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It was breast hypofx that really opened the hypofx floodgates. It was not an overnight thing. And in the early days all those winds of change blew from beyond our shores (or beyond our northern border... a Chinook? a Squamish?). If this is good work by "our field," and I agree it was for sure, us folks in America shouldn't use the word "our" without some sense of the irony of the word. There used to be a real skepticism toward non-American data and thankfully those days are done. Regarding the increase in survival thing... well, we all know if being truly honest in our hearts of hearts that we are as unlikely to be victors in the survival improving business by varying radiotherapeutic approaches as surgeons could be by varying surgical approaches. Certainly (and maybe in my opinion only) there will never be a radiotherapeutic equivalent of Herceptin, e.g. At the turn of the last century Lord Kelvin said that there was nothing left in physics except to extend all measurements to six significant digits. Perhaps all that's left in rad onc is to further decrease cost, decrease patient inconvenience, and decrease toxicities. This is not nihilist (or misanthropic), it's simply "our" reality... one only need read the latest ToC of the Red or Green Journal to see it's so. This can be our best work: lowering patients' damn bills. And maybe their damn bells too. Do they ring bells over in the chemo suite?
In fairness to them, I find it a lot harder to get anything done when I am not very busy.
Correct. The people that need to hear that are not those of us in practice, but rather those of us in academics who don't seem to understand the situation but are in positions of power to regulate supply.
We didn't. We just used one of our retired partners, when they retired, to help cover the linac for vacations.
He ignored commenting on increased surveillance in breast and prostate which, when done appropriately, is good for patients and society. That does change the need for the rad oncJust to be fair to Dr O he said "[Hypofx] doesn’t change the need for RadOnc"... not that hypofx doesn't change the need for more, or less, rad onc docs. Just to be fair
Those boomers and septogenarians in academics know how to help out their PP brethren
Just to be fair to Dr O he said "[Hypofx] doesn’t change the need for RadOnc"... not that hypofx doesn't change the need for more, or less, rad onc docs. Just to be fair
If you see “need” as a 0 or 1 binary variable, sure. However, demand for radiation oncologists is not a binary variable and should not be treated as such.
The ACGME lawyers tell the same story to the RRC. Day 1 of orientation you are told "thou shalt not discuss workforce issues as it relates to accreditation decisions".
It’s been done:
The National Resident Matching Program and Antitrust Law
In May 2002, a group of physicians filed a class action lawsuit alleging that the National Resident Matching Program (NRMP) violates antitrust laws. The plaintiffs contend that NRMP practices have stabilized lower-than-competitive wages and imposed exhausting working conditions on residents. They...jamanetwork.com
“...In contrast, antitrust law has proved quite solicitous to the professional judgments of physicians and their associations. Cases (almost invariably brought by private parties) challenging accreditation by medical societies and boards and questioning hospital staff privilege determinations have been almost uniformly unsuccessful. In addition, the US Supreme Court has occasionally given the signal, as it did in its most recent antitrust decision, that where market imperfections are present in a business sector such as health care, restraints of trade involving professionals might warrant somewhat greater leniency.”
Prisoners dilemma. Greedy academic chairmen are doing what is best for their own interest and actively hurting the entire specialty in the process. ASTRO states its hands are tied. That's basically it
largely same people different hat. leadership/chairmen drawn from the same clique and ASTRO can certainly take a position for such an important issue facing our field like in Emergency Medicine.
I would love to read that too. And not just the argument as to why restriction might be legal. What if... an anti-trust case was brought re: residency restriction. I'd like to know:
). How can we trust ASTRO to make these decisions and push for something against their own interest? Theoretical it should be an entity that has mostly non-academics with some academics. The academics need "Skin in the Game" ala Nassim Taleb, otherwise they will not do the right thing.They know it now. Or should.
This sentiment is right (though as a stickler not sure the above instance is a Nash equilibrium
100% agree. Getting on ASTRO committees is the best way to make an impact/be heard
So basically it's up to greedy academic chairs to do the right thing.
I.e. let the free market regulate itself like zietman said I guess. Med students, you have been warned.
Which is?
