully no book burning/banning yet

 

[TheWallnerus]

@Dan Spratt we can let our voices be heard; the market has its own voice.

Rad oncs are averaging $6520/week according to locumstory.com (aka $340K/yr).

Med oncs are getting offers of "$25K+/week" (aka $1,300,000+/yr)

 

[communitydoc13]

Remarkable post in terms of formalism and structure. I'll try to address some things. I expect no resolution.

it is reasonable to consider how similar dynamics may play out in institutional board rooms, editorial boards, and mandated DEI training sessions in the community

The dynamics you are describing include self-censorship and the risk of targeting. To this I ask sincerely, what things would you say if there was no perceived threat of retribution and no self-censorship? Now is your chance. Self-censorship is a mature state of being. Only children do not self-censor. Anonymous web is the place to not self-censor.

if one accepts the necessity of DEI led diversity trainings, the second thing I would invite you to consider is that the scientific evidence for many of the fashionable training concepts is surprisingly weak

I have no doubt that the scientific evidence is remarkably weak. If the reproducibility of phase III clinical trials is on the order of 40%, the number is going to be markedly lower for behavioral work and social sciences. The scientific evidence for the superiority of two parent families is remarkably weak. The scientific evidence for gender fluidity in primates and in multitudes of pre-Christian cultures is remarkably strong. I'm just breaching the point that we count on science very little for most of our cultural preferences. Diversity training may be bad. I don't know.

The authors go on to make the point that so many of today’s fashionable ideas, such as DEI related concepts of microaggressions, risk reinforcing those cognitive distortions by promoting the concept of safetyism, treating people as fragile (rather than anti-fragile), encouraging suspicion toward the intentions of others, and encouraging people to lean into their emotional reasoning.

Do you encounter this really? Are you scared to engage with colleagues or staff because of their remarkable sensitivity or is this a rare phenomenon? Are you scared of the fragile people around you or are the fragile people in general acknowledged as such by large groups of folks around them (of course they are)? Is it a tyranny to have someone assign their own pronouns? Are there great ideas or jokes that are lost today because of this environment? Is it a shame that we no longer comment on our female colleagues appearances?

DEI informed worldview

What is this even? It means something different to you than to me. DEI as a term is not threatening to me. It means a commitment to working towards a world with representative diversity of leaders, equity in wealth and opportunity across large groups of people and acceptance of nearly anyone who isn't hurting others. That's it. The controversial part is of course the equity part because we are so far from this presently and someone is going to have to lose a lot of relative status. I just will never reconcile the morality of gross inequity. (I participate in it, but I don't feel good about it, while sitting in my beautiful house sipping a latte.)

I have sincerely held classical liberal beliefs

My initial thought harkened back to Lip Gallagher's quote, “Every Libertarian was born on third base and thinks he hit a triple.” I would say the converse of this is that every affluent liberal was born on third base, knows it, acknowledges it, and then runs home as fast as they can when a teammate hits a single instead of calling for a pinch runner. They then complain about how unfair the rules are, but when offered an opportunity to go up to bat, choose to place themselves (and their children) on 3rd base anyway.

You can explain to me the difference between classical liberal and libertarian some time (aside from some historical context). But, I believe in this era, where the powers of monarchs and churches have receded to a great degree, they are one in the same. Our jobs are by definition collectivist, our certification process collectivist, our form of payment collectivist, our training programs collectivist, our compliance with regulations and the rule of law...all collectivist.

That being said, I know many lovely libertarians. Every society and many academic departments need this crew. Even some libertarians ascribe to the "3%" myth and brand it. I like DEI but I would (and do) tolerate a 3%er in my midst, as long as they go through the same damn training as everybody else and got Vaxxed.

 

[TheWallnerus]

Why everyone forgettin' about CRT and JJ all the time?

and new guy at Moffitt

 

[communitydoc13]

I think we’re getting off topic. It’s the jobs and the scope of practice. Of this, I am confident.

Perhaps the Dare you to Reply thread may be better for debating the value of DEI initiatives and more general contemporary culture issues?

 

[GapCalc]

@Dan Spratt how was SCAROP? Can we see your presentation?

 

[temujim]

The more interesting question is what does the OP get out of this? ie, how does this interaction help their career/ambitions?

 

[Wildcat321]

@Dan Spratt how was SCAROP? Can we see your presentation?

Curious as well. Tough crowd?

 

[medgator]

Curious as well. Tough crowd?

Wow never saw that until now. That's some quality gaslighting right there

 

[deleted1111261]

Seriously - wow.

Astro / chairs are quite tone deaf.

 

[elementaryschooleconomics]

Curious as well. Tough crowd?

WOW. I don't remember seeing this either.

 

[communitydoc13]

Curious as well. Tough crowd?

Never seen this as well. Thank you.

The vast majority of us will never be leaders in the field. In every healthy field, the vast majority of aspirants have no intention to be leaders but rather practitioners. This is how medicine and every other field (law, science, engineering, nursing (please lord nursing)) should work.

It is clear that SCAROP feels very little obligation to the mere practitioners. Even the author is telling.

 

[GapCalc]

Oh no, not the dreaded REDDIT

 

[CurbYourExpectations]

80% of the 50% of academic institutions think they may have a job available in the next 3 years. That is at least 40 jobs in the next 3 years, we should expand residency spots.

 

[communitydoc13]

Oh no, not the dreaded REDDIT

I know. Even this boomer gets it. If things were good, both REDDIT and SDN would be inundated with, "Things are so effing good, are you sure you are good enough to join this club?" posts. That's how things once were.

 

[RickyScott]

So they feel the largest percentage expansion of any medical specialty was completely justified. Can sdn write a counter letter?

 

[elementaryschooleconomics]

"Academic programs alone had enough openings for each graduating resident"

WHAT?? How in the world does that math work? If you have a 45% response rate, and 86% ANTICIPATED (not guaranteed) that they might have some jobs available over the "ensuing two to three years"...how do you arrive had "enough openings for each graduating resident"?

As per usual, SCAROP leaves out that the job satisfaction statistic comes from a survey given to senior residents who have yet to even work a single day of whatever job took. By this logic, I am also highly satisfied with my Thanksgiving plans I made for November.

Err, yeah, the primary novel/exciting approach we've developed is cutting everything down to 1-5 fractions. Definitely exciting and great for patients, but not great if the economy of your specialty is tied to number of fractions.

 

[Mandelin Rain]

SCAROP...

 

[winstonfoot5]

Never seen this letter before - a leak? SCAROP is the new SCOTUS?

 

[CurbYourExpectations]

That survey does nothing but make me more worried about the job market, I don't know how they are spinning it to be a good thing.

 

[RickyScott]

View attachment 354769

"Academic programs alone had enough openings for each graduating resident"

WHAT?? How in the world does that math work? If you have a 45% response rate, and 86% ANTICIPATED (not guaranteed) that they might have some jobs available over the "ensuing two to three years"...how do you arrive had "enough openings for each graduating resident"?

As per usual, SCAROP leaves out that the job satisfaction statistic comes from a survey given to senior residents who have yet to even work a single day of whatever job took. By this logic, I am also highly satisfied with my Thanksgiving plans I made for November.

View attachment 354770

Err, yeah, the primary novel/exciting approach we've developed is cutting everything down to 1-5 fractions. Definitely exciting and great for patients, but not great if the economy of your specialty is tied to number of fractions.

Incidence of cancer has actually been falling.

 

[elementaryschooleconomics]

Incidence of cancer has actually been falling.

Shhh don't tell SCAROP about the HPV vaccine and LDCT lung cancer screening.

PSA? Never heard of it.

Lower incidence of cancer means more time to spend on our notes, P2P calls with eviCore, removing the "very low risk" group from prostate cancer, and making sure no one tries to give more than 50.4 for cervical esophagus cases. We're busy!

 

[deleted1111261]

Shhh don't tell SCAROP about the HPV vaccine and LDCT lung cancer screening.

PSA? Never heard of it.

Lower incidence of cancer means more time to spend on our notes, P2P calls with eviCore, removing the "very low risk" group from prostate cancer, and making sure no one tries to give more than 50.4 for cervical esophagus cases. We're busy!

Ah yes, the famous esophageal study where 9 patients died on the dose escalation arm before reaching the control dose, the mere thought of higher dose was dangerous.

 

[RickyScott]

Shhh don't tell SCAROP about the HPV vaccine and LDCT lung cancer screening.

PSA? Never heard of it.

Lower incidence of cancer means more time to spend on our notes, P2P calls with eviCore, removing the "very low risk" group from prostate cancer, and making sure no one tries to give more than 50.4 for cervical esophagus cases. We're busy!

Smoking related cancers will plummet in 2030s. Smoking rate from 90s onwards is a fraction of what it was in 60/70s

 

[OTN]

Oh my God, I simply cannot believe that letter.

We all knew "misinformation" was going to be used to censor contrarian viewpoints, but I am impressed with speed with which it has been used in our particular corner of medicine. I'm not surprised that it came from a Canadian head of SCAROP (the insanity of which will have to wait for another post), given Canada's dramatic turn towards illiberalism over the last few years.

Anyone who has done even a cursory readthrough of this forum can see the data that has been presented, read the stories about difficulty with the job search, and knows what money is and what locums rates mean. It's not hard- at ALL- to see that, in aggregate, this forum has done a good and thorough job of explaining the issues in dry, analytical terms (thanks be to Scarb and the Wallernus).

The letter is a great example of disinformation- that is, information deliberately spread with intent to deceive (as opposed to misinformation, in which information is spread without the intent to deceive). Although disinformation technically has to be spread by a government, I think we can use it here, with SCAROP as a stand-in for a state actor. Dr. Liu is either ignorant to the problems within the field (inexcusable as head of SCAROP and very hard to believe), or she is using her organization to deliberately spread false information about our specialty. My vote is solidly for the latter.

 

[jondunn]

Ah yes, the famous esophageal study where 9 patients died on the dose escalation arm before reaching the control dose, the mere thought of higher dose was dangerous.

mutliple other negative dose escalation studies in esophagus since then, of course.

 

[Chartreuse Wombat]

Curious as well. Tough crowd?

ASTRO has officially jumped the shark.

 

[deleted1111261]

How do you communicate with these people, @Chartreuse Wombat ? They seem downright thick.

 

[elementaryschooleconomics]

Oh my God, I simply cannot believe that letter.

We all knew "misinformation" was going to be used to censor contrarian viewpoints, but I am impressed with speed with which it has been used in our particular corner of medicine. I'm not surprised that it came from a Canadian head of SCAROP (the insanity of which will have to wait for another post), given Canada's dramatic turn towards illiberalism over the last few years.

Anyone who has done even a cursory readthrough of this forum can see the data that has been presented, read the stories about difficulty with the job search, and knows what money is and what locums rates mean. It's not hard- at ALL- to see that, in aggregate, this forum has done a good and thorough job of explaining the issues in dry, analytical terms (thanks be to Scarb and the Wallernus).

The letter is a great example of disinformation- that is, information deliberately spread with intent to deceive (as opposed to misinformation, in which information is spread without the intent to deceive). Although disinformation technically has to be spread by a government, I think we can use it here, with SCAROP as a stand-in for a state actor. Dr. Liu is either ignorant to the problems within the field (inexcusable as head of SCAROP and very hard to believe), or she is using her organization to deliberately spread false information about our specialty. My vote is solidly for the latter.

On the off chance it's ignorance -

I have been coming to SDN for almost 20 years. I have used it at key steps in my career, starting with getting into medical school.

I'm an MD-PhD, and was interested in RadOnc long before I had the chance to match.

I was a student when the "Bloodbath" stuff happened.

I read all the doom and gloom on SDN but didn't think the numbers at the time (2013 or so) were convincing.

Clearly I was not alone.

What changed? The numbers add up now. The doom and gloom as always been here, now the math is here too.

Maybe the ABR shouldn't have failed half a class on boards in 2018 and published an article calling them dumb?

Nah, it is the children who are wrong!

 

[TheWallnerus]

Curious as well. Tough crowd?

Wow never saw that until now. That's some quality gaslighting right there

Seriously - wow.

Astro / chairs are quite tone deaf.

WOW. I don't remember seeing this either.

View attachment 354768

Incidence of cancer has actually been falling.

“As people live longer, incidence of cancer will continue to rise by ~2-3% each year.”

This one statement gets many things not only factually but conceptually wrong. And these are our leaders?

SCAROP is like a farmer who sees his crops are failing and blames it on all the sin in the world. So he thinks “If people would just pray more, our crops would come in like they used to do.” This is not as far off an analogy as you might think as “ASTRO” is similar to the root aster which meant star (or a sign from the heavens) to the ancients. And it’s where we get the word “disaster” from… literally a bad star sign… which is what this specialty is facing.

I pray for ASTRO.

 

[Chartreuse Wombat]

How do you communicate with these people, @Chartreuse Wombat ? They seem downright thick.

I used to be on the inside and did what I could to advocate from within the walls.

It became clear to me that the apparatchiks don't like information that goes against the narrative and I decided to focus on other things like patient care and developing an efficient team so that everyone could get the work done in time to return home for dinner with friends and families

Now I am on the outside and the "leadership" considers those like me to "not have the emotional intelligence to take a nuanced position on a complicated subject" (direct quote).

In the last few years ASTRO has produced videos to attract medical students; provided $$ for URMs to "engage" with RadOnc as medical students, invited a race hustler to speak for $20K at the annual meeting,....

Sadly this group has lost their way.

 

[temujim]

I used to be on the inside and did what I could to advocate from within the walls.

It became clear to me that the apparatchiks don't like information that goes against the narrative and I decided to focus on other things like patient care and developing an efficient team so that everyone could get the work done in time to return home for dinner with friends and families

Now I am on the outside and the "leadership" considers those like me to "not have the emotional intelligence to take a nuanced position on a complicated subject" (direct quote).

In the last few years ASTRO has produced videos to attract medical students; provided $$ for URMs to "engage" with RadOnc as medical students, invited a race hustler to speak for $20K at the annual meeting,....

Sadly this group has lost their way.

Sounds about right. Had a glimpse behind the curtain many years ago, and definitely there was a push/selection at scientific meetings for race and/or gender quotas.

 

[winstonfoot5]

Not sure if there is a good way to share this letter with the greater SDN community but other specialties may be interested in this for historical context… as this letter is what a dying specialty looks like

 

[OTN]

I used to be on the inside and did what I could to advocate from within the walls.

It became clear to me that the apparatchiks don't like information that goes against the narrative and I decided to focus on other things like patient care and developing an efficient team so that everyone could get the work done in time to return home for dinner with friends and families

Now I am on the outside and the "leadership" considers those like me to "not have the emotional intelligence to take a nuanced position on a complicated subject" (direct quote).

In the last few years ASTRO has produced videos to attract medical students; provided $$ for URMs to "engage" with RadOnc as medical students, invited a race hustler to speak for $20K at the annual meeting,....

Sadly this group has lost their way.

"not have the emotional intelligence to take a nuanced position on a complicated subject"

Considering the academic radiation oncologists I've known, this is a very funny statement.

 

[jondunn]

didn't Potters write a letter from SCAROP as well? Was that letter done to hide the true shadow letter from Canada?

wtf is going on

 

[medgator]

didn't Potters write a letter from SCAROP as well? Was that letter done to hide the true shadow letter from Canada?

Must be... That's the only one i recalled. Not nearly as ridiculous, still awful though with the DEI pivot and deflection away from the real issues affecting the specialty

DEFINE_ME

 

[thecarbonionangle]

It is pretty interesting to me that the response rate is like 44 pct. The laziness of the job is super embarrassing. They could not even get their stuff together for the disinformation campaign. Less than fifty percent cared to respond and “leaders” said ya let’s go with that! These boomer “leaders” are very sloppy and lazy. The field is in great hands folks so doncha worry!

 

[jondunn]

I didn't realize Canadians were part of SCAROP anywyas

 

[TheWallnerus]

It is pretty interesting to me that the response rate is like 44 pct. The laziness of the job is super embarrassing. They could not even get their stuff together for the disinformation campaign. Less than fifty percent cared to respond and “leaders” said ya let’s go with that! These boomer “leaders” are very sloppy and lazy. The field is in great hands folks so doncha worry!

They really are pretty sloppy and lazy with the facts

I knew this when Simul was on that virtual visiting prof show way back when with Potters and BK and Chelain and Chelsea and Royce et al

And if Potters said there are 4000 rad oncs once he said it a hundred times

 

[Lamount]

I wonder what would happen if someone posted that letter on twitter and tagged a few chairs

 

[winstonfoot5]

Plenty of good content from this crew

DEFINE_ME

 

[TheWallnerus]

I didn't realize Canadians were part of SCAROP anywyas

 

[CurbYourExpectations]

It is pretty interesting to me that the response rate is like 44 pct. The laziness of the job is super embarrassing. They could not even get their stuff together for the disinformation campaign. Less than fifty percent cared to respond and “leaders” said ya let’s go with that! These boomer “leaders” are very sloppy and lazy. The field is in great hands folks so doncha worry!

Would be interesting to see which programs replied. You being a specialist in this topic, what percentage of them do you think are good programs with everyone's best interest in mind?

 

[thecarbonionangle]

Would be interesting to see which programs replied. You being a specialist in this topic, what percentage of them do you think are good programs with everyone's best interest in mind?

I think there is a pretty pretty pretty good chance that none of these people have the best interest of the field. What do you think?

 

[Ray D. Ayshun]

Would be interesting to see which programs replied. You being a specialist in this topic, what percentage of them do you think are good programs with everyone's best interest in mind?

it's broken down by state i believe. For instance, 2/2 in KY

sorry, that was the resident survey i think.

 

[fiji128]

Plenty of good content from this crew

DEFINE_ME

“The concern of the current residents and the job market is understandable, yet opportunities for obtaining jobs appear positive based on the ARRO data that identified that 72% of graduating residents were offered satisfactory positions and 88% of chief residents obtained their “first choice job type.”