ASTRO should censure these Penn attendings

[speakeroftruth]

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I was walking outside today and stepped in dogsh*t. As I looked to survey the damage on the bottom of my shoe and saw feces caking the soles, do you know what I immediately thought of? This looks exactly like the article out of Penn by Butala et al about the need for a certified palliative care network. I refrained from making any comments when the article initially came out and I am upset that I was reminded of that absolute sh*tstain of a publication today because I stepped in dog feces. If you are wondering what article is this and why didn't I link it, it's simple. I didn't want the run the very high risk of my computer developing cancer by opening such a horrific, insulting article.

I know Simul and Todd responded. They were far too professional in their response. I'm glad though that there was a response but it should have been a much, much more harsh. I don't want to get into why the article is so bad as it is painfully obvious to anyone. But one of the many reasons it really bothers me is that it further degrades the very important relationship between academics and private practice.

As I tried to wipe off the dogsh*t, I wondered what was running through the minds of the authors who decided that in the middle of a once-in-a-lifetime pandemic, with hundreds of thousands dying across the world, often alone and bereft of loving touch of their families due to virus-related restrictions, that anyone could countenance writing such a piece of dogsh*t article. I can't even say the authors names because it pains me so - I'll refer to them as their own sub-primate species, monke. And I don't mean monkey because don't you dare associate the monkey, an intelligent, beautiful animal with this new sub-primate species now called monke.

The field of rad onc: on fire with massive residency overexpansion, increasingly terrible job prospects, and decreasing RT indications
COVID-19: just killing so many people
No one:
Literally no one:
Guys, I mean actually no one:
Monke: (grunting/squeaking/screeching sounds from the basement) this year is a great time to address a major crisis in rad onc - there are board certified rad oncs who have passed physics, rad bio, clinical written, and oral boards giving 8 Gy x 1 and 3 Gy x 10 in the community that have not been certified by the ABR to give palliative RT!
Rad onc journal: this is incredible

I have no words. At this point, our field deserves to simply die. But hey, I discovered a new sub-primate species that can apparently write English, the monke. Which rad onc journal should I send it to?

Which brings me to my question to you all. Should residents be punished for insulting, field-degrading publications such as this one? For example, if you saw this type of article on someone's CV, is it ok to throw that CV in the trash and vow to never hire such a person? If someone has already snuck past security and in your dept, is it ok to exclude them from academic opportunities such as study collaborations, clinical trials, journal reviews, committee assignments, etc.?

And what about the attendings you ask? There is no question that any attending who voluntarily puts their name on this type of absolute dogsh*t should be ridiculed and put on indefinite leave so that they can't infect other rad oncs with their mere presence. They should absolutely be shunned by their colleagues and punished in any way possible. So yes, the attendings should be shamed and there is no question of that.

As a note to medical students and residents (and I can't believe I have to say this to attendings), a publication is not a chance to pad your CV. You were born with one thing and will die with one thing in this world - that is your name. Treat it like gold because you only have one name and you better be 120% sure putting your name on something that is going to be published. There can be real consequences.

Edit: Some grammar and spelling
Edit 2: I changed the title of the post.

Moderator edit: I edited your title again. Please do not attack students/trainees. Also, please use professional tone. Swearing is not allowed on SDN, even if it's ****ed out.

Edit 3: I changed the title again mod. I agree, we should focus on the attendings who should be mentoring students and residents from avoiding these types of mistakes.
Edit 4: I edited the paragraph about the attendings. I realized it was very unclear. From the start, I was saying we should always blame the attendings and that there was no question of that.

 

[RadOncDoc21]

Monkies are known for throwing their own feces on to people. So maybe rad oncs are a lesser life form such as the monke!

To answer your question... yes, they all should be shamed!

 

[Krukenberg]

I was walking outside today and stepped in dogsh*t. As I looked to survey the damage on the bottom of my shoe and saw feces caking the soles, do you know what I immediately thought of? This looks exactly like the article out of Penn by Butala et al about the need for a certified palliative care network. I refrained from making any comments when the article initially came out and I am upset that I was reminded of that absolute sh*tstain of a publication today because I stepped in dog feces. If you are wondering what article is this and why didn't I link it, it's simple. I didn't want the run the very high risk of my computer developing cancer by opening such a horrific, insulting article.

I know Simul and Todd responded. They were far too professional in their response. I'm glad though that there was a response but it should have been a much, much more harsh. I don't want to get into why the article is so bad as it is painfully obvious to anyone. But one of the many reasons it really bothers me is that it further degrades the very important relationship between academics and private practice.

As I tried to wipe off the dogsh*t, I wondered what was running through the minds of the authors who decided that in the middle of a once-in-a-lifetime pandemic, with hundreds of thousands dying across the world, often alone and bereft of loving touch of their families due to virus-related restrictions, that anyone could countenance writing such a piece of dogsh*t article. I can't even say the authors names because it pains me so - I'll refer to them as their own sub-primate species, monke. And I don't mean monkey because don't you dare associate the monkey, an intelligent, beautiful animal with this new sub-primate species now called monke.

The field of rad onc: on fire with massive residency overexpansion, increasingly terrible job prospects, and decreasing RT indications
COVID-19: just killing so many people
No one:
Literally no one:
Guys, I mean actually no one:
Monke: (grunting/squeaking/screeching sounds from the basement) this year is a great time to address a major crisis in rad onc - there are board certified rad oncs who have passed physics, rad bio, clinical written, and oral boards giving 8 Gy x 1 and 3 Gy x 10 in the community that have not been certified by the ABR to give palliative RT!
Rad onc journal: this is incredible

At this point, our field deserves to simply die. I have no words. But hey, I discovered a new sub-primate species that can apparently write English, the monke. Which rad onc journal should I send it to?

Which brings me to my question to you all. Should residents be punished for insulting, field-degrading publications such as this one? For example, if you saw this type of article on someone's CV, is it ok to throw that CV in the trash and vow to never hire such a person? If someone has already snuck past security and in your dept, is it ok to exclude them from academic opportunities such as study collaborations, clinical trials, journal reviews, committee assignments, etc.?

And why the resident and not the attendings you ask? Because there is no question that any attending who voluntarily puts their name on this type of absolute dogsh*t should be ridiculed and put on indefinite leave so that they can't infect other rad oncs with their mere presence. They should absolutely be shunned by their colleagues and punished in any way possible.

As a note to medical students and residents (and I can't believe I have to say this to attendings), a publication is not a chance to pad your CV. You were born with one thing and will die with one thing in this world - that is your name. Treat it like gold because you only have one name and you better be 120% sure putting your name on something that is going to be published. There can be real consequences.

Are you the genius who suggested shaming students who match at bad programs? You should have learned your lesson the first time that your light bulb moment ideas are actually pretty s****y

 

[scarbrtj]

I was walking outside today and stepped in dogsh*t. As I looked to survey the damage on the bottom of my shoe and saw feces caking the soles, do you know what I immediately thought of? This looks exactly like the article out of Penn by Butala et al about the need for a certified palliative care network. I refrained from making any comments when the article initially came out and I am upset that I was reminded of that absolute sh*tstain of a publication today because I stepped in dog feces. If you are wondering what article is this and why didn't I link it, it's simple. I didn't want the run the very high risk of my computer developing cancer by opening such a horrific, insulting article.

I know Simul and Todd responded. They were far too professional in their response. I'm glad though that there was a response but it should have been a much, much more harsh. I don't want to get into why the article is so bad as it is painfully obvious to anyone. But one of the many reasons it really bothers me is that it further degrades the very important relationship between academics and private practice.

As I tried to wipe off the dogsh*t, I wondered what was running through the minds of the authors who decided that in the middle of a once-in-a-lifetime pandemic, with hundreds of thousands dying across the world, often alone and bereft of loving touch of their families due to virus-related restrictions, that anyone could countenance writing such a piece of dogsh*t article. I can't even say the authors names because it pains me so - I'll refer to them as their own sub-primate species, monke. And I don't mean monkey because don't you dare associate the monkey, an intelligent, beautiful animal with this new sub-primate species now called monke.

The field of rad onc: on fire with massive residency overexpansion, increasingly terrible job prospects, and decreasing RT indications
COVID-19: just killing so many people
No one:
Literally no one:
Guys, I mean actually no one:
Monke: (grunting/squeaking/screeching sounds from the basement) this year is a great time to address a major crisis in rad onc - there are board certified rad oncs who have passed physics, rad bio, clinical written, and oral boards giving 8 Gy x 1 and 3 Gy x 10 in the community that have not been certified by the ABR to give palliative RT!
Rad onc journal: this is incredible

At this point, our field deserves to simply die. I have no words. But hey, I discovered a new sub-primate species that can apparently write English, the monke. Which rad onc journal should I send it to?

Which brings me to my question to you all. Should residents be punished for insulting, field-degrading publications such as this one? For example, if you saw this type of article on someone's CV, is it ok to throw that CV in the trash and vow to never hire such a person? If someone has already snuck past security and in your dept, is it ok to exclude them from academic opportunities such as study collaborations, clinical trials, journal reviews, committee assignments, etc.?

And why the resident and not the attendings you ask? Because there is no question that any attending who voluntarily puts their name on this type of absolute dogsh*t should be ridiculed and put on indefinite leave so that they can't infect other rad oncs with their mere presence. They should absolutely be shunned by their colleagues and punished in any way possible.

As a note to medical students and residents (and I can't believe I have to say this to attendings), a publication is not a chance to pad your CV. You were born with one thing and will die with one thing in this world - that is your name. Treat it like gold because you only have one name and you better be 120% sure putting your name on something that is going to be published. There can be real consequences.

HIGH comedy

personally I am of the Ben Franklin school though: you can catch more flies with honey than vinegar.

 

[medgator]

Are you the genius who suggested shaming students who match at bad programs? You should have learned your lesson the first time that your light bulb moment ideas are actually pretty s****y

Someone sounds a little triggered

 

[ramsesthenice]

Are you the genius who suggested shaming students who match at bad programs? You should have learned your lesson the first time that your light bulb moment ideas are actually pretty s****y

I’m with Kruk on this one. There are a lot of folks who deserve to take **** for publications like this. But why do you want to go after the people on the bottom? Culpability is as follows: Attending/Mentor > Editor > Reviewers > resident. If someone let their dog drop a deuce in your yard right in front of you do you kick the dog or slap the owner?

 

[RadOncDoc21]

I’m with Kruk on this one. There are a lot of folks who deserve to take **** for publications like this. But why do you want to go after the people on the bottom? Culpability is as follows: Attending/Mentor > Editor > Reviewers > resident. If someone let their dog drop a deuce in your yard right in front of you do you kick the dog or slap the owner?

Both!

 

[Radonky]

There is too much of a power dynamic to be able to point the finger at the resident. Yes residents have some agency, but when master say write, monke write.

Edit: Oh, you got a shoutout speakeroftruth. Looks like we are becoming the WallStreetBets of Rad Onc. Ape strong together.

 

[ramsesthenice]

Both!

Fozzy would be very disappointed 😞

 

[RickyScott]

There is too much of a power dynamic to be able to point the finger at the resident. Yes residents have some agency, but when master say write, monke write.

Edit: Oh, you got a shoutout speakeroftruth. Looks like we are becoming the WallStreetBets of Rad Onc. Ape strong together.

Kind of like the casting couch in Hollywood.

 

[Lamount]

No one deserves to be "punished" for writing an unhelpful paper... or even for expanding their residency program.

People deserve to be punished for committing crimes. Doctors deserve to be punished for committing crimes and malpractice. That's about it.

It is reasonable to ridicule lesser offenses, but even that should be focused at that action and not the person.

 

[fiji128]

I was walking outside today and stepped in dogsh*t. As I looked to survey the damage on the bottom of my shoe and saw feces caking the soles, do you know what I immediately thought of? This looks exactly like the article out of Penn by Butala et al about the need for a certified palliative care network. I refrained from making any comments when the article initially came out and I am upset that I was reminded of that absolute sh*tstain of a publication today because I stepped in dog feces. If you are wondering what article is this and why didn't I link it, it's simple. I didn't want the run the very high risk of my computer developing cancer by opening such a horrific, insulting article.

I know Simul and Todd responded. They were far too professional in their response. I'm glad though that there was a response but it should have been a much, much more harsh. I don't want to get into why the article is so bad as it is painfully obvious to anyone. But one of the many reasons it really bothers me is that it further degrades the very important relationship between academics and private practice.

As I tried to wipe off the dogsh*t, I wondered what was running through the minds of the authors who decided that in the middle of a once-in-a-lifetime pandemic, with hundreds of thousands dying across the world, often alone and bereft of loving touch of their families due to virus-related restrictions, that anyone could countenance writing such a piece of dogsh*t article. I can't even say the authors names because it pains me so - I'll refer to them as their own sub-primate species, monke. And I don't mean monkey because don't you dare associate the monkey, an intelligent, beautiful animal with this new sub-primate species now called monke.

The field of rad onc: on fire with massive residency overexpansion, increasingly terrible job prospects, and decreasing RT indications
COVID-19: just killing so many people
No one:
Literally no one:
Guys, I mean actually no one:
Monke: (grunting/squeaking/screeching sounds from the basement) this year is a great time to address a major crisis in rad onc - there are board certified rad oncs who have passed physics, rad bio, clinical written, and oral boards giving 8 Gy x 1 and 3 Gy x 10 in the community that have not been certified by the ABR to give palliative RT!
Rad onc journal: this is incredible

At this point, our field deserves to simply die. I have no words. But hey, I discovered a new sub-primate species that can apparently write English, the monke. Which rad onc journal should I send it to?

Which brings me to my question to you all. Should residents be punished for insulting, field-degrading publications such as this one? For example, if you saw this type of article on someone's CV, is it ok to throw that CV in the trash and vow to never hire such a person? If someone has already snuck past security and in your dept, is it ok to exclude them from academic opportunities such as study collaborations, clinical trials, journal reviews, committee assignments, etc.?

And why the resident and not the attendings you ask? Because there is no question that any attending who voluntarily puts their name on this type of absolute dogsh*t should be ridiculed and put on indefinite leave so that they can't infect other rad oncs with their mere presence. They should absolutely be shunned by their colleagues and punished in any way possible.

As a note to medical students and residents (and I can't believe I have to say this to attendings), a publication is not a chance to pad your CV. You were born with one thing and will die with one thing in this world - that is your name. Treat it like gold because you only have one name and you better be 120% sure putting your name on something that is going to be published. There can be real consequences.

This was not published in the Red Journal but in the pay to publish Advances in Radiation Oncology. Not defending the article but you can basically publish whatever in there.

 

[medgator]

There is too much of a power dynamic to be able to point the finger at the resident. Yes residents have some agency, but when master say write, monke write.

Edit: Oh, you got a shoutout speakeroftruth. Looks like we are becoming the WallStreetBets of Rad Onc. Ape strong together.

Been the WSB of rad Onc since March 2019...

 

[medgator]

No one deserves to be "punished" for writing an unhelpful paper... or even for expanding their residency program.

Yes clearly should be no repercussions for wasting billions of cms and healthcare dollars over decades overtraining people who will likely overuse a modality when there their labor simply isn't needed 🥱

 

[thecarbonionangle]

Given the current societal situation, and depending if you live in one of those liberal “mecca” cities, there is a high chance that this was actually human feces. Reading feces on your shoe as you walk the side walks of life is the new reading the tea leaves Did you see a piece of a carrot?

the environment in our field is quite fetid so there is more where that came from. The breadlines are coming.

 

[medgator]

Given the current societal situation, and depending if you live in one of those liberal “mecca” cities, there is a high chance that this was actually human feces. Reading feces on your shoe as you walk the side walks of life is the new reading the tea leaves Did you see a piece of a carrot?

the environment in our field is quite fetid so there is more where that came from. The breadlines are coming.

Could be SF

 

[evilbooyaa]

While I personally would not hire a resident who showed poor enough judgment to be involved with a project of that level of controversy and disdain for a significant proportion of the Rad Onc community, I believe the major blame lies with the attendings in question. I'm not really sure what you mean by 'punished', however.

That being said, all of those authors likely want to stay in academics for life, and thus a paper like that will be extremely unlikely to diminish their job prospects, and potentially even IMPROVE their job prospects from a significant silent proportion of academic rad oncs who think they do palliation better than the community guy closer to the patient's home.

I will agree with Kruk, with the caveat that your light bulb thoughts are just marginally less ****ty on a per new thread basis. Fun to read however, so don't let me stop you!

 

[ramsesthenice]

While I personally would not hire a resident who showed poor enough judgment to be involved with a project of that level of controversy and disdain for a significant proportion of the Rad Onc community, I believe the major blame lies with the attendings in question. I'm not really sure what you mean by 'punished', however.

That being said, all of those authors likely want to stay in academics for life, and thus a paper like that will be extremely unlikely to diminish their job prospects, and potentially even IMPROVE their job prospects from a significant silent proportion of academic rad oncs who think they do palliation better than the community guy closer to the patient's home.

I will agree with Kruk, with the caveat that your light bulb thoughts are just marginally less ****ty on a per new thread basis. Fun to read however, so don't let me stop you!

When you say improve their job prospects you mean it moves them to the top half of the 10 people vying for each available job? I guess that’s technically an improvement...

 

[Lamount]

Yes clearly should be no repercussions for wasting billions of cms and healthcare dollars over decades overtraining people who will likely overuse a modality when there their labor simply isn't needed 🥱

Were you thinking cat-o-nine tails or prison time?

 

[Neuronix]

Keep it professional! Please refrain from swearing and name calling. I don't want to delete this thread because I do believe in the overall point of the post, but we need to keep professional tone on the forums.

My take: those in glass houses shouldn't throw stones. Not all my papers are amazing. The reality is that everyone counts your number of publication. It's too much work to assess for "quality". Residents take whatever opportunities they're handed. So sure, I'm fine with calling out attendings and journals for this nonsense, but please refrain from attacking the residents or conspiring to harm them.

Also, what is with the red journal? Every time I send something there that's original I get nitpicked to death or killed by one hostile reviewer, while you can get ridiculous opinion pieces, low effort reviews/meta-analyses, and 5% survey response rate papers published. Why even submit there anymore?

 

[speakeroftruth]

Appreciate most the comments. Also, yes I did edit the title of my post. But a mod may have changed it.

I'm glad to hear there is no doubt that the attendings on the paper deserve to be punished (censured, fired, suspended, ridiculed by their colleagues, publicly shamed, have less academic opportunities, etc.). @ramsesthenice makes a great point that the editor and reviewers at the journal deserve equal blame as the attendings on the paper. Probably another reason we should actively recruit private practice and community rad oncs to serve on editorial positions and compensate them for the time.

Obviously if there were medical student authors, we shouldn't blame them. The differential in the power dynamic and ability to gaslight from an attending medical student is simply too strong. Trust me, I've learned my lesson.

But why do you want to go after the people on the bottom?

I don't. But you raise a good point @ramsesthenice and that is at what point should rad oncs in our field be fully responsible for their actions? I say at the PGY4 resident level and above. A PGY2 and PGY3 are likely still too young to fully resist the power of the gaslighting academics. At the end of the day, we need to start holding people accountable for the stuff they publish.

Just like people rightfully called out all the gaslighting and straight victim shaming around the 2018 ABR physics and radiation biology board exam disaster and the truly terrible response by monke troop leaders Paul Wallner and Lisa Kachnic, we need to call out bad publications (not just opinion pieces but bad trials as well).

To the rad onc community, especially those who want to publish and become "famous". Do you really think you can just publish dumb dogsh*t and get away with it? Welcome to the f*cking THUNDERDOME.

 

[medgator]

Were you thinking cat-o-nine tails or prison time?

I'm fine with public shaming and making sure said programs fill with the stinkiest 🧼 candidates or not at all...

 

[thecarbonionangle]

I can tell you as someone who reviews multiple manuscripts per month for multiple journals, I do what i can to reject the overwhelming amount of truly trash no good research which comes my way. There has been multiple instances where more than one us has rejected a paper only to be bypassed by senior editors who strong arm and take the papers out of your hands as juniors and all of sudden you are emailed the paper is approved.
Being in the sausage factory for a few years now has been very eye opening. Man if only i could share more lmao. Im just turning the grinder and filling the guts with fatty meat.

certain people and institutions can get ANYTHING pushed through if you know the right people. The ultimate responsabilty are with senior editors and reviewers but like i said, there are plenty of politics involved.

 

[kimplera]

it is also really really hard to get qualified reviewers to say yes - really really hard to get private practice people to do so - hard to get senior folks who might put up a stink about a paper, and pretty easy to get residents - on editorial board for PLOSone now and my success rate is <25% (and that is when the reivewers i ask often know who i am). i routinuely ask first authors rather than last but still it's hard

 

[radonc17]

it is also really really hard to get qualified reviewers to say yes - really really hard to get private practice people to do so - hard to get senior folks who might put up a stink about a paper, and pretty easy to get residents - on editorial board for PLOSone now and my success rate is <25% (and that is when the reivewers i ask often know who i am). i routinuely ask first authors rather than last but still it's hard

this is bc the process is broken

good citizenship of reviewing is often described by journal editors as reason to review for free

journal gets our hard work for free, reviewed for free, then you hand over your publishing rights to journal

journal/publisher gets to sign multi-million dollar deals with institutions etc

at same time they get to bill advertisers

it’s shocking there is still resistance to at minimum establishing a more incentive based structure for reviewing articles

waiving aubmission fee at journal one reviews for is not a real incentive

it assumes my work is either good enough for that journal (most papers rejected) or that I want to submit to that same journal (maybe my work is JAMA level not Red J)

 

[communitydoc13]

What about establishing an open access culture like arXiv for onc related stuff? Is this feasible. Could even use this format on SDN? Moderation without peer review. Bypass the publishers.

 

[radonc17]

What about establishing an open access culture like arXiv for onc related stuff? Is this feasible. Could even use this format on SDN? Moderation without peer review. Bypass the publishers.

I personally believe the prestige factor/potential implications for promotion that exists by being published in major journals will not be able to be overcome by arXiv or Cureus, etc.

Similarly, the best trials ($$$ sponsored) are not going to give up the chance to be in NEJM, JAMA, etc.

I don't believe peer-review lacks value as some do. I just believe it should be properly incentivized.

 

[kimplera]

this is bc the process is broken

good citizenship of reviewing is often described by journal editors as reason to review for free

journal gets our hard work for free, reviewed for free, then you hand over your publishing rights to journal

journal/publisher gets to sign multi-million dollar deals with institutions etc

at same time they get to bill advertisers

it’s shocking there is still resistance to at minimum establishing a more incentive based structure for reviewing articles

waiving aubmission fee at journal one reviews for is not a real incentive

it assumes my work is either good enough for that journal (most papers rejected) or that I want to submit to that same journal (maybe my work is JAMA level not Red J)

definitely agree - editorial duties often also performed out of good will - in academics both have some "value" for promotion, but not equivalent to the time invested. I think the submission fee is bs too.
but to bring it back to this discussion - if you don't like the things being published - participate in some way to change it...

 

[speakeroftruth]

a significant silent proportion of academic rad oncs who think they do palliation better than the community guy closer to the patient's home.

@evilbooyaa - I really don't believe this is true. There is a lot of pompousness and self-promotion that happens in academia but I've seen myself and colleagues tell patients to have their RT courses at home, especially palliative RT courses when quality of life and time with loved ones is so important. When the monke gang at Penn published the article, I remember the controversy it generated and I don't remember a single kind word being said. I know it is just one dept but though people may not like how I wrote my initial post about this degrading article, I have never met anyone in person or SDN/social media defend this trash. For our field to become strong again, the very important relationship between academia and private practice/community rad oncs has to be fixed and thrive once more.

Not all my papers are amazing.

Same here. I've said it elsewhere and will say it again, my CV is littered with crappy retrospective papers. I wouldn't care if those Penn monkes just published standard retrospective crap. That isn't what angers me so about this monke trash out of Penn. Pump all the retrospective crap you want (as long as you aren't gaslighting med students into taking a year off to do it) but when academics call for another damn certification from the ABR only for private practice/community rad oncs who have gone through the most board exams of any specialty + the old q10 year re-certification exam/now the MOC, it is a joke beyond comprehension. And it is completely degrading to the academic-private practice relationship.

but to bring it back to this discussion - if you don't like the things being published - participate in some way to change it...

Many of us do. Trust me, if I was a reviewer on the JAMA Onc PROMISE feces out of MSKCC or the Penn palliative network certification excrement, I would have shot it down as would 99% of rad onc reviewers. Part of me wants to believe it was reviewed by a thoracic surgeon who fears lung SABR/SBRT or a lymphoma med onc specialist who hates radiation. But we all know given the journal, it was reviewed by an academic rad onc or two...what an embarrassment for the rest of us in academics. An apology is owed.

 

[evilbooyaa]

@evilbooyaa - I really don't believe this is true. There is a lot of pompousness and self-promotion that happens in academia but I've seen myself and colleagues tell patients to have their RT courses at home, especially palliative RT courses when quality of life and time with loved ones is so important. When the monke gang at Penn published the article, I remember the controversy it generated and I don't remember a single kind being said. I know it is just one dept but though people may not like how I wrote my initial post about this degrading article, I have never met anyone in person or SDN/social media defend this trash. For our field to become strong again, the very important relationship between academia and private practice/community rad oncs has to be fixed and thrive once more.

I don't think it's a majority of folks, and the ones who had a public reaction to this article were all going to have a negative one. But I do think some proportion of academics (like maybe 10-25%) do feel like this.

Some of it is likely driven by financial incentives of 'holding onto patients'.

As a resident I saw people drive 3 hours for uncomplicated palliation when they could have gone to a center 30 minutes away. When I brought up, during consult, sending the patient to a facility closer to their home, the attending said "they might do something wonky, so they should come here for their 30/10". Not every attending, not every scenario, but definitely a consideration. Maybe it's not that they truly believe they are better, but just want to hang onto their patients.

 

[speakeroftruth]

Some of it is likely driven by financial incentives of 'holding onto patients'.

Great point and you articulated much more eloquently what I was trying to say. There are so few academics (much less than 10-25%) that truly, deep down, believe that patients needed palliative RT are better served at a large academic center.

The primary reason academics tell these patients "they might do something wonky, so they should come here (to the main academic site) for their 30/10" is financial. I guarantee when that happens, the academic rad onc is on a RVU-heavy (or something similar where high volume is encouraged) compensation system. I don't agree with the rad onc lying to the patient but I think we can all understand why the academic rad onc is saying that. I would venture that if many of you in private practice were in the same position, you'd do the same thing.

% of academic rad oncs who are on a RVU-heavy compensation system telling patients to come get 30/10 to a semi-painful femur met (regardless of reason stated) at the main academic site even if it involves 1-3 hours of driving due to personal financial compensation reasons = 99%

% of academic rad oncs who truly believe that an academic attending can give palliative RT better than someone in the community or that fully board certified private practice rad onc needs a palliative RT certification = <1% (basically it's 7 people, the 5 monkes on the article, the reviewer, and the journal editor).

I think the difference is very important because it gets to the heart of this god awful article. There is not a single person, other than the Penn monke troop gang (and the ABR who would love another revenue source), that truly believes (in terms of clinical care, patient QOL) in this certification need for palliative RT. If they do, the reasons are for $$$ and not good, quality patient care.

I think it is telling that not only in person (n=1 academic dept) but also here on SDN/social media, no one has defended this article. I will be highly surprised if anyone does because we all know this article is completely and absolutely indefensible unless you are the ABR and need another revenue source through yet another a certification program. Even Kruk had to resort to making it personal but said nothing about actual merits (or non-merits) of the article.

 

[kimplera]

I find it disgusting that someone would tell a patient the palliative 30/10 8/1 is better at an academic center - if we can do and 8/1 before someone is discharged i'll do it, but if headed home and that is better than so be it, we'll make the referral and send along prior fields.
The cases where i argue for patients to stay are locally advanced H&N (my area) where i really believe the multidisciplinary care is better (nutrition, speech/swallow, nursing, social work, pain, etc...). I actually tell patients that it is not for the doctor or the machine that they should stay (even though i believe our generally smaller fields have less toxicity and similar control) but for all these other issues that are challenging to do smoothly when you have a couple H&N under treat vs. 15-30.

 

[medgator]

I find it disgusting that someone would tell a patient the palliative 30/10 8/1 is better at an academic center -

Bad actors in both spheres unfortunately, same folks who have (and continue) to push protons unnecessarily at higher cost and in the absence of solid supporting data. The hard sell from the local academic center for protons in prostate was disgusting over a decade ago, now it's just business as usual

 

[RickyScott]

Does every proton center use a rectal spacer or balloon?

 

[medgator]

Does every proton center use a rectal spacer or balloon?

I would think they would have to...

 

[RickyScott]

I would think they would have to...

So how can you compare them to photons which often are not given with inasive rectal maneuvers?

 

[medgator]

So how can you compare them to photons which often are not given with inasive rectal maneuvers?

They probably overlook that during the sell

 

[RickyScott]

They probably overlook that during the sell

But on trials?

 

[radoncopotamus]

Great point and you articulated much more eloquently what I was trying to say. There are so few academics (much less than 10-25%) that truly, deep down, believe that patients needed palliative RT are better served at a large academic center.

The primary reason academics tell these patients "they might do something wonky, so they should come here (to the main academic site) for their 30/10" is financial. I guarantee when that happens, the academic rad onc is on a RVU-heavy (or something similar where high volume is encouraged) compensation system. I don't agree with the rad onc lying to the patient but I think we can all understand why the academic rad onc is saying that. I would venture that if many of you in private practice were in the same position, you'd do the same thing.

% of academic rad oncs who are on a RVU-heavy compensation system telling patients to come get 30/10 to a semi-painful femur met (regardless of reason stated) at the main academic site even if it involves 1-3 hours of driving = 99%

% of academic rad oncs who truly believe that an academic attendings can give palliative RT better than someone in the community or that fully board certified private practice rad oncs need another palliative RT certification = <1% (basically it's 7 people, the 5 monkes on the article, the reviewer, and the journal editor).

I think the difference is very important because it gets to the heart of this god awful article. There is not a single person, other than the Penn monke troop gang (and the ABR who would love another revenue source), that truly believes (in terms of clinical care, patient QOL) in this certification need for palliative RT. If they do, the reasons are for $$$ and not good, quality patient care.

I think it is telling that not only in person (n=1 academic dept) but also here on SDN/social media, no one has defended this article. I will be highly surprised if anyone does because we all know this article is completely and absolutely indefensible unless you are the ABR and need another revenue source through yet another a certification program. Even Kruk had to resort to making it personal but said nothing about actual merits (or non-merits) of the article.

The problem with your initial post was the title and your advocacy that we should blame residents for bad articles their attendings influence them into contributing to. Everyone agrees that paper was asinine.

 

[RickyScott]

The problem with your initial post was the title and your advocacy that we should blame residents for bad articles their attendings influence them into contributing to. Everyone agrees that paper was asinine.

I really don’t think we can blame residents but post appeals to my juvenile humor.

 

[speakeroftruth]

The problem with your initial post was the title and your advocacy that we should blame residents

I tried to frame it as a question. From the reaction of the community, obviously we should not shame residents which I agree with.

Hopefully it was clear that there is no question the attendings are to be blamed. The reason I asked if the residents should be shamed as well was because it was hard for me to believe that any attending who has gone through the asinine board exams we have all gone through (in addition to the 2018 board exam testing disaster), could rightfully call for a palliative RT certification from the ABR. But I now realize even if this was originally a resident idea, it is the attendings that are to blame because they are mentors who need to protect and nurture residents to avoid making these kind of terrible mistakes. Thank you all for correcting me in that we cannot shame trainees.

---

I just posted this to the Twitter discussion but given that this topic was the inspiration for monke and how long it took to make sure the sound/video could be posted to SDN, I'll post it here again.

A tribute (recorded footage in the Penn basement from Nov 2020) to the founding members of the monke troop gang at Penn celebrating their field-degrading, asinine publication calling for a palliative RT certification but only for private practice/community rad oncs who have been board-certified. Monke strong together. Make sure your sound is on.