…but what you can you do for your country
I think in a lot of ways SDN has served as the proverbial canary in the coalmine regarding many of the current issues we have in the field (at least in the US). I’ve always been impressed with the level of intellectual discourse and wide array of opinions on this board. In fact, I would posit that the unfiltered academic/private discussion on these boards likely exceeds that of any conference or communication medium in the field today.
With that said, I would like to see if we could sublimate the braintrust of the board to shift the seemingly singular focus on issues regarding residency overexpansion into something more useful and actionable. What can we do, on an individual and practice level, whether private or academic, to ensure the long-term success and longevity of the field?
To me, the single most important thing we can do to ensure our relevancy is to expand the uses and indications of radiation. And not just oncology, as many here of pointed out, benign indications are a huge opportunity for us to improve patient care and quality of life in a more cost efficient way than drug therapy. There are a number of things I think we can do in this regard (hopefully you guys can chime in with many more)
However, if one were to step back and look at the long, long-term health and viability of the field I think that at some point, expansion has to be part of the overarching goal. Quite simply, we need the human capital. I don't know the right answer on how to rationally do this without causing a job squeeze. But its clear at some point we would benefit from a larger specialty. We need more people to be innovative in generating new indications for radiation use. We need more people to advocate on our behalf in congress when they try to cut funding or abruptly change rules. We need larger departments to pushback when hospitals try to marginalize our specialty. We need more people to have negotiating power against insurance companies when they try to lower reimbursement. We need more people to run our trials. We need more people to be in the lab to find that holy grail radiosensitizer. Because I don’t think 100-200 people a year is going to cut it. Are we really going to put that trust on the shoulders of the 20-30 people each year that actually end up doing any meaningful research in our field? Can we really expect any significant innovation using that strategy? Because we are really squeezing the last drops we have on technological innovation. We can’t be comfortable with where we are now, otherwise we will be stuck in the same position – reacting to larger forces (CMS, etc) rather than the other way around.
I think in a lot of ways SDN has served as the proverbial canary in the coalmine regarding many of the current issues we have in the field (at least in the US). I’ve always been impressed with the level of intellectual discourse and wide array of opinions on this board. In fact, I would posit that the unfiltered academic/private discussion on these boards likely exceeds that of any conference or communication medium in the field today.
With that said, I would like to see if we could sublimate the braintrust of the board to shift the seemingly singular focus on issues regarding residency overexpansion into something more useful and actionable. What can we do, on an individual and practice level, whether private or academic, to ensure the long-term success and longevity of the field?
To me, the single most important thing we can do to ensure our relevancy is to expand the uses and indications of radiation. And not just oncology, as many here of pointed out, benign indications are a huge opportunity for us to improve patient care and quality of life in a more cost efficient way than drug therapy. There are a number of things I think we can do in this regard (hopefully you guys can chime in with many more)
- Design (and enroll! – especially for those in community centers) trials that expand the indications for radiation. Oligomets, SABR vs TORS, SABR vs wedge, etc. If you are community center with even a modicum of clinical trial resources, considering enrolling on one or all of these “potentially increase radiation utilization” trials. Think of each one as a blue chip stock that if it hits, will lead to future long term gains for both you and future generations.
- Donate and volunteer for Radiation Oncology advocacy at Capitol Hill. Some of you guys hate ASTRO, I get it, but if not ASTRO find an organization like ACRO that does advocacy and volunteer to get our voices heard. If you don’t have time to volunteer, donate. Again, another form of long term investment in the field. If we had a stronger voice in CMS, strong chance that the current rules changes don’t happen.
- Volunteer in hospital committees. These come in various shapes and sizes. There are cancer control committees, IRBs, etc. at all private and academic centers. These are constantly in turnover because quite frankly, they are boring and thankless jobs. Do them anyway, they increase visibility of the people in our field and you will be an a better position to advocate.
- Speak up at tumor boards. Remind people of the standards of care involving radiation and always make yourself available to discuss radiation with pts, even if it is not something they will end up getting
However, if one were to step back and look at the long, long-term health and viability of the field I think that at some point, expansion has to be part of the overarching goal. Quite simply, we need the human capital. I don't know the right answer on how to rationally do this without causing a job squeeze. But its clear at some point we would benefit from a larger specialty. We need more people to be innovative in generating new indications for radiation use. We need more people to advocate on our behalf in congress when they try to cut funding or abruptly change rules. We need larger departments to pushback when hospitals try to marginalize our specialty. We need more people to have negotiating power against insurance companies when they try to lower reimbursement. We need more people to run our trials. We need more people to be in the lab to find that holy grail radiosensitizer. Because I don’t think 100-200 people a year is going to cut it. Are we really going to put that trust on the shoulders of the 20-30 people each year that actually end up doing any meaningful research in our field? Can we really expect any significant innovation using that strategy? Because we are really squeezing the last drops we have on technological innovation. We can’t be comfortable with where we are now, otherwise we will be stuck in the same position – reacting to larger forces (CMS, etc) rather than the other way around.
