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A Naive Thought

FifthDayOfMay

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Scrolling through these posts on this message board and I can’t help but have a genuinely put off reaction to the snark. It seems like every thread is used as an opportunity to let out all the negativity so many folks in this field apparently have pent up.

Might be helpful to think about some of the things people reading through these posts are actually going through. Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.

It’s a tough time right now. People are worried about jobs, smart hard working people just like you. Reimbursement in the field continues to change with quite a bit of near term uncertainty. Perhaps we should focus on how we can help each other and even strangers. I know, a naive thought, but one nonetheless.
 
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RadsWFA1900

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Scrolling through these posts on this message board and I can’t help but have a genuinely put off reaction to the snark. It seems like every thread is used as an opportunity to let out all the negativity so many folks in this field apparently have pent up.

Might be helpful to think about some of the things people reading through these posts are actually going through. Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.

It’s a tough time right now. People are worried about jobs, smart hard working people just like you. Reimbursement in the field continues to change with quite a bit of near term uncertainty. Perhaps we should focus on how we can help each other and even strangers. I know, a naive thought, but one nonetheless.

What are you on about?
 
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thecarbonionangle

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Scrolling through these posts on this message board and I can’t help but have a genuinely put off reaction to the snark. It seems like every thread is used as an opportunity to let out all the negativity so many folks in this field apparently have pent up.

Might be helpful to think about some of the things people reading through these posts are actually going through. Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.

It’s a tough time right now. People are worried about jobs, smart hard working people just like you. Reimbursement in the field continues to change with quite a bit of near term uncertainty. Perhaps we should focus on how we can help each other and even strangers. I know, a naive thought, but one nonetheless.

We all wish rad onc world was a bunch of care bears and dancing teletubbies but unfortunately, it ain’t!!!!! E78C63CB-8124-451C-B960-94A0A5CD4E09.jpeg
 
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OTN

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“Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.”

We here had nothing to gain from trying, in vain, to help keep our field from destroying itself from within. We simply wanted younger physicians to have the same opportunities and career satisfaction we have been able to enjoy. We always have been sympathetic to their cause and have offered, time and time again, real solutions that have fallen upon deaf ears.

As a result, I’m sure you’ll understand when we don’t take well to someone who, after conveniently ignoring the aforementioned history, rides into a forum on a horse that’s several stories too tall.
 
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FifthDayOfMay

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“Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.”

We here had nothing to gain from trying, in vain, to help keep our field from destroying itself from within. We simply wanted younger physicians to have the same opportunities and career satisfaction we have been able to enjoy. We always have been sympathetic to their cause and have offered, time and time again, real solutions that have fallen upon deaf ears.

As a result, I’m sure you’ll understand when we don’t take well to someone who, after conveniently ignoring the aforementioned history, rides into a forum on a horse that’s several stories too tall.

Good take, reacting judgmentally to the simple suggestion of not being so judgmental is spot on. Good work.
 
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elementaryschooleconomics

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Scrolling through these posts on this message board and I can’t help but have a genuinely put off reaction to the snark. It seems like every thread is used as an opportunity to let out all the negativity so many folks in this field apparently have pent up.

Might be helpful to think about some of the things people reading through these posts are actually going through. Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.

It’s a tough time right now. People are worried about jobs, smart hard working people just like you. Reimbursement in the field continues to change with quite a bit of near term uncertainty. Perhaps we should focus on how we can help each other and even strangers. I know, a naive thought, but one nonetheless.

I understand where you're coming from here - a few additional thoughts, then:

1) Have you ever tried to vent to your colleagues in real life about systemic issues in Radiation Oncology? How did that go for you if so? At least in my neck of the woods, even just researching issues is met with derision. Specific stories would probably doxx me, but I have had my career threatened for asking about change on a local level - meanwhile, people like Ralph and Drew get on Twitter and blast people on a national level. For further reference, one needs to look no further than the infamous "Bloodbath in the Red Journal" thread. Who can I vent to, then, if I have been taught that in real life exploring issues means I can't feed my family?

2) I think a lot of creative solutions (born of empathy) have been developed on this forum. The big one - perceived oversupply leading to a tenuous job market - is discussed the most, as well as what could (should?) be done. The answer is probably pretty basic though - doubling residents so quickly was a questionable idea, therefore, resident numbers should quickly decrease.

3) I don't know if you mean "helping each other" in an emotional sense or a literal sense. In a literal sense - no one can help anyone else here without sacrificing anonymity, which brings me back to point #1 - the main draw of SDN is being able to talk/vent about issues without personal retribution.

In my experience, the snark and negativity on SDN is reflective of what Radiation Oncology is actually like. There are a lot, A LOT, of people that are very nice to my face, and then I hear about their terrifying machinations and gossip later on. At least here, what you see is what you get.

The highroad of RadOnc is paved with the bodies of the naive.
 
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RickyScott

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I understand where you're coming from here - a few additional thoughts, then:

1) Have you ever tried to vent to your colleagues in real life about systemic issues in Radiation Oncology? How did that go for you if so? At least in my neck of the woods, even just researching issues is met with derision. Specific stories would probably doxx me, but I have had my career threatened for asking about change on a local level - meanwhile, people like Ralph and Drew get on Twitter and blast people on a national level. For further reference, one needs to look no further than the infamous "Bloodbath in the Red Journal" thread. Who can I vent to, then, if I have been taught that in real life exploring issues means I can't feed my family?

2) I think a lot of creative solutions (born of empathy) have been developed on this forum. The big one - perceived oversupply leading to a tenuous job market - is discussed the most, as well as what could (should?) be done. The answer is probably pretty basic though - doubling residents so quickly was a questionable idea, therefore, resident numbers should quickly decrease.

3) I don't know if you mean "helping each other" in an emotional sense or a literal sense. In a literal sense - no one can help anyone else here without sacrificing anonymity, which brings me back to point #1 - the main draw of SDN is being able to talk/vent about issues without personal retribution.

In my experience, the snark and negativity on SDN is reflective of what Radiation Oncology is actually like. There are a lot, A LOT, of people that are very nice to my face, and then I hear about their terrifying machinations and gossip later on. At least here, what you see is what you get.

The highroad of RadOnc is paved with the bodies of the naive.
In total agreement with you. More scarce that jobs become, more afraid people are going to be about speaking out.
 
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Mandelin Rain

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I'm not sure this board is the place to solve the world's problems. Yes, acute joblessness is rampant across the country. It's terrible. No one wants that. This board has been dedicated to preventing chronic joblessness in radiation oncology. I think that's pretty important for future, smart, hard-working radiation oncologists.

I guess my question is, what are you doing to help, right now?
 
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Lamount

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I understand where you're coming from here - a few additional thoughts, then:

1) Have you ever tried to vent to your colleagues in real life about systemic issues in Radiation Oncology? How did that go for you if so? At least in my neck of the woods, even just researching issues is met with derision. Specific stories would probably doxx me, but I have had my career threatened for asking about change on a local level - meanwhile, people like Ralph and Drew get on Twitter and blast people on a national level. For further reference, one needs to look no further than the infamous "Bloodbath in the Red Journal" thread. Who can I vent to, then, if I have been taught that in real life exploring issues means I can't feed my family?


In my experience, the snark and negativity on SDN is reflective of what Radiation Oncology is actually like. There are a lot, A LOT, of people that are very nice to my face, and then I hear about their terrifying machinations and gossip later on. At least here, what you see is what you get.

The highroad of RadOnc is paved with the bodies of the naive.

I agree with the sentiment of the original poster... there is a fair amount of negativity and "snark" on this forum. I would challenge elementaryschooleconomics' post by pointing out that his/her experiences in rad onc are not universal. I am a junior faculty at an academic center and have a supportive chair, supportive mentor, and supportive colleagues... and I feel I could comfortably complain if need be (which is a fairly rare occurrence). I have a ton of autonomy in deciding my treatment approaches (perhaps even too much) and I don't lack for opportunities to do meaningful research. His/her experiences are anecdotal, as are mine... and neither of us can intelligently speak to what "Radiation Oncology is actually like"

To all,

As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.

While self-flagellation may make many feel better, it's hard to see how its utility extends beyond catharsis. Absent objective data that demonstrates pervasive discontent in practicing rad oncs rad onc, don't presume that we all must feel this way. I can tell you that I don't.. and I am guessing we all have the same telepathic abilities to read the minds of everyone in our field.
 
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As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.
SDN is the yin to Rad Onc Twitters #radoncrocks "everything is awesome" yang ....

As many of us have stated before, we love our current jobs/compensation/lifestyle etc but do not like how these opportunities are becoming rarer through expansion
 
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I agree with the sentiment of the original poster... there is a fair amount of negativity and "snark" on this forum. I would challenge elementaryschooleconomics' post by pointing out that his/her experiences in rad onc are not universal. I am a junior faculty at an academic center and have a supportive chair, supportive mentor, and supportive colleagues... and I feel I could comfortably complain if need be (which is a fairly rare occurrence). I have a ton of autonomy in deciding my treatment approaches (perhaps even too much) and I don't lack for opportunities to do meaningful research. His/her experiences are anecdotal, as are mine... and neither of us can intelligently speak to what "Radiation Oncology is actually like"

To all,

As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.

While self-flagellation may make many feel better, it's hard to see how its utility extends beyond catharsis. Absent objective data that demonstrates pervasive discontent in practicing rad oncs rad onc, don't presume that we all must feel this way. I can tell you that I don't.. and I am guessing we all have the same telepathic abilities to read the minds of everyone in our field.
"Absent objective data that demonstrates pervasive discontent"....i don't know that anyone is claiming that the discontent on this board is representative of the field...if anyone is then a smart person would know that it is not true..
Personally I have a great job with a supportive boss. One of my children is a second-year medical student and don't recommend radiation oncology as a future career because the job dynamics are so poor.
The moderators have done a fine job of deleting and banning the ad hominem attacks but the nature of this medium is too let people "self-flagellate".
If you don't like it go someplace else (or better just ignore and pay attention to those posts that interest you)
 
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Mandelin Rain

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I love my job. I would like to be able to find a job that I love equally if I had to move for some reason. I also think that new graduates should have the opportunity to find jobs that they love. I don't think the current path will sustain those opportunities, so I speak out about it here.

Self-flagellation? You decide.
 
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RickyScott

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I love my job. I would like to be able to find a job that I love equally if I had to move for some reason. I also think that new graduates should have the opportunity to find jobs that they love. I don't think the current path will sustain those opportunities, so I speak out about it here.

Self-flagellation? You decide.
Exactly. Would also caution against invoking "compassion" to argue that residents should take the job in Salina, KS or some exploitative one.
 
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KHE88

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Scrolling through these posts on this message board and I can’t help but have a genuinely put off reaction to the snark. It seems like every thread is used as an opportunity to let out all the negativity so many folks in this field apparently have pent up.

Might be helpful to think about some of the things people reading through these posts are actually going through. Incredible to have to suggest empathy and creative solution based thinking over judgment and negativity to a group of physicians that take care of dying people so often.

It’s a tough time right now. People are worried about jobs, smart hard working people just like you. Reimbursement in the field continues to change with quite a bit of near term uncertainty. Perhaps we should focus on how we can help each other and even strangers. I know, a naive thought, but one nonetheless.

The reason why thought processes like this are dangerous is because it allows us to be exploited. To say that we should focus on helping each other and strangers (when did we ever stop helping our patients? and really by exposing this stuff we are helping our would-be peers to avoid this field) be grateful for the privilege of helping save lives and palliate the dying is to ignore what it took to get where we are as well as to ignore the realities of how our labor is traded. It allows large hospital organizations to exploit, and in the case of the academic institutions who serve as gatekeepers artifically manipulate with essentially no regulation, a supply demand curve, gaslight medical students into entering a saturated specialty, blind them to the realities of the business in training with a silly focus on pointless research projects, and the ultimately pay them a small fraction of their professional fees they have earned (let alone global revenue), and use that profit margin to pad their bottom line. If you complain, well then you are just greedy and don't value that privilege, which is apparently an intangible in a job offer now. How much is our privilege of taking care of cancer patients worth? An extra 100k/year? 200k? If you want to make the argument our services are overpriced and cut reimbursement and pass those savings on to the payors, fine, but the job market issues allow employers to pay rad oncs less and simply pocket the excess. They will gaslight and distract with other nonsense (e.g., the relentless red journal "diversity" publications keeping us focused on the big bad evil patriarchal ghost in the machine) and get a bunch of useful idiot-sycophants on Twitter to parrot the party line having literally no clue what they are talking about because they are as far removed from the business operations as the janitor.
 
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KHE88

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The yin to Rad Onc Twitters #radoncrocks "everything is awesome"yang ....

The difference is that there is no ulterior motive here. What does discussing problems with the field get us? You could make the argument we are conspiring to manipulate the supply-demand curve back in our favor by steering applicants away, but since programs will fill with FMGs, and that that grossly overestimates the impact of this place, that doesn't hold much weight.

Whereas a young academic posting some pollyanna silliness on Twitter next to his/her face certainly has a much greater impact if trying to gain the favor of a thought-leader with similar viewpoints. I would imagine posting a bunch of crap about how much rad onc sucks, regardless whether valid or not, isn't going to be a good look when your boss wants the department to look like a Potemkin village.
 
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This reads like a twitter post, but made on SDN. Might need a few more hashtags about #RadOncRocks Good luck, OP. Perhaps if you spoke in some direct fashion rather than vague niceties about solution finding.

We have been trying to come up with solutions for residency contraction on this forum. Nobody takes it seriously until it gets re-tweeted on twitter. SDN's anonymity is both its blessing and its curse. It's a blessing because it doesn't allow for professional retribution (which would certainly be in the realm of possibility for the KO's and other gungho folks that (still) believe that the specialty's "**** does not stink"). but it's a curse because it lets people simply ignore any points we have, because "who knows if we're even real radiation oncologists".

The stuff people are discussing on twitter now as things that need to change.... SDN was talking about 3 to 5 years ago. We're frustrated because people are paying lip service to all these things that are wrong, but no significant tangible event has occured that will take any steps to fix the problem. Just meeting after meeting where everyone can wring their hands and say "oh no, whatever can we do" for those "in power".
 
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FifthDayOfMay

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Seems like some of this discussion has actually been somewhat productive. I tend to believe intentions matter. Part of my initial post was to suggest that thinking about why we post something on here and what anyone's goal is in doing so matters. If you want to vent, fair, but I think that should be explicitly noted. Also important, in my opinion, as others have mentioned to consider whether your particular viewpoint can be or should be extrapolated to the field as a whole.

Maybe blaming is a part of trying to make the field, or just your job, better. I was honestly just taken aback when scrolling through posts at just how angry and judgmental the majority seem to be. The undercurrent of bitterness and disdain is nearly palpable and maybe that's just where things are at today for some of you. That said, also worth asking if that's not necessarily a product of big-picture happenings, but rather your particular situation. The field may or may not have major issues; that isn't mutually exclusive to folks not liking their specific job and/or position and/or the field as a whole.

Ultimately, I don't see going on to an online message board and angrily spouting out sarcastic cynical thoughts as something that would make too many people much happier, but I could be wrong.
 
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scarbrtj

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Seems like some of this discussion has actually been somewhat productive. I tend to believe intentions matter. Part of my initial post was to suggest that thinking about why we post something on here and what anyone's goal is in doing so matters. If you want to vent, fair, but I think that should be explicitly noted. Also important, in my opinion, as others have mentioned to consider whether your particular viewpoint can be or should be extrapolated to the field as a whole.

Maybe blaming is a part of trying to make the field, or just your job, better. I was honestly just taken aback when scrolling through posts at just how angry and judgmental the majority seem to be. The undercurrent of bitterness and disdain is nearly palpable and maybe that's just where things are at today for some of you. That said, also worth asking if that's not necessarily a product of big-picture happenings, but rather your particular situation. The field may or may not have major issues; that isn't mutually exclusive to folks not liking their specific job and/or position and/or the field as a whole.

Ultimately, I don't see going on to an online message board and angrily spouting out sarcastic cynical thoughts as something that would make too many people much happier, but I could be wrong.
Have some biryani(sp?). Can't spell it but it eats pretty good.
 
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elementaryschooleconomics

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Ultimately, I don't see going on to an online message board and angrily spouting out sarcastic cynical thoughts as something that would make too many people much happier, but I could be wrong.

I have written and deleted like 7 versions of this question because it reads as super sarcastic to me which is ironic and unintentional but - you're questioning the purpose of human expression?
 
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thecarbonionangle

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Seems like some of this discussion has actually been somewhat productive. I tend to believe intentions matter. Part of my initial post was to suggest that thinking about why we post something on here and what anyone's goal is in doing so matters. If you want to vent, fair, but I think that should be explicitly noted. Also important, in my opinion, as others have mentioned to consider whether your particular viewpoint can be or should be extrapolated to the field as a whole.

Maybe blaming is a part of trying to make the field, or just your job, better. I was honestly just taken aback when scrolling through posts at just how angry and judgmental the majority seem to be. The undercurrent of bitterness and disdain is nearly palpable and maybe that's just where things are at today for some of you. That said, also worth asking if that's not necessarily a product of big-picture happenings, but rather your particular situation. The field may or may not have major issues; that isn't mutually exclusive to folks not liking their specific job and/or position and/or the field as a whole.

Ultimately, I don't see going on to an online message board and angrily spouting out sarcastic cynical thoughts as something that would make too many people much happier, but I could be wrong.

catharsis is very important for many. Things are a lot more nuanced in real life and unfortunately these conversations can’t be had in an honest straightforward manner in person in a field with history of retribution toward those who hold dissenting views (see Shah hit job). So you end up with sdn. It may be imperfect but its probably the best thing we have at the moment.
Your opinion here matters as well and i welcome your views, so hope you stick around and provide that voice for those who agree with you.

in the end, we all want things to get better.
 
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elementaryschooleconomics

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catharsis is very important for many. Things are a lot more nuanced in real life and unfortunately these conversations can’t be had in an honest straightforward manner in person in a field with history of retribution toward those who hold dissenting views (see Shah hit job). So you end up with sdn. It may be imperfect but its probably the best thing we have at the moment.
Your opinion here matters as well and i welcome your views, so hope you stick around and provide that voice for those who agree with you.

in the end, we all want things to get better.

I totally agree - stick around!
 
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deleted774703

I agree with the sentiment of the original poster... there is a fair amount of negativity and "snark" on this forum. I would challenge elementaryschooleconomics' post by pointing out that his/her experiences in rad onc are not universal. I am a junior faculty at an academic center and have a supportive chair, supportive mentor, and supportive colleagues... and I feel I could comfortably complain if need be (which is a fairly rare occurrence). I have a ton of autonomy in deciding my treatment approaches (perhaps even too much) and I don't lack for opportunities to do meaningful research. His/her experiences are anecdotal, as are mine... and neither of us can intelligently speak to what "Radiation Oncology is actually like"

To all,

As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.

While self-flagellation may make many feel better, it's hard to see how its utility extends beyond catharsis. Absent objective data that demonstrates pervasive discontent in practicing rad oncs rad onc, don't presume that we all must feel this way. I can tell you that I don't.. and I am guessing we all have the same telepathic abilities to read the minds of everyone in our field.

Since you are such a positive person, why not go to your chair and tell them to sacrifice their net profit by hiring 10 new grads this year

Then you can say you helped everyone out and how supportive your department is :p
 
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deleted774703

SDN is the yin to Rad Onc Twitters #radoncrocks "everything is awesome" yang ....

As many of us have stated before, we love our current jobs/compensation/lifestyle etc but do not like how these opportunities are becoming rarer through expansion

This is awesome!

The keep things happy posts on SDN are such BS

Why don't the same ppl go on Twitter and say let's keep the overtly FAKE optimistic situations to themselves?

B/C Twitter, with the exception of a few honest ppl, is full of liars who do not have the best interest in the field. Just promote themselves and how great and humanistically superior they are to the rest of the world
 
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I personally enjoy the snark (within reason). If I post something *****ic (and I've certainly done so) then it should be rightfully called out. People should not withhold constructive criticism because of who I am or my seniority. Twitter is rife with such "attending worship."
 
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I personally enjoy the snark (within reason). If I post something *****ic (and I've certainly done so) then it should be rightfully called out. People should not withhold constructive criticism because of who I am or my seniority. Twitter is rife with such "attending worship."

My goal is to keep you humble... sharing that MJ tough love is hard but it’s only because I want you to win in life!
 
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I personally enjoy the snark (within reason). If I post something *****ic (and I've certainly done so) then it should be rightfully called out. People should not withhold constructive criticism because of who I am or my seniority. Twitter is rife with such "attending worship."

Great, comment GFunk, now you're getting the hang of this! [Insert meme]

Hope to see you at RSNA!!!! Biryani cookoff? [Several memes inserted, many a hashtag added, at least 9-10 other attendings tagged as well]
 
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Perhaps we should focus on how we can help each other and even strangers.

SDN would love to hear your suggestions about how we can help fellow radiation oncologists or medical students considering our specialty.
 
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Great, comment GFunk, now you're getting the hang of this! [Insert meme]

Hope to see you at RSNA!!!! Biryani cookoff? [Several memes inserted, many a hashtag added, at least 9-10 other attendings tagged as well]

So woke. #radoncrocks
 
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Gfunk6

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My goal is to keep you humble... sharing that MJ tough love is hard but it’s only because I want you to win in life!

Don't ever trash talk to Brown Jesus
 
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Lamount

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...i don't know that anyone is claiming that the discontent on this board is representative of the field...if anyone is then a smart person would know that it is not true..

Personally I have a great job with a supportive boss. One of my children is a second-year medical student and don't recommend radiation oncology as a future career because the job dynamics are so poor.
The moderators have done a fine job of deleting and banning the ad hominem attacks but the nature of this medium is too let people "self-flagellate".
If you don't like it go someplace else (or better just ignore and pay attention to those posts that interest you)


"i don't know that anyone is claiming that the discontent on this board is representative of the field...if anyone is then a smart person would know that it is not true.."
I would disagree to the extent that anyone who argues that this forum is not reflective the field usually earns quite a bit of ire.

I am an idealist at heart and enjoy a debate ... I guess I am aspiring to entoombed in the elementrayschooleconomics' "high road of RadOnc" haha.

"If you don't like it go someplace else (or better just ignore and pay attention to those posts that interest you)" Respectfully, the same could be said to those who responded to the original poster. This medium is also well suited for debate.



Clearly, you and I are both grateful for our lots in life... thus I don't think we disagree about all that much. 'Self-flagellation' doesn't irk me because I take it seriously nor does it really change how I view what I do or how I feel about the field. I simply think it is has no utility. It enlightens no one and advances nothing...
The problems with the field have been and are stated ad nauseum. Now what?
 
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Lamount

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Since you are such a positive person, why not go to your chair and tell them to sacrifice their net profit by hiring 10 new grads this year

Then you can say you helped everyone out and how supportive your department is :p

Not a bad idea.
...and of course, if I don't take credit for it here or on twitter, did it even happen? :)
 
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Chartreuse Wombat

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"i don't know that anyone is claiming that the discontent on this board is representative of the field...if anyone is then a smart person would know that it is not true.."
I would disagree to the extent that anyone who argues that this forum is not reflective the field usually earns quite a bit of ire.

I am an idealist at heart and enjoy a debate ... I guess I am aspiring to entoombed in the elementrayschooleconomics' "high road of RadOnc" haha.

"If you don't like it go someplace else (or better just ignore and pay attention to those posts that interest you)" Respectfully, the same could be said to those who responded to the original poster. This medium is also well suited for debate.



Clearly, you and I are both grateful for our lots in life... thus I don't think we disagree about all that much. 'Self-flagellation' doesn't irk me because I take it seriously nor does it really change how I view what I do or how I feel about the field. I simply think it is has no utility. It enlightens no one and advances nothing...
The problems with the field have been and are stated ad nauseum. Now what?
Nothing to do which is why people rant.
IMO three major problems for RO-
1) Increasing supply of RO doctors. Resident expansion can only be fixed by SCAROP (and they are not interested). All the moaning about ABR, ACGME, ASTRO-it is not within their mission to reduce trainee numbers.
2) Decreased demand for RO doctors. Supervision requirements and hypofractionation (sometimes extreme). The ship has sailed and when we discover that the horrible radiation disasters did not increase during COVID when supervision was even looser...hard to make the case (see scarb posts ad infinitum (not ad nauseum because that might trigger someone.)
3) Radiation Oncology has become a technopoly. This is mentioned less but is evident behind the scenes and deeply embedded in the way many think within RO. If you don't know that a technopoly is the short version is here. Longer version here. Neil Postman defined a technopoly as a society in which technology is deified, meaning “the culture seeks its authorisation in technology, finds its satisfactions in technology, and takes its orders from technology." In RO it is manifest by engaging in DVH idolatry and accepting weak evidence that the newest technology (e.g. SBRT) is the best. The work that we do and the questions we ask are all defined by technology. The typical criticism is to cry "Luddite". Of course technology development is important but we seem to forget that the machines, etc are means to an end not an end in and of itself.

Thoreau warned us that humans "have become tools of our tools".
 
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Chartreuse Wombat

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I have no distaste for prostate SBRT. I have performed it for more than a decade; LDR and HDR for 2 decades.

Let me give you an example of the larger point I was trying to make. This January at the RTOG NRG (sorry i am old) GU strategy meeting attended by 50 or so people 7 concepts were presented. ALL 7 explored SBRT in different contexts-radiorecurrent prostate cancer, ureteral cancer, etc. Every single new idea had SBRT in the schema. One episode yes but it is reflection of my larger point that all of our "new" ideas are wedded to technologies.
 
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2014XRT

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I have no distaste for prostate SBRT. I have performed it for more than a decade; LDR and HDR for 2 decades.

Let me give you an example of the larger point I was trying to make. This January at the RTOG GU strategy meeting attended by 50 or so people 7 concepts were presented. ALL 7 explored SBRT in different contexts-radiorecurrent prostate cancer, ureteral cancer, etc. Every single new idea had SBRT in the schema. One episode yes but it is reflection of my larger point that all of our "new" ideas are wedded to technologies.

well this I agree with, in large part at NRG because med oncs are obsessed with the idea of SBRT. They think it is something 'special'
 
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Lamount

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Nothing to do which is why people rant.
IMO three major problems for RO-
1) Increasing supply of RO doctors. Resident expansion can only be fixed by SCAROP (and they are not interested). All the moaning about ABR, ACGME, ASTRO-it is not within their mission to reduce trainee numbers.
2) Decreased demand for RO doctors. Supervision requirements and hypofractionation (sometimes extreme). The ship has sailed and when we discover that the horrible radiation disasters did not increase during COVID when supervision was even looser...hard to make the case (see scarb posts ad infinitum (not ad nauseum because that might trigger someone.)
3) Radiation Oncology has become a technopoly. This is mentioned less but is evident behind the scenes and deeply embedded in the way many think within RO. If you don't know that a technopoly is the short version is here. Longer version here. Neil Postman defined a technopoly as a society in which technology is deified, meaning “the culture seeks its authorisation in technology, finds its satisfactions in technology, and takes its orders from technology." In RO it is manifest by engaging in DVH idolatry and accepting weak evidence that the newest technology (e.g. SBRT) is the best. The work that we do and the questions we ask are all defined by technology. The typical criticism is to cry "Luddite". Of course technology development is important but we seem to forget that the machines, etc are means to an end not an end in and of itself.

Thoreau warned us that humans "have become tools of our tools".


I agree with the spirit of your argument. As I see it (with my many months of wisdom) problems we face can be divided into two semi-distinct entities:
A) Problems facing Rad Onc as a profession. Unbridled residency expansion, decreased radiation utilization (hypofx, better surgical/systemic options), decreased opportunities for re-reimbursement (decreased supervision requirements), and now we likely face a decrease in our patient population due to their disproportional susceptibility to COVID.
B) Problems facing Rad Onc as a discipline
Rad Onc is not very supportive of innovation. There is no greater past-time in our field then throwing stones at anyone who dares try something new (Particles? FLASH? Low Dose RT for COVID?... "why even bother looking?"). We struggle to translate some truly innovative lab research into the clinic and tend to shy away from testing uncoventional applications of RT. This is partly due to risk aversion (e.g. to paraphrase Weichselbaum, 'we have to be focused on how we look to other disciplines'); and partly due to an unhealthy degree of momentum behind current treatment paradigms.

The way I see it, we can't do much about A) for the reasons you said, but we can do something about B), and may end up helping A) in the process.

I also agree with the concerns about "technocracy" but, ironically enough, I think is also due to a lack of innovation. We are failing to stay ahead of our technology
-We treat DVHs as gospel but forget that it only represents the world as we hope it is. We will normalize a plan up or down by 0.5 Gy to meet constraints or get adequate coverage without acknowledging the possibility that the target or OAR may not be where we think it is. Rather than hanging our hat on what we think we know, we should get better at modeling error.

-SBRT isn't magical and radiobiology still applies. If one is hitting constraints in 5 fractions, the therapeutic ratio will probably be better in 8, 10, or 15 fractions (except for low a/b tumors). The true advances that led to the expansion of SBRT were better conformality and better image guidance and these improvement has nothing to do with the number of fractions.

-Protons aren't magical either. They have an additional degree of freedom, which can dramatically improve conformality, but it comes at the cost of systematic errors. The failure to respect the impact of range uncertainties and LET on can result in real harm.

If we can't explain to ourselves (and any layman) the limitations of a technology, we probably don't know enough to use it safely and effectively.

*edited to fix some iPhone-related errors
 
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thesauce

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I agree with the sentiment of the original poster... there is a fair amount of negativity and "snark" on this forum. I would challenge elementaryschooleconomics' post by pointing out that his/her experiences in rad onc are not universal. I am a junior faculty at an academic center and have a supportive chair, supportive mentor, and supportive colleagues... and I feel I could comfortably complain if need be (which is a fairly rare occurrence). I have a ton of autonomy in deciding my treatment approaches (perhaps even too much) and I don't lack for opportunities to do meaningful research. His/her experiences are anecdotal, as are mine... and neither of us can intelligently speak to what "Radiation Oncology is actually like"

To all,

As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.

While self-flagellation may make many feel better, it's hard to see how its utility extends beyond catharsis. Absent objective data that demonstrates pervasive discontent in practicing rad oncs rad onc, don't presume that we all must feel this way. I can tell you that I don't.. and I am guessing we all have the same telepathic abilities to read the minds of everyone in our field.

So when you say that SDN is skewed towards those with grievances...are you saying there are a bunch of people practicing out in the real world (and not on SDN) trumpeting how great the oversupply problem is?

Basically every “complainer” on here that has exposed the poor job prospects and the horrible over-supply problem (both of which DO have objective data) hurting graduating residents have started or ended with “I am in a good place, but I feel for these new grads.”
 
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