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I disagree with closing that thread.

But, also don’t want to talk politics

Astro is making a horrendous decision, even though I agree đź’Ż with the politics of what they are saying.

My issue is that as paying members, don’t we just want to improve cancer care for patients? Isn’t that the singular core feature of a cancer PAC? How does withholding funds from (in my opinion, despicable) folks that I disagree with politically - 1) fix partisanship and 2) improves cancer care? It does neither.

This is truly cancellation at its finest. What a gross error in judgement that ASTRO will walk back, and then erase that it ever happened. Clown show. I bet a lot of people cancel their membership.
 
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medgator

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They were a clown show before they decided to delve into the political debate. Maybe they wanted to appear "woke" with the rest of corporate America and F500 companies doing the same thing.

But yes, clown show for years, if not decades:

1. Opposed urorads blindly full stop without thinking about the ramifications, to the point where pt care has likely been harmed on net
2. Opposed site neutral bundled payments which would have leveled the playing field between hospitals and FS centers and saved the healthcare system money overall
3. Supportive of trash proton registry studies to pay for expensive, unproven proton treatments (access to patients getting "vital" PBT).

Also choosing wisely nonsense without considering costs, only looking at fractions (more on ASTRO than the PAC, but still).

It's stupid for people to finally cancel/stop supporting the PAC over this imo. Lobbying malpractice been going on at ASTRO PAC forever. They should have cancelled it years ago for not doing it's job except for the anointed in academia
 
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scarbrtj

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1. Opposed urorads blindly full stop without thinking about the ramifications, to the point where pt care has likely been harmed on net
2. Opposed site neutral bundled payments which would have leveled the playing field between hospitals and FS centers and saved the healthcare system money overall
3. Supportive of trash proton registry studies to pay for expensive, unproven proton treatments (access to patients getting "vital" PBT).

Also choosing wisely nonsense without considering costs (more on ASTRO than the PAC, but still).
Either you're an irresponsible confabulist or there's a lot of maddening injustices in rad onc.
 
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Gfunk6

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The arguments on RO Hub and the hyperpartisanship demonstrated is the ultimate red herring. Whether or not we give our PAC money to these representatives is utterly and comprehensively irrelevant. We are fiddling while Rome is burning.

The document posted above by BobbyHeenan just says it all. "Get woke, go broke"
 
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Chartreuse Wombat

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Reminds me of one of my favorite books

Amazon product
Dr Fish (a man of the left to be sure) argues that there is one proper role for the academy-to advance knowledge and to prepare students to do the same.

By analogy ASTRO should be focused on supporting the art and science of radiation oncology and nothing more.

ASTRO has lost it's way. Virtue signalling is a disease and it has infected ASTRO.
 
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medgator

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Just met with accounting/billing.

For 2021 right now the pro fee cut from 2020 to 2021 is real. 10% less payments for weekly visits, IMRT plan, etc.

10% is a HUGE haircut. Crazy to think you do the same work you did in Dec 2020 but in January all the sudden it’s worth 10% less.


E&Ms went up/stayed the same... Better start hanging on to more of your follow ups (j/k, sort of).
 
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BobbyHeenan

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The arguments on RO Hub and the hyperpartisanship demonstrated is the ultimate red herring. Whether or not we give our PAC money to these representatives is utterly and comprehensively irrelevant. We are fiddling while Rome is burning.

The document posted above by BobbyHeenan just says it all. "Get woke, go broke"

They've lost their way, though I'm not sure they ever had it.

Australian radiation advocate group got their version of HHS/medicare to state that for best practices for prostate cancer all men should be meeting with BOTH rad onc and urology. This is the way. Prostate short course/SBRT/"mandated" rad onc consult and cross fingers on oligomets trials is the glimmer of hope.

ASTRO brass wastes nearly a decade on uro rad while failing to enroll on a randomized proton/photon prostate trial. Costs continue to soar and the eye of the govt descends upon rad onc. There is a specific case study on costs of prostate cancer proton therapy in the CMS documents on poor value/skyrocketing costs.

ASTRO brings Ibram Kendi in as a keynote speaker while the world burns.
 
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BobbyHeenan

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E&Ms went up/stayed the same... Better start hanging on to more of your follow ups (j/k, sort of).
I did see that.

I follow my patients a TON. More than any partners in my group. Was thinking I might start cutting back on that but maybe I won't.

I'm biased, but I think it's better for patient care and also helps palliate symptoms. I'm amazed at the amount of "just increase narcotics" that goes on instead of zapping mets to help with pain when some (not all) med oncs are following and take the attitude "I'll send them back to you if they need radiation."

My advice to young docs is follow your patients a ton. Even your palliative cases.
 
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scarbrtj

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Australian radiation advocate group got their version of HHS/medicare to state that for best practices for prostate cancer all men should be meeting with BOTH rad onc and urology. This is the way.
And what an inspiring move it was. To accomplish the same thing in the US would require lobbying ALL the politicians.
There is a specific case study on costs of prostate cancer proton therapy in the CMS documents on poor value/skyrocketing costs.
Psst. Everyone should read it.
 
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And what an inspiring move it was. To accomplish the same thing in the US would require lobbying ALL the politicians.

Psst. Everyone should read it.

What Astro pac should do:

Dear CMS,

look. I’ll level with you . We F’d CMS on protons for prostate. We get it. We’re willing to quit that ****. But can we please make it to where a prostate cancer patient has to see a rad onc as a quality metric for urologists?

Signed,

ivory tower ASTRO suit man.
 
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medgator

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I did see that.

I follow my patients a TON. More than any partners in my group. Was thinking I might start cutting back on that but maybe I won't.

I'm biased, but I think it's better for patient care and also helps palliate symptoms. I'm amazed at the amount of "just increase narcotics" that goes on instead of zapping mets to help with pain when some (not all) med oncs are following and take the attitude "I'll send them back to you if they need radiation."

My advice to young docs is follow your patients a ton. Even your palliative cases.
One of the boomerific med oncs in my area will basically wait until they're borderline hospice to send, sometimes get referrals from elsewhere, pulm etc seeing them for dyspnea or chest pain. I tell every palliative pt i treat indications for further palliative rt and some do end up coming back on their own
 
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FrostyHammer

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I did see that.

I follow my patients a TON. More than any partners in my group. Was thinking I might start cutting back on that but maybe I won't.

I'm biased, but I think it's better for patient care and also helps palliate symptoms. I'm amazed at the amount of "just increase narcotics" that goes on instead of zapping mets to help with pain when some (not all) med oncs are following and take the attitude "I'll send them back to you if they need radiation."

My advice to young docs is follow your patients a ton. Even your palliative cases.
Disagree 100%. My advice to young docs is to not do that.

1. The average patient severely dislikes going to the hospital if they don't have to. We just need to finally understand that our desires are not congruent with those of most patients. This is even more true in a pandemic, where nearly all patients aren't vaccinated yet and nearly all are old and/or have a comorbidity.

2. Seeing extra docs increase patients' co-pays and other out-of-pocket costs. Financials may be relatively hunky-dory for us as doctors, but the average patient having to give $30 as a copay for each doctor they see is actually quite a lot to them, and we need to get off our high horses, have some empathy, and really understand this issue. Before the pandemic hit, 50-60% of American adults lived paycheck to paycheck. Let that sink in.

3. Medical oncologists or other referring providers are not stupid, and if they are nicely and gently taught to just refer back to us if patients have increasing pain, limited areas of recurrence, etc, they will do this readily. Just as importantly, teaching one's patients to ask to be referred back in case any of the above happens (especially the palliative cases or other higher risk cases that may end up coming back for a second or subsequent course), one will be extremely surprised as to how deeply appreciative they are... And they get to keep extra money in their purses.
 
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BobbyHeenan

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Disagree 100%. My advice to young docs is to not do that.

1. The average patient severely dislikes going to the hospital if they don't have to. We just need to finally understand that our desires are not congruent with those of most patients. This is even more true in a pandemic, where nearly all patients aren't vaccinated yet and nearly all are old and/or have a comorbidity.

2. Seeing extra docs increase patients' co-pays and other out-of-pocket costs. Financials may be relatively hunky-dory for us as doctors, but the average patient having to give $30 as a copay for each doctor they see is actually quite a lot to them, and we need to get off our high horses, have some empathy, and really understand this issue. Before the pandemic hit, 50-60% of American adults lived paycheck to paycheck. Let that sink in.

3. Medical oncologists or other referring providers are not stupid, and if they are nicely and gently taught to just refer back to us if patients have increasing pain, limited areas of recurrence, etc, they will do this readily. Just as importantly, teaching one's patients to ask to be referred back in case any of the above happens (especially the palliative cases or other higher risk cases that may end up coming back for a second or subsequent course), one will be extremely surprised as to how deeply appreciative they are... And they get to keep extra money in their purses.

I do always ask the stable patients if they want to come back. We discuss co pays, etc.

A lot depends on med oncs that you work with. If you work with some like medgator mentions or a group with Locums or turnover, there is more merit to closely following.
 
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I went hiking this past summer for a week in the high mountains in California. I randomly meet and spent time with two older docs, one a neurosurgeon and one a anesthesiologist. After talking with them over several days I do think part of the root problem with Astro is nearly all leadership is academic. Apparently this isn’t the case in other specialities. I would guess Astro probably has the highest percentage of academics in leadership positions compared to any other professional medical group (there is probably an easy paper in that). True academics should be a niche but not in charge of a whole specialty especially one where there is significant treatment being done in community. Astro has consistently stood with high cost low benefit academic practice above all else including protons for everything, choosing wisely, jumping the gun on APM (for whatever misguided reason), urorads, unlimited residency expansion, a now most recently the embrace of political activism , ect.... I believe if private practice had a real voice in Astro a lot of these problems may have been avoided.
 
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RadOncMegatron

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I disagree with closing that thread.

But, also don’t want to talk politics

Astro is making a horrendous decision, even though I agree đź’Ż with the politics of what they are saying.

My issue is that as paying members, don’t we just want to improve cancer care for patients? Isn’t that the singular core feature of a cancer PAC? How does withholding funds from (in my opinion, despicable) folks that I disagree with politically - 1) fix partisanship and 2) improves cancer care? It does neither.

This is truly cancellation at its finest. What a gross error in judgement that ASTRO will walk back, and then erase that it ever happened. Clown show. I bet a lot of people cancel their membership.
I agree where else can we talk about this? Not ROhubs and prb not too friendly on Twitter. SDN is the perfect place to criticize ROHub and keep open dialogue about what is going on. No political talk per se, but if ASTRO our national org, does ridiculous political stuff, that is fair game for us to discuss (I love you @evilbooyaa let this pass!)

@BobbyHeenan I'm with you 100% though on follow ups SBRT Lung, H&N, and prostate rad onc follow up is much more important than say breast (ie if someone gets kicked off the team its med onc). GI is a mixed bag - esophagus, panc, gastric eh, but anal yes very important that rad onc follow.

@fiji128 BULLSEYE. Private practice derms and LINAC owning Uros seem to be able to hang with the academics. While academics in rad onc are like, private practice docs, "ugh those guys we have to deal with after the Univ. buys them out..." (one does not easily forget the palliative care network article)
 
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If you guys want to discuss ASTRO's partisan stance ONLY, then OK. That thread had gotten derailed by all sorts of political discourse that was not at all related to ASTROPac.

The work to police a thread that is so close to politics and delete every little thing that crosses the line is staggering. If you all can play nice in the sandbox and keep the discussion PURELY FOCUSED to ASTROPac and only discuss politics AS IT RELATES TO ASTROPAC, then I will let you have this thread.

If this goes into random political babble like the previous thread is, I will maybe delete a post or two here and there, but not culling the thread just to 'keep it alive'. I will just lock the thread if there's diffuse political discussion (and not oligopolitical discussion) - I use a cut off of > 3 posts.

SO - if you want this thread to remain open and you see a political post that has NOTHING to do with ASTROPac - click the report button, do not quote/reply it. If we can keep the political disease suppressed during oligoprogression, then this thread can continue to live. If the political disease spreads too diffusely, this thread will be locked and sent to hospice.
 
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Mandelin Rain

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We need a big tent. Leave the truly crazy people outside. The politicians just looking out for their re-election? Well, that's like 95% of them.

Just a bad move that literally no one was pressuring them to make and accomplishes nothing.
 
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