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

[OTN]

I agree with @communitydoc13

Walmart SHOULD pay their folks more

I agree. I didn't bring it up to point out that Walmart pay is too high, but rather to point out that pay for radoncs is too low. My sister-in-law manages an entire store in Illinois. I'm very happy for her and, seeing how hard she works, I know she deserves each and every one of those dollars.

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[TheWallnerus]

"It's the oversupply stupid."

Limit supply, increase demand, restore the profession. Duh.

Maybe, gone are the days of a small group buying a linac and keeping technical (hint: they're pretty much gone), but we have the tools to each treat more and more patients per unit doctor. This SHOULD drive salaries higher and make the job more appealing for all. Whether that job is community, academic, or true PP. We just need to stop diluting the pool.

It's really simple, it's not easy.

At this point whether or not oversupply is the actual issue, it is the perceived issue. It's like the price of a barrel of oil: it's linked to supply and demand, sure, but even more to what politicians and the President says and people's feelings.

The perceived issue of oversupply continues to hurt the Radiation Oncology brand. Right now the best ASTRO seems to come up with is "We are forming a workforce analysis committee" or some such. It would kind of be like if Elizabeth Holmes when she did that first Cramer/Mad Money interview was like "I am forming a committee at Theranos to see if we actually have any working devices; many in the company feel confident we do, but a few disgruntled employees seem to think we do not." At least she lied and tried to do some fierce spin and damage control!

 

[RickyScott]

At this point whether or not oversupply is the actual issue, it is the perceived issue. It's like the price of a barrel of oil: it's linked to supply and demand, sure, but even more to what politicians and the President says and people's feelings.

The perceived issue of oversupply continues to hurt the Radiation Oncology brand. Right now the best ASTRO seems to come up with is "We are forming a workforce analysis committee" or some such. It would kind of be like if Elizabeth Holmes when she did that first Cramer/Mad Money interview was like "I am forming a committee at Theranos to see if we actually have any working devices; many in the company feel confident we do, but a few disgruntled employees seem to think we do not." At least she lied and tried to do some fierce spin and damage control!

If there is a just risk of oversupply (and 100% will agree that exists), who would even consider the specialty given alternatives like medonc.

 

[jondunn]

Love the barrel of oil comparison

 

[TheWallnerus]

If there is a just risk of oversupply (and 100% will agree that exists), who would even consider the specialty given alternatives like medonc.

Exactly why you don't go ramping up your oil well construction when a barrel of oil is going for rock bottom prices. I don't know where my analogy is exactly going now but rad onc hit and passed Peak Oil a while back

 

[Dan Spratt]

As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them

 

[TheWallnerus]

As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them

@Neuronix @evilbooyaa

Any way for Dan to email to you guys and you upload to SDN for a public downloadable link

 

[RadOncDoc21]

Lol, what’s the point? I’m sure the final conclusion is the same.

 

[DoctwoB]

Exactly why you don't go ramping up your oil well construction when a barrel of oil is going for rock bottom prices. I don't know where my analogy is exactly going now but rad onc hit and passed Peak Oil a while back

The issue is that producers of oil get paid for their product which follows laws of supply and demand, while producers of residents get "paid" for making the product regardless of if the product sells.

 

[fiji128]

As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them

State what was presented in 1 short sentence, please. Thanks!

 

[deleted1111261]

State what was presented in 1 short sentence, please. Thanks!

😂
Touché

 

[Neuronix]

As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them

Sure email them to me at [email protected], I'll get it uploaded one way or another.

 

[Ray D. Ayshun]

So Mr guided linacs yes, print to pdf no?

 

[CurbYourExpectations]

State what was presented in 1 short sentence, please. Thanks!

At least a potential of 40 academic jobs in 3 years, therefore expanding to 300 residents per year.

 

[Dan Spratt]

State what was presented in 1 short sentence, please. Thanks!

Changes

State what was presented in 1 short sentence, please. Thanks!

Challenge accepted.

PowerPoint slides.

 

[elementaryschooleconomics]

Changes

Challenge accepted.

PowerPoint slides.

Dan strikes me as a man who finds 3-button suits inefficient and is actively trying to find a way to put his pants on two legs at a time.

I would love to commission his brother to create a retro movie poster featuring Chairman Spratt battling prostate cancer - and ketchup, and anonymous internet misanthropes - but, after reviewing his portfolio and past clients, I'm 100% sure I can't afford it, because I'm an attending Radiation Oncologist in 2022, not 2002.

 

[deleted1111261]

Changes

Challenge accepted.

PowerPoint slides.

😂

I’ve seen the slides.

Don’t expect a panacea or catharsis. Dan is one person and he has his own constituency there to satisfy. “Anti - trust” keeps coming up as the biggest cock-block.

 

[TheWallnerus]

State what was presented in 1 short sentence, please. Thanks!

Challenge accepted.

PowerPoint slides.

(this joke only works for 1970s and earlier when technology didn't exist to trace calls to a location)

Man uses phone...
MAN: "Hello, fire department... my house is on fire! Please send help!"
FIREMAN: "Yes sir! How do we get there?!"
MAN: "Well hell ain't you all still got them red fire trucks?!"

 

[TheWallnerus]

😂

I’ve seen the slides.

Don’t expect a panacea or catharsis. Dan is one person and he has his own constituency there to satisfy. “Anti - trust” keeps coming up as the biggest cock-block.

Sounds like ASTRO will let you give a PowerPoint presentation, but not an illegal PowerPoint presentation.

CONSTITUTION: All speech is free.
ASTRO: Yes. Except if you're speaking about how many rad oncs there should be... then, you're a criminal.

 

[RadOncDoc21]

I’ve yet to see one person accused, prosecuted or convicted. Hell, I would take alledged anti-trust at this time.

Nothing to see here folks, move along. Can we close this thread now?

 

[winstonfoot5]

😂

I’ve seen the slides.

Don’t expect a panacea or catharsis. Dan is one person and he has his own constituency there to satisfy. “Anti - trust” keeps coming up as the biggest cock-block.

let’s see them!

 

[Ray D. Ayshun]

I got ahold of this first slide:

Haven't seen where it went after that.

 

[RadOncDoc21]

Sounds like ASTRO will let you give a PowerPoint presentation, but not an illegal PowerPoint presentation.

CONSTITUTION: All speech is free.
ASTRO: Yes. Except if you're speaking about how many rad oncs there should be... then, you're a criminal.

Lock ‘em up!!

 

[communitydoc13]

Anti-trust as bogus as it gets. I cannot imagine anti-trust applying to a "recommendation" from an entity such as SCAROP to reduce spots, made publicly and impacting individual institutions not by mandate but by culture.

SCAROP could address this with a couple sentences.

"SCAROP recommends a marked reduction in residency training positions nationally. The most equitable path forward is for each department to consider a 50% reduction in trainees to be accomplished over a 3 year period."

Maybe that's in one of the slides?

 

[Ray D. Ayshun]

Anti-trust as bogus as it gets. I cannot imagine anti-trust applying to a "recommendation" from an entity such as SCAROP to reduce spots, made publicly and impacting individual institutions not by mandate but by culture.

SCAROP could address this with a couple sentences.

"SCAROP recommends a marked reduction in residency training positions nationally. The most equitable path forward is for each department to consider a 50% reduction in trainees to be accomplished over a 3 year period."

Maybe that's in one of the slides?

I think that quote was represented by the boy in the slide. The PM represented trial lawyers.

 

[taserlaser]

"And as far as I can tell, all the research is being done by docs at nci centers and suggests worse care at non-nci centers."

My wealthiest and healthiest patients are the ones who make it to tertiary care centers. The sicker and poorer ones are those who cannot travel and stay in the community for care. In my opinion the difference in outcome between NCI centers and non-NCI centers is fully explained by socioeconomic factors.

I love hypofractionation, but I’ll be the first to admit that in my rural patients (of which I have many), I sometimes have no other choice but to use suboptimal hypofractionated regimens when the alternative is no treatment. Can’t do low-toxicity, curative intent 5 fr for everything even if you want.

 

[BobbyHeenan]

What exactly are the damages and who are the parties that would bring a suit in an anti trust case?

There is no army of med students just dying to get into rad onc and can't do so. Who is being harmed by training less rad oncs? There is now loads of data showing a disconnect between training more doctors and filling rural positions, so it's not like if you cut spots you make it harder to fill Rhinelander.

I contend their biggest threat of lawsuit is a group of disgruntled residents or early career rad oncs that were lied to regarding career opportunities and/or can show collaboration from chairs to intentionally flood the market to drive down costs.

 

[Mandelin Rain]

I contend their biggest threat of lawsuit is a group of disgruntled residents or early career rad oncs that were lied to regarding career opportunities and/or can show collaboration from chairs to intentionally flood the market to drive down costs.

Yup.

 

[communitydoc13]

I contend their biggest threat of lawsuit

Nah. The biggest threat is one of the SCAROP members themselves initiating a lawsuit on behalf of their own institution. It would be frivolous of course, but I think its the threat of frivolous chairs that is now the real "cock-block" to change.

 

[RickyScott]

If anti trust is a concern, then problem is not solvable, and it is everyone's obligation including SCAROPS to warn med students.

 

[jondunn]

Telling SCAROP not to match is like telling @thecarbonionangle to lay off the coke. It simply isn't going to happen.

 

[TheWallnerus]

Telling SCAROP not to match is like telling @thecarbonionangle to lay off the coke. It simply isn't going to happen.

Or like telling a community private practice doc not to use 20 fractions for bone mets. Hey-o!

 

[BobbyHeenan]

Nah. The biggest threat is one of the SCAROP members themselves initiating a lawsuit on behalf of their own institution. It would be frivolous of course, but I think its the threat of frivolous chairs that is now the real "cock-block" to change.

I didn't even think of that.
So one of the chairs that wants to expand ("just look at our volumes, we NEED more residents, we DESERVE more residents") but is "blocked" and so files anti-trust?

That makes sense.

 

[DrAdonis]

Great points. I think radonc needs to expand more like how clinical oncologists have done in the UK to give systemic therapies, and at minimum radiopharm. I may be fortunate, but have spoken to many private practice radoncs who do the same, but I write for all oral ARSIs and are getting our hot lab up in radonc to deliver 177Lu-PSMA. I am also lucky, but lead many drug trials and work with pharma to help inform future work with combination drug-RT, and radoncs are uniquely suited for many of these roles given our vast knowledge of cancers across the body and various treatments. We also have more and more biomarkers being developed and play important roles at tumor boards.

I just worked with our newest faculty recruit who is amazing to put out 2 papers in PRO on how to use radiopharm and stressed the importance of radonc being involved. Hope they come online soon.

Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologists the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next lines of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years while sole Med Onc training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologists?

We don’t need permission from ABIM to do this just like dermatologists didn’t get ABR certification to use LINACs and GyneOncs didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists (Clinical Oncs are recognized as the leaders of tumor boards) and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.

 

[RickyScott]

Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologist the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next line of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years. Med Onc only training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologist?

We don’t need permission of ABIM to do this. Dermatologist didn’t get ABR certification to use LINACs, GyneOnc didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.

Couldn’t agree with you more. Problem is not fixable just by cutting spots.

 

[OTN]

Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologist the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next line of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years. Med Onc only training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologist?

We don’t need permission of ABIM to do this. Dermatologist didn’t get ABR certification to use LINACs, GyneOnc didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.

If SCAROP/ASTRO/WHATEVER BAG OF LETTERS keeps on bringing up the asinine "anti-trust" argument, then moving to creating "clinical oncologists" rather than purely radiation oncologists is realistically the only thing that can be done to save the specialty.

 

[jondunn]

I'm sure our med onc colleagues will be HAPPY and THRILLED and won't say a PEEP!

 

[Chartreuse Wombat]

"Anti-trust" could be the one sentence to describe the problem and why students are less interested, they see the oversupply and have lost trust.

I am not a lawyer..but it strikes me that "anti-trust" goes both ways

Scenario #1-Entities collude to fix prices
Scenario #2-Entities collude to fix labor

 

[medgator]

I am not a lawyer..but it strikes me that "anti-trust" goes both ways

Scenario #1-Entities collude to fix prices
Scenario #2-Entities collude to fix labor

The issue is that for the ASTRO honchos like Harari and Hallahan etc it only goes in one direction

 

[CurbYourExpectations]

Do we have access to the slides yet?

 

[Neuronix]

Do we have access to the slides yet?

I have not yet received anything.

 

[RickyScott]

Do we have access to the slides yet?

Just the awards…

 

[elementaryschooleconomics]

 

[RickyScott]

Scarop effectively seems to be a part of Astro?

 

[DrAdonis]

I'm sure our med onc colleagues will be HAPPY and THRILLED and won't say a PEEP!

MedOnc and Clinical Onc coexist is most climes. They’ll continue their job as it is, our expansion won’t affect them significantly as demand is high. They’ll exclusively manage benign hematology and hematologic malignancies, both specialties can prescribe systemics for solid tumors and we will continue to irradiate.

For a RadOnc majorly treating prostate and already prescribing ARSIs, adding Docetaxel to the list will more or less make one a clinical oncologist for that site - those are the common drugs for PCa. It will take people like Dan Spratt not so much to take such single steps, we can start from there and make it not unusual to be a clinical oncologist in the US.

I can also think of many scenarios without putting in much thought e.g inviting renowned clinical oncs from Europe to spend 2-3 months in our departments as exchange scholars if MedOnc tries to make the 1 year rotation difficult.
There’s no doubt that MedOncs will grumble at the beginning but that’s not unexpected. We will all be fine at the end and our patients will most likely be better for it.

 

[pikachu]

If SCAROP/ASTRO/WHATEVER BAG OF LETTERS keeps on bringing up the asinine "anti-trust" argument, then moving to creating "clinical oncologists" rather than purely radiation oncologists is realistically the only thing that can be done to save the specialty.

I think you are right but changes will be painful in the short term. Training will require structural revision down to the intern year. No more cush TYs…all will have to do IM. Is the specialty ready for this?!?!🤔

 

[thecarbonionangle]

I would argue that attracting the kind of applicant who would not want to do an IM year might have been what bit us in ass. We basically hyper selected people who wanted to make tons of money, have a light schedule and wanna live within a 30 mile circle of manhattan otherwise the horror! Wait until the pitchforks come.

 

[CurbYourExpectations]

I would argue that attracting the kind of applicant who would not want to do an IM year might have been what bit us in ass. We basically hyper selected people who wanted to make tons of money, have a light schedule and wanna live within a 30 mile circle of manhattan otherwise the horror! Wait until the pitchforks come.

A linac, a couple of cytotoxic drugs, a swamp.. sounds like a good time.

 

[thecarbonionangle]

A linac, a couple of cytotoxic drugs, a swamp.. sounds like a good time.

Im not attending this party unless you throw in some rosé and chicken

 

[OTN]

I think you are right but changes will be painful in the short term. Training will require structural revision down to the intern year. No more cush TYs…all will have to do IM. Is the specialty ready for this?!?!🤔

I did an IM year bring it